Inspired

This is a letter that I've written to apply for a scholarship, something I rarely do because I hardly ever feel qualified... but it came to me in a flash of inspiration this morning and it really reflects my thoughts on a lot of different things that have been going on lately in my life.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

These three rights are often quoted, but the definition of “Life” isn’t as fully explored as the idea of “Freedom.” When I reflect on it, the connection to medical ethics becomes apparent: Beauchamp and Childress’ bioethical principles of Beneficence, Nonmaleficence, Autonomy and Distributive Justice echo the same theme. I shared my ideas through an Ethics Workshop that I organized this year for the Medical Student Mentorship Program (MSMP.) The idea of “basic human rights” is a fundamental notion – treat each other with kindness, respect and love. These are very deep topics perhaps, but they are entirely relevant to why I’ve chosen to go into medicine and serve others.

The right to Life equates to a right to be healthy, in my opinion. I’ll admit, I do not know if this was the intent of our founding fathers. However in this day and age, we have the knowledge and the power to help everyone in this respect! It frustrates me how something so obvious to me could be stymied by the short-sightedness of some political parties and insurance companies. The money problems of rising health care costs cannot be solved by putting power into the hands of private insurance companies who focus solely on their bottom line and how they can cut costs and deny coverage. Only by having a huge pot and nationwide coordination may we have a basic, free healthcare plan available to everyone. Until that day, some disadvantaged populations will continue to suffer and they will never get the same opportunities as everyone else. This is why I joined the Hawaii Homeless Outreach and Medical Education (H.O.M.E.) Project where I am currently a second-year clinic manager. I volunteer at the Kaka’ako and Waianae homeless shelters where we provide free outpatient healthcare for the residents. Instead of blithely accepting an unjust system, I have sought out opportunities to be a part of something that could catalyze change and help people recognize their right to Life.

I am committed to helping the people of the Pacific region and I dream of big things for our future. As a small state with diverse cultures and strong communities, Hawaii has the unique opportunity to show the rest of the nation what Aloha really means and how we can truly care for all people. I want to be a part of that and inspire others to help as well. I feel that my current work in MSMP and HOME are only the beginning of these good things.

I hope it doesn't come off as overly pompous, cheesy or insincere because it is the truth as I see it. One of my pet peeves is when people declare something "BS" -- to me, it is only if YOU think it is and it isn't if you think it isn't. Depends on whether you have a cynical or an optimistic eye of the beholder.


^Beholder

Gems for USMLE Step 1 studying

These are a few years old... just some links I found as I browsed through blogs in my "free time" while I study for boards. It makes me feel like posting more, but I could hardly match the level of quality entertainment in these.

http://www.agraphia.net/category/zac-facts/
Zac shares some of his favorite random facts while he studied for Step 1. My favorite part is Stereotyping for the USMLE.

I mentioned that you shouldn’t stereotype… openly. The USMLE is your chance to practice. Nobody ever needs to know that the instant you see lawyer you immediately think scumbag who sleeps with prostitutes and therefore has gonorrhea, syphilis, chlamydia, and herpes. It’ll stay our dirty little secret.

http://rumorsweretrue.wordpress.com/usmle-step-1/
The Table of Contents for a series of posts on Step 1, written by one of the newest editors of First Aid for the Boards... he got the job after garnering a list of corrections for the book on his blog! Amazing. :)

My personal favorite item from this blog came up in one of the comments on micro corrections. From it, I found a great way to memorize the single-stranded, positive sense RNA viruses.
on the mnemonic for the ss(+) RNA viruses. (Wow, the list on wikipedia is impressive.)

"Happy Flava Flav is having a Retro-Toga & Corona party in Pico Cali!"

• ACE: Hep A (PicoRNAviridae), Hep C (Flaviridae), Hep E (HepEviridae, the virus formerly known as Prince. I mean, Caliciviridae.)
• Retroviridae: HIV and HTLV
• Togaviridae: Rubella, an ARbovirus (ARthropod borne for Eastern/Western Equine Encephalitis, but Rubella wants to be a PaRaMMyxovirus)
• Coronavirus: a crown is round (helical), this is the only ss(+) RNA that is helical, NOT icosahedral!

