Mormonhippie Answers: Why Don't Mormons Drink Coffe?

The last few weeks some of my coworkers who know I'm a Mormon asked me about the whole 'mormon's don't drink coffee' rule and  I don't think I did a very good job at explaining it, so I'm going to try again here.

The coffee restriction is part of a health code called

"The Word of Wisdom"

(If that title sounds intimidating, it's not...it's basically just 'common sense diet and health guidelines')

But a lot of people really misunderstand what its all about, and many of us (People of the mormon faith) get so caught up in the rules themselves, we forget what the rules are actually for.

So I'm gonna do a little overview and commentary of the Word of Wisdom here:


The Word of Wisdom is found in a document of Mormon Scripture called "Doctrine and Covenants", (Section 89 if you ever wanna look it up). A lot of the language is archaic 1800-ish words because that's who it was originally written for. In fact, it was originally aimed towards the leaders of the church at that time, but has since been received as a guideline by the general church.

The Words of wisdom were to be received:

 "not by commandment or constraint, but by revelation  showing forth the order and will of God in the temporal salvation of all saints in the last days—

(These rules are not meant to be something that holds you back, or keep you from experiencing all that life has to offer, they're meant to help you live the best life you can.)

3 Given for a principle with promise, adapted to the capacity of the weak and the weakest of all saints, who are or can be called saints.

(Many people can drink alcohol socially without becoming addicted to it, but some people can't. These guides are meant to protect both groups of people.)

 4 Behold, verily, thus saith the Lord unto you: In consequence of evils and designs which do and will exist in the hearts of conspiring men in the last days, I have warned you, and forewarn you, by giving unto you this word of wisdom"

(There are people in the world who will use food, drink or drugs to take advantage of you. This problem will get worse in the future.)



The rest of the 21 (short) verses go over some particulars for healthy nutrition, like:

• 'Strong drinks' are bad for you.
• Tobacco is bad for you, but it's good for sick animals.
• 'Hot drinks' (Modernly interpreted as "Coffee and Caffeinated Teas") are not good for you.
• Don't over-indulge in meat, even during times of thanksgiving (ie. holidays) 
• Eat plenty of healthy grain

The Word of Wisdom itself refers to these rules as "principles" as opposed to "commandments".  and we are promised that when we observe these principles we will receive health, knowledge, energy, and we will be protected from destructive influences.


So coffee isn't some evil "Broth of Satan" substance, and in fact the Word of Wisdom makes it pretty clear that God created it (and a host of other plants and herbs) for medicinal use. The problem is when people use it (or any other substance) in ways that are destructive.

One thing I'd like to stress here is that while many Mormons shun coffee, very few of us actually observe the whole health code of the Word of Wisdom. I think that, to a large degree, the reason why we (Mormons) have made such a big deal about coffee is because it's the one part of the Word of Wisdom that we can honestly say we follow with impunity.


The Word of Wisdom is about a lot more than coffee. Like Sabbath Day Observance, it's meant for our temporal (earthly) salvation, and to protect us from unhealthy (physical and spiritual) influences.

In the Bible, when people caught Jesus breaking the Sabbath he reminded them that, "The Sabbath was made for man, not man for the Sabbath"

The commandment was a means to an end, not the end itself, and the 'rules' should never be used as an excuse to do what's right. When Jesus "broke" the Sabbath, he was healing people. He expressed that it would be absurd to hold the "Sabbath day observance" rule against someone who was helping a trapped animal getting out of a well (or helping other people who are sick to get better)

The Sabbath is for remembering what's really important in life: giving thanks for what we have, helping others, spending time with our families, and being mindful of our walk with God. The Word of Wisdom is for giving us the strength to achieve the righteous desires that God planted in our hearts: take care of our families, help others, avoid materialism etc. 

So, drinking the occasional coffee when you need to stay awake on your 3rd twelve hour shift after you've taken the kids to school and picked up your husband from his doctor's appointment is not going to be detrimental to your spiritual salvation. 

1) Because the Word of Wisdom is about so much more than just coffee consumption

and

2) Because the Word of Wisdom is aimed to assist you in your temporal salvation...To help you be all that you can be in this world.

But I know that when I eat right, I'm motivated when I get out of bed in the morning (or evening...as the case may be...), my body craves things that are actually good for it

(Like...Steamed Kale...mmmmm!)

And exercise actually feels good...

I want to be there again. I want my body and my mind to be on the same page, I want to be motivated to get stuff done...and not just "OK, When can I go get Del Taco?"

But I'm so not there yet!

