Darrell Issa's remarks about Obama:
'In an interview with Rush Limbaugh in October, Issa dubbed President
Barack Obama "one of the most corrupt presidents in modern times."And this
quote:
"Rep. Darrell Issa of Vista [Calif] will have the power to investigate and
subpoena the Obama administration, which he has pledged to do."
Quote in The Mercury News today 11:10 AM 12/26/2010
And I want to discuss what I call Obama's Destroy America Plan:
1) turn US miltary into social experiment to give homosexuals a springboard to
government paid pensions and benefits ;and reduce effectiveness of fighting forces.
2) make Medicare a " feeder fund" for abortionists and Planned Parenrhood;
and the Medicare beneciariesfodder for hospice killing organizations.
Read http://prolife-nurse.blogspot.com for
entry for 26/Dec/2010 more on topic that was in NY Times labeled 'end-of-life-plan
of Obama'
3) funnel all income through the federal government one way or the other to get
control of it. Reduce all private sector jobs by taking over industries and tranferring the
wealth of private corporations to public government of US.
4) Write an executive order [despot's decree since no authority for any such activity in
the true laws of the US which is the US Constitution] relabeling preborn humans
as 'research material' for 'scientists' so they get billion dollar grants from NIH to kill
preborn humans and call it research. Similar to gassing the jews by first labeling them as 'non-Aryan'
in order to turn the nation agains them to get their wealth in the
Nazi regime.
5) Saddle every man.woman and child in America with millions of dollars of debt created
by Obama plans but do not include illegal emigrants in the debt since the plan is to help
them overthrow the government via anarchy.
6) Send/transfer all military equipment to Russia/Iran/China through the Afghanistan
corridor in exchange for opium and hard drugs to narcotize the nation with.
7) Set up secretive 'drug plans' via Medicare/Medicaid to pay for the aforementioned drugs.
8) Persecute all christians by spying on them, censoring their First Amendment liberties,
intercepting their emails, confiscating their hosting of websites,taking down Christian
content without due process and thus violating their civil liberties.
9) using the U S federal government ' agencies of NIH,CMMS,DHS to spy on.control,regulate
communications of the poor and needy to keep them [they think] docile and subservient to
"Big Brother government'.
10) to use student loans as a weapon,giving children of the so-called politically correct
[always demoncrats] grant money and giving children of poor republicans loans, and requiring
payback of loans selectively, acting as loan sharks in some cases, refusing to even verify some
people graduated college until they pay back their student loans but they can't pay back their student
loans with no proof of graduation[ withheld by Dept of Ed; and ruined credit also on purpose
by the Dept of Propaganda aka Education]. And refusing to report to credit bureaus when
payments are made to Dept of Ed in attempt to forever control the credit report of prolifers
and republicans. { I know this first-hand as I have paid back $5600 to Dept of Ed for a $2500
student loan and they have NEVER reported it as paid back though paid ,monthly for nearly 3 years.]
The Department o Education is sort of like that Nigerian email scam only with them their propanganda is
'get a student loan,get a college degree' but what they don't tell you is they have so much
absolute power over your life via credit reports since they only update them for those who kill
on demand,[abortionists/killer groups] and for those who kiss Obama's behind or nether parts daily.
Gloria Poole; in Missouri; 11:50am;26/Dec/2010
I, Gloria Poole, am a Registered Nurse licensed in Missouri and an artist. I am also a graduate of University of Georgia and Georgia Baptist College of Nursing. I moved to Republic MO on 31Jul 2023. I am a white,unmarried,Christian, woman.
Sunday, December 26, 2010
Tuesday, December 21, 2010
A Plan to Improve Meds against Malaria
I read an article this morning in the BBC news for Africa [I read all news,all countries,generally speaking or headelines only sometimes,] about a plan being developed to provide a way for people in Niger and Ghana to know for certain if medicines they bought for malaria,are authentic. The real ones would have a scratch-off code printed on the prescription label that could be texted to the pharmaceutical company-maker and they would reply back if real medicine or placebo sold as real medicine. This is close to home to me since my youngest daughter
Leigh served in one of the West African nations in the Peace Corps and had to take anti-malarials while there for two years. Once when I talked to her via telephone, she said that fake medicines were a big problem there and that what is called a clinic there in certain areas is not remotely what Americans envision when we hear that word. And that she was worried ,and then of course, I was very worried too.
