This was a sobering story on CPR in the elderly (NPR)

A ‘natural death’ may be preferable for many to enduring CPR

A frightening issue discussed in this article was the concept of ‘CPR-Induced Consciousness’, where chest compressions circulate enough blood to the brain to awaken the patient during cardiac arrest, who may then literally experience hell, with ribs popping, needles entering their skin or a breathing tube passing through their larynx.

TL:DR

Survival

The overall survival rate from CPR ranges from 7.6% out-of-hospital and only 17% in-hospital.

These numbers are worse in the elderly (6.7% in the 70’s to 2.4% in those over 90.)

Less than 2% of patients with cancer, heart, lung or liver disease survive more that 6 months.

Harm?

Fractured/cracked ribs common (and very painful.)

Pulmonary hemorrhage, liver lacerations and broken sternums also occur

CPR-Induced Consciousness

Chest compressions circulate enough blood to the brain to awaken the patient during cardiac arrest, who may then experience ribs popping, needles entering their skin, a breathing tube passing through their larynx.

Brain Injury

30% of survivors of in-hospital cardiac arrest have significant neurologic disability

Only 2% of survivors over 85 escape significant brain damage

Quality of Life

The traumatic nature of CPR may be why as many as half of patients who survive wish they hadn’t received it, even though they lived.  It’s not just a matter of life or death, if you survive, but quality of life.

https://www.npr.org/sections/health-shots/2023/05/29/1177914622/a-natural-death-may-be-preferable-for-many-than-enduring-cpr

DMOST

Click to access DMOST-Form-and-FAQs-new-form.pdf

https://edhub.ama-assn.org/jn-learning/video-player/18751089

Good patient resource for vertigo:
https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv

Yet another reason to get fully vaccinated!

“New research has found the spike protein of the SARS-CoV-2 virus in the blood of long Covid patients up to a year after infection but not in people who have fully recovered from Covid. Virus has also been found in tissues including the brain, lungs, and lining of the gut, according to scientists and studies

The findings suggest that leftover reservoirs of virus could be provoking the immune system in some people, causing complications such as blood clots and inflammation, which may fuel certain long Covid symptoms, scientists say.”

https://apple.news/AluNPNAyOTjC93fofRj9D4A

“The data are stark: the typical American diet is shortening the lives of many Americans. Diet-related deaths outrank deaths from smoking, and about half of U.S. deaths from heart disease – nearly 900 deaths a day – are linked to poor diet. The pandemic highlighted the problem, with much worse outcomes for people with obesity and other diet-related diseases.”

https://www.npr.org/sections/health-shots/2022/08/31/1120004717/the-u-s-diet-is-deadly-here-are-7-ideas-to-get-americans-eating-healthier

“In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts with sleep expert Dr. Matthew Walker to help listeners understand this topic more deeply, as well as to identify which previous episodes featuring Matt may be of interest. In this episode, Matt gives an overview of why we sleep, the stages of sleep, and sleep chronotypes, and he provides tips to those looking to improve their total sleep and sleep efficiency. Additionally, Matt discusses the pros and cons of napping, and gives his current thinking on the effects of blue light and caffeine on sleep. Finally, Matt explains the dangers of sleeping pills and reveals what he believes are the most useful alternatives for someone struggling with sleep, such as those with insomnia.”

#221 ‒ Understanding sleep and how to improve it

Delaware Division of Motor Vehicles (DMV) has implemented a NEW onlineMedical Tint Waiver Application process.

Effective August 29, 2022, you will no longer start the Medical Tint Waiver application process by picking up a secure paper application in person at a DMV location. Instead, you will begin by filling out the online Medical Tint Waiver Application:

Link to Application: https://deldot.prod.simpligov.com/prod/portal/ShowWorkFlow/AnonymousEmbed/c40b8b2f-6a4d-4ab5-b207-004587ea0827

FAQ Here:
https://dmv.de.gov/OnlineServices/medical-tint-waiver/index.shtml?dc=faqs

Can the vehicle listed on my Medical Tint Waiver application be listed in my spouse’s/partner’s name?

No, the name on the registration and title much match the name on the Medical Tint Waiver.

Do I have to have my physician sign a new Medical Tint Waiver application if I purchase a new or used vehicle?

No, if DMV can verify you have a current Medical Tint Waiver on record, a waiver can be issued for up to four (4) vehicles every time you complete an online application. The new process will help eliminate multiple trips to your physician to have an additional application signed.

I have an application on secure paper I picked up from DMV a couple of weeks ago, can I still use that to apply for a Medical Tint Waiver?

DMV will continue to accept Medical Tint Waiver applications on secure paper through October 31, 2022. After that date, all applications must begin online.

What do I do after I complete my Medical Tint Waiver application online?

Once you complete the online application, print out the application packet and take it to your physician to sign. Once signed, bring all pages of the application to your nearest DMV location for processing and approval.

What if there is an issue with my driver license? May I still apply for a Medical Tint Waiver?

