Life-Saving Drugs in Medical Emergency

 

I was just discussing with some doctors and with some of my ex-medical colleagues yesterday in our WhatsApp chat group that drug-based medicine fails miserably in managing most chronic diseases due to nutritional lifestyle, environmental exposures, occupational insults among other external and internal factors. Here's a comic illustration: 

 

I discussed with them drugs do not cure lifestyle diseases if we are unwilling to change the way we eat and live. Most patients take the easy path by swallowing pills than modifying their lifestyles such as managing their body weight, some are pathologically obese, others smoke and drink, yet others lead a sedentary life and is easily upset by the slightest stress among many other causative factors. They depend only on pills, tablets and surgery as a panacea for all their disorders and ills with each follow-up appointment their medication needed to be titrated to higher and higher dosage to the maximum only to be substituted by another as adjunct. 

 

Other medication needed to be added for other emerging linked diseases till they and all their drugs do them part into death. This is the sad scenario for most of the drug-dependent chronic disorders because they refuge to change the ways they live their lives, especially dietary and nutritional lifestyles. 

 

 

In medicine non-compliance by patients to take the prescribed medication is already one of the problems. This may be due to many reasons, such as social, cultural and economic reasons, taboos, belief systems, forgetfulness, too much medication to take especially by the elderly. These factors for non-compliance are mostly unknown or ignored by the clinician, let alone the much more difficult path to follow by changing or modifying patients' lifestyles to replace drugs.

 

However, there is a moderately long list of essential emergency drugs that are very life-saving and crucial in emergency situations that cannot be replaced by lifestyle changes or other alternative, complementary or traditional systems of medicine.

 

Let us have a very brief tour on some of these rapid-acting drugs used in emergency situations. Let us just very briefly run through the list. The emergency drugs are:

 

lignocaine, propranolol, verapamil, digoxin, inotropic agents such as adrenaline, aminophylline, atropine, diazepam, dopamine, flumazenil, glucose, isoprenaline. Other useful drugs are morphine sulphate, naloxone, nitro-glycerine, nitroprusside, pancuronium bromide, dobutamine, chlorpromazine, ipratropium, corticosteroids, phenytoin, potassium chloride.

 

Listing further are protamine sulphate, salbutamol, sodium bicarbonate, intravenous fluids such as 0.9 % normal saline, fluid expanders such as dextrose 3% with 0.3 saline, Hartmann’s solution, fluid expanding solution (e.g., Haemaccel, Gelofusin), including colloids for patients with hypovolaemic shock in association with crystalloid solutions.

 

Lignocaine for example is recommended for the treatment of ventricular fibrillation and ventricular tachycardia; atropine is used in the treatment of asystole and severe bradycardia. It acts to block the effects of the vagus nerve on the heart.

 

Sodium bicarbonate is used to treat the metabolic acidosis associated with cardiac arrest.

 

Our list can go on, but this short list will do as they are just examples. They will suffice for us to know how important, and lifesaving fast-acting drugs are in emergency situations.

 

But let us give ourselves just one example. Let us take a heart attack as the most common one even any lay person is aware of.

 

Let us say we are confronted by a cardiac emergency? A person has a heart attack or even a total cardiac arrest. What shall a doctor or even a well-trained and well qualified licensed paramedic with 4 -years of structured training in pre-hospital emergency care would do. We shall discuss this shortly.

 

Cardiac emergency is just one of the many types of medical crisis.  They can range from anything from cardiac arrest, hypertensive encephalopathy, eclampsia, phaeochromocytoma, aortic dissection.

 

Others are respiratory emergencies like acute ventilatory failure, spontaneous pneumothorax, primary and secondary pneumothorax, tension pneumothorax, haemothorax re-expansion pulmonary oedema, acute severe asthma, respiratory distress syndrome, massive haemoptysis, acute gastrointestinal emergencies such as GIT haemorrhage, variceal haemorrhage, hepatic encephalopathy, acute pancreatitis.

 

Listing further are metabolic emergencies to include diabetic comas, hypoglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic non-ketotic coma, hypernatremia, hypercalcemia, hypocalcemia, Addisonian crisis, hypomagnesemia, hypophosphatemia, lactic acidosis, uraemic crisis.

 

Then we also encounter neurological emergencies such as subarachnoid haemorrhage, head injuries, acute myelopathy, myasthenia gravis, to haematological emergencies such as severe anaemia, severe neutropenia, fat embolism syndrome, massive pulmonary embolism, acute limb ischaemia, acute mesenteric embolism.

 

Listing down other medical emergencies include, anaphylaxis, acute auto-immune emergencies such as cerebral lupus, down to acute poisoning from overdose of drugs, poisoning from swallowing detergents, bleaches, disinfectants, salicylate, barbiturates, organophosphate, carbamate, insecticide, paraquat, paracetamol, opium alkaloids and morphine, benzodiazepines, and methanol poisoning.

 

Other medical emergencies may include, but not limited to, are acute life-threatening infections like septicaemia and septic shock from streptococcal, gram-negative bacillus septicaemia, malaria, tetanus, dengue, melioidosis, all the way down to other medical crises from near drowning to heat disorders like heat cramps, heat exhaustion, heat stroke to snake bites, etc, etc.

 

There are other medical emergencies too besides what we have briefly listed here that need to be considered, and it is outside the scope of this very short article to even list them partially, let alone discuss their treatment using drugs and other adjunct therapies.

 

Let us now go back to what we mentioned earlier that the most known emergency event of all is a heart attack or myocardial infarction or even more serious a total cardiac arrest.

 

 Let us use only this example most lay people are aware of, and how drugs come in very useful and lifesaving, besides other non-pharmacological interventions such as CPR. Let us discuss only this emergency.

