Tuesday Tips- Screening tests

Your doctor can let you know what illnesses you need to be screened for and when, but here is a quick rundown. (Of course, this list doesn't take into account your family history or current health.)

Heart Disease: 55 years old and regularly after that, or with the presence of any symptoms or risk factors

Colon Cancer: 50 years old, for men and women done every 10 years


Male Cancers: regularly between the ages of 40 and 75


Female Cancers: Breast cancer- every 2 years between the ages of 50 and 74, Cervical cancer- every year after age 21

Diabetes: age 45, but sooner with the presence of symptoms or risk factors

Osteoporosis: women age 60 and then every 5 years

How to stop the Flu

You don't want to get sick and I don't want to get sick so I'm gonna tell you how to best avoid the flu. I've numbered these in order of importance.

1. Get a flu shot. This is the greatest step in flu prevention, but it is not the only one and does not guarantee that you will not catch the flu. This step is especially important if you have a weak immune system, have long term breathing problems, or are a senior citizen.

2. Wash your hands often. Wash before you eat and after you cough, sneeze, or blow your nose. Use a Kleenex and throw it away right after you are done. Even if it is only allergies act as though you are contagious. If there is not soap and water available then use an alcohol based hand sanitizer.

3. Stay home if you are sick. Stay home until your temperature has been normal for 24 hours without taking Tylenol or other fever reducers. You can spread the flu from 1 day before you have symptoms to 5 days after. If your child is sick, then you are carrying the germs with you. Be considerate of others and keep the germs confined.

4. Be mindful of what you touch, in fact, don't touch it if possible. Try not to touch your face (that's especially hard to do when you're thinking about it) because that is the easiest place for flu germs to infect. Handrails, door knobs, money, counter tops, and shopping carts- they are all very, very dirty. If you do touch a public surface, go back to #2.

For more info about how to tell if you have the flu and what to do about it visit the Centers for Disease Control's flu page.

Tuesday Tips- Safe chemicals

1. Use hydrogen peroxide to clean and disinfect. It kills germs on contact and doesn't leave any residue behind since it breaks down into hydrogen and water. It is great to clean shallow wounds or scratches as it does not sting. It will also clear up any sores in your mouth if you swish and spit a tablespoon. Do not swallow. It is a wonderful cleaning solution that does not require any scrubbing, the bubbles do it for you. Just soak items in a bowl of it to sanitize them.

2. Boric acid is a wonderful insecticide. It is not nearly as dangerous as commercialized insect killers and it remains active for many years! It kills many bugs including ants and roaches and prevents mold growth and wood rot.  The best way to treat for roaches with it is to drill a hole between each stud in your walls and put several tablespoons in each hole then spackle the walls back up. The roaches will not come back for 8 years, even if your neighbors have an infestation. It should not be inhaled or eaten so put it out of the way of children and pets. I put it under my dishwasher and fridge and behind my washer and dryer.

3. Baking soda is a great cleaner as well. It is completely safe (you can eat it), it has whitening and abrasive powers, and it pulls out odors. Besides that, it is super cheap! You can use it everywhere- clothes, carpets, bathtubs, hair, sink drains, barbecue grills, pets- it's amazing. Baking soda has many heath uses too; as an antacid, sports drink, cure for diaper rash, bug bites, and poison ivy. Look here for more uses!

4. Vinegar is great for cleaning and several health issues as well. It is completely safe, but doesn't always smell so great. It is safe for almost every surface in your house in diluted solutions. A comprehensive list of vinegar uses is here. It can be used to clean bathrooms, kitchens, laundry, and cars. It has many health and beauty uses, and will repel bugs.

Saturday Stories

I enjoy working with neurologic (brain) patients, specifically head injuries. I enjoy it because their condition changes rapidly, often for the better. I like to see the change- the difference I am making. They are often also very entertaining. : )

One such patient I had while I was working my way through college as a nurse's aid. She had been found unconscious on the side of the road by an ambulance. I still don't know how she got there. It was my job to bathe her and check her vital signs every two hours and report to the nurse. They had placed a small tube through her nose into her stomach to feed her. For a day and a half she just slept there, then she began to come around. At first she only moaned when I moved her, but soon she was moving on her own. At that point she started to pull on her IV and other tubes so I was assigned to sit with her in her room all day and keep her out of trouble. It takes a lot of patience to work with someone with a brain injury because they are very forgetful. I'm quite sure that I said, "Don't pull that!" every two minutes for a couple of hours...

