Happy Thanksgiving.

Good Evening Everyone and Happy Thanksgiving.

We had a very nice Thanksgiving today. The post command went all out at the dining facility and prepared an amazing dinner for us. Every sort of holiday food was available for all. They decorated the facility with a Thankgiving decor. Even the workers dressed up in pilgrim and indian outfits. I have some pictures down below of the dining facility.

After we ate, the company had organize a game day. Our troops had a ping-pong tournament, euchre tournament, a cornhole competition, and Volleyball. It was a nice day to celebrate eachothers company. Tomorrow it will be back to the grind but for today, we felt like we had a little bit of home with us.

We did have a Marine Corps General stop in today to say 'Hi' to the troops. Major General Lafeevbra toured our clinic and met our guys. He was a very nice man and he thanked everyone for their service.

The following pictures were taken this afternoon. As you can see, the military has gone all out this holiday season.

The above picture is a cake. Well at least we think it is a cake as it was covered in frosting, but then again so was the turkey. In fact many of the pictures that you will see was decorated with frosting. I think they built a supporting structure and then covered it in icing. In any case, it was a lot of work to make these decorations.

The decoration in this picture is made with colored rice.

Another picture of the entrance to our dining facility.

The next four pictures are of bread that had been baked into the shapes of animals and plants.

More Bread

I really liked this palm tree. They wouldn't let me eat it.

What you see behind this gentleman are watermelons. The white carvings are the rhine from the melons.

Another Cake.

The entire structure is covered in frosting.

They gave us sparkling grape juice for our celebration. No alcohol is allowed in country...thank goodness.

As you can see, we all ate very well and had a nice time. I hope that you and your families are having a great Thanksiving. May the Lord bless and keep you safe.

Jeff

The Gift of the Heart...

I have been troubled by the number of divorces and relationships that go badly. In the military, the divorce rate is extremely high and in the civilian world half of all marriages will end in a divorce. We could argue about the cause of all of these failed marriages and I suppose all would be right on some level. But I have to say that marriages need to be based on love. The kind of love where you give your heart to your future spouse. It is difficult to actually trust someone to give your heart to because their is such pain if your partner rejects your love or violates your trust with your heart. It can be devestating. So, my advise to you young people who are considering marriage...Marry the person who you are willing to give your heart and be sure that that person understands the magnificent gift that he/she has just been given. If you are given the honor of having someone's love then do whatever it takes to hold on to that and to care for that love as if your life depended on it. A broken heart never really heals...it scars and can become hardened, and as a result makes it much more difficult to give it away again.
So scrutinize your marriage before you marry. Make sure you marry your friend and your soulmate. Spend a great amount of time in prayer and ask for the Lord's guidance. He will be faithful to answer. For those who are trying to reconcile a relationship, you have my prayers. I would suggest that instead of praying that the Lord will bring you the one you love back into your life...you should pray for the wisdom and insight to do what is right, weather or not if the end result will be reconciliation. I pray for soften hearts, mercy, and grace. I am hopeful that the Lord will answer our prayers. For us all, we have had lessons learned and will be a better person because of those lessons and hardships. God knows what he is doing and he is maturing us to be his disciples. Seek Christ first for His guidance and you may be suprised by his response.

God Bless all of you and you are all in my prayers.

Visiting Dignitaries and Asthma...

Good Evening Everyone,

Medical clinics in Iraq are favorite spots for visitation by dignitaries. I suppose it always looks good to visit troops who are injured or ill. Over the last month, we have been flooded with visits from our higher military command. One of the reasons is that we have recently went through an Army change of command at the battalion level, secondly much of the duties on this post is being transferred to the Air Force. So, we have had visitation from both the Army and Air Force. Some times I feel like we are a museum and visitors are lining up to catch a glimpse of an Army clinic.

