What is the definition of a medical error?
A medical error occurs anytime what was planned to happen to help a patient does not happen – or when something that should have happened does not. We are most familiar with errors that occur in hospitals or offices, because they are the most reported of errors.
There are the dramatic medical errors, such as wrong site surgeries – but medical errors also include taking the wrong dose of medications, taking medications to which we are allergic, and even such things as falls related to medical treatments.
So while we know that medical errors happen in places such as hospitals and surgery centers, they can also happen in pharmacies, or commonly, at home.

How do medical errors happen at home?
Medical errors happen at home when we take the wrong medication, take the wrong dose of the medication, or use a treatment that is meant for someone else. There have been tragic reports of children who died because they got into their parent’s medications, or because they were given too much of their own medication.
Another error that happens in our homes is when a person who is on something such as a sleeping pill or other medication that causes drowsiness falls – or worse yet drives and hurts someone else.
In hospitals, we have elaborate safety systems designed to prevent these types of errors. In our homes we can benefit from doing the same.

Healthcare is often frightening – and the idea that an error can happen is particularly disturbing. What is being done to prevent errors?
Healthcare, like the airline industry, puts a great deal of resources into preventing errors. In the hospital, we have entire departments dedicated to preventing errors through education, double check systems, and technology that helps us become more and more safe. However, for each of us, we as patients are one of the most important parts in assuring our own safety.

It seems amazing that in such a technical and complex world as medicine that patients are a key part of safety. What can we, as patients, do to promote our safety?
We, as patients, are very powerful forces in promoting our own safety, because healthcare is information-driven, and we are the source of the information about ourselves. Some of the things we can do to help
1) Carry a list of all the medications (including over the counter, vitamins and herbs) that you take, including the doses
2) Have a list of all your allergies – including the reactions you get
3) Have a list of all your ongoing diseases and surgeries that you have had
4) When your doctor gives you a prescription, make sure that you can read it
5) When you pick up a prescription – ask the pharmacist – “Is this the drug that my doctor prescribed?”
6) Speak up and ask questions! You deserve to know what is going on and how to care for yourself
7) Make sure healthcare providers wash their hands before taking care of you

For more information on this topic, try these websites

AHRQ
IHI
CDC

Good Health!
Dr. Dianne

What do you do to help your child through something like yesterday’s school shooting?
Following a trauma like this, children may initially show agitated or confused behavior.  They also may show intense fear, helplessness, anger, sadness, horror or denial.  They may withdraw, or want to avoid talking. Studies show that children with greater family support and less parental distress over the event have lower levels of PTSD in the future, and at times like these, we benefit from the shelter of one another. We, as parents will model ways to cope to our children, and so we need to be sure and “put on our own oxygen mask first” – in other words, you need to deal with your own feelings in  healthy ways in order to help your children through theirs:

1) Maintaining family routines
2) Making a “safe space” for your children to talk about their feelings – make it ok for them to express their feelings, whatever they may be
3) Limit your children’s exposure to the coverage of the event – it may feel like it’s happening again if they see it on TV
4) If you are having difficulty yourself, be sure and find friends or a professional to help you process your own feelings. 
5) Minimize family conflict – a calm safe environment at home will give you all comfort.  This may be difficult to do, since one of the responses to trauma, especially in older children and teens, is to become impulsive or aggressive as an expression of these events.

The concern is also real for teens that don’t go to that particular school. Gunman drills have become a regular part of the school life. How do you reassure your student about the fear, in light of the shooting?

As a parent, we know that the world has dangers, such as car accidents, drug and alcohol abuse, and, sadly even school shootings. While this is true, it is also true that most of us go through every day with nothing bad happening. It is important to help our children, and ourselves, focus on the 99 plus percent of the time that we are safe.

The fact that schools are doing things such as having drills for disasters  can help reassure them by giving them knowledge about what they would do if something were to occur – and by knowing that the schools have plans to keep them safe. Finally, help your children learn to use techniques that decrease stress such as:

1) Positive self-talk
2) exercise or other healthy activities
3) taking breaks and doing calming things like listening to music, talking to a friend or playing with a pet

This is also hard on the people who have lived through Platte Valley, Columbine, Virginia Tech and other similar events. How can they cope?