Once she began to talk I had a constant stream of amusement: "Look at all those pretty fishes out the window!" We were on the ninth floor in Tulsa, but she told me this was a wonderful cruise. Every two hours we would go over who she was and what day it was and where we were and who was president. She didn't remember any of it for about three days. Every so often she would sit up and say, "There goes that pretty kitty cat again!"

Once she began to swallow without choking I was allowed to pull the tube out of her nose. I let her have the satisfaction since she had been trying for two days. Then began the adventure that was meal time. She hadn't quite got her balance and coordination back yet, so she made a big mess and every little while she would just fall over in a random direction. I always stood very close.

Then the day came when she was well enough to not need to be watched every minute. The maintenance department brought up a "mesh bed". It was basically a large play pen that fit over the bed frame and zipped close from the outside. This would prevent her from getting out of bed on her own and falling. I knew that sometimes patients did not like this confinement, and believing that perception is a big part of a person's reality; I said in an eager voice, "You're going to get a new bed today! It is a very pretty blue bed!"

"Ooohh!" she was entranced when they brought it in. Mission accomplished. I took care of her for a couple more days and she was ready to go home. I had very much enjoyed helping her to recover and was happy-sad to see her go.

Home Health Nurse

I have just started a new job as a part time home health nurse. I am, of course, learning much and reviewing more. I enjoy change and am so thankful that the nursing profession offers a myriad of opportunities.

The home health nurse visits patients in their homes after they are released from the hospital. The goal is to prevent the patient from going back to the hospital because they didn't take care of themselves, or to provide basic nursing services (such as dressing changes) outside of the hospital because it is much cheaper than staying in the hospital. This service is often paid for completely by Medicare.

I am looking forward to this type of nursing because seeing the patient in their home provides a complete picture of the issues and problems that they must overcome to heal and stay healthy. I will have the chance to assess their home environment and get them whatever type of assistance will best benefit them. This includes physical therapy, speech therapy, occupational therapy, house cleaning, meal assistance, grooming assistance, or social assistance. I will be able to sit down with the patient and discuss their medications and their illness and teach them how to take good care of themselves. I know that this job will often be frustrating because many people don't want to do what it takes to take good care of their bodies; but perhaps I can bless a few lives by spreading Love around.

Tuesday Tips

One of the main reasons that I became a nurse was to help my family avoid unnecessary trips to the doctor. Now, I know if one of us truly needs medical care or if we can "wait it out" (my husband's favorite option). Sometimes it is difficult to decide, and if you're not sure then go ahead and see your doctor. However, there are some general guidelines that I follow at my house:

-fever in adults higher than 101.
-vomiting and/or diarrhea for more than 3 days
-sick for more than 7 days
-any infection that is worsening (swelling, redness, pain, puss, fever)

Of course, if you have any symptoms of a medical emergency you need to go to an urgent care center or emergency room right away (please call 911):

-chest pain/heaviness/pressure, especially with single arm numbness/tingling/pain
-sudden and unusually severe pain or headache
-any muscle weakness or fainting
-trouble talking or walking
-uncontrollable bleeding
-difficulty breathing or swelling of the throat
-sudden changes in vision

If you have a question about a specific situation (clearly not an emergency), just ask me and I will be glad to give you my advice (I am not a doctor) about what I would do if I were you.

What did she say?

One of the proposed solutions to the nursing shortage is to bring foreign nurses to the U.S. to  work in our hospitals. I have worked with several such nurses in the hospital. These nurses have been trained in their home countries, mostly India, but must pass the U.S. tests for nursing to be licensed here. The organization that brings them over assists with their visas and expenses. They often must sign one or two year contracts to ensure that the company's investment is returned, and so are unable to quit if they feel their job is not a good fit.

