While unexplained sudden death of apparently healthy young men in their sleep is rare in the West, it is more common in South-East Asian countries and Japan. These men are called “lai tai” in Thailand, “bangungut” in Philippines and “pokkuri” in Japan.

Back in late 1980s and early 1990s, doctors cannot find out the cause of these deaths. They postulated various causes of death, such as heart rhythms going awry in some unspecified way, and they identified these as cases of Brugada syndrome, a mysterious condition that kills victims in their sleep because of spontaneous abnormal heart rhythms.

Nevertheless, it seemed that most of these populations were quite inaccurate.

The cause, as confirmed by different groups of experts in various countries, has now been identified as mutations in 7 particular genes, which are specific segments of our DNA code. As such, Brugada syndrome is now regarded as an inheritable heart condition.

These mutations affect “ion channels” that are found in the living membrane that covers the heart muscle cell. These channels are protein complexes structured like tubes running through the thickness of a cell membrane. Their function is to permit or restrict the movement in and out of the heart cells of positively charged atoms, or ions, of potassium and sodium.

Through the movement of ions in and out of cells, a voltage difference is generated between the inside and outside of the cell. The voltage difference then gives rise to electric signals in the membrane that go around the heart, causing the organ to beat rhythmically.

These electrical signals stimulate the heart chambers to contract regularly and continuously in the correct order, pumping blood throughout the body.

If this electric activity is disrupted, the heart may fail to be effective as a pump, and one could suffer a blackout, notice palpitations and even die if his or her heart stops beating and pumping. This is what happens in Brugada syndrome.

This condition can be summarized as a case which sees abnormal channels letting potassium ions in too slowly or sodium ions too quickly. However, potassium channel problems are associated with sudden death that is usually caused by exercise or if the person is startled or awoken suddenly. Sodium channel problems are more likely to be associated with death while one is asleep.

The one area where homeowners loose money is overpayment for materials that was never installed. Contractors pad each job for extra material and labor to increase their profit margins. You should pay a small fee to a FHA home inspector to measure your roof system. He or she will be able to supply you with a list of items needed and the correct square footage of shingles for the installation of your new roof system.

Take your list of roofing supplies to Home Depot and Loewe’s Home Improvement and let them bid against one another and see who can get you the best price on material. The brand names may be different but the roofing tiles will be essential the same. Who ever wins your business should be able to deliver the material free of charge.

You will need a waste container to haul away the old debris from your home. Choose a container company from your local directory that is environmentally friendly. These container companies usually recycle the asphalt shingles as they get a huge discount off their dump fees. They will pass these savings on to you in order to compete with the other container companies. Get at least 3 quotes from qualified companies.

The hard part is finding a sub contractor who is qualified to do the work. There are many fly by nights who are terrible at roof installation, but they pose as qualified roofing contractors. I suggest you go to your local home improvement store and ask the pro desk in they know of a qualified roofing sub contractor. You can also go to a roofing material supply warehouse as well. Be sure to indicate that you want a sub contractor and not the owner or roofing company. Let them know that you are cutting out the middle man.

You will get at least 3 qualified sub contractors who will be glad to bid on your roofing project. Each of them shall have their insurance certificates and license available. Also, be sure to ask for references of prior work from the past 6 months and addresses where you are able to view their work. Let each of them know that the work will be inspected prior to payment by a FHA inspector for quality craftsmanship.

Finally, do not advance any funds up front for you have everything in place for them to commence work. If the ask for any money up front, this is a red flag and I highly advised that you do not engage them in business. Pay the sub contractor upon final inspection and approval from the FHA inspector that states the roof has been installed correctly. You should have a warranty for the sub contractor and from the FHA inspector which should give you some leverage if anything ever happened to your new roof system.

There has been an increase in complaints to the Better Business Bureau for many insurance companies have been denying residential claims for storm damage. You may be curious to know that a large portion of insurance companies have outsourced their claims department. This gives the insurance company a buffer between you and them. Your agent will often apologize for the denial of your claim and express remorse. They will explain that the independent adjuster is the person who has the power to refuse or validate your claim for storm damage.

