Tag Archives: edema

One Face of MRSA, Resistance Bug, in Kitsap County

One Face of MRSA – What Does the Resistance Bug MRSA Look Like in Kitsap County? Here is one face.

A Look at MRSA

Ignoring edema in your lower legs?
I did. Ask your doctor how to get rid of it – permanently…not just take water pills and forget it.

There is a reason edema develops for each person. Find out the cause, and, if possible – fix it. You do not want what I have.

Ask your partner – your doctor.
The latest recent culture of my open wound came back positive again – the second positive result since it began again in my lower left leg, October 2013..

“MRSA stands for methicillin-resistant Staphylococcus aureus. It causes a staph infection (pronounced “staff infection”) that is resistant to several common antibiotics. There are two types of infection. Hospital-associated MRSA happens to people in healthcare settings. Community-associated MRSA happens to people who have close skin-to-skin contact with others, such as athletes involved in football and wrestling.

Infection control is key to stopping MRSA in hospitals. To prevent community-associated MRSA

Practice good hygiene
Keep cuts and scrapes clean and covered with a bandage until healed
Avoid contact with other people’s wounds or bandages
Avoid sharing personal items, such as towels, washcloths, razors, or clothes
Wash soiled sheets, towels, and clothes in hot water with bleach and dry in a hot dryer

If a wound appears to be infected, see a health care provider. Treatments may include draining the infection and antibiotics.

NIH: National Institute of Allergy and Infectious Diseases”
http://www.nlm.nih.gov/medlineplus/mrsa.html
My opinion: (Test all patients and personnel in hospitals – stop the spread of MRSA)

Ignoring it – spreads it
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Harrison Medical Center Wound Care, Hyperbaric Medicine, Infusion Center
The understated low-slung buildings in the old Sheridan Village show a benign face to the wounded people who fight life and death wound care treatment inside.
Opening the door to the reception area brings a cheery “Hi! …Debbie knows your name.

Debbie Knows Your Name and smiles a welcome!

Debbie is usually the first introduction to the amazing friendly, competent and cheerful docs, nurses, technicians – all the great people working there. The patients reflect their environment as does the varied reading material offered. From deep sea training to bird reading …nothing ordinary about this place or the people in it – health care or patients.
A minor breakthrough happened when I awoke a few mornings ago feeling nothing. An absence of pain in my leg – no pain anywhere….the apparent result of the new sulfur antibiotic for the escalating lymphedema/cellulitis/MRSA wounds in my left leg.
The pain gradually returned.

Debriding is done with a sharp razor after the wounds get surface Lidocaine to deaden the flesh. Most of the time it works.
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GOOD NEWS: I heard about an Ultrasonic Debridement machine – pain free that takes the place of a sharp razor and found a study on it in Ontario, Canada.
Efficacy Study of Ultrasound-Assisted Debridement to Influence Wound Healing (UltraHeal)
Principal Investigator: Christine A. Murphy, MClSc PhD(c) The Ottawa Hospital
Sponsor: Ottawa Hospital Research Institute
The start date was December 2013 – Estimated completion December 2014.
Official Title ICMJE A Randomized Controlled Trial to Investigate if Application of Low Frequency Ultrasound-assisted Debridement May Improve Healing and Infection Outcomes for the Person With Vasculopathy and Recalcitrant Wounds of the Lower Extremity
Brief Summary The UltraHeal Study is a randomized controlled trial to compare healing response of low frequency contact ultrasonic-assisted debridement in addition to best practice wound care to best practice wound care alone in a Vascular Surgery Clinic patient population with wounds of the lower extremity.
Detailed Description The study will also investigate the bacterial tissue burden and protease activity to provide further insight into the infection and inflammation aspects of healing barriers in a challenging population.

IF the study proves out, we should be thinking about getting a Ultrasound machine that uses new technology to debriding wounds and helps healing…

Harrison Medical Center Foundation – how can we help you help us get that machine if the study is successful?

Thanks for listening… more later…
Sharon O’Hara, (familien1@comcast.net)

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Dr. Halligan and Harrison Medical Center Angels, Part 1 of 3

Sharon O'Hara

I am writing this from a hospital bed on the cancer floor at Harrison Medical Center in hope someone will take note what edema can and may do to those who ignore it.

