Good Everyone,
I just want to ask you guys to pray for Karen and me. Deployments are hard on all families and we are no different. Karen has to be mom and dad and I have little ability to take care of matters at home and it is frustrating. My life here is consumed with the military and I have zero time to myself. I spend my entire time taking care of troops. Karen, spends her entire time taking care of the homefront. She teaches, and runs Karis everywhere, takes care of the PTA stuff and still we try to maintain a relationship. It is hard at this point in the rotation. We are about six months in and it is like a cold day in February. When will the sun come out!?!
So, keep us in your prayers that we survive this deployment with a deeper understanding of eachother. It is hard and we need your prayers.
Thank you,
God Bless
Thursday, January 29, 2009
Wednesday, January 28, 2009
Love...
“You will find as you look back upon your life that the moments when you have really lived are the moments when you have done things in the spirit of love.”
Henry Drummond
Henry Drummond
Tuesday, January 27, 2009
Appendicitis
Good Evening Everyone,
Well we had our mass casualty event today. We had dignitaries from the Army and Air Force attend as well as a group of Iraqi physicians. The exercise went well and in the next few days I will post photo's and give a brief description of what we accomplished.
Today, however, I would like to discuss a medical topic. It is a rare day that I do not evaluate a patient with a complaint of abdominal pain. For those of you in the health care field know, abdominal pain is a pain to work up. So many illnesses can present with a complaint of abdominal pain. Most commonly I am asked by my patients, "Do I have appendicitis?" I even had a young lady who had already had an appendectomy as a child, ask me if I thought perhaps her recent abdominal pain was related to another case of appendicitis. I simply chuckled and reassured her.
Anyway, tonight I would like to discuss the all to common condition that is appendicitis.
Anatomy:
The appendix is actually called the Veriform Appendix and is located as a small pouch off of the Cecum portion of the large bowel. The small intestines connect the terminal portion of the stomach where the duodenal sphincer is located and the Cecum. The Cecum is the beginning portion of the large bowel and is part of the ascending colon. See Diagram below:
The appendix is an appx. 10 cm pouch that extends from the medial edge of the cecum and extend normally toward the midline portion of the abdomen. The appendix size can range from 2-20 cm in length and can extend in any direction depending on a persons anatomy. Because the fecal matter from the small intestions or more specifically the ilium portion of the small intestine, is emptied into the cecum in a liquid state, the appendix is prone to filling. Normally, this filling is not a problem, but there are times when the appendix pouch can become infected and inflammed. Weather the inflammation is secondary to stagnating fecal fluid or from a bacterial infection that infects the tissue of the appendix is not always known, but the result is the same. Abdominal pain will develop and this is what we call appendicitis.
Signs/Symptoms:
Appendicitis can present with a variety of clinical complaints. Most commonly a patient will experience, early on in the course, diffuse abdominal pain, nausea, anorexia and/or lack of appetite. As the infection progresses, the patient will begin to experience a localizing of the abdominal pain to the right lower quadrant of the abdomen. As the pain localizes, the patient will start to spike a fever, become diophoretic (begin to sweat), vomit, and have sharp abdominal pain with motion. Patients will be very guarded and will complain that even the ride over to the hospital caused abdominal pain, secondary to hitting bumps or potholes in the road.
Diagnosing:
A good clinical exam should point the provider in the right direction for appendicitis. So, a thorough evaluation should start the diagnostic process. Bowel sounds may or may not be decreased. Pain will be illicited on palpation of the abdomen, especially in the right lower quadrant. The odd finding of rebound tendernous or pain that is more severe with the releasing of palpation is often noted. The patient will have pain to the right lower quadrant by simply tapping firmly on the bottom of the right foot. This jarring sensation will irritate the inflammed appendix.
A rectal exam to check for rectal bleeding is appropriate. If the pt. has right lower quadrant pain upon the digital rectal exam, then appendicitis should most certainly be in the differential. A digital rectal exam will not only cause abdominal pain but a hemoccult or test for rectal bleeding can be assessed.
Fever and vomitting is often times the part of the presentation of appendicitis so a complete set of vitals should be obtained. If the patients, blood pressure suddently drops, then septic shock should be ruled out.
Labs should be drawn to assist with the diagnoses. A CBC (Complete Blood Count) should be drawn. A CBC contains a white blood cell count which will be elevated during an appendicitis. This is an indication of infection. The CBC also monitors the hemaglobin and hematocrit in the the blood. If either of these are low, then the patient is anemic, which could indicate a loss of blood, perhaps through rectal bleeding. A CMP or comprehensive metobolic panel should also be drawn. A CMP will assess kidney funtion through measuring of electrolytes. Electrolytes tells us the hydration status of the patient and assesses the sodium, potassium, chloride, and carbon dioxide of the patient. Additionally the CMP will assess the liver function and other kidney funtions through blood urea nitrogen and creatinine levels.
We assess the function of other vital abdominal organs to ensure that the cause of the pain and other symptoms are being caused by anything other than the inflammed appendix.
Once a provider has a high index of suspicion that the patient has appendicitis then an ultrasound of the right lower quadrant of the abdomen or a CT scan of the abdomen should be performed to give a final diagnosis. Many people have asked my why we just don't go straight to the ultrasound or CT scan and avoid all of the other work ups? We don't do this because more times than not, abdominal pain is not due to appendicitis and other disease processes can be identified with the previously mentioned battery of test.
Differential Diagnosis:
Appendicitis doesn't alway present with textbook symptoms and so a list of differential or alternate diagnoses should be considered as the patient goes through the work up phase. Other pathology that should be considered are ovarian cysts, pelvic inflammatory disease or PID in a woman, kidney, bladder, or urinary tract infections, (always ensure a urinalysis is performed), Cholecyctitis or gallbladder inflammation, colitis, Crohn's disease, fecal impaction, and mesenteric ischemia or an obstruction of blood flow to the bowel.
Any of these illnesses could cause similar symptoms as that of appendicitis.
Treatments:
Once the diagnosis has been made then the patient needs to be sent to a surgeon for surgical intervention. Older protocols directed that a patient with abdominal pain should not be given pain medications as symptoms could be masked. Now, recent studies show that the usage of analgesics, to include narcotics, does not delay the diagnosis of appendicitis. So, be sure that the patients pain is adequately managed. Remember pain is that 5th vital sign and should be assessed and managed aggressively.