 

During a myocardial infarction, commonly called a heart attack there are three things we need to consider, namely: airways, breathing and circulation (ABC). If the heart stops beating or just quiver (fibrillating) we need to perform cardiopulmonary resuscitation (CPR) immediately besides maintaining patent airways with head tilt, chin lift.

 

We need to initiate mouth-to-mouth resuscitation with rescue breath in the prehospital environment, and in the hospital environment, ventilate with 100 % oxygen through air viva and intubate via oral route. Ventilate through downstroke at every 5^th chest compression, namely, 12 to 15 ventilation per minute.

 

Next, we need to establish circulation by external cardiac massage at the rate of 60 compressions per minute by transmitting heel of hand compression at sternum 2 fingerbreadths above the xiphisternum without pausing for ventilation.

 

Open cardiac massage may be considered if there is a cardiothoracic surgeon available.

 

Defibrillate if VT or VF serially with 200, 300, then 360 joules of shock. If no ECG rhythm gives blind DC shock since VF collapse rhythm is common. If cardiac rhythm is established after successful defibrillation, give lignocaine infusion to maintain.

 

All essential drugs should be given through the central line or through antecubital vein reserving intratracheal or intracardiac routes as the last option. Emergency drugs of choice for asystole is 1:10,000 adrenaline 10 ml given bolus, repeat every 5 minutes. This drug can cause fine VF to coarse VF more suitable for defibrillation.

 

Lignocaine is indicated for VT to be given at 50 to 100 mg bolus.

Giving Sodium bicarbonate is debatable and may not be suitable since acidosis may be reversed through adequate ventilation.

 

In acute myocardial infarction this should be differentially diagnosed from pneumothorax, aortic dissection, acute pulmonary embolism and pericarditis. Management includes total bed rest in CCU, intranasal oxygen at 2 litres per minute, maintaining IV access with slow infusion, IV morphine 3 -5 mg titrated to 10 – 15 mg for pain management.

 

Sedate with oral benzodiazepine such as diazepam at 6 mg tds. Antiplatelet agents such as aspirin (100- 300 mg) om may be indicated. Betablockade such as propranolol 40 mg tds may be considered. Other areas of intervention to be considered are diltiazem 30 mg tds for non-Q infraction.

 

Thrombolytic therapy with streptokinase 1.5 megaunit or rTPA 100 mg at 10 mg bolus, 50 mg first hour, 20 mg in 3^rd hour can be considered in define Q-wave infarction for age below 75 years, with no risk factor for bleeding, example recent surgery, prolonged CPR and no history of allergy or streptococcal infections.

 

These are just some examples where essential emergency drugs become very lifesaving. There is no other system of medicine that can match conventional pharmacological interventions in medical emergency events such as in a cardiac emergency.

 

We have very briefly outline in point form other medical emergencies where conventional drug-based medicine is beatable by other systems of medicine.

 

Unfortunately drug-based medicine fails badly in all other lifestyle and age-related diseases such as obesity, type 2 diabetes, high blood pressure, CVA (stroke), asthma and Chronic Obstructive Pulmonary Diseases (COPD), cancers, dental disease, heart, liver and renal failures, mental disease, osteoporosis, and other diseases due to dietary lifestyles and other unhealthy causative factors such as smoking, physical inactivity, stress, anger and personality disorders among others.

 

I hope we have high-lighted how certain drugs whose pharmacodynamics are very fast acting and clinically very efficient in managing very acute medical events that will open our eyes that no other medical system can replace.

 

Unfortunately, drugs are synthetic and most fail miserably in managing most other chronic and degenerative diseases of lifestyles where the root causes are never addressed, preventive medicine and health education are largely ignored by clinicians.

 

This is where other medical systems such as naturopathic medicine, nutritional medicine far surpassed conventional drug-based medicine, and that is where they take over to replace drug-based medicine effectively and permanently.

 

Health care is an integrated system not based only on monotherapy of an isolated modality. Nutrition and lifestyles take precedence over drugs for the prevention of chronic diseases. 

 

Hippocrates, the Father of Medicine said:

 

"Let food be thy medicine”. 

 

He has never said: Let medicine be thy food?? This was put into his mouth after he was long dead. 

 

I hope this is helpful to clinicians and medical doctors and also to practitioners of other systems of medicine.

 

 

jb lim 

 

 

 

On Titles such as Professor, and Doctor: What's in a Name?

 

I received a question yesterday on 1 March 2023 from an ex-colleague of mine when we were working at the Institute for Medical Research in Malaysia in the 1970’2 till the mid 1990’s.  

It reads:

Dr Lim, may I know why the title Professor Dr is given to a teacher who is attached to a technical college for mammals.

Here’s my answer:

Dear Mano,

The answer your question is, this is because everyone likes to be called a professor before he or she is forced to enter into that black hole, called ‘grave’ beneath the ground '? – jokingly

So the teacher you mentioned gave himself the title Professor and Doctor as a consolidation title before he or she dies. I think it would be more blessed  for their souls in the next world after they have died than to be in this world using all kinds of titles. See my explanation here:

https://scientificlogic.blogspot.com/2023/02/material-blessings-here-on-earth-or.html

A Professor is a university academic appointment, not some title earned like a PhD  and it is only valid as long as the person is still a professor in the university. But once he leaves the university or has retired, he ceased to be a professor, and he or she is no longer a professor or eligible to be called or addresses as a professor unless the university confers him or her title Emeritus Professor on retirement in which case he or she is still allowed and is still eligible to be address as Emeritus Professor. But NO, definitely NO to anyone who claims to be a “professor” when he or she is NOT even attached to any university as this is a very learned, academically high and exclusive appointment.

