Sunday, May 28, 2023

The Cockroach Catcher II: Attempted Living---Finland

Finland

 Men occasionally stumble over the truth,

 but most of them pick themselves up

 & 

hurry off as if nothing ever happened.

Sir Winston Churchill.

Finland – Settled and Unsettled Medical “Truths”

Blood pressure is another medical question far from having been settled.

In 1988, a paper came out of Finland that was quietly unsettling.  Generations of doctors have been trained to work hard to get our patients to lower their blood pressure, no matter how old or frail they are.  Yet according to this paper the highest mortality was observed in those in the lowest systolic and diastolic groups, and lowest in subjects with systolic pressures at 160 mm Hg or higher and diastolic pressures at 90 mm Hg or higher.

This was further confirmed in  1997 of a 5-year survey of seniors aged 75 years and over.

Goodwin who covered the above concluded:

Medicine is practiced in a cultural context. One of the tenets of our culture is that high blood pressure is bad. In my experience, levels of systolic blood pressure greater than 200 are often viewed by medical personnel as a medical emergency.  At a minimum, however, the geriatrician can share the news that such levels of blood pressure are a good prognostic sign.

The biggest problem according to Goodwin: the geriatrician who does not treat such patients risks many calls from--wait for it: the grandchildren who are physicians. 

In 2019 The Berlin Initiative Study found that people aged 80 and over who had a lower blood pressure — of 140/90 mm Hg or under — actually had a 40 percent higher mortality risk than peers with blood pressure exceeding those thresholds.

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The Cockroach Catcher II: Attempted Living.

Just published on Amazon

The Cockroach Catcher II: Attempted Living.  


Review on Amazon:

Maureen
5.0 out of 5 stars Not the ordinary memoir

Reviewed in the United Kingdom 🇬🇧 on January 17, 2023

Verified Purchase  Am Ang Zhang has brilliantly woven together nostalgia, discoveries, astute observations and intelligent opinions. The fascinating title of the book is a deliberate understatement of his abundant life, where being a senior consultant psychiatrist is only a part of it . He is obviously a man of gifted intellect and refined tastes who, rather than hampered by material scarcity as a young child refugee, was fascinated by beauty in nature, and quickly acquired an appreciation of the finer things in life, enriched by travels and sustained by a keen engaging mind.
Reading his memoir is eye opening, and at times therapeutic. It was like meeting up with a learned old friend, as you sit with him and listen while his memories and ideas overflow. You travel with him as his stories move from continent to continent, from detailed episodes to gentle remarks, from freshly harvested catches to gourmet preparations, from ancient finds to modern scientific research ......
A most delightful read.


USA: Check it out on Amazon














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Friday, May 26, 2023

The Cockroach Catcher II: Attempted Living---Inverted Therapy







Farewell              Wang Wei (701-761)

Dismounting, let me share your farewell wine  
Where, friend are you heading now?
Choking, fate has not been kind to me
Will retire to the southern slopes to seek rest

Enquire no more when I am gone
Till the end of clouds, endless white clouds!

One of the poems sung in Das Lied von der Erde


Most of us assumed that therapy is about helping a patient in many different ways, but with the patient described in this Chapter he in fact introduced me to Mahler, his music and his struggles: a sort of inverted therapy. 

........Joshua and I were able to talk about Mahler's struggles, the sadness brought by the death of his daughter and the Rheumatic Heart Disease that eventually led to his death

One day he was able to declare that his struggles were nothing compared to Mahler's.

It is interesting that he never really talked about his own sadness as Mahler's overshadowed his and yet in true traditional psychotherapy style he gained his own insight..........


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Hands only CPR.

Following an article in the FT

Life without kissing
By Margaret McCartney
Published: September 17 2010 22:37

Hands-only CPR, at a rate of 100 per minute until the emergency crew armed with automated cardiac defibrillators arrive, was superior to the traditional method of CPR.


A Brief History of Time: CPR (Cardiopulmonary Resuscitation)

In April, my good friend the cardiologist in California received an email from one of his friends on the subject of “New AHA rules for CPR finally released to the general public”.
It read:

“Thanks to you, I'd had a two year head start on this subject that's only this week published in the popular press. When you first advised me on it, I'd forwarded that info to all my friends. Believe it or not, a GI friend of mine actually saved a life at a wedding last year. Some elderly gent at his table suddenly collapsed to the floor without a pulse. He remembered the article I'd forwarded him and began vigorous CPR without giving mouth to mouth. That gent survived to thank him. Indirectly, of course, he's thanking you.”