Today, we had a visit from Major General Thomas Loftus. He is the Deputy Surgeon General for the Air Force. He toured our base and stopped in to see our facility. I had the honor of showing him our operation and he seemed pleased by what he saw. I tried to pawn off the duty of touring him around to one of the other providers but alas, they left me hanging and they were no where to be found. So much for backing up your buddy.

Well today's medical topic is asthma. In the military, a person isn't suppose to be allowed to join any branch of the service with asthma. So, recruiters tell their recruits to not mention the fact that they have asthma or they will say that they don't have asthma but reactive airway disease. The result is that soldiers come over here, find themselves exposed to new and different environmental allergens and suddenly they have an asthma attack. So, I thought it would be appropriate to go over asthma tonight. I hope you find these medical lessons useful. I try to go over topics that are useful to parents as often times a parent will come to their doctor and leave without having their questions answered. So, I hope this will be helpful to you.

Twenty two million American’s, six million of which are children, have asthma.
Asthma is by definition, a reversible airway disease. In other words, it is a condition that presents with symptoms that can cause airway obstruction and then will resolve to some extent and the airways will reopen. This definition distinguishes asthma from other obstructive airway diseases like chronic obstructive pulmonary disease and emphysema, both of which are permanent conditions and non-resolving.
Asthma is an inflammatory disorder of the smaller airways of the lungs and presents with the triad of symptoms of inflammation, constriction, and excessive mucus productions.
The air that we breathe enters the lungs through the trachea and travels down and bifurcates into the right and left main stem bronchi. The main stem bronchi then divide down even further to smaller bronchioles and then air reaches the terminal end in the alveoli. The alveolar sacs are the location where oxygen and carbon dioxide are exchanged. The exchange of these two gases are critical to the oxygenation of our bodies tissues and maintaining the pH balance of our blood. Many people understand the importance of our body receiving oxygen but few understand the importance of getting rid of the carbon dioxide that builds up in our blood. If the lungs are unable to blow off the carbon dioxide then our blood becomes acidic, end organs like the kidneys and liver fail, and death can ultimately result.

The Asthmatic Response

Asthma is a disease that adversely affects the lungs ability to exchange oxygen for carbon dioxide. The obstruction of the airways that is caused by asthma is a result of the sudden onset of inflammation in the lung tissues of the smaller passages in the lungs. The bronchioles and the alveolar sacs become inflamed, narrowing the air passages and causing the classic wheezing sound that is associated with an asthma attack. Imagine blowing up a balloon and then squeezing the opening closed so that only a small amount of air is allowed to escape. There is usually a whistling sound when we do this. Well, this is the idea behind the wheezing sound made during an asthma attack.
In addition to the inflammation and constriction of the smaller airways, the lung will produce an excessive amount of mucus, which further obstructs air flow.
When a person has an asthma attack, inflammation, constriction, and excessive mucus production create an environment in the lungs where the air going into the lungs cannot reach the small blood vessels that are so desperately trying to bind oxygen and get rid of carbon dioxide. A patient will become short of breath and begin to posture for air. Breathing becomes labored and panic sets in which can exacerbate the symptoms. Eventually the patient can become cyanotic where the skin and mucus membranes will adopt a bluish color. This color change is due to lack of oxygen in the blood.
The triggers for asthma are varied. Often times people with asthma have allergies to dust, pollen, etc…and these antigens can trigger an attack. Other triggers include respiratory illnesses, cold weather, and exercise.
Treatment for asthma is also varied. Most practitioners agree that asthmatic patients will need to have a rescue inhaler in their possession at all times. The best known and most widely used rescue inhaler is albuterol. Albuterol helps improve the airway function by relaxing and dilating the muscles of the smaller airways. Pt. will usually have the side effect of slight shaking after using albuterol, but this usually resolves in a few minutes.
The goal of therapy for asthma is not to treat the acute attack but to prevent a future attack or at least lengthen the time between attacks and reduce the severity of each episode. This goal can be accomplished using some other long term medications. There are several classes of medication that can be used as long term agents. The first and perhaps most common are glucocorticoids like flunisolide, beclomethasone, fluticasone and triamcinalone. These medications are steroids and serve to prevent the immune response that causes inflammation in the lung passages. Then there are the Leukotriene modifiers like Montelukast and Zafirlukast that assist the body by preventing the inflammatory process in a different manner. Leukotrienes are lipid mediators that are responsible for the inflammatory effects in the lungs. The Leukotrienes inhibitors act by preventing the cascading effect of the Leukotrienes.
Another form of asthma medications are the mast cell stabilizers like Cromolyn and nedocomil. Mast cells are tissue cells that are filled with histamines. When these cells rupture or lyse then histamine is released. The body will respond to histamines with an inflammatory process. When this occurs in and around the smaller passages of the lungs, your body responds like it has had an allergic reaction. The fluid production and inflammation cause airway obstruction.
There are other forms of older medications that are still in use like Theophylline and newer medications like Spiriva as well as combination medications that mix a steroid with a shorter acting medication. The best known of these medications is Advair. Additionally, persons who have a history of allergies and who have asthma should be on an antihistamine like Claritan or Allegra.
Asthma is diagnosed by performing a pulmonary functions test (PFT). This procedure can usually be done in your local allergist office or pulmonary clinic. In addition to PFT’s a allergy skin test should be performed. Your doctor will want to order some laboratory testing and a chest x-ray prior to starting medications.
Asthma is a condition that can affect people of all ages, race, and gender. In the majority of cases an asthma exacerbation can be handled with the use of an inhaler and limiting of activities. In severe, cases a person who is experiencing an asthma attack should go immediately to the emergency room.
Asthma is a serious condition and compliance to your doctor’s medical regime is critical. If you have any questions about asthma, please call your provider’s office.