I am very aware some people calls themselves as a “professor” when he or she is not even a graduate or attached to any very senior teaching appointment in any university. He /she does some unrecognized   teaching or practice on his or her own and calls himself / herself a “professor” without even wanting to reveal his / her degrees or qualification. That’s it. Full stop.

Then  we also get a lot of people these days with only a Bachelor' degree who call themselves a ‘doctor' when academically, legally, and technically they are not eligible for this.

 The title Doctor (Dr) is  bestowed only on those who actually holds a Doctorate degree such as a PhD or a DSc

That's why in the UK  all surgeons are always addressed as "Mr" because they were traditionally barbers or barber surgeons who cut off limbs and bodies except for physicians whom patients called  as 'doctors' as a courtesy title only, and not that they are educationally and legally eligible for it.

In the UK male surgeons are always addressed as "Mr" and female surgeons as "Miss” irrespective of their marital status. Female surgeons would not call themselves as Ms, Mrs or Madam. It is always Miss and nothing else even if they are married 10 times over, or are already a great, great grandmother. 

But for us who are much higher up in academia, we never call or address a medical doctor as a "doctor'. We merely call them as clinicians.  That's it. In fact, the term “clinicians” would be much more appropriate for medical doctor’s with only a basic bachelor’s degree in medicine and surgery (MBBS).

Most of us already have MDs, Master's degrees, PhDs who additionally are also Senior Fellows of Royal Learned Societies in Medicine or in Science in London. 

Admissions as fellowships into some of these Chartered Royal Learned Societies are exceedingly, exceedingly difficult unless they have higher degrees such as the higher postgraduate MD or a PhD or are Fellows of the Royal Colleges of Physicians or Surgeons, etc, etc. plus already in very senior positions such as Head of a medical or surgical department, or have already published at least a hundred research papers in prestigious scientific journals. That's it. There is no argument about this, or other way out to gain Fellowship of these Chartered Royal Societies

Hence we normally address a medical doctor as just a clinician, or even a nurse as a nurse clinician as in Singapore or in the United States of America  

Even that, the job description "clinician" may not necessarily be confined for medical doctors, though generally the alternative name for a medical doctor is a clinician. This is because medical doctors do clinical work where they come directly with the patient. Unfortunately, other health workers like nurses, medical assistants, paramedics do far more clinical work than doctors. It is the nurses, not the doctor who periodically take blood pressure of the patients, taking their body temperatures, taking readings of ECG, setting up intravenous drips and periodically monitoring their rates of flow.  It is also the nurses who set up the oxygen supply and give  the supplementary oxygen to their patients and monitoring their flow rates. They were actually the ones who gives the   medication and injections to the patients while  dressing their  wounds ...etc, etc. These are all very busy clinical work done by the nurses.

Doctors in hospitals normally do not do this routine clinical work.  They spend at most 30 minutes examining a patient, requesting for diagnostic tests and prescribing the medicine, but most of their time are spent  writing and clerking notes, and notes, files of them about their patients. That’s not much of a clinical work. They are merely writing note and clerking cases.

Hence, nurses or nurse clinician, and other healthcare workers are more clinicians than the doctor. The word 'clinician' merely describes the nature of the work they do most of the time It is not a profession, but just a job description such as any person who drives a car is called a motorist, a person who rides a bicycle, a cyclist, a person who plays the violin, a violinist, a person who plays the piano, a pianist, a person who tends to his garden, a gardener, an expert in nutrition, a nutritionist, a chemist who analyses a compound, an analytical chemist, someone who looks through a microscope, a microscopist, someone who sings, a singer...and so on and on, and on. 

For instance, I like to look at the galaxies through a telescope. You may call me an astronomer if you wish.  After all I still did my postdoctoral in astronomy from the University of Oxford, whether or not I looked through a telescope. You may also call me an Evolutionary Biologist, or a Forensic Toxicologist. I studied these too after my PhD at the University of Cambridge and also worked as one at MIT (Massachusetts Institute of Technology). 

So, the job description is based on what we do. A doctor or anyone who does clinical work is just a clinician, not necessarily confined to a doctor although normally people associate a clinician as a medical doctor.  That is what they are eligible for – a clinician.  

But now we get dentists, pharmacists, drug sales people, nurses, bomohs, soothsayers,  witch hunters, traditional healers, fortune tellers and all kinds of Dick Tom and Harry who also like to be addressed as "doctors"

If you are a  Malay surgeon  working in a government hospital here in Malaysia he will  get angry if you  address him  as  Encik instead of Mr, because surgeons working in a government hospital are always addressed as Mr. But the word for Mr. in Malay language is Encik. But no, they want to be addressed as Mr, not Encik? Maybe they want to distinguish themselves from all other Enciks? What a name and fantasy? 

But once a Mr. surgeon who works in a government hospital goes into private practice naturally he suddenly calls himself as a Dr surgeon for obvious commercial reasons. If he calls himself a Mister in private practice, he will not get any patient, unlike in a government hospital he gets paid, whether he was called a Dr or a  Mr. 

The origin of the word ‘doctor’ in ancient times actually means a Teacher, a Sage,  a very wise and Learned Person. He is regarded as a Philosopher. Hence the name Doctor of Philosophy (PhD).  

But these days everyone with only a Bachelor’s degree wishes to be called a 'doctor' when academically, legally, and technically they are not eligible for this, except those who actually holds a Doctorate degree such as a PhD or a DSc. A DSc is almost impossible to get unless you are a Nobel Prize Laureate in Science or in Medicine. 

But now we also get dentists, pharmacists, paramedics, medical technologists, nurses and pharmaceutical representatives with a bachelor’s degree or only a diploma or certificate who also call themselves as “doctors”.  So do bomohs, witch hunters, traditional healers, and all kinds of Dick Tom and Harry who also like to be addressed as "doctors"


That's why I  always tell them to write out very clearly all their university degrees behind their names instead of putting  all those vain  titles  before  their names for which they are not eligible when they only have a basic Bachelor’s degree or only a diploma.

