Promoting Health and Patient Education

Glucose Test Strip Recall, December 2010

2011-01-03T00:42:00.015-06:00

Abbott Labs Blood Glucose Test Strip Recall

Abbott Laboratories produces a variety of blood glucose test systems--most of their strips have names that include Precision, Optium, ReliOn and Medisense. A recall of 359 million of Abbott's blood glucose test strips (359 lots) was announced in December of 2010. Abbott reports that the affected test strips, which were produced from January through September 2010, are reading blood glucose results incorrectly. The fault is not with the glucometer, but with the test strips that are included in the recall.

What is wrong with the strips?

Abbott's press release warns that the faulty strips can cause a blood glucose reading that is too low. A press release from the FDA further explains that the strips do not absorb enough blood to correctly read the true blood glucose result. A low reading can result in a false sense of security--this is particularly dangerous for individuals with Type 1 Diabetes who rely on accuracy in order to keep from experiencing diabetic ketoacidosis (dka) when blood glucose goes too high. Harm can result when an individual tries to raise their blood sugar to a higher level (because the reading on the machine is falsely low), or an individual may delay properly intervening to correct a blood glucose that is actually too high.

Prolonged storage and/or exposure to warm temperatures pose an even greater risk of these strips producing a false reading.

What lot numbers are included in the recall?

List of Affected Products List with Lot Numbers:

MediSense® Optium™ Blood Glucose Electrodes

45001A133, 45001A137, 45001A226, 45001A252, 45001A257, 45001A277, 45001A285, 45001A817, 45001A835, 45001A921, 45001C001

OptiumEZ Blood Glucose Test Strips

45358, 45369, 45377, 45504, 45677, 45678, 45681, 45789, 45841, 45848, 45849, 45999, 46000, 46008, 46061, 46067, 46102, 46104, 46117, 46159, 46179, 46201, 46202, 46211, 46230, 46247, 46311, 46312, 46341, 46368, 46369, 46371, 46395, 46399, 46401, 46436

Precision G3b Smartblue Blood Glucose Test Strips

45001A710

ReliOn® Ultima Blood Glucose Test Strips

45358, 45369, 45377, 45379, 45466, 45504, 45511, 45608, 45613, 45641, 45642, 45644, 45672, 45674, 45675, 45676, 45677, 45721, 45734, 45736, 45739, 45742, 45743, 45789, 45790, 45800, 45801, 45840, 45841, 45849, 45850, 46008, 46009, 46061, 46067, 46069, 46072, 46103, 46105, 46148, 46201, 46202, 46214, 46215, 46232, 46313, 46332, 46336, 46338, 46341, 46368

MediSense® Optium™ Blood Glucose Test Strips

45001A159, 45001A195, 45001A228, 45001A233, 45001A236, 45001A243, 45001A247, 45001A249, 45001A250, 45001A255, 45001A279, 45001A285, 45001A295, 45001A298, 45001A306, 45001A317, 45001A318, 45001A327, 45001A346, 45001A398, 45001A449, 45001A469, 45001A578, 45001A693, 45001A697, 45001A747, 45001A790, 45001A795, 45001A839, 45001A917

Optium™ Blood Glucose Test Strips

45001A484, 45001A486, 45001A512, 45001A514, 45001A517, 45001A519, 45001A527, 45001A541, 45001A544, 45001A552, 45001A558, 45001A564, 45001A572, 45001A598, 45001A665, 45001A677, 45001A709, 45001A713, 45001A732, 45001A771, 45001A819, 45001A852,

45455, 45516, 45708, 45709, 45737, 45738, 45777, 45778, 45783

Precision Xceed Pro® Blood Glucose Test Strips

44535H, 44545H, 44565H, 445A5H, 44645H, 44665H, 446E5H, 44725H, 44745H, 44755H, 44925H, 44945H, 44945H, 44975H, 44995H, 449A5H, 44A15H, 44A35H, 44A75H, 44A85H, 44C65H, 44C75H, 44CE5H, 44CH5H, 44CP5H, 44CR5H, 45025H, 45035H, 450A5H, 450C5H

Precision® Point of Care Blood Glucose Test Strips

45515, 45517, 45701, 45791, 45963, 45964, 46367

If Your Current Strips are Part of the Recall:

Get free replacement strips. Call Abbott Diabetes Care Customer Service for replacement of your affected strips at no charge: 1-800-448-5234. Abbott will send you unaffected Precision Xtra, Optium, OptiumEZ, and ReliOn Ultima Blood Glucose Test Strips.

While waiting for the replacement strips to arrive, use an alternate method to measure blood glucose (such as a different test system) or purchase at least two weeks worth of new, unaffected strips while waiting for replacement strips.
When purchasing from a store or online, be sure you are purchasing strips that are not included in the recall. You can ask your pharmacist to make certain that the strips they have available are from unaffected lots.

What to do until you get new strips

If the only test strips available to you are from affected lots, do not stop testing your blood glucose. But do take the following two precautions to reduce the chance of erroneous reading:

Precaution 1: Check the amount of time it takes for your blood glucose meter to start the “countdown” after you first apply blood to the test strip. Start timing immediately after blood first makes contact with the test strip.

If your meter takes longer than five (5) seconds to start the countdown that test strip is defective and the result should not be used.
Check the time for each test strip you use because all of the strips in a package may not be affected to the same degree.

Precaution 2: If any reading from a strip appears lower than you would expect or does not seem to match the way you are feeling, you should contact your health care provider.

Pay special attention to signs and symptoms of high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia).

Symptoms of high blood sugar include excessive thirst, excessive urination, blurred vision, weakness, nausea, vomiting and abdominal pain. If you are experiencing any of these symptoms or are not feeling well, contact your health care professional immediately.
Symptoms of low blood sugar may include trembling, excessive sweating, weakness, hunger, confusion, and headache. Some individuals may have no symptoms at all before they develop unconsciousness or seizures. It is important to treat low blood sugars promptly to avoid loss of consciousness or a seizure. If you are unable to obtain unaffected strips, you should contact your health care provider for advice on how to treat these symptoms before they occur.

In Health Care Settings (Hospitals, Nursing Homes, Doctor's Offices)

Precision Xceed Pro is a point-of-care glucometer used in some health care settings. If your facility uses this system, check the lot numbers of your test strips against the recalled lots (above).

If your facility has affected strips,the FDA recommends the following: If available, immediately switch to using test strips from lots that are not part of the recall.

If your facility only has test strips that are part of the recall, switch to an alternate blood glucose system (if you have one readily available) and stop using the Precision Point of Care system until you obtain strips that are not part of the recall.
If your facility only has test strips that are part of the recall and you do not have an alternate blood glucose testing system available, the FDA recommends the following procedures:

Verify any critical glucose test results (e.g., test results that may be used to adjust insulin therapy in vulnerable patient populations) generated on the Precision Xceed Pro Blood Glucose Test System using a central laboratory blood glucose method. Medical judgment should be applied when deciding whether to act on results prior to verification.
Verify any Precision Xceed Pro Blood Glucose Test System results that do not match a patient’s symptoms, or seem unexpected for the patient’s clinical status, using a central laboratory blood glucose method.
When using the Precision Xceed Pro Blood Glucose Test System, take precautions to reduce the chance of an erroneous reading. Limited evidence suggests that results may be accurate using strips from affected lots if fill time does not exceed five seconds. Monitor the amount of time it takes for the Precision Xceed Blood Glucose Meter to start the “countdown” after blood is first applied to the test strip. If the amount of time exceeds five (5) seconds, discard that test strip immediately because the blood glucose result may be erroneously low. In addition, if this occurs:

i. Note the specific lot number of that test strip.
ii. Notify Abbott Diabetes Care to report the observed problem with that lot by calling 1-877-529-7185.
iii. Make sure to check fill time on each individual strip during use and do not assume if one strip in a package/lot appears to be unaffected, that all strips in that package/lot are unaffected.

Sources:

FDA Announces Recall of Abbott Test Strips, News Release, December 22, 2010, accessed online at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm237900.htm
Abbott Test Strip Recall Press Release, December 23, 2010, accessed online at: http://www.abbott.com/PressRelease/2010Dec23.htm

. . . .

Which Vaccines are Live?

2010-06-07T22:26:00.006-05:00

Which vaccines are "live"?

A patient posed an excellent question when she pointed out that the literature she received about her intravenous rheumatoid arthritis medication recommended that she avoid individuals who have recently received a live vaccine. Because she has many grandchildren who are in the age-range for various vaccinations, she was wondering--just which vaccines are "live?"

"Live" vaccines contain a weakened version of the disease. It is possible for individuals with weakened immune systems (due to disease, long-term steroid use, or because of medications such as chemotherapy or biological drugs that intentionally weaken the immune system) to become ill after being exposed to a live vaccine. A "live" vaccine could unintentionally cause a mild case of the illness that it is intended to prevent.

List of Live Vaccines (These are "Not OK" for those with weak immune systems):

Influenza (Intranasal Mist): Note, only the intra-nasal flu mist vaccine is live. (The injected flu vaccine ("flu shot") is an inactivated or "killed" vaccine and not usually dangerous.
Measles
Mumps
Polio (Oral vaccine): Note, only the polio vaccine that is taken by mouth is live; the injected polio vaccine is now the vaccine of choice for most patients.
Rotavirus (Oral and Injectable)
Rubella (German Measles)
Smallpox (Vaccinia): After vaccination the risk to persons with vulnerable immune systems is so great, that the vaccinated person is told not to have household or personal contact with pregnant women, infants, individuals with compromised immune systems until the vaccine scab has healed and fallen off. Check out the link for details.
Typhoid (Oral vaccine). There is also a "killed" (inactive) version of the Typhoid Vaccine.
Varicella (Chickenpox)
Yellow Fever
Herpes Zoster vaccine (Shingles)
BCG (Tuberculosis): This vaccine is rarely given in the U.S.; however, it is still administered in Mexico and in Europe.

List of Inactivated or "Killed" Vaccines (These are OK for most patients):

Influenza Injection ("Flu shot"): Note that the injection is a killed vaccine, but the nasal flu mist vaccine is a live vaccine.
Haemophilus influenzae type b (Hib)
Diphtheria toxoid (Included in DTAP vaccine)
Tetanus Toxoid (Lock Jaw): Typically combined with the diptheria vaccine
Pertussis (Whooping Cough)
Polio (Injection)
Hepatitis A
Hepatitis B
Typhoid Injectable: Note that there is also an oral version of the Typhoid vaccine available which is "live." The link gives information about both versions of the vaccine.
Meningococcal (Meningitis)
Japanese Encephalitis (Adult) and Japanese encephalitis (Pediatric)
Tick-Borne Encephalitis (TicoVac) (Not available in the U.S)
Rabies (see also National Network for Immunization Information: Rabies)
Pneumococcal polysaccharide vaccine (“Pneumonia Shot”)

Sources of Information for Vaccines:

Vaccine Information Statements (VIS): Available in many languages.
CDC Vaccine Information Statements: Available in an audio version and in Spanish
National Vaccine Information Center
National Network for Immunization Information

Humanitarian Health Volunteers in Haiti

2010-05-25T23:35:00.000-05:00

It's been nearly 6 months since the Haitian earthquake tragedy

The need for humanitarian assistance in Haiti persists. I wrote a blog in January than pondered the issues and challenges likely to face "first world" caregivers responding to the unfolding medical needs in Haiti.

Recently, Priscillia Patterson, an old friend and a retired Army colonel and registered nurse kindly shared some highlights of her experiences as a civilian volunteer (nurse anesthetist) with the University of Miami Global Institute Medishare Haiti Project. Reflecting on her experience as an Army nurse with two separate tours of duty in the war zones of Iraq, versus civilain humanitarian disaster volunteer nursing, Priscilla wrote, "Traveling with the Army is living large: hot food, cold water, hot showers, flushing toilets, ample staff, supplies, equipment and blood, and even shopping opportunities." Her experience in Haiti, on the other hand, was in sharp contrast. The harsh conditions there resulted in "nurse" becoming "patient" one day when 103 temperatures and a 14-hour-day in the spartan operating room left Priscilla (and others among the staff) so dehydrated that she required treatment in Medishare's ER.

Priscilla kindly granted permission for me to publish excerpts of her emails in my blog:

"We worked everyday from 7:30 am to about [7 pm] and then were on call for emergencies. Each day was pretty much the same, very busy: lines and lines of patients, very sick children, traumas, ladies in labor. We tried to care for all who came . . . We managed everything from the routine, to very sick, to trauma, to burns, to labor and delivery . . . There were Haitian interpreters available to translate for us. Some patients understood French but most only knew Creole.

"At eleven in the morning we got mystery meat sandwiches and at five in the afternoon we got a scoop of rice and a fatty, gristly knuckle from an unknown mammal. These meals were cooked somewhere in Port au Prince and brought in on the back of a pick up truck. I do not know who paid for the food, perhaps a charity. The U.S. Army left some MREs behind so we also had these to pick through. Most volunteers brought food like nuts, dried fruit, tuna packets, peanut butter. I preferred the MREs and the dried food I took.

"The U of M Medishare volunteers shared one huge tent. There were probably 100 cots side by side. Some sort of water filter was installed a few months ago, so we got our water from two water faucets. The water supply was limited and the faucets went dry from time to time. We had cold showers and were limited to 60 seconds of water flow . . . We had port-a-potties which were cleaned every morning and supplied with toilet paper. An enterprising Haitian-American businessman has a hot dog/burger wagon which visited our compound on Mon, Wed and Fri. I was more than happy to pay $8.00 for a hamburger and coke.

"There have been tens of millions of dollars given to charities for Haitian relief efforts. I’m not sure where that money is, as I saw little signs of it. Perhaps some charity money was used for the meals of rice and mystery meat, cleaning the port-a-potties and toilet paper. Maybe there is a grand plan for all that money, who knows. All I can say is that if you give or have given to a charity ask lots of specific questions about what the money is going to be used for."

Priscilla shared a few lessons learned:

Take toys, goodies for the children.
Have at least two water bottles and keep them full at all times.
Take lots of electrolyte drink mix.
Take food.
Go with a buddy

Final Thoughts

I have to admit that Priscilla's description of the warm-hearted spiritual Haitians she encountered who were so greatful for the care they received and accepting their grave situations with grace and humility has inspired me to contribute to the Medishare Haiti Project in some way. It's wonderful to hear first-hand of a humanitarian aide success story.

. . . .

May 2010 Multiple Chemical Sensitivity Awareness Month

2010-04-30T00:29:00.005-05:00

Multiple Chemical Sensitivity awareness is one of the health observances for the month of May. MCS is also variously known as Environmental Illness, Idiopathic Environmental Intolerance, and 20th Century Disease. Over the course of the last 8 years I have become acquainted with a number of individuals who are afflicted with this often misunderstood condition. MCS causes many of those who are severely affected to isolate themselves in order to take refuge from the synthetic fragrances and fumes that are ubiquitous in industrialized nations.

My interest in MCS resulted from experience caring for one of my hospital patients who is severely afflicted. (Read about my patient's experience with MCS in my blog post from May of 2009). Recognizing the lack of scholarly published literature to inform health care providers about the specific needs of the chemically sensitive in the health care setting, I eventually wrote a feature article published by the American Journal of Nursing (AJN) in 2007, Multiple_Chemical_Sensitivity_in_the_Clinical Setting. (At times this article can be read free of charge on the AJN website, but I've noticed sometimes they charge a fee to read it).