Also, I’m writing in heartfelt thanks to Dr. Halligan, Internist/Surgeon at Silverdale Doctor’s Clinic who saved my life and leg recently by taking over failed treatment for my Lymphedema/Cellulitis/Edema filled legs and painstakingly, day after day treated and changed leg wraps.

Dr. Halligan patiently explained my left leg needed debriding to remove the dead skin, much as burn victims and he couldn’t tell what was under the surface dead skin or how deep the dead tissue went. This four-month pain riddled sleep deprived patient gratefully lay in a bed at Harrison Bremerton 23 hours a day, 7 days a week. Four weeks total this Thursday.

Tomorrow, Wednesday, I am moving to a rehab place for rehabilitation and further healing.

I battled without success since early September the Cellulitis/Edema in my left leg until my right leg reddened with infection and edema and began the water blisters that experience taught would lead to lymph fluid running down my lower legs, scalding the skin it touched and spreading the poison…

Chris Goss, MD, my lung doc at the University of Washington Medical Center straightened out the Restless Leg Syndrome medication problem so I could sleep if the pain eased.

Edema patients – PLEASE – check out the following photos of the latest rise and fall of my edema filled legs and ask yourself if ignoring edema is worth it.

Dr. Halligan – thank you!

More next time on Harrison Medical Center’s Angels in disguise.

….thanks for reading. Sharon O’Hara

Thanks for reading…Sharon O’Hara

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Does a hospital’s right to hire smokers trump a patient’s right to breathe clean air?

Sharon O'Hara

I was recently in the hospital to get a head start on trying to control the leaky cellulitis/lymphedema/edema causing havoc and pain on my left leg and life. For an entire day all my experiences in the hospital were incredibly good… until…

The new aide came closer to take vitals until she was close enough to smell cigarette smoke on her. “Smoker”? I asked – she said, “Yes” and continued to wrap the blood pressure cuff around my left arm and placed the thermometer into my mouth.

For whatever reason when she finished with the blood pressure, she held on to the handle of the thermometer and I smelled the smoke on her fingers held next to my nose. My mouth was tight around the thermometer and now could not breathe without smelling her smoke and I pulled away and said, “Your fingers reek of cigarette smoke.”

She agreed and I suggested she wash her hands. She said she did but the smoke smell did not come off. I was trapped – a hospital patient forced to inhale cigarette smoke from a hospital worker. She said she would get someone else to do my vitals.

Funny thing. I was in that hospital because of a forty-year smoking habit and developed emphysema (COPD) due – probably – to smoking.

I stopped smoking in 1997 – a tough time that took me over two years to get over the gut wrenching addiction urge to smoke again…and here I was trapped in the hospital, forced to inhale smoke from a hospital employee reeking of cigarette smoke. The irony of all their outside hospital signs proving they were a “Smoke-free” hospital and grounds was laughable.

I complained. The hospital person I complained to told me they would get someone else to do my vitals…that I did not have to have a smoker helping me. I asked about the other seniors – any patient – who would probably not complain of being forced to inhale the toxins of cigarette smoke from a hospital employee for fear of retaliation…no one seemed concerned about them. Apparently, the issue is only an issue with me, an ex-smoker, as far as the hospital is concerned.

A few hours later, the RN came in with the vials of antibiotics and other meds that went directly into my veins. He dropped one vial, hesitated, picked it up, hooked it into the devise going directly into my vein, and plunged the contents inside. Neither of us said a word. I remember thinking, isn’t this hospital floor dirty? And hoped the contents of the vial stayed uncontaminated.

As an almost thirty year hairdresser, if I dropped a comb on the floor it was cleaned and re-sterilized before touching a patron. Apparently, hospitals are different.

A while later it was time to hook up the oxygen tube to my bipap. I pulled to get it for her but the end was stuck between the hospital bed wheel and the metal bedframe I’d just lowered. I left to visit the bathroom and when I came back, the hospital employee had ‘fixed’ it.

I looked and she had placed the deformed tube end on my machine but had not pushed it on to secure it. I did it and went to bed…wondering why an employee was allowed to reek of cigarette smoke and work around patients….wondered why an RN didn’t throw the vial away and get a new one for the patient when it dropped to the dirty floor…wondered why the tube end of the oxygen tube wasn’t replaced by a clean, sterile one when it had been lodged against the dirty hospital bed wheel.