And I can't honestly say that I'm observing the word of wisdom when I'm really just living out of habit by not drinking coffee. So no, the reason I don't drink coffee isn't because I'm keeping the Word of Wisdom, I rather think it's because I'm too lazy to keep it.

(Sorry for the long confessional...hope this made sense!)

The Return of the Jedi Doesn't (?) Stink

I've been putting this post off for a while. Partly because I've been focusing on work, but also because I want to work on the "Doesn't Suck" series in reverse-chronology and I realized how much I kinda don't like The Return of the Jedi. I mean, I've always known it was my least favorite of the original sequel trilogy, but now I'm thinking it might be my least favorite installment of the franchise to date.

What it does well: An incredibly heart-wrenching conclusion to Darth Vader's story-arc, particularly in relation to Luke. 

What it does bad: Literally everything else.

Really though, the whole plot is rehashed content to serve as placeholder until Luke can finally get to Vader again and offer him redemption. Every other character, relationship, and conflict in the story gets sidelined.

(Even the actual "Star War" between the Rebellion and the Empire.)


Luke shows up as our resident "Badass Jedi" ™ because the plot requires him to be one, with no explanation as to how he got that way.

Lando Calrissian? (You know, that guy who was the head of this whole colony/organization and had this awesome cyborg sidekick and henchmen galore?)
....He becomes just another face to do stuff the main characters can't do because they're off playing with teddy bears.

"This deal's getting worse all the time!"

Even the resolution to Han Solo's cliffhanger feels off...like it even belong in the same story: like it's just a plot point the story has to get over with so it can get on to more pertinent things.

(Which I suppose from a storytelling perspective it actually is.)

And let's not even get started on this guy....

Most disappointingly, the suggestion that there is 'Another New Hope' that is moot NEVER becomes a significant part of the story.

 (Even though, it totally could have.)

I'm sorry to be so negative, but it's all I can think of when I contemplate the end of the original trilogy. 

Leia was kinda cheated out of her own heroic arc. 

I've also realized that in some ways, the newest movie makes it worse. Because even if they don't show the resolution to all of these stories, you can kind of imagine how it went in your own mind. Leia might have gone on to become a powerful Jedi. She might have had her own journey/spiritual awakening and ended up helping her brother restart the Jedi order. Luke could have been a teacher to new Jedi initiates, and she an administrator and organizer: head of the new Jedi Council. And together they would have brought in a new golden age of enlightenment and spirituality for the galaxy. 

But now that's ruined...in two planes of un-reality! 

One thing I do appreciate is that the costume department was able to finally give Leia an outfit that makes her look like a boss.

(You were thinking of the metal bikini weren't you? :P )

And now for another of Mormonhippie's Star Wars Theories:

I can't believe it took me so long to realize that Bail Organa (Leia's dad) wasn't just sending her on a random errand to recruit Obi-Wan Kenobi. He was sending her so that she could be trained as a Jedi, learn her about her heritage, and be reunited with her brother. (And, obviously, they would take down the empire together)

But Ben Kenobi had other plans:

From his perspective, Anakin should have never become a Jedi at all. Old Ben blames himself because he couldn't tame Anakin's personality.


And which of Anakin's children inherited his temperament?

There we have it! Leia was not "Chosen" to become "A New Hope" because Obi-Wan thought she was too much like her father.

Book vs Film: Wolf Hall & Bring Up the Bodies

 Last year I read a historical non-fiction book called "Six Wives: The Queens of King Henry VII" by David Starkey and since then I've become really interested in the minor historical figures of Tudor England, particularly...

 Thomas Cromwell

 and...

Thomas Cranmer:

These two were some of the most influential figures in the rise of the Church of England.

Cromwell was a big figure in secular transition, although he was learned in scripture of his day and disenchanted with a lot of the corruption he saw in the Catholic Church of the time, and Cranmer was a leader of the religious reformation.

As David Starkey tells it, it seemed like these men were kind of using the situation of their King being unhappily married, seeking an annulment/divorce/prosecution (or whatever would work to get the undesired wife out of his life...) to further their own social, political, and religious ends.

It's a fascinating story! And a lot more complex than I would have imagined.

However, it wasn't until I was getting a little bored of this years Children's Reading Challenge that I decided to delve back into Tudor-era history. This time in Historical Fiction.

I watched the miniseries, "Wolf Hall" (Which is a compilation of two novels: Wolf Hall and Bring Up the Bodies by Hilary Mantel) on amazon prime, and then listened to the book series on CD.