Surgical intervention is almost aways the treatment of choice of a confirmed appendicitis. Several method of removal are available. First method of surgery is the open abdominal approach. This method is where the surgeon makes an apprx. 15-20 cm incision in the lower right quadrant of the abdomen, exposes the bowel and removes the appendix. This method has fallen out of favor as abdominal wall muscle are cut and damaged, the risk of infection is higher than other procedures, and recovery time is prolonged.
The second and most common method is the laproscopic approach. This is where a surgeon will make three small incisions on the abdomen. One incision is in the right lower quadrant the other on the lower middle quadrant and then the middle portion of the mid abdomen. The incisions are small and a should only be large enough to insert a camera and instruments into the abdominal cavity. This should be apprx. 1-2cm in diameter. The abdomen is filled with carbon dioxide to inflate the belly to increase work area around the appendix site. Then instruments and a camera are inserted and the appendix is removed. When complete the surgeon may place one suture in each incision and the patient is sent to the recovery room. Sometimes sutures are not used at all as the incisions are so small that the wound edges approximate themselves.
Recovery time and risk of infection is quicker and lower for this procedure versus the open surgery.
Finally, a new technique for appendix removal is finding favor. This procedure is the incision free, alternate orifice removal. This is where the surgeon will take a camera and instruments down the throat and through the stomach into the duodenum. A small incision is made in the duodenal wall and the instruments and the camera are passed through and extended down to the appendix, by passing the small intestines. The appendix is removed and brought out of the abdominal cavity through the stomach, up the esophagus, and out of the mouth. No external incisions are made and the patient is sent home the same day.
Pain management post operatively and prevention of infection is a must following surgery. Often time the patient is treated with vicodin or similar strength narcotics and given an antibiotic. The use of narcotics should be kept to a minimal as dependency can occur and the bowel motility can be reduced causing a secondary complication of constipation.
Appendicitis is a very serious and painful condition. If left untreated the appendix can rupture and the patient will develop peritonitis and die if left untreated.
We will all have abdominal pain at some point in our lives, but hopefully, now you will be able, more easily, recognize the difference between abdominal pain caused by virus or some other etiology and a true appendicitis.
I am thinking about all of you a great deal lately and I pray that the Lord continues to bless you. If you have any prayer request, please pass it along and I will pray for your concerns.
God Bless You All,
Jeff
Well we had our mass casualty event today. We had dignitaries from the Army and Air Force attend as well as a group of Iraqi physicians. The exercise went well and in the next few days I will post photo's and give a brief description of what we accomplished.
Today, however, I would like to discuss a medical topic. It is a rare day that I do not evaluate a patient with a complaint of abdominal pain. For those of you in the health care field know, abdominal pain is a pain to work up. So many illnesses can present with a complaint of abdominal pain. Most commonly I am asked by my patients, "Do I have appendicitis?" I even had a young lady who had already had an appendectomy as a child, ask me if I thought perhaps her recent abdominal pain was related to another case of appendicitis. I simply chuckled and reassured her.
Anyway, tonight I would like to discuss the all to common condition that is appendicitis.
Anatomy:
The appendix is actually called the Veriform Appendix and is located as a small pouch off of the Cecum portion of the large bowel. The small intestines connect the terminal portion of the stomach where the duodenal sphincer is located and the Cecum. The Cecum is the beginning portion of the large bowel and is part of the ascending colon. See Diagram below:
The appendix is an appx. 10 cm pouch that extends from the medial edge of the cecum and extend normally toward the midline portion of the abdomen. The appendix size can range from 2-20 cm in length and can extend in any direction depending on a persons anatomy. Because the fecal matter from the small intestions or more specifically the ilium portion of the small intestine, is emptied into the cecum in a liquid state, the appendix is prone to filling. Normally, this filling is not a problem, but there are times when the appendix pouch can become infected and inflammed. Weather the inflammation is secondary to stagnating fecal fluid or from a bacterial infection that infects the tissue of the appendix is not always known, but the result is the same. Abdominal pain will develop and this is what we call appendicitis.Signs/Symptoms:
Appendicitis can present with a variety of clinical complaints. Most commonly a patient will experience, early on in the course, diffuse abdominal pain, nausea, anorexia and/or lack of appetite. As the infection progresses, the patient will begin to experience a localizing of the abdominal pain to the right lower quadrant of the abdomen. As the pain localizes, the patient will start to spike a fever, become diophoretic (begin to sweat), vomit, and have sharp abdominal pain with motion. Patients will be very guarded and will complain that even the ride over to the hospital caused abdominal pain, secondary to hitting bumps or potholes in the road.
Diagnosing:
A good clinical exam should point the provider in the right direction for appendicitis. So, a thorough evaluation should start the diagnostic process. Bowel sounds may or may not be decreased. Pain will be illicited on palpation of the abdomen, especially in the right lower quadrant. The odd finding of rebound tendernous or pain that is more severe with the releasing of palpation is often noted. The patient will have pain to the right lower quadrant by simply tapping firmly on the bottom of the right foot. This jarring sensation will irritate the inflammed appendix.
A rectal exam to check for rectal bleeding is appropriate. If the pt. has right lower quadrant pain upon the digital rectal exam, then appendicitis should most certainly be in the differential. A digital rectal exam will not only cause abdominal pain but a hemoccult or test for rectal bleeding can be assessed.
Fever and vomitting is often times the part of the presentation of appendicitis so a complete set of vitals should be obtained. If the patients, blood pressure suddently drops, then septic shock should be ruled out.
Labs should be drawn to assist with the diagnoses. A CBC (Complete Blood Count) should be drawn. A CBC contains a white blood cell count which will be elevated during an appendicitis. This is an indication of infection. The CBC also monitors the hemaglobin and hematocrit in the the blood. If either of these are low, then the patient is anemic, which could indicate a loss of blood, perhaps through rectal bleeding. A CMP or comprehensive metobolic panel should also be drawn. A CMP will assess kidney funtion through measuring of electrolytes. Electrolytes tells us the hydration status of the patient and assesses the sodium, potassium, chloride, and carbon dioxide of the patient. Additionally the CMP will assess the liver function and other kidney funtions through blood urea nitrogen and creatinine levels.