If they spell out their academic qualifications behind their names, we will immediately know who they are. We can instantly tell their educational status. So, why hide their educational qualifications but write 'doctor' before their names without wanting to reveal their degree credentials after their names?  

I was taught by many Jewish professors when I did my postgraduate and research in British universities. One of my many very eminent professors was this Jewish professor by the name John Yudkin at the University of London.

He was a very famous, celebrated and a highly qualified physician, a biologist, a chemist, a nutritionist, a physiologist. He received all his medical and Doctorate degrees from the University of Cambridge.  He was the Chair in all these professions at the University of London when I was studying under him.

In one of his books on NUTRITION, he merely wrote his name as:  

John Yudkin

MA, MD, PhD, FRCP, FRIC, FIBiol.

But just look at the strings of elite degrees behind his name, without even writing his title as Professor Dr John Yudkin, Chair of Nutrition, University of London in front.  He was so humble. That was why earned so much respect from the academia, the British society, and around the world especially on his work on sugar and heart disease.

 

A lot of my other very eminent professors at the Massachusetts Institute of Technology (MIT), at Reading, Oxford and at Cambridge Universities were also very humble. The greater they were, the humbler they were.  In fact, the humbler they are, the greater respect they earn from society.

 
What a rat race for the rest, and others for names and titles when we are zoologically and scientifically classified as animals under these categories:

 

Kingdom: Animalia, Phylum: Chordata, Class: Mammalia, Order: Primates, Suborder: Haplorhini, Infraorder: Simiiformes, Family: Hominidae, Subfamily: Homininae, Tribe: Hominini, Genes: Homo, and Type Species: Homo sapiens (humans)   

 

I am afraid I am unable to answer your question why that teacher you mentioned called himself a Professor and Doctor if he is not?

You may need to ask him yourself. 

LJB 

 

The Truth about Cholesterol, HDL and LDL and Heart Disease

 

Thank you, Professor Dr Andrew Gomez,  

Let me add to this gentleman explanation about “bad” LDL and “good” HDL cholesterol.

My personal opinion is, none of these two types of cholesterols is good or bad.

What is bad are the free radicals present in the body, from the metabolic breakdown of food we eat and drugs we take, from our stress hormones, and the intake of smoke from cigarettes.

 The free radicals easily oxidize the LDL cholesterol into a gummy, sticky by-products that stick on to the blood corpuscles, fibrinogen and fibrin, calcium salts, dead cells in the blood and other materials circulating in the blood stream to form complex atherosclerosis and plagues.

 These gummy substances stick on to the intima of the coronary blood vessels to narrow them and clots in those vessels to give us a heart attack or a stroke.

 The high-density HD lipoproteins are more resistant to oxidative stress by free radicals and hence do not form sticky and gummy type of oxidized cholesterol and hence they do not stick on to the inner lining of the blood vessels (intima) to cause plagues and clots and stenosis (narrowing) of the coronaries, 

 It is not that the HDL are the 'good' cholesterol, and the LDLs are the 'bad' ones. This kind of information is chemically, nutritionally, and medically wrong. 

 We would not go into the chemistry of how these cholesterols are oxidised. We shall also not go into the pathways they take in their metabolism and how they are essential in the synthesis of various cholesterol-dependent hormones. 

 All we need to know is, cholesterol is found abundantly in eggs, brains, liver and other cholesterol rich foods and neither these foods contain HDL nor LDL. They are just neutral dietary cholesterol containing C27H46O in which the central sterol nucleus has four hydrocarbon rings, which are arranged in a circular configuration which is neither low nor high density cholesterol. 

 The high- and low-density cholesterol is synthesised by our own liver. So, blame our liver, and not goat's, cow's and monkey's brain we eat. 

 I ate goat's brain every day for lunch for over one year in the 1970s, but my cholesterol was never high, in fact lower than normal.

 Please understand the chemistry and biochemistry of cholesterol before linking cholesterol and heart disease.

 They are not connected and don't believe those Big Pharma drugs and statins are going to “solve" or “cure” any of our dietary and lifestyle diseases.

 Other animals do not suffer from heart attacks except humans with our dietary, smoking, stress, sedentary lifestyles among others. The statin drugs we take for hypercholesterolemia that need to be titrated into higher and higher doses are not going to help us if we are unwilling to change the way we live.

 Please go further on my take on cholesterol and heart disease published on Tuesday, August 17, 2021, here:

https://draft.blogger.com/u/1/blog/post/edit/5147710646665023010/3238482793102355023

Also, these two videos sent to me today on Wednesday, 1 March, 2023 here:

1.       The truth about eggs, butter and cholesterol

https://www.youtube.com/watch?v=iQPfYghxXQI

2.       Doctors Syndrome:

https://www.tiktok.com/@mohanaturoholistics/video/7202991888549350683

Thank you.

Ju-boo lim

 

 

 

 

 

 

 

 

 

 

 

 

 

Material Blessings here on Earth, or Preferred Eternal Blessings for our Souls Beyond our Graves?

 

In one of the WhatsApp messages sent by someone to us in a chat group, he was talking about how rich some people live a life of plenty and how “lucky” and “blessed” they are while many live in abject poverty all their lives. I gave a lengthy reply among them briefly this:

Not just alone. In their entire lives they gather a lot of material wealth to burden themselves to keep and unnecessary to maintain until at old age they no longer have those strength and desire to maintain their rich lifestyles only to drop everything they have, including themselves into their graves.

Always remember from the day we were born, no matter what we have, or have achieved, the grave is ALWAYS there in front waiting for us.

Tell me dear friend, what is the purpose of your life when none, absolutely none can escape the grave.

