Yittz's Clinic!!

[Han Solo]

For a heart case, i.e. someone with a pacemaker, is 2 litres of sodium water too much for one day?

The answer depends on why the pacemaker was put in the first place. Was it because of symptomatic bradycardia or other reasons or was it for ppl with heart failure?

For ppl with heart failure, it is generally advised for them to have a fluid restriction as their body cannot cope with large ammount of fluids. So depending on how severe their heart failure is, 2 litres may be too much or it may be adequate.

For other indications of pacemaker, there are no limits on how much they can have orally.

Han SOlo

[xcutie]

doctor, i think i'm suffering from insomnia! it takes me like 30mins-1 hours to fall asleep sometimes, and i'm not even stressing from anything? the days that it happens are just random... and when i take that long to fall asleep, i start to get anxious because i heard that if i dont get more than 8 hours of sleep, i'd get pimples! what can i do other than take pills?

[Han Solo]

I had posted on this before

Basically, good sleep hygeine is what you really need.

Sleep at around the same time every day.

Use your bed to sleep, not for work or study.

Try not to drink coffee or tea at night, if you can't cope with it.

Relax your thoughts before sleeping, do not go to sleep with thinking about things.

http://www.css.to/sleep/normal_sleep.pdf

Han SOlo

[xcutie]

I had posted on this before

really?? LOL, thanks anyway!!

[Dania]

Dear Han Solo, I'm not sure if this is relevant to this thread, but decided to try after some deliberation:

Do you know how long it would take for someone familiar with the human anatomy to:

1. Strangle till the victim loses consciousness.
2. Thereafter, slit the throat, severing the neck vessels thereby killing the victim.
3. After the victim is dead, mutilate the face by nicking the eyelids, (almost) detaching the nose, dividing the lips, cutting and forming a triangular flap on both cheeks. Generally almost hacking away the lower half of the face.
4. Cut obliquely through the lobe and auricle of the right ear.
5. Cut open the body.
6. Stab the liver and slit through the left lobe. Cut the pancreas. Dislocate the spleen.
7. Detach the intestines and draw them out from the cavity. Cut away part of the colon.
8. Cut through the peritoneal lining on the left side and the left renal artery. Remove the left kidney (carefully).
9. Cut through the lining membrane. Cut through the womb horizontally, leaving a stump of three quarters of an inch. Remove the rest of the womb together with some of the ligaments.
10. Cut the upper part of the thigh.

It required a great deal of medical knowledge to have removed the kidney and to know where it was placed. Hence, the assumption that the person committing these deeds was well-versed with the positions of the organs in the abdominal cavity, and the way of removing them. Time was tight, the deeds were committed outdoors on the streets, at night in almost total darkness. I wonder how long it would take for one person to do all of the above?

I'm asking because it was believed that the same person had, 45 minutes prior to the discovery of this murder, killed someone else at a nearby location. He cut through the neck of this earlier victim, severing the arteries and other vessels, causing death. When the body was discovered, it was still warm. The face was still warm too, but the hands cold. The legs were quite warm. Hence the conclusion that the victim was killed shortly before discovery.

It was believed that after killing the earlier victim, the killer was interrupted by the man who discovered the body (of the earlier victim). Hence, the killer fled the scene of crime, before he could perform any mutilation. Which was why he went on to find another victim.

45 minutes later, his next victim was discovered, dead and mutilated as described above. The body was quite warm. No death stiffening had taken place. According to the reports, death most likely occured within the half hour.

Hence, it appeared that the killer took 15 minutes to walk to this next location, find and kill his next victim. Within the next 30 minutes, he performed the mutilations and disappeared completely from the scene of crime, taking along some of the organs he had removed. In almost total darkness. Outdoors. After he had just barely escaped being caught when he killed his earlier victim less than 45 minutes ago.

Granted that the killer was deduced as someone with medical knowledge, but is it probable for one person to perform all these mutilations within 30 minutes? I'm not a medical person thus I'm very surprised.

Actually, in the reports, the ME wrote that, 'I think the perpetrator of this act had sufficient time, or he would not have nicked the lower eyelids. It would take at least 5 minutes.' I'm unsure if the ME meant that nicking the eyelids alone would take 5 minutes, or that all of the mutilations would take only 5 minutes.

By the way, after the death of the victim in point 2), the rest of the mutilations might not have taken place in the same order in which I've listed. It was generally believed that the killer cut the face before moving on to the abdomen, but the exact order was not confirmed.