We assess the function of other vital abdominal organs to ensure that the cause of the pain and other symptoms are being caused by anything other than the inflammed appendix.
Once a provider has a high index of suspicion that the patient has appendicitis then an ultrasound of the right lower quadrant of the abdomen or a CT scan of the abdomen should be performed to give a final diagnosis. Many people have asked my why we just don't go straight to the ultrasound or CT scan and avoid all of the other work ups? We don't do this because more times than not, abdominal pain is not due to appendicitis and other disease processes can be identified with the previously mentioned battery of test.
Differential Diagnosis:
Appendicitis doesn't alway present with textbook symptoms and so a list of differential or alternate diagnoses should be considered as the patient goes through the work up phase. Other pathology that should be considered are ovarian cysts, pelvic inflammatory disease or PID in a woman, kidney, bladder, or urinary tract infections, (always ensure a urinalysis is performed), Cholecyctitis or gallbladder inflammation, colitis, Crohn's disease, fecal impaction, and mesenteric ischemia or an obstruction of blood flow to the bowel.
Any of these illnesses could cause similar symptoms as that of appendicitis.
Treatments:
Once the diagnosis has been made then the patient needs to be sent to a surgeon for surgical intervention. Older protocols directed that a patient with abdominal pain should not be given pain medications as symptoms could be masked. Now, recent studies show that the usage of analgesics, to include narcotics, does not delay the diagnosis of appendicitis. So, be sure that the patients pain is adequately managed. Remember pain is that 5th vital sign and should be assessed and managed aggressively.
Surgical intervention is almost aways the treatment of choice of a confirmed appendicitis. Several method of removal are available. First method of surgery is the open abdominal approach. This method is where the surgeon makes an apprx. 15-20 cm incision in the lower right quadrant of the abdomen, exposes the bowel and removes the appendix. This method has fallen out of favor as abdominal wall muscle are cut and damaged, the risk of infection is higher than other procedures, and recovery time is prolonged.
The second and most common method is the laproscopic approach. This is where a surgeon will make three small incisions on the abdomen. One incision is in the right lower quadrant the other on the lower middle quadrant and then the middle portion of the mid abdomen. The incisions are small and a should only be large enough to insert a camera and instruments into the abdominal cavity. This should be apprx. 1-2cm in diameter. The abdomen is filled with carbon dioxide to inflate the belly to increase work area around the appendix site. Then instruments and a camera are inserted and the appendix is removed. When complete the surgeon may place one suture in each incision and the patient is sent to the recovery room. Sometimes sutures are not used at all as the incisions are so small that the wound edges approximate themselves.
Recovery time and risk of infection is quicker and lower for this procedure versus the open surgery.
Finally, a new technique for appendix removal is finding favor. This procedure is the incision free, alternate orifice removal. This is where the surgeon will take a camera and instruments down the throat and through the stomach into the duodenum. A small incision is made in the duodenal wall and the instruments and the camera are passed through and extended down to the appendix, by passing the small intestines. The appendix is removed and brought out of the abdominal cavity through the stomach, up the esophagus, and out of the mouth. No external incisions are made and the patient is sent home the same day.
Pain management post operatively and prevention of infection is a must following surgery. Often time the patient is treated with vicodin or similar strength narcotics and given an antibiotic. The use of narcotics should be kept to a minimal as dependency can occur and the bowel motility can be reduced causing a secondary complication of constipation.
Appendicitis is a very serious and painful condition. If left untreated the appendix can rupture and the patient will develop peritonitis and die if left untreated.
We will all have abdominal pain at some point in our lives, but hopefully, now you will be able, more easily, recognize the difference between abdominal pain caused by virus or some other etiology and a true appendicitis.
I am thinking about all of you a great deal lately and I pray that the Lord continues to bless you. If you have any prayer request, please pass it along and I will pray for your concerns.
God Bless You All,
Jeff
Saturday, January 24, 2009
Out of the Mouth of Babes...
Good Evening,
Just a quick note. Many of us received Christmas cards and correspondence from elementary school kids. Some of these children had no problem asking whatever was on their minds. They wrote, we wrote, and they wrote back. It has been a joy to have that communications with these kids. They have made us laugh and made us cry and their child like insight has often times given us a reason to pause and remember what is important in life. Well, Bryan received a letter today from a very astute seven year old girl who sent Bryan the following letter. It may be hard to read but it says the following.
"Dear Captain McFarland, Hi this is laura again and I am wondering if you can tell me a little bit more about your life and your family? I also caught a spelling error..." (on your last letter) "You spelled sweat instead of sweet when you were talking about your daughter."
Listen, I pray that you are all well and that the fills you with His Spirit. God Bless you.
Jeff
Just a quick note. Many of us received Christmas cards and correspondence from elementary school kids. Some of these children had no problem asking whatever was on their minds. They wrote, we wrote, and they wrote back. It has been a joy to have that communications with these kids. They have made us laugh and made us cry and their child like insight has often times given us a reason to pause and remember what is important in life. Well, Bryan received a letter today from a very astute seven year old girl who sent Bryan the following letter. It may be hard to read but it says the following.
"Dear Captain McFarland, Hi this is laura again and I am wondering if you can tell me a little bit more about your life and your family? I also caught a spelling error..." (on your last letter) "You spelled sweat instead of sweet when you were talking about your daughter."
Out of the mouth of Babes the truth is revealed.
Few things can assault your ego more than a seven year old correcting your spelling. Bryan is now in remedial spelling and english classes. He will not have the opportunity to be on 'Are you smarter than a 5th grader' as he hasn't even got past a second grader yet. He has to have all of him medical dictations reviewed by a seven year old before we can approve them for record submission. Bless this young lady and I hope her future husband realizes what he is getting into as she is unlikely to take any flack from anyone. :0)
Andy on the left, Bryan on the right.