Steady as She Goes...

Good Afternoon, Everyone,

It is 1:30 am and I am on call. I just finished sewing a soldiers finger back together. He sliced it open with a knife. So, I have returned to my room and decided to update the blog. The internet has been unreliable over the last 10 days or so and as a result I haven't updated as I would like.
Well, clinic business is going well. Our medics are really doing well. It is amazing to watch as a young person, who maybe a carpenter, or plumber, or office worker in the civilian world, comes over here and starts to mature as a medic. It is a great opportunity for us to teach and a great opportunity for the medics to increase their knowledge base and improve their skills. We are blessed with some really talented people. So as far as clinic business it is 'Steady as She Goes.'

As many of you know, Bryan and I go to the gym almost daily, so we have been feeling pretty proud of our fitness level...that was until we decided to go to the indoor pool and go swimming. We decided we were going to swim laps. So, we dove in and flapped our arms and kicked our legs and about 5 minutes later we had only went 25 meters. It was at this point were Bryan started shouting for the life guard to throw him a line. I too was out of breath and energy so I dove straight down and put my legs up in the air so that my shorts could trap air and then I flopped back over hoping that my new balloon shorts would allow me to float. Bryan was floundering and he started to go under. He would come up for a breath and scream for his life and then he would go under. The life guard walked over to the edge of the pool and as Bryan's head came back up, the life guard shouted, "STAND UP!!" Bryan looked around and then realized that he was only in three feet of water. So, thank goodness for his quick thinking.
I was o.k. as my balloon shorts allowed me to float for two hours.

O.k. it is flu shot time. Please go see your doctor and get vaccinated. We have about 20,000 troops here at Balad and everyone of them will be getting a flu vaccination. Our immunization section is doing a bang up job in accomplishing this mission.