If you're into Tudor history, this is a pretty intense retelling. It's about the rise of Thomas Cromwell in King Henry Tudor VIII's court, and his role in the prosecution of two major historical figures:

Thomas More

And Anne Boleyn

Surprisingly, most of the brutality does not come from people getting executed in horrible ways (Although that does happen). This is not "Game of Thrones", violent and illicit content is off-screen (and for the most part off page).What's really messed up is the psychological aspect: Henry and Co rationalizing every selfish maneuver, and Cromwell's systematic, "guilty even when proven innocent" approach to investigating trumped-up charges (particularly in book 2).


I can't speak for the historical accuracy of either the novels or the miniseries, but as stories I thought both versions of the story were pretty well told. I watched the mini-series (which covers both books) first and I felt like the narrative was a little disjointed at the start; where they just barely introduced characters to us, and then do a flashback with them meeting each other for the first time, that was a little confusing. But it turns out they were just trying to follow the format of the book. The book is able to get inside Cromwell's head really well and follows the flow of his thoughts so he becomes a really engaging, personable character. That doesn't work very well in film format, but fortunately they do have an excellent actor: Mark Rylance, who does a fantastic job with his chillingly understated portrayal of the character. In both adaptions, the result is the same: you become seduced by the persona of this man so completely, you start to forget about all the evil stuff he did until it's staring you in the face.









Notes:


More Alignment posers I made for this book:


William Tyndale-

Henry Tudor-

Why Harry Potter and the Cursed Child Sucks

As much as I love the Harry Potter series, I was a bit skeptical about the feasibility of continuing the story at all. I consider the Harry Potter Series to be a monumental achievement in children's literature and I wasn't convinced anything should be added to the story.

So when I went to the Harry Potter and the Cursed Child midnight release, it was mostly on a whim...because I realized I didn't work that night and I had nothing else to do...

I didn't place expectations on it. (Unlike when I went to the Deathly Hallows midnight release...where I'd planned for days, dressed up, and made butterbeer and licorice wands for the occasion, stalked the Barnes and Nobel forums for weeks to read people's theories for what the last installment of Harry Potter had in store, and agonized about what would happen when/if my favorite characters would die.)  

At this point, there are thousands and thousands of fanfictions on what people who've read Harry Potter think should happen to the next generation of Hogwarts students. There is no way this story could've fulfilled all of those expectations. But the cool thing is, JK Rowling and her script-team don't try to. They're too busy giving nods to various fan-theories, explaining various purported "plot holes" in the series, and expounding on some of the themes that went over people's heads six years ago.

As such, this story feels less like an "Eighth Harry Potter" book than a review of the series.

-The Pros:

The strongest parts of the story are when JK Rowling and Co revisit the relationships between familiar characters:

It's enjoyable to see your favorite characters interact in ways they ever got to in the original books. Harry and Draco could never be friends as kids, but in adulthood they can put differences aside and find common ground.

In play format, we get to view the story outside of the confines of Harry Potter's POV, characters like Ron and Severus take on a new light outside of his limited perspective.

At the end of Deathly Hallows, Harry has opinions about parenthood and the type of father he'd like to be, in many ways this story continues his development so it's rewarding to see him struggle to be the best dad that he can be.

-The not-so-bad: 

The Epilogue of Harry Potter and the Dealthly Hallows introduced us to a whole new generation of Hogwarts attendees and a big, sprawling extended family for Harry. Unfortunately, except for Albus and Scorpius, they're largely absent for much of this story. 

Although she seemed to annoy a lot of fans, I really liked Delphi Diggory, not in the least because I wrote a fanfiction character somewhat like her. She's an interesting character, and its unfortunate they only used her as a plot device. 

Even the whole time-travel plot wasn't completely horrible (even though some parts of it felt like a bad Doctor Who episode). 

-The slightly sucky:

The fact that all of the younger characters have this minutely detailed knowledge of things that happened years and years before they were born, knowledge that the can recall and exploit at leisure. (Did they have Tri-Wizard Tournament Trivia night at Malfoy Manor?) Everybody in this story is a freaking 'Harry Potter' Nerd! Gah!

...But the worst part of the story? The part that really made this story suck? 

Is this little jerk right here:

Yes, the most promising character of the Harry Potter and the Deathly Hallows Epilogue and the ONLY Character I could have envisioned as a future protagonist of a second generation "Potter" series is the most annoying and unsympathetic character in the Cursed Child. 

And now, I will explain why:

....Remember [CAPS LOCK HARRY] from The Order of the Phoenix? 

This was Harry Potter at his most annoying. He's all insecure and super hormonal, angry, and confused. And he takes out his anger at all the people closet to him: at Ron and Hermione, Mrs Weasley, Sirius Black  and Albus Dumbledore.

