When you are concerned about a child's development

Act Early . . .

Children's growth and developmental milestones may differ somewhat, but the guidelines below will give you some ideas of what's to be expected.  Click on the links to the CDC's "

"Act Early" campaign for complete details.

List of developmental milestones:  Click on your child's age to see a list of typical developmental milestones.  Halfway down the page is a feature that allows you to complete an interactive checklist based on the milestones that your child has accomplished.  Be sure to discuss this list of milestones with your child's pediatrician and read more on the Act Now website about programs available to provide children with extra help when necessary.  Above all, be a positive parent to your child-- get tips for positive parenting techniques here.  

Select this link to read more about developmental screening.  You can order free publications from the Act Now campaign including a growth chart with information on appropriate developmental milestones:  growth chart with information about appropriate developmental milestones.

 At 1 month of age many babies will:

• Lift their head briefly when on stomach
• Respond to sound
• Blink at bright lights
• Stare and focus at faces

Hold baby in your arms for feedings, respond to baby's cries promptly, talk and sing to your baby.

By 3 months of age many babies will:

• Exhibit a social smile, enjoy playful interaction with adults, and communicate through facial expressions and body movements
• Bring hands to mouth and swipes at dangling toys
• Watch faces intently, turn head in the direction of sound and babble

 Talk and sing to your baby--your baby finds this soothing.




By 7 months many babies will:

• Turn their head when their name is called
• Smile back at another person
• Respond to a sound with a sound
• Enjoy social play (like peek-a-boo)

Cuddle and hold your baby.  When baby babbles, answer by repeating sounds; add words to develop language skills. 

By 12 months (1 year old) many babies will:

• Use simple gestures (point at an object, wave bye-bye)
• Make sounds such as “ma” and “da”
• Imitate actions (clap when you clap)
• Respond when told “no”

Give your baby plenty of loving attention and praise.

By 18 months (1 and a half years old) many toddlers will:

• Pretend when they are playing (talk on a toy phone)
• Point to interesting objects
• Look at an object when you point at it and tell them to look
• Use several single words unprompted (“Uh-oh!,” “No!,” etc.)

 Read stories to your toddler to develop language skills.

By the end of 24 months (2 years) many toddlers will:

• Use 2- to 4-word phrases
• Follow simple instructions
• Become more interested in other children
• Point to objects or pictures when named (such as parts of the body and different foods or toys they are familiar with)

Teach your toddler to tell you his/her name and age.

By the end of 36 months (3 years) many children will:

• Show affection for playmates
• Use 4- to 5-word sentences
• Imitate adults and other children, (run when other kids run)
• Play make-believe with dolls, animals, and people (feed a teddy bear, play dress up)

 Take some time every day to play with your child. Teach her interactive songs like "Itsy Bitsy Spider."

   
By the end of 48 months (4 years) many children can:

• Use 5- to 6-word sentences
• Follow 3-step commands (Example: “Put on your sweatshirt, get your ball, and come downstairs.)
• Cooperate with other children

 Encourage your child to play with other children to build friendships and learn sharing.


Where to get more information?  There are tons of sites online to get more information about early childhood development and ways in which parents can help their babys develop into happy healthy individuals.  I strongly recommend these two sites: the Mayo Clinic pages about Infant and Toddler Health and the parent handouts available on this site "Zero to Three."

Aprenda los signos: Reaccione pronto (Publications in Spanish from the CDC's Act Now Program) 

• Aprenda los Signos Advertisement in Spanish
• Poster, Spanish Version
• Spanish Fact Sheep about Developmental Milestones
• Spanish information Card
• Spanish Growth Chart

All rights reserved for photos, 2009, Carolyn Cooper, MPH, RN

. . . .

Another Black Box: Aranesp, Epogen, Procrit, What you should know about drugs that tell your body to make more red blood cells

Erythropoiesis Stimulating Agents (ESAs) tell your body to make more red blood cells. Drugs in this class include:

• Aranesp (darbopoetin alfa)
• Epogen (epoetin alfa)
• Procrit (epoetin alfa)
• There are other brand names & epoetin variants marketed worldwide

The Good News First . . .

Twenty years ago we didn’t have synthetic medications to treat anemia. Depending on the cause anemia was often treated through diet, by administering supplementary iron or vitamin B12, and frequently, by blood transfusions. The 1980's was a decade of concern over the safety of our blood supply due to blood borne pathogens such as Hepatitis B and C and the HIV virus. New technologies in recombinant DNA allowed science to explore and develop innovative alternative therapies.

In 1989, Epogen (epoetin alfa), the first of a class of drugs called erythropoiesis stimulating agents (abbreviated as “ESAs”), was approved by the FDA in the United States to treat patients suffering from anemia due to chronic kidney disease. Epogen was eventually joined by similar ESAs called Aranesp and Procrit and treatment was eventually broadened to include patients suffering from anemia related to chemotherapy.

The benefit to both groups was that they no longer needed to rely on frequent blood transfusions to treat their anemia. ESAs directly influence the body to speed up the production of its own red blood cells by introducing a synthetic version of the hormone erythropoietin. Erythropoietin is a chemical messenger of sorts with the specific mission of instructing our bone marrow to produce more red blood cells. Epogen, Aransep, and Procrit are easily given by a simple injection under the skin from one to three times per week.

So what exactly is anemia? Anemia results when we don’t have enough healthy red blood cells called erythrocytes circulating in our bloodstream. Healthy red blood cells are vital; they carry a protein called hemoglobin which picks up molecules of oxygen from our lungs and delivers it to the tissues throughout our body. We don’t store oxygen in our body but we use it continuously, and our body’s demand for oxygen is constant as oxygen molecules literally fuel every basic function that each cell in our body must perform.

Symptoms of Anemia. Moderate to severe anemia can cause symptoms of weakness, fatigue, shortness of breath, rapid/irregular heartbeat and pale skin. Milder or chronic anemia may cause subtle symptoms or no symptoms at all.

Erythropoietin. This hormone is a chemical messenger with several functions relating to the manufacture of red blood cells, preserving their lifespan in the body, and enhancing the growth of blood vessels. As we develop before birth, erythropoietin is active within our livers. After we are born, erythropoietin is manufactured and released by cells in the kidney.

Kidneys and Anemia. People often don’t think of a relationship between the kidneys and anemia, but when you carefully consider it, it makes sense for the kidney to have this function. Like a waste-water treatment plant adds chemicals based on the scientific observations of the plant technicians, the kidneys have specialized cells that detect decreased oxygen levels in the blood circulating through them, and as a result, these specialized cells release erythropoietin to enhance red blood cell formation and longevity. If the kidneys become diseased and fail, this system of checks and balances is impaired or lost. When ESAs, or synthetic erythropoietin, was first introduced in 1989, the drug was intended specifically for the benefit of patients in kidney failure.

Chemotherapy and Anemia. Cancer cells are bizarre mutant cells that divide rapidly. therefore, malignant tumors can grow large very quickly. The goal of chemotherapy is to target those rapidly-dividing bizarre cells and kill them. Other “good” rapidly-dividing cells in our body get caught in the cross-fire and are also damaged by chemo drugs. Hair is lost when rapidly-dividing cells in the roots are targeted by the chemo drugs. Other fast-growing cells affected by chemotherapy are in the digestive tract; that’s why mouth sores, nausea, and vomiting are a common consequence of chemo. The body’s rapidly dividing blood cells (red cells, white cells, and platelets) are also among the good cells that fall prey to chemotherapy. The anemia that results from chemotherapy is not caused by a lack of erythropoietin, but ESAs were approved by the FDA in 1993 to treat anemia to reduce the amount of blood transfusions necessary for patients suffering from chemotherapy-induced anemia.

Sobering News about ESAs . . .

All medications have both benefits and risks. In the U.S. the FDA places "black box warnings" on the medication labels and inserts of drugs when research suggests there is a risk of serious adverse effects. The first black box warning for ESAs appeared in March of 2007. Eight months later in November 2007, the black box warning was emphatically strengthened by the FDA.

Both the chronic renal failure and chemotherapy patients were found to have some increased risks when using ESAs. Patients with certain types of cancer were found to be at risks of tumor progression and decreased survival when taking ESAs to increase red blood cell production. Chronic renal failure patients were found to be at increased risk of developing heart attack, stroke, blood clots, heart failure and death if their ESA dose was high enough to cause them to make more than recommended number of red blood cells.

The FDA’s guidance to physicians was very specific on the recommended dosage to achieve good results without increasing patients’ risks for a bad outcome. Further, their guidance suggested that physicians specifically discuss the risks and benefits of these medications with their patients.

What’s Inside the Black Box . . . guidance for physicians about prescribing:

For patients with cancer: ESAs should only be used to treat anemia caused by chemotherapy—not to treat anemia from any other cause. After chemotherapy is finished, ESAs should no longer be used. Risks of tumor progression and decreased survival were noted in some clinical trials. The FDA strongly recommends that healthcare professionals discuss these risks with their patients before this therapy is started.

For anemic patients with chronic renal failure: Treat with the lowest level of the drug which will maintain hemoglobin levels within the target range of less than 12 g/dL. The established goal for this group is to maintain hemoglobin between 10-12 g/dL, because the risk for death and serious cardiovascular events increases when higher hemoglobin levels are achieved on ESA therapy. Further, it’s recommended that ESA therapy be discontinued if the patient’s hemoglobin levels remain so low that blood transfusions are still required.

What the FDA recommends for physicians and other healthcare professionals to discuss with their patients:

1. The primary goal of treatment with erythropoiesis stimulating agents (ESA) is to increase the number of red blood cells in order to avoid receiving blood transfusions.
2. These medications require at least two weeks of treatment before there is an increase in the number of red blood cells, and the dose may be adjusted periodically, but not more often than every four weeks.
3. ESAs increase the patient’s chance of blood clots and the risk of dying may be greater in certain circumstances.
4. Patients should keep appointments for blood tests so hemoglobin levels can be monitored.
5. Patients should monitor their blood pressure and call their healthcare provider for changes outside of the range that has been established for them.
6. Call the healthcare provider if they experience any of the following symptoms:

• Pain and/or swelling in the legs
• Worsening in shortness of breath
• Increases in blood pressure
• Dizziness or loss of consciousness
• Extreme tiredness
• Blood clots in hemodialysis vascular access ports

What the FDA wants patients to know about treatment with Aranesp, Epogen and Procrit . . .