Let us evaluate the top 5 reasons why residential claims for storm damage get denied.

The independent company has the responsibility for inspecting all residential claims for storm damage. They have the power to approve or deny your insurance claim. However, the independent company receives their orders from the insurance company. I find this a conflict of interest for the independent adjuster has to consider the ramifications if to many claims are approved. I have met with many adjusters who have told me that if they approve more than 70% of the claims that their annual contract would not be renewed by the insurance company.

The adjuster is the person who evaluates the property for damage. He or she may be very experienced in residential construction or they may have none at all. It is hit or miss with the adjuster you get to process your claim for storm damage. The inspection for damage is very subjective to say the least. I have seen homes torn to shreds with hail damage and the adjuster would deny the claim as mechanical damage. Mechanical damage is a term used for pop nails or it could be for poor craftsmanship. The inspection is purely subjective on the part of the independent adjuster. On the other hand, I have seen times when there has been minimum damage and it could go either way and the adjuster would approve the entire claim. The key factor for approval or denial is dependent upon the experience level of the adjuster who has the responsibility of mitigating the claim for storm damage.

I have had many adjusters convey to me that they were going to deny the claim, but to request a second inspection from the insurance company. I found it strange that an adjuster would tell me to request a second inspection for storm damage. I had worked with this one particular adjuster many times who explained the rationale behind this odd request. He explained that insurance companies have insurance on their insurance policies. The insurance company will often times tell the independent adjuster to deny all claims for they are out of money for the quarter. The adjuster explained that when the money became available for the next quarter they would be allowed to approve the claim. In a nutshell, your insurance provider is waiting for the secondary insurance company to reimburse them for your claim prior to approval.

If weather conditions are bad in your area, this could hurt your chance of getting your claim approved. This may seem odd, but independent adjusters have a certain amount of time to complete the claims they receive from the insurance company no matter how bad the weather. As you can see, if the adjuster gets behind in his reports the only way he can get caught up is by denying a few claims to off set the days of bad weather. He may be inclined to tell you or your contractor to resubmit for a second inspection. This makes no sense for it is an inconvenience to the homeowner as well as a waste of time. The insurance companies are concerned with keeping their double A plus ratings with the review board. If the weather is bad in your area, do not be surprised if your claim gets denied.

Most insurance adjusters are from out of town. They travel from state to state following the storms. You will have a better chance of getting your claim approved if you file shortly after the storm. The adjusters know that if they approve a claim that they will be responsible for the loss report statement until all repairs are completed. Basically, if the roof was measured to be 3900 square feet and there was a discrepancy about the size of the roof structure, then the adjuster is required to come back to the property and remeasure the roof with the roofing contractor. The adjusters are off on their measurements quite often. They measure tight to keep cost as low as possible for the insurance company. Therefore, they come back to about 60% of their claims that they have approved. Toward the end, when request for inspections begin to decline, the independent adjuster will start denying claims in an attempt to keep him from having to come back to that state to mitigate a claim. Once the independent adjuster leaves the state, rarely will your claim be reopened for review.

The size of the hail will have an impact on the amount of damage you may find to your home. The air conditioning unit is the easiest place to locate damage. The metal coils will have dents that are circular in appearance. It may appear that the unit was struck by hundreds of golf balls.

Locate the downspouts that extend down from your gutter system. There may be large amounts of ceramic granules in the drain that have washed off of your roof system. If you find more than a handful of granules, then the integrity of your roof system has been compromised. Be sure to keep the granules in a zip lock bag to show the insurance adjuster when he or she arrives to inspect your home.

All homes usually have screens on their windows. The screens are considered an excellent source for locating hail damage. There will be dents in the screens and a torn place or two may be present as well. The larger the hail the bigger the dents will be on the screen mesh. The metal frame that holds the screen in place is likely to have dings and dents visible.

Your patio or lawn furniture is a great place to locate hail damage. Most patio or lawn furniture is made from soft metals. These soft metals will show dings and dents if it was stuck by hail stones. The material for your umbrella or the seats may have damaged material with holes present. Your grill will have dents or splatter marks from the impact of hail stones if it was out in the open.