If you have HHAPPPy DNA viruses and Flava Flav down, the other ones are the other ones. Don't bother classifying them beyond segmented (Reo and Ortho) and enveloped (Naked PAP and CPR)


Some other informative links:
http://www.grahamazon.com/2006/09/grahams-guide-to-boards-prep/
-Whoa, I was the first one to comment on this entry! He has some great recommendations on books to read. Topher has a much more comprehensive breakdown. I thought about unbinding my USMLE book like some of my classmates as Graham recommended, but i noticed that they have to flip through the pages one at a time. I ended up just keeping it together (though I still have a month of studying left and if the pages fall out, I might as well unbind the dang thing.)

http://prep4md.blogspot.com/2008/03/how-to-get-99-on-usmle-step-1.html
-Y.S. links up some recommendations from people on StudentDoctor.net who scored high.

http://www.pimpnotes.com/index.php

PimpNotes.org is an open-source notes project for medical students and doctors in training. The site hosts free notes, guides, books, or any other materials created by and for medical students and residents. It currently hosts a complete systems-based pathology charts ("the grids") and pathophysiology flash cards (in progress). an open-source guide to usmle step 1 is forthcoming--created and maintained by those who are closest to the material--the students themselves."
-J. Zimmerman, MD'07, Brown Medical
School

I looked through the charts and they are very thorough -- the text is tiny on the computer screen, but it's formatted for print. So far, he's got Path, Micro and Pharm as open source notes (meaning you're free to copy and distribute them and edit them as you wish.)

Stay tuned, I'll keep updating this list as I come across new items.

Emotions and the Way

"This commercial actually made me cry a little bit.
I wish I had a family."

I was chatting with my friend tonight and he sent me a youtube link with that message on AIM. I'll let you take a chance to watch it before I continue.




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Done? Good. The part at the end translates as "Thai Life Insurance."
So it's a totally fake commercial, but it made me tear up anyway. Decisions that don't make sense to doctors AREN'T bad decisions per se. Patients might have a completely different perpective that is totally valid.

If you open your eyes and listen, you might even be touched.
*sniffle*
Oh my. Sometimes I worry that my emotions will get in the way. Other times, well... allow me take the scenic route towards another conclusion.

This commercial reminded me of a class I had last year.

A guest lecturer came for a "blood banking lab" which turned out to be a confusing session on making checkboxes in the appropriate columns to "type and crossmatch" blood so we don't inadvertently kill patients in the future. While this isn't the job of a doctor typically, Dr. R wanted to impress upon us the difficulty of this task.

"Blood banking isn't as easy as 'giving them O blood.' There's a lot that goes on," he stressed. "As a matter of fact, a lot of difficult decisions are made every day. How many of you know about rationing? No? Basically, each unit of blood that is ordered for a patient is a unit of blood that CANNOT be given to another patient. If everyone demands Type O blood and we only have a dozen units, it gets used up very quickly."

"Let me tell you a story. I was called to see a patient who was delivering a baby and ran into some complications. She had Disseminated Intravascular Coagulation (DIC) and started to bleed out of almost every orifice. She was rushed into the Intensive Care Unit with nurses literally squeezing bags of blood, but she was losing blood faster than we could put it in. We might as well have opened up the bags and spilled them directly onto the floor."

"The blood wasn't enough. Platelets and Fresh Frozen Plasma too. But there was something else we could try. The magic blue juju vial."

Ok, so I made that name up. Keep in mind, that I'm recalling a story from a year ago and I haven't actually PRACTICED medicine in any hospital situation so I don't know what the indications are for using FFP vs platelets vs the magic blue juju vial (MBJJV). What matters to me is the story and the lesson I got from it.

"The only thing is, MBJJV would cost the hospital ten-thousand dollars. On top of that, she would only live for fifteen or twenty minutes, tops, even if we gave it to her."