On a sad note, Karen's father died yesterday. He was 83 years old and suffered from dementia. It is hard to see a loved one go through that process. Her father, Grant, was once a strapping farmer and a preacher. He was strong and vital and intelligence. Towards the end his life was reduced to a bed and bedside table. I believe that he is now in a much better place. He loved the Lord and he was a good father. He was from a different era where dads worked hard and weren't able to spend time with the family, but Grant made sure that his children knew he loved them and was the true leader of the family. I also want to recognize Karen's mother, Reva, she spent the last ten years caring for her husband. When she could no longer care for him in the home, she had him placed in residential care. She visited him everyday. She is an example of loving unconditionally. She has been a blessing to our family and her example of Christian devotion has done more to bring people to Christ then words could ever accomplish.

The weather here in Balad has been great. We are in the 70's during the day and down into the 50's at night. Hard to complain about weather like that.

Before I go, I want to thank everyone for their prayers and support. Some of you have sent care packages and I am most appreciative of your gifts. All care packages get shared with the unit. It is funny but whenever a soldier receives a package, the room becomes like a bee hive with everyone crowding around to see what treat that they can have. So your thoughts and efforts go along way to boosting our morale, so again, thank you.

Well, I will close for now. Remember to let love be the strength in your legs and let mercy lead you. Forgive those who have done wrong esp. if they are seeking forgiveness, encourage those who are poor in Spirit, and rejoice with those who have been blessed by our Lord. How you treat others, by that standard you shall be measured. So do right by those in your life and show love and mercy.

God bless you all,

Jeff

Spontaneous Shortness of Breath...And Planting a Seed...

Good Evening Everyone,

Well we had a busy day today. Sick call was swamped and we felt like just when we could get ahead then another flood of troops would come in. But today had it's rewards. We were honored to have the Medical Director of the local medical centers visit our clinic today. The medical director is in charge of five medical facilities and 13 remote clinics in the surrounding Balad area. What makes this Medical Director so special is that the Director is a woman. I was so pleased to see a female in the position of authority in this country. I have always found it a great tragedy that a country would fail to realize the potential of half of their population. I truly believe that true success in the Middle East will only occur when the women can have equal rights and have the ability to receive the same educational opportunities as men. So, I was very pleased to see this very capable physician leading her team through our clinic especially considering two of her nurses were men. As a past nurse, I was happy to see Middle Eastern men take on this role. The Iraqi medical team wanted to see how we operated and was hoping to obtain some ideas on how to better serve their patients. We shared information, asked and answered questions, and parted with an agreement that we would see eachother soon.

Then later this afternoon, I held the Thursday afternoon Provider meeting where I meet with just the Physicians and PA's and our nurse LT. Nott. We have been working on updating policies and changing protocols to make our clinic run smoother. The last medical team were great people but they ran a rather lax clinic, so I have had to tighten things up. We have implemented several changes. We had three years of X-rays that had been burned to CD's and were sitting on a back shelf of a cabinet in the radiology suite. They had not been sent to radiology for an official reads by a radiologist. Which means that these films are not placed in the pt. record. So, I called the Chief of Radiology at the Air Force hospital and he was most accomodating. He has agreed to read our films on a daily bases. So I have instructed our radiologic tech to take the films over daily for a read. We of course read our own films after we examine the patient and then we examine the films for obvious anomolies. But it is a rule in medicine to have an official read from a radiologist so that the results can be placed in the record. So, we have accomplished that.

Another item that we addressed at our Provider Meeting was the appointment of Lt. Nott as our new Clinical Director. I have placed him in charge of the entire clinic. He will serve as my clinical medical officer and will be an extension of my position. I am the first to admit that I am at times overwhelmed with my duties to see my fair share of patients, manage the needs and concerns of the provider staff, ensure that the enlisted medics are being trained appropriately and have their needs met, and trying to manage other unmentioned missions that are getting ready to come. So, adding the very capable Lt. Nott to my staff has been a great snag for me. He is competent and strong in his clinical skills. He has great rapport with our medics and he is a natural teacher. He usually scrubs in with me when I do a small surgical procedure and he has been a good friend to me. He also gets along well with our providers so he will serve as a go between them and the rest of the staff. So, I am happy to have him on board and look forward to saving the world together. It is tough using our superhuman powers for good and not evil.