Before she went to there years before in fact, when I lived in Falls Church Virginia, and was told by the Episcopal Church there that they were sending 'medical volunteers' to dispense medicines and to take medicines to Africa, and I asked how that is possible since volunteers are not allowed to dispense medicines in the US [requires licensure of some sort: MD,RN,RPh] their reply was that it was allowed because a mission/charity. I was appalled that there would be a total removal of standards of care simply because a mission effort was funding it, and said so. Of course, that put me in disfavor with the Episcopal Church there. Nevertheless, it is still my concern that Africa needs a HIGHER standard of care than America in all cases because of the AIDS/HIV prevalent there, the malaria risks, the endemic poverty,the emaciation of many of their people which leads to many problems including how the liver detoxifies medicines, and the immune system.
The article in the BBC today shows some companies are combatting some of the problems of mercenaries and charlatans in Africa.
Also, speaking of charlatans, I fear that is also happening in the US' Social Security System. I am anti-drug generally speaking,meaning I do not believe in pain medicines that knock a person out except DURING general anesthesia, nor do I believe in mind-altering drugs. I have avoided those like the bubonic plague. I cannot get caught up in addicting substances or have my ability to think controlled by chemicals. I am supposed to take anti-seizure meds however and because of that, I considered signing up for the disability drug plan through Social Security. The reason I am telling you the public this is because that drug plan seems to be secretive. I have gone through several steps to find the information about it-- about the premiun for it, and what it covers. I asked at the Soc Security office who told me to call a number and I called the number and got a recording., left message, and 'volunteer' called me back wanting my SSN, and I said no way. I was told then the premium depended upon what zip code I live in, and that I would have to wait on another volunteer to call me back. I decided if the premium is secretive and or rigged so that some people [depending maybe on political party you are in??] pay more than others I would not sign up for such a suspicious program. I want to stay alive and I want to have honest people who work for Social Security to answer my questions and not unknown 'volunteers' calling me from 800 number asking for my SSN.
I am always anxious about any medicine since I have had some very bad adverse reactions to prescription medicines in the past, but to put my information and or medical history and or future medical needs into the hands of a volunteer sounds like voodoo medicine to me--some of that version of ObamaCare from Indonesia's witch doctors. I do not want Obama controlling my medicines nor his spies.
I want real doctors who promote life and real Pharmacists when I need medicines.
Gloria Poole,RN;7:32am;21/Dec/2010
Leigh served in one of the West African nations in the Peace Corps and had to take anti-malarials while there for two years. Once when I talked to her via telephone, she said that fake medicines were a big problem there and that what is called a clinic there in certain areas is not remotely what Americans envision when we hear that word. And that she was worried ,and then of course, I was very worried too.
Before she went to there years before in fact, when I lived in Falls Church Virginia, and was told by the Episcopal Church there that they were sending 'medical volunteers' to dispense medicines and to take medicines to Africa, and I asked how that is possible since volunteers are not allowed to dispense medicines in the US [requires licensure of some sort: MD,RN,RPh] their reply was that it was allowed because a mission/charity. I was appalled that there would be a total removal of standards of care simply because a mission effort was funding it, and said so. Of course, that put me in disfavor with the Episcopal Church there. Nevertheless, it is still my concern that Africa needs a HIGHER standard of care than America in all cases because of the AIDS/HIV prevalent there, the malaria risks, the endemic poverty,the emaciation of many of their people which leads to many problems including how the liver detoxifies medicines, and the immune system.
The article in the BBC today shows some companies are combatting some of the problems of mercenaries and charlatans in Africa.
