All Purpose Weekend Open Thread

Cowabunga~

Submitted by GG_NB on Sat, 06/09/2012 - 4:11pm.

So it's cow eating cabbage...really bad gas...hence, really bad news. Is that right?

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Maybe ...

Submitted by Newsbubba on Sat, 06/09/2012 - 4:05pm.

... he's a liberal Democrat thinking about running for office?

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The humidity here is not for the faint of heart, Rick

Submitted by Blonde on Sun, 06/10/2012 - 12:33pm.

Yesterday, I threw a small chunk of ice in the carport at noon. It melted in 5 minutes, but the puddle was still there at 7:30. Hadn't evaporated one iota.

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Scubie~

Submitted by GG_NB on Sun, 06/10/2012 - 12:51pm.

I know, it's frustrating. Same as the "new green jobs" bull, but at least that came out under Issa's brilliant questioning. As for that new jobs number, I agree with Blondie...or perhaps Dems asked their kids to do one extra chore and totaled those up as new jobs.

^_^

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I've often wondered that

Submitted by ricklail on Sun, 06/10/2012 - 1:04pm.

I've often wondered that myself. I just remember that figures don't lie but liars figure. I keep hearing our governor talk about all the jobs created under her lack of leadership. She never mentions the ones lost. It is hard to figure what the net jobs gain is in this state.

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$400.00 fine for not flushing a public toilet.

Submitted by upcountrywater on Sun, 06/10/2012 - 2:46pm.

Yea, Low Attorney count... New Zealand was the same way...over there when you sign a piece of paper that sez they aren't responsible, (like bungee jumping, or Luge on concrete) they mean it.

To bad taxes are much higher in NZ than Singapore.

Can you Imagine an unemployment of 2% around here... the folks that would be "working" for ya...
The chronic unemployment level around here is about 5%... hiring folks below that range is, pure disaster. 30 bucks an hour for someone to dig that never used a shovel.

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Cobra

Submitted by stratman on Sun, 06/10/2012 - 7:12pm.

This will be a lengthy post concerning some of the words used in Medicine to describe observations and investigations and some of the effects of smoking.  I'll just touch on a couple of things and leave the rest for a conversation with your physician. Also, I will speak in generalities since I have not examined you or seen your medical records.  You need to talk with your physician for specifics relating to you.

The medical record is used to record observations and findings. Tobacco use is a finding that has medical importance since it is a major reason for health issues. The words used take on an importance for the intended reader, such as insurance companies requiring specific wording for specific amount of reimbursement as well as to decrease the risk of misunderstanding. Standardization is the desired outcome so that wherever a patient or physician goes, the words used will mean the same things to the intended audience. The ICD codes are a standardization. As such, physicians, or whomever does the coding, must eventually conform their diagnoses to the standardized ICD codes if they want to be reimbursed properly for the work performed.

What word is used in describing tobacco use can be a little frustrating as you can see from the link I gave in my earlier post. The ICD codes are a way to be very specific about a finding or diagnosis, and getting more specific all the time, although some would say convoluted (or worse). Some physicians might say "tobacco use" while others say "tobacco abuse". You could even say "dependence" or "addiction", depending on how you define those terms. The ICD codes are a way to standardize diagnosis or findings, including chronicity and type of use as in your situation.

Why "Nicotine" is specifically used instead of cigarette, cigar, pipe or smokeless tobacco could be as a shorthand convention,ignoring there are 4000 chemical entities found in tobacco, of which over a hundred are known to be harmful to humans. "Chronic" implies long term. Without any other modifier such as "Ex" or "Former" or "Quit", the chronic also implies still current "nicotine" user.

The use of "Disorder" certainly can be argued for or against. Medical jargon is prone to the politically correct. "Disorder" sounds better that "abuse" or "addiction", at least to some, just the same as using "dependence" instead of "addiction". In the end, physicians are forced to certain naming conventions, especially with the electronic medical record, and those conventions may be changed to increase precision or to please the Liberal politically correct mindset. One example of a more recent change is from Sexually Transmitted Disease to Sexually Transmitted Infection. More precise but possibly more politically correct.

