Saturday, June 8, 2013

In Which My Computer Is Still Fried And I Whine A Lot

I'm currently typing this in the library, with Connor sprawled out fast asleep across my lap.  My left leg is rapidly going to sleep, but at least he isn't making that glorious noise where he manages to hit three clashing notes simultaneously, which is what he was doing before this.  The other library patrons were not amused.  He's currently recovering from a double outer-ear infection and is still feeling a bit punky; I had to perform mouth-to-mouth on him last week during a seizure for the first time in over a year.  Eden is on the computer next to me, muttering under her breath in Thai as she checks up on how her friends are doing.  Basically it's All Together Time, All The Time right now when the kids are home from school. 

Yes, as Jer told you all a few days ago before the impromptu lesson on neurotoxins (most of our phone conversations sound exactly like that now), my laptop fried.  It would make the appropriate I'm Busily Booting Up And Being Productive sounds, but the monitor remained stubbornly black no matter how many random buttons I pushed.  After trying unsuccessfully to hook it up to a desktop monitor, I took it in to a repair place in the vain hope that I was just being an idiot and had hit the wrong hotkey or something.  Unfortunately the very nice guy there told me that the motherboard is fried, which in a laptop is pretty much All She Wrote.  It was a good little computer and served me faithfully through four years and a very tumulteous time in my life, so I'm sad to see it go.

Being sans computer is a very odd feeling for me.  My parents have very generously offered me their little-used laptop as a replacement when they arrive here, so I'll only be about a week without one.  But I have essentially no access to e-mail, Facebook or anything that requires a sensitive password at home at the moment.  I had no idea just how dependent on Internet communication I'd become until all of the sudden that easy access was missing.  I'm not really appreciating the sabbatical-- I manage a lot of the little guy's care on my computer and I'm sincerely hoping I'm able to pull all of that off the hard drive once I've got the new machine.  Lesson learned: back up your data, kids.

This week has been pretty intense, and it looks like next week will be more of the same.  I've put a lot of miles on the van in the past few weeks between the two kids.  I'm feeling a bit burned out-- especially since we're coming off of two weeks with no night nursing and we haven't had a respite care worker for over a month now.  I can't remember the last time I've had face-to-face social time wth someone sans children, and I've started having long, drawn out fantasies about things like sleeping in past six in the morning and going out for dinner by myself.  I think a big part of my feeling so frazzled is that I usually can vent online, and I don't have that option right now. 

My parents are recently retired and are moving up here just in time for summer, which I'm extremely excited about, and they want to have a chance to spoil the grandchildren by spending some quality time with them.  So I know things will be looking up soon.  I'm especially thankful because it doesn't look like the army will be reinstating our respite care before school is out, which means that without my parents here my 'little' alone time would suddenly become 'no' alone time. 

I think that's one of the hardest things I've had to adjust to with Jer being away, and even after eleven months I stll struggle with it.  I've always needed time to myself that isn't filled with the many activities of the day, and right now I just don't have that luxury.  I've already informed Jer that when he finishes up this first part of his school in January and returns, I will be Going Away somewhere for a weekend By Myself.  I'll find a little bed-and-breakfast, and I wlll take a three hour bubble bath and read six books and drink tea and eat chocolate and sleep for eighteen hours and it will be glorious.  Of course we will go on a vacation together too-- quality time with Jer is one of the other things I desperately miss right now-- but I will stlll take my Alone Vacation and it will be fantastic.

And it looks like my library computer time has almost timed out, so I need to wrap this up.  Rereading this I sound a bit whiny and down; but really I'm doing fine.  I just stored up all my complaining for one post, apparently-- thanks for letting me vent.  This parenting thing gets hard sometimes, and also Eden keeps getting into my chocolate supply.  Now I know why my mom always hid hers!


Tuesday, June 4, 2013

In which something something broken computer

Jessie has deadlined (Army for broken in a manner which makes it non mission capable) her computer.

Now that explanations are complete, this post is about my favorite gram positive anaerobic bacteria.

Clostridium spp.

Clostridium is a genus of about 100 specific species.
General characteristics of the genus include:

- Gram positive: meaning the cell wall surrounds a single phospholipid bilayer. This is important for culture staining and antibody/antigen interactions.

- Anaerobic: meaning the cells are unable to neutralize reactive oxygen species like O2-, H2O2, or -OH. This means that the cells thrive in low oxygen environments. Think environments created in home canning or found in honey or your intestine.

- Spore forming: meaning that the cells will form a dormant, durable spore when environmental conditions are  poor for survival. Spores can survive a long time. Supposedly the oldest known viable recovered spore was 25 million years old in a bee trapped in amber(wikipedia). I'm not sure I believe that yet, but they can last a long time.

- The various species of the genus compete poorly with many of the other bacteria you have probably heard of. Many of these other bacteria are actually normal flora (sort of good for you bacteria) of humans. E. coli and various Staphys and Streps tend to hang out with us.
This is good because...

- Neurotoxins

The neurotoxins are why this bacteria is so awesome.

Clostridium (C) botulinum produces the single most deadly toxin that is known to humanity. The toxin acts by preventing neurons from transmitting an action potential (go command) to muscles. This results in a flaccid paralysis and eventual asphyxiation. 1 microgram/kg is potentially fatal.
Most people recognize the toxin's medicinized name; Botox.

C. tetani produces a slightly less deadly toxin. This toxin acts by preventing the inhibition of muscle activity. This results in tetany (constant muscle contraction) and eventual asphyxiation.

C. difficile can colonize your digestive tract if you have been on antibiotics for a long period of time. Basically, an antibiotic might create a situation where difficile can out-compete your normal digestive flora. When this happens, difficile produces a toxin (not a neurotoxin I think) that causes pseudomembraneous colitis. An easier way to say that is your bowel gets inflamed and you have very foul smelling diarrhea. A severe infection could cause the patient to begin to pass bloody, foul smelling, diarrhea.

Now before anyone reads the above paragraph and starts jumping to assumptions like a kangaroo on atropine + epinephrine understand that if you need an antibiotic you should take an antibiotic.
Many antibiotics tend to work well on specific types of bacteria but not others.

Any time you've gotten sick and the doctor took a specimen for culture but didn't give you an antibiotic immediately was because they were running the cultures through SURVIVOR: Laboratory Version where the losers die out from antibiotics and the winners are incinerated. As such, if you take an antibiotic for your ear infection and difficile takes over, you shouldn't think of it in terms of the difficile is now a super bug and you're doomed. I mean, you might be, but you probably just need a different antibiotic with a different target profile. Think of it this way, you don't use a APFSDS round on a dismount squad, you use a canister round (use google).

Finally, C. perfringens produces a toxin which can cause food poisoning and gas gangrene. If you don't like looking at open wounds and dead tissue you should probably just imagine gas gangrene and avoid google images.

There are many more species but these are ones important from a primary care perspective.

The good news is that most people don't encounter these bacteria because they can't really compete against more common aerobic bacteria (aerobic doesn't refer to a need for O2 in this usage). That being said, don't feed infants honey or home canned food before the age of one. Commercially canned baby food is prepared in a way to destroy any present spores.

Also; dangit Jes I'm a physician assistant student not an english major.

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