Another of my MCS acquaintances is Toni Temple, President of the Ohio Network for the Chemically Injured. As an severe MCS-sufferer, Toni has written widely about this condition. Her published work includes the book, Healthier Hospitals, a publication with a wealth of suggestions for accommodating the chemically sensitive in the hospital setting. Toni is president of the Ohio Network for the Chemically Injured and in this capacity she advocates and lobbies on behalf of the chemically sensitive.

In recognition of MCS month, I'm including the latest press release issued by Toni Temple on behalf of the Ohio Network for the Chemically Injured:

Ohio Network for the Chemically Injured (ONFCI) Urges Adoption of CDC Fragrance-Free Policy to Protect Health

"The U.S. Centers for Disease Control (CDC) is on record affirming that some building conditions have the “potential to adversely impact the health of building occupants. Potential hazards include chemicals, biological agents, fragrant products, and physical conditions that may cause irritation, illness, or exacerbate existing health conditions.”

"The CDC’s June 2009 internal Indoor Environmental Quality Policy protects employees from many harmful health effects by: controlling VOC emissions that are found in many buildings and commercial products; using integrated pest management to ensure the least possible hazard to people, property, and the environment; utilizing a safety official with qualifications to assess indoor air quality; using biodegradable, low toxicity, fragrance-free cleaning products; and other preventive measures.

"In conjunction with Multiple Chemical Sensitivity (MCS) Awareness and Education Month during May, the Ohio Network for the Chemically Injured (ONFCI), a not-for-profit corporation that educates about and advocates on behalf of those who have been harmed by toxic chemicals in our everyday environment, urges all employers, businesses, and homeowners to review and adopt the CDC policy in order to reduce illness, disease, and disability.

"Readily achievable policies include prohibiting the use of any air fresheners, air wicks, plug-ins, incense, candles, reed diffusers, fragrance-emitting devices of any kind, plug-in or spray air fresheners, and toilet blocks. Encourage fragrance-free personal care and laundry products and request employees to be as fragrance-free as possible. The CDC Policy prohibits applying personal care scented products on any CDC premises. The use of “green” cleaning chemicals and building materials along with monitoring for appropriate ventilation will not only reduce indoor air contamination, but will reduce employee absenteeism as well.

"In a letter to Governor Strickland, Senator Dale Miller asked for the Governor’s “…consideration to develop and put forward an Indoor Environmental Quality Policy for use in all state facilities. The model proposed by the Centers for Disease Control would be an excellent starting place for development of this policy. We need to make every effort to provide work environments that are clean, comfortable, and safe. We also should pay particular attention to protecting those who are particularly sensitive to chemical irritants.”

"Cuyahoga County Public Library’s 28 branches and their administrative office building will participate in MCS Awareness Month. Some branches will display related books and provide other information. A copy of the CDC Policy will be available for copying. The Downtown branch of Cleveland Public Library will again have an MCS Awareness Month display in the Science and Technology Department.

"Many mayors including Cleveland Mayor Frank Jackson, Berea Mayor Cyril Kleem, and Strongsville Mayor Thomas Perciak, will again issue Proclamations supporting MCS Awareness and Education Month in May.

"An MCS article appears in the 2010 Environmental Briefing Book on the Ohio Environmental Council’s website. http://www.theoec.org/LobbyDay2010.htm . For further information about MCS and the ONFCI visit our website at www.ohionetwork.org or contact ONFCI at (440) 845-1888.

"For Further Information Contact: Toni Temple, ONFCI President (440) 845-1888."

. . . .

OneTouch Ultra Test Strips Recall

2010-03-10T18:50:00.006-06:00

Recall of Some OneTouch Ultra Blood Glucose Test Strips

I just received a letter from LifeScan , the Johnson & Johnson Company that manufactures the OneTouch Ultra glucose meters and test strips, The company has launched an "Urgent Medical Device Correction" --which amounts to the same thing as a recall--of approximately 900 packages of OneTouch Ultra Test Strips.

The Problem

The wrong test strips were packaged in certain lots of OneTouch Ultra Test Strips. Your test strips should be light blue with the name "OneTouch Ultra" printed on them. Like the one on the right. The strips under recall that were packaged by mistake are of a dark blue color without any writing on them. These incorrect strips will fit into your OneTouch meter, but they won't turn it on, and they won't give you any result. All of us who must purchase test strips know that they are expensive at about $1 for each strip, so you will certainly want to take advantage of the opportunity for a refund or replacement from LifeScan.

Check Your Strips

The mislabelled test strips are only contained in boxes that have 100 strips (4 bottles of 25 strips each) and all of them have the same lot number. Check your boxes of strips (and your loose bottles of strips as well). The affected lot has this number:

Lot # 2964512

Where to Find the Lot Number

The lot number can be found on the side of your box of strips and on the label of your individual 25-count bottles. (My supplies which are pictured, do not have the lot number in question, but I'm including the snapshots with the lot numbers circled to show you where to look).

What to do?

If you have any of the test strips from the affected lots, check the strips in the packages. If you find any of the dark blue strips do not use them. Instead visit the manufacturer's website to apply for a replacement of your products: OneTouch Ultra Strips Recall Form. You can also call Lifescan's special telephone number that is specific for this problem: 1-866-247-1029. According to their letter, Lifescan will have representatives available to speak with you at this number 7 days a week from 5 a.m. to 7 p.m. Pacific Time.

Keep up on Product Information about Your OneTouch

To make sure you receive important product information about your OneTouch meter and supplies directly from the manufacturer, visit www.OneTouchProductID.com to register your meter and update your contact information.

Basic Information about Dense Deposit Disease (one of the rarest of the rare diseases . . . )

2010-03-08T20:33:00.007-06:00

Introducing Jamie Sue

Jamie Sue Turner of Runnells, Iowa is 8 years old and in the second grade. She’s somewhat of a girly-girl favoring the color pink, singing and dancing, and Disney TV fare such as “Hannah Montana.” Her beauty is certainly more than skin deep, yet her wide smile and large, expressive eyes no doubt added to the "total package" that won her a tiara in a children's beauty pagent at the Iowa State Fair in 2009. But little girls are made of sugar AND spice, are they not? In addition to hobbies like scrapbooking, Jamie Sue is a tough cookie who plays on a youth softball team in the summer.

Until recently, Jamie Sue has enjoyed the kind of idyllic childhood that we all cherish. Her life has revolved around her large family, many friends, pet dogs, hobbies, school and social activities. Due to circumstances beyond her control, Jamie has spent much more of her time at the University of Iowa Hospital in Iowa City than she has at home over the past 10 weeks. You could say Jamie has added another dimension to her active life, and she’s proving that in addition to everything else, she is a tenacious fighter.

Jamie Sue was the picture of robust health until something alarming occurred on December 15, 2009. That evening her ankles were unaccountably swollen. The next day Jamie Sue was at her doctor's office where it was revealed that her kidneys were responsible for the fluid retention. Early treatment and intervention didn't resolve the symptoms, and her journey within the medical system was well underway . . . A kidney biopsy early in the course of her illness established a diagnosis of Dense Desposit Disease, a rare autoimmune condition that affects the kidneys.

Dense Deposit Disease (DDD) is the second, and more serious, type of Membranoproliferative Glomerulonephritis. DDD usually leads to chronic kidney failure and the need for regular kidney dialysis. Typically there is a window of time (8-10 years) before the disease damages the kidneys to that extent. Unfortunately, Jamie Sue is an exception to the rule. Her experience with DDD has been rapid and unrelenting so that she is already battling imminent chronic kidney failure as physicians strive to slow the progression of the disease. At the moment, Jamie Sue is receiving a combination of plasmapheresis and occasional renal dialysis for two purposes: to prevent her immune system from continually damaging her kidneys by removing the certain "bad" proteins from her blood, and to cleanse her blood of toxic waste products and excess fluids. Soon Jamie expects to begin clinical trials to determine whether a hopeful new medication may better spare her kidneys from continued damage by her immune system.

About Dense Deposit Disease

It’s been written that Dense Deposit Disease (DDD) is rare even among rare diseases. DDD makes its appearance in childhood, usually between the ages of 5 and 15 years of age. Experts have estimated that DDD occurs in only two to three people out of 1 million. We can do the math to demonstrate how DDD is “rare among rare” diseases. Taking a rough estimate of 304 million U.S. citizens and expecting to find 2 to 3 cases of DDD per 1 million, we can estimate that significantly less than 1,000 Americans would be afflicted with Dense Deposit Disease. To gain even more perspective, keep in mind that in the U.S. diseases are officially designated as “rare” when less than 200,000 Americans are affected. (So even if there were 200 times more cases of DDD in the U.S., this condition would still fall into the “rare” category.)

Basic Information about Dense Deposit Disease

A lot of great scientific articles have been written about Dense Deposit Disease. This blog entry doesn’t pretend to be one of them. Instead, this piece intends to take a complicated disease and break some of the key features into understandable concepts in order to help parents, family, and friends be better informed about this condition. When a serious illness affects a child that we love, we want to learn as much as we can in order to be helpful and supportive. As parents we want to know as much as possible in order to advocate for our children. Scientific literature is written in a language all its own and often with explanations that may include unfamiliar and confusing terms. (It’s always best to jot down specific questions as you think of them to ask your child’s physicians). For a great website written by experts who manage and study Dense Deposit Disease, visit the University of Iowa’s website devoted to DDD, it's called Kidneeds, and if you are affected by DDD in some way, you will want to check it out.

What’s in a Name . . . ?

In medical jargon, many diseases and conditions have more than one name. When you are looking for information about Dense Deposit Disease, you will also see it referred to as Membranoproliferative Glomerulonephritis Type II (or MPGN II). Scientists originally felt that Dense Deposit Disease was a variation of two similar types of kidney diseases, therefore it was differentiated by calling it “MPGN Type II.” However, in recent years scientific research has discovered that the unique features of this particular variation makes the name Dense Deposit Disease more appropriate. So although MPGN II is an “older” term, you will still see it in literature about this condition.

What are Dense Deposits?

Physical signs and symptoms are present when the kidneys are functioning poorly. Nephrotic Syndrome, is a term that refers to the combined signs and symptoms that occur when the kidneys are unhealthy. More information and test results may be necessary before the physician is able to pinpoint a specific reason for the kidney dysfunction.

A kidney biopsy is necessary to diagnose DDD. This procedure gathers evidence of the underlying reason for kidney damage and allows the physician to make a definite diagnosis. When the tissue from the biopsy is examined with an electron microscope, the unique features of Dense Deposit Disease are clear to the trained eye. As the body’s immune system has malfunctioned, certain proteins have "gone crazy" and started to attack an important membrane deep within the kidneys; bits and pieces of the rogue proteins end up "stuck" to the kidney’s membrane in thick ("dense") ribbon-like patches ("deposits").

An Autoimmune Disease

Dense Deposit Disease is an autoimmune disease. This means that the patient with DDD is suffering an attack from within; their kidneys are damaged by their own immune system.

In theory our immune system protects our bodies from outside invaders such as viruses and bacteria. Sometimes, for reasons that are not well understood, a “glitch” in the immune system causes it to go out of sync. The out-of-sync immune system triggers proteins that usually protect us to, instead, attack healthy tissues within our bodies by mistake. There are more than 80 different types of autoimmune disorders; each one has resulted from a glitch that is aimed at a specific organ or tissue type. Some well-known examples of autoimmune diseases and their specific targets include Multiple Sclerosis in which nerve sheaths are damaged; Lupus, which affects connective tissue throughout the body; Type 1 Diabetes in which insulin-producing cells of the pancreas are destroyed; and Crohn’s Disease and Ulcerative Colitis which both affect the lining of the digestive tract. Autoimmune disorders are chronic in nature meaning they are not reversible, but there are specific treatments for most autoimmune illnesses that can control or manage the condition.

Why an autoimmune illness affects one person and not another is still a mystery. Roughly 5% of the population is afflicted by some type of autoimmune condition. A number of theories have been introduced to try to explain what goes wrong. Heredity, environmental factors, viruses and certain drugs have been suggested. It may be that a combination of just the “right” factors is all it takes for the immune system to make a mistake that will spiral out of control and direct damage towards a specific tissue in our body. Much research is directed towards unlocking the secrets behind what really triggers an autoimmune disease. It’s intriguing (and frustrating) that over the years evidence shows that even with identical twins, one twin may be afflicted by an autoimmune disease while the other stays completely healthy.

Glomerular Basement Membrane

An anatomy and physiology reference is the best source for an in-depth understanding of the intricate and complex means in which the complement proteins of the immune system attack and damage the glomerular basement membrane (GB Membrane) in Dense Deposit Disease. However, I can give you a few key points in layman’s terms to provide a very basic understanding of what this illness entails.

The glomerular basement membrane is the part of the kidney that filters extra fluid and waste products out of the blood. On one side of the GB Membrane is the bloodstream, on the other side of the GB Membrane is urine. The fluid and waste that are filtered out of the blood cross the GB Membrane to become components in urine and are ultimately eliminated from the body in the usual way.

When the immune system damages the GB Membrane, it no longer filters properly. Proteins that circulate in our blood have various important "jobs" to perform within the body so we certainly don't want to lose them. When our kidneys are healthy, there is very little chance of that happening. Proteins are simply too large to go across a healthy GB Membrane. Unfortunately, a damaged GB Membrane does allow those large proteins to be filtered through, and with terrible consequences. When these useful proteins cross the GB Membrane, they are eliminated with the urine. Because they are gone from the bloodstream, the specific jobs they are supposed to perform in the body are jeopardized.

(If you are having trouble visualizing this concept, imagine a trampoline--when the fabric is tight we can hit the surface and bounce back off without fear, but if we happen to bounce on a patch of fabric that is loose and frayed we may fall right through and hit the ground instead. Instead of "bouncing off" the GB Membrane as they normally would, the large proteins go right on through the weakened membrane and are lost to the body when they are expelled by urination.)

With kidney disease the loss of proteins in urine results in a “Catch 22 scenario.” The same proteins that leave the body when the kidneys are damaged have functions that include absorbing unneeded fluids in the bloodstream. Without these proteins to soak them up, the extra fluid in the blood seeps back into the tissues and causes swelling (edema). Importantly, in addition to fluid, dangerous waste products such as creatinine and urea are also retained in the bloodstream. These waste products eventually become toxic to tissue. If the kidneys become too diseased to handle removal of these substances, kidney dialysis is essential.

High Blood Pressure, too . . .

Along with fluid retention from poor kidney function comes sodium retention. Damage to the kidneys also causes an increase in a hormone the kidneys produce (called renin). These three factors combine to cause dangerously elevated blood pressure which must be treated by medication.

Signs and Symptoms of DDD

The early signs and symptoms of poor kidney function may be subtle. When the kidneys are unhealthy enough to allow protein to enter the urine, the urine that is voided is often fizzy or frothy looking. Red and white blood cells may also leak into the urine. White blood cells tend to make the urine cloudy, while red blood cells may cause a red or pinkish hue (or they may only be detected by a lab test and not visible to the naked eye.)

More dramatic and obvious signs of kidney problems include:

“Puffiness” or swelling (called edema) around the eyes, feet and ankles, hands, and abdomen.
Dark, "tea-colored" urine. Dark urine is a symptom of glomerular problems and it is related to the inability of the kidneys to properly filter the waste products from the blood.(But dark urine can also be caused by other condtions and can even result from eating certain foods.)
A general inability to concentrate and mental confusion.