On death we all MUST face eternity (time without end) and that eternity is either with Satan in the Lake of Fire for possessing excessive wealth, lusting for fame, power and name, and the  enjoyment of life  for a maximum of 100 years  here in this world, or to seek  entry into the  Kingdom of God for all eternity for suffering here in poverty

Which would we prefer?

Always be mindful of the warning Jesus gave of the rich man and Lazarus here:

https://www.biblegateway.com/passage/?search=Luke%2016%3A19-31&version=NIV

(Luke 16:19-31)

Most of the warnings like this parable are quietly and conveniently ignored by churches and their pastors because they themselves cannot, and are  unwilling to give up everything as Jesus told them to do to follow Him

They have plenty, including taking offerings from church goers to pay their high monthly salaries, getting married to have families, buying houses here and there, and indulge in buying several cars and other properties in the name of "serving God".

Jesus gave up all. He was never even married to burden Him to take care of His family, so that He can sacrifice all for His heavenly Father. He laid down everything to God.

But we get pastors and their church goers who merely wear a cross around their necks, wear some white clothes the easy way instead of taking the difficult path by carrying the cross in their lives like Jesus did.

“Beware of the scribes, which desire to walk in long robes, and love greetings in the markets, and the highest seats in the synagogues, and the chief rooms at feasts” (Luke 20:46).

“Enter by the narrow gate; for wide is the gate and broad is the way that leads to destruction, and there are many who go in by it. Because narrow is the gate and difficult is the way which leads to life, and there are few who find it.” (Matthew 7:13-14).

On their deathbeds most rich people worry about all those possessions and wealth they have worked for, and have accumulated in their entire lives only to haunt them  they are going to release them all behind to crumble when they breathe their last,  or all their worldly assets  taken away from them by someone else when they closed their eyes for the last time. The grave or the fierce fire of cremation is always there ahead waiting for all of us. There is no escape even if we manage to live for over a 100 years.

There is just no way of escaping no matter who we are, all those  material possessions we accumulated,  the titles we vainly and proudly write before our names, or the powers we invested over others.

If we do not believe we have a soul, we will not remember anything all we had or have enjoyed here. They will all  come to a naught and in sheer dark emptiness, but if we believe we have one, we will remember all we possessed in this world but regretfully we are unable to carry them to the next world

We cannot  deny this till kingdom come, and even if we argue to choose between the two, we will still lose, either way.

But if we think we have a soul, unless we admit we are a soulless person (hmm! not a very pleasant way to describe ourselves), which would we prefer, invest treasures for our eternal souls in heaven, or gather physical wealth here temporarily to transit through the next world without them?

I am always mindful that the soul exists  eternally, and that spiritual life cannot be killed or destroyed unlike physical life, once created as it is the breath of God pumped into the elements of the soil out of which we are all made from our scientific understanding of the chemical composition of the human body. See this explanation in one of my hundreds of blog articles also.

I am also mindful of the  explicit  warning Jesus gave about the rich man and Lazarus as already mentioned about gathering material wealth while living temporarily with material “blessings" most only seek here in this world, and not blessing for their souls  beyond their graves  when this parable about the rich man and Lazarus is the clear evidence of the existence of a soul leaving us and carried away after death

It is easier for a camel to go through the eye of a needle, than for a rich man to enter into the kingdom of God

(Mark 10: 21- 25)

It does not count one iota  how many times we go to church or all the churches we attended all our lives to listen to all those preachers, but what is going to save us is, are we prepared to give up all we have to follow Jesus physically and spiritually?

Believing in Jesus as the Son of God is to believe all that He asked us to do here in practice, and not merely theoretical lip service of  believing

In His  Sermons of the Mount written in Matthew chapters 5 to 7 Jesus clearly taught us what needs to be done before we hope to enter heaven.

Are we prepared to put all these into practice, and also as a Good Samaritan to those in need?  Yes, or no? Our conscience has already answered. We know this ourselves: The Sermon of the Mount has never, never been taught in any church I have attended because the pastors there knew they themselves are unwilling to practice them. It is impossible for them to practice in their daily lives. So they merely preach what Paul or Saul taught after Jesus left

Paul is NOT Jesus. Paul was just an ordinary first preacher to the early churches exactly like our current modern pastors today who  preach the same easy way out. Did Jesus tell us it is easy to enter heaven?

Only Paul as the first preacher to the early churches claimed this:

“We are saved by grace through faith in Christ Jesus and not by our own efforts or works” (Ephesians 2:8-9), This was claimed only by Paul to the early churches after Jesus died. But did Jesus actually claim that about Himself?

The  practical and spiritual meaning of "carrying the cross" is  not just wearing a cross around our necks the easy way and merely by lip service to say we believe Jesus is the Son of God in this verse

"For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life" (John 3:16)

We can deny our unwillingness but we shall never win till kingdom come, or will we be able to enter into heaven if we are unwilling

I have written many articles about the mysteries of life, about the existence of a soul, our purpose and temporary existence here in this temporary world and many similar articles in  my blog.. Readers may search them in my blog  by keying in these 5 words into Google:

"Lim Ju Boo Scientific Logic"

Just two examples  below will do:

The Existence of a Soul:

https://scientificlogic.blogspot.com/search?q=Existence+of+a+soul

Mystery of Life:

https://scientificlogic.blogspot.com/search?q=Mystery+of+life&m=1

For  similar subjects such as the First Miracle of Jesus, just key in the title  of interest on the internal search engine on the top right hand corner of my blog

Fools rush in where angels fear to tread if we think we can just continue to invest in worldly treasures forever in this world to “enjoy” life,  and that we shall never die, and that there is no grave or the fierce fires of cremation awaiting in front.

