Friday, December 2, 2016

Unknown Author: Who Wrote this Book Review on: Archives of the Vagina: A Journey through Time?

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by Unknown Author
Here is the book review that got me to appreciate the huge impact that one book review has on a book.
“Archives of the Vagina, a journey through time by Margaret Aranda MD.  Although Dr Margaret Aranda’s book is a serious book written about serious issues it is often funny, she “threw her panties out the window.” But why would any young lady want to do that? And sometimes it’s rather like a detective story with unusual facts, such as, “Some women have died using a tampon.” And there is good practical advice concerning putting in your first tampon and when best to do so that it goes in easier.
Dr Aranda brings up the subject of sex openly; and encourages women to do the same and to talk with their doctor or close friend about it. Body language can play a major role here; and the use of innuendo and imagination is found to be equally important as well. There are serious health warnings; that “sex before marriage or with a person you don’t know can be fatal.” Sex talk becomes more intimate, “if she has an orgasm she desires you. It is sexy to a woman that you care more about her than yourself… You care how she feels… Care enough to use a condom… Most women do not experience orgasm with a penis. It is mainly down to the male, he must make her comfortable. That she is not being abandoned. If she is relaxed, only then might she have an orgasm.”
Basically there are 3 holes to look out for in the vagina. There are diagrams to aid the reader and health research charts. And many good tips, for example, if women go to the toilet before having sex it may help to prevent Unitary Tract Infection (UTI). Every abbreviation is made clear. There are also healthy suggestions when making love. For instance, rectal sex is dangerous; women can get bacteria E coli. Keep your fingers away from her urethra (pee hole) located between the vagina and clitoris. Instead lubricate her with love… and how to find the G Spot. That there are two kinds of orgasm; in fact, a woman can have several orgasms following each other.
Other health conditions are also mentioned such as, Anorexia nervosa and bulimia. Dr Aranda gives detailed explanation of the difference between these two conditions. That both conditions can lead to death. Also included are, cancer, diabetes, and postnatal depression and many more, and offers practical advice concerning these conditions and how to avoid them where possible.
I particularly found the chapter THE MOTHER fascinating and some of it is very witty. At the end of most chapters there is a quote of wisdom, here is one of them; “No matter what you do, someone will not be happy, someone will not agree, someone will criticize you. Make sure that person is not you!”
Some historical characters are mentioned and their achievements and contributions to society, such as; William Thomas Stead who made great contributions against child abuse. And Jacqueline Cochrane (1938) who won the Bendix Air Race; at this time it was widely believed by men that menstruation would hinder women’s performances in whatever work they did. Therefore her achievements proved that women could perform and function equally as well while on their monthly cycle.
The Normal Changes of Ageing in Women this chapter I found enthused with medical terminology. There are also many radical ideas untypical of today’s society. One Spoon at a Time, “Being on a diet implies suffering, withholding quality of life and deprivation… Exercise is not a chore. It’s an accomplishment.” Basically makes you happy, and there is a reason given why this is. There is an excellent table chart to aid the reader, and GI value list. And book recommendations such as, Jen Zerling – Breaking the Chains of Obesity.
How many of us knew that, “Too much urine production can lead to dehydration.” Nonetheless, it’s good to drink plenty of fluids, helps “fight off infections”.
Most of us have learnt to trust other bodies and organisations to keep us healthy and strong whether TV adds, health professionals and so on. But Dr Aranda (P.184) says it’s a mistake. “You cannot count on the government or insurance company to keep you healthy. You can only count on yourself.” (P.186) “Immunonutrition is cutting – edge for you right now, and I want you to know. Morcellation of the uterus and Essure ® nickel coils are 2014 issues that need to simply end and not get passed on to the next generation.” Another chapter that ends with a quaint short quote, “I alone am responsible for the quality of my life.” – Susan Barbara Apollon
MENOPAUSE AND QOL (p. 187) begins with brief introduction to the French physiologist and neurologist Charles-Édouard Brown-Séquard who “used animal ovary extracts for treating menopausal women”. So what better way to begin than with simple definition of menopause?
1) The ovaries no longer function
2) The monthly menstrual periods have stopped