Treatment

Plasmapheresis is one way in which DDD is treated. Plasma is the “watery” part of our blood. Among other things, plasma carries the components of the immune system that damage to the "good cells” in people with autoimmune illnesses. In DDD the object is to preserve kidney function for as long as possible, removing the damaging immune components has proven to be a helpful means of doing so. This is done by plasmapheresis in which the patient’s blood is filtered through a machine that removes their plasma and replaces it with plasma from a donor. The donor plasma doesn’t contain the damaging autoimmune components, so the kidneys get a temporary break. Eventually the body will produce more of its own "bad" immune system proteins which will be circulated in the bloodstream.

Over time the damaging effects of DDD eventually leads to chronic renal failure (abbreviated as CRF and also simply called "kidney failure"). About 50% of all individuals diagnosed with DDD will require regular dialysis within 8 to 10 years of diagnosis in order to stay alive.

Kidney transplants have been performed on patients with DDD, but the nature of the disease makes this only a temporary benefit. The body attacks the donor kidney in the same manner that it attacked the original and the donated organ eventually fails. For patients with DDD and their potential kidney donors, the risk of transplant versus the limited benefit to the recipient makes it difficult for the medical establishment to easily recommend this option.

Back to Jamie Sue . . .

Lately, as Jamie Sue ponders the future she envisions a career in medicine. She wants to be a doctor. She can do that. She can do anything she wants to do. Individuals with autoimmune conditions learn to adapt and live life to the fullest while managing their illness and undergoing whatever specific treatments that their disease requires. Jamie Sue will do this . . .

How Can You Help?

Support research that aims at finding a cure for DDD. Participate in Fundraising via the Universtiy of Iowa's Kidneeds program which supports DDD research.

Donate Blood or Plasma. Plasma donation is a great way to contribute and it costs only your time. Learn more about the process in the article "Plasma Donation" from LifeShare Blood Centers.

To learn more about blood donation opportunities and find a location near you:

Visit American Red Cross website or call them at 1-800-GIVE-LIFE (1-800-448-3543)
Visit America's Blood Centers website or call 1-888-USBLOOD

Photos of Jamie Sue Turner used by permission of Misty Turner; photos copyright of Misty Turner.

For Additional Reading:

National Kidney and Urologic Diseases Clearinghouse, "The Kidneys and How They Work"

National Organization for Rare Diseases, Membranoproliferative Glomerulonephritis Type II

Smith, R.J.H.; Sethi, S.; Zipfel, P.F. (2007). Dense Deposit Disease, Membranoproliferative Glomerulonephritis Type II, Accessed online from NCBI>>Bookshelf>>GeneReviews.

Ferrario, F. & Rastaldi, M. P. (undated), Renal Pathology Learning, Type II Membranoproliferative Glomerulonephritis; Accessed online Mar. 3, 2010.

Appel, G.B.; Cook, H.T.; Hagerman, G.; Jeannette, J.C.; Kashgarian, M., Kirschfink, M.; et al. (2005 May; Epub 2005 Mar 30). Membranoproliferative glomerulonephritis type II (dense deposit disease): an update. Journal of the American Society of Nephrology, 16(5):1392-403.

Plasmapheresis, The free dictionary online, medical dictionary.

. .. .

Links to Spanish Language Health Information (Patient Instructions in Spanish)

2010-03-04T21:57:00.019-06:00

Spanish Discharge Instructions and other Health Teaching

When making blog articles about specific healthcare teaching issues I look for links to reliable Spanish translations. So many Google searchers are ending up at a recent blog entry that included some basic English/Spanish translation I decided to make a more helpful page that will lead searchers more directly to helpful and reliable Spanish language health information.

Don't forget to use the search box in the right hand column to look further, but for now this page provides a variety of helpful links for the Spanish-speaking patient.

Best Spanish Translation Books for Healthcare Workers:

I have used many Spanish/English healthcare translation books. Far and away my favorites, and the two that I recommend are Medical Spanish, An Instant Translator, by Nasr & Cordero, published by W.B. Saunders and Spanish for Health Care Professionals, by W.C. Harvey, published by Barron's.

Miscellaneous Spanish Language Health Information Links:

Discharge instructions in Spanish for TURP (Transurethral Resection of the Prostate): "Reseccion Trans Uretral De La Prostata, Instrucciones Para Cuidado En Casa.”

Allergy and Asthma Information in Spanish: Spanish translations from the American Academy of Allergy Asthma & Immunology including information about allergies, asthma, cough and more. Información sobre alergias, asma, tos y más.
Topics in Spanish from the National Digestive Diseases Information Clearinghouse including information about colon polyps, diarrhea, constipation, cirrhosis, food borne illnesses, various types of hepatitis and more. Información sobre los pólipos de colon, diarrea, estreñimiento, cirrosis, enfermedades transmitidas por los alimentos, diversos tipos de hepatitis y mucho más.
Information in Spanish about head lice or "Piojos de la cabeza": .Center's for Disease Control and Prevention, Piojos de la cabeza and National Pediculosis Organization, Piojos de la Cabeza en Espanol.
Consumer information about safety of cribs, drywall, fireworks, and more: Noticias sobre Cunas, paneles de yeso, fuegos artificiales y mas . . . U.S. Consumer Product Safely Commission en ESPAÑOL with updates on the latest product safety and recalls: CPSC Spanish language page. La CPSC, es una entidad reglamentaria federal, que protege al público contra riesgos irrazonables, lesiones y muertes asociadas con productos de consumo.
Care of the JP (Jackson Pratt) drain from the National Institutes of Health: Instrucciones después de la inserción de un tubo de drenaje "JP" y otras drenajes.
Osteoporosis information from the Dairy Council of California: Mantengan sus Huesos Fuertes, Consuman Productos Lácteos.
Healthy eating and Meal Planning from the Dairy Council fo California: Articulos y recetas sobre la Alimentación Saludable.
National Institute of Health, a Variety of Surgery-Related Topics for download in Spanish. Pre-operative/Pre-procedure Instructions, after care for these procedures: Biopsy, Bone Marrow Biopsy, Breast Biopsy, Bronchoscopy/Laryngoscopy/Esophagoscopy, Cardiac Catheterization Test, Catheter-Based Treatment, Colonoscopy, Dialysis Access Procedure, Drain Insertion, Endoscopy, Eye Surgery, Gynecologic Procedure, Interscalene Block, Kidney Biopsy, Montgomery Tube/Tracheostomy Placement, Muscle/Nerve Biopsy, Oral Surgery Sinus Precautions, Periodontal Surgery, Port-a-Cath insertion/removal, Septoplasty, Strabismus Surgery (for adults), Strabismus Surgery (for children), Tenkhoff Catheter Insertion, Tenkhoff Catheter Removal, Urological Surgery: cystoscopy, ureteral stent insertion/removal, bladder/prostate biopsy and Postoperative procedure/anesthesia instructions. Pre-operative/Pre-procedure instrucciones, después de cuidar de estos procedimientos: Biopsia, Biopsia de médula ósea, biopsia de mama, Broncoscopia / Laringoscopia / Esofagoscopia, Cateterismo Cardíaco de prueba, basada en el catéter de tratamiento, la colonoscopia, la diálisis Procedimiento de Acceso, la inserción del drenaje, Endoscopia, Cirugía ocular, Gynecologic Procedimiento, interescalénico Block, la biopsia renal, Montgomery Tube / traqueostomía de nivel, músculo / biopsia de nervio, cirugía oral Sinus Precauciones, cirugía periodontal, Port-a-Cath de inserción / extracción, septoplastia, cirugía de estrabismo (para adultos), estrabismo Cirugía (para niños), Tenkhoff la inserción del catéter, Tenkhoff remoción del catéter, Cirugía urológica: la cistoscopia, la inserción de un stent ureteral / eliminación, de la vejiga / biopsia de próstata y el procedimiento postoperatorio / anestesia Instrucciones.
Kidshealth, Teaching your kids about menstruation and puberty. Talking to your child about Menstruation. Hablar con su hija sobre la menstruación.
24 hour urine test, patient instructions: Procedimiento: Recolecta una muestra de orina de 24 horas.
Healthfinder.gov in Spanish. A wealth of health information translated to Spanish is available here, including an encyclopedia of health topics from "the most reliable sources." Healthfinder.gov en español le ofrece la información más actualizada para que usted y sus seres queridos se mantengan saludables con una Enciclopedia de temas de la salud de las fuentes más confiables.
Disaster Preparedness (Spanish Version). Spanish version of suggestions for readiness in the event of a natural or man-made disaster. Preparación para Desastres asesoramiento para la preparación en caso de un desastre natural o de origen humano.
Caringbridge Website keeps loved ones in touch during times of crisis, information for Spanish-speaking patients and families. Un sitio web CaringBridge ayuda a mantener informados a los seres queridos durante momentos difíciles. Por otra parte, los familiares y amigos brindan apoyo al paciente y a las personas encargadas de su cuidado a través de los mensajes del libro de visitas.

Rare Disease Day, February 28, 2010

2010-02-27T19:49:00.007-06:00

For Rare Diseases, Research and Funding are Rare . . .

"A rare disease." It sounds like a bad cliché from an old movie, doesn't it? Of course in those old movies the beautiful and tragic leading lady afflicted with the rare disease somehow crosses paths with a (single) up-and-coming young physician who falls madly in love with her and miraculously discovers a cure. And they all live happily ever after . . .

Even in real life we look for heroic figures (so-called "champions") to emerge when faced with a rare disease because without them, rare diseases suffer for lack of research and funding to seek a cure.

There are more than 6,000 diseases or conditions that meet the criteria of rarity. The National Organization for Rare Disorders (NORD) maintains a database with information and helpful links for more than 1,200 of these diseases.

Advocates for Rare Diseases Come Together

When it comes to finding a cure for a disease, there is strength in numbers. If very few individuals are afflicted by a specific disease, condition or syndrome, the costs associated with research and funding are prohibitive. Of course, when there are hundreds of thousands (or millions) of dollars to be spent on a research project, obviously "bang for the buck" is a guiding principle, specifically they need to determine to partake in research that will benefit the the largest number of individuals. Drug companies invest hugely in research projects and their funding is largely directed towards the traditional diseases that affect the millions who will, in turn, buy their pills and capsules for treatment purposes. Rare diseases are at a distinct disadvantage in both scenarios.

Orphan Diseases and Orphan Drugs

Rare diseases are sometimes called "orphan diseases." The NORD states, "The rare disease patient is the orphan of health systems, often without diagnosis, without treatment, without research, therefore without reason to hope."

In the United States the Rare Disease Act of 2002 defines a rare disease as one that affects fewer than 200,000 Americans. The National Organization for Rare Disorders (NORD) is a healthcare coalition of sorts, dedicated to concentrating limited resources in order to lobby on behalf of rare diseases in general. The organization is committed to the identification, treatment, and cure of rare diseases through programs of education, advocacy, research and service. Among the outstanding accomplishments of the NORD is their successful lobbying that resulted in the 1983 Orphan Drug Act. This act legislated tax incentives and more perks for drug companies to produce the relatively small amounts of pharmaceuticals needed by individuals affected by rare diseases. These incentives allowed the drug companies to produce these drugs and still recognize a profit.

Why is Rare Disease Day Important?

Rare Disease Day is an opportunity to provide information about the disparity in healthcare that results when individuals are afflicted with a rare and difficult condition. It's also an occasion to advocate on behalf of patients with rare diseases and their families who often struggle with isolation, complex medical needs, financial and emotional stress.

Parents of Children Affected by Rare Diseases . . .

. . . this is a place for you: Children's Rare Disease Network. Here you can connect with others through social networking, keep up with breaking news via their e-newsblog, SNIPS, share your story, get involved in advocacy projects and more . . .

Oliver's Story, in the words of his parents . . .

. . . read how Oliver and his family are coping with a rare disease at their new blog: Oliver's Story.

More links of interest:

. . .

Worried about difficulty swallowing . . . (dysphagia)

2010-02-27T03:51:00.004-06:00

If you've come to this blog entry, perhaps it's because you may have concerns about the swallowing ability of yourself or a loved one. Difficulty swallowing is frightening and it can obviously be dangerous. Many of the underlying factors that make a person vulnerable for difficulty swallowing are related to muscle weakness from a variety of causes: stroke, multiple sclerosis, and generalized developmental difficulties, etc.

Asphyxiation and Aspiration

Weakness of the muscles that allow food to pass from the mouth, down the esophagus, and into the stomach can cause choking. If the choking doesn't dislodge the food from the windpipe, it can become lodged there and result in asphyxiation when air can't pass into the lungs.

Choking can result in some food or liquid actually entering the lungs. The medical term for inhaling food or liquid is aspiration. Aspiration can hurt the lungs in various ways, often a severe case of aspiration pneumonia results..

Swallow Screening for Stroke Patients--Always Necessary

When a stroke is suspected, hospitals require that a "swallowing screen" be performed before a patient is allowed to have anything by mouth. In addition, among the questions patients are asked when they are admitted to the hospital for any reason is, "Do you experience any difficulty swallowing?" If they answer, "yes," or give any other clues that make the admitting RN suspicious, the swallowing screening test is easily performed.

RN Swallow Screening Guidelines

Each hospital will have their own particular screening procedure. This is an example taken from my personal experience in a facility where I was employed, and I'm presenting it to give you an idea about the factors that help define swallowing difficulty. The RN performing the screening needs applesauce (or if patient is allergic something of the same consistency, like pudding), a graham cracker, and a spoon. The patient cannot be lying down for this exam. They need to be sitting almost at a right angle, and suction needs to be readily available in case the patient needs quick intervention.

Positioning

Elevate the head of the bed at least 70 degrees
Support the weak side of the body with a pillow if appropriate. (This keeps the patient from slouching to the weak side.)
Perform each step of the screening (bites or sips) in this order and STOP if any item would cause a check on the documentation checklist at any point in the screening.

Procedure

1. Give 1 teaspoon of applesauce. Watch for any signs and symptoms of dsyphagia (see checklist below.) STOP if any item is checked. If no signs or symptoms Repeat with a second teaspoon. If no signs and symptoms after the second spoonful, proceed to step 2.

Checklist:
__Holds food in mouth without initiating swallow or spits food out
__Significant facial droop with food or liquid coming out of mouth (Facial droop: one side of the face droops from muscle weakness)
__Pocketing of food/drink in mouth or cheeks (Pocketing: instead of swallowing, the food/fluid is kept in the mouth, usually held in the "pocket" between the bottom cheek and gums--like a chipmunk holds nuts.)
__Suctioning required during assessment
__Food or liquid coming out of nares (the nose "holes")
__Choking or persistent coughing during any stage of the swallowing screen
__Eyes reddening or tearing
__Wet, gurgly voice
__Patient reports painful swallow or food lodged in throat
__Labored breathing or moist breathing sounds (known medically as "rales")

2. Give patient one teaspoon size of thin liquid (nurse is to control the amount of liquid placed on the spoon for patient to sip.) If successfully swallowed, allow the patient to give self a second sip independently. STOP if any sign or symptom occurs.

Checklist:
__Holds food in mouth without initiating swallow or spits food out
__Significant facial droop with food or liquid coming out of mouth
__Pocketing of food/drink in mouth or cheeks
__Suctioning required during assessment
__Food or liquid coming out of nares (the nose "holes")
__Choking or persistent coughing during any stage of the swallowing screen
__Eyes reddening or tearing
__Wet, gurgly voice
__Patient reports painful swallow or food lodged in throat
__Labored breathing or moist breathing sounds (known medically as "rales")

3. Give the patient a graham cracker and ask him or her to take a bite, chew it up, and then swallow. If successful, offer the rest of the cracker. STOP if any sign or symptom occurs.