But now onto the show. We had a young man come into the clinic tonight who was complaining of shortness of breath. He is a 26 year old thin young man who is very athletic. He said that he felt a pop in the side of his right chest and then he started having a difficult time breathing. Well what would your clinical diagnoses be based on these symptoms?

Well my friends...He has a spontaneous pneumothroax or what is commonly called a collapsed lung.

So how does a lung suddenly collapse? Well your lungs and chest wall are elastic and as you breath in and out your lungs tend to recoil inward while your chest wall expands outward. These two oppossing forces creates a negative pressure in the pleural space between your ribs and the lung. When the air enters into that space between the rib and lung the pressure that it exerts on the lung and the air coming from the inside of the lung can exerts pressure on all or part of that lung and it can collapse. Now a lung may collapse completely or me only pull away from the chest wall and end up with a partial collapse.
The patients who are at risk for spontaneous pneumothroax are generally young men between the ages of 20-40. They are generally tall, and thin and tend to be smokers. And recent studies show that perhaps there is a family history of pneumothorax. What happens in these folks is that a small bleb of air can forms on the lung and can rupture thus causing the lung to collapse.

The lung can completely collapse which can become a surgical emergency or the lung could only partially collapse which may be managed by a night in the hospital on positive pressure air. If surgey is need then a chest tube is inserted in between the rib space between the two ribs that overlay the site of the collapse.

These spontaneous pneumothorax can happen at any time and any place. They can happen after an traumatic injury. change in air pressures like sky diving or under water diving, or doing mountain climbing. But the truth is that most of these pneumothorax' occur when a young man is simply walking.

Pt. may present to your office with nothing more then a feeling of shortness of breath and no other symptoms. Pulse oximetry may be misleading and the pt. may have a 98 or 99% on room air. But the pt. will say that he just doesn't feel right and cannot catch his breath. Now, you have to have your differentials in play here as this young man could have a pulmonary embolisms so be careful. A PE will present with similar symptoms except pain is more common with a PE. Spitting up blood is a sign of a PE as well as true dyspnea and a feeling an overwhelming sense of doom and gloom. Pneumothroax patients, whereas, maybe uncomfortable, are not in a panic mode.
A simple PA and lateral chest x-ray should give you the anwer. See the chart below:

You see the lung can pull away and only deflate about 25% or the lung could collapse completely. The degree of the collapse can often times determine the severity of the symptoms.

This situation should be handled as a surgical emergency or at least the pt. should have an immediate visit to the ER

Tonight we had just such a case and the young man came in with these symptoms. Dr. Baez evaluated the patient and had a suspicion that he may be dealing with a pneumothorax so he went and obtained an x-ray and sure enough the patient has about a 25% reduced pneumothorax. Dr. Baez asked me to look a the film and to provide him with a second opinion. Sure enough this young man had a pneumothorax. So, we sent him over to the hospital and he is being tubed as we speak. This is just one of those uncommon cases that we get in from time to time. I do not, of course publish or discuss any wound or injury that happens to our American soldiers who have been injured in combat. Whereas those type of wounds are much more significant and much more complex, we will never put those type of injuries on line. And fortunately for us and our troops, we have not had a problem with combat injuries in our clinic.

Well, when I finished in the clinic, I finally made it back to my room. When I opened my army email, I had a note from a young Captain that wants to go to PA school so she is trying to get some experience in a clinical setting. I am off tomorrow, well actually on call, and so I had to go and ask Travis a favor. It isn't fun to ask Travis a favor because he ususally wants something in return. But he never tells you what it is right away. He will come back in two weeks and expect me to shine his boots or to do his laundry. But I humbled myself and asked him if he could supervise her tomorrow morning. He agreed but I am sure that I will be paying something in return. Maybe I can help him out by teaching him that orthopedics is not the only area of medicine that is important. I just don't know if I will be successful in that endevour.