Well, that's pretty much ALL Albus Potter does in this story. 

The problem is, Harry Potter had four books of character development to get him to that point. We knew about his relationships with all of those people: Ron and Hermione had stopped writing to him, Mrs Weasley and Sirius weren't being honest with him, and Dumbledore was avoiding him...

Even if you didn't particularly like Harry Potter during his hormonal-teenage years, you could understand how he felt when the people he loved shut him out.

(...Like his son does in this scene:

(Harry was angry because he felt isolated from the people he cared about, 

Albus is angry because he's not as popular as his dad is.))

Albus Potter never gets the chance to become a sympathetic hero because he gets one transitional scene to convey all of that complicated family dynamic and it just. doesn't. work.

(It just appears as if Harry is making effort after effort, and Albus is being a little shit.)

What bothers me even more is that throughout the story, different characters keep insisting that Albus' personality is sooo different from Harry's and that's why the two don't get along...

I could understand that, if they'd made Albus' neurotic or introverted, or even remotely Slytherin in aspect AT ALL. 

(But then he wouldn't be pushing his father away, but rather looking for ways to exploit his relationship with a famous person)

But they don't. Harry knows what his son is going through, OK? Harry knows what it's like to be lonely, and he's had to deal with people gossiping about him as a kid. What he's forgotten is what it feels like to be insecure. For Albus all those emotions are present. For Harry, they're all a part of his past. 

It's like when you're really worried about something: A date, or not getting a date...a big test at school, or not getting invited to someone who you thought was your friend's birthday party or some such first world problem.  Your parent's are dismissive of your concerns because they went through the same thing when they were your age (only they'll insist it was a million times worse) and they got through just fine. 

^^That would have been true to character. It would have made Albus a little more sympathetic, and it would have been HILARIOUS to watch. 

Unfortunately, the Cursed Child version of that argument just doesn't sting as it should. Partly because they failed to build up Albus and Harry's relationship to where we lament their falling out. Their reunion is less sweet because the relationship that should have been the cornerstone of this entire story was never big enough a deal for us to care about anyway.

Fortunately, there's more to this story than Harry Potter's Garbage Son. 

Like this sweet roll:

(Why didn't they make a scene where he comes over to Grandma Weasley's house for Christmas dinner, and everyone there loves him more than Albus? Now THAT would be realistic!)

Postpartum Hemorrhage

Hemorrhage is the most common complication mothers face in the postpartum period. It usually occurs within the first 24 hours after giving birth, but it can occur later on during the postpartum period.

In pregnancy, the uterus had to grow to accommodate the fetus: the uterus' muscle fibers stretch and, in between the fibers, blood vessels enlarge to supply and accommodate the growth. The placenta, which is basically network of blood vessels and capillaries (albeit with a little barrier between the mom and the baby) that supplies nutrients to the growing fetus, it is attached to and fed from the uterus' blood supply.

After childbirth the uterus is basically a big bleeding wound, and it's up to hormones and mechanical changes to cut of circulation to the wound so it can stop bleeding.  

Postpartum Mom's bodies do have advantages that normal women don't, though. Even though their blood is expanded to almost double it's original volume, most of the extra blood volume exists as plasma. That the part of the blood that contains the clotting factors that are activated in injury, protect against excess bleeding, and promote healing. 

However, it also means Mom's blood is hemodiluted: there are fewer red blood cells circulating, mom is already anemic before birth even happens. So a large amount of blood loss at birth, or shortly thereafter can have a big impact on cardiovascular stability. 

That's why its important for the postpartum nurse to get a time of birth estimated blood loss (EBL), so total blood loss can continue to be monitored. 

There are several reasons Postpartum Hemorrhage can occur:

Sometimes the uterus muscle becomes atonic doesn't clamp up like it's supposed to, and blood continues to flow as if it's still supplying a baby there. 

Other times there's a mechanical obstruction, such as a full urinary bladder, or clots that prevents the uterus from contracting and getting smaller like it's supposed to.

There can be a retained placental fragment still in the uterus after the rest of the products of conception have been delivered. 

A multiparous mom (a mom who's had a lot of kids), or a multigestational mom (a mom who has been carrying more than one fetus), is also at increased risk for postpartum hemorrhage just because her uterus has had to stretch more.

A mom who experienced a traumatic birth; laceration or epistotomy along the birth canal is also a source of bleeding. 

There are also medications that can increase the mom's risk for developing hemorrhage, such as magnesium sulfate (given to moms who have preeclampsia or eclampsia, and are at risk for having seizures).