There was a quaver in his voice and a gleam of anger in his eyes. Dr. R's voice rose to a shout.

"What would YOU do?" He challenged a few people in the class who had no idea what answer would appease this boiling man.

"What if I told you that those 15-20 minutes would give her enough time to spend with her daughter. An occasion that the husband could recall, at best bittersweetly rather than traumatically." (Ah yes, this is the connection with the Youtube clip.)

"What if I told you that the hospital had only one MBJJV and it would take months until another one came -- and another patient who could have otherwise been saved -- died because it had already been used."

"What would you do..." he trailed off, taking the time to remove his glasses and wipe his tears away.

I mustered up the courage to speak up, my own voice wobbling and wavering as I imagined the situation before me. "There's two sides to this -- payment and resources on one side and the needs of the patient on the other. When we talk about futile care, resources should not... hm, ought not to be expended if they can save a life. But in this case, we aren't talking about what best benefits the patient, are we? It's about what will be best for the husband and her daughter. Is the hospital willing to pay the money that insurance surely won't cover?"

So what happened?
She held her baby for the first and last time. She held on two hours. (Or my memory is adding in this detail for the sake of the story.)

-------------------

Afterwards, I learned that some of my classmates completely misinterpreted Dr. R's position. "That guy got really pissed off about ten-thousand dollars," someone told me. Wha? I thought his anguish over the ethical dilemma was obvious.

Do emotions get in the way? Do they cloud our judgement on what is right and wrong?
Perhaps, it's wrong to distance ourselves.
Maybe mmotions should guide us along the Way. They can reorient us to what actually matters.

Dear Congress,

Hello,

My name is Clinton. I am a second year medical student at the John A. Burns School of Medicine and I'm a minority in my class. Why is that? I want to go into a primary care field -- Family Medicine. I have long recognized the need in our country. We have a shortage of primary care physicians, dedicated people who coordinate care across our entire health care system. Family doctors have the greatest potential to impact the lives of many patients with the tools for early detection, prevention and education, in terms of cost (insurance savings) and benefits (better quality of life.)

Many of my classmates have been discouraged by the long hours, endless paperwork and low reimbursement rates seen in Primary Care. Many of them seek careers in more lucrative, more "successful" specialties. Is this really the direction we want to drive some of America's best and brightest? Is the message "We don't Care about Health Care" really an idea we want to spread?

There's something you can do to help. I'm not expecting you to change our health care system overnight; I'm merely asking for your support on a bill that will greatly benefit our Family Physicians. Hopefully, this will be a step that will take us in a new direction and everyone will have the care they deserve.

As a future family physician, I urge you to support S. 2785, the Save Medicare Act of 2008 and stop the Medicare payment cut that will take place after July 1, 2008, and guarantee an 18-month positive update so that Congress and the White House can work on fixing the Medicare payment program.

Unless Congress acts, family doctors will be hit with a decrease of more than 10 percent in payments after July 1. This sort of shifting Medicare reimbursement makes it harder for them to take new Medicare patients - do you want them to pay out of pocket to take care of patients?

Congress MUST replace the current, confusing Medicare physician payment formula that determines payment amounts. We need a NEW formula that makes sense and provides predictable annual increases that reflect the cost of providing care to patients. Family physicians deliver the primary and preventive care seniors need to stay well and to better manage chronic conditions - the leading drivers of health care spending. As the population ages, family physicians are positioned to keep seniors healthy and cut U.S. health care costs. But, they can't do it unless Congress acts now.

I urge you to help family physicians stay in business. I would like to be able to provide quality care for America's elderly without worrying about "breaking even." Please support the Save Medicare Act of 2008 to stop the payment cut by July 1 and ensure an 18-month positive update to the Medicare physician payment rate.

Change can start, here and now! Care about Primary Care, please. :)

TED Talk: Eva Vertes on Cancer

Meet Eva Vertes. In 2005, at age 19, she presented to "Technology, Entertainment, Design (TED)" on the subject of cancer. Her enthusiasm about science is really quite astounding; at 14 she decided to work in a neurology lab and in the process she discovered a purine precursor inhibits degeneration.