O.K. my friends thank you for listening to me drone on about my day. I have shared with you that we had a hectic day, that woman are receiving an eduction in this country, that Lt. Nott will be my our new Clinical Director, and that young skinny guys who smoke can sometimes have a lung pop and collapse. We also learned that Travis will do you a favor but it will come at a price.

So, this is how my day went. Tomorrow I am off. I will sleep until someone knocks on my door and ask me to arbitrate some argument. Then I will go to the gym and lift until my body aches which is about ten minutes into my routine and then Bryan and I will stop by and get pizza at pizza hut and then we will sit in my room and watch a classic movie like that 'Ballad of Ricky Bobby. I love the oldy but goodies.

I will then spend sometime with the Lord and then Pray for you, my friends, family, and past friends who I pray will return to my life. I have a friend from high school that I reconnected with before I deployed and I would like to catch up with him. He is the guy who led me to the Lord.

I hope you will all remember that God has planted seeds in all of you to go and do great things. And in at least one of you He has planted a seed that I pray will change your life for the better. It is a beautiful place where the Lord will take you. Full of love and kindness and understanding. Full of hope and joy and glory. The Lord will lead you into the direction of his purpose to fulfill promises and duties of the past. Let us honor our duties to the Lord and submit to his plans for us, no matter where these plans may take us. God bless you everyone and thank you for checking in.

Bryan and Mike to the Rescue...

Good Evening,

I just returned from the showers where Spc. Troxel used up all of the hot water and I and Spc. Eldridge had to take cold showers. I will proceed with court martial charges against Spc. Troxel in the morning. Hey, for those of you who have been in the military or been to summer camp, will testify to the high crime of using the last of the hot water.

Well, I have to share my debt of gratitude to Mike and Bryan. About a week ago, I had a Master Sergeant come in to the clinic with a complaint of a lump under his left breast. He is a 40+ year old gentleman and he had had the mass there for quite a while. He was concerned about the lump as he had read that men can sometimes develop breast cancer. I did my exam and sure enough he had a moveable, painless, mass under his left areola. So, I discussed the pt. options here in theater and gave him the opinion that it was most likely a fatty tumor. I offered to remove the lesion and send it to the lab or at least a portion of it to the lab for diagnosis. He agreed. So, I performed the procedure that you see below. The patient gave consent to take these photographs and to publish them on this blog.

Here I've made my initial incision and am dissecting down. At this point, I am praying that this lump is nothing more than a cyst or a lipoma.

Here I can see the top of the mass.

Trying to figure out how deep this goes. I always try to use the smallest incision possible.

I am getting there.

Here I have removed the lump and am exploring the wound with my finger to see if I left any other cyst behind.

The lump is removed and the wound looks clean. Time to close.

My prayer is answered, it appears to be a lipoma, which is benign.

Here I have closed the incision and am finished...or am I?

Here's the rest of the story. After I finished with this procedure, I went to the gym to workout. When I returned from the gym, I went to my room grabbed my clothes and showered. Our showers are in the clinic. When I finished, I was leaving the clinic when one of the medics grabbed me and said that my patient had returned and that his incision was leaking blood. I went into the procedure room and there was Bryan and Mike with the patients wound open and blood everywhere. What happened was the patient had left the clinic and went to a meeting. After the meeting he was walking back to his office when he started to bleed from the wound.

So, Bryan and Mike were trying to find the vessel that had rupture. As soon as I entered the room I grabbed a pair of gloves and went to work. Mike stepped out as three was too many people for such a small wound, but Bryan stayed on. It tooks us over an hour and a half to get that bleeding under control. What happened was a blood vessel had broken open and retracted up superior to the areola. It is amazing how much blood can come from a small blood vessel.
Well, we finally got the bleeding under control by using epinephrine, ties, and good old fashion direct pressure. Bryan stayed the entire time to help me out and I am so thankful to him.

