caregivers - ask jan

On-Line Medical Information

2012-09-07T20:17:00.001-07:00

There is wonderful, accurate, and medically sound information on-line. However, there is also inaccurate, dangerous and down right false medical information on-line.

On-line medical information is not a replacement for proper medical care and evaluation by a physician. I have recently had some patients that did not have primary doctors and had symptoms of illness. In both cases they went on-line. One patient found his problem on a medically accurate site that directed him to go to a physician, which he did. The other patient went on-line and found several sites that were vague. From his description they were not reputable medical web sites. He delayed care by several weeks by looking on line and thinking his problem was a minor episode of indigestion. However, he had heart symptoms that finally resulted in a heart attack a trip to the ER and emergency heart by-pass surgery.

What about Wikipedia? Wikipedia itself reports that they have an error rate. Most colleges and universities will not accept Wikipedia as a source for research. The reason is the way Wikipedia works; anyone can post an article on Wikipedia. "Wikipedia is collaborative writers by largely anonymous Internet volunteers who write without pay. Anyone with internet access can write and make changes to Wikipedia articles," this per Wikipedia.

So where can you get accurate medical information? Stick with universities, medical schools, government agencies and specific disease associations or societies for accurate medical information on-line.

A few of examples of reliable web-sites:

World class medical centers such as the Mayo Clinic http://www.mayoclinic.com/

Government organizations such as National Institute of Health http://www.nih.gov/

Major teaching centers such as The University of Virginia http://www.healthsystem.virginia.edu

The largest local hospital system such as Northern Virginias Inova Health System http://www.inova.org/

Disease specific websites such as:

American Heart Association www.americanheart.org/

American Diabetes Association www.diabetes.org/

American Cancer Society www.cancer.org/

Remember, on-line medical information does not replace good medical advise by your doctor!

Constipation

2012-04-14T18:22:00.003-07:00

What is normal for bowel movements? Normal can range from 3 movements per day to three movements per week. Therefore, before you can determine if constipation is the issue, you must determine what the normal is for that person. Constipation includes infrequent, difficult or incomplete bowel movements.

Defining characteristics of constipation include:
1. A decrease in one’s typical frequency of bowel movements
2. Hard, pellet like stools
3. Straining to have a bowel movement
4. Bowel movements are infrequent and hard to pass

What are the causes of constipation?
1. Inadequate hydration – not drinking enough fluids (8 glasses per day 8 ounces each glass)
2. Inadequate fiber in the diet – lack of fiber (bulk) makes it so there is not much to move through the intestines.
3. Lack of activity – particularly for the ill and elderly
4. Ignoring the urge to have a bowel movement
5. Medications – in particular pain medications, antidepressants, Blood pressure medications, antihistamines, Parkinson’s medications, anti-diarrhea medications and others always read the medication information provided by the pharmacy
6. Other conditions such as pregnancy or travel
7. Obstructions of the bowels – such as cancer, strictures, adhesions, diverticulosis, and others
8. Other medical conditions

Severe constipation can be a true medical emergency and even require surgery depending on the cause. I will do another blog on treatment of constipation.

Tools to Quit Smoking

2012-03-05T19:41:00.004-08:00

Now you should have your quit date set. You should have a list of personal motivators to help you quit smoking. Ideally you have made your lists of motivators and placed them strategically around the areas you frequent.

Thirty days prior to your quit date:
1. Start decreasing smoking. You want to quit so that on you last day you are only going to smoke five or less cigarettes on that day. 2. Make a doctor appointment to discuss strategies for quitting with your physician. You need to discuss nicotine replacement if you plan to use it.

3. Nicotine replacement includes such things as: Nicorette gum, Commit lozenges, Nicoderm CQ or Habitrol patches, Nicotrol nose spray or inhaler. While some of these products can be purchased over the counter you need to consult your physician to ensure your body can tolerate these products. You also must follow the directions – use of cigarettes and nicotine replacement together can lead to an overdose of nicotine and serious heart irregularities.
4. There are many medications that can reduce the cravings, such as Chantix or Zyban (Wellbutrin). Reading this information is meant to give you inspiration as well as information.