Also discussed at some length throughout is “hormone-replacement therapy” (HRT) “To alleviate symptoms, most especially hot flashes and vaginal dryness,” which “the FDA approves” (HRT) “because the QoL issues are so important.”
Other definitions are also given for the following;
1) Premature Menopause
2) Perimenopause
3) Surgical Menopause
4) Postmenopause
5) Male Menopause

And (p.194) “Menopause occurs when the ovaries cease to function and there has been no menstruation for one calendar year. Now she is postmenopausal.”
There is also a relatively simple “quality of life” (QoL) self-tests provided, well worth setting aside some quite time to take this self test.
PAIN ON INTERCOURSE
I especially like the quote at the end of this chapter; “You were never created to feel depressed, defeated, guilty, condemned, ashamed, or unworthy. You were created to be victorious. “- unknown
although this is aimed at women, it is useful for men to know as well so they may point women in right direction. As there are given a whole heap of reasons a woman may get pain with intercourse. Apart from the obvious that she and her partner may no longer love one another.
SURICAL MENOPAUSE AND TESTOSTERONE THERAPY
This chapter provides detailed explanation of the following; hysterectomy, and several ways it can be performed. And also types of hysterectomy there are. And short paragraph on how it has developed through the ages. (P. 238) provides some astounding statistics, for example, “In 1988, the American Medical Association analyzed 700,000 hysterectomies per year, finding that 50% were “unnecessary.” If the ovaries are normal yet removed during a hysterectomy, menopause will instantly occur after surgery. This is known as surgical menopause. And (p.240) there is a Table 1. Risk and Benefits of Several Hysterectomy Procedures and (p.242) there is discussion concerning the risks involved with having hysterectomy. And (p.243) explains why you need your ovaries and the importance of keeping them. This is further endorsed on (p.244) “If your ovaries are normal, their estrogen, progesterone and testosterone production may serve to protect you from heart disease, bad moods, insomnia, vaginal dryness, fatigue, losses in bone density, and hot flashes, to name a few.”
Concerned whether you should keep your ovaries or have them removed (p.245) Dr Arana says, “Keep your ovaries unless you are at increased risk of ovarian or breast cancer.” And she provides a number of reasons of “How do you know that you are at increased risk?”
There is also a further chapter (p.246) on THE DIFFERENT TYPES OF HYSTERECTOMIES with some very interesting statistics, such as, Table 1. A Hysterectomy is a Major Surgical Procedure. In a 2004 study by the Hysterectomy Education and Resource Services wherein a second opinion and counselling were sought before hysterectomy, 98% of the hysterectomies were determined to be unnecessary.” Included is an in-depth discussion on anesthesia. Women are advised before singing the Consent Form, to make sure they understand what they are agreeing to have done. Because “once your uterus and ovaries are gone, you can never get them back.” Dr Aranda, says, “I have spoken with many women who had no idea that their ovaries would be removed, and that they would suffer afterwards.”
OVARIAN CONSERVATION, ETHICS, AND INFORMED CONSENT (P.252) Dr Aranda makes a very bold statement that according with medical practice is precise, “Ovarian conservation” refers to the practice of keeping the ovaries at the time of surgical menopause, or hysterectomy, for a benign cause. Specifically, in this case, to “conserve” the ovaries, one does not take the ovaries out at the same time as a hysterectomy for a non cancerous uterus or ovary. Please bear in mind that removing the normal ovaries equates to castration of the female. While this may seem to be a severe word, it is nonetheless a word that would be equally applied if we were talking about surgically removing the testes out of a man.”
MEN, MENSTRATION, AND MENOPAUSE (P.260) Begins with very endearing paragraph. A romantic notion passed on from father to his young daughter about menstruation. When Dr Aranda, was a child she had asked her father in all innocence what “rape” meant. A word she had read in a book. His answer though silent was sufficient to let her know what it might mean. It’s rather a long quote so suffice to say one must read it in context to appreciate it as it was between father and daughter, a very bright young daughter that was quick to learn what he meant.
However, (see p.262) it wouldn’t be unusual if men notice this more than women, that while most men do not like talking about women’s periods at all as Dr Aranda points out, “Other men have observed that they can pick up on the pheromones their woman excrete when she is on her period, stimulating the man to have increased sexual desires or libido.” The rest of this paragraph is extremely interesting and the findings of which most fascinating. However, it’s a rather long paragraph to quote and again one would need to read it in its entirety to appreciate its meaning.