Would we get the same bountiful blessings for souls after death? Think this over and over again. I shall add much more to this thought later as it is already 3:30 am in the morning and I need to be in the hospital by 7 am

Take not just care, but very, very great care

Seek wisdom, not wealth in our daily prayers. This never fails

jb 

 

The Power of an Earthquarke

 

A lady friend of mine by the name of Ms Josephine Wong Hian Boon sent me a video of a huge chasm in what was once an olive field near Antakya that was ripped by sheer power of the recent Turkey- Syria earthquake.

https://youtube.com/watch?v=IiDvo-xTinY&feature=share

 

I  would like to dedicate this article to her, Josephine Wong.

My feeling about an earthquake is the display of the power of Nature. It is so strong that it can shake parts of the Earth. Let’s have a look at how powerful the Turkey’s earthquake was.

 

The energy released by the 7.8 magnitude quake on Turkey and Syria was equal to around 32 petajoules according to seismologist Januka Attanayake at the University of Melbourne in Australia who told The New York Times.

 

(1 petajoules = 1,000,000 gigajoules)  

 

This means the power released by the Turkey earthquake was:

 

3.2^16 Joules, or 32 million gigajoules.

 

One gigajoule = 10 x 10⁹ (1000 million or one billion joules)

One petajoule is 10 x 10¹⁵ joules = 1 million billion joules or 278 gigawatt hours.

 

One ton of TNT releases 4.184 gigajoules or 4.184×10⁹ joules of energy

 

That amount of energy in Turkey’s earthquake is enough to generate 8.88 million megawatts continuously for one hour. It's also equivalent to the energy released by 7.6 million (nearly 8 million) tons of TNT.

 

The atomic bomb dropped on Hiroshima was only equivalent to about 20,000 tons of TNT or 83,680 gigajoules (8.368 x 10¹³ joules) of energy.

 

But the earthquake in Turkey was 32 million gigajoules = 32 x 10¹⁵ joules

 

This means it was equivalent to 382 atomic bombs dropping simultaneously onto Turkey.

 

If not an atom bomb, how does this compare to a hydrogen bomb?

 

The explosive power of hydrogen bombs is frequently expressed in megatons, each unit of which equals the explosive force of 1,000,000 tons of TNT.

 

One megaton hydrogen bomb or any weapon would have the energy equivalent of 1 million tons of TNT which is equivalent to 4.184 × 10¹⁵ joules, since one ton of TNT releases 4.184 gigajoules or 4.184×10⁹ joules of energy

 

Hence the earthquake that afflicted Turkey was still 7.7 times more powerful than a one megaton hydrogen bomb.

 

But if we were to go further into the calculations, a nuclear bomb filled with 212 tonnes of deuterium would produce a 5,200-megaton explosion.

 

If this deuterium bomb were to substitute the earthquake, then that would not only be the total end of Turkey but all countries around it would be annihilated.   

 

That would be the power of Nature.

 

Let us now use the Sun’s energy to compare.

 

The Sun is a G-type main-sequence star (G2V) formed about 4.6 billion years ago. Every second, the Sun's core fuses about 600 million tons of hydrogen into helium, and in the process converts 4 million tons of matter into energy.

 

In more technical language (sorry about that since astronomy is one of my areas of interest / study), the energy of the Sun comes from its proton–proton chain reactions that occurs

around 9.2×10³⁷ times per second in the core.

 

In the process it converts about 3.7×10³⁸ protons into alpha particles (helium nuclei) every second (out of a total of ~8.9×10⁵⁶ free protons in the Sun), or about 6.2×10¹¹ kg/s.  Each proton takes around 9 billion years to fuse with one another using the PP chain.  Fusing four free protons (hydrogen nuclei) into a single alpha particle (helium nucleus) release around 0.7% of the fused mass into energy.

 

In simple non-technical language, this means the Sun uses the mass–energy conversion by destroying itself at a rate of 4.26 million metric tons per second to release energy. This requires 600 metric megatons of hydrogen to yield 384.6 yottawatts (3.846×10²⁶ W)

 

This is equivalent to the power of 9.192×10¹⁰ (90,000,000,000) megatons of TNT per second. The Sun is about halfway through its lifespan and has about 5,000,000,000 (five billion) years more to go before it dies once its nuclear fuel (hydrogen into helium) is depleted.

 

During its death throes, it will start to consume its heavier elements and vast quantities of stellar material will hurtle into space as the sun's body expands to 100 times its current size to become a red giant, before it shrinks into a tiny, extremely dense white dwarf star about the size of Earth.

 

The origin of Earth rests on three theories, namely the core accretion theory, the disk instability theory and the pebble accretion theory. Whatever it was, it must have originated from the Sun from which Earth must have extracted its energy to form its molten core and the earthquakes. If that was right, then let’s have a look.

 

The Sun is 148.06 million km (1.4806 x 10¹¹ metres) away from this Earth.

 

A Sun-Earth sphere in space would subtend an area of 2.75 x 10 ²³ sq. metres given by the formula: pi r squared (4πr^2).

 

Within this sphere the Sun radiates its energy to reach Earth and of course far beyond Earth into the outer reaches of the Solar System though dim it might be far beyond Pluto.

 

The Sun radiates about 5.6 x 10 ²⁷ calories or 3.846×10²³ KW of energy per minute. Spread out this energy over a Sun-Earth sphere across 148.06 million km, Earth will receive 1.398 KW of solar energy per square metre on its surface (1 square km = 1000,000 square metres)

 

This is the solar constant we manage to derive here theoretically by mere calculation which fits practically and almost exactly the same as 1.3608 ± 0.0005 kW/m², which scientists found through measurement using sophisticated satellite technology.  