You will also want to read information from other reliable sources such as:
American Lung Association: http://www.lung.org/
American Cancer Society: http://www.cancer.org/
Center for Disease Control:
http://www.cdc.gov/tobacco/quit_smoking/
Smoke Free: http://www.smokefree.gov/
Women Smoke Free: http://women.smokefree.gov/

I will continue to pray for you in your effort to quit smoking. If I can be of assistance in nswering other questions please leave me a comment and I will answer them.

You too can Quit Smoking - Some information to help

2012-02-27T18:22:00.006-08:00

I have faith that if you really want to quit you can! I know it may seem like you never will. I remember quitting on at least four separate occasions before I actually quit for good. Being a person of faith I will say that praying about quitting smoking helped me immensely. I am praying for all who read this blog that they will be able to quit smoking.

So, you should now have your list of reasons to quit and have it somewhere you can read it regularly. You may want to add more lists with more reasons in other places – like the car, the bedroom mirror, on your desk at work, in your calendar and any other places you look frequently. I know we all know the dangers of smoking as it is very prominent on the news and many other sources. You need to have some of this information in your quiver of motivation to quit! Smoking can cause damage to all the organs of the body – not just the lungs.

The American Lung Association reports that every year 392,000 die from smoking related illnesses, making it the leading cause of preventable death. Let this sink in.

Quitting smoking is the number one way to prevent your death!
You would never think of consuming some of the products in cigarettes such as:
a. Acetone - which is found in nail polish
b. Led - used in batteries
c. Arsenic – used in rat poison
d. Cadmium – component in battery acid
e. Carbon Monoxide – product of car exhaust
f. Lead – we know this is very harmful to children
g. Tar - used for paving roads
h. And many more. There are over 600 ingredients that when burned create 4,000 chemicals.

Tobacco is as addictive as heroin as a mood and behavior altering agent. In a University of Minnesota Study they report:

Nicotine is 1000 times more potent than alcohol
Nicotine is 10-100 time more potent than barbiturates
Nicotine is 5-10 times more potent than cocaine or morphine

A smoker takes in 200 to 400 puffs a day for years. This constant intake of fast acting drug, which affects mood, concentration and performance eventually, produces dependence. Let this information sink in. You will need to be able to recall this information along the path to quitting. I needed to keep telling myself “why” it was good for me to go through the process of quitting smoking. For more information please see the websites below.
Sources:
http://www1.umn.edu/perio/tobacco/nicaddct.html
http://www.lung.org/

Preparing to Quit Smoking

2012-02-23T18:59:00.004-08:00

To this day there are a few things I will always remember about smoking. First, I still clearly recall the day when I got out of the car in front of my parents house smoking a cigarette. I had been successfully hiding it for about a year. Busted. My dad sat down on the curb in front of the house and said, “So you got a pack of those coffin nails on you.” I said, “yes.” He said something like, “smoke the whole thing now. If you are going to be a smoker, smoke them now.” He hoped I would get sick and quit. I had picked up smoking from friends in of all places – nursing school. This was in the days smoking was allowed at the hospital in fact most of the nurses and doctors smoked at the nurses station when I was a student nurse.

Dad’s motivation did not work. I smoked for the next twenty-five years. I have been a successful non-smoker now for thirteen years. So I know the pain of smoking, coughing in the morning, smelling like smoke, health issues and the expense. There is hope and freedom as a non-smoker. I was very motivated to quit by the youth pastor at my church as well. I was working with the youth at the time and we were about to go on a service project trip to Belize. The youth pastor said that to be a good example for the youth I could not smoke on the trip. This was about five months before the trip. It was also about a month before my birthday. So I set my quit date as my birthday so I would never forget the day I quit smoking.