The best place to locate the most damage is on your roof system. This can be extremely dangerous so I must advise against scaling a ladder unless you are experienced. The shingles will have divots that are clear to see. It will appear that someone has been teeing off golf balls on your roof. The roof tiles will have round circles present where the granules have been disrupted from the hail. Also, there will be more damage noted on the north elevation due to the Jet Stream. Be sure to check the soft metals on the roof structure for dents or dings.

Finally, NOAA’s National Weather Service keeps an archive on their website of all the major storms that hit the United States. You can enter your address and it will display the date, time, and type of storm that hit your area. You can call your insurance agent and they will have a free map showing the areas hit the hardest in your area. If you have found any damage to your home, you will need to notify your insurance company first and foremost.

The morning of the work shift started out kind of hectic. The patient was hospitalized with a diagnosis of Epistaxis. As a child when I had a nose bleed, the mom would always tell me to hold your head back. Oh the nauseating feeling from the blood gushing down the back of my throat. While in nursing school I learned that the nausea comes from the stomach not being able to digest the blood. And you never ever tilt your head all the way back. The patient had experienced nose bleeds most of their life, but the last few weeks it had gotten worse.

A few hours into the shift, the patient calls and states that their nose was bleeding. Upon entering the room, there was blood every where. Trailing from the bathroom to the bed. The blood was pouring out, saturating towels and making it almost difficult for the patient to breath. The physician was in the hospital and was called to the room. Within 30 minutes the patient had became unconscious and was intubated and transferred to the ICU.

The majority of nose bleeds are controllable and with the proper technique used will stop.

Apply a cool wash cloth to the bridge of the nose
Pinch the bridge of the nose with one hand for about 10-15 minutes
Lean the head forward, if the person feels like they pay faint, have them to bend over their lap and place the head toward the knees.
Never blow your nose after you have stopped the nose from bleeding.
This will cause the small clot to break loose and start the nose bleed all over again.

If you are unable to control the nose bleed either call your primary care physician or call 911 for further assistance.

While unexplained sudden death of apparently healthy young men in their sleep is rare in the West, it is more common in South-East Asian countries and Japan. These men are called “lai tai” in Thailand, “bangungut” in Philippines and “pokkuri” in Japan.

Back in late 1980s and early 1990s, doctors cannot find out the cause of these deaths. They postulated various causes of death, such as heart rhythms going awry in some unspecified way, and they identified these as cases of Brugada syndrome, a mysterious condition that kills victims in their sleep because of spontaneous abnormal heart rhythms.

Nevertheless, it seemed that most of these populations were quite inaccurate.

The cause, as confirmed by different groups of experts in various countries, has now been identified as mutations in 7 particular genes, which are specific segments of our DNA code. As such, Brugada syndrome is now regarded as an inheritable heart condition.

These mutations affect “ion channels” that are found in the living membrane that covers the heart muscle cell. These channels are protein complexes structured like tubes running through the thickness of a cell membrane. Their function is to permit or restrict the movement in and out of the heart cells of positively charged atoms, or ions, of potassium and sodium.

Through the movement of ions in and out of cells, a voltage difference is generated between the inside and outside of the cell. The voltage difference then gives rise to electric signals in the membrane that go around the heart, causing the organ to beat rhythmically.

These electrical signals stimulate the heart chambers to contract regularly and continuously in the correct order, pumping blood throughout the body.

If this electric activity is disrupted, the heart may fail to be effective as a pump, and one could suffer a blackout, notice palpitations and even die if his or her heart stops beating and pumping. This is what happens in Brugada syndrome.

This condition can be summarized as a case which sees abnormal channels letting potassium ions in too slowly or sodium ions too quickly. However, potassium channel problems are associated with sudden death that is usually caused by exercise or if the person is startled or awoken suddenly. Sodium channel problems are more likely to be associated with death while one is asleep.

The one area where homeowners loose money is overpayment for materials that was never installed. Contractors pad each job for extra material and labor to increase their profit margins. You should pay a small fee to a FHA home inspector to measure your roof system. He or she will be able to supply you with a list of items needed and the correct square footage of shingles for the installation of your new roof system.