Sometimes clotting factors can activate when they're not supposed to and deplete: forming tiny little clots in some areas of mom's capillary bed and extremely thin blood that bleeds very easily everywhere else. This is a very ominous condition called dissiminated intravascular coagulation (DIC)

It's important to monitor the patient's uterus and lochia flow. Palpate the patient's abdomen, while supporting the neck of the uterus at the pubic bone, and locate the fundus (the thick, top part of the uterus) of the uterus in relation to the patient's umbilicus (belly button). Note if the fundus feels firm or boggy. If the fundus is boggy, perform a fundal massage until it is firm.

If the fundus is deviated to the left or right of the umbilicus, it may mean the patient's bladder is full, and the uterus is being displaced. Assist the patient to the restroom to void and then re-assess.

If clots or excess lochia are expelled on fundal massage, weigh the soiled linens. It is also important to assess the patient's pad and peritoneal area. If patient is on bedrest, have the patient lift or turn to assess bed pad, if patient is ambulatory make sure the patient is not saturating 1 peri-pad per hour or more, if this occurs it is important to weigh the pad

(To weigh soiled linens: First place clean linens of the same type on scale and zero the scale, then remove and place the soiled linens. (If you weigh in grams, you can convert easily to ml because 1gram=1ml))

and calculate the patient's total blood loss.

IF

The cumulative (added together) blood loss is greater than 500 ml (for a vaginal birth)

The cumulative blood loss is greater than 1000 ml (for Cesarean birth)

OR

Vital signs are unstable:

 a 15 percent change in vital signs is noted

• HR 110 tachycardia
• BP less than 85/45 Hypotension
• O2 saturations less than 95 percent Hypoxia
  

OR

There is even more bleeding in the recovery or postpartum period, which when weighed increases the patient's total blood loss above 500/1000ml respectively. 

• The patient is in Stage 1 of Postpartum Hemorrhage.
  

It's important that a nurse (usually the primary nurse) stay with the patient and call for the assistance of the charge nurse, or another nurse. Continue fundal massage, and (if patient's IV has been removed) start another one, preferably 18 gauge or larger because those are the ones suitable for fluid resuscitation.

Call the doctor and notify of EBL at birth, current loss in MLs, presence of clots, lochia color (bright, dark, pale red) vital signs, and most recent hemoglobin and hematocrit level.

Receive orders, which may include:

• Oxytocin 10-40 units IV (Oxytocin is a hormone is released in a pregnant woman's body when the placenta disconnects from the uterus, and when the infant starts to breastfeed. It can also be given as an IV infusion.)
  

• Hemabate 250mg IM (NOT IV) Q15-90 minutes. Not to exceed 8 doses/24 hours. May cause nausea, vomiting, hypertension.
  

• Methergine 0.2 mg IM (NOT IV) Q 2-4 hours. Do not give to patients who have high blood pressure, primary hypertenstion or pre-ecclampsia/ecclampsia because it can make their blood pressure go even higher and they can have a stroke or seizure.
  

• Misoprostol 800-1000 mcg PR once. Causes diarrhea (sorry mom D: ) Nausea, vomiting, transient fever and headache.
  

• Type and screen for 2 units of blood
  

• Oxygen administration, frequent V/S, LOC checks, keep patient warm, insert foley catheter for strict I/O and to depress bladder, continue vigorus fundal massage.
  

These medications are available on the hemorrhage crash cart located in L&D.

It's also important to review the patient's history and consider the potential cause of the bleeding (For instance: atony, trauma/laceration, retained placenta amniotic fluid emboli, uterine inversion, coagulopathy etc.)

If Vital sign instability continues, or bleeding continues to greater than 1500ml

• The patient is now in Stage 2 of Postpartum Hemorrhage.

This is where a team effort really comes into play, as everyone prepares to take the patient to Labor and Delivery, OR, or recovery room.

You'll need another nurse to help perform a bimanual uterine massage (which is basically a uterine massage with two sets of hands).

The charge nurse will call a code OB

Labs are drawn for STAT CBC with platelets, CMP, Coagulation panel, ABGs.

Additional doses of medications listed above will be given,

Blood products are administered

A second large bore IV site will need to be inserted, the primary nurse will need to communicate the total blood loss and vital signs to team members.

Prepare for massive transfusion protocol.