Patients with cancer who are currently using or considering the use of an ESA should know the following:
• ESAs may shorten your survival time or may cause your tumors to grow faster.
• ESAs should only be used to treat anemia caused by chemotherapy and not other anemia from other causes in patients with cancer
• ESAs should not be used to treat the symptoms of anemia, such as fatigue or improve the quality of life in patients with cancer. The goal of treatment with ESAs is to avoid blood transfusions
• Treatment with an ESA should be stopped after you complete your course of chemotherapy.

Patients with chronic kidney failure (this includes both patients on dialysis and those not on dialysis) who are currently using an ESA should know the following:
• Your hemoglobin level should be checked regularly to make sure it stays between 10 and 12 g/dL.
• ESAs can increase your chance of heart attack, stroke, blood clots, heart failure, and death when they are given to maintain higher hemoglobin levels.
• If you are not responding to treatment with an ESA (your hemoglobin levels are not increasing) ask your doctor if you need to be checked for other causes of anemia.

Report Adverse Reactions to the FDA: Healthcare professionals are to report adverse and unexpected reactions with these meds to the FDA MedWatch reporting program online or by phone: 1-800-332-1088.

Links to more information about ESAs:

• Comprehensive information about ESAs from the U.S. Centers for Medicaid and Medicare Services: www.cms.hhs.gov/determinationprocess/downloads/id203d.pdf
• Kidney Disease and Anemia: http://kidney.niddk.nih.gov/kudiseases/pubs/anemia/
• Anemia and Kidney Disease: http://www.aakp.org/aakp-library/Anemia-in-Chronic-Kidney-Disease/
• A plus: Anemia and Kidney Disease from Anemia.org: http://www.anemia.org/patients/information-handouts/kidney-disease/
• ESA use for anemia in cancer patients: http://www.medscape.com/viewarticle/571464




.(All rights reserved, Carolyn Cooper, MPH, RN, 2009)  .. . .

How to Take Care of Your JP Drain at Home (Jackson-Pratt Surgical Drain)

It's not unusual to be sent home from the hospital after surgery with a surgical drain still in place. Typically a nurse will have taught you (or your loved one, if you’re squeamish) how to take care of  the drain at home and they probably gave you some paperwork with instructions.  Sometimes, however, such teaching is given after surgery when the patient is groggy or in pain and family members are tired and ready to just get on the road towards home.  The instructions may get lost in the shuffle of paperwork you were handed at discharge.  For this reason I wanted to make a blog entry that includes some basic information about the JP drain and includes links to patient education sheets from reputable physicians and hospitals.

About the Jackson-Pratt (JP) Drain . . .

The JP drain is a soft, pliable bulb drain that is either tunneled directly into a surgical incision, or more often into another smaller "stab" incision right next to the main incision. The purpose of the JP drain is to allow the large surgical incision to heal well by draining blood and thin serous material that can build up behind fresh incisions.

The bulb part of the JP drain is connected to the surgical incision by means of a long plastic tube that’s sutured in place on the skin where it enters the body. When the bulb is compressed (squeezed together), it provides constant suction that draws any accumulating fluids such as blood, pus, or other thin drainage from the incision, through the tube and into the bulb. On a regular basis (at least once a day), the fluid that is collected in the bulb is emptied by opening the small plug in the top and squeezing the fluid into a measuring cup.  While the empty drain is still unplugged, the drain is squeezed together to remove as much air as possible so it is mostly “flattened.”  Then the plug is recapped. The flattened bulb gently expands as it again slowly suctions fluid from the incision.

Keep Track of the Amount of Fluid . . .

The amount of fluid, date and time, and any ususual details about the fluid (color, thickness, clots, smell) is written on a paper for the doctor to review at your appointment, then the drainage is emptied into the toilet and flushed away.  Keeping track of the amount of fluid emptied from the bulb is important. This information allows the physician to know if the wound is healing according to schedule . . . or if there are complications that require further attention such as an unusual amount of blood coming from the wound, a foul smell to the discharge, or an unusually large volume of fluid. When the drainage falls to a certain level, usually a few days after surgery, the drain is easily removed by a physician or nurse at the doctor's office.

I’m by no means an artist, but I’m including a couple of my own sketches here. The websites (at bottom) often include great drawings or photos of the drains and their care, but of course they have  copyrights to their art and photos so I’ll give you just a basic idea.

Parts of the JP Drain

Drain reservoir bulb—about the size and shape of a large lemon or (in my mind) a hand-grenade. Made of soft flexible semi-transparent silicone with an attached drainage tube that is sutured into a slit on the body near the surgical incision. In order to collect drainage from the tubing, the bulb plug must be opened, air is squeezed out until the bulb appears mostly flat. While still squeezing the bulb flat, the plug is replaced. As the bulb fills with fluid, it may expand. The bulb is emptied at least daily or when full and the drainage is measured and recorded and reported to the physician.

Drain aperture—the hole with a plug, this is where you empty the drainage that is collected. It reminds me of a beach-ball plug and works exactly the same way.

Drain tubing—hollow tubing made of a soft semi-transparent silicone. It’s connected to the drain reservoir bulb. Sometimes the tubing may accumulate drainage that becomes a clot which blocks the drainage.  This can be cleared by a gentle pinching motion of the tubing just above the clot, away from the body and towards the bulb, it is usually recommended to “milk” the tubing in this way when needed to keep it draining freely.

Surgeries that result in a drain . . .

. . . includes just about any that may result in a large incision, for example, breast surgery, thyroid operations, weight loss surgery, abdominal surgeries, and operations on the kidneys or bladder.  There are other types of surgical drains as well, but the JP is one of the most common.

Keep the JP Drain from Pulling on the Incision

To keep the weight of the drain from pulling on the incision, a flap of tape is applied near the bulb. A safety pin is pinned through this tape flap and then pinned to the patients clothing in such a way as to take up the slack of the tubing. (If you have more than one drain, they will each be numbered for easy reference on the tape flap.)  Be careful not to poke a hole through the tubing of your drain!

I don't seek advertising or any funding for my blogging, but I do point out commercial products that may be helpful to my readers.  Here are two products that I came across created by patients in order to more comfortably manage their JP drains post-operatively.

• Surgishorts is a unisex garment that has pockets specifically for the JP bulbs:  http://www.surgishorts.com/. 
• The drain pouch management gown is a unique hospital gown created with the post-op breast surgery patient in mind: Sage Solutions Drain Pouch Gown. 

Links to Reputable Websites with Instructions on JP Drain Care.  Most of these include log sheets you can copy to record your drain output . . . or you can just write it on a piece of notebook paper--that would be just fine, too, as long as you include the date/time/amount (and drain number if you have more than one.)

• National Institute of Health Patient Education: JP Drain (English) and  in Spanish
• Breast Reconstructive Surgery.
• UCS Breast Center: JP Drains
• Jackson-Pratt Drain Care
• Health AtoZ: JP Drain pdf
• Carolina Breast Cancer Information
• Dr. Holmes MD Patient Resources
• Cheboygan Surgical
• UCS Drain Record Sheet

Youtube Videos

 

Youtube doesn't have many videos about care of the JP drain.  I'm surprised.  I did find two amateur videos posted there by breast cancer patients who are demonstrating emptying their JP drains at home.  These brave ladies are doing a service by posting their experiences to help others.  I applaud their willingness to do so and want to include links to there videos here.  These are not professional videos, but they give you a glimpse of other people at home with their JP drains in real life:

• An amateur video in which Deborah demonstrates emptying and measuring the contents of her four surgical drains.  Note: Deborah is wearing a brassiere, but does have some skin of her upper torso (not breasts) exposed. I know my blog readers come from all walks of life, so if exposed female flesh is offensive to you, this is not a video for you.  I think it is interesting to see how the output of each of Deborah's drains varies slightly in amount, color, and consistency.
• Sylvia Soo demonstrates emptying of her two JP drains.  This amateur video starts out SLOW and very playful, but if you hang in there for a few seconds, Sylvia comes on camera to show how she cares for her two drains. She does a good job of demonstrating “milking” the drain to remove clots and measuring the drain “output.” Sylvia is completely covered by clothing in this video, so not to worry if bare skin offends you.   

. . . ..(All rights reserved, Carolyn Cooper, MPH, RN, 2009) . .

What's Up with Hiccups? (Hiccoughs) A Basic Explanation for Kids . . .

Everyone gets the hiccups . . .  in fact, most babies get the hiccups before they are even born. Kids seem to get hiccups more often than adults. Maybe that is why some people believe that having the hiccups “means you are growing.”

What causes hiccups?

Do you think that hiccups are a sign that someone is thinking about you? Well, in some cultures that’s another superstition people have used to try to explain why we get hiccups.

These days we know that hiccups are actually caused by a muscle called the diaphragm (DYE-a fram). The diaphragm is a flat muscle that lays underneath our lungs and above our stomach. The diaphragm helps our lungs take in big, deep breaths.

If we eat so much that our stomach is too full, or laugh until we are out of breath, our stomach is squeezed up against the diaphragm. This squeezing can irritate the diaphragm and cause it to spasm. (A spasm is like a tiny twitching or jerking motion.) When the diaphragm twitches, little puffs of air will quickly be pushed up and out of the lungs and into the throat. When the puff of air pops through the vocal cords deep within the throat, the familiar (HIC-cup!!)  sound is produced. Every few seconds the cycle is repeated. (Hic-CUP!!)

Do you have a favorite “cure” for getting rid of the hiccups?

Most cases of hiccups only last five minutes, and they usually stop all by themselves. Hiccups can be uncomfortable, though, so most people want to get rid of them fast.

You have probably heard that that quickly drinking down a big glass of water or holding your breath for as long as possible will get rid of hiccups in a hurry.  Most of us also know that sometimes a good scare can chase away the hiccups.

There are many home remedies for curing the hiccups. Here are a few that you may not have tried:

• Eat a spoonful of peanut butter (without bread—just peanut butter on a spoon).
• Plug both of your ears with your fingers, then drink a glass of water through a straw.
• Wet a tiny scrap of paper and stick it to the forehead until the hiccups go away. (This belief is common in West Texas and North Central Mexico).
• And . . . My favorite "no fail" hiccup cure:   Place a clean washcloth or towel on top of a full glass of water, then drink the water through the washcloth. In my experience, this is hiccup cure is both very fast and always effective.