Also, speaking of charlatans, I fear that is also happening in the US' Social Security System. I am anti-drug generally speaking,meaning I do not believe in pain medicines that knock a person out except DURING general anesthesia, nor do I believe in mind-altering drugs. I have avoided those like the bubonic plague. I cannot get caught up in addicting substances or have my ability to think controlled by chemicals. I am supposed to take anti-seizure meds however and because of that, I considered signing up for the disability drug plan through Social Security. The reason I am telling you the public this is because that drug plan seems to be secretive. I have gone through several steps to find the information about it-- about the premiun for it, and what it covers. I asked at the Soc Security office who told me to call a number and I called the number and got a recording., left message, and 'volunteer' called me back wanting my SSN, and I said no way. I was told then the premium depended upon what zip code I live in, and that I would have to wait on another volunteer to call me back. I decided if the premium is secretive and or rigged so that some people [depending maybe on political party you are in??] pay more than others I would not sign up for such a suspicious program. I want to stay alive and I want to have honest people who work for Social Security to answer my questions and not unknown 'volunteers' calling me from 800 number asking for my SSN.
I am always anxious about any medicine since I have had some very bad adverse reactions to prescription medicines in the past, but to put my information and or medical history and or future medical needs into the hands of a volunteer sounds like voodoo medicine to me--some of that version of ObamaCare from Indonesia's witch doctors. I do not want Obama controlling my medicines nor his spies.
I want real doctors who promote life and real Pharmacists when I need medicines.
Gloria Poole,RN;7:32am;21/Dec/2010
Saturday, December 18, 2010
Senate: NO to Obama's plan to divide US;Warn wicked
Senate: this is my open letter asking you to remember that the plan of Obama to divide and conquer the US Military by turning them against each other so that homosexuals are fighting heterosexuals instead of the enemies of the US, will destroy America. The divide and conquer scheme is the devil's oldest tactic. The first recorded time he used it was when he hissed to Eve in the Garden of Eden that she could defy GOD and live. What the devil-serpent did not tell her was that by defying GOD and eating from the tree GOD told her not to eat from she introduced sin into the Garden and she introduced death physically and death of the soul [in hell] and death as a generational curse [since one of her sons killed another of her sons also being disobedient to GOD].
GOD told Moses to tell the men that having sex with men is abomination to GOD. The exact words are in Leviticus 18:22, King James Holy Bible.And in Romans chapter one of same Bible beginning with verse 18 [summed up] it says the wrath of GOD is revealed against those who worship the created human more than The Creator GOD. Those in Congress who are wanting to throw away America to appease an element that is not one percent of the population are not only fools but evil fools who think "they can" defy GOD and get away with it. But in the last verse of Romans chapter one it says the end result of those is death. I encourage you to read those scriptures for yourself because some people don't believe anything they read in a blog. Read Romans 1: 18-32 King James Holy Bible. And also read Galatians 6:7 which is written, 'be not deceived. GOD is not mocked."
I beleive the Word of GOD as written in The Holy Bible to be true and because of that, I believe if the US Senate legalizes sodomy as a 'right' trying to defy and mock GOD, it will destroy the US Senate and the nation of the United States by the deeds of GOD HIMSELF.
The Bible says to warn the wicked and this is my attempt to do that. Senate, do not legalize sodomy or homsexuality in any form, or wording or trick method. You will collectively and individually answer to GOD if you do.
Gloria Poole.in Missouri;8:55am;18/Dec/2010
Update @ 9:21am;
i logged back in to add this info. I know for certain that homosexaul/bisexual men are terrorists and are reprobate in their minds because I unwittingly married a seond time a man who was bisexual. I did not know he was bisexual and he moved more to being totally homosexual after marrying. It seemed the marriage was merely a ruse by him to gain financially. I am divorced from him now since Oct 2007 and thank GOD and resumed my maiden name via court order in Arapahoe Count Colorado, and moved to Missouri in Oct 2009. My point is homosexual men,[ and I have no experience with homosexual women and thank GOD, but the Bible says they are the same reprobates in Romans chapter one verses 26-30 as referenced above], are not like heterosexual men at all. Sodomite men and homosexual women are described in verses 29 -31 as "being without natural affection" , "implacable","full of envy" murderous,unrighteous,unmerciful--not the sort of persons you want to find yourself in close encounters with--they are sort of like the devil. I barely survived my encounter with the devil and but for GOD, I'd be dead. Do not unleash that evil on the military that is supposed to defend the nation.