[Han Solo]

That's a tough nut that u passed to me.

Strangling takes very little time. With the expected resistance and so, i will give it minutes.

Slicing the jugular veins takes seconds.

What do you meant by nicking the eyelid?

Oblique cut through ear takes seconds.

Laparatomy takes minutes.

Stabbing the liver takes seconds

Taking the pancreas out is hard, takes minutes.

Dislocate spleen is easier, takes couple of minutes

Taking part of the intestine out into the open takes minutes

Cutting the kidney takes minutes.

Cutting through the uterus takes minutes.


It will be very close to be 45 minutes to get everything done.
First, assuming that the first part of overpowering your victim is going to be relatively brief, in addition to the fact that the attack had to be in a deserted place.
Second, that the perpetrator has surgical equipments and things like forceps and retractors. (seriously, without retractors, the whole thing would be too hard for one person)
Thirdly, is it only one person? It seems much easier if this is a 2 person job. one to hold the person, and the other to slit the throat. and then they divide and do their dirty deeds.

Han SOlo
Scared!

[Dania]

What do you meant by nicking the eyelid?

Thank you, Han Solo.

For the eyelids, there was a cut about a quarter of an inch through the lower left eyelid, dividing the structures completely through. On the upper left eyelid, there was a scratch through the skin, near to the angle of the nose. The right eyelid was cut through to about half an inch.

Of all the mutilations on this victim, those done to the eyelids were the "mildest". I wonder why the ME equated this to the killer having sufficient time. ('I think the perpetrator of this act had sufficient time, or he would not have nicked the lower eyelids.')

Perhaps what was done to the eyelids was a delicate procedure that took time?

I'm not sure about what tools/equipment the killer had at his disposal. The ME only mentioned that '...the wounds on the face and abdomen prove that they were inflicted by a sharp, pointed knife, and that in the abdomen by one six inches or longer.'

It does seem incredible for this to be the act of only one person, doesn't it? Still, it's generally accepted and believed to be so. According to the ME, 'I feel sure that there was no struggle, and believe it was the act of one person.'

The attack did take place in a deserted square. But the killer had already struck twice within the same month. Hence, the entire area was in a heightened state of alert. The square in which this attack took place, though secluded, was patrolled frequently. 15 minutes before the discovery of the body, a police constable went through the area, but didn't see or hear anything out of the ordinary. When he returned again (15 minutes after), he found the mutilated remains of the victim.

I don't know how thorough the constable was in his patrols, but his bosses/superiors believed him. Hence, it appeared that the murderer got his victim into the square, killed her, carved her up silently and completely escaped in the space of 15-45 minutes. How remarkable. After he had just slashed another person some 45 minutes ago. Even more remarkable.

The killer had a very distinct, regimented modus operandi when dispatching his victims. In brief, strangle, sever the carotid artery (a deep, clean slit), then mutilate. No signs of struggle. The throat was very deeply slashed from left to right. Usually he took a piece of his victim's viscera. The mutilations were very brutal, and there was a distinct trend of escalation.

In the opinion of most of the surgeons who examined the bodies, it's believed that the killer had to have some degree of anatomical knowledge to do what he did. For example, in one case (I think it's the one I mentioned), he removed the kidney from the front rather than from the side, and didn't damage any of the surrounding organs while doing so. In another case, he removed the sexual organs with one clean stroke of the knife. In yet another one, the heart was "delicately removed".

It's believed that the killer worked alone. Given the circumstances of the crimes (outdoors, often in pitch dark conditions, keeping one eye out for the approach of others, and under extremely tight time constraints), the killer almost certainly would have had some experience in using his knife.

His killings were all contained in the same small area of the city. His killing spree only lasted <2.5 months. All his victims were, or thought to be, drunk when they were killed. They were all poor women. But appearances and ages varied. There's no evidence to indicate that the killings were sexual in nature. Though genitalia was mutilated, but so was the rest of the body, including the faces of his later victims.

As to the actual number of women he killed, it's "generally accepted that he killed 5...at least 4, probably 6, just possibly 8". Many, including the press and junior police offcers, believed that the killer was responsible for 9 slayings.

The police never caught this killer, which was a pity in my opinion, for we might have learnt much from him. For example, how to singlehandedly manage all he did in mere minutes. In pitch black conditions. And thereafter disappear totally from the scene. And not arousing any suspicion. All while having the entire police force actively hunting for him.

Once again, thanks for the reply, Han Solo. I was going to address the points you raised, but ended up rambling. Anyway, I've already typed, so I might as well post it.

