On the uses of a liberal education: September 1, Harper's Magazine Mark Edmundson A college student getting a liberal arts education ponders filling out a questionnaire that includes an opportunity for him to evaluate his instructor. At times it appears that the purpose of his education is just to entertain him.
Any history of heart murmur or valve prolapse?
The reader suspecting Lyme symptoms should either identify with a number of sections of this article, or, in this absence, be fairly certain of excluding the possibility of Lyme. Any Doctor investigating prudent treatment for Lyme Disease would do well by reading this essay.
Because this is long, those needing a shorter diagnostic tool may scroll up this page for a quick checklist directly above this essay.
Traditionally, the public has been advised to suspect Lyme LD if a round or oval, expanding, red rash develops days after a deer tick bite associated with or followed by a flu-like illness. This limited description will apply to only some cases.
The rashes associated with LD can assume a variety of morphologies including vesicular, urticarial, eczematoid or atrophic Acrodermatitis Chronicum Atrophicans.
While deer ticks and LD have a well known affiliation, other potential vectors can carry the spirochete that causes LD Borrelia burgdorferi; Bb. These include, the lone star tick, fleas, the biting flies e.
A case of suspected transmission via blood transfusion has been reported by Dr. The demonstration of Bb by PCR in two museum mouse specimens dating from Massachusetts and in ticks collected during WW II, provides a mechanism for potential life long exposure and disease which predates the formal discovery of LD.
An occasional patient will date their symptoms which resolved on antibiotic therapy for LD to early childhood. Before the diagnosis was made, patients would dismiss those symptoms with the statement: That resigned characterization implies that the longevity of the symptoms rules out a reversible cause.
Subsequent resolution of the long standing symptoms on antibiotic therapy for LD belies that notion.
Symptoms of LD can begin within days of inoculation with Bb or appear belatedly, but usually in the first to fourth month. Mice innoculated intraperitoneally had Bb demonstrated in the brain on biopsy 12 hours later with a peak at 48 hours Stockholm Conference, If dissemination can occur early, then staging the disease according to the temporal appearance of symptoms may be irrelevant.
The absence of symptoms related to a particular organ system doesn't necessarily exclude the presence of Bb from that organ. Conversely, due to the possibility of symptoms being engendered by chemical mediators and autoimmune reactions by the host against non-viable but immunoreactive DNA blebsorgan dysfunction and attendant symptoms can appear at sites removed from the actual spirochetes.
The diagnostic and therapeutic problems that these phenomenon entail should be obvious. Rapid dispersion of Bb could lead to the prompt appearance of complications; e. There is no absolutely predictable clinical sequence for LD.
The flu-like syndrome may be absent from the initial presentation and may endure once established without treatment. Cardiac and neurologic complications can be observed sometime within the first 3 months after microbiologically contracting the disease.
The onset of complaints can not only be subtle and desultory, but delayed for a year or more. One of my patients denied all LD related symptoms until her husband died, whereupon, a plethora of complaints cascaded into her life beginning that very day.
Another had an annual flare of LD as part of an anniversary reaction centered on the date of his mother's death. Moreover, the early constellation of symptoms can have a paucity of findings with unidimensional presentations: Over time, as the untreated LD percolates, symptoms accrue to the burgeoning clinical picture until a multisystem presentation is created.
Other patients can have their manifold symptoms complex develop in the manner of an avalanche. These patterns represent the extremes of a clinical continuum between which there are many variations on the theme ranging from mild to severe disease. Thus, The failure of a pathognomonic unique and specific presentation to consistently unfold causes sufficient clinical confusion, that a punctual diagnosis is problematic.
Therefore, a high index of suspicion is placed at a premium. If a clinician can't reconcile preconceived notions about how LD should announce itself with a patient's history and physical findings, it is a disservice to the patient and an abdication of professional imperatives to presumptiously conclude that the symptoms are psychosomatic or that the patient is faking!
Antecedent or concomitant factors which can cause symptoms and physical changes de novo or aggravate contemporary problems are reliably solicited on close questioning of LD patients. Females experience an exacerbation of their LD symptoms before or during their menses, while pregnant and with oral contraceptive hormones.
Many patients have symptoms intensify or reappear with physical and emotional stress, if sleep deprived, after exercise, in a hot bath, after alcohol consumption, with fasting hypoglycemia or dehydration.Room - Persuasive Writing Speech Uploaded by Claisse Opulencia Room essay (Writing to Persuade) - Human Centipede - Cancer - Discrimination against gay marriages.
Open Document. Below is an essay on "Room Speech" from Anti Essays, your source for research papers, essays, and term paper examples. How to Write a Speech Introducing Yourself. In this Article: Article Summary Sample Speeches Preparing Your Speech Revising and Practicing Your Speech Planning Your Speech Delivering Your Speech Community Q&A First impressions have a big impact on how others perceive you, so how you introduce yourself to others is extremely important.
Room by George Orwell Essay - Room by George Orwell Room is an imaginary room invented by George Orwell and was originally envisioned as a kind of torture chamber which contains your worst fears which are used as the instrument of your pain; it has now become a sort of warehouse into which your pet hates can be exiled.
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Essay Writing Guide. Learn the art of brilliant essay writing with help from our teachers. Learn more. Next I would like to situate all bullies to room I feel that a bully is a sick person who is powered on by other people's pain and this makes me angry.
The Student Room and Get Revising are all trading names of The Student Room.