Discovering that guanosine protects against Alzheimer's is an impressive feat... and she's got so many more years as a researcher to learn and investigate! Cool.

She goes on to share some of her ideas about cancer cells and stem cells. Her ideas matched my own when I first started learning about medicine... I too was shocked to discover that cancer and stem cells weren't really that far apart. Both are immature tissue, but one has a purpose, the other is selfish. Perhaps cancer is a reaction to injury that just gets out of control, she proposes.

I think she's right... in part on this issue. My current understanding on cancer is that the injury causes cells to regenerate and this replication process increases THE RISK of mutations that lead to cancer. Our bodies never intend to make cancer. We are a Collective of cells that function as a group... we don't intentionally make Invasive Parasites that will kill us. So, I think the causal chain of events looks more like:
injury --> regeneration + OOPS, replication error! --> CANCER
than it does
INJURY --> OUCH, I NEED TO BUST OUT THE BIG GUNS, *fiddling around* --> CANCER.

Cancer is the dark side of stem cell therapy. Stem cell treatments just introduce something that is "totipotent", the power to become 'anything and everything,' into the body and then you sit back and hope that it will follow your directions. What if we get an OOPS moment instead? Suddenly, our most promising therapy becomes our most feared and difficult disease to treat -- ourselves.

Her questioning takes her onto the subject of muscles and cancer. Again, I asked the same question that she did. I've heard of breast cancer and lung cancer... how come I've never heard of Heart cancer? Terminally differentiated tissues that do not regenerate like muscle cells do not become cancerous. There are some embryonic cancers of the heart and skeletal muscle (rhabdomyoma/rhabdomyosarcoma), but these come from the OOPS stem cells in children rather than the damaged heart or muscle tissue in an adult.

What excited me most about her talk were her theories on metastasis and skeletal muscle's resistance to invasion by cancer cells. She offered up a few theories on inhibition of the necessary blood supply for cancer, a reorganization of the tissue or most interestingly, the skeletal muscle tells the tumor to become muscle tissue as well!

She finishes with one final thought:

When the body initiates a process and we call that a disease... it doesn't seem that elimination is the right solution. So this might sound far fetched but in the future, cancer could be used as therapy. If there are diseases where tissues are degenerating, for example Alzheimer's, where the brain cells die and we need to restore new brain cells, what if we could use cancer, a tumor, and put it in the brain and cause it to differentiate? These cancer cells are so versatile; we just have to manipulate them in the right way.

A compelling idea indeed. If we manage that, without any neurological damage like memory loss, we would be well on our way to immortality at the cancer rejuvenation clinic.

Cooking Stew

I bought some beef at the store a week back, intending to make beef curry. Instead, I had a pot of spoiled rice (that I neglected on my kitchen counter for four days as it cultured Bacillus cereus most likely) and I realized... I've never actually made stew before! I mean, I've helped my dad cook stew when I lived at home, though my role was washing and chopping vegetables, not running the show from start to finish. Then, as I dug through my closet to search for the curry packet I discovered that it was a ready made meal -- you're supposed to just toss it into hot water to heat it up and then cut it open and pour it on top of rice. Serving size: one. Lame!

Tasty Planner is a great website for recipes, meal-planning and assembling a shopping list so I thought I'd give it a go. I found a recipe for beef stew and got my shopping list together.

All I need is some beef broth, mushrooms, an onion, tomatoes and potatoes... how hard can that be?

As I wandered through Safeway, I started buying ingredients for future meals thinking to myself "Oooh, that sounds tasty!" My mind wandered through the aisles. When I got home and started cooking, I realized I was missing a few key ingredients -- namely potatoes and tomatoes! "Ah well... it'll still come out OK," I reassured myself.