Those who have been through one of the other experiences of school violence, or even those in the community that were affected through friends or relatives in one of these events, may notice some of the signs of Post Traumatic Stress Disorder (PTSD) returning. This is not unexpected, and should be seen as normal. It is important to talk about these feelings, and it may be necessary to seek professional help if these feelings are persistent or very intense.

What signs should parents watch for? When should you seek professional help?

The research shows that up to 77% of children/teens exposed to a school shooting can develop PTSD. The important thing to remember is that these symptoms usually do not appear right away, but rather may appear months, or even years, down the road.  So, if your child has been exposed to a trauma, some of the things to watch for include:
• having frequent memories of the event, or in young children,  play in which  some or all of the trauma is repeated over and over
• having upsetting and frightening dreams
• acting or feeling like the experience is happening again
• developing repeated physical or emotional symptoms when the child is reminded of the event
Children with PTSD may also show the following symptoms:
• worry about dying at an early age
• losing interest in activities
• having physical symptoms such as headaches and stomachaches
• showing more sudden and extreme emotional reactions
• having problems falling or staying asleep                  
• showing irritability or angry outbursts
•  having problems concentrating
• acting younger than their age (for example, clingy or whiny behavior, thumbsucking)
• showing increased alertness to the environment
• repeating behavior that reminds them of the trauma
If your child exhibits these symptoms, getting them the resource of help from a trained professional will help them.

These websites contain more information on this topic:

AACAP Website

Channel 7 Interview about Deer Creek Shooting

Veterans Administration Post Traumatic Stress Disorder Site

Good Health,

Dr Dianne

First of all, what causes a stroke, or “brain attack?”
Strokes are damage that occurs to a part of the brain There are two reasons that this can occur:
• Ischemic strokes occur when there is blockage of the blood flow from a narrowing of a vessel, or a blood clot in a vessel.
• Hemmorhagic strokes occur when there is bleeding into an area of the brain.

In either case, the cells called neurons in our brain are damagd, and that has a negative effect on the functions of that part of the brain.

What are the symptoms of a stroke?
The symptoms can be very different based on the area of the brain that is involved, because each area of the brain controls different functions in our body. In general however, the warning signs of a stroke include
• Sudden numbness or weakness of the face, arm, or leg.
• Sudden confusion or trouble speaking or understanding others.
• Sudden trouble seeing in one or both eyes.
• Sudden dizziness, trouble walking, or loss of balance or coordination.
• Sudden severe headache with no known cause.
If you have any of these symptoms, you should call 911 because getting immediate help can help prevent permanent damage.
What can be done to help someone who is having a stroke?
The answer to that question depends on the type of stroke a person is having. With some ischemic strokes, we can give clot-busting medications if the person gets into the ED right away. The clot busting drug, tPA has to be given within 3 hours of the onset of symptoms. This means you need to get to the ED right away.
With all strokes, we can control blood pressure, blood sugar, temperature and other things that have been shown to improve the chances of getting the most function back. Many hospitals, like Porter, are certified by The Joint Commission as stroke centers, meaning that we have specialized teams in place that work together with proven techniques and treatment to improve functional recovery in stroke patients. The most important thing is to get medical attention as quickly as possible. If you think someone is having a stroke, don’t delay.
Since second strokes are so common – are there things can be done to prevent a second stroke?
There are many things that we can do to prevent a second stroke, and it is important to talk to your physician about what you need in your situation. Some of the things he/she may recommend include:
1) Management of high blood pressure
2) Management of high cholesterol
3) Control of diabetes
4) Exercise
5) Good nutrition
6) Stop Smoking
7) Management of abnormal heart rhythms

For more information on this topic, you may want to check out the following websites:
CDC

National Stroke Association

Porter Hospital Website

Neurology

Good Health!
Dr. Dianne

First of all, is there a chemistry to love?
We are complex beings, and there is no “formula” for love. However, it is known that oxytocin, which is a chemical in the brain, is related to feelings of love or bonding. This is the chemical that increases when a mother breastfeeds her child, and has been shown in a SUNY New York study to be more active in the brain in people who are in love. Oxytocin’s effects are to produce a warm and calm feeling – which many of us associate with the various kinds of love – parent/child, romantic – and even the feelings we get around good friends.