(all rights reserved, Carolyn Cooper, MPH, RN)

Traveling with Portable Oxygen: Carefully Prepare in Advance

I just found out how complicated it can be to travel with portable oxygen. My friend Mr. D. asked me to accompany him as a medical companion on a trip by air across country. In advance of our departure, the organization we were traveling with arranged everything at no cost to Mr. D.  Included was the delivery of a portable oxygen concentrator from the local medical supply store (this machine provides a high concentration of oxygen mechanically, without a metal oxygen cannister). Meanwhile, I had already consulted Mr. D's doctor to obtain a prescription for oxygen to cover his use of the device while on this trip.

The group we were part of, a local chapter of the Honor Flight Network, had dealt with oxygen issues before, but on a different airline. Still, everything seemed to be in perfect order.  Our portable oxygen concentrator was clearly marked as appropriate for airline use. I had the complete manufacturer’s manual for the concentrator in hand, along with Mr. D’s current doctor’s prescription for the use of supplemental oxygen. Mr. D’s respiratory condition is quite stable; he is often "fine" on room air, but he does need some extra support from time to time (especially if he is exerting himself too much or in case of anxiety.) The battery on our concentrator was fully charged, and we had a portable (cigarette lighter) charger with us as well. Mr. D hasn’t flown for quite some time, and we honestly didn’t know whether or not he would need the extra oxygen while in-flight, but we wanted to be sure to have it on hand for our very active day in Washington D.C.

At our departure security screening, the TSA representatives x-rayed our portable oxygen concentrator and took it away briefly to perform further routine safety tests. They returned it without comment and we were on our way. The concentrator went into the cabin with us, neither the gate attendants nor the flight attendants commented on it at all, and we would have used it in flight, but Mr. D. didn’t need it. Fortunately, during our day trip in the nation’s capital, no member of our group (consisting of mid-80 to mid-90-year old veterans and their younger traveling companions) required any supplemental oxygen. When we departed late that evening for the trip back home on the same airline, the TSA portion of the boarding process was identical to that morning. However, the airline gate attendants informed us as we boarded the plane that while the oxygen concentrator could go with us in the cabin, it could NOT be used in flight, because we were lacking some very specific documentation that their airline requires.

Fortunately, Mr. D. was once again just fine without extra oxygen. However, this experience informed me that other travelers using supplemental oxygen might not be so lucky. In doing a bit of research it appears that various airlines have significantly different rules and regulations for the use of on-board oxygen. Individuals who are using several airline carriers for connecting flights are obviously particularly vulnerable to travel delays (or worse) if they are not adequately prepared in advance of their trip.

Oxygen Freedom a website that includes links to many major airline’s travel oxygen policies.  Be sure to read exactly what your carrier requires well in advance of your trip. (Their site also offers links to major transportation providers useful for those who are going to travel by bus, cruise ship, or train.)

Hightlighted below are direct quotes from the Transportation Safety Administration's (TSA) website which offer the low-down on air travel with oxygen in the U.S. from the TSA's point of view:

Medical Oxygen and Respiratory-Related Equipment. Supplemental personal medical oxygen and other respiratory-related equipment and devices (e.g. nebulizer, respirator) are permitted through the screening checkpoint once they have undergone screening. Any respiratory equipment that cannot be cleared during the inspection process will not be permitted beyond the screening checkpoint.

Persons connected to oxygen. Inform the Security Officer if your oxygen supply or other respiratory-related equipment cannot be safely disconnected. Only you can disconnect yourself to allow for your oxygen canister/system to be X-rayed. Check with your Doctor prior to coming to the checkpoint to ensure disconnection can be done safely. If your Doctor has indicated that you cannot be disconnected or if you are concerned, ask the Security Officer for an alternate inspection process while you remain connected to your oxygen source. Infants will remain connected to their apnea monitors throughout the screening process. Apnea monitors will be screened while remaining connected to the infant. Oxygen equipment will either undergo X-ray screening (only disconnected oxygen equipment) or physical inspection, and explosive trace detection inspection.

Oxygen suppliers or persons carrying oxygen supply. An oxygen supplier or personal assistant may accompany you to the gate or meet you at the gate once they have obtained a valid gate pass from the appropriate aircraft operator. Persons carrying his/her supply must have a valid boarding pass or valid gate pass to proceed through the security checkpoint. Oxygen being carried by the supplier or person will either undergo X-ray screening and explosive trace detection sampling.

Oxygen and Arrangements. Passengers are responsible for making the arrangements with: (1) The airline(s) for supplemental Oxygen onboard the aircraft, and (2) Local providers for oxygen use during any layover stop(s) and at the final destination, (3) The airline, friends, relatives or a local supplier for removal of the canister from the originating airport's gate area immediately after you leave the gate area to board the aircraft. You must make similar arrangements for your return trip. Please, check the procedures outlined below for details. More information on airline accommodations for oxygen users can be found at the National Home Oxygen Patient's Association  web site. You can also download the "Airline Travel with Oxygen" brochure. This publication provides valuable information on traveling with oxygen, including airlines that do and do not provide in-flight supplemental oxygen.

When You Make Your Reservation. Arranging for Supplemental Oxygen (O2) Aboard the Aircraft. Neither the Air Carrier Access Act nor the Americans with Disabilities Act require airlines to provide oxygen service. Consequently, airline policies, procedures and services on accommodating passengers who use supplemental oxygen vary widely. Notify the carrier when you make your reservation that you will need to use supplemental oxygen aboard the aircraft(s). Ask about the airline's policies on the use of supplemental oxygen onboard. Federal regulations prohibit airlines from allowing passengers to bring their own oxygen canisters aboard to use during the flight. Passengers who use oxygen canisters must purchase canisters from the airline for use during the flight. However, some airlines do permit passengers to bring aboard oxygen concentrators, which do not contain oxygen, and use them during the flight. Policies vary from carrier to carrier, so be sure to check with your airline well in advance.

Keep in mind that not all airlines offer supplemental oxygen service, or may not offer it aboard all their aircraft. Inquire whether: 1) the airline provides oxygen service, 2) it is available on the flights you wish to take, and 3) you must provide a doctor's letter, or permit them to contact your doctor directly to verify your medical need.

Arranging for Supplemental Oxygen during Layovers or at Your Destination.  Notify the carrier(s) you are traveling with that you will need oxygen at the airport(s). Let them know that your oxygen supplier will be meeting you at the gate with an oxygen canister. Ask about their policy for allowing oxygen suppliers to meet you at the layover airports and/or at your destination gate. Contact your oxygen supplier and request that they make arrangements for your oxygen at the city or cities you'll require. The supplier will need to know the airline(s) you'll be using, departure and arrival dates and time, departure and arrival gates, flight number(s), arrival time(s), and the equipment you will need. Make all these arrangements as soon as possible. If a representative from the oxygen-providing company is going to meet your flight with an oxygen canister, arrange for your flight(s) to arrive during the supplier's normal business hours, if possible. Also, have a local phone number and a contact person in the event of any unforeseen situation(s), such as if their representative is not at the arrival gate when you get there.”

What I Should Have Known in Advance

We flew with Southwest Airlines.  Their website provides specific guidelines about the use of oxygen on their planes.  The prescription I obtained for Mr. D. is nowhere near meeting the three specific criteria that their policy requires. 

In fact, Southwest's policy requires that specific details about the passenger's portable oxygen concentrator be provided when the initial reservation is made.  Further, the passenger must have a letter from his/her physician on letterhead with an issue-date of no more than one year prior to flight departure date.  (This document will only be accepted if it is printed on the physician’s letterhead, a basic template for physicians to follow is available here for download.) The doctor's letter MUST include three specific details: (1) Whether the user is able to operate the device and recognize and respond appropriately to its alarms, and if not, that the user is traveling with a companion who is able to perform these functions, (2) The phases of the flight (taxi, takeoff, cruise, landing) during which use of the device is medically necessary, and (3) The maximum flow rate corresponding to the pressure in the cabin under normal operating conditions. (Cabins are pressurized to an altitude of 8,000 feet.)

Travel Tip:  Have at least two nasal cannulas on-hand.  Mr. D. brought his own tubing/cannula sets.  It was a good thing, because the medical supply company had forgotten to include tubing with they delivered the concentrator.  By the time we actually received the device, it was much too late for us to get tubing from them.

Quick Links:

Airline Travel with Oxygen Brochure
Oxygen Freedom's links to major commercial airlines, cruise/bus/and train providers
Yourlunghealth.org/--Traveling with Oxygen

. . .

October 15th is Pregnancy and Infant Loss Remembrance Day

Just One Hour . . .

Heartbreaking is one word that can be applied to the loss of a baby during infancy or pregnancy.  Unfortunately, I'm all too familiar with such situations (from a second-hand point of view.)  When I was an emergency room nurse some years ago, our large ER usually cared for at least one patient experiencing a miscarriage each day.  One of the saddest that I was personally involved in occurred when a middle-aged woman came in for an exam due to some "female problems."  She was in pain and bleeding, but suspected she was menopausal.  Her spouse was at her side, and they were both were shocked by the doctor's announcement that the lab tests confirmed that she was, in fact, pregnant.  This stunned couple digested the news, and even as the lady was prepped for a bedside ultrasound, they began to plan how they would fit an infant into their lives now that their other kids were grown and out of the house. Sadly the ultrasound soon revealed the cold fact that this early pregnancy was in the process of an irreversible miscarriage. Although aware of this pregnancy for less than one hour, the emotional toll on this wonderful couple was tremendous, nevertheless.

PG and Infant Loss Awareness

Since 1988 October has been recognized as  Pregnancy and Infant Loss Remembrance Awareness month.  Special worldwide observances are planned for October 15th each year.  Perhaps most notable among the planned observances is the "wave of light" that will sweep across the world for 24 hours in memory of the babies who have "gone too soon."  You can  participate in this symbolic gesture of remembrance by lighting a candle at 7 pm in your own time zone and keeping it burning for at least one hour.

