Wednesday, April 15, 2015

Choices

Everyone hates paying taxes, but it is so much worse when you know that the money taken from you is being used to support jihadists and terrorists throughout the world. Obama has made our country a sponsor of terrorism. Should one go Galt? Should we refuse to fund our own destruction? Then, US falls apart and this is precisely what Obama and his gang are working towards. They are parasites that invaded our nation and how do we get rid of them without destroying the country?


Tuesday, April 7, 2015

Advice from the Sultan

The left is not fighting this as a war of ideas. It attacks the area of least resistance with whatever slogan or argument is most convenient at the time. Don't debate its ideas. Indict its hypocrisy. It mocks the values of others, but demands that what is sacred to it be off limits. This is a weakness. Don't defend your own values. Attack its values. You aren't the establishment. You lost. You're the rebels. Be rebellious. They are the owners. Wreck what they have made without counting the cost.

This is some heavyweight advice, and I intend to ponder it some more and think of how to implement it. Think about it, for over a week we are talking about a father and daughter who make pizzas and how they should have the right to freedom of association, the right to hold their religious teachings sacred,...  

We stopped talking about Hillary and her web of lies and now feel compelled to defend our values and plead for understanding.  I think the Sultan is absolutely correct. The left propaganda machine wants to find someone to beat up on, lets talk about the death threats the Pizza owners received, lets talk about Obama's lies, lets talk about what the left's cultural teachings have brought to their communities and our country as a whole.  Lets talk about failed families and wrecked lives that the left's "change" brought to our culture and our country.


Monday, January 26, 2015

Achtung, your papers!

Revolution that fascist shit all over NY have been waiting for, has finally arrived. As another commie said - "Don't let a crisis go to waste".

Tonight, MTA will cease all operations by 11PM, including LIRR and MetroNorth. In addition, a curfew covering all non-essential individuals has been imposed in NYC. The curfew will go into effect at 11PM. Health care workers traveling to work with proper identification are exempt from this curfew. - From a letter sent to nyc hospital staff.



New Yorkers should get used to being shoved around and treated like criminals, because guess who is running the city and the state. When you can no longer move around freely, you're in jail. Enjoy communism, NYC.

Sunday, November 23, 2014

Immigration Reform.

The million immigrants a year are not entering booming industries, but serving as cheap labor in declining ones. And they’re doing it in a country where declining industries and poor workers are already being subsidized by taxpayers in a dozen different ways. Why then should taxpayers also be subsidizing the replacement of American workers with Somali and Honduran workers?
-Sultan Knish

Saturday, November 22, 2014

Why have the patients treated for Ebola in the U.S. done so well?

The truth is, we don't know.  There is a scarcity of quality information on this outbreak because the governments in the 3 hardest hit countries don't want negative publicity. The reporters from developed Western countries have returned to their countries after some of them contracted the disease, and I have not heard of any news crews returning to West Africa.

Recently, there was a study published in NEJM by Schieffelin et al, which reported observations made at the Kenema hospital in Sierra Leone. There, they found 57 percent mortality among those younger than 21, and 94 percent mortality among those aged 45 and older. Overall fatality from Ebola was 74 percent. These are some pretty scary numbers and they simply do not compare with what has been reported in the case updates provided by WHO and the CDC. In the latest situation update from WHO, Sierra Leone reports a total of 6190 cases, with 5150 of them being confirmed and only 1267 fatalities. If you calculate the mortality from this report, you get only 20% using total cases or 24% if you only use confirmed cases number. The most likely explanation is that the numbers reported in WHO and CDC surveys are bogus.

Here in USA, everyone who received treatment early during the course of their illness, including the 2 nurses from Texas and the irresponsible doctor treated in NYC, survived. So how do you square the remarkable survival rates we've seen in the few people treated here at the US, with the survival rates reported in that study cited above? One possibility is that the people who were treated at the Kenema hospital were much sicker than the typical person who contracts this strain of Ebola. Perhaps those with only mild symptoms never show up at treatment centers in Sierra Leone and are able to weather this disease at home. Another possibility is that the folks treated in the U.S. were given medications unavailable in West Africa, such as Zmapp, early during the course of their disease, and such medications proved very effective. To repeat what I said in my opening sentence, we just don't know.

