Arthritis

It was interesting going through the news today; there was a good variety of information. The new drug for rheumatoid arthritis is great news: New Actemra data shows significant benefit for patients suffering from rheumatoid arthritis . According to the Arthritis Society, rheumatoid arthritis affects 1 out of every 100 Canadians. The effects of RA can range from mild discomfort and pain to severely affecting quality of life. RA doesn’t only affect adults, but children can have juvenile rheumatoid arthritis.

There are several types of arthritis, the most well-known being RA and osteoarthritis. Both affect the joints and cause pain, but they differ in terms of cause, effect, and treatment. RA is an autoimmune disease, meaning that the immune system has begun to attack itself, causing the inflammation of the joint lining. The joints, most often the hands or feet, become red, swollen, and warm to touch.

Osteoarthritis, on the other hand, is more common than RA – it affects 1 in 10 Canadians. Rather than the inflammation caused by RA, osteoarthritis is caused by the wearing away of cartilage in the joints. As the cartilage breaks down, the bones no longer have the cushion between the bones and the bones begin to rub together. It’s often called arthritis caused by use because the joints most commonly affected by OA are the hips, knees, and spine.

If you want to learn more about arthritis, you can check out the Canadian Arthritis Society or the American Arthritis Foundation.

News for Today:

Respiratory infections in babies increase asthma risk: study
New mom's NYC Marathon win stirs debate
'Runner's high' may also strengthen hearts
Anemia drugs could be harmful to cancer patients: FDA
Many vaccine booster shots may be unnecessary
Chronic pain affects 1 in 3 Canadians: poll
Merck not sure why trial AIDS vaccine failed in volunteers
Emotional eaters susceptible to weight regain

Effective communication in health care

I touched on the idea of effective communication the other day. This is something that we were taught in nursing because a large part of caring for others is being able to truly hear what it is they are saying. This is important in all aspects of life, but particularly in anything health related.

When we go about our daily business, how many times are we asked, or we ask, “How are you?” when coming across a friend or acquaintance? Unless we really have time to chat, we’re usually not expecting any answer other than the standard, “Busy!” or “I’m fine, thanks.” While this is ok in every day quick contact, this isn’t ok when you are trying to find out what really is wrong.

Nurses often hear that response as well, “Oh, I’m fine,” when they ask patients how they are. It’s not the best question to ask, because years of courtesy and convention usually still kick in, no matter how sick a patient is. So, then how should a patient be approached?

How a healthcare professional approaches a patient greatly depends on many factors: Has a previous relationship been established? How long has the patient been on the unit/floor/in the waiting room? What seems to be the problem? Is it an acute situation? The list goes on. So, an important issue is to assess the situation. Asking yes or no questions may have a place sometimes, but it’s not a great way to get information. Asking questions that encourage description are often a better way to go. When asking about pain, you can ask if the patient does have pain (a yes/no question), but then you can probe for clarification. “Can you describe the pain? Can you show me where it is? How long have you had it?” – and so on.

This type of communication may be obvious for the physical issues, but if we are going to go deeper, we can learn about things such as how families are coping with an illness. With good communication, a healthcare professional can find out a lot about a person’s emotional health, living situation, and ability to cope with illness or injury.

Another important issue that healthcare professionals must deal with is suspected domestic abuse; then, we need to be even more careful. We need to help the patient understand that we can be trusted and that we will not judge them. Most importantly, we need to help them understand that we *will* listen. The article Appropriate ER questions can start talk on domestic violence describes a study done in emergency rooms to identify communication with patients who may be victims of domestic abuse. The emergency room is one of the main areas where these people may be seen. While the study has its drawbacks, the main ones being that the people involved knew they were being taped and nonverbal communication was not investigated, it does do a good job of showing the importance of effective communication.

News for Today:

Appropriate ER questions can start talk on domestic violence
Overweight, post-menopausal women have higher cancer risk: U.K. study
Manufacturer restricts use of diabetes drug Avandia
New strain of superbug at Sick Kids' Hospital
Caffeine helps reduce disability in very preterm babies

Energy drinks - in moderation, if you're healthy

Energy drinks are gaining popularity, not just among college students who want/need to stay up all night to write a paper, but among many adults who feel they need that boost. The problem is, these drinks are not without issues: Energy drinks may pose risks for people with high blood pressure, heart disease.

Some people argue that energy drinks are like coffee – some people use coffee to kick start their day, others use energy drinks. Most energy drinks contain as much caffeine as a regular cup of coffee. While this is true, what is happening with a lot of energy drinks is that younger children are drinking them – children who wouldn’t ordinarily be drinking coffee, or at least not drinking it regularly.

