A Country Doctor Writes:

Another video post about a common medical topic. (This one with a cameo appearance at the end of a blonde who keeps following me around.)

Warfarin dosing requires viewing past values and past dosing. If every time a certain dose change results in an unwanted result, we should probably avoid making the same over- or under-correction again and again.

For many years I have used a paper(!) flowsheet that takes seconds to utilize and gives a practical overview. These sheets sit in a three ring binder. My nurse can flip through this binder and spot who is delinquent with their testing. The actual lab values are of course in the computer, but so far the three EMRs I have used can’t give me the overview I need within anything even close to a reasonable timeframe.

These two pictures say it all. My patient in the paper flowsheet has a home INR that requires weekly testing for the insurance to cover it. The “workflow” (how I dislike that word) on the bottom is from Epic.

I thought computers had the capability of speeding things up, but in my corner of the world that is mostly a pipe dream.

It’s all about inflammation, from cancer to Alzheimer’s disease and arthritis, colitis and psoriasis in between. And now we hear the brain controls inflammation via the vagus nerve.

A couple of years ago I wrote about how the vagus nerve regulates mood and emotions. Now The Wall Street Journal writes about how it controls our immune responses. I had a professor in medical school who used to say “if you know lupus, you know medicine”. Maybe at this point in time one might say “if you understand the vagus nerve, you understand medicine”.

According to an interesting article in the Wall Street Journal the other day, a decades old discovery that the brain regulates the immune system through the vagus nerve is promising possible new ways of treating what seems to be the root cause of many chronic diseases.

Electricity Is the New Medical Miracle

“Dr. Tracey’s break­through two decades ago was the dis­cov­ery that the brain also con­trols the im­mune sys­tem through the va­gus nerve. By us­ing elec­tri­cal stim­u­la­tion to hack into neural net­works, it’s pos­si­ble to reg­u­late the im­mune re­sponse and per­haps some­day cure in­flam­ma­tory con­di­tions such as mul­ti­ple scle­ro­sis, lu­pus and even Alzheimer’s dis­ease.”

https://www.wsj.com/amp/articles/electricity-is-the-new-medical-miracle-crohn-vagus-nerve-biotech-startup-trial-remission-treatment-11658512502