Checklist:
__Holds food in mouth without initiating swallow or spits food out
__Significant facial droop with food or liquid coming out of mouth
__Pocketing of food/drink in mouth or cheeks
__Suctioning required during assessment
__Food or liquid coming out of nares (the nose "holes")
__Choking or persistent coughing during any stage of the swallowing screen
__Eyes reddening or tearing
__Wet, gurgly voice
__Patient reports painful swallow or food lodged in throat
__Labored breathing or moist breathing sounds (known medically as "rales")

4. Document results on the sticker and place it in the physician's progress notes.
5. Obtain an order for a Speech Therapy consult if patient fails screening.
If one or more items are checked in any phase of the screening, the swallowing screen is FAILED. The patient is to be kept NPO or "nothing by mouth." Speech pathology consult is ordered.

If NO items are checked, then the screening is PASSED.
If the patient passes only on the applesauce (step 1), check with the physician to see if medications may be given crushed and mixed in applesauce while wating for the speech consult.

What can you do?

If you live with someone who is at risk for aspiration because of difficulty swallowing, make sure that their physician is aware of this and follow his or her advice and recommendations. If they haven't suggested it already, ask for a Speech Pathology evaluation for your loved one. In some cases, thickened liquids and specific consistency of foods will be recommended. There are other important tips that a Speech Pathologist will teach you to help you or your loved one prevent aspiration and asphyxiation because of dysphagia.

Also, if you haven't already done so, learn CPR and the Heimlich Maneuver so that you will be able to quickly intervene on behalf of your loved one.

Find a CPR class via the American Heart Association or the American Red Cross

Read more about dysphagia, check out the hyperlinks in this article for additional reading.

. . .

Risk Factors for Deep Vein Thrombosis (DTV) and Venous Thromboembolism (VTE)

2010-01-22T02:45:00.001-06:00

I've written about blood clots before on my blog, see DVT, blood clot, deep vein thrombosis. I wanted to touch on this subject again because I came across a flyer from a class I once attended which introduced nurses to an excellent tool aimed at reducing the incidence of DVT by recognizing the individuals at greatest risk. Patients need to know about this, too, so they can be vigilent and take precautions when they are at risk.

Apparently this educational endeavor is defunct because I cannot find a word about it in my Google searching. "SCORE IT" DVT Patient Profiler for Selected Patients at Risk was presented by CARE FORCE (Clot Assessment & Risk Reduction Through Education). The acronym SCORE IT cues the nurse to remember what patient types are at greater risk. The more catagories that apply to a specific patient, the greater the risk and the need for higher levels of DVT prevention protocols in the hospital to be implemented in order to prevent a blood clot from developing.

I found this program compelling and want to record the information here for reference:

S . . . Surgery Patients.

General Anesthesia is a risk factor for postsurgical DVT development.
All surgeries are associated with risk of DVT/General and orthopedic surgeries are associated with a higher risk of developing DVT and PE (pulmonary embolus) than other types of surgery.
Total knee or hip replacement and hip fracture orthopedic procedures are associated with the highest postsurgical (within 1 to 2 weeks) risk of DV--over 50%.

C . . . Cancer Patients and Cardiovascular Patients

Cancer Patients

Chemotherapy, radiotherapy, central venous catheters, and surgery contribute to the increased risk of VTE (venous thromboembolism) in patients with cancer.
Tamoxifen or hormone replacement therapy are risk factors for DVT
Tumors may also cause obstruction which can contribute to venous stasis.

Cardiovascular Patients

Acute myocardial infarction (AMI), ischemic and non-ischemic cardiomyopahy, congestive heart failure (CHF) secondary to valvular disease, and chronic idiopathic dilated cardiomyopathy may increase the risk.

O . . . Obese Patients

Modifiable Risk Factor
Weight loss may decrease risk

R . . . Respiratory Failure Patients

Acute exacerbation of chronic obstructive pulmonary disease (COPD), adult respiratory distress syndrome, moderate to severe community-acquired or nosocomial pneumonia, lung cancer, interstitial lung disease, or pulmonary hypertension are associated with increased risk.

E . . . Elderly Patients

Bed rest, frailty, and immobility features often associated with advanced age, predispose patients to venous stasis.
Advancing age (older than 40 years) is a risk factor for VTE.
As the population ages, the number of cases of VTE is expected to increase.

I . . . Infection/Inflammatory Disorder/Immobile/ICU Patients

Infection Patients

Disseminated infections, sepsis, and serious systemic infections, including urinary tract (UTI), complicated skin and skin structure, pneumonia, and abdominal infections may lead to increased risk of DVT.

Inflammatory Disorder Patients

Disorders such as systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are associated with an increased risk of IBD.

Immobile/ICU Patients

Venous stasis of the lower limbs may predispose a patient to thrombosis formation
Patients confined to bedrest for fewer than 5 days had a 21% occurrence of VTE compared to a 36% occurrence in patients on bedrest for over 10 days. [There is no source citation given for these statistics on the flyer.]
Incidence of DVT in stroke patients with a paralyzed lower limb exceeds 50%. [No source cited.]
Increased risk in ICU patients with medical disorders.

T . . . Trauma/Thrombophila/Thromboembolism History Patients

Trauma Patients

Patients with major trauma who do not receive thromboprophylaxis have a 50% risk of DVT. [No source is cited for this statistic.]
Multiple injuries and lower extremity or pelvic fractures are associated with a higher risk of VTE.

Thrombophilia/Thromboembolism History Patients

Prior history of DVT/PE confers risk of a future event.
As many as 20% of patients with confirmed thromboembolic disease have a history of DVT or PE.
Patients with an acquired or genetic predisposition to hypercoagulable states are at risk for VTE.

If you find yourself among those at highest risk of developing a blood clot and you you are hospitalized, ask your doctor and nurse what precautions they are going to take to prevent you from developing blood clots. The options for prevention include tight white stockings on the legs (TED hose) that help improve the circulation; "squeezy" wraps to the lower legs that inflate and deflate via an electric pump (many name brands for this type of equipment); injections of blood thinning medication into the skinfolds of your abdomen (Lovenox or Fragmin); or they may simply suggest "early ambulation"--which means you are up and out of bed quickly, in a chair and walking in the hallways. If they haven't suggested any of these options, insist that they come up with a plan for you. This is required by the Joint Commision, the authority that accredits hospitals.

Patients--be concerned about pain and swelling in your legs. Often a blood clot will first appear in the back of one of the lower legs. This can occur while you are in the hospital or even a few weeks after you get home. Also be concerned about any sharp pain in the chest, wheezing breath sounds and frequent moist cough; those signs could suggest a small blood clot has gone to the lungs.

. . . .

Anglo Nurse's Reminders of Spanish Translations

2010-01-22T01:34:00.004-06:00

Edited to add: I have used many Spanish/English healthcare translation books. Far and away my favorites and the two that I recommend are, Medical Spanish, An Instant Translator, by Nasr & Cordero, published by W.B. Saunders and Spanish for Health Care Professionals, by W.C. Harvey, published by Barron's. When making blog articles about specific healthcare teaching issues I look for links to reliable Spanish translations.

So many Google searchers are ending up at this article, but I urge you to use the search box in the right hand column to search my blog further, as you'll likely come to some helpful links to the specific Spanish translations you are looking for. Meanwhile I'll make it a project to blog a separate page devoted solely to links to good Spanish patient information.

Spanish phrases for me . . . in case I ever need them again

I'm putting a lot of miscellaneous information in my blog right now, things that have been useful to me at one time or another. I'm overwhelmed with papers that contain helpful information that isn't exactly at my fingertips.

Sometime back, I must have used this Spanish/English "cheat sheet" to help me ask pertinent questions when admitting pediatric patients in a mostly Spanish-speaking city. Just in case, I'm jotting these notes here for reference. Actually I had a lot of good Spanish/English medical references that I used to learn the important questions. I was seeking yes or no answers for the most part. Not being bilingual, I would most certainly refer anything beyond my expertise to my colleagues who were fluent. However, I learned to function very independently in most circumstances over time. It's been a while, so I'm rusty on some of this. I was happy that I was able to pick out some very glaring inaccuracies just now in a nursing journal article from 1999 that was among my papers. Seems they didn't proof read and about eight body parts were mislabelled in their list. : )

My List of Important Spanish Phrases for an Anglo Nurse (probably some mistakes here):

Don't be afraid, I'm here to make you feel better.
No tengas miedo. Estoy aqui para hacerles sentir major.

I'm going to weigh you.
Le voy a pesar.
Scale--bascula

I'm here to help.
Estoy aqui para ayudarla.

What have you given him/her?
Que le ha dada usted?

I hope you feel better soon.
Espero que se sienta mejor pronto.

Who's child is it?
De quien es el nino?

Is he taking any medications?
Esta tomando alguna medicinas?

What have you given?
Quye le ha dado Usted?

Are the shots up-to-date?
Esta al corriente sus vacunas su hijo/hija?

Was the baby exposed to TB?
Ha sido expuesto a la tuberculoses?
Contagiouis diseases=enfermedads entagiosos

How long sick?
Cuande se enfermo?

Last doctor visit?
Cuando en la ultima visita al doctor?

Was the birth/delivery normal?
Fue normal al nacimiento?

What was the birth weight?
Cuanto peo al nacer?

Was he premature?
Nacio su hijo premature?

Is he eating and drinking like usual?
Ha estado comiendo y bebiendoa liquidos como lo normal?
Esta tomando o comiento bien?

Does the baby sleep more than normal?
El (or Ella for a girl) bebe duerme mas de le normal?

Does he play like usual?
El bebe juega como lo normal?

Does he vomit right after taking formula?
Vomito immediamenta despues de toma su formula?

Have you changed the formula?
Le ha cambiado la formula.

How often----cada cuanto tiempo
How long ago-----hace cuanto tiempo
Entonces---then . . .
Almost always--casi siempre
Almost never--casi nunca

What kind of formula does he take?
Que marca de formula tomar?

You look very well.
Se va Usted muy bien.

I gave . . .
Le di . . .

I will give medicine for . . .
Voy adarle medicina para . . .

We are going to call the doctor.
Vamos a llarmale el doctor.

Dehydration--deshidratacion
Dehydrated--deshidratado

Crib--la Cuna

Toy--el juGete

Wash your hands.
Lavase las manos . . .

Patient Care Tech--Ayudante de enfermera
Therapist--Terapueta
Technician--tecnico

Birth defect--defecto de nacimiento
Blind--ciego
Deaf--sordo
Mentally retarded--retraso mental

Tonsils--las amIGdalas

Can he crawl/walk?
Puedes gateAR/caminar?

comiZON--itch

Bruise easily?
Se le hacen mohreTONes facilmente?

Scared--Ausustados
Unhappy--Infeliz
Angry--Enojado (if a girl: Enojada)
Happy--Contento
Depressed--Deprimido

Breakfast--El Daysayuno
Lunch--El Almuerzo
Dinner--Le cena

Body parts--just ones that I don't remember well

Ankle--tobillo
Buttocks--nalgas
calf--pantorilla
elbow--codo
Hair--pelo
Heel--talon
shoulder--hombro

Clothes--again, just a partial list

Robe--Bata
Pants--Pantalones
Socks--Calcitones
Stockings--Medias

. . .

Discharge Instructions: Trans Urethral Resection of the Prostate (English and Spanish version)

2010-01-21T23:43:00.004-06:00

*(Looking for other types of discharge instructions in English or Spanish? Click here).

I Hope You Were Given Some Discharge Instructions . . .

Waste not, want not. I'm reviewing my collection of patient educational materials which includes brochures and flyers that I've picked up over the last 14 years. This entry is a transcription of an undated, uncopyrighted, no author given, flyer that we used at Providence Memorial Hospital in El Paso, Texas as discharge instructions for our "TURP" patients (Trans Urethral Resection of the Prostate). El Paso County is roughly 90% Hispanic with Spanish being the primary language so it was essential to have discharge instructions available in both languages. I've included the Spanish version here and have linked (at bottom) to another blog post I created with LOTS of Spanish discharge instructions.

Looking at these TURP discharge instructions now, I'm surprised at what BASIC information our patients were given.

***TURP Patients: Be sure to look at the information you were provided at discharge to ensure you are following YOUR physician's post-op recommendations.***

Trans Urethral Resection of the Prostate, “Discharge Instructions”

What do I need to remember when I go home?

1. Eat well-balanced meals.
2. Drink at least eight (8) glasses of liquids per day, preferably water.
3. NO heavy lifting.
4. NO heavy straining.
5. Take a mild laxative if you have difficulty with bowel eliminiation.
6. NO strenuous exercise.
7. Keep all follow-up appointments with your physician.
8. Call your physician if you have:

Fever (101 degrees F or over) and/or chills
Persistent, heavy bleeding and/or clots
Inability to urinate
Severe Pain

Questions that you need to ask your physician:

1. When can I drive a car?
2. When can I go back to work?
3. When can I engage in sexual activity?

What should I do if I have bleeding?

Blood in the urine is a natural product of the healing process. You should drink ample amounts of fluid to “flush out the system” and prevent clots from forming.
If bleeding persists and clots form, call your physician.

Any Other Specific Instructions?

______________________________________________________

Reseccion Trans Uretral De La Prostata, “Instrucciones Para Cuidado En Casa”

¿Que Debo Recordar Al Irme A Casa?

1. Coma comidas bien balanciadas.

2. Tome por lo menos 8 vasos de liquidos al día, preferiblemente agua.

3. NO levante cosas pesadas.

4. NO se esfuerze en exceso.

5. Tome un laxante suave si Ud. tiene estreñimiento.

6. NO haga ejercicio rigueroso.

7. Asista a las citas con su doctor.

8. Llame a su doctor si Ud. Tiente:

Calentura (101 F o mas) y/o escalofrios
Sangrado persistente o coagulos
Inhabilidad de orinar
Dolor severo

Preguntas Que UD. Debe Hacarle a Su Doctor:

1. Cuando puedo empezar a manejar el coche?

2. Cuando puedo regresar a mi empleo?

3. Cuando puedo resumir actividades sexuales?

¿Que Debo Hacer Si Hay Sangrado?

La sangre en la orina es un producto natural del proceso de sanamiento. Ud. Debe tomar cantidades amplias de liquidos parea “enjuagar el sistema” y prevenir la formación de coagulos.

Si el sangrado persiste y coagulos se forman, llame a su doctor.

¿Otras Instrucciones Especificas?

*Click here: to link to my blog post with many more links to discharge instructions in Spanish *

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Patient Education Brochures and Booklets are Still Essential Despite the Internet: Where to Find Them?

2010-01-21T22:22:00.004-06:00

A Small Cost to the Provider, but Invaluable to the Public and the Patient

I mentioned in another blog post that I'm a bag lady when it comes to medical brochures. I expect to pick up something of interest if I happen to visit a health fair or health-related event. The vendors are not going to attract my interest by merely displaying a poster or a table-top video display. I want to pick up something that I can read when I'm ready. "Readiness to learn," after all, is a basic fundamental in the teaching-learning realm of education.

While the internet offers vast opportunities to find what we seek in the way of health information, I still have a desire for the traditional illustrated pamphlets that were so long a staple of patient education. I can attest that even now, in large hospitals that promote themselves as cutting edge, the lack of a patient educational handout means the lack of patient teaching. Period and end of story. I have never seen any patient willingly turn the TV to the patient education channel to learn more about their health needs.  A patient sick enough to be bedfast in the hospital is typically not online to search for health-related information.  And many patients can't afford the luxury of a laptop to bring to the hospital--or perhaps they are not internet savvy to begin with.