In my experience, these nurses are well educated and competent. The problem is their communication skills are very poor. Communication is a huge part of what nurses do, especially hospital nurses. We communicate with the patients, the doctors, and with each other to ensure the best care for our patients. These foreign nurses have trouble communicating in our English language. The patients don't understand what they ask, or try to teach them. The doctors often flat out refuse to speak with them on the phone, and are little better in person. Their fellow nurses struggle to understand them, adding needless stress to every one's day. In the end, patient care suffers, as do these poor nurses, who are brought here as our saviors but are actually treated as stepchildren.

This can be a viable short-term option, though it is clearly not the best solution to our nursing shortage. If you do find one of these foreign nurses, be kind. Remember that you need to work extra hard to communicate your needs, and ask for clarification if you don't understand something she says. If you have a complaint then take it to the management and let them know what your specific problem is so that they know what to fix.

Tuesday Tips

Learn the generic names for the medications that you take on a regular basis; you will eliminate confusion and be able to compare prices. You should also know general information about the drug, such as what other medications it interacts with and how best to take it. Your pharmacist can give you this information, or find it here.

Before you have a surgery or procedure done you can take a tour of the part of the hospital where it will occur, or where you will be recovering. Ask the nurses there which doctor they recommend- they know who they would go to if they were in your shoes. You can also ask them what personal effects would be best to bring with you, and what equipment you may need for your recovery.

Be aware of the qualifications of the "nurse" who is caring for you. Many companies have begun to use personnel with less training in traditional nursing roles because they are cheaper. This is not to say they are not qualified to care for you, but you deserve to know their level of qualification. Some examples include school nurses, professionals in urgent care clinics, and hospitals. Many "nurses" in our schools are not really nurses at all, and are poorly equipped to handle medical situations. Often there is one true nurse for multiple schools. I spoke with a nurse at a local urgent care company that said she is the only nurse for all their Tulsa sites, the rest are "care technicians". In the hospital most of the people who enter your room are not nurses, but helpers. Do not hesitate to ask health care personnel if they are a nurse.  I know it's confusing, so I will list the true nursing titles:
NP- nurse practitioner: does many things a doctor can do. 8 years of school
RN- registered nurse: very knowledgeable nurse, may supervise other nurses. 4 years of school
LPN/LVN- licensed practicing nurse/licensed vocational nurse: general nurse. 2 years of school

Lister-what?

Listeriosis is a type of food poisoning caused by the bacteria Listeria monocytogenes. The CDC has confirmed that there has recently been an outbreak of this illness due to contaminated cantaloupes from Jensen Farms in Granada, Colorado. Check here for updates regarding the outbreak. There are 55 people infected from 14 different states, 8 from Oklahoma. If you have one of these cantaloupes, throw it out, even if you have eaten part of it without illness. If you do become sick, see your doctor and let him know it could be listeriosis.

This bacteria is commonly found in soil and water; and often infects animals without any symptoms. It is usually not a severe illness for healthy adults and children, however, it can be deadly for infants, babies still in the womb, elderly people, and people with weak immune systems. It can be diagnosed with a lab culture (growing bacteria) of amniotic fluid, blood, feces, or urine.

Listeriosis contaminates food that has come into contact with water, dirt, or animals that are infected with the bacteria. It can survive for years and grows well at room temperature, but can even grow in the refrigerator.  The bacteria is killed by heat. To prevent listeriosis be sure to wash all fruits and vegetables well, buy pasteurized products when possible, and thoroughly cook your foods. Lunch meats should be heated to steaming before being eaten by pregnant women or those with weak immune systems.

Listeriosis first causes general digestive problems and diarrhea. The bacteria will often spread beyond the stomach eventually causing symptoms such as fever and muscle aches, headache, stiff neck, confusion, loss of balance, or convulsions. It is treated with antibiotics and with early treatment is easy to overcome.

Overall, you should not be fearful of listeriosis- only aware. It is easily prevented with basic food safety practices and not a severe illness for the general population.