Maybe this is where you are having issue - something called a disorder - which has an unintended consequence in the imagery it creates in the patient's mind. I understand your point. Disorder does sound unusual for the purpose since it can represent something for which the person has no control over, such as Attention Deficit Disorder. It could be that since tobacco use can lead to addiction, the people responsible for the ICD code wanted a more universal and gentler sounding word than addiction or abuse (which has also been used to describe alcohol use in medical records). Maybe the naming convention will change again for tobacco users.

As to the effects of tobacco use and your previously mentioned medical issues, while High Blood Pressure may not be chronically induced by tobacco use - a point some argue for various reasons - your Crohn's may flare more and require more or stronger medications due to tobacco use.

Some background before discussing other potentially related effects.

Oxygen is carried from the lungs to the body's tissues and organs by a protein called hemoglobin found inside red blood cells. Physicians check the amount of hemoglobin in your blood to look for signs of anemia and other blood related issues. Chemicals/molecules from tobacco smoke interfere with hemoglobin taking up oxygen from the lungs. For instance, carbon monoxide in tobacco smoke binds to hemoglobin preferentially over oxygen, ie carbon monoxide gets VIP status over oxygen even though oxygen is needed by the body. Since there is less oxygen riding the red blood cell in your circulation, there is less oxygen available to be given to tissues and organs. This hypoxemic effect can be as simple and short lived as dizziness like that seen from smoking too much or in a naive smoker (first timer) or slow wound healing (wound repair needs oxygen!), or, long term as with premature wrinkles around the mouths of smokers or general or specific dysfunction of various organs in the body.  It could also contribute to a smoker experiencing potentially life-threatening Altitude Sickness quicker and at lower altitudes.

Concerning your issues, since there is less oxygen available per red blood cell in smokers for a period of time during and after smoking, there is the potential for causing the heart to have to beat faster to circulate more blood cells in order to make up the difference. (The cardiovascular system may also respond by narrowing blood vessels to move blood faster even if heart rate does not increase. This is a mechanism that does acutely increase blood pressure in smokers, though the effect should only last minutes).  Anyone with cardiac issues is at risk for potentially harmful and life threatening problems resulting from a heart that is stressed by the effects of smoking - including the issue that smoking increases your cholesterol which can result in narrowing of blood vessels - including coronary arteries feeding the heart muscle.  Narrowing of arteries by cholesterol deposits increases the risk of heart attack, stroke, or an embolism to other parts of the body including lungs, legs and organs.  (Embolisms are a chunk of cholesterol plaque build-up in an artery that breaks free, travels downstream in the circulation, and then plugs up a vessel that has a diameter small than the chunk of broken off cholesterol plaque, like a stopper in a sink drain.)

Since I don't know your medical condition beyond what you've written, the potential for exacerbating your current medical issues is real and worth discussing with your physician to understand better than my general points which may or may not apply to you entirely.

Last, but not least, asking about tobacco use each time you see you doctor "kills two birds with one stone", so to speak.  First, because tobacco use cause significant morbidity and mortality (disease and death), it is proper practice to inquire in order to identify and then try to decrease the patient's risk of problems now and in the future.  Studies have shown that a physician just mentioning quitting smoking leads to more attempts at smoking cessation than otherwise.  Second, and probably so prominent because of the first, asking about tobacco use satisfies a data point requirement in order to bill at a certain E&M billing code level (different than ICD codes which are diagnostic and form part of the justification for the E&M code billed).  So, asking about tobacco use is a win-win for everyone - patients, the medical facility providing care, and the insurer who wants to identify preventable problems early to try to control costs.

I know this is a lot to read. There is more that could be discussed, especially how things may apply to you specifically.  The important overall point is for you to understand your own health issues as best as possible, including discussing tobacco use effects on you and planting the seed of smoking cessation.  Talk with your physician.

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