Some of the procedures the doctor may perform include:

• Repair of laceration or episiotomy
• D&C to remove retained placenta fragments
• Intrauterine balloon
• selective embolization
• B-Lynch suture
• Bilateral uterine relaxation drugs
• Hysterectomy
• Aggressive respiratory, vasopressor, and blood products support (if DIC)
  

If blood loss continues beyond 1500ml, 2 PRBCs have been given but V/S are still unstable or disseminated intravascular coagulation (DIC) is suspected:

• Initiate massive transfusion protocol
• Move patient to OR (prepare for artery ligation or hysterectomy)
• Call ICU for bed
  

Other considerations:

The patient will probably be really cold through all of this, do your best to keep patient warm and if possible warm blood products before infusion using designated device.

Re assign staffing for infant

Support for other family members.

Resources:

http://www.ncbi.nlm.nih.gov/pubmed/4075604

https://www.hon.ch/Dossier/MotherChild/preg_changes/circulation.html

http://www.open.edu/openlearnworks/mod/oucontent/view.php?id=279&printable=1

My hospital's policy and procedure

Notes:

I had this all printed up and the text flowed all pretty, but I forgot to save BOOOOOOOOOOO!!!!!

Serves me right for typing up on blogger.

Neonatal Jaundice

I recently transferred to the Maternal Child Care (Postpartum) Unit at my work and as kind of a homework assignment I'm exploring the pathology of a common complication for newborns: Jaundice.

Mostly in the past when I've taken care of people with jaundice it's because they have really bad liver disease. So bad that their livers can't get rid of bilirubin, a waste product of erythrocytes (red blood cells). In babies, it usually works a little different. Their livers are immature, but aren't usually damaged as much as they are overloaded with more bilirubin than they can handle.

But first I'll explain the normal physiology of bilirubin production and elimination: Like a lot of the waste products in your body, bilirubin is transformed multiple times, and different molecules are added or subtracted so the waste product is 1) less toxic 2) easier for your body to identify and get rid of, because they can recognize that it's trash.

Most bilirubin comes from heme: a component of erythrocytes (or Red Blood Cells), where it exists as hemoglobin.

"Hemoglobin" is the part of the red blood cell that makes it red: it has the iron that holds on to the oxygen in your blood, and it's the thing that makes your blood red when it touches air; blue when it is oxygen deprived. It's a very important component of your blood, however erythrocytes, only live a short amount of time (120 days in adults, 70 days in fetuses) and they don't reproduce.

When they die, the body needs a way to get rid of the parts it doesn't need anymore. A lot of the bodies waste products are excreted by the kidneys, but heme is usually excreted from the liver into your intestines as a component of bile.


I'm gonna show you a picture just to give you an idea of how heme is transformed on it's way to leave your body:

^ When red blood cells die, they release the "heme" from the "globin" and the heme exists in a form called bilirubin.

It would be just sitting around in the blood, but luckily there's a really big, powerful protein (called Albuimin) already circulating in the blood that binds the bilirubin to itself and carries it where it needs to go. In this form, (attached to the Albumin) the bilirubin is called "Unconjugated". The unconjugated bilirubin travels to the liver where it is processed and sugars are attached to the Albumin-Bilirubin molecule. In this form, we call it "Conjugated" bilirubin, because of the way all those smaller molecules (sugar, protien, bili) are bonded together.

This form it should not be circulating in the blood, it should be excreted into the intestines, get broken apart by all the bacteria living there, and go out with all of your poop. But sometimes, if it sits in your intestines for too long (this happens when babies don't feed well) or you don't have enough intestinal flora growing in your gut (newborn babies have very little), it can be re-absorbed into the blood.

Your body, of course, tries to find other places to put it (it is a waste product after all, it's TOXIC!) and, a very small amount (1 percent) is converted to urobilinogen and excreted from the kidneys, but it's really not very much. So the conjugated bilirubin just kinda gets stuck in your body

E.V.E.R.Y.W.H.E.R.E.

It can get so bad, you can see it in your skin. It was red in your blood, but now it's YELLOW:


                                      

and your eyes!

 (This condition is called "Jaundice" or icterus)

But the WORST is when bilirubin gets to your brain, because it ends up causing encephalopathy and brain damage. (this is called Kernicterus)


Although Jaundice is relatively common in infants it's usually not a really big problem, most babies do have some degree of physiologic jaundice because their livers are immature. In a healthy infant who is feeding well usually won't need any treatment. Therefore, its important for parents to be able to distinguish when jaundice is progressing into a problem.