GOD told Moses to tell the men that having sex with men is abomination to GOD. The exact words are in Leviticus 18:22, King James Holy Bible.And in Romans chapter one of same Bible beginning with verse 18 [summed up] it says the wrath of GOD is revealed against those who worship the created human more than The Creator GOD. Those in Congress who are wanting to throw away America to appease an element that is not one percent of the population are not only fools but evil fools who think "they can" defy GOD and get away with it. But in the last verse of Romans chapter one it says the end result of those is death. I encourage you to read those scriptures for yourself because some people don't believe anything they read in a blog. Read Romans 1: 18-32 King James Holy Bible. And also read Galatians 6:7 which is written, 'be not deceived. GOD is not mocked."
I beleive the Word of GOD as written in The Holy Bible to be true and because of that, I believe if the US Senate legalizes sodomy as a 'right' trying to defy and mock GOD, it will destroy the US Senate and the nation of the United States by the deeds of GOD HIMSELF.
The Bible says to warn the wicked and this is my attempt to do that. Senate, do not legalize sodomy or homsexuality in any form, or wording or trick method. You will collectively and individually answer to GOD if you do.
Gloria Poole.in Missouri;8:55am;18/Dec/2010
Update @ 9:21am;
i logged back in to add this info. I know for certain that homosexaul/bisexual men are terrorists and are reprobate in their minds because I unwittingly married a seond time a man who was bisexual. I did not know he was bisexual and he moved more to being totally homosexual after marrying. It seemed the marriage was merely a ruse by him to gain financially. I am divorced from him now since Oct 2007 and thank GOD and resumed my maiden name via court order in Arapahoe Count Colorado, and moved to Missouri in Oct 2009. My point is homosexual men,[ and I have no experience with homosexual women and thank GOD, but the Bible says they are the same reprobates in Romans chapter one verses 26-30 as referenced above], are not like heterosexual men at all. Sodomite men and homosexual women are described in verses 29 -31 as "being without natural affection" , "implacable","full of envy" murderous,unrighteous,unmerciful--not the sort of persons you want to find yourself in close encounters with--they are sort of like the devil. I barely survived my encounter with the devil and but for GOD, I'd be dead. Do not unleash that evil on the military that is supposed to defend the nation.
Saturday, December 4, 2010
Learn about cholera
This lesson is about cholera since it is the news as being in Haiti.
Cholera is an acute infection of the gastrointestinal tract. It is caused by vibrio comma [V.cholerae] which is a gram negative, short,curved bacillus [bacteria] with a terminal flagellum. It is aerobic meaning it needs air to thrive, and is mobile,grows on ordinary culture mediums, and exists in favorable condtions for a few days but dies out in the bowel movement in 1-2 days. Cholera is acquired by ingestion [eating,swallowing] food or drink contaminated with feces which conatins the v.Chloerae bacteria. Which is why you should always wash your hands before eating,before handling food,after touching your shoes,or being in areas where feces might be on handles,seats,etc [public btahrooms, or in rural remote areas those places designated as 'outhouses',or outdoor bathrooms.
.
History of disease
Cholera is always present in the lower Ganges River in India, because of the contaminated water of that river where animals and humans bathe [and probably defecate]. It spread to China in the 17th century. A number of pandemics [defined by WHO] occurred in the US during the 19th and 20th centuries but was practically eradicated at the seaports after 1873. During and after World War I, there were epidemics in Europe. Also during WWII there were epidemics in the "Far East" and "Near East' but at that time they did not reach the Americas or Europe.