To be clear…I do not care if the hospital person smokes. I care when her/his right to smoke interferes with my right to breathe clean air – especially in a hospital.

I was discharged and came home the next day.

Am I overreacting and expecting too much from a hospital?

Thanks for reading… Sharon O’Hara

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Edema, Lymphedema and Cellulitis – you don’t want it

Sharon O'Hara

Do not ignore edema in your ankles and lower legs as I did for years. Get the edema checked out and find out what is causing it. Follow your doctors directions to get rid of it before it develops into something I can promise you do not want, Lymphedema and Cellulitis.

My recent visit to Harrison Silverdale er and Dr. Gilbert Ondusko is fixing my right leg. The great news is the growing painful lump and spreading painful area on my inside; lower right thigh is not a blood clot waiting to burst loose and run amuck willy nilly, hither and yon to create havoc.

Its called Thrombophlebitis a swelling and inflammation of a surface vein and I’m guessing mine was caused by abrasion from the large hard plastic noodle we use for water exercising. The one exercise that could have caused the problem is the slow and fast jumps out of the water, including shifting of feet. We have built up to 125 times and I will be sorry not to continue with that particular exercise because I am getting into a good muscular shape. No doubt, Marilyn will come up with another way to accomplish the same thing without the noodle.

The CEPHALEXIN has done a great job – the pain of the infection on my right leg has decreased to tender and the lump is almost gone.

Almost in direct opposition, the lymphedema in my left leg is alive and throbbing. The antibiotic for the right leg is not doing a thing for the left leg. I’m calling my doctor later this morning because it is not getting better – the skin feels on fire and I’m oozing lymph fluid.

The point of this blog post is to let you know there can be serious consequences to ignoring lower leg edema and the pain is a big part of it.

The gorgeous sunset seen outside the Harrison Silverdale ER. I had to stop and take the picture.

Thanks for reading… Sharon O’Hara

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Lymphedema Post Script 2010: Meet John Mulligan, RMT/CLT-LANA

Sharon O'Hara

Greetings!

Following is some basic information I wish I had known years ago. Meet John. Following is his response to my email asking if he had anything to add to an article he wrote in 2007. The url is at the end and his comments are fresh this morning, Thursday, 30 December 2010.

“ … I had a look at your blog of December 22 and you raise an important question: when is lymphedema not lymphedema?

There are two kinds of lymphedema; primary and secondary. Primary lymphedema is something you are born with and secondary is something you acquire. One common cause of secondary lymphedema is the surgical removal of lymph nodes due to cancer.

How can we differentiate lymphedema from other types of swelling? Lymphedema, whether primary or secondary, usually occurs in one limb. The foot or hand of that limb is often involved. If both legs or arms are swelling they are usually different from one another; one is “worse” than the other.

If lower extremity (leg) edema is bilateral (occurring on both sides) and symmetrical (same on both sides) and the feet are involved it is more likely to be edema than lymphedema. This swelling can be caused by pulmonary edema or congestive heart conditions. It is a backing up of fluid throughout the system, so to speak. If there are ulcers occurring as well it is more likely that venous insufficiency is part of the picture, where the blood flow from the legs back to the heart is not working properly. If cardiac or pulmonary insufficiency is part of the problem then compression bandaging could make things worse.

If the problem is chronic venous insufficiency then the bandaging and compression garments will help the ulcers to heal and will help the muscle pump in the calf return the blood supply to the heart properly.

With a wider awareness of lymphedema comes the question of accurate diagnosis. A simple hallmark of lymphedema diagnosis, especially in the legs, is the Stemmer sign; can you pick up the skin of one of your toes with two fingers, pinching the skin? If you cannot then it is more likely that you have lymphedema; if you can pick up a fold of skin on your toe, it is less likely to be lymphedema. Please keep in mind that this is a simple clinical test and not foolproof.

It is important to understand that swollen legs or feet that are associated with COPD are more likely to be something other than lymphedema. A complicating factor is that sometimes these conditions can stress the lymphatic system, causing a mixed lymphedema.