There is a real need, in my opinion to preserve the traditional patient education tools. In a pre-op or post-op teaching situation, computer based learning is not conducive to the one-on-one, individualized teaching that needs to take place. The patient brochures are awesome adjucts to this type of patient education interaction. Hospitals--start stocking more patient education brochures and making distribution of them a priority--please!!

Patient Education Publishers of Note

One of my favorite patient education brochures that I've kept is by the Channing Bete publishing company. Channing Bete has been in this business for decades and now boast a host of patient education products and services. I've had this booklet so long that I see it's been replaced by an updated version. The one I have (in two versions, English and Spanish): "Sooo . . . You're going to have an OPERATION" and "De mondo que . . . le van a OPERAR!" And the newest versions: About Having Surgery, About Ambulatory Surgery, and for kids: Same Day Surgery: A Coloring and Activity Book. Honestly, these publications are sublime in their simplicity and ability to communicate the need-to-know basics of surgery day to patients and their loved ones.

Krames Education Products and Services is an offshoot of a larger company called Staywell. My old favorite publication by Krames is called, "Pressure Ulcers, Your Role in Prevention and Treatment" (aimed at nurses.) Now there is a newer version on their website called, "Pressure Ulcers Prevention and Treatment." These are great publications for caregivers with wonderfully detailed illustrations and excellent explanations. Find other worthwhile topics for patient education from their catalog:
Krames Patient Education Print Materials

One thing about physician's offices these days--there are not a lot of actual nurses in these settings. Nurses are more expensive than medical technicians, so physicians tend to employ more of these unlicensed assistants. The loss of professional nurses in that setting allows for a gap in patient teaching.  Often in pre-surgery teaching sessions bewildered patients who had already been with their physicians for a previous appointment to determine that surgery was necessary, would admit that they had no real idea what their upcoming surgery entailed. And for some of the complicated surgeries they didn't know how to spell the procedure correctly in order to search for appropriate information online. I found that Colen Publishing offers a dozen or so titles to explain surgical procedures (often ones that are in the neurosurgery realm), these titles cover Craniotomy, Laminectomy, Ventricular Shunt, Cervical Fusions and more. See an example of one of their Tri-Fold Surgery Cards: Anterior Cervical Discectomy and Fusion. I think it would be a great service for a patient anticipating surgery to have one of these nice explanatory tri-folds instead of trying to (alone) search out information online that may or may not pertain to their particular situation and surgery.

Of course the American Cancer Society and National Cancer Institute offer many wonderful publications about cancer, but please don't overlook the three that are available free from the Patient Resource Cancer Guides (3 titles available free to patients & in bulk to hospitals or clinics.) Place your order today: Patient Resource.Net.

Some other worthwhile sources of hard-copy patient educational brochures:

National Institue of Health Publications for Consumers, see also titles in Spanish.
American Cancer Society free brochures
Public Health Foundation Learning Resource Center
National Cancer Institute, "What you need to know about . . . " (various cancer topics)

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Learn about Your Asthma and Allergy Medications

2010-01-21T18:28:00.004-06:00

The American Academy of Allergy Asthma and Immunology (AAAAI) website has a section devoted exclusively to patients and consumers. You'll find all kinds of information there for parents, children, senior citizens, and school nurses, etc.

Tips to Remember . . .

A highlight of this website is online access to the AAAAI's patient education brochures from their "Tips to Remember" patient brochure series. (Spanish tips brochures are also available.)

Get the most out of your asthma and allergy medications. Learn more about them in these two brochures available for download: Tips to Remember: Asthma and allergy medications and Tips to Remember: Inhaled Asthma Medications.

For quick, basic information about all kinds of medications used to treat allergic reactions (including those used for the eyes, nose, skin, lungs, etc.) check out AAAAI's: Allergy and Asthma Drug Guide.

Youtube Video: Basics of Asthma Treatment

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ERCP (Endoscopic Retrograde Cholangiopancreatography)

2010-01-21T17:20:00.002-06:00

The Society of Gastroenterology Nurses and Associates (SGNA), Inc. distributed this patient education handout back in the mid-1990's and I have always found it to be very useful. Certainly there are many easily accessed patient education tools about ERCP via the internet, for example this one this one courtesy of the Jackson/Siegelbaum Gastroenterology Group in Camp Hill, PA is especially nice.

Because my copy of the pre-internet ERCP patient information handout distributed by the SGNA is tattered and of poor quality, I'm transcribing this helpful patient education handout below. It's undated, no author listed and lacks a copyright statement. (Today I inquired with Kathleen O'Brien from SGNA via their online support suite chat feature and received no objection to transcribing this information here for the purposes of my blog readers.)

Patient Education: ERCP (Endoscopic Retrograde CholangioPancreatography)

After careful medical assessment, your doctor has recommended that ERCP be performed for further evaluation and treatment of your condition. ERCP is a valuable examination of the diagnosis of many diseases of the pancreas, bile ducts, liver and gallbladder. ERCP allows the doctor to perform necessary treatments such as enlarging a bile duct opening, removing gallstones lodged in the bile duct, inserting a stent (drain) in the duct or taking a biopsy specimen (tiny bit of tissue).

A flexible fiberoptic tube (duodenoscope) is passed through the mouth, esophagus (food tube) and stomach into the duodenum (first part of the small intestine.) The ampulla (opening where the bile and pancreatic ducts empty into the duodenum) is then identified. A small plastic tube (cannula) is passed through the duodenoscope into the ampulla. X-ray dye is injected through the cannula into the ducts. X-rays are then taken to study the ducts. Any necessary treatments can be performed at this time.

Dentures and eyeglasses must be removed prior to the start of the procedure. You may prefer to remove contact lenses at this time.

You will be asked to sign a consent form authorizing the doctor to perform the procedure.

Be sure to tell the doctor and the GI nurse if you are allergic to any medicines, x-ray dyes or iodine products.

A needle for intravenous (IV) medicines and fluids will be placed in your arm vein. Medicine will be injected through the IV needle that will make you sleepy and relaxed. Your doctor may also spray your throat or ask you to gargle with a numbing medicine.

You will lie on an x-ray table on your left side and a small plastic mouthpiece will be placed between your teeth. You will be able to breathe normally. The doctor will help you to swallow the lubricated flexible duodenoscope tube. When the tube is present in the duodenum, you will be helped to turn onto your abdomen with your head turned to the right.

During the procedure you may feel some abdominal fullness or bloating due to the air which the doctor puts into the duodenum. As the X-ray dye is injected into the ducts, you may feel some mild discomfort. These feelings should be completely tolerable and not painful.

After the duodenoscope is removed, you may be asked to move into various positions so that more X-rays can be taken.

Many people do not recall any of the procedure because of the effect of the medicine. After the procedure you will probably feel drowsy and may sleep for a short time. After you have rested, the doctor will discuss the findings with you.

If you have any questions please feel free to ask the doctor, the GI nurse, or the technician.

More ERCP factsheets for patients:

"A+" link: http://www.gastro.org/wmspage.cfm?parm1=860 from the American Gastroenterologic Association
National Institues of Health Factsheet on ERCP

GI Care Endoscopy Center, ERCP
PDF format with excellent format and info for patient teaching

. . . . . . . .

Getting Rid of Lice

2010-01-21T03:31:00.006-06:00

Pediculosis (Ped-ICK-u-LO-sis)--the scientific name for lice

When I worked as a telephone advice RN for a large health insurance company, often our after-hour calls were from young parents with questions about their childrens' health. While most of the calls related to febrile and respiratory illness, parents called about any number of concerns. We regularly fielded calls from parents who were surprised and frustrated as they battled head lice that their children brought home from school.

Head lice is not a pleasant topic, and it tends to make one itch a bit at just the thought of these pests invading the sanctity of our precious children's hair and, of course, our beloved homes. I would like to say that it's a quick and easy fix to resolve a lice infestation, instead I'll have to assert that the steps taken to rid lice from your life require some dedicated effort and diligence.

Rich or Poor, Clean or Dirty: Lice do not Discriminate

Headlines were made in our local paper some years back when we lived in El Paso, Texas. The reason? An outbreak of head lice at one of the most prestigious private schools in town. The children of the ultra-rich were affected and local interest in the story piqued. There is a notion that lice infest only the poor and unclean, but that simply is not the truth--they have no such boundaries.

Don't Treat Unless You are Sure

A tickling feeling or an itchy scalp may be a sign that there are lice present, but it's absolutely necessary to visually inspect the scalp to be certain. Be sure to treat only the individuals who actually have lice or nits; this is so important when using chemical treatments as lice can become resistant to these medications when they survive repeated applications. Therefore, use such treatments sparingly and absolutely in accordance with the directions provided by the manufacturer.

Check for lice: In bright sunlight or with strong lamplight, carefully check the scalp and roots of the hair. Lice like to spend their time in dark areas so they are typically found in the nape of the hair behind the ears and at the bottom portion of the hairline. Nits (lice eggs) cling to the base of the hair by means of a glue-like substance, but those unfamiliar could misidentify normal scalp flaking or dandruff with nits. Ask your child's school nurse for guidance if you are not certain about what you are seeing. Note: A recent German study found that wet combing the hair was more effective in finding evidence of lice infestation than the naked eye.

Remove lice and nits: For best results, use a good quality fine-tooth-comb (like a metal flea comb) and a pair of reliable tweezers to remove the adult lice and the nits. (The directions never say what to do with them after they are removed, I would have to suggest disposing of them in a little container of rubbing alcohol to make sure they are dead, or perhaps in a hot soapy water.)

Getting Rid of Head Lice, Home Cures and Medications

Please check out the links below to learn more about head lice and the recommended methods for getting rid of the lice and their nits. There are a variety of home remedy or folklore cures that may help get rid of head lice without the use of chemicals. Nevertheless, such cures typically involve a fine-toothed-comb, some type of shampoo, and a thick gooey application of (mayonnaise or something similiar) to the scalp for an extended period to smother the lice followed by more shampoo and meticulous combing to remove the nits. As for home remedies, I'm not going to provide detailed information about any one in particular, but I urge you to please be careful and exercise good judgment if you go that route. Some home remedies call for wrapping the hair of the head in a plastic bag overnight and that is certainly NOT something that is safe for a child due to the risk of suffocation--I shudder to think of it.

The FDA recommends a first-line and second-line approach about the medications available to combat head lice. There are two alternate medical regimens which are suggested as first-line treatments. One of these first-line treatments is a very new one, approved in the Spring of 2009. It's a lotion for the scalp that is made with Benzyl Alcohol. Like some of the home remedies, this lotion is geared toward smothering the lice. Read more about this type of product here.

The other first-line FDA-approved medications are the lice-killing shampoos that can be purchased over-the-counter at any drugstore. Bear in mind that unless you approach this as a multi-stepped process, you will be disappointed with the result. When using these shampoos it's still necessary to comb for nits and be persistent in following a daily routine until you are certain that the eggs are all gone. In addition, hairbrushes, pillow cases, sheets, nightclothes, caps and hats, etc. need to be washed and dried using a HOT temperature to kill any vermin crawling on them. Look for more advice about cleaning the environment on the links provided below.

Second line chemical treatment for lice includes some powerful shampoos that are essentially pesticides. These are only available with a physician's prescription, and they are only meant to be prescribed if the first-line medication(s) are not successful in treating the infestation. These strong shampoos contain "black box warnings" because of the known possible adverse effects. They can be neurotoxic (harmful to the brain or nervous system) if used in excess or if used on vulnerable individuals. Seizures or even death may result if the directions are not adhered to. These medications are definitely NOT to be used on premature infants or individuals with known uncontrolled seizure disorders. When indiciated they are to be used WITH CAUTION because of the risk for serious neurotoxicity for infants, children, the elderly, anyone who weighs less than 110 lbs (50 kg) and individuals with skin conditions like eczema, dermatitis, and psoriasis.

Recommended Sites for More Information about Head Lice:

Comprehensive head lice information from Medicinet/WebMD
National Association of School Nurses: S.C.R.A.T.C.H. campaign
Fact Sheet for Parents from National Association of School Nurses
Center's for Disease Control Head Lice Fact Sheet
CDC's Head Lice Information Page
http://www.headlice.org/ (National Pediculosis Organization)
About.com, Headlice

Links to information in Spanish about head lice or "Piojos de la cabeza":

Center's for Disease Control and Prevention, http://www.cdc.gov/lice/head/sp/index.html.
National Pediculosis Organization, http://www.headlice.org/spanish/index.html.

National Association of School Nurses President talks about head lice in this video:

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Bayer Diabetes Web Site and a Helpful Book about Diabetes for School-Aged Children and their Teachers

2010-01-20T21:02:00.004-06:00

My Health-Brochure Collection

I am a bag lady. That is . . . when it comes to state fairs, county fairs, health fairs or displays of health- related-flyers at the doctor's office, pharmacy or anywhere else, I eagerly pick up a copy of whatever looks like good information for patients. My bag full of brochures may not garner my attention again for a while, but I'm reluctant to get rid of any of it until I've carefully considered each item. My current goal is to whittle down the stack of brochures and booklets that I've had way too long. One brochure in my collection can't go to the trash without a few words of disapproval . . .

But . . . I Don't Always Like what I Collect

Sometime back at the endocrinologist's office I selected a brochure in the waiting room called, "Will Diabetes Ever Be Cool?" It was published by Bayer Healthcare Diabetes Care ostensibly as patient eductation, but actually as a mechanism to influence interest in their Ascencia Contour Blood Glucose Monitoring System. I'll happily place this booklet in the trash tomorrow, but not after commenting here about why I utterly despise this booklet. Happily, it's old enough that I doubt this stupid little pamphlet is still cluttering up any doctor's waiting room.

Why I hate this booklet: "Will Diabetes Ever Be Cool?"

Honestly, it doesn't take a psych course in Erikson's stages of childhood development to recognize that kids want to fit in with their peers and be cool. We who have survived childhood know that fitting in and thriving socially is difficult enough without the added burden of a chronic disease or medical condition. And in truth, to have (or not have) diabetes doesn't necessarily have any impact on the tenuous and multi-faceted intricacies of "coolness." This booklet is obviously aimed at kids, the cover and first few pages are designed to look like typical notebook scribbles and graffiti, and I hold Bayer responsible for a poor effort in producing this booklet for mass distribution in the diabetes community.

I truly believe that even if I wasn't the parent of a type 1 diabetic I would still find it outright offensive to ask a kid, "Will diabetes ever be cool?" And then to answer the question on the inside cover with a huge "NO," followed by the condescending: "after all, it's a disease." Other similar want-to-be gems of wisdom on those first few pages aim to reassure kids that despite their uncool diabetes "there's nothing to be ashamed of," "just accept it," and "the best attitude is NO BIG DEAL." The end of the kids' section plants a rather mixed message of "just remember you are no different than anyone else."

Wow, Bayer, NO thanks for this horrid little brochure and let me suggest that to avoid publishing such insulting drivel in future you enlist the expertise of an MPH with experience in behavioral theories and media marketing. This brochure is insulting to kids who are learning to manage Type 1 diabetes. From day 1 with Type 1 diabetes, both parents and kids KNOW that managing this condition absolutely IS a BIG DEAL. Yes, it gets easier to manage Type 1 Diabetes with experience and education. With an eye on today, we can prevent future complications of the illness that are absolutely a big deal. It's unconscionable to present such a mixed up message and an insulting one to young people who are depending upon a responsible message.

