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gastro ./ gastrointestinal tract

Peptic Ulcer Disease
An ulcer is defined as a breach in the mucosa of the alimentary tract, which extends through the muscularis mucosae into the submucosa or deeper. Although ulcers may occur anywhere in the alimentary tract, none are as prevalent as the peptic ulcers that occur in the duodenum and stomach. Acute gastric ulcers may also appear under conditions of severe systemic stress.

Peptic ulcers

Peptic ulcers are chronic , most often solitary, lesions that occur in any portion of the gastrointestinal tract exposed to the aggressive action of acid peptic juices. Peptic ulcers are usually solitary lesions less than 4 cm in diameter, located in the following sites, in order of decreasing frequency:

Duodenum, first portion
Stomach, usually antrum
At the gastroesophageal junction, in the setting of gastroesophageal reflux
Within the margins of a gastrojejunostromy
In the duodenum,stomach, or jejunum of patients with Zollinger-Ellison syndrome.
Within or adjacent to a Meckel diverticulum that contains ectopic gastric mucosa

In the United States, approximately 4 million people have peptic ulcers (duodenal and gasteric), and 350,000 new cases are diagnosed each year. Around 100,000 patients are hospitalized yearly , and about 3000 people die each year as a result of peptic ulcer disease. The lifetime likelihood of developing a peptic ulcer is about 10% for American men and 4% for women. Visit for Medical help

Peptic ulcers are remitting , relapsing lesions that are most often diagnosed in middle aged to older aged, but

When convenience is not worth the price
What a week!

One week ago, Bunny was transfered to the rehabilitation center. The hospital had arranged for her to go to (what I'm calling) The Good Rehab?, but Bunny wanted another one that was much closer to Chez Boca. As in walking distance of Chez Boca (that is, if you ignore multiple fences along the way and the lack of a cross walk across a six lanes of traffic on a major road). So that's where she was transported to.

But upon entering that place, it was clear it was a mistake. What happened next is a blur of the next 72 hours:

  • The smell! It wasn't nauseating or unbearable, but ? unfamiliar and thus disturbing. It purmeated the place. You could not get away from it.
  • The initial room that Bunny was assigned lacked a bed. Fortunately (I guess) there was another room nearby where she was reassigned.
  • Speaking of rooms, while sizable, all it contained was a wall-mounted TV, a wall-mounted clock, a wall-mounted light fixture, the said bed (which wasn't much bigger than the gurney Bunny arrived on), a bed-side stand, and a chair. That's it. No other decorations other than the faded pastel paint on the walls. The closet was more of a built-in cabinet with a piece of plywood for a door, sans latch.
  • The bathroom in Bunny's room (which I didn't even realize existed until late Sunday which says something about the place) was a bathroom in a technical sense?it had a toilet and a sink with a soap and paper towel dispensers on other side. No tub nor shower unit. And the sink had standing water in it.
  • The window shade was broken. It could neither move up nor down. It was stuck where it was.
  • The food at the rehab center was, to put it bluntly, the ?grocery store you hate to shop at branded TV dinner? quality. Technically edible, but far from palatable (on the other hand, the food at the hospital was quite good).
  • The rehab center was severely understaffed. And they routinely failed to listen to Bunny (?Don't move my arms! I can't be rolled on my side!?).
  • It took over a day for the rehab center to get Bunny's pain medications. I had failed to pick up her prescription before her pharmacy closed on Saturday.
  • The two times Bunny let me go home to get some sleep (since I felt really guilty about leaving her there alone) I got a call only a few hours later to come back and help her as she felt she was being ignored.
  • I purchased a cheap air matress and pump in order to get some sleep. Sleeping on the chair was not comfortable, and the rehab facility had nothing to offer, citing fire codes (and I really didn't want to leave her there alone for any length of time).
  • I overheard two RNs talking about the horrible working conditions there. One was worried about losing her license.
  • Our only two options for leaving were bleak: 1) we could leave immediately ?against medical advice? but were were responsible for our own transportation, or 2) wait until Monday to initiate a transfer as it couldn't be done over the weekend. We opted to wait until Monday.
  • The transfer request was made on Monday; it didn't happen until Tuesday afternoon.
  • A third RN, just prior to Bunny being transferred, wished us well as the place we were going. She worked there, and felt this place was better.

About that last bit with the RN: on the day we arrived, I did visit The Good Rehab? to see what it would take to get transferred there. Not only was it cleaner, brighter, better smelling, and spacious, but within ten minutes of arriving, I was being given a tour from the concierge (they have a concierge!). It was definitely clear that we should have come here first.

But alas, mistakes on our part were made.