Improved sanitation and enforcement of the International Sanitary Regulations has resulted in cholera being mostly in lower Ganges River now and in areas where flooding,and sanitation merged [sewers ran over, and cesspools did, and contaminated flooding with feces happened] .
Epidemiology
Subclinical disease may be present in some communities.Sub-clinical means that symptoms have not appeared yet. The most likely sources of the bacteria are those people in the incubation stage or with mild symptoms. Contaminated water is the most often method of the disease spreading. [Which is why if you are in areas where flooding occurred,or known cholera disease reported,or known fecal contamination
you shoud boil your water before drinking or bathing. Flies also spread the disease bacteria. The conditions which cause it to rapidly spread are high tempaerature, high relative humidity,and intermittent rains[monsoons,flooding]. It is possible for it to spread rapidly but everyone who comes into contact with it does not necessarily contract it.
Symptoms,signs,and morbid anatomy
It is characterized by diarrhea,vomiting,dehydration, which is severe in most cases. Striking changes to the person's appearance occur because of the extreme dehydration. After death of cholera-infected persons,the rigor mortis is unusually marked. Dryness and shrinkage of person's flesh/bulk is apparent everywhere. Inflammatory changes are not usually present. The person's blood is thick and scanty. The walls of the intestines are bluish looking and congested. The membranes look like
ground glass and are sticky. The lumen of the bowel contains gray opalescent liquid not feces.
Large areas of mucosa may be gone but ulceration is not present. The lymphoid tisse of the ileum may be prominent. The kidneys show marked congestion.
Pathology
The cholera vibrio is primarily found in the ileum,but may be also in small numbers in the lungs and other organs of the body. They are seldom found in the blood stream. The bacteria does not produce an exotoxin,but does produce a powerful endotoxin. The usual first effect of infection is loss of large amounts of fluid and salt as a result of profuse vomiting and diarrhea.
That affects the acid-base balance of the body. The extraction of massive amounts of fluid from the cells,tissues,spaces,in a short period of time,is rarely found in any other disease except infant diarrhea,and hemorrhage of blood. The blood quickly becomes concentrated with specific gravity of 1.070;20 gms hemoglobin per 100 cc of blood,and 75 for erythrocite volume percentage,and 7,000,000
per cu mm for erythrocyte count. The concentration of plasma proteins is also inreased,and the circulation of blood throughout the body is greatly effected. The blood pressure falls,and the cardiac output [blood pumped by heart] is much decreased [shock]. Because of these systemic problems,the
renal function is greatly compromised and impaired unto death. [When enough blood does not get to to the brain,heart and kidneys, the person dies.] The sodium lost from the infected bowel results in a shift of the acid-base balance of sodium and chloride and is accentuated by the acid which is
retained when the kidneys start failing. Values as low as 7.1 were noted in some people for pH,and 138 milliequivalents per liter for the total base in the blood. Urea and nitrogen are retained because of renal failure. If a person dies in the early stages of cholera it is usually because of dehydration.
But in the later stages death is usually from renal failure.
Having cholera and surviving it does not prevent another infection later i.e. it does not cause the person to build antibodies against it.
Incubation and physiology
The incubation period is 1-5 days, with sudden onset usually. It might be preceded by depression, malaise,and simple diarrhea. Cholera infection is manifested by volumes of watery stools,copious vomiting,and being unable to get up. The speed with which it becomes overwhelming to the body is striking. Stools are so frequent that soon lose any fecal content and start sloughing off the inside of the bowel, but no blood or pus is noted. The absence of tenesmus is often noted.
Vomiting may occur without nausea or retching [projectile and sudden]. Great thirst occurs but fluids or food are vomited up. The person becomes gaunt, and pinched looking with sunken eyes.
The skins becomes bluish [cyanotic] and shriveled. The voice becomes thick and feeble.
Marked tachycardia [fast racing pulse] occurs and pulse may be barely perceptible. The blood pressure may fall below 60 mm mercury for systolic. Urine may cease [a particularly important sign of approaching death] and uremia may result. The body temperature falls.