One good thing about the brochure--Suggestion for a kid-friendly book on diabetes

This booklet has one redeeming factor in that it recommends a book for kids in elementary school called, "Taking Diabetes to School," written by Kim Gosselin, mother of a Type 1 Diabetic .  If you are a parent, teacher or school nurse this book appears to be a good investment in cultivating peer-understanding that will help a youngster with Type 1 diabetes both meet their unique needs and assimilate into the school routine.  I had never heard of this children's book before, but it does have good reviews online and the price is certainly reasonable (check it out on your favorite online book site).

Bayer's Current Diabetes Website

I visited the Bayer diabetes website before writing this piece, mostly to confirm that this horrid booklet is no longer part of their offerings (and I can't find it there). Their current diabetes-related campaign is called Simplewins. The information they offer appears worthwhile. Check it out and you are likely to find something of interest. Of course product marketing drives the site, so be prepared for advertising about their glucose meters.  (I glimpsed one that is a USB drive, very nice for easy downloading the meter-data without needing to order extra cables and software.)

Looking at the bright side (with humor)

While the truth is we don't want any kid to have to deal with a chronic medical condition, we don't need to rub their nose in the "uncoolness" of it all. I found this blog link to offer just the right amount of wit and good humor as the author offers 5 reasons why having diabetes is cool.

. . . .

What You Need to Know about the Johnson & Johnson (McNeil Products) Voluntary Medication Recall: Tylenol, Motrin, Simply Sleep, Rolaids, St. Joseph's Aspirin, Benadryl Allergy

2010-01-16T02:46:00.003-06:00

What's going on?

What started in December of 2009 as a recall of certain Tylenol Arthritis formula pain reliever has now expanded to a voluntary recall of an array of over-the-counter medications marketed by Johnson & Johnson/McNeil Consumer Healthcare. It seems that some consumers have become ill with gastrointestinal complaints including nausea and vomiting due to a musty or moldy odor and taste caused by traces of a chemical called 2,4,6-tribromoanisole (TBA) which has leached into certain lots of the tablets. Read the company's press release to learn complete details about this recall.

What to do?

Don't panic. Simply check the identifying lot numbers of your products (Tylenol products, Motrin products, Benadryl Allergy Ultratabs, Simply Sleep, Rolaid antacid tablets, and St. Joseph aspirin products). You will find the lot number on the side of the bottle's label. Compare your product's lot number with the list of affected product lot numbers that the manufacturer has provided (here) on their web site.

If you have products that are affected, stop using them. Contact the manufacturer through the toll free number they've established for this recall (see below) and they will tell you how to return or dispose of the product. They will also tell you how to get a refund or a replacement.

Need to Contact the Manufacturer?

Call the company's toll free recall line: 1-888-222-6036 (Monday through Friday 8 a.m. to 10 p.m. Eastern Time, or Saturday and Sunday 9 a.m. to 5 p.m. Eastern Time).

Log on to the manufacturer's website to learn more about this recall as it unfolds: www.mcneilproductrecall.com.

Feel that your health has been affected by one of these products?

Contact your healthcare provider for immediate medical questions or health concerns. If you have noticed a serious adverse effect or reaction, you may also report it to the FDA's MedWatch Program by completing an online reporting form or by downloading the form to complete by hand and faxing it to 1-800-FDA-0178, or mailing it to MedWatch, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787.

. .. . .

Going to Haiti to Provide Aid or Healthcare? Some Helpful Reading about Haitian Health Beliefs . . .

2010-01-14T21:05:00.010-06:00

I'm not going myself, but was contemplating the scenario that many humanitarian delegations will be embarking on over the next days, weeks, and months. I've never been to Haiti, and I've never been part of a massive disaster recovery aide mission. As a registered nurse with a great interest in public health, I surely understand the cultural implications of healthcare delivery. Whether it be a disaster or not, it's always necessary to respect the cultural beliefs and practices in the host nation.

For those seeking information in advance of their deployment to Haiti to render aid, I'm sure you are Googling for information. I know you will find many scholarly articles that discuss some aspects of cultural relevance in the Haitian culture. Most notably the articles I've seen address HIV-related treatment, diarrhea in children, and influenza vaccination. I'm not linking to any of those articles since they require a paid subscription to read them and my budget (and perhaps yours) won't accomodate the luxury of unlimited access to those scholarly articles at this point. (As a side note, wouldn't it be a wonderful and valuable altruistic gesture on the part of publishers to release those Haitian-related publications for full-access at a time when the world attention is focused on wishing to help the unfortunate victims of this disasterous earthquake?)

Here are a few (for the most part free) readings that may augment your current knowledge about Haiti and the healthcare practices and beliefs of the Haitian people.

Library of Congress Country Studies: Haiti
Salisbury University article on Haitian culture and health beliefs
U.S. Committe for Refugees, a health handout in Haitian Creole listed here for your information as I realize that the information contained herein is not relevant to the emergent needs you will be serving. Still this appears to be a really nice publication: Eating a balanced diet--Haitian version (pdf)
From what I've read, communication can be tricky as the Creole language is primarily and may include difficult dialects. French may be understood by an individual, but apparently it is often on a more formal level and not the language of health literacy, so to speak. In that case, it would be wonderful to have access to the Massachusetts General point talk book as their website specifically endorses its value with Haitians among others. This publication must be ordered, but I'm sure there would be a way to access a copy very quickly if you contact them: About Mass General PointTalk Interpretor Tool
U.S. based nurses brief (list-serve-type) discussion of nursing experiences in the Haitian culture
Looks like A plus information: A group of relevant articles of experiences of Western healthcare providers who have worked on health projects in Haiti: http://www.encyclopedia.com/doc/1G1-53893762.html But you have to register for a 7-day-free subscription to Highbeam Research in order to read this group of articles. Credit card info is required, then don’t forget to cancel the subscription after 7 days or you will be charged a monthly $29.00 for access.
From scribd.com comes the article embedded below:

Haitian-American Article

Please feel free to leave a comment with advice based on your personal experiences or links to information that will help caregivers heading for Haiti.

. . . .

How to Give Medication to Infants and Toddlers: Ear Drops and Oral Medications

2009-12-16T16:12:00.000-06:00

Yesterday I was writing about corneal abrasions and the medications that a physician will likely prescribe after such an injury occurs.  It occurred to me today that listing some good links on "how to" administer eye drops (and other prescribed medications) to infants or toddlers would be a good idea.

Based on my past years of working as a pediatric registered nurse, I know how difficult it can be to medicate infants and toddlers.  In order to give the medication with the minimum of fuss, it's best to swaddle (wrap) an infant gently but firmly in a receiving blanket so that the baby's arms are fixed at his/her side.  For an older toddler, it may very well take two people to give necessary medication.

Here are two websites with rather nice information about how to give medication to infants and toddlers:

Great Ormond Street Hospital for Children: How to Give your Child Eye Drops

From the Ohio State University Medical Center: How to Give Your Baby Medicine by Mouth

Follow the Doctor's Orders

Give your child medication that is prescribed for him or her. Don't borrow or share medication meant for someone else. Store the medication as directed by your pharmacist's instructions. Most antibiotics will need to be refrigerated. Continue to give the prescribed medication for the entire period that the doctor has ordered. Don't stop the medication early because the child "seems better." Doing so can cause lingering infections that become resistant to the medication.

Do Not Give . . .

Never give aspirin to infants or children. Check the lable of any medication you intend to give. If any of the ingredients contain salycilic acids don't give your child the medication. Check the labels on all of your over-the-counter medications. Look for "black box" warning labels and other instructions to parents.  Recently many cold and cough medications have been deemed dangerous to young children and the new packaging reflects such information.

Talk to your pharmacist . . .

Pharmacists do more than fill your prescriptions. They will gladly discuss over-the-counter medications with you and help you find appropriate options for your child. In addition, consult your pharmacist to determine whether or not the prescribed medication can be made more palatable for your child--by adding "better" tasting flavors by compounding the medication.

. . . .

Corneal Abrasion, Corneal Scratch, Pain and Sensation of Something in the Eye

2009-12-16T04:21:00.007-06:00

“It feels like something is in the eye, and it's very painful.”

Why I’m compelled to write about this topic today: Recently one of my patients was expected back from surgery after undergoing a complicated procedure to repair a fracture. Shortly before the young man was due to arrive in his hospital room, the nurse from the surgical recovery care unit called to report that he was experiencing severe pain in one eye along with a sensation of “something in the eye.” The surgeon was aware and had ordered an eye flush. Although the nurses in recovery had copiously irrigated the eye with sterile water, the patient’s extreme discomfort persisted. The pain from his orthopedic surgery was nearly eclipsed by the pain and irritation in his eye. Close examination hadn’t revealed any obvious reason for the persistent eye pain. When he arrived on our floor, the patient’s affected eye was “bloodshot,” very sensitive to light, and he was writhing due to the combination of both eye and surgical incision pain. The surgery resident physician was soon at his bedside. She ordered an application of “Lacrilube” ointment to soothe the eye and diagnosed a corneal abrasion. Having participated in the surgery, she remarked that the affected eye “really wasn’t taped closed well enough” during the lengthy surgical procedure.

Corneal Abrasions

There are a number of reasons why a cornea might be scratched or irritated resulting in an abrasion. Although they are extremely tiny, corneal abrasions, are very painful . . . and why not? After all, even a paper cut to our fingertips can cause startling pain. Often a small corneal abrasion will heal itself within 24 hours. There is treatment that may soothe the affected eye, such as sterile artificial tears (see below for further discussion of additional treatments). Keep in mind, however, not all eye pain is due to a corneal abrasion, and not all corneal abrasions may be treated with home care alone.

Some Structures of the Eye

To understand what the cornea is, it’s useful to think of the eye as a room with the cornea being a window. The eyelids are similar to shutters that can be opened or closed. The space between the shutters and the window glass is the conjunctiva. The cornea functions as the window glass does; that is, the light flows through the cornea to enter the eye. Directly behind the cornea is the round, colored iris which functions in much the same way as curtains; the muscles of the iris expand and contract to allow more or less light inside of the “room.” The pupil is the space through which the light passes between the open curtains. The lens is yet another “window pane” that the light passes through before it enters the room. My suggestion is to think of the lens, for this example, as a large glass “sun catcher” suspended from the ceiling just inside the window. Vitreous humor is the gelatinous substance that fills the center of the eye just as normal atmospheric gasses fill up a room in your home. The retina is the back wall of the room just opposite from the window. As light strikes the “wall” (retina) there is inevitably a particular spot where the sunlight is more concentrated. The macula in the back of the eyeball is similar to that part of the room with the brightest exposure to the light. The fovea is an area of the macula which provides the sharpest vision; similarly the brightest spot in the room is best for reading or performing tasks that require sharp visual acuity.

(See a nice depiction of the eyes' anatomy here: http://www.eyecareamerica.org/eyecare/anatomy /).

A Little More About the Cornea

As mentioned in the preceding paragraph, the cornea functions like the glass of our windows. It’s a protective structure for the more delicate features behind it, and it functions to let light flow into the eyeball. Although the cornea consists of five distinct layers, it is very thin—with a depth of only about 1 mm at its deepest point.

The cornea has an abundance of nerve endings, as a result it’s very sensitive to both touch . . . and pain.. That trait helps protect our vision from trauma as all of our instincts quickly react to try to prevent an injury to the eye. However, corneal abrasion is still one of the most common eye injuries.

How Does a Corneal Abrasion Occur

A person may have no recollection of trauma to the eye and there are numerous scenarios that may result in a corneal abrasion. A poke in the eye (particularly if a fingernail is involved), a branch from a tree, flying glass or metal shards, or a surgical drape or equipment brushing across your eye if it is exposed during a surgical procedure . . . any of these things can cause a corneal abrasion. Debris in the eye can also cause an abrasion, particularly when the eyes are rubbed vigorously or if a contact lens causes friction.

Prevention during Surgery

Taping the eyes closed is a standard preventive measure aimed at protecting the eyes from corneal abrasion. Some surgeries pose a greater risk of a corneal abrasion occurring. Those in which the patient is positioned face down, surgery on the head or neck, and any lengthy procedure carries more risk. Of course in some surgeries taping is contraindicated as the eyes may need to be opened during the procedure. In such cases the anesthesiologist or nurse anesthetist will use their judgment to make the appropriate decisions. Instillation of eye drops, gels or eye ointments may be the decided course of prevention, or special goggles, eye cushions or pads may be used.

Diagnosis

Your doctor may use a combination of fluorescent dye and either a cobalt-blue filtered ophthalmoscope or a “slit-lamp” to make a definite diagnosis of a corneal abrasion. The physician may instill drops to temporarily numb the eye during the exam. If they observe a foreign body present in the eye, it will also be removed during this examination.

Treatment

At one time eye patches were applied when patients suffered a corneal abrasion. This is no longer a standard treatment; however, in some cases your physician may determine that an eye patch is in your best interest. It’s more likely that eye drops or ointment will be prescribed for home use. The drops and/or ointments may include a medication to control the pain, an eye lubricant, a topical antibiotic, or a steroid. Steroid eye drops may be prescribed to reduce inflammation. (Please note, some of the eye drops and ointments may result in temporarily blurred vision). Occasionally, a pain medication to be taken by mouth will be prescribed as well.

If metal shards were responsible for your eye injury, a tetanus booster shot will be needed. If it has been more than 5 years since your last tetanus shot--or if you cannot remember when your last tetanus shot was given--you will should be given a booster shot after the eye examination.

Follow your physician’s orders and use the medications exactly as prescribed. Do not stop the medication sooner than the directions tell you to simply because the eye “feels better.” Continuing the full course of prescribed treatment is important to prevent possible complications later on.

If you have questions about your doctor’s ordered treatment, ask him or her. You have a right to know the reason for the treatment decisions that are made on your behalf.

How long to heal

A small corneal abrasion may heal in a few hours. Often after a night’s sleep the cornea has healed. In the case of a larger abrasion, it may take several days time for complete recovery. It is important to keep from rubbing the affected eye as that may delay healing. If the symptoms suddenly recur after the initial healing phase, consult your physician right away. Inadequate treatment of a corneal abrasion can sometimes lead to complications such as a corneal erosion.

First Aid for Eye Emergencies

Plan to seek treatment at your urgent care center or ER for any bleeding from the eye, chemical splash, visible scratch or penetrating injury, eye pain, double or blurred vision, nausea and headache.

Do not rub the injured or irritated eye. Wash your hands with soapy water. Remove contact lenses if they are in place. Do not attempt to use any tweezers or cotton swabs to try to treat eye emergencies at home.

Chemical splash to the eye: Start flushing the eye with cool clean water from a sink, bottle, hose, etc. Tilt the head back and to the side. Keep the affected eye wide open and pour the clean water gently but directly into the eye. Make sure the head is tilted away from the “good eye” so that chemicals which are rinsed out don’t flow into that eye during the flushing process. (A child might be more comfortable laying down in an empty bath tub to have the eyes irrigated.) Continue to flush chemicals from the eye continuously for at least 15 minutes. Call 911 or have someone drive you to the ER. If the chemical that splashed into the eyes is known, be sure to provide the name to the healthcare providers at the hospital. For more information see:
First aid tips for a chemical splash to the eye from the Mayo Clinis.

Foreign body in the eye: Do not rub the eye. With clean hands, open the eye and allow tears to move the foreign body (such as an eyelash or speck of dirt). Rinse the eyes with cool clear water as explained above if tearing isn’t effective. If an object is embedded in the eye—do not attempt to remove it. Seek medical help in the ER or urgent care center immediately. For more information see: Mayo clinics advice on corneal abrasion and Mayo's first aid advice for a foreign body in the eye.

Bleeding from an eye: Do not put any pressure on the eye, gently cover it with a clean cloth and go directly to the Emergency Room. (The person with the injured eye should not drive).