Please see this web page for some information on differential diagnosis of lymphedema:

http://emedicine.medscape.com/article/1087313-diagnosis

John Mulligan, RMT/CLT-LANA: Lymphedema Therapy, Education & Consulting

T: (905-687-1828| F: (905) 687-8224 | John@LymphedemaTherapist.com

http://www.lymphedematherapist.com/articles/10Q&A.pdf

More later… Sharon O’Hara

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Lymphedema, Kissing Frogs and the Right Match

Sharon O'Hara

Greetings!

And another reminder that I am a patient – not a medical person. My comments are based on my own experiences and others and I take full responsibility for my opinion and perceptions. My hope is that patients will speak up and question the medical people trying to help us when need be. They can’t help us without an open and honest dialog.

That said, Lymphedema treatment is available. Finding the right help at the right time is not easily available and getting the right treatment for the right diagnosis is sometimes difficult. So is finding the right medical help match for a patient yet both are key to a patient’s survival and the best quality life possible.

Did you ever wonder how many frogs the fabled Princess kissed before she found the right frog? Well, if frogs were medical providers, patients occasionally need to kiss lots of frogs to get the right match.

Lymphedema is nasty stuff and I was sorry to learn lymphedema can be a real problem for cancer patients, especially breast cancer.

Lower leg lymphedema disease is apparently different though since cancer caused lymphedema support groups don’t allow ‘regular’ lymphedema patients to join. I know because I looked for close by lymphedema support groups and learned Harrison Medical Center had one. I called to ask if I could attend a lymphedema support group session and the Harrison spokesperson didn’t think so. She did promise to ask at the next meeting and let me know. That was several months ago.

During the pleasant phone conversation, Harrison’s spokesperson asked how I knew I had lymphedema and I had to say I assumed it was caused from years of ignoring edema and pitted edema.

Her question stayed with me though and I recently asked my pulmonologist at the University of Washington Medical Center what caused it and his answer surprised me “Sleep Apnea” …something to do with ‘insufficiency’…wow, Dr. Christopher Goss, I need to learn more about that!

Lymphedema is lymphedema or isn’t it? When is lymphedema not lymphedema if

Harrison Medical Center’s Lymphedema Support Group is limited only to cancer patients?

I’m happy to say there is good news for ‘Breast Cancer-Related Lymphedema.’

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http://www.lymphnet.org/pdfDocs/nlnexercise.pdf

JAMA. 2010 Dec 8. Weight Lifting for Women at Risk for Breast Cancer-Related Lymphedema: A Randomized Trial.

Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, Bryan CJ, Williams-Smith CT, Chittams J.

University of Pennsylvania School of Medicine and Abramson Cancer Center, Philadelphia (Drs Schmitz and Troxel and Mss Lewis-Grant, Bryan, and Williams-Smith and Mr Chittams); Department of Dermatology, University of Minnesota Medical School, Minneapolis (Dr Ahmed); Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Cheville); and Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia (Drs Cheville and Smith).

Abstract

Context Clinical guidelines for breast cancer survivors without lymphedema advise against upper body exercise, preventing them from obtaining established health benefits of weight lifting. Objective To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise (control) among survivors at risk for breast cancer-related lymphedema (BCRL)

. …

Weightlifting May Not Increase Risk for Lymphedema in Breast Cancer Survivors http://www.medscape.com/viewarticle/734429

Laurie Barclay, MD

…

December 17, 2010 — A slowly progressive weightlifting program for breast cancer survivors does not increase the risk for lymphedema, according to the results of a randomized controlled equivalence trial reported online December 8 in the Journal of the American Medical Association.

“Breast cancer survivors at risk for lymphedema alter activity, limit, activity, or both from fear and uncertainty about their personal risk level, and upon guidance advising them to avoid lifting children, heavy bags, or other objects with the at-risk arm,” write Kathryn H. Schmitz, PhD, MPH, from the University of Pennsylvania School of Medicine and Abramson Cancer Center in Philadelphia, and colleagues. “Such guidance is often interpreted in a manner that deconditions the arm, increasing the potential for injury, overuse, and, ironically, lymphedema onset. Adherence to these precautions may limit physical recovery after breast cancer and, for some women, result in lost employment.”

The goal of the study was to compare onset of lymphedema after a 1-year weightlifting intervention vs a no-exercise control group among survivors at risk for breast cancer–related lymphedema (BCRL) who were enrolled in the Physical Activity and Lymphedema trial.