[xcutie]

oh god, that scared me to death. i wish i didnt read all that . Dania, are you a police? where did that case happen? (hopefully not where i live..).

Dr. Han, i have a question now. how can you calm down a very scared person?? i'm so scared now after reading all that...

[Han Solo]

How to calm a scared person?

Talk to them in a calm manner, with no sudden movements.

Reassure them.

and there's always anxiolytics such as oxazepam or alprazolam etc.

Han Solo

[Dania]

oh god, that scared me to death.

I'm sorry you were scared.

[Han Solo]

Han Solo is going to NZ for holiday for 2 weeks starting next week and will be unavailable for any questions.

[xcutie]

have a nice trip, Dr. Han!

[PJ]

Why is it that flu shots must be delivered by needle, not by mouth?

[xcutie]

^ probably it's because the vaccine would go straight to your blood so your body will start a fighting it rite away. if you ate it in a pill, your stomach acid might kill the vaccine and make it not work as well.

[wkeej]

Hi Han, are you back? we have a "shark" question whom i think you should be the expert to answer.
http://www.spcnet.tv/forums/showthre...1&page=4&pp=20
basically, if a shark has a stick in its mouth, can it eat? will it starve?

[Han Solo]

I'm back from my holiday and the clinic is opened again.

1) PJ,

The flu shots was administered via injections because they are viruses that are incapacitated and would need to be detected by the body's defence system through the lymphatic systems. To swallow it would unfortunately destroy the virus.

2) Weekj,

I doubt that a shark with a huge and very very strong action not be able to chew through the stick. I'm basing this assumption from a documentary of a crocodile who can pretty much chew through anything.

But then again, a biology student would be the best for you to ask, as i have absolutely no idea.

Han Solo

[hyperlink989]

Han Solo is going to NZ for holiday for 2 weeks starting next week and will be unavailable for any questions.

Heh i live in NZ...

moving along...
Do you believe the H2N1 would change into a Person to Person spreading virus, since there is already H9N2 (Chicken to Person) virus and do you think it would be much more lethal than SARS?

and just asking...what do you think would be the symptoms of the Bird Flu?

[Han Solo]

Hyperlink,

Which part of NZ do you live in?
The country was beautiful, although very desolated.


Regarding the bird flu, correct me if i'm wrong, i think it is the H5N1 that is the bird flu variety that is causing the problem. The H2N1 is either the variant bird flu that struck in holland about 3-4 years ago, or the asian flu of the 50-60s.

Symptoms of bird flu unfortunately is very similar to the common variety flu, but with the added and increased rate of complications of lower respiratory tract infections and death.

Unfortunately, there are no great treatment for birdflu. Tamiflu which is treatment for flu has been tried, and so has relenza (a less effective flu treatment). Success unfortunately has not been anywhere near 100%. Nonetheless, they represent one of the last barriers in the treatment of the condition.

There had been coordinated research into the production of the bird flu vaccine, which if possible can help to protect millions of vulnerable ppl. That again unfortunately is still in the pipeline.

The rest of the things that are being done is the vital epidemiological works of the various national health authorities with the help of WHO, in addition to the surveillance, prevention and destruction of any diseased avian stocks.

The Bird flu has been around for a few years now, andgiven the way things are going, the pessismists are thinking that it will become pandemic and thus clearing the way for increased opportunity for the virus to mutate even further, up till it reached the virulence potential of the spanish flu.

Han SOlo

Trivia1: Do you all know that the naming of the H and N of the flu virus corresponds to the differences in the neuramidanase and hemagglutin proteins on the viral surface?

Trivia2: Amantadine, which is an older anti-flu medications, is currently being used more in Parkinson's disease/

Trivia3: The Spanish flu occured during the early 20th century, the combined death toll of both world wars was less than that from this flu epidemic.

Add: http://www.cdc.gov/flu/avian/gen-info/facts.htm is quite good for brief overview.

[Dania]

Hi Han Solo!

Hope you had a good time during your hols. New Zealand is indeed a delightful country, isn't it? I remember those cute seals in Cape Foulwind, with their amusing antics and behaviour. It was a long ride to get to those seals, but well worth it.

Question: Does lime accelerate or retard the decomposition of soft tissues in buried remains?

[Han Solo]

Hi Dania,

Didn't go to Cape Foulwind (is there any place with that name?)

Anyway, a quick google search says that lime does indeed hasten body decomposition.

As to why someone wants to know that?

Han Solo