2009 All rights reserved for content and photos, Carolyn Cooper, MPH, RN
References:

WebMD: http://www.webmd.com/eye-health/tc/objects-in-the-eye-home-treatment and http://firstaid.webmd.com/corneal-abrasion-treatment

Eye Safety for Emergency Response and Disaster Recovery from the CDC: www.cdc.gov/niosh/topics/eye/eyesafe.html

Wilson, S.A. and Last, A. (2004). Management of Corneal Abrasions. American Family Physician. Retrieved 12/16/2009 from: http://www.aafp.org/afp/2004/0701/p123.html

Verma, A. (2009). Corneal Abrasion. Emedicine from WebMD. Retrieved 12/15/2009 from: http://emedicine.medscape.com/article/1195402-overview

First Aid for Eye Emergencies from Prevent Blindness: http://preventblindness.org/safety/firstaid.html

Tarmey, N. & White, L.A. (2009). Chapter 5, Damage to the Eye. Risks associated with your anaesthetic, Information for patients: the Royal College of Anaesthetists. Retrieved 12/16/2009 from:
http://www.rcoa.ac.uk/docs/Risk_5Eye-damage.pdf

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Window Blinds and Shades Recall: Safety Information and Free Cord-Repair Kits

2009-12-15T17:59:00.001-06:00

Get a Free Kit to Make Your Old Blinds, Shades, and Curtains Kid-Safe

Do you know how old your window blinds, shades, or curtains are? Blinds sold after 1995 were manufactured particularly to eliminate a dangerous loop that was implicated in stragulation deaths of 140 children. But the pull-cord-loop is not the only known window covering hazard. The older your window coverings are, the more likely you may benefit from the U.S. Consumer Product Safetly Commision's (CSPC) December 15, 2009 recall. The CSPC has teamed with the Window Covering Safety Council to provide important safety information and free cord-repair kits.

Check out these websites for more information, diagrams, photos and videos that show the potential dangers window coverings may hold for children, and be sure to pass this information along to your child's grandparents, childcare providers, or other appropriate individuals:

Window Covering Safety Council Recalls to Repair All Roman and Roll-Up Blinds Due to Risk of Strangulation--Press Release

WASHINGTON, D.C. - The U.S. Consumer Product Safety Commission (CPSC) and the Window Covering Safety Council (WCSC) are announcing today a voluntary recall to repair all Roman shades and roll-up blinds to prevent the risk of strangulation to young children. This recall involves millions of Roman and roll-up blinds. About five million Roman shades and about three million roll-up blinds are sold each year.

CPSC has received reports of five deaths and 16 near strangulations, since 2006, in Roman shades and three deaths, since 2001, in roll-up blinds. Strangulations in Roman shades can occur when a child places his/her neck between the exposed inner cord and the fabric on the backside of the blind or when a child pulls the cord out and wraps it around his/her neck. Strangulations in roll-up blinds can occur if the lifting loop slides off the side of the blind and a child’s neck becomes entangled on the free-standing loop or if a child places his/her neck between the lifting loop and the roll-up blind material.

“Over the past 15 years, CPSC has been investigating window covering hazards and working with the WCSC to ensure the safety of window coverings. We commend the WCSC for providing consumers with repair kits that make window coverings safer and look forward to future steps to eliminate these hazards,” said Inez Tenenbaum, CPSC Chairman.

Over the years, CPSC has been investigating deaths associated with different types of window coverings and has worked with the WCSC to address the hazards posed by them. In 1994 and in 2000, CPSC and WCSC announced recalls to repair horizontal blinds to prevent strangulation hazards posed by pull cord and inner cord loops. As a result of CPSC investigations, the industry has modified its products and provides free repair kits for existing horizontal blinds and other window coverings. In October 2009, CPSC issued a new safety alert to warn parents about the dangers associated with window coverings.

Consumers that have Roman or roll-up shades in their homes should contact the WCSC immediately at www.windowcoverings.org or by calling (800) 506-4636 anytime to receive a free repair kit.

To help prevent child strangulation in window coverings, CPSC and the WCSC urge parents and caregivers to follow these guidelines:
Examine all shades and blinds in the home. Make sure there are no accessible cords on the front, side, or back of the product. CPSC and the WCSC recommend the use of cordless window coverings in all homes where children live or visit.
Do not place cribs, beds, and furniture close to the windows because children can climb on them and gain access to the cords.
Make loose cords inaccessible.
If the window shade has looped bead chains or nylon cords, install tension devices to keep the cord taut.
CPSC is still interested in receiving incident or injury reports that are either directly related to this product recall or involve a different hazard with the same product. Please tell us about it by visiting https://www.cpsc.gov/cgibin/incident.aspx

To report a dangerous product or a product-related injury, call CPSC's Hotline at (800) 638-2772 or CPSC's teletypewriter at (301) 595-7054. To join a CPSC e-mail subscription list, please go to https://www.cpsc.gov/cpsclist.aspx. Consumers can obtain recall and general safety information by logging on to CPSC's Web site at http://www.cpsc.gov/.

Children Can Strangle in Window Covering Cords--Press Release

In cooperation with the U.S. Consumer Product Safety Commission (CPSC), the Window Covering Safety Council (WCSC) announced recalls to repair horizontal window blinds to prevent the risk of strangulation to young children. The recalls involved millions of window blinds with pull cords and inner cords that can form a loop and cause strangulation.

From 1991 to 2000, CPSC received reports of 160 strangulations involving cords on window blinds: 140 strangulations involved the outer pull cords, and 20 involved the inner cords that run through the blind slats.

In 1994, CPSC worked with the window covering industry to redesign new window blinds to eliminate the outer loop on the end of the pull cords and provide free repair kits so consumers could fix their existing blinds. Window blinds sold since 1995 no longer have pull cords ending in loops.

In 1999, CPSC began a new investigation of window blind deaths. In an extensive review of incidents, CPSC found that children could also become entangled in the inner cords that are used to raise the slats of blinds. These entrapments occur when a young child pulls on an inner cord and it forms a loop that a child can hang in. All of these deaths involved children in cribs or playpens placed next to windows. In most cases, the outer pull cords were placed out of reach, but the children still strangled when they pulled on the inner cords of the blinds. The strangulation victims ranged in age from 9 months to 17 months.

As a result of the CPSC investigation, the industry has further redesigned window blinds. Window blinds sold since November 2000 have attachments on the pull cords so that the inner cords can’t form a loop if pulled by a young child. Consumers with blinds bought before Nov. 2000 should repair them.

Consumers who have window blinds with loops should immediately visit WCSC (http://www.windowcoverings.org/) or call 1-800-506-4636 to receive a free repair kit for each set of blinds. The repair kit includes small plastic attachments to prevent inner cords from being pulled loose. Instructions for cord stop installation (http://www.windowcoverings.org/) are easy and repair can be done in minutes without removing blinds.

The kit also includes safety tassels for pre-1995 window blinds with outer pull cords ending in loops. Consumers should cut the loops and install the safety tassel at the end of each pull cord.

Consumers who have vertical blinds, draperies or pleated shades with continuous loop cords can also order from the same toll-free number a special tiedown to prevent strangulation in those window coverings.
Parents should keep window covering cords and chains permanently out of the reach of children
Never place a child’s crib or playpen within reach of a window blind.
Unless the cords can be completely removed from the child’s reach, including when the child climbs on furniture, CPSC recommends against knotting or tying the cords together because this creates a new loop in which a child could become entangled.
Consumers can obtain this publication and additional publication information from the Publications section of CPSC's web site or by sending your publication request to info@cpsc.gov.

This document is in the public domain. It may be reproduced without change in part or whole by an individual or organization without permission. If it is reproduced, however, the Commission would appreciate knowing how it is used. Write the U.S. Consumer Product Safety Commission, Office of Information and Public Affairs, 4330 East West Highway, Bethesda, MD 20814 or send an e-mail via CPSC's On-Line Form.

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Physicians who understand and treat patients with MCS, Multiple Chemical Sensitivity

2009-12-09T01:12:00.000-06:00

Last month I asked friends and acquaintances to share names and locations of physicians who treat Multiple Chemical Sensitivity. I received several responses and post the results below. If you would like to recommend another physician who treats environmental illnesses such as MCS, please leave me a comment so that others who are searching may benefit.

Rodger Norris of Timberon, NM recommends two physicians:

Dr. Ambrose Aboud, MD specializes in Hematology, Oncology, Internal Medicine.
1900 North Oregon Street, Suite 500
El Paso, TX 79902
(915) 544-8844

Dr. Ahmad Hajj, MD specializes in Critical Care and Pulmonology.
1700 North Oregon Street, Suite 540
El Paso, TX 79902
(915) 351-2300

Melinda Honn, MCS advocate and president of the Southwest Environmental Health Association makes several recommendations (below) and also commented, "Finding a doctor that understands MCS is very difficult. Even more difficult is finding a doctor's office that is low enough on chemical contaminants that someone with MCS can visit. There are only a handful of doctors in the country that have a fragrance free office policy and perform any type of enforcement to see that the environment is maintained."

Dr. William J. Rea
Environmental Health Center of Dallas
8345 Walnut Hill Lane, Suite #220
Dallas, Texas 75231
(214) 368-4132

Dr. Alfred Johnson, D.O.
Johnson Medical Associates
997 Hampshire Lane
Richardson, Texas   75080
1-800-807-7555

Allan D. Lieberman, MD
Center for Occupational Medicine
7510 North Forest Drive
North Charleston, SC 29420
(843) 572-1600

Nathan Shaaf of Michigan comments regarding his suggestion for this list, "The details are that Professor Hu is a very kind caring and compassionate, physician, professor, scientist."

Professor Howard Hu, M.D., MPH, Sc.D., of the University of Michigan Schools of Public Health.
1500 East Medical Center Drive, Suite # 3116
Ann Arbor, MI 48109
(734) 936-5582
Dr. Hu also practices at: Beth Israel Deaconess Medical Center
181 Longwood Ave
Boston, MA 02115
(617) 384-8870

Here's a breakdown by state of the MCS physicians my friends have recommended so far:

Texas:
Aboud, Ambrose, MD, El Paso
Hajj, Ahmad, MD, El Paso
Alfred Johnson, DO, Richardson
Rea, William, MD, Dallas

Massachusetts:
Hu, Howard, MD, MPH, ScD, Boston

Michigan:
Hu, Howard, MD, MPH, ScD, Boston

South Carolina:
Lieberman, Allan D., North Charleston

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Suicide hotlines and helplines with counseling for teens worldwide

2009-12-03T03:30:00.002-06:00

You are not alone . . . but there are times in everyone's life where we honestly feel just that way. Hey, there wouldn't be so many caring people sitting in crisis centers at this very moment just waiting to hear your voice so that they can help if you were really alone in this world, would there? Call one of them . . . why not do it now?

Friends, relatives and parents, if you are worried about a teen or a family, don't wait. Call now.

Here are just a handful of the hundreds of exceptional organizations with the resources and know-how to help.

In the United States:

National Youthline
1-877-968-8454 (1.877.YOUTHLINE).
Toll free peer-to-peer hotline network that links callers to community-based peer counselling hotlines across the U.S.

Boys Town National Hotline for teens, parents and families: 1-800-448-3000 or send hem an email. The Boys Town National Hotline is a 24-hour crisis, resource and referral line. Trained counselors are there to respond to your questions whenever you make the call. They help teens and parents with many issues including but not limited to: suicide prevention, physical or sexual abuse, depression, school issues, parenting troubles, chemical dependency and runaways. Teens, check out their new website, Your Life, Your Voice.

The Trevor Project Helpline.
1-866-488-7386 (1-866-4.U.Trevor). The Trevor Helpline. The only 24-hour, national suicide prevention line for gay and questioning youth in the U.S.

Internationally:

Befrienders.org. Worldwide help for people in crisis. This site translates into 21 languages and links site visitors to their regional or national crisis line.

International Suicide Hotlines: Select your country from the map to find a toll free number in your location.

The U.K. and Ireland:

Samaritans, UK: 08457 90 90 90 and ROI: 1850 60 90 90

In Canada:

Kids Help Phone Counselling 1-800-668-6868 or select your province on the interactive map to find the correct crisis centre phone number for your location.

A patient with Down's Syndrome and ARDS; Carol was not "my" patient

2009-12-01T09:00:00.014-06:00

Not My Patient . . .

“Your patient is being discharged,” my nursing instructor informed me as we started our clinical rotation on a medical/surgical floor in my first year of nursing school.

"Oh, just great," I thought to myself. I had spent hours learning about and planning the proper care for "my patient" who had recently suffered a basilar skull fracture. My sheaf of clinical documents, medication lists, and a large pathophysiology flow sheet, were now suddenly made obsolete by my patient's imminent departure to a rehabilitation facility.

“He’ll still be here for a couple of hours. We’ll find you another patient later,” she assured me.

I was relieved that my painstakingly-crafted flow sheet, care plan, and medication cards wouldn’t go to waste. Although I only had one patient, the preparation required for the clinical day was nevertheless tedious and often proved exhausting in addition to other demands of family, school, and life in general. Still, as a new nursing student with little experience in the healthcare setting, the advance preparation gave me confidence that I would know what to do for my assigned patient. I decided not to fret about it, and simply hoped I'd be able to cope with whatever came my way in the shift ahead.

Our group of 10 nursing students and our instructor assembled at the nursing desk waiting for the nurses going off duty to give change of shift report to the group coming on. We were working second shift, 3 pm to 11 pm that day. Each week we spent three days attending lectures at our nursing college and two days working in the hospital to practice the hands-on-nursing skills and put into practice what we learned in class. There was always a sense of heightened anxiety on our hospital days, particularly in the chaotic environment of our very large county hospital. This was a trauma center and the busiest hospital on the U.S. side of the Mexican border. It was also a teaching hospital, with a slew of resident doctors and interns managing most of the patient care.

“The patient in 410 has a fever of 101.5!” a nursing assistant called out as she passed the nurses’ station where the harried day-shift nurse was “reporting off” to the oncoming "real" evening nurse and our huddle of nursing students.

The nurse going off shift sighed, “I’ll call the doctor—the girl in 410 just transferred here from the pediatric floor a half-hour ago. She’s supposed to go to the OR for surgery, an ORIF of the femur, as soon as her mom gets here to sign the consent.” The RN turned to our instructor, “It would help me out if one of your students could give her an acetaminophen suppository for the fever.”

Although none of our group was assigned to care for this new arrival to the surgical floor, we were always ready to perform a clinical skill to check off our list. Therefore, an entourage of three students and our instructor entered room 410 where 18-year-old Carol, afflicted with Down's Syndrome and a fractured femur, would prove to teach me more than any other patient that day.

Carol had been struck by a car as she crossed a busy street the day before. The fractured leg was her only known injury. She appeared to be sleeping deeply, with regular, but deep and fast respirations. Her eyelids fluttered as I explained that we needed to give her a suppository. Working together, we students gently repositioned her, mindful of the Buck's traction supporting her injured leg. A slight groan was Carol’s only acknowledgement as we cleaned her bottom (she had been incontinent with a bowel movement), before I inserted the suppository. Our instructor pointed out scattered petechiae on Carol's chest as we snapped a fresh gown across her hot skin and turned her to replace the soiled linen on her bed with clean sheets.

“These petechiae are probably the result of the trauma from her car accident,” our instructor explained, as she gestured towards the splash of flat pink spots that looked to me like tiny red freckles.

Back at the nurses' station our little group reassembled to continue shift report. We told the nurse about our interventions and reported Carol's limited response to our actions.