As I added in all the ingredients in for my final stew, it looked more like soup. "Thickener! Oh, so THAT'S why the recipe said to roll the beef in flour before cooking it... whoops." My kitchen isn't fully outfitted, in spite of the full pantries. I knocked on a few of my neighbor's doors but seeing how it was noon, no one answered. No corn starch, no flour... what to do, what to do.

I went online to look for some ideas and someone said "add any sort of starch. Rice or potatoes are good."

Rice! I just cooked a batch of fresh brown rice to go with my meal, so I added that in. My goodness. It is the best tasting stew I've ever eaten! Of course, being the chef might influence my opinion somewhat, but the red wine certainly jazzed it up. That's an ingredient my family stew neglected to use.

The funny thing about my whole thickener experience was that when I read the recommendation to use "starch," I made the connection that oh yeah, corn starch is a starch. And hey, the reason why it thickens is identical to extracellular matrix (ECM)!

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ECM is a mixture of polysaccharides (which includes starches) and proteins that surround cells. One of its functions within joints is to trap water and provide a cushion... basically thickening it up into a gelatinous mush.

Science to the rescue! I lack a lot of common sense when it comes to things like cooking, but boy, I like it when something esoteric like knowing about ECM actually provides an explanation for everyday things. :)

"So I'm taking these yellow pills..."

For some reason, I thought that doctors knew how to identify pills. On top of memorizing those complicationed jumbles of nonsensical consonants that pass as "names", the mechanism of action, indications, contraindications, drug interactions, side effect profile... doesn't it make sense?

I soon found out in med school that's not necessarily the case. Docs don't get hands-on with the pills. They write a prescription and the pharmacist fills it. I haven't taken very medications so... I'm not even sure I could tell the difference between Tylenol and Aspirin. Pharm-techs probably could ID the pills based on a description, but tell the MD "I'm taking something for my blood pressure. I don't remember the name, but it's a yellow pill..." you'll get a blank stare.

Surely there's some sort of resource out there for swift ID!

After a split-second search on Google, I found the "Pill Identification Wizard" over at drugs.com. It has an extensive US based formulary with pictures of various medications after you fill out a short description. Here's a sample, based on the only medication I've ever taken:

This is a service I'll definitely utilize in the future. It would be even more fantastic if you could snap a picture of it (on your cell phone, for example) and get a list of possible meds from that.

Hot tubbin'

Sundays are my work-out study days. I usually cruise down to a swanky condominium near Ala Moana Beach in the afternoon to study with a few of my classmates, J and G. We go over our cases (summarizing them and then writing up a quick review with key points) or pathology question books ("slapping in" when we've got the right answer after someone reads it aloud to make it more like a game show.)

Then we work out in the gym and have what G affectionately calls "pool time" :) The gym/pool is a big motivator for me to meet every weekend with them; the weather usually behaves and we catch the last few rays of sunshine before the golden-red glow of the sun signals that it's about time to leave the jacuzzi and get some food.

G told me about one time she broke out with a strange rash a few days after enjoying her pool time. It was like having bumpy acne from her chest down...
"G!!!! You had hot tub folliculitis!" I exclaimed, in the excited tone I adopt whenever I stumble across a surprisingly cool diagnosis.
"Whhaaaa... what's that?!?!" She said in shock.

Hot tub folliculitis is caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the water's acid and chlorine levels are strictly controlled.

Hot tub folliculitis can be seen within several hours to 2 days of exposure. It first appears as itchy bumps, some of which may be filled with pus. It may then develop into dark red tender nodules. The rash may be thicker under swimsuit areas, where the material has held the contaminated water in contact with the skin for a longer period of time. via Medline

"Ewww!!!! Gross!"
"Yeah, I guess it cleared ok for you," I said, performing a cursory examination of her skin"
"You perv," she said, laughing, splashing some water at me.

There's another condition that's linked with hot tubs and microorganisms.
It's called Hot Tub Lung!