I also know the freedom that comes with quitting smoking! Let me encourage you. It can be done! You can be smoke-free for the rest of your life! I can tell you from first hand experience that the hardest part is making the decision to quit and the first several months after you quit. The urges get less and less as time passes. If you are ready to take the steps to quitting here are some tips that helped me. Please feel free to post comments with questions, successes and struggles. I will follow-up on any comments. Set a date that you plan to quit by. You will be more successful it you set that date for within 30 days. You are more likely to follow through if the “quit date” is soon.

Make a personal list of benefits to quitting smoking. Identify some motivators to quit smoking and write them down. I kept mine on the mirror and read it when I brushed my teeth. Keep this list where you will see it. Here is my list from all those years ago:

1. Better example for my patients and the youth at my church
2. Stop smelling like smoke
3. Save money
4. No more coughing or being short-of-breath
5. Avoid long term effects of lung disease, cancer and potential oxygen dependence when I get old
6. Save time by not taking “smoke breaks”
7. Overall better health for the rest of my life
8. I will lower my risk for stroke, cancer, heart disease, cataracts, wrinkles and early death.

I will follow-up with more information on quitting smoking. Quitting smoking is a process and one of the biggest positive life changes you can make. I will follow-up with more information on this positive life change over the next few blogs. Remember, feel free to leave comments or questions and I will provide answers and follow-up information.

February is Heart Month

2012-02-20T18:49:00.001-08:00

February is Heart Month so it is only appropriate that I write about Heart Disease in
February. Aside from being a nurse for over thirty-five years I myself have been a Woman with Heart Disease for the past five years. So professionally as well as personally I am qualified to write about heart issues.

I will be focusing on the most important things you can do to protect your heart over the
next several blogs. A quick preview is:

~ Have an annual physical with your regular physician and follow through on their advice.

~Follow a Heart Healthy Diet - for more information seethe American Heart Association website at http://www.heart.org/ and see the section getting healthy. I will discuss some heart health eating basics in some future bogs.

~ Exercise Regularly - The American Heart Association recommends for heart health exercise, “at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). 30 minutes a day, five times a week is an easy goal to remember, however you will also experience benefits even if you divide your time into two or three segments of 10 -15 minutes per day.”

~ Quit Smoking - We all know this is a huge benefit to health. I am living proof it can be
done. I was a very heavy (2-3 packs per day) smoker when I quit. I would not go
to non-smoking restaurants as I was a very committed (addicted) smoker. I will be sharing more insight on this topic in a few days.

~ Maintain a Healthy Weight - This is something you and your doctor need to determine what your number is. I have had weight problems most of my life and I am still a work in progress in this area to achieve my best health level. However, I am still a work in progress.

~ Manage Stress - There are sources for stress in our everyday lives. I have experience with stress and stress reduction that I will share with you.

Cold or FLU?

2012-01-23T18:21:00.000-08:00

How do I know if it is a cold or the flu? Prevention is key – if you get your flu shot you can be pretty sure it is a cold. Many health care workers are required to get a flu shot by their employer so know that research has been done and it is safe for most people to get the flu shot yearly.

Cold symptoms will give you many “flu like” symptoms but in a much milder version. For example with a cold you may feel fatigued where as with the flu you will have extreme exhaustion that can last for weeks. The chart below will help you determine what you have. Sometimes it is impossible to tell them apart. A cold has many symptoms of the flu but in a milder version. If the person is getting sicker and extreme or intense symptoms then if you seek medical attention they can do a test to determine which is, cold or flu.

If you have the flu seek medical attention. If you have a cold it is from a virus and antibiotics will not help. There is an old saying that if you see a doctor it will be better in one week, if you do nothing you will be better in seven days. Your body can fight a cold on its own, the flu you will need to see the doctor. If you have the flu seek medical attention as there can be some serious complications associated with the flu such as pneumonia. If in doubt ask your doctor. If you are not better in a week see your doctor.