Secondly, Andy, who is one of our family practice physicians is being sent to an artillary unit somewhere in the middle of nowhere. He will be there to provide medical coverage for this unit's soldiers. Please pray for him as this mission is not without its dangers. It is important to note that Andy is a practical joker and at some point has gotten everyone of us. He took my clothes one night when I was showering and left me with nothing but underwear. Our showers are in our clinic, so I had to go out to the front desk in my boxer-briefs and ask my medics for some help. Yes, they took great pleasure in my humiliation. He took Bryans hat and sewed his captains bars on sideways and Bryan wore his hat with pride not knowing that he was looking a little silly. I was on my Army email when I called called to see a patient. I didn't close out my email and while I was gone, Andy wrote Dr. Baez and told him that he had been extended in theater. As this type of information is generally filtered through me, it seemed to be official to him. He then sent Bryan an email from me and told him that I was developing feelings for him. Bryan and I have been friends for years but we are not that close. So, we had to take action prior to Andy's departure.
Andy leaves early in the morning, so he has packed his bags. I sent a few of the guys on a mission and had them take Andy with them. Meanwhile, I convinced the supply sgt. to give me a key to Andy's room. I took all of his underwear out of his bag and replaced them with some very nice, soft, and extremely attractive women's panties. Not the granny panties but the waist cut, bikini type of panties. I am quite sure the the Artillary boys will love their new doc. Please do not feel sorry for him as this is a most appropriate payback for his juvenile actions. The rest of us are, of course, above such childish behavior. Yes, this is your tax dollars hard at work.
Listen, I pray that you are all well and that the fills you with His Spirit. God Bless you.
Jeff
Friday, January 23, 2009
Tossed About...
Good Evening Everyone,
Before I start, I want to thank those of you who have been following along with my blog. One can never be certain if other people even care what you have to say, but I have had some very nice comments and I am truly appreciative. So, thank you so much for checking in.
We have been busy. We have been fortunate lately. It appears that the number of attacks that we have had on our base have decreased, but over the last few weeks we have been rattled a few times. Let us hope this isn't a trend. Our ambulance platoon has been busy with patients coming in from the local villages. Unfortunately, some of the patients have been children. I don't mention military conflict much on this website as I have to be careful, but I am so proud of my staff and of our EMS soldiers and paramedics. They are doing such a great job and at the end of the day, no one will even know all that they have done. It is thankless work but our guys take great pride in what they do.
Well tonight I want to talk a little about Christian maturity. For many years, I have had a touch and go relationship with the Lord. I would fall into his presence and then fall away only to return back to a state of immature faith. I have found that constant communication with the Lord and the willingness to submit all things to Christ is what develops a true relationship with our Lord. It takes a great deal of committment to surrender all aspects of our lives issues to the Lord, but the joy that comes from the relationship with Christ far outweighs the effort.
In Ephesians 4:11-14 it says: 'It was He who gave some to be prophets, some to be evangelists, and some to be pastors and teachers, to prepare God's people for works of service, so that the body of Christ may be built up until we all reach unity in the faith and in the knowledge of the Son of God and become mature, attaining to the whole measure of the fullness of Christ. Then we will no longer be infants, tossed back and forth by the waves, and blown here and there by every wind of teaching and by the cunning and craftiness of men in their deceitful scheming.
I read this and am reminded of the man I used to be. Unstable in my faith. Allowing the smallest of temptations to take me out of the presence of God. How ashamed I am for allowing myself to be like that. Praise the Lord for His patience and guidance and love. We are all in danger of being tossed about and being overcome with fear due to lack of faith. When the disciples were literally being tossed about by angry waves, they became afraid and lost their faith and they were with Christ. But what was Christ doing? Sleeping peacefully. He was confident of the Lord's protection and power and so he had nothing to worry about. Waves could not toss Christ around. We are no better than Christ disciples and need to strengthen our relationship with Christ so that when temptations come, we can go to the One who can overcome the Devil.
It is my prayer for you that '...out of His glorious riches He may strengthen you with power through His Spirit in your inner being, so that Christ may dwell in your hearts through faith. And I pray that you, being rooted and established in love, may have power, together with all the Saints to grasp how wide and long and high and deep is the love of Christ and to know this love that surpasses knowledge--that you may be filled to the measure of all the fullness of God. (Ephesians 3:16-19)
Before I go, I want to show you a picture of Karis from Halloween. My wife just sent me this and I find it amusing. It looks as if she went as some oriental ninja princess. I am not sure that the ancient Japanese wore nylon lace leg warmers or whatever they are called but it looks as if she is ready for some superhero action. I am glad that she uses her superhero powers for good and not evil. She has a variety of Superhero powers. She can procrastinate homework, run late for school by trying to decide what outfit to wear, and of course the most powerful of super powers, she can roll her eyes. Is this exclusive to my daughter or do all daughters have these powers?
God Bless you all,
Before I start, I want to thank those of you who have been following along with my blog. One can never be certain if other people even care what you have to say, but I have had some very nice comments and I am truly appreciative. So, thank you so much for checking in.
We have been busy. We have been fortunate lately. It appears that the number of attacks that we have had on our base have decreased, but over the last few weeks we have been rattled a few times. Let us hope this isn't a trend. Our ambulance platoon has been busy with patients coming in from the local villages. Unfortunately, some of the patients have been children. I don't mention military conflict much on this website as I have to be careful, but I am so proud of my staff and of our EMS soldiers and paramedics. They are doing such a great job and at the end of the day, no one will even know all that they have done. It is thankless work but our guys take great pride in what they do.
Well tonight I want to talk a little about Christian maturity. For many years, I have had a touch and go relationship with the Lord. I would fall into his presence and then fall away only to return back to a state of immature faith. I have found that constant communication with the Lord and the willingness to submit all things to Christ is what develops a true relationship with our Lord. It takes a great deal of committment to surrender all aspects of our lives issues to the Lord, but the joy that comes from the relationship with Christ far outweighs the effort.
In Ephesians 4:11-14 it says: 'It was He who gave some to be prophets, some to be evangelists, and some to be pastors and teachers, to prepare God's people for works of service, so that the body of Christ may be built up until we all reach unity in the faith and in the knowledge of the Son of God and become mature, attaining to the whole measure of the fullness of Christ. Then we will no longer be infants, tossed back and forth by the waves, and blown here and there by every wind of teaching and by the cunning and craftiness of men in their deceitful scheming.