Nonetheless, over the page is a funny quote “For a man’s insight on menstruation blood,” in this particular instance a young man talking with his “teenage sister”, who had “explained” to him “that she had become a woman.” and though I will not include the entire paragraph as this review or critic is already rather long, he concludes his understanding by saying, “So, largely, I did what my older sister told me, because it was obvious that she was a werewolf.”
There is a list to follow concerning men and menstruation and their notions about it. Basically some men act in a positive and sensitive way about it that women appreciate while other men are a complete and utter “jerk”.
Naturally I’m having to skip a lot as this is a 501 page book, but the aim and hope of my writing this review is at least to present and gave some idea of what it contains and how it is written.
FROM THE INSIDE OUT (p.267) immediately I wondered what on earth does this mean, nevertheless, Margaret Aranda, MD begins this chapter by asking and answering this very question. She never writes to confuse her reader with pent up jargon or intellectualism, though this is an intellectual book, she makes things perfectly clear: she says, “What does that mean, “From the Inside out”? It means that the inner beauty of a woman is not commensurate with her nose, her lips, her breasts, or her waist line. Inner beauty only comes from within.”
DIVORCE (p.270) Dr Aranda, is speaking from personal experience. She arrives home to a quiet empty house, “too quiet” her husband is gone and he has taken many items with him but above all, he has taken their little boy as well. She is faced with the dilemma of what to do and who to turn to for emotional support and advice. Some of her friends and family criticize her harshly for pursuing medical career when she has a young boy to take care of, but the rest of her friends and family gave her encouragement to continue with medical school. She uses a drove of superfluous words to describe her situation and how she felt. But nothing was going to deter her. She was going to come out on top. 15 years pass-by when she makes up her mind to get married again. But everything would be different this time and she would have a romantic wedding. In due course another child comes along, this time a baby girl. But 7 more years pass and then to her horror she discovers her husband is not the family guy she thought she had married. And once again, she is faced with prospects of another divorce and what to do for the best.
The following chapter Immunonutrition and Fish Oil although is relatively short it is full of content. Traditionally we are taught “we are what we eat”, but Dr Aranda, takes it a step further by introducing a new concept; she explains how some foods can purify the body because certain foods we eat can “tear down the bad”. Food that can be digested before and after surgery are also discussed, “should you take fish oil before surgery?” I would say, “Yes, after you ask your doctor.” And a diagram of Plasma Membrane Structure can be found on (p.277) showing benefit of, “Omega 3 fatty acids”. Several types of fatty acids are mentioned in this chapter and list of benefits they have on one’s health.
Raising Women (p.282) is partly about child development. Dr Aranda says, Firstly we learned that we were different from boys. We were “missing” something, you know. It was funny for many of us to the point of giggles…Later, we learned that we get our periods and we have to wear a bra. And she includes many other things women do and desire all part of growing up. The material and the physical; from having babies, sharing with other mothers rearing children or not having babies, to postmenopausal years. This chapter also includes a discussion on Immunization, for girls and boys ages from about 9-26, that the Federal Advisory Committee and the American Cancer Society endorsed, for example; the Human Papilloma Virus (HPV) vaccine preventing cervical cancer.
However she goes onto say, one of every 914 girls vaccinated by Merck during their own trials with Gardasil ® have died. Leaving a big question mark…She therefore advises, to do your own research before subjecting your daughter to something you don’t know about. That is the message from the mothers whose daughters have died. (See p.283) There is a list of interesting statistics on (p. 284) and rest of the chapter gives good sound advice, such as; why can’t we teach our daughters to get their annual Pap smears (which they will need, even if they get the vaccines that can cause death)? Our daughters need annual Pap smears. That is the answer. Period.
