Thanks to Dr. Sargeant for an interesting morning report today, allowing us to explore some of the more complex issues affecting our patients with mental health concerns, including their disproportionately high representation in the prison system. The causality of this relationship is complex, and often influenced by confounders like addiction, but ultimately we have to look at this as a matter of public policy and how Canada (and other nations around the world) have chosen to allocate resources. I found an interesting resource document (here) from the American Psychiatric Association that discusses some of the broader factors and implications of the relationship between mental illness and the criminal justice system. An article on the role played by addiction can be found here.
We also discussed the clinical examination for airway obstruction, focusing on Dr. Sharon Straus' practical approach outlined here. Essentially, the combination of (all three) 1) self reported COPD, 2) Forced expiratory time >9 seconds, and 3) wheeze on auscultation had a positive likelihood ration (see here for definition) of 59, essentially ruling in COPD. Patients with none of the three findings had a negative LR of 0.3, effectively ruling it out.
I was diagnosed of COPD in July 2016. I was on Albuterol Nebs and levalbuterol to ease the situation as i constantly go out of breath when talking or when walking, I was adviced for Lung Volume reduction surgery (LVRS) because my both upper lobes of the lungs were affected, i was making preparation for this surgery when a friend of mine told me about a traditional herbal doctor called doctor Ayes who prepares herbal medicine to cure all kind of diseases including COPD disease, When i contacted Dr Ayes his email and bought the herbal medicine I received the herbal medicine through courier service in 3days, when i received this herbal medicine i used it as prescribed and was totally cured of COPD within 18-20 days of usage, he is able to cure any kinds of disease such as 1. Diarrheal Diseases,2. HERPES 1/2,3. CANCER,4. ALS (Lou Gehrig’s disease),5. Herpatitis B,6.chronic pancreatitis,7.Emphysema,8.COPD (Chronic Obstructive Pulmonary Disease),9.asthma,10.Acute angle-closure Glaucoma,11.CHRONIC PANCREATITIS,12. Preterm Birth contact Dr Ayes via his email: iraborayes@gmail.com
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