I read this and am reminded of the man I used to be. Unstable in my faith. Allowing the smallest of temptations to take me out of the presence of God. How ashamed I am for allowing myself to be like that. Praise the Lord for His patience and guidance and love. We are all in danger of being tossed about and being overcome with fear due to lack of faith. When the disciples were literally being tossed about by angry waves, they became afraid and lost their faith and they were with Christ. But what was Christ doing? Sleeping peacefully. He was confident of the Lord's protection and power and so he had nothing to worry about. Waves could not toss Christ around. We are no better than Christ disciples and need to strengthen our relationship with Christ so that when temptations come, we can go to the One who can overcome the Devil.
It is my prayer for you that '...out of His glorious riches He may strengthen you with power through His Spirit in your inner being, so that Christ may dwell in your hearts through faith. And I pray that you, being rooted and established in love, may have power, together with all the Saints to grasp how wide and long and high and deep is the love of Christ and to know this love that surpasses knowledge--that you may be filled to the measure of all the fullness of God. (Ephesians 3:16-19)
I pray the Lord is blessing you.
Before I go, I want to show you a picture of Karis from Halloween. My wife just sent me this and I find it amusing. It looks as if she went as some oriental ninja princess. I am not sure that the ancient Japanese wore nylon lace leg warmers or whatever they are called but it looks as if she is ready for some superhero action. I am glad that she uses her superhero powers for good and not evil. She has a variety of Superhero powers. She can procrastinate homework, run late for school by trying to decide what outfit to wear, and of course the most powerful of super powers, she can roll her eyes. Is this exclusive to my daughter or do all daughters have these powers?
My wife is dressed up like a mother who has been trying to manage a nine year old on her own. It is a great costume. :0) Bless them both, they look great and I am so appreciative for my wife's ability to be both mom and dad to Karis. It has been rough but she is a strong woman and is really doing a great job. I owe her so much for her allowing me to do my job for the military and understanding the committment that soldiers have to eachother. I will be home soon and get back to my civilian job and hopefully return to a normal lifestyle.
Well, my friends, keep the faith and believe that the Lord is wanting to move in your life. We are so blessed to serve Christ who provides us with hope and direction and salvation. What more shall we desire?
God Bless you all,
Jeff
Wednesday, January 21, 2009
Breast Cancer and Self Exams.
Good Evening Everyone,
Well we have had a busy week. We had two of our docs rotated home and Travis went on leave so that left only for of us providers to cover the clinic. We have been working around the clock. So we were very happy to have Dr. Perez arrive tonight. He is coming for a three month tour. Additionally, Travis came off leave yesterday and so he will be added back to the schedule as of tomorrow.
We have been working on our mass casualty exercise that will be coming up on the 27th. We will be hosting a group of Iraqi physicians on that day. We will be teaching them some medical classes in the morning and then in the afternoon we will have them participate in our mass casualty exercise. In this environment, real mass casualties are nothing new but we are now trying to prepare the local physicians to manage their own mass casualty event. I will be giving the physicians a class on how we run our exercises and how we utilize our personnel. The Iraqi health care structure has historically excluded or margianalized their ancillary and non-provider staff. Nurses for example, are nothing more than hand maidens for the physician. When I presented our system of health care to the Iraqi's at our December conference, the physicians were amazed that our nurses were not only officers but college educated. They were equally suprised to learn that often times females are in charge of many aspects of our medical health care system. So, I look forward to this collaborative training exercise. Please pray that our efforts are a blessing to our Iraqi friends.
Tonight, I am presenting a medical topic in my main blog area because I feel that the topic is of the highest import. I have always been an advocate of early detection and preventative medicine. Tonight's topic is breast cancer and if there was ever a disease where early detection and preventative measures are essential then this disease is it's poster child.
Let's take a moment and look at the devestating disease that is breast cancer.
Women often are reminded to obtain yearly breast exams from their provider and encouraged to perform monthly self breast exams. The reason for this is because breast cancer is the second leading cause of death from cancer in women just behind lung cancer. This year alone, over 200,000 women in the United States will be diagnosed with breast cancer. The current statistic shows that 1:8 women will be diagnosed with breast cancer at some point in their lifetime.
Whereas breast cancer can develop in completely healthy women, there are risk factors that may increase the likelihood of cancerous growth. The first and most common risk factor is one that cannot be controlled and that is increased age. Increased age doesn’t necessarily mean being elderly when it comes to increasing risk. The age at which a young lady starts menstruating can increase risk. The younger the onset of menses, the more likely breast cancer will develop. Additionally, the older a woman is at the time of her first pregnancy the more likely she is to develop breast cancer. Other factors include the use of exogenous estrogen, increased body weight (Obesity), alcohol consumption and of course, family history.
Detection of breast cancer is sometimes difficult.
Monthly breast exams are encouraged as breast cancer is often times, painless and masses or nodules are not easily palpated. Often times a woman’s sexual partner is the one who detects a cancerous lesion first. When performing self breast exams, a woman should be methodical in her approach. Using the fingers of the right hand a woman should palpate her left breast in a circular pattern being sure to assess for any masses or small nodules then switch hands and do the same to the other breast. Cancer will frequently present as a small BB sized nodule that will be solid and painless. Be sure to palpate the entire breast as well as the axilla or armpit. Enlarged lymph nodes in the axilla can be an indicator of breast cancer so careful inspection of that area is important.
Once palpation is complete, be sure to squeeze the nipple and assess for drainage. If blood is expressed or fluid is returned in a non-lactating woman then notify your provider immediately.
Visual examination of the breast is of noted importance. Be sure to stand in front of a mirror and examine the breast for symmetry. If you notice a change in the size or shape of one breast then notify your doctor. Additionally, be sure to lean forward when visually inspecting the breast. If you notice that indentations or spiculations form when the breast are dangling then you will need to follow up for further testing. In some moderate to advanced cases of breast cancer a tumor will form and then spread in a web like fashion and attach itself to the chest wall. When this happens, the tumor becomes bound down and when a woman leans forward the breast will fall with the exception of the attached tumor which will stay suspended and an indentation or spiculation will form.
Additional methods of breast cancer detection commonly include mammogram screenings and ultrasound evaluations. Mammograms are recommended for all women over the age of 40. If there is a family history of breast cancer, then an initial mammogram should be performed at the age of 35 or as directed by the physician.