INVISIBLE ILLNESSES (p.288 – 296) is precisely what this chapter title suggests. That begins with a suitable definition, an “invisible disease” is not visually apparent. There are no glasses worn, no wheelchair, and no contraptions. The person looks “fine” to everyone and may act fine or be ok when lying down in bed, for example. But before Dr Aranda, goes on to talk about her own situation and experiences (as she suffers from an invisible illness called Dysautonomia), she mentions how it came about as a direct result of a serious motor vehicle accident. That she and her daughter was involved in 2006. Their Ford Expedition was hit by a lady driver that drove her BMW without due care and attention. The lady was probably coming from Chinese takeaway as she was reaching over to pick up Chinese food from the floor had stepped on the gas instead of the brakes; the speed upon impact was about 90mph that span Dr Aran’s vehicle around to face oncoming traffic. And of the many on-lookers, only one stepped into offer her assistance. Although Dr Aranda suffered no obvious physical injuries it was not long afterwards she experience many symptoms that she was unable to diagnose. Even the doctors she saw shortly afterwards looked blank faced in disbelief. She compares them with the drivers of the oncoming vehicles and onlookers that just walked on by. However, her own cardiologist, Dr. David Cannom, did believe in her, tested for imbalance, found abnormalities and admitted her directly to hospital.
One particular doctor while putting her through subsequent of tests had let her fall to the floor. He didn’t believe in her. He thought she was only pretending.
Dr Aranda tells her story because she knows it has happened to countless others that have had genuine severe health condition but are treated as though it is all in their head. Invisible Illnesses can nonetheless be deceiving not only to the doctor but also the patient suffering from a severe health condition; as the patient might feel perfectly fine one moment but the next in total agony. Therefore there is need for proper examination and diagnoses and only then can one receive correct treatment and hopefully be on the right road to recovery or at least learn the best way to cope with that condition whatever it may be.
THE COST OF ILLNESS FOR WOMEN provides good practical advice for both men and women. But mainly women; (p.298) for example, “women are advised to eat an anti-inflammatory diet, use HIIT, consume fish oil, and keep your ovaries if you need a hysterectomy and don’t get cancer. That case managers have limited impact on such things that we care about… Even if we are disabled we can exercise in bed or in a wheelchair. Remember also to write down any contact information.
Bear in mind, Doctors don’t prescribe preventative medicine that would ward of heart disease. Three preventable causes of death, obesity, alcohol and cigarettes. If you smoke then your heart disease will cause blockages faster. Heart disease is major cause of death – manage stress, and go to the doctor and take your medications.”
(p.302) Dr Aranda says; “spend your future health-care dollars on vacation and time with your family, instead of purchasing needles and meters for diabetes… The main killers of American women include; heart disease, diabetes, and high blood pressure… Smoking increases the risk of these cancers; breast, nasal, lip, mouth, throat, lung, esophagus, pancreas, cervix (hence the need for the annual Pap Smear), ovary, kidney, bladder, colon, rectum, stomach, and also increase risk of leukemia.”
Included are some astounding health facts; for example; “the death rate for Alzheimer’s disease is on the rise. That is yet another reason why women need to conserve their ovaries if hysterectomy is completed before menopause. Ovarian removal before menopause leads to an increase risk of osteoporosis, hip fracture, depression, dementia, Parkinson’s, cognitive impairment, anxiety, increased risk of coronary artery disease, lung cancer, and all except for ovarian cancer.” And most importantly, she says, “The preservation of cognitive function is most especially important to a woman’s quality of life and to living independently as we age.”
ACTIVITIES OF DAILY LIFE In this chapter Dr Aranda discusses various methods of assessments used by occupational therapists, nurses, doctors, and health professionals “to quantify whether a patient is able to live independently”. It is important to find out what a patient can or cannot do (to prevent causing the patient more harm than good) before deciding on what activities are possible. This is because, “The activities of daily living (ADLs) are necessary for human survival”…(p.309) “For patients having Dysautonomia, EDS, mastocytosis, POTS, or other diagnoses that render one to be bed ridden, there is a need to improve quality of life. For example, if the patient is unable to walk or incapable of doing laundry, it is reasonable that improved mobility and transportation via wheelchair can be implemented for the patient to provide herself with clean clothes”. This chapter is also important because if a person is not correctly assessed great harm can be done. Therefore this book is about many things concerning life of women in general and it includes men.

