Friday, November 16, 2007

Healthcare professionals and stress

I had to dig deep to find these stories – not much happened yesterday.

On Wednesday, I posted a link to an article about healthcare workers and stress. Anyone who has ever worked with the public in any capacity, be it a server in a restaurant, a bus driver, or receptionist, to name a few, can attest that it can be very stressful at times. While many members of the public are polite and understanding, many are not. Separately, being responsible for someone’s health is stressful. You don’t want to make mistakes, you’re dealing with people’s dreams and lives, with pain and discomfort. That’s pretty stressful too. So, combine working with the public with working in health care and you’ve got a heck of stressful situation sometimes.

There is never an excuse for a rude or nasty nurse or healthcare professional. Ever. The thing is, sometimes certain attitudes can be mistaken for rudeness and this can set off a chain of events. Picture this scenario: a nurse has a patient who is deteriorating rapidly and needs emergency interventions. She has another patient who is close to discharge, not well, but not acute any more. The healthier patient wants the nurse to do something, like perhaps get a pain medication, just as the sicker patient is crashing. The nurse has to address the sicker patient and deals with the emergency, delaying the pain medication for the other patient, or perhaps forgetting altogether. The scenarios that can follow are numerous. The original patient may end up perceiving the nurse as rude or uncaring, when this may be completely untrue – but it is the patient’s perception.

The stress doesn’t come from just the patient care though. Often, nurses (and other healthcare professionals) are pressed to make do in situations that really shouldn’t happen. This could mean short staffing, work overload, forced over time, and so on.

Then, there is the physical stress of the job. For example, someone has to be awake and moving at 2 in the morning. This person has to be able to make snap decisions and move quickly, regardless of if he or she has been able to get a decent sleep during the day. Patient care is heavy and very physical; causing many nurses to experience back pain.

All this paints a bleak picture, doesn’t it? I don’t mean to. Health care is very rewarding; there are few other things you can do in life that can affect someone as deeply as you can do if you work in this environment. But the stress is causing many people to quit the profession or to shut down while working – doing on the basic minimum and not striving to reach their best.

News for Today:

FDA adds heart attack warning to diabetes drug Avandia
New Drug Fights Medication-Linked Bone Loss
Weight Loss Drug Rimonabant Linked To Severe Depression Or Anxiety Risk

Thursday, November 15, 2007

Death by plastic surgery

Plastic surgery, Botox, Restalyn, liposuction – procedures all to keep us from looking older. According to this article, Plastic surgery complications rare: study, complications – and death – are rare during cosmetic procedures, but they do happen. In 2004, a prominent Montreal woman, Micheline Charest, died after having a face lift and breast augmentation; the same year, Olivia Goldsmith, author of The First Wives Club, died during cosmetic surgery; and earlier this week, Kanye West’s mother died. That’s just three women whose lives were cut short due to unnecessary and avoidable surgical procedures. If we look beyond those who died, there are many women (and men) who undergo such procedures who live, but have had bad results due to botched or unsuccessful surgeries. No surgery is every successful 100% of the time – complications can and do happen.

Many people don’t see plastic surgery as “real” surgery. The thing is, it is very real surgery. It involves anesthetic, which has risks of its own, and the procedures – all of which have some risk. Is it worth it? Is this search for never-ending youth worth it? Some people think so.

I’ve heard women compare having cosmetic surgery to dying your hair. While I respect the decision to have cosmetic surgery, if that’s your choice, but I won’t accept that comparison. As far as I know, there is no risk of death from dying or permanent disfigurement from hair dye.

So, if someone does want cosmetic surgery, they need to be sure that they are healthy enough for the surgery. If one surgeon says you’re not a good candidate for surgery – is it really a good idea to shop around until you find one who will take the chance? You need to be sure the surgeon is board certified and experienced in the procedure you’re about to undergo. Most of all, you need to go into the surgery knowing full well all the risks.

Charest, Goldsmith and West probably all thought that nothing bad would happen to them.