It's only natural to seek support in times of grief.  Here are some suggestions:

Organizations providing support to bereaved parents
National Share, support for parents


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Menstruation Education and other Puberty Resources for Parents

Learning about Menstruation

In 1970 I was in the 5th grade. I vividly remember an afternoon in which all the girls in the class were given a mimeographed note for our mothers to sign and return giving permission for us to stay after school on a certain day to view a film about "menstruation." This was a term that I had never heard of. My classmates didn't have an explanation either, although one boy teased that HE knew what it was all about! We scoured our school dictionary to no avail. At home, my mother signed the note without comment. She encouraged me to "look it up in the encyclopedia" when I tried to probe further into this mystery. The encyclopedia explanation baffled me, and the sketch of female reproductive organs was as abstract to my 10-year-old mind as a Rorschach inkblot. Back at school the girls asserted that since "menstruation" started with the word "men-," we were going to learn something about boys. One dear little friend then confided some secrets she knew about sex which seemed impossible (but turned out to be true.)

The thirty (or so) 5th grade girls of Willitts Elementary gathered at the end of the day, sitting cross-legged on the cement basement floor of our dear old school. The classroom teachers were joined by the school nurse. Our principal disappeared after he had ensured that any lingering boys were absolutely gone from the campus. Our film called, "It's Wonderful Being a Girl," featured Libby, a preteen who was learning about menstruation. (Watch it here if you like.) The film featured the Modess brand of menstrual sanitary napkins, understandable as they were products of the sponsor, Personal Products Corp. a division of Johnson & Johnson. It's common for makers of "feminine hygiene" products to offer such educational fare--offering an educational service as they advertise and make babysteps towards influencing brand loyalty. (It was obvously effective, in my case anyway, because I've vividly remembered this film for all of these 35-plus years.) After the film we were given the companion booklet with the (somewhat threatening?) title of, "Growing up and Liking it."

After the film the school nurse gamely lectured the assembled bewildered little girls. As it turned out, a few girls in the other class admitted some knowledge of this subject. Meanwhile, I was still confused and now rather frightened. Sometime later while visiting my friend Sandy, we raided her older sister's room and examined her sanitary napkins and belt--she would have killed us if she'd known. The subject of menstruation never came up again for perhaps a year or so. My mother one day showed me a "starter kit" she had purchased for me for the day I would need it. Ugh! When that day eventually came, I was scared and upset.  Mom was at work and the box was in the closet of her room. I did cry a little bit while telling her about "what had happened" to me that afternoon. She gave me the box and a bit of reassurance and that was that.

Menstruation Resources . . .

Menstruation was never much of a topic of conversation in my life. I don't have a daughter and didn't anticipate having to explain menstruation to my son. But he was inquisitive when a 1999 episode of the animated series, "King of the Hill" featured Hank, the main character, awkwardly coping as his neighbor's daughter started her first menstrual period while her parents and his wife were away. Of course, an 8-year-old boy was satisfied with minimal information. I was surprised at the time to notice in myself the urge to be forthcoming coupled with a reluctance to be specific.  I attributed it to the lack of discussion on such issues in my own life.

I decided I needed to prepare for more puberty talk to come so I did a bit of research and found a great book to help me explain the "need to know" issues in what was then the pre-internet era for my family. Now days there are all kinds of resources online to help educate girls and boys about menstruation and puberty. Again, many of these informational websites are sponsored by personal product manufacturers, but the approaches are subtle and not off-putting.

. . . from the Feminine Products Industry

Kimberly-Clark, the makers of Kotex, offer "My Daughter's Period," an informational web-based brochure that offers advice on when and what to discuss when talking with your girl about puberty. The Kotex website also includes "Girlspace," a sort of social networking application targeting puberty issues.  For the girl or woman who really needs to plan ahead, check out this Kotex Period Planner so that you'll always be prepared.

Johnson & Johnson manufactures a number of different feminine “protection” products including O.B. tampons, Carefree panty shields, and Stayfree sanitary napkins. Their website is worth checking out and includes these notable educational offerings: an interactive website, "Teens for Teens" and for parents "A Guide to Handling Your Child's First Period."

Proctor & Gamble is the parent company of Tampax and Always. Not to be outdone by the competition, their website also boasts a Period Predictor. Most importantly their educational features include, "A Page for Mom" and Beinggirl.com, a website which provides age-appropriate information for pre-teens. The site includes an explanatory section called, "Your Period," which is good information, but I honestly feel it is written over the heads of girls at an age to learn about their first period. Fortunately there are better publications from P&G available for download, namely:  "Always Changing" for boys concerning puberty and "Always Changing," for girls  to explain menstruation. These booklets also serve as companion literature to Proctor & Gamble's,  Always Changing school-based program.

Grade A Plus!!! For any inexperienced young girl, I truly feel this publication is the most exceptional:  "Always Changing," Special Ed Version for Girls.  Although this is aimed at special ed students, I think that the clear, basic explanations in this publication are very appropriate for tender young girls of age 9 and 10. I would also consider this a good choice in cases where English is a second language. Kudos to P&G on this publication.

. . . from Professional and Governmental Entities

The American College of Gynecologists Educational Pamphlet about Menstruation:  http://www.acog.org/publications/patient_education/bp049.cfm

Talking to your child about menstruation,. from KidsHealth.org: http://kidshealth.org/parent/positive/talk/talk_about_menstruation.html

Mayo Clinic, Menstruation: Preparing your preteen for her period:  http://www.mayoclinic.com/health/menstruation/FL00040

http://www.girlshealth.gov/

http://www.4parents.gov/: Download brochures to help you explain sexual development to boys and girls.

. . . and even More, More, More about Menstruation!

Grade A Plus!!! Find a treasure-trove of vintage Feminine Products Company Booklets about Menstruation (some from as early as the 1920’s.) These booklets are available in their entirety on the Museum of Menstruation website.

My Little Red Book  is a recently published anthology of women's stories from around the world discussing the circumstances surrounding their first menstrual periods.

See comments left below from Elizabeth Kissling of the Society for Menstrual Research.  I look forward to checking out their website.  Thank you Elizabeth.


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Attitudes, Wishes, and Needs of Youth With Diabetes (Type 1 Diabetes in Kids)

Diabetes, Attitudes, Wishes, and Needs in Youth (DAWN)

The DAWN Youth Survey is an initiative that was undertaken in 2001 by NovoNordisk, a major pharmaceutical company specializing in the manufacture of insulin, other diabetic medications, and supplies. 
This 13-nation endeavor was intended as a first step in a larger program which aims to address the unmet needs of young people with diabetes, their families, peers and healthcare professionals.  Results from the survey will be analyzed and used in problem-solving to determine solutions to the concerns that emerged. The ultimate goal of the DAWN program is ensuring that all children and youth with diabetes receive the best care and support possible.

Survey Results

More than 6500 individuals responded to the DAWN Youth Survey.  A brief summary of the survey results reported on the website reveal that one-third of the youth who responded felt that their diabetes is rarely or never in control due to the difficulty of managing proper diet, exercise and glucose monitoring.  In the school setting, the youth perceived a distinct lack of support.  Eighty percent of the parents who responded to the survey reported sometimes feeling overwhelmed by their child's diabetes.  Healthcare providers acknowledged that in only about one-half of all situations are they able to meet their young diabetic patient's psychosocial needs. 

Checkout the DAWN Youth Website

I have to admit, I find the website has so many paths that it is somewhat difficult to easily navigate.  This is the best path to enter the dawnyouth main page.  There is a lot of good information here and a chance to share your own story and opinions.

.Animated Insulin Video

This great little animated "mini-video" is on the NovoNordisk main site--not part of the DAWN Youth site, but included here since both are brought to us courtesy of NovoNordisk.  Too often the basic fundamentals of how and why insulin is important to our bodies are not fully understood by patients with diabetes.  This little video is a great visual guide to a basic understanding of insulin, somewhat similar to an understanding-insulin-analogy that I have developed.  (I mean to "do something" with mine to make it fit for public consumption one of these days . . . )  Meanwhile, here is Hands On: an Animated Slide Show to Help Patients Understand the Role of Insulin.


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Speak Up: Prevent Errors in Your Healthcare

A JCAHO Initiative

The Joint Commission was formerly known as the Joint Commission on Accreditation of Healthcare Organizations, or "JCAHO" [JAY-co].   The Joint Commission is the agency that sets and enforces standards for health care organizations in the United States.  More than 16,000 health care organizations and programs in the United States are accredited or certified by the Joint Commision. Written policies and expectations established by the Commission are evaluated by on-site inspections that last days and scrutinize the details of a hospital's day-to-day operations. 

The accountability that Joint Commission certification ensures cannot be underestimated.  In the days of announced inspections, hospitals would prepare for months in advance in order to put their best face forward.  The standards set by the Joint Commission were sure to be met, at least for that period of preparation for the inspection.  Afterwards, evidence of the old, day-to-day routines would usually fall back in to place.  (I can call to mind so many specific examples.)

The Joint Commission knows the deal.  These days their inspections are on a "surprise" basis.  The Commision records and investigates specific complaints against organizations they've accreditied, and in keeping with their stated vision that, "all people always experience the safest, highest quality, best-value health care across all settings,"  they have introduced a number of initiatives to inform and educate patients.

The Joint Commission's Speak Up™ Initiative

In March 2002, The Joint Commission, together with the Centers for Medicare and Medicaid Services, launched a national campaign to urge patients to take a role in preventing health care errors by becoming active, involved and informed participants on the health care team. The program features brochures, posters and buttons on a variety of patient safety topics. Speak Up: Help Prevent Errors in Your Care™ encourages the public to advocate for themselves in seven general ways. (Download the entire brochure in English or Spanish to learn more.)

• Speak up if you have questions or concerns. If you still don’t understand, ask again. It’s your body and you have a right to know.
• Pay attention to the care you get. Always make sure you’re getting the right treatments and medicines by the right health care professionals. Don’t assume anything.
• Educate yourself about your illness. Learn about the medical tests you get, and your treatment plan.
• Ask a trusted family member or friend to be your advocate (advisor or supporter).
• Know what medicines you take and why you take them. Medicine errors are the most common health care mistakes.
• Use a hospital, clinic, surgery center, or other type of health care organization that has been carefully checked out. For example, The Joint Commission visits hospitals to see if they are meeting The Joint Commission’s quality standards.
• Participate in all decisions about your treatment. You are the center of the health care team.