“They gave her an injection of Demerol before she was transferred from the pediatric unit," the nurse mused, "And we don’t know her baseline mental status, she has Down's, and for all we know she could be profoundly retarded.”

I was absorbed in my clinical experience for a few hours. The care for my basilar skull fracture patient proved to be very minimal. One of our nursing students needed a helping hand with a very complicated dressing change for a young man who had lost a leg in while trying to jump aboard a moving train. And I was pleased to learn that another patient needed a new intravenous needle placed. I was lucky enough to get the chance to do the venipuncture. I suspect that I caused that patient a great deal of pain with my novice attempt, but with a seasoned nurse over my shoulder talking me through it, the result was satisfactory. I kept busy in this way helping the staff nurses and other nursing students with their tasks until my patient was officially discharged. My instructor disappointed me then by suggesting that I return to Carol and follow up on her care. It seemed a puzzling assignment to me, I knew there were no meds to pass, IV's to start or dressings to change in that room--and I was here to learn nursing . . .

In Carol’s room I found that her mother had arrived from out-of-state. She was regarding her daughter pensively.

“She won’t wake up,” she complained.

I repeated the explanation that the nurse had given us in report earlier, that Carol had been medicated with Demerol.

“When did they give that? And how long will it last? Something’s just not right,” she continued.

Her questions were good ones.  I set out to find the "real" nurse to explain the mother's concerns, but the nurse arrived at that moment with a syringe in hand to give Carol another intramuscular injection of Demerol for her pain. The busy nurse briefly attempted to reassure Carol's mother before rushing back to care for her other nine patients.

As I continued to converse with Carol’s worried mother, I became uneasy. She described a high-functioning independent young woman who lived in a group home while attending a vocational educational program in the city. Demerol or not, the Carol we were observing didn't fit the girl her mother described.

Carol occasionally writhed and moaned, seeming to struggle to wake as her mother tried to arouse her. Her breathing was audibly harsh with a frequent moist cough. The family doctor was alarmed at her appearance when he made informal rounds to check on Carol. He wasn't in charge of her hospital care which was in the hands of the attending physicians who were on staff at this hospital, but he asked that the chief trauma resident be called to see her right away.

Before the staff nurse could return to Carol's room, the senior trauma resident appeared at the bedside and started questioning me. He examined Carol while I slipped out to get her nurse who told me she would "be there as soon as she could."

Awkwardly, I waited with Carol's mother as the resident considered Carol.  He wondered aloud why she hadn't gone down to the OR earlier as scheduled. I reminded him of the fever and as he listened to her lungs, I casually pointed out the petechiae, which was more diffuse across her chest now.

The resident was suddenly abrupt and to the point, it seemed he'd slapped the last piece into a puzzle. “She’s thrown a fat embolus from her fractured femur--get her to ICU stat.” Then he turned on his heel and was gone before I could say a word.

I had enough of the classroom experience in nursing to fear a pulmonary embolism (a tiny blood clot that lodges in the lungs), but I didn't have a great deal of insight into the prognosis and treatment for a fat embolus. The hours that Carol's condition had progressed undetected were haunting me. Right away I knew that Carol needed her nurse, and I needed my instructor.

It took some time to find Carol’s nurse and convince her that the resident wanted her patient transferred to ICU. She made the requisite phone calls to confirm the orders and set the wheels in motion so that the ICU would assign Carol a bed. Meanwhile, Carol's chart was nowhere to be found. It was misplaced somewhere on the surgical floor. I nervously looked for the chart while the nurse arranged for Carol's transfer.

My instructor, aware of the unfolding drama, gave me a brief suggestion, "Just help where you can with the transfer."

Carol's mother, numb with worry, was making phone calls to advise her family members of this turn of events. A sense of urgency was consuming me as I returned to Carol’s room. Carol's nurse was still on the phone making arrangements for the transfer. Suddenly the resident reappeared and scolded me. “This patient should have been in ICU already! Get her there now!!”

But no such luck . . . The nursing unit had their own procedures to follow. They set about taking a complete set of vital signs, "It's required that we do so before transferring a patient."

The nurse's aide who was trying to check Carol's blood pressure was having a hard time because, "This machine can't be right, her pressure's way too low." She went to search for a manual blood pressure cuff that affirmed the hypotensive state of the patient.

Carol’s nurse returned with a respiratory therapist who placed a pulse oximeter on Carol's cool, pale finger and advised, “She needs oxygen, her oxygen saturation is only 65%!” Her saturation should have been at least 92. The oxygen set-up for transport through the hospital to the ICU floor would have to wait for a few minutes while someone went looking for the missing key to the metal portable oxygen cylinder. The precious moments SLOWLY passed as these tasks to make Carol ready for transfer were completed.

I felt useless as the evening nurse and an aide prepared the bed for transport. “What can I do to help?” I pleaded.

“You can carry the patient’s bag of belongings and make sure not to bring her flowers, she can't have them in ICU,” the staff involved in this whole situation seemed snappy and angry. I thought it was a waste of brain cells for the nurse in charge to even think about the flowers under the circumstances. In retrospect, I'm sure I was sensing the staff's anxiety and concern, and I have to believe they all shared my frustration with the obstacles that slowed the transfer to what seemed like a crawl.

My neck flushed as we awkwardly maneuvered the Carol's bulky hospital bed into the hall and then, after all the delays, ironically took off running for the elevator leading to the intensive care unit. There wasn't enough room for all of us on the elevator. Carol's mother and I rode together on an adjacent elevator.

The small ICU waiting room was overflowing with visitors waiting to be allowed in to see other patients. I said farewell to Carol's mother and urged her to call her ex-husband to let him know what was happening.

I'd never before been through the sliding doors that isolated the large intensive care unit from the rest of the hospital. No matter, I found Carol’s room easily. Nearly every nurse in the ICU was at her bedside, hooking up monitors, taking vital signs, putting in an additional IV, preparing suction, and hanging fluids. I could see the resident doctor with his interns assembling supplies. In a few minutes time Carol would have a tube in her trachea that allowed a mechanical ventilator to breathe for her.

I layed down Carol's bag of belongings lingered in the background for a few minutes. Clearly Carol was in good hands, these nurses were calm and in control of the situation.

Suddenly my shift was over--it was time to meet my instructor and the rest of the clinical group before going home. But I was sad and miserable. I went beyond my required textbook reading that night. Fat emboli and acute respiratory distress syndrome (ARDS) consumed my thoughts. I grieved for Carol's mother and lamented that I hadn't known enough to help expedite her care that evening.

Two days later as I skimmed the morning paper, I was shocked--but not surprised--to see Carol’s photograph smiling brightly from the obituary column. I cut that little clipping out of the newspaper and pasted it into my tiny notebook of nursing tips. To this day I still carry that notebook in my nursing work bag. I guess Carol's legacy has been with me every day that I've worked as a nurse, now that I think of it.

Technically, Carol was never "really" my patient. No medication cards, flow sheets, or care plan followed me to her room that evening and my education and experience to that point certainly didn't prepare me for the gravity of her situation. Of course, ironically, it was the deepest and most vivid clinical situation I experienced as a student. I always recognized that I contributed little, but benefited much from this experience. Many of the lessons learned are so obvious that they don't bear repeating.

An obvious lesson that does bear repeating, on the other hand: never assume nor underestimate any patient's baseline mental capacity.  Good communication with a responsible party who can provide definite information on a patient's usual abilities is absolutely vital so that care is not compromised or delayed in the event of important neurological changes. That's Carol's legacy to me.

All rights reserved 2009 Carolyn Cooper MPH RN

. . . . ,

Sturge-Weber Syndrome

2009-12-01T04:22:00.002-06:00

Because I started my career in nursing as a pediatric nurse in a very large city on the border of a third world country, I have a personal connection with many rare and unusual conditions affecting newborns. I very clearly remember in the first weeks on the job that one of my young patients was suffering from Sturge-Weber Syndrome. The fact that he had a large port-wine birthmark irregularly covering about one-fourth of his face didn't detract at all from this beautiful 8-month-old baby boy. He was in the hospital for evaluation of brief, mild seizures which occurred several times each day. We were providing medications in an attempt to establish the best possible seizure control for this child. Seizures that affect the same side of the body as the vascular birthmark and sometimes weakness on this affected side are hallmarks of this condition. I'm by no means an expert on this condition, so I urge you to seek additional information from the reliable sources below.

To learn more about Sturge Weber and its affects:

I wonder what became of that baby boy in El Paso, Texas? He would be about 16 years old now . . .

Here's a video from YouTube that gives a glimpse of Sturge-Weber across the span of different age groups:

. . . .

July is the best month for new health observances

2009-12-01T03:45:00.005-06:00

Earlier this year I was making a monthly post about the various health observances of note that were occurring in the coming month. Some months were overwhelmingly packed with a variety of specific "days" or "weeks" to observe good health-related causes.

Tonight I've been reviewing some entries that I never actually posted, and it occurred to me that it might be worthwhile to mention that July is a very "slow" month for health observances. Perhaps because it's a traditional vacation month, school is out, and people are enjoying nicer weather instead of paying attention to media messages. However, if you have a cause to publicize and a great campaign to lauch your message, July just might be the month you want to consider.

Better 5-months-late than never, here are links to the major health observances for July 2009:

Hemochromatosis Awareness Month. Too much iron in the body is a bad thing. Hemochromotosis results when the body absorbs excess iron from the food and stores it in vital organs. Get free downloads from the hemocromatosis center--including an 8-page-informational handout for your physician to help manage the disease with the best possible results. Learn about all kinds of iron disorders at the Iron Disorders Institute page and sign up at the bottom of this page: to receive an email with their monthly newsletter "id insight" (or read them here online.)

International Group B Strep Awareness Month. Group Strep B is a bacteria that can be deadly to a newborn baby. It can cause a bloodstream infection called sepsis, pneumonia, or menigitis. A woman may be a carrier of this bacteria without being ill. If it is present in the birth canal, the baby is exposed to the bacteria during the vaginal birth process. The good news is that treatment of the mother in advance is available and testing mothers-to-be for Group B Strep in advance of delivery is becoming the norm in the U.S. Learn more about "GBS" and why it is a big deal. Check out the Group B Strep International website for an abundance of information (available in 10 languages).

Juvenile Arthritis Awareness Month. Juvenile Rheumatoid Arthritis (JRA) is the most common type of arthritis occurring in kids under the age of 16. It's one of the auto-immune illnesses in which immune cells within the body start to attack healthy tissues--in this case the joint tissues. This is a painful and debilitating condition that may be short-term or lifelong. Read more about Juvenile Arthritis in this Mayo Clinc article and at Kidshealth.org.

UV Safety Month sponsored by the American Academy of Opthalmology. Ultraviolet light can damage visions as wel as skin. Too much UV light is a known risk factor for developing sking cancer. Learn more from http://www.skincancer.org/

July 20 - 24, National Youth Sports Week. July is usually a month in which kids are enjoying some beautiful weather and have the opportunity to be playing outside a lot. The National Recreation and Parks Association (NRPA) are a major promotor of this observance week. Their slogan: "Healthy Lifestyles . . . It Starts in Parks." Link to their calendar page to discover other events they endorse all year long.

July 27 - August 2, Phelan-McDermid Syndrome: This syndrome describes a chromosomal abnormality that is not well publicized. In this condition genes, at the tip of the 22nd chromosome important in the development of the nervous system, are absent. It's sometimes difficult to discern the syndrome as some of the features may seem subtle or be dismissed as variations of "the norm." Learn more about the characteristics of Phelan-McDermid Syndrome at the website of their national foundation.

. . .

DVT, Blood Clot, Deep Vein Thrombosis

2009-12-01T00:48:00.007-06:00

Dangerous blood clots may develop unexpectedly within the deep veins of a lower leg. Such clots can cause deadly complications when microscopic pieces break off and clog the circulation to distant parts of the body. Clots that find their way into the brain, lungs, or heart may result in deadly or life-altering complications from stroke, pulmonary embolus, or heart attack.

Preventing a DVT is certainly much easier than curing the condition. In hospitalized patients several methods are used to enhance the flow of blood to the lower legs. First and foremost, being up and around as soon as possible, and as much as possible after surgery or while recovering from an illness is a major advantage in increasing venous flow and decreasing the chance of clots forming. Tight white compression stockings (TED hose) may be prescribed depending on the level of risk for the specific patient (see below). Mechanical "pumps" squeeze the lower legs at regular intervals in another means of prevention. For patients at the highest risk of DVT, blood thinning medication is injected daily under the skin of the abdomen.

Greater Risk of Clots for Some Patients

DVT (Deep Vein Thrombosis) can occur in almost anyone. However, certain individuals may be at increased risk for developing a DVT. Risk factors include but are not limited to:

Recent surgical procedure (and greater chance of a DVT with a long, intense surgery and joint replacement surgeries)
Restricted mobility from bedrest, paralysis, traveling for many hours without taking a break to walk around
Active Cancer
Congestive Heart Failure (CHF)--if you take "water pills" and are not sure why--ask your doctor if you have CHF
Age greater than 40 years old
Pregnancy and the postpartum period (6-8 weeks after delivery)
Injury to the leg or the deep veins of the leg
Smoking
Use of certain medications such as birth control pills and estrogen
Dehydration
Polycythemia
Obesity
Current smoker
Past history of having a blood clot or an inherited family tendency to develop blood clots

Spot a Clot . . . a Campaign sponsored by the Venous Disease Coalition

Check out their website to learn more about DVT and related conditions such as:

Post Thrombotic Syndrome (PTS) After a DVT is treated and resolved, this chronic condition may result in up to 40% of all individuals. It's the result of damage done by the clot to the valves that move blood through the vein.
Pulmonary Embolis (PE) Blood clots in the smallest vessels of the lungs.
Thrombophila Blood that clots too easily. Hypercoagulability is another word used to describe this condition which can be inherited.
Chronic Venous Insufficiency results when the valves in the veins that move blood don't function properly, often occurs from injury to veins caused by a DVT, from varicose veins, or as the result of an inherited condition.

Venous Disease Coalition Patient Education Resources:

The Vascular Disease Foundation has a variety of full-color brochures available for download including a great pamphlet called "Focus on Clots." (This publication was previously called "Spot a Clot," but otherwise it's the exact same informational card.)
You may also request a copy of these brochures by calling toll free: 1-888-833-4463.

Other related publications you can download:

Vitamin K and Warfarin (Coumadin): http://www.nattinfo.org/documents/KandWarfarin(Web).pdf
Family Testing for Clotting Disorders http://www.nattinfo.org/fam-test.pdf
Sanofi-Aventis (makers of the blood thinner Lovenox) provides tips about DVT's, Risk Factors for DVTs, and includes a risk assessment tool.
A plus: Deep vein thrombosis article from eMEDtv.com

eMedTV.com has many wonderful patient education videos.
Here's a two-minute presentation that explains how unwanted blood clots occur in the vein and why they are dangerous from the: Heart Disease Health Channel on eMedTV.com

Provided by the

. . .

. . .

When you are concerned about a child's development

2009-11-26T05:32:00.007-06:00

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)

. . . .

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

2009-11-24T04:57:00.010-06:00

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)

2009-11-12T05:12:00.011-06:00

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 (including log sheets to record drainage). 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.)

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 their 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.

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

2009-11-03T01:36:00.008-06:00

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.

Traveling with Portable Oxygen: Carefully Prepare in Advance

2009-10-29T02:46:00.081-05:00

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

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October 15th is Pregnancy and Infant Loss Remembrance Day

2009-10-15T05:08:00.016-05:00

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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