Take your list of roofing supplies to Home Depot and Loewe’s Home Improvement and let them bid against one another and see who can get you the best price on material. The brand names may be different but the roofing tiles will be essential the same. Who ever wins your business should be able to deliver the material free of charge.

You will need a waste container to haul away the old debris from your home. Choose a container company from your local directory that is environmentally friendly. These container companies usually recycle the asphalt shingles as they get a huge discount off their dump fees. They will pass these savings on to you in order to compete with the other container companies. Get at least 3 quotes from qualified companies.

The hard part is finding a sub contractor who is qualified to do the work. There are many fly by nights who are terrible at roof installation, but they pose as qualified roofing contractors. I suggest you go to your local home improvement store and ask the pro desk in they know of a qualified roofing sub contractor. You can also go to a roofing material supply warehouse as well. Be sure to indicate that you want a sub contractor and not the owner or roofing company. Let them know that you are cutting out the middle man.

You will get at least 3 qualified sub contractors who will be glad to bid on your roofing project. Each of them shall have their insurance certificates and license available. Also, be sure to ask for references of prior work from the past 6 months and addresses where you are able to view their work. Let each of them know that the work will be inspected prior to payment by a FHA inspector for quality craftsmanship.

Finally, do not advance any funds up front for you have everything in place for them to commence work. If the ask for any money up front, this is a red flag and I highly advised that you do not engage them in business. Pay the sub contractor upon final inspection and approval from the FHA inspector that states the roof has been installed correctly. You should have a warranty for the sub contractor and from the FHA inspector which should give you some leverage if anything ever happened to your new roof system.

There has been an increase in complaints to the Better Business Bureau for many insurance companies have been denying residential claims for storm damage. You may be curious to know that a large portion of insurance companies have outsourced their claims department. This gives the insurance company a buffer between you and them. Your agent will often apologize for the denial of your claim and express remorse. They will explain that the independent adjuster is the person who has the power to refuse or validate your claim for storm damage.

Let us evaluate the top 5 reasons why residential claims for storm damage get denied.

The independent company has the responsibility for inspecting all residential claims for storm damage. They have the power to approve or deny your insurance claim. However, the independent company receives their orders from the insurance company. I find this a conflict of interest for the independent adjuster has to consider the ramifications if to many claims are approved. I have met with many adjusters who have told me that if they approve more than 70% of the claims that their annual contract would not be renewed by the insurance company.

The adjuster is the person who evaluates the property for damage. He or she may be very experienced in residential construction or they may have none at all. It is hit or miss with the adjuster you get to process your claim for storm damage. The inspection for damage is very subjective to say the least. I have seen homes torn to shreds with hail damage and the adjuster would deny the claim as mechanical damage. Mechanical damage is a term used for pop nails or it could be for poor craftsmanship. The inspection is purely subjective on the part of the independent adjuster. On the other hand, I have seen times when there has been minimum damage and it could go either way and the adjuster would approve the entire claim. The key factor for approval or denial is dependent upon the experience level of the adjuster who has the responsibility of mitigating the claim for storm damage.

I have had many adjusters convey to me that they were going to deny the claim, but to request a second inspection from the insurance company. I found it strange that an adjuster would tell me to request a second inspection for storm damage. I had worked with this one particular adjuster many times who explained the rationale behind this odd request. He explained that insurance companies have insurance on their insurance policies. The insurance company will often times tell the independent adjuster to deny all claims for they are out of money for the quarter. The adjuster explained that when the money became available for the next quarter they would be allowed to approve the claim. In a nutshell, your insurance provider is waiting for the secondary insurance company to reimburse them for your claim prior to approval.

If weather conditions are bad in your area, this could hurt your chance of getting your claim approved. This may seem odd, but independent adjusters have a certain amount of time to complete the claims they receive from the insurance company no matter how bad the weather. As you can see, if the adjuster gets behind in his reports the only way he can get caught up is by denying a few claims to off set the days of bad weather. He may be inclined to tell you or your contractor to resubmit for a second inspection. This makes no sense for it is an inconvenience to the homeowner as well as a waste of time. The insurance companies are concerned with keeping their double A plus ratings with the review board. If the weather is bad in your area, do not be surprised if your claim gets denied.