Other Brochures in the Speak Up Initiative are available for download:

• Help Avoid Mistakes in Your Surgery
• Information for Living Organ Donors 
• Five Things You Can Do to Prevent Infection   
• Help Avoid Mistakes With Your Medications
• What You Should Know About Research Studies
• Planning Your Follow-Up Care   
• Help Prevent Medical Test Mistakes
• Know Your Rights
• Understanding Your Doctors and Other Caregivers
• What You Should Know Pain Management
• Prevent Errors in Your Child's Care  
  

Understanding Medical Terms, Lingo, and Abbreviations

Medspeak, Medical Lingo . . . Need Help in Understanding the Language of the Medical World?

Right now I'm going through a stack of patient information brochures that I've been holding on to for awhile. A standout brochure in my collection is called, "Deciphering Medspeak," published by the Medical Library Association (MLA). This publication provides a quick A-to-Z plain-language guide which helps explain the meanings behind common medical terms and abbreviations.

In addition to the original version of Deciphering Medspeak, the plain language (low literacy) version (pdf) is also available online along with French and Spanish versions: Décryptage du Langage Médical and in Descifrando el Lenguaje Medico.

Other Resources with Medical Abbreviations and Terms:

This online medical dictionary can also help you find answers:  Medlineplus encyclopedia.

If you have ever wondered what the abbreviations on doctor's prescriptons mean, you'll find this to be a useful guide: RX Riddles Solved, A Prescription Shorthand Guide.

For Very Basic Explanations of Health Terms . . .

MLAnet's "plain-language brochures" are written for health consumers with a 5th grade or lower reading level. These publications are ideal for consumers struggling with limited health literacy.  Here is an example of the same health term definition from the original Deciphering Medspeak publication (1) and the plain-language version of the brochure (2):

• (1) DIFFERENTIAL DIAGNOSIS - is a list of the different diseases that can cause these symptoms
• (2) DIFFERENTIAL DIAGNOSIS - a list of diseases with symptoms that are alike. A fever and a runny nose are symptoms. The flu or the common cold are possible causes.

In case you were wondering . . . abbreviations for medical titles and degrees

"MPH" is my highest professional degree. It stands for "Master of Public Health" (not miles per hour, as one friend suggested.)  I earned my MPH from the University of Texas Health Science Center at Houston.  The MPH program requires study in five specific areas important to public health: epidemiology, health education, biostatistics, environmental health, and health services management.  My MPH course also required completion of a thesis.  (Mine was a qualitative study of lost opportunities in umbilical cord blood banking.)  Often, you'll find individuals with an MPH degree working in health departments, for the CDC, or as key personnel in non-profit health organizations.  Physicians, dentists, veterinarians, attorneys, and nurses are among the professionals who pursue this degree.

" D.O.":  In the U.S. we have two types of medical doctors, those with the M.D. behind their names and those with the less familiar "D.O." or Doctor of Osteopathy.  Both types of physicians receive the same basic medical education and pass similar licensing exams.  Osteopaths receive training that is holistic in nature--looking at the whole person rather than one aspect of an individual's symptoms.

"P.A.":  Many physicians employ P.A.s to serve as mid-level health providers.  P.A.s are licensed to practice medicine under the supervision of a licensed physician.  Their highest educational level is either at the bachelor or master's degree level.  In the clinical setting you'll find P.A.s treating and diagnosing illness, ordering lab tests, performing physical exams and even assisting in surgery.

"N.P.":  Nurse Practitioners are another type of mid-level health provider.  Like P.A.s, they work under the supervision of a licensed physcian.  In addition to a bachelor's degree in nursing, they hold a master's degree and licensure as an advanced practice nurse.  You'll find N.P.s providing individualized patient care, performing physicals, ordering lab tests, prescribing medications, etc. in physician's offices, clinics, and hospitals.

"BSN":  Bachelor of Science in Nursing.  This degree is earned by successful completion of a 4-year-university program.  However, the degree does not guarantee licensure as a registered nurse. All graduates are required to complete licensing exams before entering practice. (Personal Note: I earned my BSN from the University of El Paso at Texas.  This is my highest nursing degree, although I do have a master's degree in public health.)

"MSN": After completing a baceholors in nursing, the MSN degree is the next step towards career advancement.  Nurses with the MSN may be teaching in nursing schools or practicing as certified nurse midwives, nurse practitioners, certified nurse anesthetists, or clinical nurse specialists.

"ADN":  Associate Degree Nurse.  Most community colleges offer 2-3 year programs in nursing which prepare the graduate for the role of registered nurse.  Graduates must successfully pass state licensure exams before entering practice.

"RN": At one time, RN's were educated chiefly in hospital schools of nursing.  Instead of a degree, upon completion, they were awarded a diploma which entitled them to sit for the RN licensing exams.  Today there are still some "diploma" nurses in the workplace, but RN's are also educated in ADN and BSN programs (see above.)  In addition, advanced practice nurses such as nurse practitioners, midwives, and nurse anesthesists are RNs, but with an expanded scope of practice.  Licensing requirements may vary slightly by state, but the NCLEX exam is the standardized test required for licensure within the U.S..  Even though an individual may hold a degree or diploma in nursing, if they have never passed a licensing exam, or if they lose or surrender their license to practice, it is illegal for them to use the title of "RN."

"LPN or LVN":  I know of LPN programs that can be completed in as little as 9 months; however, at least one year of study is the norm.  Instruction may occur in a community college or vocational school.  An LPN (or LVN, depending on the state in which one lives) is educated in the basics of nursing care.  LPN/LVN's must pass state licensing exams before entering practice in this field.  You will ususally find LPNs working as nurses in doctor's offices, nursing homes, hospitals, and home health agencies.


Not finding what you are looking for?  Leave me a comment and I'll soon get back with an answer for you.

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24 Hour Urine Collection: How to do it and Why it's done

What's the Purpose of Urine Testing?

An incredible amount of information can be obtained from examining a urine sample. In fact, over 100 different tests can be performed on a single specimen. Most of the time a simple "quick catch" specimen of urine (voided into a cup) is sufficient for a basic urine test. Urinalysis results may reveal problems with the body's electrolytes or hormones, the presence of infection, dehydration, evidence of microscopic blood (that can't be seen with the naked eye), drug levels, or problems with kidney function.

Why a 24-Hour Urine Collection?

A small sample of urine isn't always sufficient. In addition to blood tests, physicians will order a 24-hour urine collection if they have reason to be concerned about overall kidney function. This test typically focuses on creatinine clearance, sodium, protein, and urine osmolality. Other substances may be examined in a 24-hour collection; for example, hormone levels, urea nitrogen, or copper. The volume of urine that is voided during the 24-hour period also yields important information. 
If your physician hasn't explained WHY he or she is requesting the 24-hour urine collection, ask for details. As a patient, being informed is one of your fundamental rights.


Tips for Collecting Your 24-Hour Urine Specimen

A 24-hour urine collection is easy to mess up, and that can be very frustrating. Just one moment of accidentally forgetting to collect and save the urine during the 24-hours ruins the test, and the collection must start all over again . . .

Before the test: Your doctor's office will provide you with one or two brown plastic collection jugs and written instructions. Certain tests may require that urine be placed in a "double container" or that a preservative be added to the collected urine; you'll be given the supplies and containers appropriate for your test.

What you need from your lab or doctor's office:

• Special instructions for the test and a lab sticker with your patient information to attach to the collection container(s).
• Collection container(s)--depending on the size of container the lab stocks--you may receive one or two of these jugs. They are made of heavy brown plastic, not just any container will do for this collection, so be sure to use the container(s) provided.
• Nice to have items--I'd ask for these if they don't offer them to you. For men: A plastic urinal to void into. For women: a plastic "nun's hat" to set in the toilet to collect the voided urine. If you don't have these items, it's okay to void into a bedpan, large plastic cup or bowl, etc. You will pour the collected urine into the brown collection container after each void, so it's nice to have something that pours easily.
• You'll also need: a way to keep the collected urine cool during the collection period. One of the most common ways to do this is to set the brown urine collection jug in larger container filled with icy water (an ice bath). An ice chest (cooler) is another option. It's also possible to place the collection jug in the refrigerator, although there are many reasons to make this impractical.

When to begin? Find out in advance when and where to return your 24-hour urine collection. This information will help you decide when to begin, because if the lab or physician's office isn't going to be open when you finish the collection, you'll have to keep the sample in a refrigerator, cooler, or in an ice bath until you can turn in your specimen. It's often suggested that you begin a 24-hour collection first thing in the morning--but that is certainly not required. However, it is essential that you make note of the date and time that the specimen collection was started and stopped. This information will need to be recorded on the specimen container (and/or label).

Ready to start? Completely empty your bladder by voiding into the toilet and flushing--DO NOT save this first urine sample. The first time you empty your bladder you are flushing away urine that has been building up in your bladder for several hours or more.  That hours-old urine will yield incorrect results if we collect it for our 24-hour specimen.  We want to start with an empty bladder to collect only the urine our body makes during the 24-hour-period. 

Record the start time and determine your stop time. All other urine during the 24-hours will need to be saved and poured into the collection jug. Use the same bathroom all day long and post a note with the start/stop time to help remind you to collect all of your samples. Replenish the ice in the basin surrounding your collection jug from time-to-time in order to keep the specimen cool.

Ending the collection: When the 24-hour-collection period is ending, make a last effort to urinate--even if you don't have the urge to "go," you will still be able to produce an ounce or two of urine. Make sure your collecton jugs are tightly capped and labelled with your name, date of birth, collection date and start/stop times.   (Note: If you weren't given a label for your specimen jug, make one and tape it securely to your jug.)Keep the specimen in the ice bath, cooler, or refrigerator until you are ready to return it to the lab or doctor's office. Place your specimen jug(s) in a sturdy plastic bag for easy carrying.

What If . . . ? Special circumstances . . .

