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Vitamin D deficiency and calcium balance is underlying nearly every chronic disease process. There is a big body of evidence suggesting it induces fibrosis (calcification) of the lungs. [STUDY LINK AT END OF POST] And it unmasks a really important Lung-Kidney connection Makes sense? So why haven’t we made this link before? The key, is to look at the mouth first. For teeth, vitamin D deficiency increases the risk of tooth decay. Tooth enamel exists in constant calcium flux. Actually your whole body is, muscles, nerves, cells all depend on the movement and balance of calcium. Tooth decay is the body’s inability to replace the flux of calcium into tooth enamel. That’s why we have to really put a microscope to what is happening with our teeth. Because it leads us straight to the root cause! And vitamin D is the king of calcium. Ok so in this study:v“Chronic vitamin D deficiency induces lung fibrosis through activation of the renin-angiotensin system” What did they do? Induced Vit D deficiency in a group of mice: They used a vitamin D deficient diet to induce a vitamin D deficiency in the experimental group: What did they find? • Chronic vitamin D deficiency destroys lung structures, impairs lung development and induces fibrosis (calcification). • Fibrosis induces a shortness of breath due to a sudden buildup of fluid in the lungs Why did it happen? • They found that it imbalanced KIDNEY hormones (renin-angiotensin) • Kidney hormones balance calcium and phosphate excretion from the kidneys. • Vitamin D deficiency increases the release of kidney hormones (RAS) to stop the excretion of calcium. • The lungs are effected by kidney hormones because extracellular fluid is retained. • As vitamin D deficiency gets worse, calcium becomes more sparse, and mitochondrial calcium levels drop, a series of changes shift cell remodeling and induce fibrosis The result? Lungs choking in fluid, and fibrosed (calcified) because of vitamin D deficiency. - @dr.hishams.holistic.oralcare on Instagram

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In light of the recent events and wave of concerns across the Bay Area, it seems helpful to share our Nasal Narcan flyer which gives information on where to get free narcan in SF. Please share widely, and remember they will be closed on New Years Day (1/1). . Concerned about overdose? Want a free nasal Narcan kit? Our friends at CBHS Pharmacy are happy to help! ** 1380 Howard (10th & Howard) Mon-Fri from 9a-3:30p ** . The lovely CBHS pharmists will train you and give you a FREE nasal naloxone kit. All you have to do is answer a few standard questions pharmacists are required to ask to dispense medication! . As a reminder, syringe access and harm reduction programming is funded to serve our most vulnerable communities, and we need to reserve our resources for them. Please respect the privacy of harm reduction program participants if you are not a harm reduction program participant by getting your needs met at CBHS Pharmacy instead . Have questions? Call 415-255-3659. . Thank you for caring for your community! - @the.d.o.p.e.project on Instagram

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How much TXA should I give? How should I give it? Should I give it for TBI? These questions (and more) just got answered for @tc3committee by an all-star group in the latest @jsomonline. Check out the full article for a great explanation of the why behind this. . How much TXA should I start with? 2grams SINGLE DOSE. This is based on literature supporting single dose regimens along with logistical ease in the prehospital environment. . What about the second dose? No need. TXA stays in the blood stream for 7-8 hours and maintains effects for up to 17 hours. Even in continued bleeding the authors do not recommend repeat dosing. . Should I use it for TBI? YES. “If the casualty has signs or symptoms of significant TBI or has altered mental status associated with blast injury or blunt trauma.” Multiple studies (to include CRASH-3) support its use and are discussed in the article. . How much time do I have to give it? NOT MUCH. Survival benefits decrease by 10% every 15 min. No benefit after 3 hours. . Can I finally give it IM? Nope, not yet. Not a lot of strong evidence on this, but you want a rapid action of TXA and IV gets to peak concentrations much quicker than IM. . Is IO route ok? YES. (some even use TX as part of flushing the IO line at the start to kill two birds with one stone). . Can I slow push it or do I still need to hang it over 10 min? YES, Slow IV/IO push over 1 minute is good. . Can I give it in the same line as blood/blood products? YES. What about with Hextend? STOP USING HEXTEND. But yes, you can. . Hope this review was useful. Remember, evidence changes frequently so keep reading! Check out the full article for further discussions and let me know your protocols/questions below. #tccc #txa #emergencymedicine - @nardoctor on Instagram

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