2nd Verse of Kipling’s poem “IF”
If you can dream- and not make dreams your master;
If you can think- and not make thoughts your aim;
If you can meet with Triumph and Disaster
And treat those two impostors just the same;
If you can bear to hear the truth you’ve spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to,broken,
And stoop and build’em up with worn-out tools:
This is a sharing of the poem by Rudyard Kipling.It was of course written many years before of sensitivity to gender equality so one must translate all reference to man, men, and son, to encompass females also. At least, that is how I am interpreting it today. Since it is several verses long, I will only do one at a time……so-o-o stay tuned.
IF
by Rudyard Kipling
If you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can wait and not be tired by waiting,
Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
And yet don’t look too good, nor talk too wise:
?
Maybe there are enough youth in the world
Suppose instead……there was a Fountain of Smart ?
Definition of a Lottery Player :….. a person who is bad at math
2 April 2019 Volume 321 Number 13 page 1306
AN EPINEPHRINE PREFILLED SYRINGE (SYMJEPI) FOR ANAPHYLAXIS
Reprint from the The Medical Letter on Drugs and Therapeutics of February 25 2019; 61 (1566):25-26.
Disclaimer: It is not my usual pattern to give the name of a specific product. I do so at this time because of the thought, that the knowledge that work is being done in this area, could be useful to any serious allergy sufferer. This is NOT an advertisement nor an endorsement for this specific product. It is mentioned here for information purposes only!
SYMKEPI. Is the name of a new preparation that has won recent FDA approval for use to treat anaphylaxis. Like the “EpiPen” it requires that the substance be injected from a syringe by hand. Allegedly it will cost less than the “EpiPen”. If you or someone you know need this type of help, please discuss these new products with your medical provider.
Better get a receipt from the IRS when you do something good.
Heaven might be just like that agency.
JAMA NOTES
1. 26 March 2019 Volume321 Number 12 Page1146
Rita Rubin MA
This is a synopsis of an article by Ruchi Gupta MD MPH discussing the idea that even though we most often think of food allergies affecting children, that in reality it is just as serious a problem when some are not afflicted until they become adults. He suggests that the old argument over “nature vs. nurture” inherited versus environmentally caused, (think climate change, food intake or behavior patterns), may be as significant. It appears that Dr. Gupta thinks that it is important that each new case be thoroughly evaluated to avoid people unnecessarily removing various dietary choices.
DMARDS AND BRM’S
Today is the last in the series of discussions about the autoimmune disorders, particularly Rheumatoid Arthritis. Almost all of the compounds discussed previously, appear to work by attacking the symptoms of the problem such as the progression of joint erosion and or pain, swell etc. The DMARDS (Disease Modifying Anti-Rheumatic Drugs), also some known as BRM’s ( Biologic Response Modifiers) approach the problem by attempting to STOP or at least slow down the progression of the problem .The DMARDS and other biologics have been so successful that their use has spread, to the benefit of the patient.
The results being achieved differ by compound. However, the bottom line is that they appear to be working. Unfortunately like almost all newer meds that come to market there are downsides and drawbacks. Some require injection administration. Some have to be taken daily. Some are used monthly, and some have severe side effects such as nausea, vomiting pain etc. For these reasons, there is no “ONE SIZE FITS ALL”.Following is a list of some of these pharmaceuticals.. Please note that some are older, and have more detailed classifications, and those ending in “mab” appear to have similar mechanisms of actions. It is beyond the scope of this piece to be more specific and the reader is referred as always to his/her own medical provider.
Chemical name Retail name
hydroxychloroquine Plaquennil
leftunomide Arava
methotrexate Trexall
sulfasalazine Azulidine
minocycline Minocine
abatocept Orencia
rituximab Rituxan
tocioizumab Actemra
anakinra Kineret
adalimmab Humira
etanercept Embrel
infliximab Remicade
certolizumab pegol Cimzia
gulimumab Simponi
This concludes the coverage on the Auto Immune maladies. Next week starts a sharing of notes from the Journal of the American Medical Society. (JAMA.)
Consider this……….
Even if you think your kid is a genius, YOU might still be an idiot !
SMILE
NSAIDS Said What ?
The NSAIDS
The medical field loves acronyms as you may have already noticed. Drugs, medicines, pharmaceuticals are notorious in this respect. This next group of drugs follows the pattern and the letters NSAIDS stand for NON STEROIDAL ANTI-INFLAMMATORY DRUGS. They are almost miraculous in decreasing inflammation and with that goes pain and swelling in most instances. They are so good at what they do, that they are often thought to be harmless by the public. They are not.
The main problem is that some people cannot tolerate these chemicals in any amount and others run into problems with long term or high dose use. I have seen these problems most often in patients hospitalized with acute kidney failure. These drugs have also been known to cause liver failure. They do best in calming symptoms but are not known to alter the course of the RA. Examples of NSAIDS are: Ibuprofen (Advil, Motrin), Naproxen(Aleve, Anaprox, Naprosyn), Celecoxib (Celebrex), Indomethacin( (Indocin), Diclofenac (Voltaren-xr), and Piroxicom ( Feldene). Are you taking one of these?……tell me about it.
Next up. Dmards and biologics…….stay tuned. Talk to me .Dr. M Listens .