Tuesday, 5 May 2020

Always allow for unforeseen positive possibilities

The days of paternalistic medicine are over. Patients are no longer expected to blindly follow doctors' orders without asking questions and thinking things through for themselves. You are the quarterback of your health care team. The ultimate capacity for good judgment lies with you. As a physician, I am here to give you information, interpret it for you, and give you options, but ultimately the decision to act is up to each of us, individually. Easy-going, agreeable, gentle. Spicy, confrontational, bold. Private, careful, quiet. Tender, emotional, graceful. Wild, silly, outrageous. There is so much good handwoven into every human person. Such beauty. So many gifts to be spilled generously onto the rest of us. We must show up truthfully, because it is in the diversity of our souls this world receives all it needs. We do not need you to be like your neighbor; Either way you will also need to address the problem of your own colonisation and seek suitable treatment. If you have a pet whose wound will not clear up, suspect that you could be a carrier and have yourself checked out. I understand that UK doctors will often refuse this type of request as there is an expense involved, and each healthcare practice has a budget to manage. In the USA, where all medical procedures are paid for either by direct invoice or insurance, it would be straightforward to request that swabs be taken for analysis. At the moment, the MRSA strains infecting cats and dogs are predominantly EMRSA-15 and EMRSA-16, the same strains of MRSA causing problems in hospitals.

CA-MRSA has not yet been detected in animals with an MRSA infection in the UK, but is being seen in the USA. Antimicrobial resistance in the veterinary world is increasing in the same way that it is increasing in the human population. Humans are more likely to acquire an MRSA infection if they have had several courses of antibiotics for recurrent infections, and the same is true for dogs and cats. Pet owners who work in a healthcare facility such as a clinic, hospital or nursing home have a significantly higher chance of being an MRSA carrier than other pet owners. Veterinary staff could be MRSA carriers. As Americans, we enjoy freedom and personal choice. I'm sharing my knowledge with you in this article to help you make the right choices for yourself. America is sick, and the blame doesn't rest solely on Big Pharma's profit mongering, our country's socioeconomic disparities, government intrusion, or doctors' overprescribing tendencies. No--we are all to blame. It's our obligation to take a good hard look in the mirror and face up to what we're doing to add to the health crisis in this country. The American Medical Association (AMA), a national association of physicians, was founded in 1847. In the twentieth century, led in large part by the AMA, organized medicine became an important force for change. Medical professionals joined together to establish standards of medical practice, such as clean hospitals, sound pharmacological research, and well-educated and -trained doctors. Patients began to expect medicine to uphold these standards and no longer blindly accepted their fate. Although these were important steps forward, the concept of preventive medicine was not yet known. we already have her. We need you, not for what you do but who you are. Please be her. Please do not shrink or twist or lie or buckle. Please do not mislabel your beautiful inmost being as too weak, too strong, too little, too much.

Stop apologizing. Stop shape-shifting. Do the work and show up for your life, because you are the only one who can live it, and the rest of us need you. At the beginning of my public career, I was invited to deliver the Sunday morning sermon at a very large, very traditional church as a guest preacher. I was young in my field, sprouting little wings, ready to fly. Just as humans are being urged to ask their doctors and nurses, 'Have you washed your hands? ' it is as important to see that the person handling your pet has done so or is wearing a pair of sterile gloves. Don't be embarrassed about asking. You have the right to expect the highest standards of care for your beloved animal, and you are paying for every visit. Whereas it is permissible for you to treat your own pet, it is illegal to treat someone else's pet unless you are a trained vet. Equine MRSA is thought to be spread internationally. Many studies have taken place around the world to look into the extent of nasal colonisation, and whether it has any significant impact on human health. There is a question over the origin of MRSA in horses. It is not clear whether the source has been from human transmission or has entered the horse population from agricultural animals. The possibility of humans being responsible for the transfer of MRSA to animals was considered back in 1999, when 11 horses were admitted to a veterinary hospital for various medical procedures. In some ways, we still haven't fully acknowledged the reach of diseases we can prevent, despite being inundated with wellness tips everywhere we look. Fast-forward to the 1960s. In the first half of the twentieth century, national health care expenses had consistently increased. President John F. Kennedy introduced legislation to develop a taxpayer-funded plan for the aged, who were most afflicted by illness.