Tuesday Tips

1. Relax a little about the germs. Good old soap and water hand washing is the best germ prevention strategy. Using alcohol based hand sanitizers isn't recommended by the Centers for Disease Control unless soap and water are not available. Germs won't make you sick unless you aren't used to them. The Hygiene Hypothesis purports that our modern outbreak of allergies is due to a too clean lifestyle. A child's immune system is looking for germs to fight; if there are none then it will fight whatever it finds- pollen, peanut residue, or wheat. Studies have shown that children with multiple siblings, in daycare, and in third world countries have dramatically fewer allergies than those who are not exposed to germ sources.

2. Lay off the Tylenol, or, at least know how much you are taking. Tylenol poisoning is a growing problem in the health care world. Many prescription drugs for pain relief have Tylenol, also called acetaminophen, in them. This becomes a problem when people take them in addition to Tylenol for pain relief. Additional problems are the availability of extra strength doses and the confusion of multiple brand names for the same drugs. The maximum recomended dose of Tylenol/acetaminophen is 4000mg per 24 hours. That is 4 extra strength Tylenol. Prescription drugs such as Lortab and Percocet have Tylenol in them in differing amounts: ask your pharmacist how much so that you know what you are taking. Over the counter drugs such as Excedrin and Nyquil have Tylenol in them as well, so read the label before taking anything! Damages from Tylenol overdoses will not make you obviously sick immediately, but it will permanently damage your liver. Once you reach a critical amount of liver damage you will need a transplant. It's a serious problem that won't manifest itself until it's too late for a simple fix.

ICE- In Case of Emergency

Emergencies happen everywhere; one happened near my husband this last week. He called me to see what he should do, but, of course, I was unable to answer.

What happened was an older lady fell outside her home and was unable to get up. She called for help and he came running. He asked if she thought she could get up; she told him that she was in too much pain to move. She told him that her injured leg had an artificial knee. He told her not to move and asked if he could call someone for her. She asked him not to call 911, but to go and get a neighbor- the neighbor was not home. She asked him to call a friend, but there was no answer. He persuaded her to let him call 911 and he stayed with her to calm her until help came. She will need another surgery to replace her knee, but she should experience a full recovery.


So, what you should do in the event of a health emergency:

1. Stop/slow any bleeding.
2. Call 911.
3. Determine if the person is awake and in their right mind.
4. Keep them still. Do not move them unless they are in an unsafe place (the middle of a road).
5. Keep talking to the operator, they will guide you through until the paramedics arrive.

Tuesday Tips!

Here are this Tuesday's tips, if there is a topic that you would like to hear about specifically just leave me a comment!

If you do not have insurance (or are not using it), called "self-pay patient", then you can usually negotiate a cheaper rate for services. This is because health care providers, especially hospitals, inflate their fees. They do this because they have a "deal" worked out with insurance providers to give them a "discount". Just tell them you are paying for the service yourself and ask for a discount. I recently got $30 knocked off of an $100 office visit for my son because our insurance hadn't kicked in yet.


Get your flu shot! Yes, it's already that time. You want to get it early because it takes two weeks to fully protect you. You cannot get the flu from the shot, the virus is already dead and cannot infect you. However, your body will be working hard to make extra antibodies to protect you and you may need more rest and protein to help it along.


Since we've all started once again venturing outside, be sure to stay hydrated. It's tempting in the "cooler" weather to not drink so much. The thirst sensation often feels like hunger, so many of us eat when we are really thirsty. Be sure to drink before, during, and after all activity. You probably don't need to drink a sports drink, unless you are at a 3 hour football practice or other very long, strenuous activity. Your body stores plenty of electrolytes and those drinks have lots of calories. If your urine is pale yellow to clear then you are drinking enough; the darker it gets the more you need to drink. You can also weigh yourself before and after your workout and drink 20-24 fl. oz. for every pound of weight that you have lost during your workout.

Eat a breakfast high in protein and low in carbs and sugars. It will jump start your metabolism while giving you enough real fuel to get to lunch without becoming tired and hungry. Breakfast burritos or quiches are good options. Eggs are a wonder food- great for you and quick to prepare!