Treatment for breast cancer depends on the type and staging of the tumor. Diagnosis of the specific type of tumor can be obtained through a biopsy. A biopsy can be performed through a fine needle or through a lumpectomy. Once a cancer has been identified then the tumor is staged and metastasis is determined. Methods of treatment will be determined through the collaborative efforts of an oncologist, surgeon, and pathologist. A CT scan or MRI maybe necessary to determine the metastatic progression of the cancerous cells.
Possible treatment options are chemotherapy, radiation treatment, and/or surgical removal of the mass or of the entire breast, mastectomy. There has been some recent debate as to weather or not a preventative mastectomy is beneficial in the treatment of breast cancer. Studies have shown that women with a mother or sister who had breast cancer or women who have a genetic predisposition to breast cancer would benefit from having the breast removed prior to even having a diagnosis of cancer. This type of treatment is aggressive but I believe maybe an appropriate course of action. This type of decision should only be made once the patient has been fully educated on the risk and benefits of the procedure.The identification, diagnosis, and treatment of breast cancer can be a difficult process. Often times the emotional stress involved with this disease can be as devastating to the patient as the disease itself. It is important that anyone with the diagnosis of breast cancer be offered and receive appropriate counseling to assist with developing a positive self image post mastectomy and utilizing coping mechanisms to deal with the trauma of the disease.
Breast cancer is a serious and all too common pathology among women. Diligent efforts need to be implemented in order to ensure early detection. Simple self breast exams are essential and painless. Constant vigilance, awareness, and education is the key to combating breast cancer and can save your life.
Well we have had a busy week. We had two of our docs rotated home and Travis went on leave so that left only for of us providers to cover the clinic. We have been working around the clock. So we were very happy to have Dr. Perez arrive tonight. He is coming for a three month tour. Additionally, Travis came off leave yesterday and so he will be added back to the schedule as of tomorrow.
We have been working on our mass casualty exercise that will be coming up on the 27th. We will be hosting a group of Iraqi physicians on that day. We will be teaching them some medical classes in the morning and then in the afternoon we will have them participate in our mass casualty exercise. In this environment, real mass casualties are nothing new but we are now trying to prepare the local physicians to manage their own mass casualty event. I will be giving the physicians a class on how we run our exercises and how we utilize our personnel. The Iraqi health care structure has historically excluded or margianalized their ancillary and non-provider staff. Nurses for example, are nothing more than hand maidens for the physician. When I presented our system of health care to the Iraqi's at our December conference, the physicians were amazed that our nurses were not only officers but college educated. They were equally suprised to learn that often times females are in charge of many aspects of our medical health care system. So, I look forward to this collaborative training exercise. Please pray that our efforts are a blessing to our Iraqi friends.
Tonight, I am presenting a medical topic in my main blog area because I feel that the topic is of the highest import. I have always been an advocate of early detection and preventative medicine. Tonight's topic is breast cancer and if there was ever a disease where early detection and preventative measures are essential then this disease is it's poster child.
Let's take a moment and look at the devestating disease that is breast cancer.
Women often are reminded to obtain yearly breast exams from their provider and encouraged to perform monthly self breast exams. The reason for this is because breast cancer is the second leading cause of death from cancer in women just behind lung cancer. This year alone, over 200,000 women in the United States will be diagnosed with breast cancer. The current statistic shows that 1:8 women will be diagnosed with breast cancer at some point in their lifetime.
Whereas breast cancer can develop in completely healthy women, there are risk factors that may increase the likelihood of cancerous growth. The first and most common risk factor is one that cannot be controlled and that is increased age. Increased age doesn’t necessarily mean being elderly when it comes to increasing risk. The age at which a young lady starts menstruating can increase risk. The younger the onset of menses, the more likely breast cancer will develop. Additionally, the older a woman is at the time of her first pregnancy the more likely she is to develop breast cancer. Other factors include the use of exogenous estrogen, increased body weight (Obesity), alcohol consumption and of course, family history.
Detection of breast cancer is sometimes difficult.
Monthly breast exams are encouraged as breast cancer is often times, painless and masses or nodules are not easily palpated. Often times a woman’s sexual partner is the one who detects a cancerous lesion first. When performing self breast exams, a woman should be methodical in her approach. Using the fingers of the right hand a woman should palpate her left breast in a circular pattern being sure to assess for any masses or small nodules then switch hands and do the same to the other breast. Cancer will frequently present as a small BB sized nodule that will be solid and painless. Be sure to palpate the entire breast as well as the axilla or armpit. Enlarged lymph nodes in the axilla can be an indicator of breast cancer so careful inspection of that area is important.Once palpation is complete, be sure to squeeze the nipple and assess for drainage. If blood is expressed or fluid is returned in a non-lactating woman then notify your provider immediately.
Visual examination of the breast is of noted importance. Be sure to stand in front of a mirror and examine the breast for symmetry. If you notice a change in the size or shape of one breast then notify your doctor. Additionally, be sure to lean forward when visually inspecting the breast. If you notice that indentations or spiculations form when the breast are dangling then you will need to follow up for further testing. In some moderate to advanced cases of breast cancer a tumor will form and then spread in a web like fashion and attach itself to the chest wall. When this happens, the tumor becomes bound down and when a woman leans forward the breast will fall with the exception of the attached tumor which will stay suspended and an indentation or spiculation will form.
Additional methods of breast cancer detection commonly include mammogram screenings and ultrasound evaluations. Mammograms are recommended for all women over the age of 40. If there is a family history of breast cancer, then an initial mammogram should be performed at the age of 35 or as directed by the physician.
Treatment for breast cancer depends on the type and staging of the tumor. Diagnosis of the specific type of tumor can be obtained through a biopsy. A biopsy can be performed through a fine needle or through a lumpectomy. Once a cancer has been identified then the tumor is staged and metastasis is determined. Methods of treatment will be determined through the collaborative efforts of an oncologist, surgeon, and pathologist. A CT scan or MRI maybe necessary to determine the metastatic progression of the cancerous cells.