..........................Cold..............FLU
Aches/Pain.......Mild..............Often Severe
Cough...............Yes, Mild.......Often Severe
Exhaustion.......Never............Often Severe
Fatigue.............Mild..............Often Severe
Fever................Rare..............Often 100 to 102 for several days
Headache.........Rare..............Usually
Sneezing..........Frequent.......Rare
Sore Throat.....Common.......Sometimes
Stuffy Nose.....Yes.................Rare

Hand Washing

2012-01-20T18:12:00.000-08:00

It is flu season, time for a refresher on hand washing and infection prevention. The skin is our first defense against infection. It acts as an outer barrier for our body. At the same time our skin is one of the many places that bacteria like to grow.

In 1975 The Center for Disease Control (CDC) published their first guidelines for hand washing. Today you can find scientific evidence from CDC, American Medical Association (AMA), The World Health Organization (WHO) and Occupational Health and Safety Administration (OSHA), American Nurses Association (ANA) and many others all pointing out the importance of simple hand washing in preventing infection.

Why then do I see people not wash their hands in public restrooms? I think we are “I have to see it to believe it” type people. So perhaps this will help.

I will never forget in nursing school they had us come in the lab and run our fingers across a Petri dish. A Petri dish is lab container where bacteria will grow; it is where the lab puts the sample the doctor takes from you. In our case the sample was the germs on our fingers. Next they had us go and wash our hands and come back and put our fingers on another Petri dish. Lastly, we did a full surgical scrub and rubbed our fingers on a final Petri dish. We signed and sealed the dishes with tape and our signatures. Five days later we went back to the lab. I was astounded at the number of germs on fingers. What I could not see with the naked eye had been given what it needed in the Petri Dish to grow and it was covered with growing germs. After a normal hand washing it appeared that there was much less bacteria growing on the Petri Dish.

The Petri Dish above shows:

Section A is from hands that appear clean but were not recently washed.

Section B is after washing hands with soap and water.

Section C is after disinfection.

So now do you think your hands are clean? You do not see the germs until they grow. By the times the germs grow you may have spread an infection and never know it.

Our mothers taught us when we were children to wash our hands. We need to remember to do it regularly!

Before and after caregiving procedures, feeding, turning and contact with person caring for
Before and after eating
After touching raw meat, poultry or fish
After the toilet (even in your own home) or after changing diapers
After coughing or blowing your nose
Before making or eating food
After playing with animals
Before and after changing contact lenses
After playing outside or working out
After any activity that contaminates the hands
After visiting or caring for someone sick
After handling garbage
Any time your hands are visibly dirty

So what is the proper technique for hand washing?

Remove rings and jewelry

Wet hands totally with warm running water

Apply Liquid Soap

Sing and scrub - Sing Happy Birthday to yourself as you scrub all sides of your fingers, nails, thumbs, palms and the back of the hands.

Rinse totally with warm running water

Towel Dry - use paper towel to turn off the faucet

Do I have to keep taking Blood Pressure Medication?

2011-12-10T21:15:00.000-08:00

Do I have to take Medication for Life?

Do I have to keep taking my blood pressure medication, my blood pressure is normal again? This is a rather frequent question. Blood pressure is not like a strep throat where you"get" high blood pressure, take some medication and you are cured. High blood pressure is more like diabetes you have it for life but with medication it can be controlled. High blood pressure is a risk factor for stroke, kidney disease, heart attack and heart failure. Medication can reduce the risk of all of these diseases. It is very important to take prescription medication as ordered until your doctor changes it. You would need to consult your physician before you stop taking your blood pressure medication. If you experience side effects from your blood pressure medication (or any medication) you need to inform you doctor.

Common side effects from blood pressure medications are dependent on the medication you are taking.