This 49 year old patient was admitted with several weeks of worsening dyspnoea and dry cough. He had no history of previous respiratory illness. Further history revealed that several months prior he and his wife installed a hot tub in their bathroom. His HRCT chest showed widespread areas of ground glass opacity. via Radiology Picture of the Day

Diagnosis? Mycobacterium. Not the type that gives you TB though... Mycobacterium avium intracellulare, apparently. It gets aerosolized from all the bubbles and then you get an allergic reaction from its presence in your lungs.

Don't worry, most people handle MAI just fine. It's ubiquitous... found in dirt and water everywhere. Just an activated macrophage here or there and CHOMP! The infection is handled without the breathing problems.

Education has a way of sneaking up on you...

So, it's official. I'm done with my second year as a medical student!

There's not much in that victory as the majority of my summer will be devoted to studying for Step 1. I've talked about it before here so I won't rehash all of the details of my particular situation. I have another story to share though.

After my 6 hour long multiple choice and essay question exam two weeks ago, I got a call from one of my friends living on the mainland now.
"Hey B, what's up?"

"Hey man, just landed on the island and I'm here with D. BTW, did you know that he's getting married this Saturday?"

Whoa, talk about last minute invites. Apparently D didn't have any of my contact info (or anyone in my circle of HS friends) so I made a few calls and found someone else to go with. I thought it would be a nice break from my board studies to go to the event. It was really nice; I got reacquainted with some of my old high school friends! J, my senior prom date (and a girl I had a crush on even when she was dating D), just graduated from acupuncture school and now she's working as a chiropractic assistant now. I made an effort to be open minded and ask her a little bit about her philosophy and practice and such. I was glad to hear that it really worked to help her with her pain after shoulder surgery (something that bummed me out about going to prom with her... the music really pained her having just had the surgery, so we only danced a few times.)

It's difficult for me to shut off that nagging factual scientific side of my brain that I use so much and approach things from a more nonjudgmental, holistic, cultural perspective (or what have you.)

Somehow, I opened a bag of worms by mentioning that I was in med school. After the polite round of "Oh, what kind of doctor do you want to be? (Family Medicine)" "Oh, that's nice (Yeah, I really want to be albe help all kinds of people)" One of the mothers on the table dove in for the kill.

So, I listen to this conspiracy radio talk show and they have some interesting topics. Yesterday they talked about vaccines, calling it the Vaccine Genocide. It's a shame how we have to vaccinate babies at birth! There's so many complications... How do you feel about it?

Obviously, a wedding table is no place to launch into a deep discussion about the pros and cons of vaccine administration, the benefits of herd immunity, the necessity for prophylaxis for diseases we don't have any other cures for... I was caught off guard by the sudden shift in subject matter, but I guess it was reasonable since I was inquiring about acupuncture just a few minutes earlier. How would I be respectful of her beliefs, challenge her assertions and not come off as angry, defensive, or patronizing as I do so?

"Yeah, I'm not a fan of genocide. I totally feel bad for all those all of these poor bacteria we're killing off!" I said jokingly. No one laughed. Not even a guffaw. Whoops. Time for a new tactic.

"We don't give vaccines to protect healthy people. Things like the the flu vaccine are given to protect people who are immunocompromised -- old people, young babies, diabetics, cancer patients, etc. I think a lot of people are forgetting what it's like to live in the days of infectious disease. In some ways, having vaccines makes it harder for us to understand why they are so important. Take the chicken pox vaccine for example...

"That vaccine is totally unnecessary. People who take it have a higher incidence of shingles!" retorted J, shaking her pretty blonde locks in disgust.

"Yeah, that's true," I conceded. "What I meant is this -- doctors don't even see patients with Chicken Pox anymore. Soon they'll forget what it looks like in person. I can only imagine what the general public will think."

Indeed, my personal philosophy about vaccines is somewhat cynical and harsh. In order to convince people of their necessity, they occasionally need to see the disease it would otherwise prevent... otherwise the adverse effects, no matter how rare or uncommon they may be, will be seen as PROOF that vaccines are harmful, even deadly, and doctors are killing babies. Perhaps I got through to her...

"What about the HepB vaccine?!? You give that to babies right at birth," the mother asserted.
"Yeah, the maternal antibodies protect the baby from HepB for a few months." J added.