• For patients with urinary catheters. It would be preferable to start your collection with a fresh catheter bag in place. Begin your collection by completely emptying the current catheter bag and flushing the accumulated urine. Record this as your start time. During the remainder of the 24-hour-collection period, empty the foley bag into the brown collection jugs at regular intervals. At the designated stop time, empty your collection bag for the last time.
• Urine becomes mixed with feces or blood. Do not empty any urine that has been contaminated by feces or menstrual blood into your collection jug. Make note of the time and stop the collection. Contact your lab or physician's office to inform them. In some cases, if enough time has elapsed, your physician may give the go-ahead to stop the test early. Most of the time you'll need to start all over again.
• "Oops! I didn't collect every void during the 24 hours!" If you forget to collect all of your urine, the test results will be inaccurate. Talk to your lab or doctor's office before disposing of all that you've collected. Most of the time you'll be advised to start all over again.
• Other questions? Call your physician's office or lab. If you'd like to suggest anything to make this entry more helpful or accurate--please let me know. I'll gladly tweak this entry to make the information more user-friendly.

For further reading, check out these links:

• Procedures and Diagnostic Tests (From the National Institute's of Health)
• Instructions for a 24-Hour Urine Collection (in English) (648 KB) (in Spanish) (32 KB) (also from NIH) 
• St. Clare Hospital Health Service: Patient Education Brochure, 24-hour urine collection: These comprehensive instructions allow the doctor ordering the test to also provide specific dietary instructions to follow depending on what element of the urine is being tested. 

. . . http://docs.google.com/gview?a=v&q=cache:Yi0raZ73PAEJ:www.ssmhc.com/internet/home/stclare.nsf/0/F8DF7DDC6ED0F94E862574BE004EF645/%24FILE/24-hr%2520urine%2520collection.pdf%3Fopenelement+how+to+do+24+hour+urine&hl=en&gl=us

Outpatient Medications for Autoimmue Conditions: Remicade, Humira, Tysabri--Sources for Patient Information and Support

Treating Autoimmune Conditions

Most of the time our immune system protects us from invaders from outside of our body, whether they may be in the form of a virus, bacteria, fungus, or even a tumor. In the worst case scenario, a "glitch" causes the immune system to overreact.  A damaged and confused immune system attacks healthy organs or tissues resulting in an autoimmune disorder such as multiple sclerosis, type 1 diabetes, inflammatory bowel disease, or rheumatoid arthritis.

Suppressing the immune system is a means of controlling an autoimmune disease, but the consequences of doing so (the risk of life-threatening infection) makes this an obviously unreasonable regimen. In seeking answers to this dilemma, scientists developed Monoclonal Antibody Immunotherapy. In this therapy, antibodies created outside the body are given as an injection or intravenous drug. Some monoclonal antibody infusions are used in conjunction with chemotherapy to treat certain types of cancer. In recent years, monoclonal antibodies targeted at major autoimmune illness have been introduced to treat conditions such as Multiple Sclerosis, Plaque Psoriasis, Rheumatoid Arthritis, Crohn's Disease, Ulcerative Colitis, or Ankylosing Spondylitis.

Hospitalization is not required for infusion of most monoclonal antibodies. Two of the major autoimmune therapies, Remicade and Tysabri, are given monthly by intravenous drip in closely monitored outpatient settings such as infusion clinics or doctor's office. Humira, a (sometimes weekly) subcutaneous injection, is given in an outpatient setting or is self-administered by the patient at home.

Patient Resources for Monoclonal Antibody Therapies

It's important to understand that although these drugs often work well in controlling the symptoms of specific autoimmune disorders, there are definitely risks that must be considered. In an effort to educate and provide support to their patients, the manufacturers of Remicade, Humira, and Tysabri have developed websites for their benefit.

• Support for Remicade Patients. Remicade (generic name is infliximab) is a chimeric monoclonal antibody derived from the combination of human and murine (mouse) sources. This drug may be used to treat Plaque Psoriasis, Rheumatoid Arthritis, Crohn's Disease, Ulcerative Colitis, and Ankylosing Spondylitis.
• "My Humira:" Patient Support and Information. Humira (Adalimumab) is a completely human monoclonal antibody that, like Remicade, may be used to treat Ulcerative Colitis, Crohn's Disease, Ankylosing Spondylitis, Plaque Psoriasis, and Rheumatoid Arthritis.
• Tysabri Patient Portal. Tysabri (Natalizumab) is a humanized monoclonal antibody that is used to treat Multiple Sclerosis and Crohn's Disease.

Avoid Serious Consequences

Carefully read the patient information regarding these drugs and heed the warnings given in order to avoid serious, life-threatening complications. Knowing what to expect from your treatment and what symptoms to promptly report to your physician is essential in ensuring good results with these medications.

Personal Thoughts

I've had experience administering each of these medications in an infusion center where I worked. It was pleasing to see real improvement and enhanced quality of life in many patients. Each of these drugs is certainly capable of producing (usually mild) allergic-type reactions during administration. Each of these drugs also carries the risk of developing other complications. Please don't disregard the brochures and patient information handouts you receive regarding these (or any) medications.

Want to Read More? I found this interesting:

Peakman, M. & Daylan, C.M. (2001). Antigen-specific immunotherapy for autoimmune disease: fighting fire with fire?. Immunology, December; 104(4): 361–366.
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Support for Teens with Ulcerative Colitis and Crohn's Disease

. . .
Scary . . . embarrassing . . . uncomfortable . . . unfair!! These are a few of the nicer words that a teen might use to describe a new diagnosis of one of the inflammatory bowel diseases, Crohn's Disease and Ulcerative Colitis.

Cope and Thrive

A diagnosis of UC or Crohn's is confusing for teens (and often for their parents, teachers, etc.) Learning to cope is the first step in maintaining long-term, thriving good health. (Yes, it is possible to be HEALTHY while living with a chronic condition that is often described as "illness.")

For Teens "Only" . . .

The Crohn's and Colitis Foundation of America has created a website specifically for teens: UC and Crohn's: A Site for Teens. Here teens will find information, personal stories, tips and tidbits, questions answered by experts, AND a chat room to discuss issues with other teens living with inflammatory bowel disease.

For Everyone . . .

The Crohn's and Colitis Foundation of America (CCFA) website is also a great source of information for patients of all ages who live with an inflammatory bowel disease. The website includes guides for patients, parents, parents and kids, teachers, schools, etc. They even offer a template to help in creating an individualized "504 plan" to address important issues in the educational setting for kids living with an inflammatory bowel disease (IBS).

School is starting . . .

Parents, to do your homework to make sure your IBS kid will have a great year, check out this page.

Don't forget to keep teachers in the loop. Link them to the CCFA's Guide for Teachers--or better yet, print them a copy so you will know they have the information in hand.


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Health Care Reform--One Nurse's View

My career as an RN has been diverse and has included both indirect and direct care of patients of all ages and in varying states of health. I entered the field after earning my bachelor's degree in nursing and out of a desire to contribute more towards patient education, I later completed a master's degree which concentrated exclusively on public health. Although I am "only" a part-time RN in a large hospital, I'm still very immersed in "what's going on" in the nursing field specifically, and health care as a whole. In the hospital setting the opportunity to provide patient education is practically zero in my current setting. It's a struggle to meet the basics of rudimentary patient care.

Honestly, I don't know all that's contained in the huge trillion-dollar health care reform bill that is currently under consideration in Congress. But I suspect that the kind of "reform" I'm hoping for isn't going to be found in this giant bag of tricks. You see, the reform I know we need depends upon enhancing the quality of health care rather than the quantity. The powers-that-be cannot fathom the ways in which the health care we currently have is marginalized.

Those of us not living or working in ivory towers are all too familiar with the slap-dash care that's doled out to us, even when we DO have good insurance. Personally, in the hospital setting I have no interest in my patients' insurance (or lack of it). Even if it was of interest to me, it would be a hassle and too time consuming to look it up. After all, when I'm working I am very, very, VERY busy . . . because I'm not the kind of nurse who is going to let my patients HURT, or allow them to linger in a wet or soiled bed, or remain un-turned for hours on end. I'm hustling myself through all the tasks set before me--exacerbated by a too high patient-to-nurse ratio and a nurse's aide who is equally overworked.

In the last few weeks my cousin went for a physical on my advice and recommendation. We collaborated in advance so that she could be an informed health consumer and advocate for the type of COMPLETE physical she wanted. She was partly successful. By no means did she get the thorough exam she went in for. A quick glance in our ears, eyes, and mouth, a stethescope momentarily applied to our chest and, very rarely, a brief palpation of the abdomen . . . that's more than a lot of patient's have come to expect from a so-called "physical" these days.

One week ago a dear family friend in good health underwent a "simple" surgery that resulted in her death a few days later. I don't know all the circumstances, but based on past experience with family and friends in that same hospital, I have serious concerns about the quality of health care that was given in response to her urgent post-operative needs.

I did a stint as an LPN nursing instructor last year. The students scared me. They were all too aware of the "nursing shortage." And most were very vocal about their a desire to enter the field to make a quick buck. These young folks were at least honest about their intentions. At a professional meeting I lunched with nursing instructors from various other colleges and universities. Amazingly, they were wholeheartedly unimpressed with the quality of nurse their schools were turning out. The group concurred on the need to "be there" with a loved one all night long to ensure appropriate care in a hospital setting.

What I want in health care reform is a system that I have faith in . . . For starters, I would like to see physicians hold themselves accountable for actually performing physical assessments and taking the time to discuss important findings and recommendations with their patients. I'd like to see better educated nurses (yes, a 4-year-degree for RNs!) and absolutely better staffing in hospitals. I'd like to see more RN's and a better quality of all employees in long-term care settings. I'd like to see more patient education--either in person, via telephone, or the web. Most of all I'd like to see TIME spent in absolutely ensuring that the individual needs of our patients are met. This is not happening now--and it grieves me.

My final assertion is aimed specifically at the nursing shortage. There are an abundance of experienced nurses who choose not to subject themselves to a system that puts them at risk of harming patients and themselves due to over staffing. They are "out there," but choosing to work part-time, in a totally different career field, or not at all. Direct patient care in a hospital setting is the place in which we need excellent, experienced nurses who are also empathetic towards patients' needs. To truly reform the system, we need to make the changes necessary to get these nurses back . . .



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Why Use a Gait Belt?

Gait belts prevent falls.

That's why we use them in health care settings, and they can really be of benefit when your elderly or debilitated loved one requires extra care in their (or your) home.

