Need Opinions (Long)

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

Again, this depends on what actual time interval you mean by "so
closely
together."

Did you not see the dates of the tests?



You still haven't defined what you mean, quantitatively, by "close
together".


See above.



I wasn't clear that you were referring to the specific tests cited,


I didn't think it would be so difficult for you to figure out since I was
clearly referring to the variations in the two tests run on Dec. 12 and Feb,
27....

I'm sure happy we cleared that up! Aren't you? Do you have any other
questions you'd like to ask that I've already answered?

Are you a hospital lab tech or a high school/college biology student?

In article , "Phil P."
wrote:

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

Again, this depends on what actual time interval you mean by "so
closely
together."

Did you not see the dates of the tests?



You still haven't defined what you mean, quantitatively, by "close
together".


See above.



I wasn't clear that you were referring to the specific tests cited,


I didn't think it would be so difficult for you to figure out since I was
clearly referring to the variations in the two tests run on Dec. 12 and
Feb,
27....

I'm sure happy we cleared that up! Aren't you? Do you have any other
questions you'd like to ask that I've already answered?

Are you a hospital lab tech or a high school/college biology student?



No, I am a clinical engineer, a biochemistry major who branched into
computer science, with about 30 years in laboratory and intensive care
clinical engineering. Current work, for example, includes real-time
telemetry and sensor correlation for intensive care and stepdown at one
major hospital, and developing expert systems for prescribing
assistance. That specifically includes dose adjustments based on renal
and hepatic function, starting with fairly basic things such as GFR
estimation by Cockcroft-Gault if there is no better information, and
then applying renal elimination curves in the presence of limited
clearance, as well as issues such as zero-order and first-order
phsrmacokinetics.

The latter often involve constructing molecular pharmacological models
to help recommend optimal dosing levels, avoid interaction, and obtain
synergies in comorbid conditions. My most recent research interest is
applying mathematical modeling of infections disease epidemiology to the
diagnosis of computer network worms and other malicious software.

Are you normally this arrogant, or are you making a special effort?
What is your experience?

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

Again, this depends on what actual time interval you mean by "so
closely
together."

Did you not see the dates of the tests?



You still haven't defined what you mean, quantitatively, by "close
together".


See above.



I wasn't clear that you were referring to the specific tests cited,


I didn't think it would be so difficult for you to figure out since I
was
clearly referring to the variations in the two tests run on Dec. 12 and
Feb,
27....

I'm sure happy we cleared that up! Aren't you? Do you have any other
questions you'd like to ask that I've already answered?

Are you a hospital lab tech or a high school/college biology student?



No, I am a clinical engineer, a biochemistry major who branched into
computer science, with about 30 years in laboratory and intensive care
clinical engineering. Current work, for example, includes real-time
telemetry and sensor correlation for intensive care and stepdown at one
major hospital, and developing expert systems for prescribing
assistance. That specifically includes dose adjustments based on renal
and hepatic function, starting with fairly basic things such as GFR
estimation by Cockcroft-Gault if there is no better information, and
then applying renal elimination curves in the presence of limited
clearance, as well as issues such as zero-order and first-order
phsrmacokinetics.

The latter often involve constructing molecular pharmacological models
to help recommend optimal dosing levels, avoid interaction, and obtain
synergies in comorbid conditions. My most recent research interest is
applying mathematical modeling of infections disease epidemiology to the
diagnosis of computer network worms and other malicious software.

Are you normally this arrogant, or are you making a special effort?
What is your experience?

He just gets this way sometimes. "It's his way".

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

Again, this depends on what actual time interval you mean by "so
closely
together."

Did you not see the dates of the tests?



You still haven't defined what you mean, quantitatively, by "close
together".


See above.



I wasn't clear that you were referring to the specific tests cited,


I didn't think it would be so difficult for you to figure out since I
was
clearly referring to the variations in the two tests run on Dec. 12 and
Feb,
27....

I'm sure happy we cleared that up! Aren't you? Do you have any other
questions you'd like to ask that I've already answered?

Are you a hospital lab tech or a high school/college biology student?



No, I am a clinical engineer, a biochemistry major who branched into
computer science, with about 30 years in laboratory and intensive care
clinical engineering. Current work, for example, includes real-time
telemetry and sensor correlation for intensive care and stepdown at one
major hospital, and developing expert systems for prescribing
assistance. That specifically includes dose adjustments based on renal
and hepatic function, starting with fairly basic things such as GFR
estimation by Cockcroft-Gault if there is no better information, and
then applying renal elimination curves in the presence of limited
clearance, as well as issues such as zero-order and first-order
phsrmacokinetics.

The latter often involve constructing molecular pharmacological models
to help recommend optimal dosing levels, avoid interaction, and obtain
synergies in comorbid conditions. My most recent research interest is
applying mathematical modeling of infections disease epidemiology to the
diagnosis of computer network worms and other malicious software.


Are you applying for job here?! I didn't ask you for your curriculum vitae.
LOL!