News for Today:

Green tea up to 5 times as healthy when citrus juice added
STD cases surge in U.S.
Older women victims of bias in Canadian ICUs
Antivirals can lower flu deaths in elderly: study
Plastic surgery complications rare: study
Study links asthma and post-traumatic stress disorder
Latinos and African-Americans live longer with Alzheimer's disease

A quick filler

I'll be back with a real post a little later, but I just had to share this animation by Walt Handelsman: Baby boomers.

Wednesday, November 14, 2007

Diabetes and foot care

Most people understand that diabetes has something to do with the blood sugar in the body and that this causes problems, but many people don’t understand exactly what some of these problems can be.

When I worked on a medical unit, I frequently had patients who were newly diagnosed with diabetes. This meant that a lot of patient teaching was needed about the disease, lifestyle changes, and how to prevent complications. Of all the patient teaching I ever did, nothing brought about more disbelief and questioning than foot care. So much so that frequently, the part about foot care would to in one ear and out the other. The article 63 percent of diabetics risk serious foot problems by wearing the wrong-sized shoes tells me that I wasn’t that far off with thinking that way.

Why is foot care so important for people with diabetes?

Your body is only meant to have a certain amount of blood glucose (sugar). Too low causes problems as does too high. The higher sugar eventually causes damage to the blood vessels and nerves throughout the body. Because your feet are the furthest away from the heart, they are most easily affected by poor circulation.

If your nerves are affected, you can have a constant type of nerve pain or you can start losing feeling in certain parts of the body, like your feet. If your circulation and nerves are working properly and you get a blister or cut, you feel it and usually can try to take measures to keep this from worsening, as well as trying to heal the wound. But, if your circulation is compromised, you may not feel the wound starting. Once the wound has started, because the circulation is poor, it is harder for it to heal and can easily become infected. It then becomes a vicious cycle.

People with diabetes who develop wounds in their feet can end up having to have their foot amputated if the wounds can’t be controlled. Of course, this results in more health issues. Great care needs to be taken to be sure the wound heals properly and doesn’t cause other problems. Ambulation (moving about) becomes affected as a wheelchair may now be needed. This results in social isolation and there are other physical issues that result from being in a wheelchair.

So, how does someone with diabetes protect the feet? Here are some simple rules:
- make sure your shoes fit properly and do not cause wounds
- wear socks with your shoes
- avoid high heels that can put too much pressure on the bottom of the feet
- shop for shoes at the end of the day when your feet are usually a bit swollen
- don’t walk around barefoot
- wear socks inside out to prevent the seam from rubbing against the toes
- check your feet every day while cleaning them
- don’t rub your feet clean – pat gently
- ensure your feet are completely dry before putting on socks
- if you want to apply a cream to cracked heels, be sure it is absorbed well
- do not self treat any corns, warts, or calluses; see your doctor or foot care nurse
- when cutting nails, be sure to cut straight across, not curved down at the sides
- keep your feet protected in the winter, keeping them warm
- notify your doctor or foot care nurse of any blisters, cuts, wounds, or other problems with the skin on your feet or toes

This is a situation where prevention is truly the most important weapon. Take care of those feet because you don’t know how much you depend on them until you can’t use them!

News for Today:

Health-care providers report high stress levels: report
New eye test credited with early cancer diagnosis
New anemia measure predicts risk of death in dialysis patients
Many seniors need daily help after hip fractures
ICU survival determines family's satisfaction with care
63 percent of diabetics risk serious foot problems by wearing the wrong-sized shoes
Number of cases of most vaccine-preventable diseases in US at all-time low

Tuesday, November 13, 2007

Vision-correction surgery?

If you wear glasses, have you considered undergoing laser surgery? I know it’s very popular and I know that people who have had it are very pleased with the results, but I just can’t bring myself to consider it.

The article Surgical errors rare but serious in ophthalmic procedures is more about other types of eye surgeries, but it’s precisely why I’m uncomfortable about laser surgery for the eyes, unless it is really a quality of life issue. My eyes are the only set I have. If anything goes wrong, what do I have?

Do I wish I didn’t have to wear glasses? Absolutely. It is a pain in the neck, but there are worse things that I could have to do. I just can’t take the risk of being one of the few people who have a bad outcome from the procedures.