Possible treatment options are chemotherapy, radiation treatment, and/or surgical removal of the mass or of the entire breast, mastectomy. There has been some recent debate as to weather or not a preventative mastectomy is beneficial in the treatment of breast cancer. Studies have shown that women with a mother or sister who had breast cancer or women who have a genetic predisposition to breast cancer would benefit from having the breast removed prior to even having a diagnosis of cancer. This type of treatment is aggressive but I believe maybe an appropriate course of action. This type of decision should only be made once the patient has been fully educated on the risk and benefits of the procedure.The identification, diagnosis, and treatment of breast cancer can be a difficult process. Often times the emotional stress involved with this disease can be as devastating to the patient as the disease itself. It is important that anyone with the diagnosis of breast cancer be offered and receive appropriate counseling to assist with developing a positive self image post mastectomy and utilizing coping mechanisms to deal with the trauma of the disease.
Breast cancer is a serious and all too common pathology among women. Diligent efforts need to be implemented in order to ensure early detection. Simple self breast exams are essential and painless. Constant vigilance, awareness, and education is the key to combating breast cancer and can save your life.
Tuesday, January 20, 2009
OPTIMISM!!!
MR. PRESIDENT
Congratulations to President Obama,
Let us all pray that this man will use his position for altruistic purposes. May the Lord bless his decisions and may the Holy Spirit fill him and guide his actions. As many of you know, I did not and would not vote for this man, simply based upon my faith and convictions, but we must all believe that the Lord knows what he is doing. We must have faith that our prayers will be answered and that the President will be good for our country. It is easy to criticize, but it takes a noble and honorable person to be optimistic in the face of doubt. Let us all give this man a chance and trust our Lord who is the One who is really in charge. Praise the Lord for the amazingly diverse country that we live in and for the peaceful transition of power. I am hopeful that President Obama's election will help to break down the walls that divide us and allow us to move forward with a united confidence based not on race or gender, but on common ideas and an optimistic hope. May the Lord bless us all.
Wednesday, January 14, 2009
Baghdad Conference
Good Evening Everyone,
I am sorry that I haven't written in a while, but we have been extremely busy. Bryan and I had the opportunity to attend a PA/NP conference at the Al Faw Palace in Baghdad. We were able to pick up 27 much needed CME hours. While we were there, we had the good fortune to take a tour of the area. Below are some of the pictures. It is hard to believe that so much money and resources were utilized for the pleasure of one man. It is enough to say that, Saddam had quite the ego and the taste for the exquisite.
Picture 1: Bath party headquarters. This is where Saddam would meet with his party leaders. This is a pool that decorated the grounds. Here a J-Dam missle took this building out, killing over 250 of Saddam's party members.
Picture 1: This is the Victory over America Palace that Saddam was building. He titled it Victory over America as a symbol to his ability to stay in power despite the first Gulf War and his continued defiance.
Picture 1: Here is Bryan next to Saddam's painting.
Picture 1: This is a swimming pool that is in the Bath Party building. The pool was never used for swimming. It was apparently used for executions. When our military took over the building they saw that the walls were covered with these dark spots like the one next to the ladder.
Picture 1: Bath Party building. This is the main meeting room where Saddam met with his leaders.
Picture 1: This is the room where Dan Rather interviewed Saddam prior to the war.
Picture 2: A mosque.
A Royal Bathroom
Picture 1: This is a chair given to Saddam by Yassir Arafat (sp?) Notice the silver head rest is decorated with the same pattern of the head scarf that Arafat wore.
MRAP vehicles. These vehicles are fully up armored and allows most soldiers to survive a direct IED attack.
Picture 1: This was the lobby outside of our conference room. Here Bryan is darting toward the snack table. 
Picture 1: Our conference room.
Picture 1: The foyer outside of Al Faw Palace.
Al Faw Palace.
Thank you for taking time to check in. May the Lord bless and keep you safe and in His Spirit.
I am sorry that I haven't written in a while, but we have been extremely busy. Bryan and I had the opportunity to attend a PA/NP conference at the Al Faw Palace in Baghdad. We were able to pick up 27 much needed CME hours. While we were there, we had the good fortune to take a tour of the area. Below are some of the pictures. It is hard to believe that so much money and resources were utilized for the pleasure of one man. It is enough to say that, Saddam had quite the ego and the taste for the exquisite.
Picture 1: Al Faw Palace. One of 89 palaces that Saddam had built in his honor.
Picture 2: This is Qusay's house. He was one of the evil son's of Saddam.
Picture 1: This was Saddam's house of horrors. He would have some of his thug's pick up girls as young as jr. high schoolers. He would rape them and then return them to their fathers who were then instructed to kill their child because she was now no longer a virgin and thus unclean. However, to save the father's the burden of killing their daughter, Qusay would kill the girls for them.
Picture 2: Saddam's helocopter pad.
Picture 1: Bath party headquarters. This is where Saddam would meet with his party leaders. This is a pool that decorated the grounds. Here a J-Dam missle took this building out, killing over 250 of Saddam's party members.Picture 2: Saddam had two son-in-laws who fled the country with party secrets. Saddam convinced them to return and he promised not to harm them. As soon as they returned, he had them killed. As a gift for losing their father's, Saddam had this 'Flintstone Village' built for his grand kids. It was fully staffed with cooks and maids and servants.
Picture 1: This is the Victory over America Palace that Saddam was building. He titled it Victory over America as a symbol to his ability to stay in power despite the first Gulf War and his continued defiance.
Picture 2: This is one of the several ball rooms in the Palace. This palace was hit with missles during the Shock and Awe attack at the beginning of the war.
Picture 1: Here is Bryan next to Saddam's painting.
Picture 1: This is a swimming pool that is in the Bath Party building. The pool was never used for swimming. It was apparently used for executions. When our military took over the building they saw that the walls were covered with these dark spots like the one next to the ladder.Picture 2: Upon closer inspection, you can see that this spot is blood. They left one spot remaining, I suppose to show people the truth behind Saddam's murderous regime.
Picture 1: Bath Party building. This is the main meeting room where Saddam met with his leaders.Picture 2: One of the hallways hit by a missle.
Picture 1: This is the room where Dan Rather interviewed Saddam prior to the war.Picture 2: A mosque.
A Royal Bathroom
Picture 1: This is a chair given to Saddam by Yassir Arafat (sp?) Notice the silver head rest is decorated with the same pattern of the head scarf that Arafat wore.Picture 2: Al Fawl Palace.