There have been many studies looking at health and relationships over the years – but what have they found?
The literature if full of studies linking relationships to improved health. In addition to increasing the calming hormones, it is also linked to increases in disease fighting chemicals in our body.
It is known that people in long standing healthy marriages are more likely to live longer than others. However, it is not just good marriages that correlates to good health. There are numerous studies that correlate having friendships to decreased mortality in diseases such as heart disease, breast cancer, and to improved brain function in older adults. One study from Australia correlated having relationships with friends, family and children to decreases in all cause mortality.  (Note – this is not true of unhealthy relationships.  If you are not safe at home, please follow this link for resources)
These are impressive results from friendship and relationships– what are the reasons that this may be true?
To put it simply, it appears that we are chemically designed to function best in a community that cares for each other. The hormones that are released when we take care of one another in healthy ways are the hormones that reduce stress. It is known that stress hormones, while good in certain situations, lead to such problems as high blood pressure, diabetes, heart disease and stroke. So the catch is that we have to create relationships that are supportive .

To make this more powerful the research also shows that friendships can release chemicals such as interleukin that help us fight infections when we are around others who support us.

What can we take away from this to help ourselves and others?
Most of us have many opportunities for friendship – but often it is up to us to take the first step
1) Reach out and do something kind for those around you – it will be good for the health of both of you.  The CDC has a website where you can send a “virtual hug” and remind your friends of healthy living
2) Go out and do things you enjoy – you will find people who can be your friends
3) Look for opportunities to serve others – such as volunteering – the same feelings of “love” can be found by serving
4) Find ways to forgive – it is a powerful health benefit to you
5) If you are in a healthy relationship – say thanks to your partner – gratitude is powerful
6) If you are alone, find ten things you are thankful for – and then find ways to connect with others

Good Health!  Dr. Dianne

For more information, here are some references:

Social Networks, Social Support, and Survival After Breast Cancer Diagnosis

Effects of Social Networks on 10 Year Survival

Effects of Social Integration on Preserving Memory Function

Any time there is a disaster of this proportion, meeting the emergency medical needs of the affected community is a challenge. However, in Port au Prince , Haiti, where much of the infrastructure – including hospitals and health care sites – have been destroyed, the challenges become even larger.
The first challenge facing volunteers will be the basics of caring for themselves and of making sure they arrive with all the equipment and tools they may need, since those have been destroyed in the earthquake.

The health care needs that the CDC lists as the priorities for Haiti include:
• Adequate quantity and quality of water
• Food security
• Appropriate shelter and protection from the elements
• Prevention and treatment of gastrointestinal, respiratory, and vector-borne illnesses
• Provision of health services to prevent maternal and infant deaths
• Prevention of violence and further unintentional injury
• Treatment of kidney failure due to crush injuries
• Prevention of deaths from infected wounds
• Prevention and treatment of inflamed lung tissue caused by concrete dust

Is there special training for this type of recovery effort?
There is definitely specialized training that the leaders of special efforts receive to help prioritize and organize relief efforts. Many hospital leaders and emergency response personnel go through Incident Command Training to help create a coordinated response to mass disasters in a way that meets the needs of the most people with the available resources. The CDC, the armed forces and many medical relief organizations have teams specifically trained to handle these types of situations.
Many of the problems that are being treated can be handled by most medical people without specialized disaster training working under the direction of the specially trained leaders, but these people need to go to help as a part of a coordinated group that has adequate supplies and can take care of themselves as well as those they go to serve.
What kinds of mental health concerns do these teams have to deal with?
While the workers find that it is a rewarding experience to be helpful to people who have such great need, the exposure to all the stress can take its toll.  According to the CDC, the following are normal reactions to these stressful situations: Normal Reactions to a Disaster Event
• Profound sadness, grief, and anger are common.
• You may not want to leave the scene until the work is finished.
• You will likely try to override stress and fatigue with dedication and commitment.
• You may deny the need for rest and recovery time.
Upon returning home one third to one half of workers will experience some type of negative emotions, and some may require professional counseling.