You must hold a valid Delaware driver license or Delaware identification card or have proof of non-domicile on record with DMV. If the status of your license or ID is currently invalid, you will need to contact DMV’s Driver Improvement team for further assistance at 302-744-2509.

What happens once my Medical Tint Waiver is approved?

Once our associate approves the tint waiver, the associate will initial and stamp the waiver with the State Security Seal. The tint waiver is added to the vehicle’s record and a new registration card indicating “this vehicle has a valid tint waiver” will be mailed to the address on the registration.

May I tint the windows of my vehicle without a Medical Tint Waiver?

No, per 21 Delaware Code it is required to have a medically approved tint waiver by your physician to legally add tint to your vehicle

• 4313. Safety glass — Federal safety standards applicable to windshield, front side windows and side wings; window tinting.

(a) No person shall operate any motor vehicle on any public highway, road or street with the front windshield, the side windows to the immediate right and left of the driver and/or side wings forward of and to the left and right of the driver that do not meet the requirements of Federal Motor Vehicle Safety Standard 205 in effect at the time of its manufacture.

(b) Nothing in this section shall prohibit the use of any products or materials along the top edge of the windshield so long as such products or materials are transparent and do not encroach upon the AS-1 portion of the windshield as provided by FMVSS 205 and [former] FMVSS 128.

(c) No person shall operate any motor vehicle on any public highway, road or street which does not conspicuously display a certificate by the manufacturer of any “after manufacture” window tinting material which may have been installed that such window tinting material meets the requirements of FMVSS 205 in effect at the time of the vehicle’s manufacture. It shall be a valid defense to any charge under this subsection if the person so charged produces in court a validated mandatory inspection notice showing that the Division of Motor Vehicles has examined the motor vehicle since the date of offense and certifies compliance with FMVSS 205.

(d) No person shall be convicted under this section if that person possesses a statement signed by a licensed practitioner of medicine and surgery or osteopathic medicine or optometry verifying that tinted windows are medically necessary for the owner or usual operator of said vehicle.

(e) This section shall not apply to anodized glass which is correctly installed in the windshield and windows of an antique motor vehicle or street rod, as such are defined in §§ 2196 and 2197 of this title or of a motor vehicle validly insured under an antique, classic or street rod designated motor vehicle insurance policy that covers the motor vehicle, pursuant to § 2118 of this title.

(f) This section shall not apply to any police K-9 unit vehicles, or any surveillance vehicles operated by a “police officer,” as defined under § 8401 of Title 11. This exception shall not apply to marked vehicles, except for police K-9 unit vehicles, or those unmarked vehicles used primarily for regular duty patrols.

Why was my online Medical Tint Waiver not approved?

The Division of Motor Vehicles will research the eligibility to add a medically approved tint waiver to your vehicle. Some of the reasons for denial are outlined below, but not all-inclusive:

• Warrant on record
• Failed inspection for safety
• Return check
• Invalid address on record
• Mismatch information
• The medical section is not on record to validate you are previously medically approved.
• Some flags on the registration; suspended by DMV, Report of Sale on file, suspended by our uninsured motorist section
• Vehicle not registered yet
• Driver license shows moved out of state

If I do not have access to a printer, may I come to DMV to fill out and print the application before taking it to my physician?

No, you will need access to a printer. DMV will review and approve the application documents once completed and signed by your physician. If you do not have access to a printer you may want to contact your local library for assistance.

“As the top infectious disease advisor in the country for four decades, Anthony Fauci has saved the lives of countless Americans. From the AIDS epidemic to the recent Covid-19 pandemic, his service to the nation is worthy of our appreciation.”

“Anthony Fauci, who has been the top infectious-diseases adviser in the United States for almost 40 years, announced on 22 August that he would resign from his leadership roles in December. Although many scientists are saddened to be losing his guidance, they understand his desire to step down. No other federal scientist has held a top position for as long as Fauci.”

https://www.nature.com/articles/d41586-022-02301-x

Short and sweet update from my favorite (local) epidemiologist

– Bivalent vaccine (hits two variants of Covid)
– Better and probably longer protection
– Broader protection
– May be the last “free” vaccine!



https://yourlocalepidemiologist.substack.com/p/fall-boosters-an-update

Stop Drinking, Keep Reading, Look After Your Hearing

You walk into a room, but can’t remember what you came in for. Or you bump into an old acquaintance at work, and forget their name. Most of us have had momentary memory lapses like this, but in middle age they can start to feel more ominous. Do they make us look unprofessional, or past it? Could this even be a sign of impending dementia? The good news for the increasingly forgetful, however, is that not only can memory be improved with practice, but that it looks increasingly as if some cases of Alzheimer’s may be preventable too.

Continue here: https://www.theguardian.com/science/2022/aug/17/stop-drinking-keep-reading-look-after-your-hearing-a-neurologists-tips-for-fighting-memory-loss-and-alzheimers