Hm. This was an issue that required more finessing. I didn't want to tell them everything about HepB transmission, so I dropped the cancer bomb on them, a little something I had prepped a few years earlier on my blog.
"Did you know that HepB prevents cancer? Yep, that's right. We're vaccinating these children so they don't get HepB during the delivery from their mother so they don't get hepatocellular carcinoma."

I felt satisfied that I defended my profession. Still...

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"A, what happened back there?" I said as we drove back from the beach house/wedding site. "You're a social worker, public health, natural disaster and all that business, I would've liked some support."

"You did a pretty good job," she said. "Thimerosal and autism? Where was she getting that stuff from? I thought it was disproven a long time ago."

Dang. A was right. Bush was right. Repeat something often enough, it becomes true to the American public, no matter what the facts are. Rather than submitting to this droning power of the collective, I will speak out! Hopefully in a nice and polite way that will help to put a good face on Medicine.

Is "O" the new "E"?

Have you heard of ecstacy? Also called MDMA, it is a recreational drug that was used by psychotherapists until it was US drug laws made it an illegal substance. "E" moved from yuppie bars to the dance rave scene and has since become one of the most widely abused drugs in the US. A lesser-known drug is being used in these raves too. Octium, "Oo" or simply "O" as it is called on the streets, is a chemical that was originally discovered by a Swedish pharmacist Carl Wilhelm Scheele in 1771. Since then, government scientists have been working on the uncovering the secrets of this deadly chemical. I have done some research and quite frankly the results they have downplayed to the public are absolutely shocking.

Chemistry
Unregulated by the Food and Drug Administration (FDA,) not classified as pathogenic by the Center for Disease Control (CDC.) Why not, I ask? Judge for yourself.

Effects
Extremely reactive. It can exist in a highly unstable form known as a "free radical" which indiscriminately disrupts chemical structures in your body.
Carcinogenic: causal links with emphysema and lung cancer!
Byproduct of many harmful pharmacologic and physiologic reactions!
Compounds with high octitative potentials can cause severe chemical burns.
There is a high correlation between unattended children with access to Octium in house fires.

Neurological effects
In excess of moderation, Octium can cause dizziness, weakness, confusion, and agitation.
In the anarchist movie Fight Club, this chemical was touted as a substance that "will get you high"

Systemic effects
Agitation, hyperpnea and tachypnea, chest pain, dyspnea, wheezing, dizziness, palpitations, tetanic cramps (carpopedal spasm), paresthesias, generalized weakness, and syncope

Long-term effects
deadly to many microorganisms, thought to be a leading cause in a massive "genocide" that changed our planet millions of years ago... and now an organic form of this chemical is a major contributor to the greenhouse effect, causing global warming!


Abuse as a drug
Extremely addictive, with painful withdrawal periods that cause eventual death for ALL addicts who try to quit.
produced in large amounts by ALL plant life (unlike other hallucinogenic compounds like those found in mushrooms, tobacco or Sativa cannabis.
Binging on octium is commonly called "diving". Octium abuse can lead to visual disturbances, ringing in the ears, dizziness, and severe mood swings. When Octium attacks the central nervous system, convulsions and finally coma are the result (otherwise known as CNS toxicity.)

Supply and administration
Inhalation is the common method and unbeknownst to many users, intravenous injections of Octium are highly dangerous and even deadly.
Some bars supply their customers with custom Octium, attempting to lure them in with trendy flavors. They are monitored by the FDA, but no major health risk crises have happened to spur them into action... yet.

Safety
Should you let your friends and family know about these dangers? Just think about this -- even though teenagers attending concerts and raves might be overusing Octium, they might also be using a drug linked to octium -- DHMO, aka dihydrogen monoxide.


Before you get too concerned, just take a deep breath. Whew... now that wasn't so bad, was it? Meditate on your breathing and enjoy the benefits of octium.
Similar to DHMO, octium's benefits outweigh its risks, bar none.

Happy April First :)