Diagnosing cholera
Patient history is very important. If the person lives in an area where cholera reported, or conditions ripe for it to flourish,it should be suspected in cases of extreme vomiting and diarrhea.
Other condtions which give similar symptoms are bacillary desentery, food poisoning,heat exhaustion,some forms of malaria, and other conditions associated with shock secondary to diarrhea. It is very important that the accurate diagnosis be made as quickly as possbile as the implications for the household and community are enormous when misdiagnosed.
The specific diagnosis is made by testing the stools passed, by agglutination of V cholerae. Cultures have be done on fresh stool, and examined under microscope for the bacillus.
Prognosis
The outcome depends on how quickly cholera was diagnosed and treated, and how good the person's health was before contracting cholera. The course of the disease averages 3-5 days but death could occur in hours, and after many days also. If not treated quickly, the mortality rate is about 60 percent. With quick and appropriate treatment,the death rate is about 5 percent.
Treatment
Strict Isolation of infected or exposed persons.
Boil clothing of infected persons and drinking,eating utensils.
Disinfect as for typhoid standards.
Keep person warm.
Give fliuds but usually cannot retain those by mouth,so give intravenously.
Do not give sedatives,pain medicines, because likely to mask or worsen situation.
Give electrolytes by IV and or by mouth when better.
Do not give blood or blood products [blood already concentrated].
Start physiological saline intravenously as soon as diagnosis is made-critical to survival of patient.
Dextrose 5 % solutions IV ar rate so as not to exceed 50 gm of dextrose per hour after saline.
Patients with cholera need rehydration faster than almost any other disease but it is possible to overload their circulatory system if too fast.
The best indicator of improvement is the specific
gravity of the blood. As as the specific gravity approaches its normal [1.056-1058] for the blood, IV fluids should be slowed.
As a general rule, two liters of Normal Saline are needed in first 2 hours,
and more afterwards at slower rate so that 4-8 liters is often required to bring blood viscosity to normal.
In some cases the loss of alkali will have to be replaced. The acidosis of cholera is different from the acidosis of diabetes or nephritis. Ketone is not present in cholera patients' urine. Alkali replacement may be IV sodium bicarbonate with 18 gm sodium bicarb and 6 gm sodium chloride to one liter of sterile distilled water. It is not unusual for cholera patients to need 500 cc of alkali replacement fluids
Also potassium and phosphate have to be replaced via IV.
Prevention
Handwashing after toileting,after handling shoes,after being in area known for cholera present,after touching sick person,or handling food trays/paltes.utensils.
Proper disposal of stool contaminated items used by infected patients .
Blood and body precautions for medical personnel.
Quarantine infected persons.
Eradicate flies.
Strict control of water supply,with boil water command for community issued at diagnosis first case.
Disposal of food touched by infected persons.
Do not allow eating of raw foods,[vegetables,fruits,cheeses,etc] when cholera in community.
Close supervision of food handlers to ensure proper hand-washing,and disposal.
Vaccination
There is a cholera vaccine and it is recommended for those traveling or living in places known to harbor cholera bacillus.
References used
A Textbook of Medicine by Cecil & Loeb, with all put into laymen's terminology and simple words
to avoid jargon and reach more people.
Gloria Poole,RN; 7:18 PM 12/4/2010;
licensed in Missouri, and resident of Missouri
Cholera is an acute infection of the gastrointestinal tract. It is caused by vibrio comma [V.cholerae] which is a gram negative, short,curved bacillus [bacteria] with a terminal flagellum. It is aerobic meaning it needs air to thrive, and is mobile,grows on ordinary culture mediums, and exists in favorable condtions for a few days but dies out in the bowel movement in 1-2 days. Cholera is acquired by ingestion [eating,swallowing] food or drink contaminated with feces which conatins the v.Chloerae bacteria. Which is why you should always wash your hands before eating,before handling food,after touching your shoes,or being in areas where feces might be on handles,seats,etc [public btahrooms, or in rural remote areas those places designated as 'outhouses',or outdoor bathrooms.