 

What scientists found was, the solar constant varies over an 11-year solar cycle, being 1.361 kilowatts per square meter (kW/m²) as the solar minimum when the number of sunspots is minimal, and approximately 0.1% greater (roughly 1.362 kW/m²) at solar maximum.

 

If we translate this solar constant over the entire surface of Earth which is 509 600 000 square km (5.096 x 10 ¹⁴ sq. metres) the total amount of energy the Earth receives round the Earth as it rotates evenly, would be 6.94 x 10¹⁴ kilowatt or 6.94 x 10¹⁴ kilojoules (Joule) per second or 5.99 x 10 ¹⁹ kilojoules each day.  

 

(1 kW = 1000 J/s)

 

But the earthquake that hit Turkey and Syria was 3.2 10³² joules, or 32 million gigajoules.

 

This was 5.3 x 10 ¹² (5.3 trillion) times more energy than the energy of the Sun gave to the entire Earth each day.

 

Another way of putting this is, if all the energy of the earthquake at 3.2 x 10¹⁶ Joules could be substituted for petrol, and put into an average car whose petrol consumption is between 8 – 12 litres per 100 km (10 litres per 100 km), this means it could go round and round the circumference of this world almost 250,000  times since the Earth’s circumference is 40,075 km in length, and the energy value of petrol is 3.204 x 10 ⁷ Joules per litre.   

 

The morale of my story is:

 

Respect the powers of Nature and never mess around with her up like we do with vaccines against Covid viruses. It does not work, and it shall never work for sure.

 

Lim ju boo 

Aortic Dissection. What is it, and how is this condition mananged?

 

 

I received a telephone call here in Kuala Lumpur a few days ago from my eldest brother in Singapore  who together with my own relatives here in Malaysia and in Singapore who would normally consult me on their health problems. I shall not reveal my brother’s name for personal and ethical reasons, but I shall just address him here as ‘brother’.

I may also consider sharing out some medical cases for general discussions and updates  I normally encounter from many other patients, but they shall only  for educational purposes.  All patients’ names shall not be revealed as this is strictly for general medical information only.

………………………………………………………………….

Dearest brother

I reviewed the results of your CT scan again a short while ago, and found you actually have what is called an “aortic dissection”.

What I explain here is just my personal opinion. You should also discuss what I mention here with your own vascular surgeon in Singapore.

Furthermore, your own son Lin Ming Shyue is a paediatrician and neonatologist, and your granddaughter is also a doctor, both in Singapore, with Anne Ann Ling Hsu our niece as a Senior Consultant Respiratory and Critical Care Physician in Singapore General Hospital. We also have so many of our relatives and their children who are also medical experts, medical and surgical consultants in Singapore, plus our youngest brother Lim Yew Cheng here in Gleneagles Hospital Kuala Lumpur who was a Professor of Surgery at the University Hospital, University of Malaya, and now a Senior Consultant Cardiothoracic Surgeon at Gleneagles, all of whom you should also seek their opinion. The more collective professional opinions the better.

However, since you have asked me, here’s my take on this is about your condition.

An aortic dissection can be serious as it may bust causing massive internal bleeding especially the blood will be flowing out from the aorta, the main artery in the body.

Let me explain a bit further.

There are three layers to the aortic wall. The inner wall or layer is called the tunica intima, the middle layer is called the tunica media, and the outer layer or wall is called the tunica adventitia.

Aortic dissection is the result from some tear in the aortic intima causing extravasation of blood into the aortic wall. This may result in aortic regurgitation and acute myocardial infarction, arrhythmias, haemopericardium, CVA, paraparesis, BP fluctuations in the extremities, bowel infarction and renal failure. 

The presentations are severe acute chest pains during onset, radiating to other areas. 

 Aortic dissection may be categorized according to DeBakey classification into

 1. Proximal to distal, from ascending aorta, arch down to the ascending aorta 

 2. Proximal, affects only the ascending aorta

 3. Distal, affects only the descending aorta, distal to left subclavian artery.

The urgent aim of treatment is to reduce systolic blood pressure to 100 to 120 mm Hg.

 The therapy of choice consists of giving IV nitroprusside combined with IV propranolol at 1 mg diluted in 5 ml of water every 5 minutes up to a maximum of 10 mg.

 Once BP is under control, surgery is considered for type 1 and type 2 

 Conservative treatment may be considered for type 3 aortic dissection. 

 

In your case, there was a tear between the inner intima and the middle media layer due to weakening of the walls of your aorta which is the main artery of your body. This weakening may be due to age as in your case, free radical damage, high blood pressure, or all 3 combined plus other causes as well.

 

The tear in the inner layer in your aorta caused the blood to enter between the inner and middle layers of the aorta to split (dissect) as shown in diagram from your CT scan. If the blood goes through the outside aortic wall, aortic dissection is often fatal as it will cause massive bleeding. However, in your case what I saw in the CT scan (I suppose it was a CT scan you showed without telling me further), the blood did not go any further into the tear along a long segment of your aorta. It stopped after a short segment. This may finally cause a blood clot to be formed in this area to block the blood from flowing any further into the segment between the intima and media (inner and middle walls of the aorta)  

 

In other words, the weakening of your aorta walls caused a tear in the intima and resulted in blood flowing between these two walls.  In other words, this caused blood to seep in between the walls of your aorta causing a bulge (aneurysm) there.  The weakening may also have caused that part of your aorta to bulge out like a balloon which your doctor there in Singapore initially reported as a pseudoaneurysm using ultrasound (Duplex ultrasound scan), but later confirmed it as a tear in the inner wall using CT scan.

 

A pseudoaneurysm is the result of an injury such as a tear to the blood vessel in your case. The artery then leaks out blood, which then pooled near the damaged spot. It's different from a true aneurysm, which happens when the wall of a blood vessel stretches and forms a bulge which may not necessarily bleed.  