It is always a providers nightmare when someone else has to repair your work. But Bryan has been kind and hasn't made fun of me or anything. Which is nicer than I would have been. If it were his patient, I would make him pay me 12 dollars to keep my mouth shut. ;-)

It is always great to have friends who can cover your backside.

Veteran's Day-Karen's Birthday...

Good morning everyone,

I am sorry I haven't updated in a while. We have been busy.

Well, yesterday was Veteran's Day and the base celebrated by having a 5k run. I being the athlete that I am, celebrated by sleeping through the 5K run. I have to pace myself. :0)

Those who participated said that it went well. Lt. Nott, our nurse finished in the top 1500. That's not bad as there were 1533 participants.

Yesterday was also Karen's birthday. I had ordered gifts online and had them sent to Karis who wrapped them all up in pretty wrapping. I was able to video cam home and watch Karen open her gifts. I was feeling pretty proud of the absolutely, wonderfully, fantastic, gifts that I had purchased when Karis whips out this homemade birthday card that she wrote for her mother and suddenly I felt like my gifts were just ornaments. Karis drew her mom a picture and made her a card and wrote a little story on the card. It was so wonderfully done that I was instantly reminded of the Godly bond that those two share. I always have prided myself on the bond that Karis and I have. We are so close...but when I see how Karen and Karis are with eachother... Well, I am just grateful that they have eachother while I am gone. Oh, by the way, our Church had a salute to those who serve in uniform ceremony at the Civic Center the other day and Karis got to say the Pledge of Allegiance. I am proud of her. She is so comfortable in front of big crowds. Sorry, I am just a proud father bragging about his child.

Well, our mission has settled in. I worry that we may become complacent. We are finally in a position where we are in a routine and everyone has become comfortable with their roles. But big changes may be coming. The Iraqi government has yet to approve the SOFA (Status of Forces Agreement). If that is not approved by the end of December, then all forces have to start moving out Iraq immediately. On one hand, I can't imagine that happening as this country will fall apart, on the other hand, I think that both parties would look at this as an honorable way out. If the Iraqi goverment refuses to let us stay in their country then we would leave and neither of our political parties would be held liable for any adverse aftermath as it would be the Iraqi's decision that we leave. I believe, however, that our government is honorable and will do what is right. I truly believe that we cannot leave here. The Iraqi people are real people. They are women and children and men. They are mothers and fathers and sons and daughters. They are trying to make a better life for themselves and if we pull out prematurely then many will perish. We have had enough killing and death. It is time to hold the line and with Gen. Petreaus work we have had remarkable changes. Believe me I am no propaganda machine for the military. In fact, I am the first to admit that so many mistakes have been made that the very nature of this war is in question, but we are here and we have an obligation to protect those whom are under our care.

I hope and pray that the Lord will find a solution to this war. I don't believe that it is pulling out now and I don't know what the conclusion should be...But the Lord does. So, I say that we pray for a solution and I believe God will honor our prayers.

Now, on to another subject. I removed Bryan's sutures last night and his wound looks good. See below.

Sorry the photo is blurry. His incision healed well but his skin did not like the sutures.

I have to apologize to Bryan's wife Stephanie. She looked at the photo's of Bryan's procedure and she took exception to the comment when I called her husband a 'hairy monkey'. So, I want to apologize. Here is goes...Ahemmm...

Dear Mrs. Frodo Baggins. I am sorry that I called your husband a 'hairy monkey.'

See, I am not too big to apologize and admit when I am wrong.

I have to say though, in all seriousness, that Stephanie has a wonderful blog and her and Bryan have a beautiful child. I have really appreciated my friendship with Bryan and am very glad that we could share this deployment together.

Well, I pray that you are all well.

Have an awesome night.

Jeff

A Panoramic View and an Eight Legged Monster...