.
History of disease
Cholera is always present in the lower Ganges River in India, because of the contaminated water of that river where animals and humans bathe [and probably defecate]. It spread to China in the 17th century. A number of pandemics [defined by WHO] occurred in the US during the 19th and 20th centuries but was practically eradicated at the seaports after 1873. During and after World War I, there were epidemics in Europe. Also during WWII there were epidemics in the "Far East" and "Near East' but at that time they did not reach the Americas or Europe.
Improved sanitation and enforcement of the International Sanitary Regulations has resulted in cholera being mostly in lower Ganges River now and in areas where flooding,and sanitation merged [sewers ran over, and cesspools did, and contaminated flooding with feces happened] .
Epidemiology
Subclinical disease may be present in some communities.Sub-clinical means that symptoms have not appeared yet. The most likely sources of the bacteria are those people in the incubation stage or with mild symptoms. Contaminated water is the most often method of the disease spreading. [Which is why if you are in areas where flooding occurred,or known cholera disease reported,or known fecal contamination
you shoud boil your water before drinking or bathing. Flies also spread the disease bacteria. The conditions which cause it to rapidly spread are high tempaerature, high relative humidity,and intermittent rains[monsoons,flooding]. It is possible for it to spread rapidly but everyone who comes into contact with it does not necessarily contract it.
Symptoms,signs,and morbid anatomy
It is characterized by diarrhea,vomiting,dehydration, which is severe in most cases. Striking changes to the person's appearance occur because of the extreme dehydration. After death of cholera-infected persons,the rigor mortis is unusually marked. Dryness and shrinkage of person's flesh/bulk is apparent everywhere. Inflammatory changes are not usually present. The person's blood is thick and scanty. The walls of the intestines are bluish looking and congested. The membranes look like
ground glass and are sticky. The lumen of the bowel contains gray opalescent liquid not feces.
Large areas of mucosa may be gone but ulceration is not present. The lymphoid tisse of the ileum may be prominent. The kidneys show marked congestion.
Pathology
The cholera vibrio is primarily found in the ileum,but may be also in small numbers in the lungs and other organs of the body. They are seldom found in the blood stream. The bacteria does not produce an exotoxin,but does produce a powerful endotoxin. The usual first effect of infection is loss of large amounts of fluid and salt as a result of profuse vomiting and diarrhea.
That affects the acid-base balance of the body. The extraction of massive amounts of fluid from the cells,tissues,spaces,in a short period of time,is rarely found in any other disease except infant diarrhea,and hemorrhage of blood. The blood quickly becomes concentrated with specific gravity of 1.070;20 gms hemoglobin per 100 cc of blood,and 75 for erythrocite volume percentage,and 7,000,000
per cu mm for erythrocyte count. The concentration of plasma proteins is also inreased,and the circulation of blood throughout the body is greatly effected. The blood pressure falls,and the cardiac output [blood pumped by heart] is much decreased [shock]. Because of these systemic problems,the
renal function is greatly compromised and impaired unto death. [When enough blood does not get to to the brain,heart and kidneys, the person dies.] The sodium lost from the infected bowel results in a shift of the acid-base balance of sodium and chloride and is accentuated by the acid which is
retained when the kidneys start failing. Values as low as 7.1 were noted in some people for pH,and 138 milliequivalents per liter for the total base in the blood. Urea and nitrogen are retained because of renal failure. If a person dies in the early stages of cholera it is usually because of dehydration.
But in the later stages death is usually from renal failure.
Having cholera and surviving it does not prevent another infection later i.e. it does not cause the person to build antibodies against it.
Incubation and physiology
The incubation period is 1-5 days, with sudden onset usually. It might be preceded by depression, malaise,and simple diarrhea. Cholera infection is manifested by volumes of watery stools,copious vomiting,and being unable to get up. The speed with which it becomes overwhelming to the body is striking. Stools are so frequent that soon lose any fecal content and start sloughing off the inside of the bowel, but no blood or pus is noted. The absence of tenesmus is often noted.