“We specialize in the treatment of acute and chronic orthopedic injuries and the evaluation and treatment of swelling disorders including lymphedema and vascular insufficiency.”

http://colpt.com/about.html

FREQUENTLY ASKED QUESTIONS ABOUT LYMPHEDEMA:

1. What is Lymphedema?

Lymphedema is an abnormal accumulation of protein-rich fluid (lymph Fluid) and specialized cells (fibroblasts, keratinocytes) in the spaces between tissues throughout the body. When the lymphatic Fluid cannot be readily moved from the extremity to the trunk swelling is seen in the limb.

2. What causes Lymphedema?

Lymphedema may be primary or secondary. Primary is when swelling is the result of lymph vessels that are too small, too few in number or too wide so the valves cannot work properly. Secondary occurs from some kind of damage to the system. This could include surgery for lymph node removal, radiation to treat cancer, trauma or parasites that block the lymphatic vessels.

3. What are the symptoms of Lymphedema?

Symptoms include tightness, swelling or thickening anywhere in the trunk or extremity, feelings of heaviness in the extremity, difficulty fitting into clothing in one specific area. Swelling may increase with activity and decrease with rest.

4. Why did I get Lymphedema?

Medical science is not able to determine why one person gets lymphedema and the next person does not. It probably has to do with the number of lymphatics you had originally and what percentage are not working.

5. Is Lymphedema curable?

Lymphedema is not curable; however, it is manageable with treatment.

6. What kind of treatment is available for Lymphedema?

There is a treatment approach called Complex Decongestive Physiotherapy(CDP). This method consists of several parts including manual lymphatic drainage, bandaging, proper skin care, compression garments, remedial exercises, and self-manual lymphatic drainage and bandaging. This treatment can be done by a physical therapist that has extensive training in the subject.

6. What happens if Lymphedema is not treated?

Lymphedema is chronic and progressive. If it remains untreated the protein-rich fluid continues to accumulate which could lead to increased swelling and hardening (fibrosis) of the tissues. The protein-rich fluid is a perfect environment for bacteria to flourish which could lead to recurrent infections. Untreated lymphedema can also lead to skin breakdown and loss of motion in the joints of the affected limb.

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We have one life and, my opinion, a patient’s best bet is to get educated about whatever we have and learn how to best handle it.

Kitsap County Library System has a book on Caregiving for Lymphedema at the main library.

There are other helpful books the Silverdale Library (360-692-2779) had donated to them:

100 Questions & Answers about Lymphedema

Lymphedema: An Information Booklet

Lymphedema Management: The Comprehensive Guide for Practitioners

Melissa at the Center for Orthopedic & Lymphatic Physical Therapy in Port Orchard mentioned using a soft baby brush to clean the affected skin and it worked fine once my husband duck taped the baby brush to a section of pvc pipe. The extra length makes leaning over easy for a lung patient and he made two – the second one I use to apply the skin lotion. Dry skin cracks too easily for lymphedemia’ites.

I thought you’d enjoy seeing this old car photo. December 2009 I was rushing to Harrison Silverdale ER but had to stop to take this photo! I don’t know why the old car was there, what kind of car it is, who owned it or why it was parked with the stuffed critters outside the ER.

Part 4 of 4

More later… Sharon O’Hara

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A Edema, Cellulitis, Lymphedema Story in Pictures

Sharon O'Hara

I’m using a thumb drive to download these photo’s – I hope it works. I hope someone – somewhere – uses what I’m trying to say to avoid reaching this point of infection/heal. Reason being…each time, it is worse, takes longer to heal and the pain is relentless and sometimes unbearable.

Do whatever your doctor tells you to do – get rid of your edema. It isn’t funny nor casual. It can turn ugly and very serious.