Saturday, November 15, 2014

Some Hopeful News on Ebola

First I would like to state that this epidemic, in all likelihood, is still raging out of control in West Africa. The numbers being reported by WHO and CDC are likely nonsensical and the motivation for under-reporting is that the 3 hardest hit countries are under tremendous financial pressures. In many villages there are no signs of life and many people are struggling to find food. The fact that the number of dead in Liberia keeps going down, offers ample proof that this number is bogus.  Our best solution to keep our own country stable is to institute strict quarantine on travel from West Africa and do everything we can to prevent this disease from reaching our shores.

Furthermore, as this disease spreads beyond Liberia, Sierra Leone, and Guinea, the number of infected travelers to the U.S. will briskly increase once there is a significant outbreak in Nigeria and the Ivory Coast. The reason for my statement is partly anecdotal as, in my 8 years of working for a city hospital, I don't recall treating anyone from these 3 countries but I have had several patients from the Ivory Coast and numerous patients from Nigeria. The population of Ivory Coast is about 23 million and Nigerian Population is 174 million, while the combined population of Sierra Leone, Guinea, and Liberia was around 15 million.  Obviously we have many more commuters to the U.S. from these 2 larger populations.

I predicted that people would run from there, once the threat of Ebola became bad enough, and obviously some people like Duncan did run. Perhaps these countries are so destitute that most people simply don't have the means to travel outside their area and so far, the rapid transit of Ebola stricken people to the rest of the world hasn't been as severe as I feared. For the reasons stated above, I believe all this can change once these other countries, that border the 3 currently affected, become heavily infected.

By this point, you are probably wondering where is the hopeful aspect of my post. The hopeful aspect has to do with the ability to survive this infection inside the U.S. or other first world countries. While we haven't had tons of experience dealing with this virus here, thank God, we have had some. The early case named Duncan didn't make it, no matter what we threw at this illness, but several others have. What we can offer here that is unavailable in West Africa is appropriate management of kidney failure and appropriate fluid management. It appears that the early period of a severe Ebola illness is marked by profound diarrhea, to the tune of 6 litters per day and inability to drink enough fluid - probably due to vomiting. They can set up an IV in West Africa, but they are unlikely to get quick lab results back and manage the associated electrolyte disturbances as well as we can here. This has to do with having a good lab in your facility that can give you results within an hour or 2.  Another item they don't have as good an access to is dialysis, which seems to have played a role in stabilizing several Ebola patients who were treated successfully with 1st world medicine.  Duncan did receive dialysis, which was a very risky procedure for the staff, but he still died. However others lived, and consequently Ebola mortality here hasn't reached the 70-90% range seen elsewhere. As the illness progressed further and complications of bacterial sepsis occurred in the severely ill man treated in Germany, he had access to effective and powerful antibiotics and mechanical ventilation. These things are also not widely available in West Africa. Bottom line, he lived because of his access to such medical treatments whereas, if he had stayed in Africa, he would have died.

So in this hopeful part of my post, I have reason to believe that mortality from Ebola in the U.S. will not be as severe as it is in Africa. If I had to guess based on known survival patterns for sepsis and organ failure, I would guess it will be somewhere in the 25% range. Still, you should take such assessment with a grain of salt because it is impossible to do good statistics on so few cases as we have treated here, and often times theory based predictions turn out to be poor predictors of reality.

Another important point to make is that our ability to deliver such high level of care to someone infected with such a deadly pathogen is very limited. Outside the 20 or so BL4 beds available in this country, the other hospitals attempting to treat such patients will place themselves and their other patients in great risk. In terms of financial risk, the hospital that treated Duncan in Texas lost millions, even before they settled with Duncan's family. This was a 900 bed hospital and patients continue to avoid it like the plague, and therefore much of it remains empty. I would not be surprised if it goes belly up soon. Just imagine such financial impact hitting multiple hospitals throughout the U.S. The key to avoiding this devastating burden on our already severely stressed medical system here, is to send all such infected patients to the few operational BL4 beds we have. The best way to keep a manageable low census of such patients remains through effective quarantine.  I sure hope our politicians will take this threat seriously and not become fooled by the obviously false estimates coming out of West Africa.