I'm almost as impressed with your education as you are with it! LOL! Too
bad credentials aren't an assurance of credibility - one can exist without
the other.

Btw, your list of accolades didn't include anything about cats. That
explains why you don't know abnormal test results should be confirmed. I'm
thankful you're not in the veterinary profession! You'd probably kill cats
that tested FeLV+ on one ELISA Snap!



Are you normally this arrogant, or are you making a special effort?


Its no effort at all. LOL! In fact, I often find academic assholes
impressed with their education amusing.


What is your experience?

With cats, obviously much more than you.

In article .net,
"Phil P." wrote:

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

"Howard Berkowitz" wrote in message
...
In article , "Phil P."
wrote:

Again, this depends on what actual time interval you mean by
"so
closely
together."

Did you not see the dates of the tests?



You still haven't defined what you mean, quantitatively, by
"close
together".


See above.



I wasn't clear that you were referring to the specific tests cited,


I didn't think it would be so difficult for you to figure out since I
was
clearly referring to the variations in the two tests run on Dec. 12
and
Feb,
27....

I'm sure happy we cleared that up! Aren't you? Do you have any other
questions you'd like to ask that I've already answered?

Are you a hospital lab tech or a high school/college biology student?



No, I am a clinical engineer, a biochemistry major who branched into
computer science, with about 30 years in laboratory and intensive care
clinical engineering. Current work, for example, includes real-time
telemetry and sensor correlation for intensive care and stepdown at one
major hospital, and developing expert systems for prescribing
assistance. That specifically includes dose adjustments based on renal
and hepatic function, starting with fairly basic things such as GFR
estimation by Cockcroft-Gault if there is no better information, and
then applying renal elimination curves in the presence of limited
clearance, as well as issues such as zero-order and first-order
phsrmacokinetics.

The latter often involve constructing molecular pharmacological models
to help recommend optimal dosing levels, avoid interaction, and obtain
synergies in comorbid conditions. My most recent research interest is
applying mathematical modeling of infections disease epidemiology to
the
diagnosis of computer network worms and other malicious software.


Are you applying for job here?! I didn't ask you for your curriculum
vitae.
LOL!

No, but since you've decided to act superior and all-knowing, it might
be worthwhile to give some baseline to see how you have gotten your
information. That, incidentally, includes whether you have a bunch of
tidbits memorized, or if you actually understand clinical biochemistry
and physiology. Hint: there are differences among mammals. There are
also more similiarities than differences.

I'm almost as impressed with your education as you are with it! LOL! Too
bad credentials aren't an assurance of credibility - one can exist
without
the other.

Then why is it that the anonymous Phil P. condescendingly asked if I was
a high school student or a lab technician -- suggesting minimal
credentials -- yet now, apparently, credentials are unimportant? Do
note that I use my real name.

Btw, your list of accolades didn't include anything about cats. That
explains why you don't know abnormal test results should be confirmed.

WHAT? You mean that we should CONFIRM abnormal test results in humans?
Why, I don't think there's a pathologist that EVER thought of that.

And would a nephrologist even conceive of the idea of planned sequential
determination of renal chemistries? The goal is not to wave one's hands
about a specific creatinine, BUN, or other measures, but to use them
together to determine the actual renal damage. That is best defined in
changes in the glomerular filtration rate, which is not directly
measurable by any single chemical measurement. Creatinine clearance, as
opposed to serum creatinine, urinary creatinine, or BUN, is the closest
test we have that doesn't get into nuclear medicine or PET scans. Feline
kidneys are not radically different in their physiology, although the
specific levels will differ from humans.

Of course, you haven't even touched on the role of the renin-angiotensin
system, therapeutic interventions with that system, or quite a few other
relevant matters of biochemistry. Instead, you seem to want to present
yourself as the Son of Bast, who must not be challenged, and apparently
will kick used kitty litter and anyone that dares disagree with his
fiats. Hint: competent clinicians and scientists constantly question
and discuss; it's the way knowledge disseminates and care improves.

While I don't propose to bother spending time educating you on
CLIA-level quality control, there are a wide range of protocols -- used
in any competent lab, human or veterinary, in which the lab
automatically goes into reconfirmation, or requests an additional
sample. This is fairly basic quality control biostatistics.


I'm
thankful you're not in the veterinary profession! You'd probably kill
cats
that tested FeLV+ on one ELISA Snap!



Are you normally this arrogant, or are you making a special effort?


Its no effort at all. LOL! In fact, I often find academic assholes
impressed with their education amusing.

Don't worry, I don't consider you an asshole. I am precise with my
language, and recognize that an anus has at least one useful functfion.


What is your experience?

With cats, obviously much more than you.

In article , "Karen"
wrote:

"Howard Berkowitz" wrote in message
...


Are you normally this arrogant, or are you making a special effort?
What is your experience?

He just gets this way sometimes. "It's his way".



Understood. Of course, some ways are pathological, some are pitiful, and
some are both.