Saturday Stories

I will never forget my very first patient, for more reasons than one. I was so very nervous; that first day in the hospital. I looked at my assigned patient's chart first thing- "Oh good", I thought, "it's a nice little old lady." I was assigned to the instructor with which I was least comfortable, and she chose to watch my assessment first. "Great." So I walk down the hall, followed by an instructor and four fellow students. I press open the door as I paste a smile over my nervous face.

"I'M GOING TO BITE YOU! DON'T YOU COME NEAR ME!" Wow. I was SO not prepared for this... My instructor took pity and said, "Tell her you are going to do your assessment and that she will not bite you." My mouse voice repeated her words. I was trembling to my very self. The patient turned her wide, wild eyes to my wide, astonished ones. "Go ahead and do your assessment," My instructor prompted. I bravely (I felt) started in. "I'm going to shine my light in your eyes," and, "please follow my pen with your eyes." Yeah, right. All the while judiciously keeping my fingers away from my patient's gaping mouth. I got to the part where I needed to listen to her lungs. "Please breath slowly in and out." Uh-huh. She was still screaming about biting me; I'm sure the nurses at the desk down the hall were all chuckling.

"Jade, I'm going to ask you to start over. Take a deep breath and start your assessment from the top. I know that you can do this." That meant I was doing something wrong, but what? I couldn't even think- in fact, I was lucky to be speaking through all the nerves. I started again. Again began to listen to her lungs, and again was stopped. I was almost in tears. My instructor (who became one of my favorite teachers), took me outside of the small room and pulled me aside. "I'm not going to pass your assessment today, Jade. You'll need to do three more practices in the lab tomorrow. You must always put your stethoscope UNDER the patients' gown and against their skin to listen to their lung sounds." Oh. Tears pooled, and began to spill. "I understand that you are nervous, but you will do better next time. Don't cry, it will be okay." Her tears then began to pool. After several deep breaths we walked back in. She chose another student to perform the assessment, and they did it right, of course. I focused on breathing in and out.

No one was bit that day, nor have I ever been bit. I passed my assessment the next week, conscientiously placing my stethoscope under the patient's gown. I eventually out grew my mouse voice, and came to love working with patients who are a bit more than your average crazy.

Quick! I need a nurse!

     There is a growing shortage of nurses, you may or may not have heard, but the health care world is scrambling to figure out both short term and long term solutions. Some have projected the shortage to reach 260,000 registered nurses by the year 2025. So what has caused this, and how do we fix it?

     The first cause is the aging nurse population. According to the 2008 National Sample Survey of Registered Nurses released in September 2010 by the federal Division of Nursing, the average age of the RN population in 2008 was 46 years of age, and nurses in their 50's are expected to become the largest segment of the nursing population. As many as one quarter of all nurses are expected to retire in the next two decades. The second cause is a lack of enough new nurses to replace the retiring ones, let alone to fill all the new positions being created by our aging baby boomer population. We are not making nurses fast enough to fill our ever increasing needs. However, U.S. nursing schools turned away over 67,500 qualified applicants in 2010-2011 because they don't have the faculty to train them. And it's no wonder why nurses don't want to be teachers- we make much more money working as nurses, and don't have the added stress of a student working under our license. Furthermore, the lack of nurses causes insufficient staffing at facilities; raising the stress level and decreasing job satisfaction for those nurses that are working-prompting them to leave the field entirely.

     So how do we fix this problem? First of all we need more nurse educators. They should be paid well, this is, perhaps, the most important job in our society. They are training nurses how to care for people, and nurses are special in that they are the most knowledgeable person that will be with the patient on an hourly basis. We are often the first to spot a problem, and we are the last barrier to mistakes in patient care. Nurse educators should be highly esteemed. Second, we need to raise awareness in the general public so that those who are looking for a good, secure profession are aware of the need for nurses. Since 2002, Johnson and Johnson has a great campaign going to raise awareness of the nursing profession, more companies, especially health care companies should follow their example. Third, we need better work environments for nurses, and where that is not possible-better compensation for the overworked nurses.