Edema Problems Today? Look at the Possible Future?”http://pugetsoundblogs.com/copd-and-other-stuff/2010/06/28/an-edema-cellulitis-lymphedema-story-in-pictures/”A New Pretty Face””YES!”an-edema-cellulites-lymph-edema-story-in-pictures/”Irony in a Sign” “A Look Ahead?””Ignoring edema isn’t smart” “Time to Heal” “A Morning View””Early Morning View From Harrison” “Another View” “Harrison\’s Great Corner Upper Room””Looking Back” “Life is Good””Home Again” “Ahh, Almost Over””Almost Healed From the Last Time…pre Harrison” “Bacteria Grows””A Raging Infection” “Another Look at Edema” “Overdue Unwrap at Home””A Different Look” “It Did Not Stick””A New Wrap From Harrison& Wound Care Center” “Relief in Healing””Healing” “Interventions Healing is Fast””Fast Healing” “Once On – Comfortable””Stockings to Keep Edema From Returning”
More later… Sharon O’Hara

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A Hot Shot At Harrison Silverdale ER

Sharon O'Hara

A few weeks ago, I visited the Harrison Silverdale ER hoping to catch the Cellulites in my lower legs before it developed into the bad stuff. Lower legs swollen, red infected usually develops into the open weepy sores.

I found a dynamo in the ER by the name of Lisa. She exuded professionalism, enthusiasm, efficiency and knowledge.

Something new for me – she actually outlined the red areas with a pen and asked me to come back the next day, Saturday to check the infection hopefully contained by another round of antibiotics.

Other than the two Thoracic Society International Conferences I have attended and my visits to the University of Washington Medical Center, seldom have I encountered doctors or medical persons who show such enthusiasm and passion for their profession.

I raved about Lisa again to my doctor when I saw her for a follow-up.

Lisa probably isn’t a doctor because I listened to her give her observations, test results to a gentleman I know to be a doctor, and offered suggestion. He listened and agreed.
She is a new and beneficial jolt of aid to the patient.

I meant to write a Letter to the Editor, Kitsap Sun, in appreciation for her extraordinary help but I got sidetracked.

Lisa showed real interest in the patient condition and dialog flowed. She was informative and thorough. She explained what she was doing and why.
I have always preferred being around people interested and passionate about what they do but this is only the second time I have encountered such professional medical enthusiasm wrapped in compassion, shared knowledge and topped with competence in an emergency room.

The reason for this outdated commentary now is an article I read in medpagetoday describing the exact type of experience I had with Lisa in the er.
The article spoke to a new type medical professional coming on the scene, a “RN, NP.”

A doctor but not a doctor, a nurse but not a nurse…, something more.
In the Silverdale Harrison er, her name is Lisa.

http://www.medpagetoday.com/Blogs/14080?userid=141073&impressionId=1241656836059&utm_source=mSpoke&utm_medium=email&utm_campaign=DailyHeadlines&utm_content=GroupD

American Academy of Physician Assistants

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After COPD changed my life, I spent years ignoring periodic swollen lower legs and did not follow my doctor’s advice to cut out salt and elevate my legs – I did not believe it was important.

(A suggestion, if I may. For those with swollen legs, see your doctor and follow her/his instructions. Change whatever you must to eliminate the edema and do it NOW)

You do not want what I have and you may well avoid it.
http://www.nlm.nih.gov/medlineplus/ency/article/003104.htm

Best wishes…

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Leg Veins Not Vain

Sharon O'Hara

Getting your lower leg veins checked is not vain and getting them checked free is a winner all the way around.
Lower leg ulcers are a condition when the skin opens in sores and yellow pus drains down the leg. It causes the worst pain I have encountered and in my case, it is chronic.
Swollen lower legs seem a common uneventful condition – do not ignore it as I did. Get your legs checked. If your doctor tells you to lay off salt and elevate your legs above your heart – do it. The future pain avoided is yours.
Pain pills are not an easy solution for a COPDer – they depress the respiratory system – the last thing we need.
Early detection and education is a key to healthy pain free legs
Today and the 4rth Saturday of every month the Kitsap Thoracic & Vascular clinic offers a FREE venous screening according to the Kitsap Sun’s latest jewel, “Better Healthy Living” magazine.
John S. Arthur M.D. F.A.C.S. is located on Wheaton Way #101, Bremerton. Dial 360-479-2400 or e-mail KTV101@msn.com for more information.
Harrison Medical Center touts two linear accelerators to fight cancer. It is a precision tool, image-guided radiation therapy…a tool developed through cancer research.
Someday COPD will have a research break-through. Someday.
In the meantime, a cheer for medical research and researchers for disease … research cuts through the ignorance barriers of disease.

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