Varices or esophageal/gastric varices are actually dilated veins that are located in the esophagus. Esophageal varices rupture as a result of what is knows as portal hypertension. The liver needs an adequate blood supply to function and it receives that through the portal vein. The liver also gets it's nutrients from the portal vein also. When blood flow is restricted from normal flow in the portal vein, the portal vein then becomes elevated in pressure and as a result causes liver problems. Many physicians, do the routine blood pressure test during a patients visit, but I have yet to find that any patient is sent for an ultrasound of the liver or hepatic system or being sent to see a GI or hepatologist or liver specialist to determine if the portal vein is elevated in pressure. As a result esophageal/gastric varices can rupture and bleed due to portal hypertension. This can cause conditions such as: ascites- this causes abnormal fluid in the peritoneum(sac where the intestines are), liver disease and enlargement of the spleen. Once esophageal/gastric varices occur, it is imperative to stop the bleeding. When you have a patient with other health problems or who is fragile to due being an older age, performing out and out "I'm going in!" surgery is probably out of the question. Especially with the older ones you're using and putting all that high-tech stuff on them, so it can take some getting used to. However, it may be possible to perform an endoscopic sclerotherapy procedure on them. Sclerotherapy is a procedure that a physician uses a blood clotting solution directly onto in esophageal/gastric varices in order to stop the bleeding. This may prove to be beneficial when the portal vein will not tolerate banding or any type of shunt. The older the person the more "out of it" they are with medical procedures and the use of them. This is not to say that all people of a certain age are that way but many people are not used to the complexities and procedures that can be done  and may not be willing to put their body through a new age strain. Endoscopic sclerotherapy may be a less complicated way of stopping damage done by ruptured varices.

I tell you, I am somewhat annoyed. People seem to just expect someone to know many different languages or their translation. The problem becomes when you work in a medical office that is not part of a hospital or a large group that may hire translators or have people who are bilingual available. In a small office, there may not exist an employee who has traveled the world and comes from a background whereby another language other than English was spoken. You are who you are and, well if you don't go around on a daily basis talking to the maid then you don't really have a need to use a language outside of what you normally speak. Patients call looking for physicians, who speak "their language". The front desk informs patients of the languages that the physicians do speak, but if it does not include a language a patient is looking for then what else can be done? It becomes costly to set up phone lines dedicated to speech language translation. After all these phone lines are live and you have to actually wait for an interpreter to get on the phone with you in order to translate a particular language. This becomes a problem. When there becomes fewer and fewer customer service people available to assist with a problem of translation, it would be just like talking to someone at a health insurance company. A person who needs to be understood by speaking their language must wait during their appointment to have a translator speak with them. If wait times are long then this delays other patients and their scheduled appointments. We need something more computer generated. You know like that vocoder thing, for music audio. Really simple, it just takes your voice and translates in into any sound. In the medical world we would need on for languages. There can even be a video/audio theremins vocoder that can produce the word or letter when using sign language. I think I'm trying to simplify things here, I really do. The vocoder language interpreter works this way. Just as the physician sits at a computer, right next to him or her will be the vocoder language interpreter. There are two microphones, they can be gooseneck if you want. The vocoder is turned on and the language selection is selected, for example: Physician- from:English to:Spanish and for the Patient-from:Spanish to:English. There is a speaker for each microphone or you can use headphones if you prefer. The physician talks into the microphone and the vocoder translates from English to Spanish, and as it does the vocoder will speak in a voice of Spanish translation to the patient. Once the patient hears to questions being asked the patient will respond by speaking into the microphone in Spanish and the vocoder will speak in a voice of English to the physician. See-no wait times or additional phone setup's. Now, when it comes to sign language, the video/audio theremins vocoder has it all. The patient begins to speak with his or her hands over the theremins and as the hand signal or expression is acknowledged via the theremins, it is then interpreted into words from the vocoder and then the vocoder will interpret the sign language of the patient. Now all the physician has to do is to speak into the vocoder and the video/audio theremins will display a sign language picture of what the physician is asking or trying to tell the patient. And of course there are no wait times for someone to locate an interpreter or to actually have to hire people who know several different languages and then some. The only wait is technology, so that every office can have a vocoder language and/or video/audio theremins vocoder language interpreter that is affordable!