I hope I never lose the humility to recognize that someone may have some
information that I don't, the consideration if that should be integrated
with other information I do have, and the professional ethics to share,
gracefully, what I do know. My mentors impressed on me the idea that
professional knowledge is something to "pay forward."

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

Are you applying for job here?! I didn't ask you for your curriculum
vitae.
LOL!

No, but since you've decided to act superior and all-knowing,

You see, that's the point you can't see through your academic credentials,
I'm not all-knowing that's why I rerun the tests when I get back
questionable or unusual test results that I don't understand before I put a
cat through a battery of stressful tests. That doesn't take a degree in
biology, just common sense, experience and compassion for the cat -- none of
which you seem to have.

You questioned my suggestion to retest the cat - I gave my reasons - that's
it. Now stop whining like a spoiled little brat because I don't agree you.

"Howard Berkowitz" wrote in message
...
In article , "Karen"
wrote:

"Howard Berkowitz" wrote in message
...


Are you normally this arrogant, or are you making a special effort?
What is your experience?

He just gets this way sometimes. "It's his way".



Understood. Of course, some ways are pathological, some are pitiful, and
some are both.


....and yours are egomanical.


I hope I never lose the humility to recognize that someone may have some
information that I don't, the consideration if that should be integrated
with other information I do have, and the professional ethics to share,
gracefully, what I do know. My mentors impressed on me the idea that
professional knowledge is something to "pay forward."


Too bad they didn't you common sense.

In article , "Phil P."
wrote:

"Howard Berkowitz" wrote in message
...
In article .net,
"Phil P." wrote:

Are you applying for job here?! I didn't ask you for your curriculum
vitae.
LOL!

No, but since you've decided to act superior and all-knowing,

You see, that's the point you can't see through your academic
credentials,
I'm not all-knowing that's why I rerun the tests when I get back
questionable or unusual test results that I don't understand before I put
a cat through a battery of stressful tests.

Let me get this straight. You get back results you don't understand. You
rerun them to see if there is anything different. Why should your
understanding of the repeated test be any different than the first?

If you are questioning possible lab error, standard practice for many
out-of-range conditions is for the lab to rerun it, as well as controls.
The blood sample volumes requested are intended to be enough that the
lab can rerun the test if necessary.

Now, as to "stressful tests". To repeat the test, you will have to draw
blood at least once from the cat. To do, say, a dynamic creatinine
clearance rate test, you need to make one puncture, draw blood, and then
inject creatinine through the same needle. At a timed interval
afterwards, you take a second blood sample.

Personally, I don't like having blood drawn. I'm sure a cat likes it
even less. Nevertheless, the only difference I see in your approach and
mine is that I propose one more stick, and getting back results that are
considerably more sensitive (i.e., high rate of detecting positives) and
selective (i.e., low rate of false positives) than two sequential
Chem-7's (Basic Metabolic Profile) giving you an additional BUN and
creatinine. Unless you also do osmolality, Hct or PCV, and other
measures of hydration, the sequential BUN and creatinine are not
necessarily well correlated.

An actual measurement of the proportion of a known amount of creatinine
metabolized in a unit time gives a far more accurate estimation of GFR
than the semi-random repeats you propose. BUN and creatinine, in and of
themselves, are not informative -- they are clues to renal function, and
the most important part of renal function is GFR.

That doesn't take a degree in
biology, just common sense, experience and compassion for the cat -- none
of which you seem to have.

Lot of assumptions there, boy. Any data supporting it?


You questioned my suggestion to retest the cat - I gave my reasons -
that's
it. Now stop whining like a spoiled little brat because I don't agree
you.



Laughing hysterically...whining like a spoiled brat? Who started the
sarcasm, asking if I was a high school student, an apparent slap at
credentials. Now you're saying it's irrelevant to have a degree in
biology.

Let me get this comedy straight...it's not quite worthy of Monty Python
logic, but perhaps we can elevate you to that point. First, you put me
down as not having knowledge and experience. Second, when I come back
with credentials, you quickly change your tune to not needing education
but using "common sense".

In article , "Phil P."
wrote:

"Howard Berkowitz" wrote in message
...
In article , "Karen"
wrote:

"Howard Berkowitz" wrote in message
...


Are you normally this arrogant, or are you making a special effort?
What is your experience?

He just gets this way sometimes. "It's his way".



Understood. Of course, some ways are pathological, some are pitiful, and
some are both.


...and yours are egomanical.

Grinning....who was the first to make personal comments in this
discussion? It's been my experience that when two parties start in a
technical discussion, and one starts namecalling and handwaving about
"common sense", that person is floundering due to lack of knowledge.


I hope I never lose the humility to recognize that someone may have some
information that I don't, the consideration if that should be integrated
with other information I do have, and the professional ethics to share,
gracefully, what I do know. My mentors impressed on me the idea that
professional knowledge is something to "pay forward."


Too bad they didn't you common sense.


Indeed. Too bad any mentors you may have had didn't you grammar.