My good friend has been interested in the subject of CPR for many years and provided me with some interesting material on the history of CPR, which I share with you below.

History in the Western World



1891: The first external cardiac massage in the Western world was reported to be done successfully by Friedrich Maass.
1960: Kowenhoven and Knickerbocker reported their method in JAMA that chest compression was accepted as a method of resuscitation for cardiac arrest.
1966: The first guideline for CPR was published.
1970: Teaching the lay public to do CPR was started.
1974: American Heart Association (AHA) formally promoted the practice involving the combination of rescue breathing and external cardiac massage for cardiac arrest in a ratio of 2:15.
2005: Ewy in Arizona showed that hands-only CPR, at a rate of 100 per minute until the emergency crew armed with automated cardiac defibrillators arrive, was superior to the traditional method of CPR.
My friend immediately drew the attention of his colleagues in Hong Kong to Ewy's work and suggested that the lay public should be taught this simplified method of CPR to encourage bystanders to give aid to victims of cardiac arrest. Many bystanders would otherwise be reluctant to help for fear of contracting AIDS through traditional mouth-to-mouth resuscitation to these strangers.
The AHA was hesitant to accept Ewy's idea in their new guidelines for CPR in 2005, but as a compromise, recommended a ratio of 2 breaths to 30 chest compressions instead.
2007: In March The Lancet reported a Japanese study on a series of over 4000 cases in Tokyo, comparing traditional CPR to hands-only CPR by bystanders. The results showed that the latter was more successful in the resuscitation of cardiac arrest with preservation of neurological function.
2008: In April, the AHA finally gave its approval on hands-only CPR from bystanders. The link has a video demo.

To date I could not find any hands-only CPR in NICE and the St John’s Ambulance site is still in the 2/30 era.
Luckily for the wedding guest, his friend did not wait for the AHA recommendation nor any British ones.

History in Traditional Chinese Medicine
403-221 BC: (Warring Kingdoms period) External cardiac massage was practised as a method of resuscitation for victims of suicide by hanging. Some credited this to Bian Que.
6 BC - 221 AD: (Eastern Han Dynasty) The first description of CPR for resuscitation of victims of hanging came from Zhang Zhongjing.
In his Essence of the Golden Chest, miscellaneous therapy #23, he described the method as follows: "Lower the victim gently, don't just cut the rope, and lie him on the blankets. One person should put his feet against the shoulders of the victim and pull on his hair, rendering it taut (to open the airway). One person should put his hands on the victim's chest and compress rhythmically (external cardiac massage). One person should flex and extend the victim's limbs (to promote venous return). One person should press on the victim's abdomen (to enhance intrathoracic pressure during external cardiac massage). ....This method is the best and usually successful."
Zhang Zhongjing's writings were handed down and read by Chinese physicians through the centuries.
1186-1249 AD: (Sung Dynasty) The above passage in Essence of the Golden Chest was cited by Sung Ci in his book on forensic medicine “Washing Away of Wrongs (Xi Yuan Ji Lu)”, which is recognized as the first book of forensic medicine in the world and has been translated into many languages both in Asia and Europe.
There is much we can learn from the past. One may even save a life.
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Cockroach Catcher-Seven Minute Cure













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Sunday, May 7, 2023

The Cockroach Catcher II: Attempted Living---Special extract on Mother's Day.

 

From: The Brain and Random Thoughts

For some time, anthropologists found that babies in the so called more primitive places hardly cried. They were considered by advanced first world paediatricians to be malnourished, yes, malnourished. What these paediatricians failed to notice, but the anthropologists did, was that these babies were carried by mother all day while mother went about her daily chores of washing clothes, sweeping floors, feeding and caring for animals, tending to vegetables grown in the yard, cooking, and so on. Parent time was all the time. Contact was all the time, awake or asleep. Now you know. Malnourishment indeed! I saw babies thus carried around the Hong Kong markets too.

AMAZON-UK    The Cockroach Catcher II: Attempted Living


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