A gait belt isn't something you would necessarily know about unless you've worked in health care or have a loved one who has been in the health care setting. The classic gait belt is long, and made from thickly woven cotton with a non-slip buckle that uses alligator teeth to keep the belt from slipping when in place. (Subtle variations of the gait belt certainly exist.)

Gait belts are an assistive device which can and "should" be used to help safely transfer a person in a weakened state from bed to chair, from sitting to standing, and even when entering and exiting a vehicle. The belt provides a "handle," of sorts, that allows whomever is escorting to weakened individual to easily grasp the belt and stabilize the patient if they lose balance.

The gait belt encircles the patient's waist snugly, but not too tight; at least two fingers should fit between the belt and body. Typically gait belts are very long to accommodate all sizes and shapes of individuals. The dangling end is best tucked into the belt to prevent trips or tangling. It is possible to find gait belts that have been manufactured so that there are actually several fabric handles incorporated on the belt to make the transfer even easier (one or more person can grab a handle as needed.)

Appropriate with a walker or cane?

By all means--use a gait belt whenever it's indicated. If your loved one has a "weak" side, be sure that you walk on that side of their body if they are using crutches or a walker. You'll be positioned in a way that allows you to more effectively help them.

Fastening the Buckle is like fastening the buckle of a military belt. In case you've never had to do that, here are some step-by-step photos to demonstrate.



The end with the metal tip starts threading behind the buckle










Insert metal tip through the open end of the buckle





Thread the metal tip forward between the metal teeth and opposite side of the buckle









Pull the metal tip completely through the buckle to tighten. Pull slack through the buckle area as necessary.






Ensure belt is not too tight by inserting two fingers between belt and patient's waist.





In this quick Youtube video: A rehab specialist demonstrates the value of a gait belt or leather belt. Although this expert discusses the value of the gait belt in a rehab/gym setting, this video is the best I've come across to concisely drive home how the belt can prevent injury.


Why I keep a gait belt on hand. My dear friend gave me a brand-new extra gait belt that her mother no longer wanted. I was rather delighted to have it, since we have a nearby friend with balance issues who has required "neighbors to the rescue" for some close calls on more than one occasion.

Recommended links:

A Plus:  Smart People Use a Gait Belt--comprehensive gait belt advice from Marcian Oliver, an experienced physical therapist.  Check out Marcia's blog for a wealth of patient information regarding physical therapy and fitness issues.

Patient Education about gait-belt-use--this nice, concise explanation is provided by a medical supply company.

From ehow: Transfer using a gait belt

OSHA guidelines for nursing homes provides tips for moving patients safely: gait belts, slider boards, slippery sheets, and mechanical lifting devices are briefly addressed with several helpful illustrations.

Select this link for another OSHA page describing even more types of assistive equipment used to move patients and here for CDC's check list for home safety

Need more ideas on how to prevent falls?

• Install grab bars for the toilet, bathtub or shower
• Keep walkways (including stairs) clear of books, papers, clothing, cords, etc.
• Ensure stairway handrails are secure
• Use light and plenty of it (ensure stairways are entirely lit--including at the top and bottom)
• Get rid of small throw rugs
• Place a glow-in-the-dark sticker or a bit of fluorescent paint on light switches
• Have a bedside commode available--urgent trips to the bathroom result in too many falls!

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Protect your eyes: UV light from the sun and tanning beds

The American Academy of Ophthalmologists (AAO) issued a press release two weeks ago promoting UV (ultraviolet) light safety awareness month. As we spend more time outdoors during the brightest, longest days of the year, it's fitting that we take some prudent precautions, not only for ourselves, but also for our children.

Because I don't want you to miss any of the important details, I'm publishing their press release here with my own bolded areas to highlight specific information:

"Don’t Forget to Protect Your Eyes This Summer," the American Academy of Ophthalmology offers tips for safe fun in the sun.

"SAN FRANCISCO – One of the greatest threats to your eyes is all around you: sunlight. Studies show that exposure to bright sunlight may increase the risk of developing cataracts, age-related macular degeneration and growths on the eye, including cancer. Unfortunately many people are unaware of the sun’s harmful rays.

July is UV (ultraviolet light) Safety Awareness Month, and through its EyeSmart™ campaign the American Academy of Ophthalmology wants to remind Americans of the importance of shielding their eyes from the sun’s damaging rays by wearing proper protection. It also wants to remind the public of the importance of protecting eyes from indoor UV light when using tanning beds.

'“Protecting your eyes from the sun is as important as protecting your skin,” said J. Alberto Martinez, MD, an ophthalmologist in Bethesda, Maryland, and a clinical correspondent for the Academy. “By wearing UV blocking sunglasses, you can enjoy the summer safely while lowering your risk for potentially blinding eye diseases and tumors.”

"The longer the exposure to bright light, the greater the risk is. Excessive exposure to UV light reflected off sand, water or pavement can damage the eyes’ front surface. In addition to cataracts and AMD, sun exposure can lead to lesions and tumors that may be cosmetically unappealing and frequently require surgical removal.

"Damage to the eyes from UV light is not confined to the outdoors; it is also a concern with indoor tanning beds. “Ultraviolet radiation levels to the eye are much greater in a tanning booths than outside in the sun,” according to Dr. Martinez. “Corneal burns, cataracts, and, in rare instances, retinal damage can occur.” It’s important to wear specially made goggles designed for use in tanning booths for protection of the eyes from UV light.

"In choosing sunglasses, look for those that absorb at least 99 to 100% of both UV-A and UV-B rays. Avoid products with labels that do not state exactly how much UV the product blocks.

"The American Academy of Ophthalmology offers these tips to protect your eyes from the sun:

• "Don’t focus on color or darkness of sunglass lenses: Select sunglasses that block UV rays. Don’t be deceived by color or cost. The ability to block UV light is not dependent on the price tag.
• "Check for 97-100% UV protection: Make sure your sunglasses block 97 to 100 percent of UV-A rays and UV-B rays.
• "Choose wrap-around styles: Ideally, your sunglasses should wrap all the way around to your temples, so the sun’s rays can’t enter from the side.
• "Wear a hat: In addition to your sunglasses, wear a broad-brimmed hat to protect your yes.
• "Don’t rely on contact lenses: Even if you wear contact lenses with UV protection, remember your sunglasses.
• "Don’t be fooled by clouds: The sun’s rays can pass through haze and thin clouds. Sun damage to eyes can occur anytime during the year, not just in the summertime.
• "Protect your eyes during peak sun times: Sunglasses should be worn whenever outside and it’s especially important to wear sunglasses in the early afternoon and at higher altitudes, where UV light is more intense.
• "Never look directly at the sun. Looking directly at the sun at any time, including during an eclipse, can lead to solar retinopathy, damage to the eye’s retina from solar radiation.
• "Don’t forget the kids: Everyone is at risk, including children. Protect their eyes with hats and sunglasses. In addition, try to keep children out of the sun between 10 a.m. and 2 p.m., when the sun’s UV rays are the strongest."
  

For more information about eye health, please visit http://www.geteyesmart.org/.

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New "Black Box" Tylenol Warning Label

Acetaminophen (brand name Tylenol) is one of those over-the-counter (OTC) medications that seems pretty harmless. We use it often in our society to treat mild to moderate pain and to reduce fever. It is a safe and effective medication when taken according to the manufacturer's recommendations. It is most definitely possible to overdose on Tylenol, either accidentally or on purpose.

New Black Box Warning for Medications Containing Acetaminophen (Tylenol)

"Black Box Warnings" are to be added to the labeling for medications that combine acetaminophen (Tylenol) with another drug. Black Box Warnings are found on the labels of medication deemed by the FDA to potentially pose a serious risk to consumers. The text of such warnings is typically surrounded by a black box to draw attention.

Acetaminophen Overdose

According to the U.S. National Institute's of Health (NIH), Tylenol overdose is one of the most common types of poisoning worldwide. An overdose of Acetaminophen can result in the need for liver transplantation or can cause in death as a result of rapid onset liver failure. Tylenol overdose requires hospital treatment--best results for a satisfactory outcome occur when the patient is seen within 8 hours of the medication overdose. Tylenol levels in the blood are monitored at regular intervals. A medication called N-acetylcysteine (also known as Mucomyst) is the first drug of choice in preventing liver damage from acetaminophen overdose.

Too much acetaminophen can be consumed on purpose in an attempt at self-harm, or by pure accident. Many over-the-counter medications contain Tylenol in combination with other (cold, flu or pain) medications. When making decisions about over-the-counter and prescription medications, it's possible to consume a toxic level of medications in the system without realizing it. Take a look at this helpful tool from the FamilyDoctor.org website which lists prescription and non-prescription medications containing acetaminophen. There are 34 prescription and 26 non-prescription medications containing aceteminophen on these lists for a grand total of 60 "different" medications.

How much Acetaminophen is too much?

The maximum daily recommended dose of Acetaminophen is 4 grams for adults; a toxic adult dose of acetaminophen after a single acute ingestion is 7 grams. However, the toxic dose may be lower in some susceptible adult patients, such as persons with alcohol abuse, malnourishment, or those suffering a viral illness with dehydration

Two tablets of regular acetaminophen equals 650 mg. Per the dosage instructions, the medication can be taken every 4 to 6 hours. The maximum daily dose is very nearly achieved if the medication is taken very 4 hours for 24 hours (3.9 grams would be consumed).

Two tablets of extra strength acetaminophen equals 1 gram; dosing instructions advise that two extra strength tablets can be taken every 4 to 6 hours--as long as no more than 8 tablets (4 grams) are taken within 24 hours.

Obviously if any additional "hidden" acetaminophen consumed within the 24-hour period in over-the-counter pain medications or cold/flu medication, an unintended toxic dose of acetaminophen could easily be consumed.

Signs of Acetaminophen Overdose:

• stomach pain
• nausea & vomiting
• jaundice
• irritability
• convulsions
• coma.

APAP is a common medical abbreviation for Acetaminophen

Consider this medication and dosage: Hydrocodone with APAP, 10/500 mg. This medication contains 10 mg of Hydrocodone and 500 mg of Acetaminophen (APAP). Understanding that APAP refers to acetaminophen and carefully reading labels will help you uncover the "hidden" acetaminophen so that you can avoid consuming toxic levels of this usually benign and helpful medication.