JFK faced significant pushback by legislators who feared the beginnings of socialized medicine, and his bill did not pass. After Kennedy's assassination in 1963, Lyndon B. Johnson assumed the presidency and picked up where Kennedy left off. In 1965 he signed the bill that laid the groundwork for our present-day Medicare and Medicaid systems. Designed to help the elderly, disabled, poor, and mothers who had to stay home, these systems were meant to cover medical costs for people who were unable to gain coverage through an employer-sponsored plan. This invitation was outrageously flattering and alternatively terrifying. I'd not yet preached on this scale and definitely not in front of that many men. I was developing my chops in the Lady Spaces, so this felt like being promoted to Big Church. I worked on that sermon like it was my doctoral thesis. I had the minor prophets, Mother Mary, the church grandmas, and Jesus of Nazareth on my personal prayer team. I spent one hundred dollars we didn't have on an outfit, because I love the Lord but I come correct. As I sat on the front row nervously shuffling through my notes, preparing for my first moment as a spiritual authority in such a legitimate space, the pastor introduced me to his congregation: Ladies, you are in for a real treat today. Jen is here to share some stories with you, and I think you'll be tickled. And men? We will just peek over their shoulders this morning until we resume our sermon series next week. Over a 13-month period, all 11 needed to return just two to three weeks after being discharged. All the horses were re- admitted with surgical wound infections, which, when swabbed and analysed, confirmed they each had MRSA. When five surgical staff were also swabbed, it was shown that three were colonised with MRSA, even though they were otherwise healthy. The conclusion was that the source of the MRSA outbreak was most probably of human origin as the horses had arrived at the hospital over an extended period of time and from several locations, yet none of the horses had presented with a staph infection on arrival. Equine vets, in general, are confident that because horses spend much of their time outside in fresh air, even if they do become colonised with MRSA in their stables, then they can quickly decolonise once they are returned to the field.

In the 1990s, Japanese researchers10 conducted research with equine isolates of MRSA but failed to make a link with human isolates of MRSA. Similar research has also taken place in Canada and the UK, where equine strains of MRSA were found to be different from the most prevalent human strains in the UK: EMRSA-15 and EMRSA-16. Throughout Canada11 the predominant clone affecting horses is Canadian MRSA-5, which is the same as USA500. This MRSA strain, which was human in origin, accounts for only a small percentage of infections in the human population but is common in horses. Some studies of MRSA colonisation in horses put the figure between 3% and 10% of healthy horses. Our vulnerable populations were taken care of. What went wrong for the rest of the population? Medicare and Medicaid started as noble endeavors, but they've become plagued with a host of problems. When Medicare was first implemented, the average life expectancy was under 70. Now, Americans on average are living to nearly 79. As a result, people are receiving Medicare benefits for a significantly longer period than when the program started. Despite the increase in life expectancy, there has been no adjustment of the minimum age at which you can start receiving Medicare benefits. When someone runs out of Medicare funds or they need long-term care, they have to use Medicaid to cover costs they can't pay on their own. If you're admitted into a nursing home, for example, Medicare doesn't pay for it--Medicaid does. Moreover, people used to go to nursing homes when they were near death, so this allotment was small. I burned with humiliation from the top of my skull to the soles of my fancy new shoes. I fully expected him to pat me on the head when I reached the stage. I thought I was invited to preach to the church, not tell some cute stories to the gals while the men looked on condescendingly, apparently unable to learn from a woman. I wasn't prepared for the misogyny, a word I didn't know back then but whose effects I felt acutely. I also later discovered they paid my male colleague twenty-five hundred dollars to guest preach a sermon in the same series;

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