When I first read the title Archives of the Vagina, a journey through time, I was baffled as to what this could mean. Was it just a human biology text book, I surmised? Well it is a medical book after all, but it’s far more than just a medical book, it’s a book of life. That we can all relate to and understand, some of which we may already have known but most of it may never have known. It brings controversial issues to our attention, call it radical, urgently challenging, daring if you like but whatever we may like to call it, it is an important book for human kind. It’s also about being successful, when the odds are stacked high against us.”
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archives-coveraa
Thank you for helping to find this book reviewer. 

Wednesday, November 9, 2016

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Tuesday, October 25, 2016

Wednesday, October 12, 2016

Friday, October 7, 2016

Intracranial Hypertension and Chiari Malformation

 / By Dr. Margaret Aranda / 


This is a medical discussion with graphic pictures. It is not suitable for minors. Parents, please use discretion.

Have you ever wondered why a baby's head is so, so soft? It really is. This is because all the bones on the brain are separated at birth. Only later do they close (See Image 1).

Invisible illnesses: Intracranial Hypertension and Chiari Malformation


Image 1 Cranial Suture Lines.  They close Gradually with time, leaving us with a completely closed skull. At birth, this is quite the protective mechanism to house a growing brain with as much protection possible to safeguard internal injury. This is why a doctor always greets a baby by placing her hand on the baby's forehead, on the upper hairline to the skull. She is actually checking for a rise in intracranial pressure, ICP.   Image Courtesy brachialartery.co .

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 It is a great thing is that if there are brain abnormalities at birth, the baby's head can swell. It may not look pretty, but it is definitely a good thing that the 'sutures' between the bones are so soft and pliable (See Image 2). When the 'water' (ie, cerebrospinal fluid) in the brain can not properly drain, it builds up and in a baby's head to cause hydrocephalus
This comments found for survival.

Invisible illnesses: Intracranial Hypertension and Chiari Malformation
Image 2. Increased Intracranial Pressure and hydrocephalus in a Baby: UNSEALED Growth Plates.  This is the normal mechanism that Ensures protection of the internal brain. Here the brain is swollen to 3x its normal size and the cerebrospinal fluid actually has "somewhere to go." Little 18-month old baby  Room to Begum  stimulated international awareness of a condition known as  hydrocephalusRoom peculiar to fans everywhere, as she defied the odds of survival. She is of the world's most famous babies with extreme  Increased Intracranial Pressure . Abdul and Fatima Begum parents were unable to pay for healthcare in India's Room. Multiple surgeries were needed to decrease the head by pulling the suture lines you back together. This image is from about one year ago. I am unable to discover recent publicity.  Image Courtesy mirror.co.uk. 

Once the bone plates are sutured together in continuous bony formation, where is the only place to go for the brain?  The brain can only be pulled down into the spinal cord.

Chiari Malformation  is an anatomical deformation of the back of the brain, a separate entity called the cerebellum (vs. the 'regular' brain, the cerebral cortex that comments found us to process information, have imagination, feelings, and be who we are, consciously ). 

When either the Primary or Secondary Chiari malformation Occurs, the base of the brain is bulging down into the spinal cord (See Image 2) through a hole in the bottom skull called the foramen magnum.

Invisible illnesses: Intracranial Hypertension and Chiari Malformation
Image 2  Chiari Malformation Type II It is definitely not normal for the brain to herniate down into the spinal cord. Parents are cautioned to listen to their children when they complain of  SYMPTOMS that could be due to Chiari Malformation.  Image Courtesy conquerchiari.com

Whenever I saw the parents getting a "Chiari Syndrome" diagnosis for their 5-year old child, I thought:
"These parents really listen to their child."
                           ~ Dr. Margaret Aranda