Most insurance adjusters are from out of town. They travel from state to state following the storms. You will have a better chance of getting your claim approved if you file shortly after the storm. The adjusters know that if they approve a claim that they will be responsible for the loss report statement until all repairs are completed. Basically, if the roof was measured to be 3900 square feet and there was a discrepancy about the size of the roof structure, then the adjuster is required to come back to the property and remeasure the roof with the roofing contractor. The adjusters are off on their measurements quite often. They measure tight to keep cost as low as possible for the insurance company. Therefore, they come back to about 60% of their claims that they have approved. Toward the end, when request for inspections begin to decline, the independent adjuster will start denying claims in an attempt to keep him from having to come back to that state to mitigate a claim. Once the independent adjuster leaves the state, rarely will your claim be reopened for review.

The size of the hail will have an impact on the amount of damage you may find to your home. The air conditioning unit is the easiest place to locate damage. The metal coils will have dents that are circular in appearance. It may appear that the unit was struck by hundreds of golf balls.

Locate the downspouts that extend down from your gutter system. There may be large amounts of ceramic granules in the drain that have washed off of your roof system. If you find more than a handful of granules, then the integrity of your roof system has been compromised. Be sure to keep the granules in a zip lock bag to show the insurance adjuster when he or she arrives to inspect your home.

All homes usually have screens on their windows. The screens are considered an excellent source for locating hail damage. There will be dents in the screens and a torn place or two may be present as well. The larger the hail the bigger the dents will be on the screen mesh. The metal frame that holds the screen in place is likely to have dings and dents visible.

Your patio or lawn furniture is a great place to locate hail damage. Most patio or lawn furniture is made from soft metals. These soft metals will show dings and dents if it was stuck by hail stones. The material for your umbrella or the seats may have damaged material with holes present. Your grill will have dents or splatter marks from the impact of hail stones if it was out in the open.

The best place to locate the most damage is on your roof system. This can be extremely dangerous so I must advise against scaling a ladder unless you are experienced. The shingles will have divots that are clear to see. It will appear that someone has been teeing off golf balls on your roof. The roof tiles will have round circles present where the granules have been disrupted from the hail. Also, there will be more damage noted on the north elevation due to the Jet Stream. Be sure to check the soft metals on the roof structure for dents or dings.

Finally, NOAA’s National Weather Service keeps an archive on their website of all the major storms that hit the United States. You can enter your address and it will display the date, time, and type of storm that hit your area. You can call your insurance agent and they will have a free map showing the areas hit the hardest in your area. If you have found any damage to your home, you will need to notify your insurance company first and foremost.

The morning of the work shift started out kind of hectic. The patient was hospitalized with a diagnosis of Epistaxis. As a child when I had a nose bleed, the mom would always tell me to hold your head back. Oh the nauseating feeling from the blood gushing down the back of my throat. While in nursing school I learned that the nausea comes from the stomach not being able to digest the blood. And you never ever tilt your head all the way back. The patient had experienced nose bleeds most of their life, but the last few weeks it had gotten worse.

A few hours into the shift, the patient calls and states that their nose was bleeding. Upon entering the room, there was blood every where. Trailing from the bathroom to the bed. The blood was pouring out, saturating towels and making it almost difficult for the patient to breath. The physician was in the hospital and was called to the room. Within 30 minutes the patient had became unconscious and was intubated and transferred to the ICU.

The majority of nose bleeds are controllable and with the proper technique used will stop.

Apply a cool wash cloth to the bridge of the nose
Pinch the bridge of the nose with one hand for about 10-15 minutes
Lean the head forward, if the person feels like they pay faint, have them to bend over their lap and place the head toward the knees.
Never blow your nose after you have stopped the nose from bleeding.
This will cause the small clot to break loose and start the nose bleed all over again.

If you are unable to control the nose bleed either call your primary care physician or call 911 for further assistance.