Another disturbing trend it adding alcohol to energy drinks. This can be dangerous for a number of reasons. The stimulants in the energy drinks could mask the level of consumed alcohol, leading to consumption of more than may be tolerated by the body. As well, if someone doesn’t think they are as drunk as they are, they could be more prone to doing things – like driving – convinced that they are sober enough. Physically, the combination of the two (alcohol and energy drinks) could really speed up dehydration. At the least, it could result in a much worse hangover than one from a night of drinking just alcohol, at the worst, the body could become so dehydrated that the body can't metabolize the alcohol properly.

In other words, like most things, moderation is the key. Energy drinks are likely harmless for the average healthy person, but people should be aware of their dangers as well.

News for Today:
Athletes most likely to die suddenly from enlarged heart
Atkins diet raises heart risks, study finds
Chronic kidney disease common in the United States
Medication does not appear to improve symptoms or outcomes for patients with acute heart failure
Energy drinks may pose risks for people with high blood pressure, heart disease

Interesting news for today

Lots of interesting news today: A drug recall, Bayer freezes sales of anti-bleeding drug Trasylol , tops my list. Trasylol is a medication that surgeons give their patients who are undergoing heart surgery. The medication is supposed to help limit the blood loss during surgery. It was approved for use in the US by the FDA in 1993, but they began re-evaluating it in 2006 after receiving reports of serious adverse events.

Another story that caught my eye is 'You're not a victim of domestic violence, are you?' Effective communication requires asking open ended questions – not ones that require only yes or no answers, and definitely not questions that already imply a negative response. Discovering domestic abuse requires a much better approach than this.

Several of the other stories are about the same topics that we’ve been reading about lately – blood pressure – for example. But this one, Bystander-delivered defibrillation improves survival after cardiac arrest was interesting. I renewed my CPR certification a few months ago and I also learned how to use one of the bystander defibrillators. It was so much easier than I had anticipated. I had imagined it was so much more difficult than it was – but it truly is mistake proof. The directions are clear and concise; you just follow the steps and do your thing.

News for Today:
Bayer freezes sales of anti-bleeding drug Trasylol
Pain medications may ward off Parkinson's
Maternal alcohol drinking during pregnancy associated with risk for childhood conduct problems
Behavior therapy plus medication may help teens with depression and substance use disorders
'You're not a victim of domestic violence, are you?'
High blood pressure, chest pains speed up progression of Alzheimer's disease
Bystander-delivered defibrillation improves survival after cardiac arrest
Blood-incompatible infant heart transplants safe, may save more lives
Heart failure patients benefit from nurse-led intervention
Large VA study finds seasonal differences in blood pressure

Will that be bottle or breast (feeding)?

There’s a lot of news out, but not much that I think belongs in this blog. And, to tell you the truth, I’m a little tired of the studies about the same topics over and over again. But, today, I found this one: Uplifting news for nursing moms.

I am a definite proponent of breast feeding; however, I fully support the choice to not breast feed. I know that some women can’t do it, some women don’t want to do it, and some just don’t feel comfortable with the issue. But, I have to honestly say that I never imagined fear of sagging breasts would be one of the reasons why a woman wouldn’t nurse her child.

I think it does bother me when the decision is made without truly weighing the pros and cons. When my second child was a newborn, I spoke with an old friend who had had a child the same time. The subject of feeding came up and I asked if she was nursing. Her answer, “Oh Lord no. I’m not putting my boob into someone else’s mouth.” I’m not speechless often, but I was then. Ok. I think a “no, I’m not” would have sufficed. Another friend of mine was discouraged from breast feeding by her own mother. Her mother used to make mooing sounds whenever my friend would nurse her child. Alrighty then.

In all honesty, there are people like that in the breast feeding camp too. They think that all women should nurse and that there is no reason not to. In my opinion, that’s not right either.

When I first began my career as a nurse, I worked on obstetrics for a few months. Here was I, all of 20 years old, telling mothers how to care for their newborns. But even back then, I was very understanding of personal choice. If a mum said to e that she was bottle feeding, leaving no opening for discussion, I respected that decision and helped her with her baby. If a mum said that she was bottle feeding because she was nervous/not comfortable with breast feeding, leaving the door open a bit, I would gently encourage her to try. My feelings then, as they are now, were, one day of nursing is better than none. One week of nursing is better than a day. One month is better than a week, and so on.

My reasoning was that if the mum was willing to give it a try and then felt it didn’t work, at least the baby had the benefit of the time he or she was nursed. As well, as I would point out to the undecided mums, you can breast feed and change your mind to bottle feed, but you can’t do it the other way around.

I did meet some men who were very against their wife breast feeding. One woman told me that she had to stop nursing after a couple of months because her husband was actually jealous of the baby. I wasn’t speechless, but I dared not say anything to that one.

Whether a mother breast or bottle feeds is an intensely personal decision. I believe that mothers have enough issues on their plate that they don’t need society approving or disapproving of the way they feed their babies. Personally, I do wish more moms nursed, but I have to remind myself when I see an infant with a bottle; perhaps the baby was adopted, perhaps the mother tried to nurse, or – and just as validly – she just didn’t want to.