History:  Chiari Malformation is named after  Austrian Pathologist Hans Chiari (1851-1916) . He was the first person to Widely distribute the information on this brain abnormality and assign initial CLASSIFICATIONS C lassificatio of  Types I - III; These were published in the year 1891 (See the original paper  here ). Born in Vienna, Austria, Dr. Chiari died On May 6, 1916 in Stasbourg, France. He is still beloved today, September 4th with Chiari celebrated as the Day. 
Chiara's father was JBVL Hans Chiari, MD., A famed gynecologist who described prolactinoma. JBVL Chiari, MD was Chair of Departments of Gynecology in Prague and Vienna, and wrote a book on the history of pathology. 
It is finely pointed out that Hans Chiari gave credit (unlike so many others) to  colleagues  who Formulated the concept of 'naming' and describing this cerebellar abnormality before him.  I. Solt  tells the story in 2010 in a Journal Editorial, which is far better than anyone can do, at this point ~
The title of this piece is:

"Chiari malformation eponym- time for historical justice"


"....... In 1883, the British anatomist John Cleland (1835-1925) was the first to publish a brief description of an infant with spina bifida and hydrocephalus 1. In 1891 and 1895, Chiari published feelings extensive and thorough landmark descriptions 2 3 , which contained comprehensive neuropathological evaluations of the malformation. in 1894, Julius Arnold (1835-1915) published a case report of an infant with a sacral teratoma, but without hydrocephalus, and described "a ribbon of tissue that protruded through the foramen magnum ' 4 . Arnold did not include in feeling report a pathological evaluation or further information, and did not cite the previous works of Cleland and Chiari, while Chiari had cited Cleland 1  in feeling first publication 2 , and went on to cite Cleland both 1  and Arnold 4  of feeling second publication 3 . Both Arnold Chiari and the reports published them in German and it is highly unlikely that Arnold was unaware of Chiara's first publication .... "
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I'll just add that John Cleland also had a penchant for poetry. 
Chiara's 1891 report drew much more attention for its highly acclaimed nature, as Cleland's descriptions were deemed to be rather incomplete. Finally, let's not forget Jean Cruveilhier (1) was a pathology illustrator, who drew images of several key brain and spinal cord pathologies without putting them into a formal classification; he did this 50 years before Chiara's original paper was published. A review and history of Chiari was published in the  British Medical Journal, 2000 , partially entitled, "Cleland Cruveilhier Chiari 'Syndrome to show the many and previous contributors to describing this syndrome.
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The cerebellum is the brain's primary organ responsible for your body's balance. Vision is also processed in the cerebellum. There is no known cause of Primary Chiari. However, "Acquired" or "Secondary" Statistically Chiari is more likely to occar if:
(1) Embryonic during fetal development was abnormal replication during cell division of the spinal cord (ie, a neural tube defect); or
(2) The bony-structured opening that leads to the base of the skull is abnormally small or otherwise shaped so that the brain just Becomes 'too crowded' in its own skull. 
The foramen magnum is the only place in the brain that is a last resort to absorb small changes in Increased intracranial pressure (ie, the pressure inside the skull, ICP).  The patient typically presents with thes the complaints, seen in Image 3:
Invisible illnesses: Intracranial Hypertension and Chiari Malformation






Image 3. Symptoms of Increased Intracranial Pressure.  For Hasta with Chiari Malformation, headaches are so Commonly and painfully felt. This is why it is importante to listen to your child's complaints.  Image Courtesy I ausmed.co. 

One can imagine several things that would make this situation is either better or worse. Factors that make Chiari SYMPTOMS worse Causes include anything that an increas in ICP. Just think of a 'mad as a hatter.' Anything that makes the face red also increases blood supply to the brain, worsening SYMPTOMS:

Makes Increased ICP Worse                            

  • Standing on your head
  • vomiting
  • Screaming
  • Holding your breath
  • High blood pressure
  • Tachycardia (fast heart rate)
  • High salt diet
  • Increased water / fluid intake
  • laying down
  • Laying down with your feet up

Eventually, the brain swelling Becomes incompatible with life. For lovers of increased & ICP Interventions are Necessary. Patients that live with Chiari Malformation frequently live with lifelong dread at all the swings of increased & ICP is going on in their head:

Increased ICP Makes Better:

  • Sitting upright with head
  • Avoid vomiting
  • Lowering your blood pressure
  • Slowing your heart rate (but be careful)
  • Breathing fast
  • quiet
  • Having the surgeon to drain the fluid

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NATIONAL BOARD EXAM QUESTION:

What is the worst-case scenario, and the favorite question from the American National Board of Medical Examinations (NMBA)? 