How do the workers minimize or deal with this depression?
When the needs are so great, it is even more important for those who can help to take care of themselves. Adequate rest, food and nutrition are obvious needs, but relief workers also benefit from pairing up to monitor one another, staying in touch with loved ones and friends, keeping a photo from home nearby, and by varying the stress level of the work they are doing.  Our colleagues who have returned from Haiti are meeting with one another to tell stories and to “debrief” themselves as a way of coping with all the tragedy they dealt with.

Good Health!  Dr. Dianne

If you want more information on this topic – you may want to check out these references:
CDC site re: Haiti medical relief and information for Haiti responders:

Is it surprising  that so many American children are now being vaccinated?
It is a welcome finding that so many parents are vaccinating their children according to the CDC’s guidelines. The increase in vaccination compliance is probably from multiple factors, but one important factor is the research that has been done to dispel many of the concerns about the safety of vaccines over the past few years, reassuring parents that these vaccines are much safer than threat posed by the diseases they are preventing.

Why are childhood vaccinations so important?
Many of us do not remember the days when no vaccines were available, and diseases such as whooping cough, diphtheria and polio caused major public health concerns for children. However, our parents certainly do. In the 1940s and 1950s, many children were not allowed to go out and play during the summer when polio was more common. The threat of paralysis or worse, being unable to breathe for themselves and put into iron lungs were terrifying possibilities for parents of young children.
All of the diseases that we now immunize against have some very serious side effects
Measles can cause brain inflammation (encephalitis) , mumps can produce sterility in males, tetanus  is  fatal 10-20% of the time, and diphtheria, too, can block the airway and cause death. We are so fortunate to live in a time when our children can be protected from these illnesses.

Let’s discuss  the chickenpox study – why is it important?
Chickenpox has been known as a generally mild disease. However, can produce life-threatening illnesses such as pneumonia and encephalitis in adults – and it is teratogenic – meaning that it can produce deformities in fetuses whose mothers develop the disease during pregnancy. Preventing chicken pox in children not only helps the children, but also protects the parents, unborn children and other adults of the people around the immunized child. More than that, it prevents shingles, which also caused by the chickenpox virus.

What is the recommended vaccines our viewers should consider for their children?

Which viruses your child should receive is something that should be discussed with your child’s healthcare provider. However, in general, the recommended childhood vaccines are diphtheria, tetanus, pertussis, poliovirus, measles, mumps, rubella, hepatitis B, Haemophilus influenzae type B and varicella (chickenpox). There are additional vaccinations recommended in children 7 and over.

Good Health!  Dr. Dianne

For more information about these vaccinations and diseases, you may want to read the following:
Vaccine schedule for children ages 0-6-

Vaccine Schedule for Children ages 7-18 –
Information on Vaccine preventable illnesses:

First of all, why do CT scans have so much more radiation than a regular X-ray?
A regular X-ray – or plain film as we call it – is a beam of radiation shot through the body from one side to the other, where a special film picks up the radiation and provides a view into the body – air appears to be dark and water-filled things appear more white, with various organs having shades in between. It allows physicians to “see” inside the body in a flat view. A CT scan is a series of regular X-rays mounted on a circle and connected to a computer. The computer takes the shadows from the series of images done and reconstructs a picture of a person that looks like a slice of the person and has much greater detail than a plain film. Since it takes multiple X-ray beams to construct the image, the radiation dose is higher.
So, CT scans are very useful in seeing the organs inside of the body and finding tumors, infections and other problems. In fact, we can now see the placques in coronary arteries that used to require a cardiac catheterization to see.