Vomiting may occur without nausea or retching [projectile and sudden]. Great thirst occurs but fluids or food are vomited up. The person becomes gaunt, and pinched looking with sunken eyes.
The skins becomes bluish [cyanotic] and shriveled. The voice becomes thick and feeble.
Marked tachycardia [fast racing pulse] occurs and pulse may be barely perceptible. The blood pressure may fall below 60 mm mercury for systolic. Urine may cease [a particularly important sign of approaching death] and uremia may result. The body temperature falls.
Diagnosing cholera
Patient history is very important. If the person lives in an area where cholera reported, or conditions ripe for it to flourish,it should be suspected in cases of extreme vomiting and diarrhea.
Other condtions which give similar symptoms are bacillary desentery, food poisoning,heat exhaustion,some forms of malaria, and other conditions associated with shock secondary to diarrhea. It is very important that the accurate diagnosis be made as quickly as possbile as the implications for the household and community are enormous when misdiagnosed.
The specific diagnosis is made by testing the stools passed, by agglutination of V cholerae. Cultures have be done on fresh stool, and examined under microscope for the bacillus.
Prognosis
The outcome depends on how quickly cholera was diagnosed and treated, and how good the person's health was before contracting cholera. The course of the disease averages 3-5 days but death could occur in hours, and after many days also. If not treated quickly, the mortality rate is about 60 percent. With quick and appropriate treatment,the death rate is about 5 percent.
Treatment
Strict Isolation of infected or exposed persons.
Boil clothing of infected persons and drinking,eating utensils.
Disinfect as for typhoid standards.
Keep person warm.
Give fliuds but usually cannot retain those by mouth,so give intravenously.
Do not give sedatives,pain medicines, because likely to mask or worsen situation.
Give electrolytes by IV and or by mouth when better.
Do not give blood or blood products [blood already concentrated].
Start physiological saline intravenously as soon as diagnosis is made-critical to survival of patient.
Dextrose 5 % solutions IV ar rate so as not to exceed 50 gm of dextrose per hour after saline.
Patients with cholera need rehydration faster than almost any other disease but it is possible to overload their circulatory system if too fast.
The best indicator of improvement is the specific
gravity of the blood. As as the specific gravity approaches its normal [1.056-1058] for the blood, IV fluids should be slowed.
As a general rule, two liters of Normal Saline are needed in first 2 hours,
and more afterwards at slower rate so that 4-8 liters is often required to bring blood viscosity to normal.
In some cases the loss of alkali will have to be replaced. The acidosis of cholera is different from the acidosis of diabetes or nephritis. Ketone is not present in cholera patients' urine. Alkali replacement may be IV sodium bicarbonate with 18 gm sodium bicarb and 6 gm sodium chloride to one liter of sterile distilled water. It is not unusual for cholera patients to need 500 cc of alkali replacement fluids
Also potassium and phosphate have to be replaced via IV.
Prevention
Handwashing after toileting,after handling shoes,after being in area known for cholera present,after touching sick person,or handling food trays/paltes.utensils.
Proper disposal of stool contaminated items used by infected patients .
Blood and body precautions for medical personnel.
Quarantine infected persons.
Eradicate flies.
Strict control of water supply,with boil water command for community issued at diagnosis first case.
Disposal of food touched by infected persons.
Do not allow eating of raw foods,[vegetables,fruits,cheeses,etc] when cholera in community.
Close supervision of food handlers to ensure proper hand-washing,and disposal.
Vaccination
There is a cholera vaccine and it is recommended for those traveling or living in places known to harbor cholera bacillus.
References used
A Textbook of Medicine by Cecil & Loeb, with all put into laymen's terminology and simple words
to avoid jargon and reach more people.
Gloria Poole,RN; 7:18 PM 12/4/2010;
licensed in Missouri, and resident of Missouri
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