Good Post Election Afternoon Everyone,

Our friend, Col. Dave took a few panoramic view of our clinic, in doors and out. I thought you would like to see what our job space looks like.

This is the outside of our clinic. We have two FLA (ambulances) here on site and additional ambulances at an off site facility to respond to the needs of the base.

Here is a photo of one of our trauma rooms. As you can see we still have fairly antiquated equipment.

Here is our main trauma room. We have our crash cart in here. This is also the room where we perform minor surgical procedures, suturing, and other invasive procedures.

We have finally, acheived a full status of medical providers, so we are up to speed as far as having a full staff.

We are prepared for most emergencies and are equipped to handle a mass casualty situation if the need arises.

Last night we did have an IED hit one of our convoys just outside of the gate. Fortunately, the injured were closer to the ER at the hospital, so they were transported there by our EMS personnel.

Then today we had a mortar land fairly close to our facility. Luckily, no injuries were sustained.

Now below is something that is off the subject but thought I would share it with you. This animal in the picture below is a camel spider. They are found all over the country. I borrowed this photo from an online source. It is a good picture of how big these things get.

Imagine waking up with this thing in your sleeping bag.

President Obama...

Obama: Mr. President

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48,589,993

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This number does not represent the number of votes that Barak Obama received during the recent Presidential election, but it's close.

This number actually represents the number of babies who had their life taken from them for having the 'Audacity of Hope' that they would have a chance to live.

This number represents the number of children who have been aborted since the 1973 Roe v. Wade decision.

To bad that none of these children had the opportunity to run for President.

Now, Commander in Chief to be, what are you going to do about protecting the rights of your constituents. You know the constitutional rights of Life, Liberty, and the Pursuit of Happiness.

You cannot protect the last two rights unless you first allow the first right to exist.

Today is Your Day...

Everyone must submit himself to the governing authorities, for there is no authority except that which God has established. The authorities that exist have been established by God.

Romans 13:1

Remind the people to be subject to rulers and authorities, to be obedient, to be ready to do whatever is good, to slander no one, to be peaceable and considerate, and to show true humility toward all men.

Titus 3:1-2

Bryan's Liposuction Surgery...

Good Evening Everyone,
We had a nice quiet Sunday today. I had the day shift and we had some walk-ins today but over all it was pretty light. Bryan had been asking me for a while to remove a lipoma from the back of his left arm for a while now, and tonight we actually had some time to get it done.

A lipoma is just a little fatty tumor that can grow anywhere adipose tissue is located. This particular lipoma was rather superficial and pretty easy to remove. I thought I would share some photos of the procedure. These are placed on this blog with Bryan's consent.

Here I am numbing him up with some 2% lidocaine with epi. He's a hairy little monkey isn't he?

Here I have scrubbed up, cleansed his wound with Betadine and after prepping him, I made my initial incision.

I start to bluntly dissect the tissue to get down to the lipoma.

I have visualized the top of the lipoma, now I just need to grab a hold pull and dissect my way to the bottom.

Almost there...

Just a little further...

She's ready to pop...

There it is, a piece of fat is born.

Boy, what some people will do to lose weight!

Time to close.

First stitch went well. Just like darning socks. (Not that I have ever darned socks, but I have been angry at my pants when they became too tight to wear.) HA!!! That joke was a hit in the 5th grade. Well, you get what you pay for on this blog.

I was reaching for a cup of coffee on the mayo tray when my medic took this picture. (Geez, I've got a big forhead.)

Finishing up.
I used 3-0 Ethilon suture material. It a little thick for a suture but this area of the arm is high tension, so I needed something with a little strength.

All finished.

Bryan lost 12 pounds during this procedure. 2 oz. was due to the removal of the lipoma; the rest was from the hair I shaved off his arm.

Thank you so much for spending your time with us today. Join us next week, when we televise Mike's colonoscopy. It should be big fun.