What was the article’s concern about cancer?
It is important to note that this was not a study that followed actual patients.
In one report, they looked at doses of radiation that 1,119 patients at a hospital had received from CT scans and then calculated the lifetime risk of developing cancer in those patients. In the other report they showed that up to 29,000 cancers could be caused by the current doses of radiation in CT scans

What is being done about this?
At Porter, for example, we are have been doing many things to address these concerns.
1) We are trying to reduce the dose of radiation for each CT scan without changing the quality of the picture. In fact, our lead heart CT radiologist, Dr. Simeon Abramson,  has done ground-breaking work with Siemens to  reduce the dose from a CT angiogram of the heart from the equivalent of 100-140 chest X-rays to the equivalent 0f 10-30 X-rays – making it less than the dose of radiation from the traditional cardiac catheterization.

2) The hospital radiology department is creating systems to track total radiation doses patients are receiving from tests done at our facility
3) We have systems in place that stop physicians from ordering radiology tests that will not give them the best information and are working with them to get a better test

What can patients do?
It is always appropriate to ask your physician why they are ordering a test, and what the risks and benefits are to you.
Also, it is a good idea to tell your physicians about any X-rays you had done elsewhere. They can get a copy of that test and you can avoid a second test.

For more information, you may want to look at the following sites:

Centers for Disease Control

American Nuclear Society – Calculate Your Radiation Exposurefrom all sources

Porter Hospital Health Library

Good Health!

Dr. Dianne

First of all, let’s look into the article in the New England Journal of Medicine

The authors of this study looked at rates of infections with pneumococcus – a common bacteria in children that can cause pneumonia, sinus infections and other respiratory illnesses – before and after the routine use of pneumococcal vaccine in children. The study showed that before the vaccine was introduced, there was a sudden spike in pneumococcal infections in adults 50 and over during the holiday season that does not occur any other time of year. In fact there was a 42% increase in the risk of adults getting pneumococcal disease. The strains of the bacteria that were increased are the types most commonly seen in children. Since the introduction of the vaccine, the authors could not find a spike in disease.
Also of interest, the study found that women were much more likely to get the bacteria than men.
The spike is not correlated with the influenza season, or with other common bacteria, so it is believed to be related to the increased contact more mature adults have with children during holiday gatherings during this season.

How concerned should we be about the findings of this new study?
We have  known for years that being in close spaces with those who are ill increases our chances of getting ill ourselves.
This study dramatically shows that when we vaccinate our children, we are not only protecting them – but also the older adults in the family who, this shows, catch illnesses from being around children. Adults with medical illnesses and those who are over 65 should also be getting the pneumovax.
This study also reinforces the idea that even at holiday gatherings – which we all look forward to – we need to be sure to follow good hygiene and stay away when we, or our children, are actively sick.

What can our we do to prevent pneumococcal disease?

1) Children should get pneumococcal vaccine as recommended by their physicians – to protect them and to protect our relatives who are older than 65.
2) Keep children who are sick away from those relatives over 65 when possible
3) Good cough and sneeze etiquette – into a tissue or elbow
4) Get enough rest, good nutrition and drink a lot of water
5) As always – good, frequent handwashing is essential

It’s always a good idea to follow good hygiene and stay home when sick.

What other illnesses are going around this time of year, are there other things we can do to stay well during the winter?

The seasonal flu normally starts sometime in January or February. It’s not too late to get a flu shot and give your family additional protection.
Other respiratory viruses that cause colds, bronchitis and sinus problems are also common this time of year. The close contact we have as we spend more time inside in closed homes helps transmit these from one of us to the other. Remembering to clean door handles, faucets, and even toys more often can help decrease spread of viruses and bacteria.

Good Health!  Dr. Dianne

For more information on this subject, you may want to look at these sites:

CDC

Porter Hospital Health Library

Good Health and Happy New Year!