National Poison Control Number: 1-800-222-1222

No matter where you live, this toll free number is the same. Staffers are available 24/7 to answer any questions.

Links for Additional Reading:

American Liver Foundation: The Progression of Liver Disease
Emedicine article by Gagan K. Sood, MD: Acute Liver Failure
FDA Consumer Update: Acetaminophen and Liver Injury: Q&A for consumers
Black Box Warnings, by FormWeb: http://formularyproductions.com/blackbox/
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Blenderized Diet . . . Fractured Jaw Diet . . .No Chewing Allowed

(See below at bottom fourth of the article, I have a number of links to reliable websites for those needing to temporarily follow a blenderized diet.)

For some reason a former patient popped into my mind a while ago. I was working at the pre-op clinic when this slender young teen was about to commence her summer vacation by undergoing corrective jaw surgery that would require her to follow a blenderized, or fractured jaw, diet for at least 4 weeks.

Her mother was concerned about keeping weight on the young lady's size-zero frame during the recovery phase. The purpose of our pre-op teaching and health-history-gathering was to deal with specific issues and concerns such as these. The dietitian was unable to join our meeting, but we did put in a consult for her expert advice for the period in which the patient was to be in the hospital. However, advance planning was also in order.

Our hospital's hand-out on blenderized diets was woefully disappointing to the mother. This many-times-over photocopied, one-page handout was meant to help a patient determine how they would take oral sustenance for 6 weeks . . . The mom was right, our information sheet lacked so much that it was embarrassing. The good news is, better resources are available online.

Fractured jaws or Jaw Surgery

We rest a broken jaw in order for the bones to knit, just as we rest a fractured arm or leg. Stressing the healing bones with chewing is painful and interferes with healing. Often during the recovery phase, the jaw is wired closed for a period of weeks. Some hospitals are better than others at providing good information about the importance of continuing oral care as well as providing specific suggestions for promoting optimal nutrition when a liquid diet is required during convalescence.

Advanced preparation--more than purchasing a blender

Before I was a nurse, my husband had jaw surgery. Advance preparation for the procedure included purchasing a blender. We were given a very simple handout from the surgeon's office with a few suggestions. There was no Internet to go to for advice, so my husband's blenderized diet was boring, repetitive and did not provide him with the level of calories and protein he needed. He lost a LOT of weight during the recovery phase--and he didn't have any extra weight to spare . . .

What am I going to feed [my kid, myself, my spouse, etc.] on a blenderized diet?


I want to begin by stressing the absolute necessity of consulting with a dietitian at the hospital if you or your loved one has special, underlying nutritional issues such as the need to also follow other diet restrictions such as: gluten-free, diabetic, vegetarian, bariatric, etc.

The American Association of Oral and Maxillofacial Surgeons (AAOMS) addresses post-operative nutritional concerns on their website. They specifically caution about the importance of taking in adequate amounts of free water and calories. The AAOMS recommends keeping a journal to record fluid volumes taken in and calories consumed to ensure these needs are being properly met. They also suggest planning blenderized meals in advance. It's hard to "wing it" unless you have all sorts of options available in your kitchen to make the blenderized meal appealing.

When restricted to a blenderized died, it's important to understand that liquids are digested more quickly than solids. In order to maintain energy and keep up with the body's metabolism during recuperation, blenderized meals should be given more frequently than a standard diet. (It may be necessary to take a blenderized meal from 4 to 6 times daily). Protein shakes are recommended for all blenderized diets. (I have some links to follow below for specific recipes.)

For the lactose intolerant, the milk-based tendency for blenderized diets may seem a bit disconcerting at first glance, but there are lactose-free options in the form of soy milk, and nutritional supplements such as Ensure, Boost, or Osmolite.

Web pages with blenderized diet information

I recommend looking at every one of these. They all offer good advice, but you will find some great suggestions that are unique to each specific site.

1. Dartmough-Hitchcock Medical Center fractured jaw diet
2. Dartmough-Hitchcock Medical Center blenderized diet information
3. Aspirus-Wausau Hospital Diet for Jaw Surgery (Blenderized Diet)
4. Ohio State University Medical Center Blenderized Diet for Jaw Wiring
5. Kaiser-Permanente, "No Chewing Required," Blenderized Diet
   

An interesting product

I have no commercial interest in any medical products and don't receive or seek any income or favors from anything I've written on my blog. In looking for my fractured-jaw, blenderized diet information, I came across an interesting product that is supplied by some hospitals for their post-op patients. It's a bag with a "straw-like" device affixed. Actually the straw is not for sucking. Instead you squeeze the liquid-filled bag and the straw is like a tap--the fluid just flows into the mouth. It can be used to clean and rinse the mouth as well as to easily take in fluids. This product looks like it would be very useful, particularly in the first few post-operative days.  Read more about Zip-n-seal here and check out their Zip-n-squeeze blenderized diet nutritional page.

Do you have suggestions?

Please let me know of other good tips and sources of information for people on blenderized diets. I'll be happy to post your suggestions or links here. I'd particularly like to know about blenderized diet recommendations and resources for individuals on special diets like gluten-free and diabetic diets.
Please click on the comments section to read Shirley Taylor's comments and suggestion. Thank you, Shirley!


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Bloody nose: Stop a nosebleed and prevent recurrent bleeding

Why do nosebleeds occur?

In medical terminology, a nosebleed is properly called "epistaxis." Trauma from an injury is probably the most common way to develop a nosebleed. Dry weather and irritation from fingers in the nose are also commonly associated with nosebleeds. Anyone who takes blood thinning medication (such as Coumadin) or even some vitamins and supplements(such as fish oil, vitamin E, etc.) are more susceptible. Cancer patients undergoing chemotherapy may have nosebleeds due to loss of clotting factors called platelets that are destroyed by the chemo. Patients who receive oxygen therapy by means of a nasal cannula (also called "nasal prongs") may suffer nosebleeds because of the dry stream of air against the nasal tissue unless some humidity is added to the oxygen set-up. Uncommon reasons such as inherited problems of the blood vessels are disorders such as Osler-Weber-Rendu Syndrome (Hereditary Hemorrhagic Telangiectasia) or an inherited blood clotting disorders such as a type of hemophilia.

How to Stop a Nosebleed:

1. Sit or stand the person with the bleeding nose UPRIGHT with their head tilted FORWARD. This keeps the blood from going down the back of the throat and into the stomach which will cause irritation and often results in vomiting. Allow the blood to flow into a basin or onto a cloth if available. Stopping a bloody nose is the priority--you can worry about cleaning a mess later.

2. Have the person with the bleeding nose breathe through their mouth as they (or you) pinch the nose together to apply pressure. You'll know that you are doing this correctly if there is no longer visible blood coming out while you are applying the pressure. Make sure to pinch the soft part of the nose to apply pressure--the lower third of the nose, just above where the nose flares outward. Obviously if you try to pinch against the bony part of the nose you won't really be applying any pressure to the blood vessels underneath. Remember to encourage them to sit upright with their head tilted forward. In addition to applying pressure, you can also put an ice pack over the bony bridge of the nose to constrict the blood vessels even more.

3. Don't let up the pressure for at least 5 minutes--not even to take "a peek." Time this by the clock, don't wing it. You are trying to establish a clot in the bleeding vessels--steady, constant pressure is important in doing this. After 5 minutes of direct pressure, check for bleeding. If the nose is still bleeding, repeat step 2, only this time keep the steady continuous pressure going for at least 10 minutes.

4. Have you done all this with no improvement? In that case, it's time to visit the doctor or ER. Don't forget to continue pressure during transport and in the waiting room. Depending on the circumstances the ER doctor may have to resort to nasal cautery to stop the bleeding, by packing the nose with a gauze "nasal tampon," or by some other means to apply compression to the bleeding vessels.

5. All fixed? What now? After the nosebleed ask the patient to rest in a reclining position with the head elevated above the heart, limit strenuous activity for the rest of the day, and avoid bending and heavy lifting. It's okay to gently sniff, but avoid blowing the nose and if the patient must sneeze--encourage them to do so with an open mouth to minimize pressure through the nose.

6. What if the nosebleed starts up again?

• Follow steps 1-3 again.
• If unsuccessful in stopping the bleeding, or if the patient is experiencing any associated symptoms such as severe headache, body sweats, weakness, or shortness of breath--it's time to go to the ER. Remember to ensure that pressure is maintained in an effort to control the bleeding during the ride to the ER.
• If the patient has already seen the doctor--review the discharge instructions and follow the written advice the physician gave--phone the doctor's office for any questions or concerns. Proceed to the ER if indicated.
• On their website, the Ear, Nose, and Throat Associates of Corpus Christi suggest this additional advice for recurrent nosebleed: "Clear nose of all blood clots by sniffing in forcefully," and "Spray nose four times on both sides with decongestant spray (such as Afrin,® Duration,® Neo-Synephrine,® etc.)"

Quick sources for additional reading:
Ask Dr. Sears: About Nosebleeds
The Children's Hospital, Aurora, Colorado



Below: Jay Dolitsky, MD, Clinical Professor and Director of Pediatric Otolaryngolgy at the NY Eye and Ear Infirmary offers his expert opinion about nosebleeds in this YouTube video.

Happy Father's Day!

Our Dads . . . without them--well, it would surely be impossible for us to be here . . . Happy father's day to all of the dads including my own dad, Bob Venard; my husband (Bob Cooper); and (remembering) my late father-in-law, "Mr. Billy" Cooper on this Father's Day 2009. (At right, Dad and I, circa 1987.)

Something to remember today, particularly if you have an elderly father--research confirms--these members of the "greatest generation" are not inclined to ask for help. Rebecca Fairbanks wrote a great article in 2007 offering suggestions on ways to help elderly parents without offending them. Just as our teenagers don't appreciate us when we act as "parachute parents" hovering over them, our parents don't deserve that that either. With both generations subtle and carefully considered gestures are likely to have the best results.

What can you give your dad today? Give him the opportunity to teach you something you wish you would have learned from him years ago . . . Give him the chance to reminisce with some stories from his past that you've never heard before--or haven't heard for a long time. Give him your undivided attention with electronic devices safely out of sight and mind . . .

For your consideration, the AARP has a list of helpful links appropriate for those who are caregivers for their parents: http://www.aarp.org/families/caregiving/caring_parents/


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