Anyway, since Tuesday:

  • I followed the transport van to The Good Rehab?. The pulled up to the entrance. By the time I parked and entered the new rehab center, Bunny was already in her room, in bed, and being looked over by a few nurses.
  • The RN helped me fill out the paper work, and gave me the week's menu so Bunny and I could work out what she wanted to eat, with options like chicken fettuccine alfredo or crab cakes.
  • The food is incredible here! It's much better than the hospital (and that was good). A few times Bunny has asked for seconds, and gotten seconds.
  • There was a dietician that came around to talk about the menu with Bunny.
  • The room is sizable, and while she's sharing a room, it's ?tastefully bland? (like the hospital room was?that was a very nice room too). And the bathroom is a full bathroom with a bathtub, and a sink that doesn't have standing water.
  • The door to the bathroom is insane! It looks like a normal door with a door handle and it latches close, but you can push it open from either side! Or pull it open from either side.
  • It's well staffed, and they do respond with ten to fifteen minutes, depending upon how busy they are. They are also friendly (but to be fair, they were also friendly at the other rehab center, even as they were understaffed).
  • There's a grand piano in the main hall. The other night there was a woman playing classical music on it.
  • I don't feel bad at all about leaving her here overnight. It's a real nice place.

And for some amusement, this rolled into the room the other day:

[A picture of a telepresence robot] "It's no FX-7 but then again, Bunny isn't in a bacta tank"

Overall, Bunny is doing quite well at The Good Rehab?. It's clear she's making progress as she doesn't scream as much when physical therapy comes by to visit. From what we've been hearing, it'll be a few more weeks before she can return home.

But in the mean time, she's in good hands.

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Her time at the hospital is nigh
The good news?Bunny will be discharged from the hospital tomorrow. The neutral news?she's going to a rehabilitation center near to Chez Boca. The bad?it was a rough day with the physical therapist. Oh was it a rough day.

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A hospital concert
I think I found the reason why the hospital parking garage was full. I arrive to the lobby to the sound of bag pipes. Down the hall was a Scottish pipe band making the rounds of the hospital. Had I known there would be a concert ongoing, I might have tried to come earlier for a better parking spot. I'm also surprised I didn't hear them in the parking garage.

In other news, Bunny is doing well. It still hurts when she moves, but other than that, not much else to report, other than the doctors expect it to take six to eight weeks for her to fully heal her broken shoulders.

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The one day I park on the top level of a parking garage
I arrive at the hospital parking garage. For the past few days I've been able to park on the second, maybe third level of the garage. But today is different. As I'm driving, there are no open parking spots that aren't reserved for doctors or handicapped people. I drive through the second level, the third level, I'm beginning to get worried as I drive through the fourth level, and by the time I hit the fifth and final level, I'm afraid I'm going to have to drive backwards down the parking garage as I don't think there's enough space for a three point turn. Maybe a thousand point turn, but at that point, it might be easier to drive backwards. But there, at the very top, was the final parking spot of the garage, still empty.

Sigh.

Now the parking garage is attached to the hospital. There's a stairwell with some elevators leading down to the lobby of the hospital. Of course, these elevators are for the garage?there's a separate set of elevators in the lobby for the rooms of the hospitals, so each day, I take the garage elevator down, head to the front desk to check in, then head to the guest elevators to the rooms, which are next to the garage elevators.

When leaving, it's just heading down to the first floor, walk some two dozen feet to the garage elevators, and head back up.

I say this, because at no time when parking do you leave an unroofed area, except when you park on the fifth level of the garage! When I was left this evening, I get to the fifth level of the parking garage, open the door to enter the parking garage proper, and find myself looking into a solid wall of rain.

And of course, my car is at the far end of the level.

Sigh.

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Notes on an overheard conversation without context because I think it's funnier that way
?There was something supernatural about it.?

?That reminds me of ? oh ? XXXX ? I blanking on his last name. He channeled an elf.?

?Oh! You mean XXXXX­XXXXX­XX.?

?Yes! XXXXX­XXXXX­XX!?

?He thought he was an elf??

?No, he channeled an elf.?

?What??

?Channeled. You know those New Age woo woo people who think they're communicating with alients from Atlantis??

?Oh, yeah.?

?And he channeled other entities besides elves.?

?Um ? how did you guys know him??

?It was high school. A different time back then.?

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they may first become evident in young adult life. They often appear without obvious precipitating influences and may then after a periof of weeks to months of active disease, heal with or without therapy. Even with healing however, the propensity to develop peptic ulcers remains in part because of the propensity for recurrent infections with H.pylori. The male to female ration for duodenal ulcers is about 3:1 and for gasteric ulcers about 1.5 to 2:1. Women are most often affected at or after menopause. For unknown reasons, there has been a significant decrease in the prevalence of duodenal ulcers over the past decades but little change in the prevalence of gastric ulcers.

Peptic ulcers appear to be produced by an imbalance between the gastroduodenal mucosal defense mechanisms and the damaging forces. Gastric acid and pepsin are requisite for all peptic ulcerations. Hyperacidity is not a prerequisite because only a minority of patients with duodenal ulcers have hyperacidity, and it is even less common in those with gastric ulcers. Gasric ulceration can rapidily occur when mucosal defenses fall, however as when mucosal blood flow drops gastric emptying is delayed or epithelial restitution is impaired.

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