Dr. Dianne

The first question , is there any reason for parents to be concerned about this recall?
The recalled vaccine, according to the CDC, the FDA and the manufacturer, is perfectly safe. This vaccine was for children aged 6 months to 3 years of age only. The vaccine met all safety and potency standards at the time it was shipped out for use. The concern that led to the recall is that the vaccine, now weeks after being shipped, is no longer as potent as the required limits. It is thought that the antigen – or the part of the vaccine that your body reacts to in order to create immunity – may be sticking to the side of the syringe, creating the lowered potency.

Should parents whose children had this vaccine need to get them re-vaccinated?
It is felt that children should not be re-vaccinated. Experts at the CDC and FDA have stated that even though it had a little less potency than the specifications, the vaccine should still be able to prevent H1N1 Influenza.

Is there still a lot of flu in the community?
Physicians in the hospital are still reporting a number of influenza-like illnesses, but the number of confirmed cases in Colorado is now listed as sporadic – or infrequent – on the CDC website. This is a decrease from earlier this fall.
However, it is important to remember that we are now just entering the seasonal influenza season. It is expected that we will see a rise in influenza as the strains that normally circulate this time of year start to appear. It is also important to remember that a separate vaccine is required to prevent the seasonal flu.

It was reported recently that the Russian army is increasing the rations of garlic and onions for their soldiers to prevent the flu – what foods are effective in preventing flu?
Frequent handwashing, covering coughs and sneezes, and keeping frequently-touched areas such as doorknobs, handles and towels clean are still the best ways of preventing the spread of influenza.

Many foods, garlic, onions, vitamin C rich foods and even chicken soup have been traditionally felt to prevent illness – or help lessen the severity of colds and flu. There are biochemical pathways that could be affected by these foods and so theoretically, they could have benefit.
Interestingly, among these foods with some comparative scientific studies – garlic, vitamin C and chicken soup, only chicken soup was shown to have benefit that was notable – it helps clear nasal blockage from the steam that comes off the soup.
So, while it may make us feel better – it still would not get FDA approval as a medication for treatment.

Good Health!  Dr. Dianne

For more information on this topic, you can go to

Centers for Disease Control (CDC)

Garlic for the Common Cold

Immunomodularity of Garlic

Every year at this time, many of us want to start the new year by becoming more healthy, and start strenuous programs that we soon give up.  These resolutions seem too simple – can they really affect our longterm health?

Actually, these small changes are associated with big health gains.
Let’s start with the resolution to brush our teeth and floss twice daily– how does that change more than our dental health?

There have been articles linking mild to moderate periodontal – or gum – disease with increased risks of both heart attack and stroke. While the reasons for the association have not been clearly spelled out, the association is clear. For that reason, picking up your toothbrush, dental floss and using them everyday is a resolution that could prevent heart attack or stroke in the future

Two of your resolutions – sleeping more every night and taking a day for time with family or friends/or spiritual activities don’t feel like resolutions – since when are fun things good for us?

Both getting enough sleep and spending time with loved ones, or in spiritual pursuits, are known to improve our health by lowering blood pressure, decreasing chances of diabetes, and lowering risk for heart attacks and strokes. All the mechanisms have not been studied, but it is felt that by following these good health habits, we lower stress. Stress is known to release chemicals that make our bodies hold onto weight, increase blood pressure – and over time increase our chances for heart attacks and stroke. We also know that pleasurable activities and time spent with people important to us help us release chemicals that calm us – lowering blood pressure.
Our bodies are designed to work best with rest

Finally, drinking water – is that really important?
Our bodies are 70% water, and the chemical reactions that make our body function are designed to happen in this watery environment. In addition, water helps us flush the waste products of living out of our bodies, helps keep our blood pressure where it should be, and is vital to living. If you are not drinking eight  8 oz glasses of water a day – start slowly building up your water intake until you are – that way you won’t be spending too much time in the restroom.

Good Health!  Dr. Dianne

If you would like more information, check out these websites:

Adventist Health Systems Creation Health

Circulation

Institute of Medicine

Medscape

NIH

University of Florida