"Which of the following is found in a patient with intracranial hypertension lovers?"
1. systolic hypotension
2. Decreased carbon dioxide levels on arterial blood gas analysis
3. Increased Heart Rate
4. Decreased Respiratory Rate

Answer in "Type K" format: 
A. 1 and 3 are correct
B. 2 and 4 are correct
C. Only 4 is correct
D. 1, 2, and 3 are correct
4 E. All are correct
Go ahead and Answer before you read on.


The reasoning behind the answer to this question is the famous  Cushing's triad  that every medical student, resident and Fellow for American National Board Exams should know :

Invisible illnesses: Intracranial Hypertension and Chiari Malformation
Image 3 Cushing's triad.  All medical students, interns, and residents need to know that if you have a patient with liver failure and on the Liver Transplantation List, you better be watching for the classic signs that your patient is about to herniate into the spinal cord below the foramen magnum.  Cushing's triad is the classic formula that every doctor should know. The answer to the above question is "D." The choices given in 1 - 5, are deliberately set out to draw the fine shades of decision-making required of a physician. So when your doctor 'thinks,' I should really be 'thinking hard.'
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MEDICAL MIRACLE:
Leaving you on a positive note is importante to me. So I'll do my best to show you a medical 'miracle' at the end of each Article. Here, let us look at the beloved Baby Rooke today: after one year of surgeries to decrease every head circumference, she smiled for the first time (See Image 4):

Invisible illnesses: Intracranial Hypertension and Chiari MalformationImage 4. One Year Later.  Room to smiling in 2014. A survivor of 'water on the brain, "hydrocephalus and the Resulting Intracranial Hypertension. Reportedly, the local community cast pressure on the parents, Particularly the mother, saying she should give the baby up for adoption each in a religious home or place of compassion. The mother refused, Desiring the closeness of wanting her baby to die on every lap. Not anywhere else.

Epilogue: To be provided with updates, I registered as a medical professional. That allowed me to access it in the July 2014 update to the article on Room,  here . Additional information on the Baby Room is not available on my research effort. I think it is reasonable to assume that she has passed away. Another possibility is that the family was under too much pressure and stress, and went out of the mainstream public. The Baby Room is still, and always will be, a medical miracle. She defied the doctor's assessments time and time again. She smiled. She laughed. She knew every mother. It is a testimony of the strong love between a mother and a daughter, no matter which way you tell this story. That is the second miracle to behold.
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So let us continue to the increased awareness. 
Additional information on Intracranial Hypertension : en Español  here  and hereİngilizce  and  Chinese too.  
And spread the word on  Chiari Malformationen Español and İngilizce.  
Here is  good information  for patient advocates, caregivers and medical professionals.
Thank you for reading my writings .

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
REFERENCES:
(1)   Cruveilhier JL'Anatomie pathologiqu du corps humain, descriptions avec figures have coloriées lithographiées; Alterations morbides diverses et dont le corps humain susceptible . 2 Vols. Paris: Bailliere, 1829-42. 
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RESOURCES:

I CHIARI

INTERNATIONAL:

International Chiari  Association  

Twitter  @ıntlchiariassn 


II. hydrocephalus

INTERNATIONAL:

Hydrocephalus Association  / Twitter @hydroassoc

Sea Download App for hydrocephalus
~ Hydrocephalus Association  on Twitter.
~ Hydrocephalus Association  on Facebook.

III. Intracranial Hypertension

INTERNATIONAL:

Intracranial Hypertension Research Foundation  / @ıhresearchfound


~ Intracranial Hypertension Research Foundation En Español
MEDICAL  DISCLAIMER:  This article is for information Purposes only and is not intended as medical advice, treatment or cure. Always consult a qualified professional when seeking medical care for your medical complaints. In the USA, call 911. In Spain, Portugal and the UK, call 112. 

Thank you for Increasing awareness of Intracranial Hypertension and Chiari Malformation.



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