Jaundice can be particularly pathologic if it exhibits within the first 24 hours of an infants life. This is usually caused by an underlying condition that's contributed to the baby's red blood cells dying:

• Blood incompatability between the mother and the infant: Where the mother has produced coombs antibodies to the infant's blood.
• Infants with cephalohematoma, or bruising underneath their scalp (from a prolonged or traumatic birth)
• Infants who born earlier, who are small for gestational age, or twins, may have blood that's concentrated, and dies quicker
• Infection, or treatment with certain antibiotics.
• Respiratory distress/hypoxia
• Certain enzyme/metabolism disorders (Such as Gilbert's syndrome)
• Infants of asian parents (?? for some reason...their RBC's die quicker...idk...)

 If a baby has these risk factors, it's important to monitor for symptoms of jaundice and inform the baby's doctor. There are screening tools like the transcutanous bilirubinometer (TcB) that you can use to determine if the baby is at risk for developing jaundice:

The doctor may order labs for the baby: Total Serum Bilirubin (TBIL, or TSB), Conjugated Bilirubin (Direct bilirubin, or DBIL) or Unconjugated Bilirubin (Indirect, or IBIL...which they basically get just by subtracting: TBIL-DBIL=IBIL)

The doctor might also place the infant's discharge on hold to monitor make sure jaundice isn't progressing and that he or she is eating enough to expel all of that bilirubin from their gut.

Aside from yellowing of the skin, and mucous membranes and eyes, babies with jaundice are usually poor feeders (either they aren't interested in eating, they have a poor suck, or they aren't pooping and peeing appropriately/enough for their day of life). They're usually really tired and won't startle as easily, they'll wanna sleep though feedings.

At the later stages, the baby's body will tense up, they'll be irritable, and they'll have a high-pitched or shrill cry.

Fortunately, there are a lot of things we can do to treat jaundice.

If labs come back with high bilirubin levels, the doctor will probably order supplemental formula feedings and photo-therapy (blue or white light is preferred: 460-490)

via a lighted blanket that sticks to their back,



a bili-bed,



or a bili-lamp...which kinda looks like a little tanning bed for babies, they even wear these little eye protectors:




If the baby's condition is critical, the doctor might order an exchange transfusion (I'd imagine this only gets done in the Neonatal Intensive Care Unit), where they take out blood, and put in new blood until the baby's circulating blood supply is completely replenished. Apparently this is particularly effective if there are a lot of antibodies in the babies system from mom, against the babies blood (if anyone knows more about this, I'd love to hear your experiences. It sounds like a pretty interesting treatment...I imagine they use whole blood, not Packed RBCs)

If a baby is going home with jaundice, or even if the baby is at risk, it's important that the baby's parents know that they're infant is at risk and know what signs and symptoms to look for that their infant might be developing this condition. Some yellowing is to be expected, but yellowing of skin and eyes accompanied by poor feeding is a concern. It's important that they know who to contact if the problem worsens (the pediatrician, NOT the obstetrician). It's also important that they keep well-baby follow up appointments with the pediatrician to make sure their baby is adjusting well to extra-uterine life. 

Sometimes an infant with Jaundice will go home with a bili-blanket or bili-lights, sometimes the pediatrician will tell the parents to put the child in sunlight for a specific amount of time each day and to stimulate the baby to stay awake during feedings.




The risk for developing jaundice, and it's associated complications, is something we should assess in every baby. But it should not be something that causes a kid problems in the long run. Treatments for neonatal jaundice are very effective, as long as the symptoms are recognized and treated before it progresses to kernicterus. Doctors, nurses, and (most importantly) parents need to know what to look for in their infant, and when and how to seek help.



Sources:

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/neojaundice.html

http://medical-dictionary.thefreedictionary.com/bilirubin

https://labtestsonline.org/understanding/analytes/bilirubin/tab/test/

http://www.newkidscenter.com/How-to-Get-Rid-of-Jaundice-in-Newborns-at-Home.html

https://www.nlm.nih.gov/medlineplus/ency/article/007309.htm

http://www.lifewithkarma.com/2011/06/bili-baby.html

http://emedicine.medscape.com/article/1894477-overview

http://www.austincc.edu/emeyerth/hemoglob.htm

Book vs. Movie: 12 Years A Slave

I started reading this book on the airport to New York (OMW to watch Les Mis!)

Before I read this book or watched the movie, the most I knew about this story was the basic premise:

Based on a true story...A free man sold into slavery, won best picture in 2012...Benedict Cumberbatch plays one of the southern slaveowners etc...

So when I was in the airport reading the book, I was expecting a pretty straightforward account of Mr Solomon Northup's horrendous experiences in the south of the United States; possibly sprinkled about with anti-slavery propaganda appropriate for the time in which it was written and the indended audience would obviously be the people of the north. Basically I was expecting a heavy-handed expose on the atrocities of the south.