     Nursing is a stressful job in it's very nature. Caring for another is exhausting-just ask any mother. Nurses often deal with life and death situations, and with people who are cantankerous because they don't feel well. But for most of us nurses, our passion is helping people and that is it's own reward. This enables us to keep going to work, while hoping that there is an end to the shortage soon so that we can improve the quality of the care we give each day.

Tuesday Tips!

Here are some helpful tips that my nursing career has taught me:


Hydrogen peroxide will remove blood from clothing. Just pour it on your garment before washing and scrub it around. The blood will be dissolved by the bubbles!

If someone is unable to get around well then fold a twin sheet in half and place it under them before they sit or lie down. Then you can pull on the sheet to move them rather than pulling on them. Be sure to smooth out the wrinkles by firmly tugging on the sheet after their weight is on it; it will be much more comfortable!

If you are going to have a procedure done that will require an intravenous line ("I.V."), then shave your arms before going in. Often the most painful part of an I.V. is the tape! Often they will have "paper tape" which is not as sticky and will not pull off fragile skin- just ask for it!

Finally, the cheapest place in Tulsa to buy medicines is Genscripts Pharmacy (http://www.genscripts.com/). They have medications at half the price, ten cent maintenance medications, and free antibiotics! They also have a delivery program. Reasor's (http://www.reasors.com/healthwell/pharmacy_hlth.php) also has free antibiotics to help our community!

Show me the money...

There is a serious shortage of common, cheap medicines. These are medicines that the pharmaceutical companies have been making for decades. They are important in the treatment of many common symptoms including nausea, swelling, and itching. Since these drugs, which control such common symptoms, are simple, well understood, and easy to manufacture; why are extreme shortages happening?

It is because these drugs are also "cheap", meaning the profit margin on them is low. In many cases there is only one company with one plant manufacturing the supply for our whole country. Because this one company is trying to make a profit from the low cost drug they manufacture, they are financially lead to cut corners- safety corners. The FDA then, during inspections, finds faults and shuts down the plant until the problems are addressed. This abruptly ends the supply of that drug indefinitely, which forces physicians to choose another drug to treat their clients symptoms. The replacement drug is always less suited to the clients problem and does not work as well causing delays in treatment and unhappy clients.

The major pharmaceutical companies, which could better handle the smaller profit margin on some drugs, refuse to manufacture these endangered drugs because the profit margins are nowhere near those of the newly researched drugs that are just hitting the market. This is especially true in the field of oncology drugs. A dose of decadron (a common steroid) may cost a few dollars, but a dose of neupogen (which stimulates white blood cell growth) may cost $6,000!

The solution, then is either to raise the cost of these common medications, or to find a company which is willing to make a smaller profit margin on some drugs for the good of the American people. I don't think the problem will end anytime soon.

This is Crazy...

The entire health care system in the United States is out of control. Insurance companies are unable to control their costs, doctors are unable to control patient care, the government is unable to control their aid programs, and the individual feels unable to control anything!

Costs have been artificially inflated while insurance companies have cut deals with providers and medcaid flat out refuses to cover the actual cost of treatments. Billing for care has become a nightmare industry with health organizations trying to get more and insurance companies trying to pay less. The individual is left to bridge an ever widening gap with co-pays and coinsurance and 80/20 versus 70/30 or 90/10. The average individual could not hope to understand all the nuances without the help of an expert in the industry, but we are all asked every year to review our insurance and make any changes or "new elections" necessary. Then, heaven forbid, we end up in the emergency room and agree to all the tests the doctor suggests not having any idea how much it will cost us in the end (and neither does the doctor, by the way). Is there any other such purchase that we would approve before we knew the total? It would be considered ridiculous to purchase a car without knowing the cost before driving it away; and even more ridiculous to drive away and then refuse to pay the full cost!

We, as individuals, must step up and demand to be informed. We should know what our health care costs, truly costs not just costs us; and we should make educated decisions concerning the direction of our care. Just as we have the right to be fully informed about our health care decisions; we have the responsibility to make informed choices directing our care.