Usually by this time of year you at least know how much in taxes to withhold from your paycheck. It's 2018 and it seems to be taking an eternity to get any information, from the federal government regarding this information. Also, the 1040 forms and instructions, for those that sort of like to know how much they will get refunded or owe, for 2017 are also not available. The new tax laws have implemented some changes and in doing so it is taking longer than usual to provide all of this to everyone else. I just wished that those who make more than $300,000 a year had some understanding of what it is like to live on less than $30,000. America used to be known as the land of opportunity and somehow that was all stripped away in favor of America not bestowing or owing anything to anyone except for that favored one percent. Now that we all have combined wages of poverty what does America expect of it's economy? Or, so what now? Let's think about ways to reduce the cost of living since wages make the necessities of living unaffordable. Brands, brands, brands, many of them have high end prices. Suppose, just like medications, things including: housing, clothes, toiletries, food, transportation of sorts could be made rather generically. This would make things more affordable and allow everyone to be able to buy and or shop like they did in the "old country". Dollar stores or stores that have heavily discounted items should have more of a shopping presence. If I were some elected official and I were in charge of a town that had land available and could be best put to use, it would be to create a conglomerate of stores, that sold generic brands of almost anything to the public. Why? Because salaries determine what a person can afford, honestly or even legally. In keeping with the law we must live within our means and therefore we should have a society that enables all citizens to afford such necessities in life. Health insurance among other things is still very expensive. My only other questions are, now that many people spend approximately half a paycheck on health insurance, how does the federal government think that people will be able to support themselves after it is paid for in premiums and what is civil about working 16 hours a day, only eating once a day and not sleeping more than three hours a day? America- are we paying too much?

The snow is here and many people with heart disease are reluctant or unable to shovel snow due to heavy shovel or snow blower exertion in the cold weather. What happens here is that the heart does more work as you inhale cold air, because it causes uneven oxygen distribution throughout the heart. This may sound strange because you may see people who run or jog regularly out in the cold, just taking in the scenery and they don't seem to have a problem with breathing in cold air or at least enough to raise their blood pressure and have them stop exercising. But I guess it depends on if you have weights in your hands or not. The heavy exertion of snow in a shovel can overdo things somewhat and cause the blood vessels to constrict. Cold air can also cause the heart to have coronary artery spasms, this decreases the amount of oxygen that goes to the heart and can cause someone to have a heart attack. If someone has decreased artery function or heart blockage that may not require a stent, once that person does activity such as shoveling snow and as it becomes strenuous on the body; the heart's arteries constrict or become restricted due to the intake or breathing of cold air and the heart blockage in the heart also increases or worsens and can ultimately cause damage. This problem can be alleviated by wearing an air activated warmer mask. Yes! But how? I'm happy you asked. The air activated warmer mask is designed to be worn around the face area and it has a protective layer so that it will not burn the face or mouth. Just peel the air activated mask to open, close the flap and put the mask around your face. The air activated warmer mask is designed so that you will not breathe in freezing temperatures that will affect your heart. As your body breathes and takes in the warm air you will no longer suffer from spikes in blood pressure or be affected by heart spasms due to exertion and the intake of cold air. The air activated warmer mask will not overheat and will not reach high temperatures causing one to perspire or sweat. The air activated mask is designed to provide room temperature warmth to the face so that when breathing the body is not affected by the frigid and cold air. Now, any person with a heart condition or even someone who wants to protect their heart from the cold weather can wear the air activated warmer mask. The mask is disposable and can be used even when walking, standing or sitting in cold temperatures. The air activated warmer mask, it protects the heart from cold weather and keeps you around for seasons to come!