MRAP vehicles. These vehicles are fully up armored and allows most soldiers to survive a direct IED attack.
Picture 1: This was the lobby outside of our conference room. Here Bryan is darting toward the snack table.
Picture 2: This is the lake outside the palace. The fish are carp and as you can tell, fed frequently by military and civilian personnel.
Picture 1: Our conference room.
Picture 2: This building was where one of Saddam's daughters lived.
Picture 1: The foyer outside of Al Faw Palace.Picture 2: View from balcony of Palace.
Al Faw Palace.Thank you for taking time to check in. May the Lord bless and keep you safe and in His Spirit.
Thursday, January 1, 2009
Good Afternoon Everyone and Happy New Years to you.
Well the holiday season has come and gone and I am thankful to say that we all have come through safe.
The holidays have really weighed heavy on our hearts as we miss our family and friends. But we have become a family here and we help eachother cope with our situation. Last night we had a cookout and we all had a really nice time.
I am supposed to be coming home for leave at the end of March, beginning of April. It will be Karis' spring break and on the 6th of April, Karis will also have her birthday. So, I am hoping to be there for both. My leave will only be two weeks, so I will need to make the most of it. I am planning to go to Bloomington, Illinois to try and reconnect with a friend that I haven't seen in 20 years. At some point, Karen, Karis, and I, will take a mini-vacation. Either down to Gatlinburg or Myrtle Beach. We haven't decided. We haven't decided yet. I would like to get down to Disney World again as we had purchased the 7 day super pass and we have yet to use all of days. Karis' pass is only good until she is nine years old then we have to convert it to an adult pass. The last two trips to Disney, we were unable to use all 7 days, so we could possibly consider that option.
Anyway, I am droning on. Last week I took some pictures of some of the base. I have posted them below.
Before I get into the pictures, I would like to say that I am praying that you will have a nice 2009. New Years is always a great time to refocus on what is important to us. I hope that this year will be a time of growing in the Lord. Now is the time to submit to the Lord's will and simply ask God, "How can I serve?" I think that simple question will be answered quickly and with clarity. So, use the start of this year as an opportunity to develop a relationship with Christ. The fields are ready for the harvest. The Lord needs workers to bring in the crop.
Now on with the pictures.
Picture 2: Here is Andy standing outside the bunker. You can see the bullet holes on the concrete wall behind him. 
Picture 2: This is the famous burn pit that has been on CNN and in the newspapers. This is where we burn all of our base trash and other materials. The pit is in the news because some soldier's wives have related their husbands cancer's to the fact that they served in the area around the burn pit.
Picture 1: This is a picture I took of the outside of the fence. We are about a mile away from the Tigres river. The area between the Tigres and Euphrates rivers is known as Mesopotamia. This area is believed to be the place where the Garden of Eden was located. It is hard to imagine that this dry and dusty area was where paradise was located, but when I look at the beautiful trees I can begin to understand why the Lord chose this area.
Picture 1: This is one of the many guard towers that enclose our base. The towers are manned by Ugandans.
Picture 1: This is the air field. This hangar is where the 101st Airborne Division is located. I have a special place in my heart for the 101st as I was stationed with these guys when I was at Ft. Campbell.
Picture 2: A broader shot of the airfield.
Well the holiday season has come and gone and I am thankful to say that we all have come through safe.
The holidays have really weighed heavy on our hearts as we miss our family and friends. But we have become a family here and we help eachother cope with our situation. Last night we had a cookout and we all had a really nice time.
I am supposed to be coming home for leave at the end of March, beginning of April. It will be Karis' spring break and on the 6th of April, Karis will also have her birthday. So, I am hoping to be there for both. My leave will only be two weeks, so I will need to make the most of it. I am planning to go to Bloomington, Illinois to try and reconnect with a friend that I haven't seen in 20 years. At some point, Karen, Karis, and I, will take a mini-vacation. Either down to Gatlinburg or Myrtle Beach. We haven't decided. We haven't decided yet. I would like to get down to Disney World again as we had purchased the 7 day super pass and we have yet to use all of days. Karis' pass is only good until she is nine years old then we have to convert it to an adult pass. The last two trips to Disney, we were unable to use all 7 days, so we could possibly consider that option.
Anyway, I am droning on. Last week I took some pictures of some of the base. I have posted them below.
Before I get into the pictures, I would like to say that I am praying that you will have a nice 2009. New Years is always a great time to refocus on what is important to us. I hope that this year will be a time of growing in the Lord. Now is the time to submit to the Lord's will and simply ask God, "How can I serve?" I think that simple question will be answered quickly and with clarity. So, use the start of this year as an opportunity to develop a relationship with Christ. The fields are ready for the harvest. The Lord needs workers to bring in the crop.
Now on with the pictures.
Picture 1: We visited one of Saddam's bunkers. Bryan, Andy, and myself grabbed a couple of flashlights and went exploring. The picture here is Bryan and Andy standing next to a window that was shot out during our invasion.
Picture 2: Here is Andy standing outside the bunker. You can see the bullet holes on the concrete wall behind him.
Picture 1&2: Bryan and Andy outside the bunker.
Picture 1: Here is, from left to right, Dr. Dave our dentist, Jose, myself, Travis, and Mike. The bar I am holding is actually a barrel from the weapon behind us.
Picture 2: This is the famous burn pit that has been on CNN and in the newspapers. This is where we burn all of our base trash and other materials. The pit is in the news because some soldier's wives have related their husbands cancer's to the fact that they served in the area around the burn pit.
Picture 1: This is a picture I took of the outside of the fence. We are about a mile away from the Tigres river. The area between the Tigres and Euphrates rivers is known as Mesopotamia. This area is believed to be the place where the Garden of Eden was located. It is hard to imagine that this dry and dusty area was where paradise was located, but when I look at the beautiful trees I can begin to understand why the Lord chose this area.
Picture 2: This is the control tower at our airport.
Picture 1: This is one of the many guard towers that enclose our base. The towers are manned by Ugandans.
Picture 2: Another shot of trees.
Picture 1: This is the air field. This hangar is where the 101st Airborne Division is located. I have a special place in my heart for the 101st as I was stationed with these guys when I was at Ft. Campbell.
Picture 2: A broader shot of the airfield.
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