 

As far as your question your doctor in Singapore wanted to follow up using CT  for you, I do not suggest that, because  it is NOT safe to use CT scans all the time as CT is actually x-rays, a prolonged exposure to this harmful radiation, often as long as 20 -30 minutes  which is not safe especially for your age, compared to ordinary x-rays that is just 1- 2 seconds of exposure.

 

CT scans means a computerized tomography that combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays but are less sensitive than magnetic resonance imaging (MRI) that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. MRI though much safer like ultrasound (ultrasonography such as Duplex) where harmful radiation is used in CT, it is more expensive.

Since we now know your case using a CT scan, is a tear in the inner lining of your aorta causing blood to flow between the intima and media, causing a pseudoaneurysm, I suggest you follow this up using only Duplex ultrasound to see if the bulge gets bigger over a short time. Initially, maybe you follow this up on a monthly basis for only 6 months, and if stable, follow it up only at a 3-month period, and if there is no further enlargement, follow it up 2 or 3 times more over a 6-month period.

 

If it is still stable, a yearly ultrasonography will suffice.  Then after a year, if it is still stable, you may do another CT scan (but much safer to use MRI) to see the condition of the tear and haemodynamic (blood flow) in that part of the lesion after a year.  

If during this period of monitoring, if the aneurysm becomes bigger which can easily be measured using the much cheaper and safer ultrasonography (Duplex), you can then consider using minimally invasive (keyhole) surgery (laparoscopy) to put a stent over that area to strengthen that part of the aortic wall. However, an aortic aneurysm stenting may also carry some risk of graft infection and possibly also narrowing of that part of the aorta (aortic stenosis) unless they use a drug-eluting stent which may only provide short-term solution after the anticoagulant drug is washed off by the continuous flow of blood through the main artery (aorta) of the body.  Here we may have another problem.

Furthermore, a clear patency benefit of a drug-eluting stent over bare metal stents for treating artery disease has not been definitively demonstrated.

In this surgical procedure, a cut is made in the upper thigh through which a catheter carrying the stent is inserted.  The stent graft is then guided using x-rays or by multi-detector CT Imaging through the arteries to the location of the aortic aneurysm. The stent graft is placed at the site and opened up.  Sometimes, they may use a fluoroscope which is also x-rays to guide the catheter in.  Whichever the procedure, you cannot avoid exposure to the radiation of x-rays.

Dye may then be injected into the blood after the stent graft is placed to make sure the entire procedure is in order and the stent is in place and working properly, and that blood is not leaking into the aneurysm. Injecting radiopaque dyes for x-ray monitoring itself is also not safe since your kidney functions are currently slightly below normal. Your blood creatinine and urea levels from the blood tests you showed me are slightly higher than normal, plus your glomerular filtration rate (GFR) is also lower than normal now. All these indicate your kidneys are less efficient now, and exposure to all these procedures may compromise your kidneys further.  The dye needs to be seen by X-rays which is yet another problem with the radio-opaque dye.

So, you need also to consider all these benefit / risk ratios for surgical options if the aneurysm becomes more pronounced on ultrasonographic measurements.

Aortic aneurysm besides aging is also linked to uncontrolled high blood pressure, and most common among elderly males.  If left untreated, the wall can fatally rupture which in the United States has 10,000 deaths annually. But I have no statistics in Singapore.

Consider all these first if you opt for surgery. But if I were you, I would just leave it and just monitor using Duplex ultrasonography.

Later, I shall find out if there are other alternative options such as the application of dietary and nutrition approaches to  strength the blood vessels from further damage or the use of botanical medicines such as the application of  yarrow, garlic, ginger, hawthorn,  Centella asiatica (Indian pennywort, pegaga, goto kola, etc), horse chestnuts, pine bark extracts, Butcher’s broom…etc, etc. that can support vascular health. But let me search the literature first to review studies done conclusively on these.  their dosages, period of application as much safer alternative therapeutic options.

Kindest regards,  

Your brother Lim ju boo

 

 

 

 

A Second Opinion on Births and Rebirths of Heavens in Cyclic Patterns

 

On Tuesday, December 10, 2019, I forwarded a theory for forum discussion as  a student doing a course in astronomy at the University of Oxford that there could  be previous universes before ours and there could also  be many more universes (heavens) yet to come as new heavens and new  earths

I wrote a hypothesis on that which is greatly summarized here in non-technical language for my general and gentle  lay-readers

Were there Previous Heavens and Future Heavens Yet to Come

https://scientificlogic.blogspot.com/search?q=Were+there+Previous+Heavens

Then about 40 minutes ago on  Sunday, 12 February 2023, at 4 am in the morning, I found Nobel Prize winner in physics Professor Sir Roger Penrose, a British mathematician and astrophysicist also came out with this same thought and hypothesis.

Roger Penrose – Wikipedia:

https://en.m.wikipedia.org/wiki/Roger_Penrose

Big Bang Did Not Start The Present Universe: Physicist Roger Penrose

https://www.outlookindia.com/national/big-bang-did-not-start-the-present-universe-physicist-roger-penrose-news-195972

Professor Sir Roger Penrose has said that the present universe did not start with the Big Bang and that there was another universe before the present one.

In the Bible in Revelation 21-22 it also spoke of a New Heaven & a New Earth after this present universe (heaven) is destroyed

But I think there shall also be many more new heavens and new earth yet to come in a cyclic births and rebirths

Do you think this is a coincidence or is it a vision given ?

Seek, it shall be given, knock, it shall be opened (Luke 11:9) (Matthew 7:7)

Seek and pray not for material wealth that lust and last like a vanishing vapour in the night, as a dew in the morning, but for wisdom and vision that is eternal and they shall be opened and given (to our souls)

Give this a very deep thought

Lim jb