These expectations were seemingly reinforced when I read on the back cover that the narrative had been completed with the assistance of a ghost writer. So, I didn't go into this book expecting anything extraordinary as far as literary quality (although his experiences would certainly be worth reading about). 

Well, I won't say that parts of this book aren't heavy reading: it deals with some very heavy topics. The story is told in a a first person account, and it reads like something of a psychological thriller/horror story. But as far as literary quality I was completely mistaken; I don't think Solomon needed a ghostwriter to tell his story. The account was absolutely riveting and it was accompanied by an extremely thoughtful and on-point analysis of human nature in general. 

My favorite part is when Solomon talks about his "Master" Edwin Epps' eldest son:

"Young Master Epps possessed some noble qualities, yet no process of reasoning could lead him to comprehend, that in the eye of the Almighty there is no distinction of color. [...] Brought up with such ideas--in the notion that we stand without the pale of humanity--no wonder the oppressors of my people are a pitiless and unrelenting race."

This is an idea that's revisited several times in the story: 

• William Ford is a really decent guy, he cares about people, even slaves...even people who he considers to be inferior.
• Mrs Epps is pretty decent too, when she's not supper jealous of Patsy.
• Mr Epps...well he's actually a law-abiding man (ie...he's only as "bad" as the law will allow him to be.)
  

Solomon is not trying to paint the white people of the south as these atrocious monsters, these 'other' beings who need to be uprooted. He recognizes that these people see the world...not in the way it is...but the way they were taught that it is.

He's trying to understand them! And he's granting them a complexity of thought...a humanity...that he himself is denied. 

#ugh! #FEELS!

Another really interesting thing about this book is how he overcomes the whole slavery system they had set up in the south. I kept expecting him to run away and get rescued, which probably says something about the way I think about problems in general (the system as something that needs to be defied...) but we see numerous reasons in this book why that approach wouldn't work. Solomon repeatedly chooses to keep his head down, to work in this system rather than fight because he knows that people who run away don't get away. He knows he's not running from the masters but from a whole line of thought that's existed for a really long time and that permeates every aspect of their society. 

It's heartbreaking, gut-wrenching, thought provoking, riveting.  And the ending?! 

Definitely not a light read, but I highly recommend it if you want something that's exciting and thought provoking at once.

And now for the movie:

This is more going to be a "what the movie missed" section. For the most part, the movie is pretty loyal to the book. Solomon's home life being told in flashbacks and, of course, the book can give us an internal monologue that lest us get inside Solomon's mind in a way a movie can't but I was actually very surprised at how much they were able to fit into the film.

Here are the differences I noticed though:

• Solomon and Anne had three kids, not two. Their names were Elizabeth, Margaret, and Alonzo. (I think they took Elizabeth out because they already had another character with the name Eliza).
  

• Uncle Abram has significance in the story other than just dying. (In fact they kind of nerfed anyone who wasn't Patsy now that I think about it...)
  

• In the book, we don't really know if William Ford was turning a blind eye to the possiblity of Solomon being a free man. In the movie, Solomon actually tells him and he just goes: "La-la-la I can't hear you!" in the book, one of Solomon's regrets seems to be that he didn't tell him because he didn't know if he could trust Master Ford or not. (Remember, it's not these people who are his enemies: it's a whole system)
  

• They never show the Epps' children; the eldest son would have been around 12 or 13 at the end. So Solomon would have watched him grow from infancy.
  

• The guy who "rescued" Solomon wasn't just Parker the Random Store Clerk, his name was Henry Northup. (I think this was done to avoid explaining why there is a black and white family named Northup, although the explanation is actually quite simple.)
  

• In the book, Solomon never tells us anything explicitly sexual, however, it doesn't require a stretch of the imagination to realize the types of things depicted in the movie must have happened. It's there to show us how brutal this world is, there's nothing particularly seductive or explicit in it. 

• Solomon's reunion with his family is even more of a tear-jerker: Not only did his daughter name the first grandchild after him, Solomon's son Alonzo was away with the aim of making money to make a trip down to the south to find his father.
  

Overall I'd say that the movie is a loyal adaption to the book, the changes made were minimal and understandable. However, I should mention the movie is Rated R, there are strong thematic elements, intense situations as well as depictions of torture and rape. I would not recommend this for children, particularly if they haven't read the book.

The acting of the three main leads is fantastic, the story is powerful, but I don't see this movie as one for casual viewing. I watched it by myself, and it's not one I wouldn't feel comfortable watching in a group unless we were gonna talk about it afterwards.