Lymphoma

Wed Jan 9, 2024

• Order of business: laxative, suppository, disimpaction. [1]
• Digital disimpaction is not recommended to be done by oneself. [2]
• How to identify fecal impaction? [3]. If so, get out the gloves.
• Why does fecal impaction cause vomiting? [4]
• When is ER required for fecal impaction? [5]
• Fecal impaction can be life threatening. [6]
• Fecal impaction is not constipation. It is result of constipation. [7].
• More questions:

1. 1. What the patient considers "normal" BMs
   2. Usual bowel habit, duration of feeling constipated, date of last BM
   3. Current stool appearance (consistency, color, odor, blood, mucous)
   4. Associated symptoms (e.g., nausea, abdominal fullness, bloating, gas, diarrhea, tenesmus)
   5. Likely causes and contributing factors (see Table 2):
   6. Medication history, including laxatives, suppositories, enemas
   7. Medical conditions affecting laxative selection (e.g., vocal cord paralysis, which precludes mineral oil, or impaired renal function, which contraindicates magnesium salts)
   8. Current diet and desire to eat as well as fiber intake (can patient consume fiber to 30 G per day and drink sufficient fluids to maximize bulk effects and avoid exacerbating constipation?)
   9. Activity level, altered mobility, fatigue, or weakness, which may interfere with usual normal BMs.

• It is prudent to anticipate opioid-induced constipation (OIC) in patients starting or taking opioid analgesics and to start prophylactic management. [8]
• Megacolon - bowel distends to 4" [9]
• Acetylcholine - anticholinergics suppress it. [10]. Is that part of cancer treatment?
• 80-90% of terminal cases report constipation
• Paradoxical diarrhea - overflow diarrhea around hard stool. Par 2 [11]
• Anal fissure - tearing of ass
• Assessment, no pun intended, for 'functional constipation' involves the 25% rule [12]
• Shits aren't well addressed for cancer patients - [13]
• Should a brain cancer treatment patient go to the ER for serious constipation - Could be serious if no shit for 1 week - [14]. If no BM after 1-2 days of laxative, go to ER.
• Fecal impaction - [15]. Suggested order is laxative followed by physical means. Careful about complications. Can take days to weeks to form over time [16]
• Dulcolax (bisacodyl) forces shit out. Miralax (polyethylene glycol) softens it first, takes longer. [17]
• Miralax works by softening shit with water by making stomach feed water into the shit. [18]
• Mechanism for hardening is sucking of water out the intestine walls, making shit hard. This occurs from retarded bowel movement. [19]

Mon Nov 25, 2024

• Forwarded Kaia's AETNA cara manager release form to HJ so MJ can communicate with AETNA
• Should I ask if HJ wants to set up portal at Neurosurgens of NJ by phone? I can call to find out about treatment scheduling before doing this.
• Kessler will check if insurance covers treatment.

Fri Nov 22, 2024

• Called MyChart tech support via Barnabas
• Called Barnabas regarding records. Sounds like HIPPA Release, talked to Kenya. We can do so, they just send a text to patient with release form. Called legal re PoA. LM with David Mebbins.
• Totaled car insurance worked out
• Setting up appointment with Dr. Liu and Dr Brown.
• Sent intake info to Kessler Rehab for eye work, occupational therapy - prescription, insurance, doctor info.
• Sent blood work prescription to criel@firstcarenj.com as We just talked on the phone. Please find the bloodwork prescription attached. Do you need anything else from us. Hieronim

Mon Nov 18, 2024

• RWJBH MyChart - online login [20]. Tech support - [1-833-764-3570.]
• Epic - promoting 'zero events of preventable harm'. Includes billing and scheduling.
• RWJBarnabas Health HIE - only available to doctors and providers.
• Hospital - [21]
• [22] RWJ Barnabas Health
• What patient record system does barnabas use?
• Medical records rights - [23]
• Patient portal is accessible for patient on smartphone. [24]
• Is patient file accessible in realtime? [25]
• Is patient file accessible to patient? [26]. HIPPA privacy rule.
• Get the patient file. Patient can do it.
• Get the source.
• No standard procedure exists for PCNSL. [27]
• What kind of lymphomas occur in the brain? [28]
• What kinds of brain tumors exist? 120 types. [29]
• CAT, PET, bone biopsy, blood, genetic tests.
• Are all lymphomas in the brain called CNS lymphomas? Yes [30]
• CNS lymphomas - [31]
• Start with visitor desk.
• Admin staff outside of nurse?
• Probably there a round by the doctor is around? Ask nurse when he is making his rounds.
• Is brain lymphoma the same as lymphoma in the brain? [[32]
• What is the typical treatment for lymphoma once tumor is removed? Chemo, ratiation, immunotherapy drugs, stem cell treatment, or no treatment. [33]
• When is he getting out of the hospital?
  • What kind of care
• Chemo cycle is for ex 28 days - 1-3 days, then off. Or 3 week - day 1 and 8, and all else is off.
• What exams are we waiting for?
• What will the exams show?
• What will the exams not show.
• What is the proposed treatment from here?
• What results are we waiting for?
• For each result, what are the courses of action?
• When is chemo starting?
• What is the expected schedule for chemo? Number of times? Does the intensity change?
• What are typical complications that happen?

Sat Nov 16, 2024

• Open access publication charges. Institutions pays. Rutgers allows publish for free in open access journals (Rutgers pays).
• Brain edema - fluid in brain
• D-index out of all H-index* - [34]
• https://www.adscientificindex.com/scientist/hieronim-jakubowski/1451740
• SIF - scietific impact factor -
• h-index of scientists (Hirsch index)- [35]
• Impact factor of a journal - [36]
• british journal of neurosurgery impact factor - 0-1
• Open source HIFU software [37]
• HIFU - high intensity focused ultrasound - [38]. [39]
• Wycieli 6x2x2 cm
• 1% complications according to Dr. Liu - [40]
• Brain lymphoma [41]
• https://wmed.edu/node/3392#:~:text=Biosketch,field%20of%20intracranial%20venous%20stenting.