Diuretic Medication such as Lasix (Furosemide) can cause loss of potassium which can result in muscle cramps, dizziness or lightheadness. Often your doctor will prescribe potassium supplement while on diuretics, like Lasix, or recommend you eat a banana daily. To prevent lightheadness or dizziness be sure you are drinking the proper amount of fluid daily about 1.5 liters to 2 liters a day (unless your doctor restricts your fluids).

Ace Inhibitors such as Lisinopril (Prinivil or Zestril), Captopril (Capoten), and Enalapril (Vasotec) can cause hacking dry cough, rash, or loss of taste.

Beta Blockers such as Tenormin (Atenolol), Metoprolol (Lopressor), Propranolol (Inderal), and Nadolol (Corgard), can cause cold hands and feet, insomnia, depression, impotence, or slow heart beat. If you have diabetes you will need to monitor you blood glucose as these drugs can impact your sugar.

Calcium Channel Blockers such as Diltiazem (Cardizem), Nifedipine (Procardia) and Verapamil (Calan or Isoptin) may cause swollen ankles edema, palpations, constipation, headache or dizziness.

Side Effects with each of these drugs can differ a great deal. Different people react differently to medications. As with all medications it is important to read the medication information provided by the pharmacy. You must inform your physician of any side effects you notice or if you in any way feel differently while taking these medications. Take medication as ordered. It is important to take the medication as ordered as suddenly stopping medications can cause problems to your health. Know the "class" of your medications as you will often see over-the-counter medications that say "do not take if you are on Ace Inhibitors" for example. So you need to know what you class of medication you are on so if other medications should not be taken with that class you will know.

Remember, consult your doctor about your care and concerns!

What does salt have to do with Blood Pressure?

2011-12-04T17:31:00.001-08:00

Salt and Blood Pressure
The relationship between blood pressure and salt is important to understand to control your blood pressure. First, salt is sodium and it is important to our bodies. Our bodies take in salt (sodium) in the foods we eat. Our kidneys get rid of the salt (sodium) keeping us in a delicate balance with just the right amount of salt.

When we eat too much salt the kidneys can not keep up and the extra sodium goes into our blood stream. Salt attracts water. So as the salt level in the bloodstream rises it pulls
water into the blood stream to dilute the salt. This increase in fluid in the bloodstream causes an increase volume in the blood which raises the blood pressure. So how much salt is too
much? If you have high blood pressure you should keep the sodium in your diet to 1,500 mg of sodium or less a day. Our bodies need 500 mg of salt daily. Canned foods have the most salt as salt is often a preservative in these foods. Fresh food hast the least sodium and frozen is in the middle.
When you read the label and you see sodium listed you are seeing salt is an ingredient that food. Notice in the food label that there is 660 mg in one serving and this product says there are two servings in the container. Reading labels and maintaining a salt (sodium) intake of 1,500 mg or less is a key to controlling your blood pressure.

Blood Pressure

2011-12-03T20:12:00.000-08:00

When the blood pressure stays elevated over time is called Hypertension or High Blood Pressure. A one time reading that is elevated should be monitored. Many pharmacies and grocery stores have blood pressure machines where you can check your blood pressure. If you have two or more readings that are elevated you must consult your physician.

What do the numbers in the Blood Pressure Reading mean?
The top number is the Systolic (pronounced - Sis tall lick) is the pressure inside the vessels when the heart beats.

The bottom number is the Diastolic (pronounced - die a stall lick) is the pressure inside the vessels when the heart is at rest between beats.

High Blood Pressure is when the top number is above 140 or the bottom number is above 90. Why is this important? As the pressure in the vessels increases it causes the heart to work harder and can lead to heart disease. It can cause other health problems; one of the most serious is a stroke. High Blood Pressure can lead to Heart disease than can lead to a heart attack. About 2/3 of people over 65 have high blood pressure. High Blood Pressure is a condition that most people will develop as they age.

High blood pressure is often a "silent" illness as you do not feel ill until something happens as a result of the high pressure. Getting your blood pressure checked is a very important part of your annual physical with your doctor.