In all fairness, bad outcomes are rare. According to, the serious complication rate is below 1% with carefully selected patients. That means that the surgeon must be careful in ruling out any patient who appears to be at risk for complications. As well, the more experienced the surgeon, usually the lower the complication rate.

Of course, this type of surgery also only corrects distance vision and not other problems – so even if someone wants to have the surgery, is confident about the outcome, and ready for the surgery – they may be refused or they may have the surgery with the caveat that they will still need glasses for the visual problems that aren’t corrected surgically.

It’s a very personal choice – but if it is one you are making, be sure to make the right choice of surgeon and clinic. Don’t be swayed by advertising – it’s the doctors’ abilities, re-education and on-going training, and manner that count. A doctor who is associated with a university, teaching hospital, or somehow involved in research is more likely to be up-to-date on the newest technologies and issues. If you’re not sure where to start, your optometrist or ophthalmologist may be able to give you some recommendations. Just because a doctor is recommended doesn’t mean you should take that at face value though; you still need to do your due diligence. You can also get names from the licensing boards of your country/province/state, for a place to start.

Once you find a surgeon, you need to ask some questions to help you make your decisions. You should know how long the doctor has been doing the surgery. Beware of claims that go back longer than the surgery exists! How many procedures has he/she done? Does he or she do them themself or do they have other surgeons working with them/for them? How many of their patients achieve a visual acuity of at least 20/40? 20/20? Can you get references from patients?

Don’t forget, you can always get a second opinion. Take your time to get the right information before making the decision.

News for Today:

Brain matures slower in kids with ADD, researchers say
Omega-3s, fruit, veggies lower risk of dementia
MRSA germ undermines body's defences
Correcting poor vision in nursing home residents may decrease symptoms of depression
Program of exercise and education improves function and symptoms in women with fibromyalgia

Monday, November 12, 2007

Time is not your friend if you're having a stroke

Strokes are life changing events, whether they result in long-lasting effects or complete recovery. The very idea that something went wrong in the brain can have a profound impact on realizing one's mortality.

We’ve often heard a lot about mini-strokes or TIAs, but what are they? TIA is short for transient ischemic attack. Ischemia is the state where there is not enough blood – and its nutrients – to body tissue, usually caused by a blockage or obstruction. A TIA occurs when there is a section of the brain tissue that is deprived of this blood for a short period of time. In other words, it’s a stroke that lasts a few minutes or a bit longer.

So, how can you tell whether you’re having a stroke or experiencing a TIA? You can’t. If you have the symptoms of a stroke, even if you have a history of TIAs, do NOT wait and see if it will resolve on its own. If you wait and it is a true stroke, you are robbing yourself of valuable treatment time. Strokes need to be treated as soon as possible to minimize the damage. Time is not your friend in this situation.

The following information was taken directly from a patient fact sheet, Stroke Facts, found at the National Stroke Association.

How can you tell if you or someone you know is having a stroke or TIA? Think FAST:

F= Face – ask the person to smile. Check to see if both sides of the face are moving the same way, or does one side droop?

A= Arms – as the person to raise both arms in front of them. Does on arm seem to drift downwards while the other one stays outstretched?

S= Speech – Ask the person to repeat a simple sentence. Does the sentence make sense? Was it repeated properly? Is the speech slurred or garbled?

T= Time – if any of those signs are present or you suspect them, call 9-1-1 or seek help immediately.

News for Today:

Risk of a major stroke after a minor stroke high
Cord blood bank could solve transplant problems: doctor
Students to get mumps shots
Caregivers benefit from cancer support programs, U-M study finds
Warning for women who binge drink

Sunday, November 11, 2007

Owning a pet = better health?

There have been many studies involving pet ownership/companionship and human health. On the face of things, you can see why it can be beneficial for a person’s health to have a pet.

For example, if you have a dog and you don’t have a yard, you are forced to take the pup out for a walk regularly. This enforces exercise and often encourages socialization. Many people have met others pet owners over the countless walks over the months and years. Pets need love and care. They need to be fed, no matter how unwell you may feel. They often demand a cuddle or a hug (dogs especially!), sometimes at just the right moment when you’re feeling your worst.

In a study undertaken by Karen Allen, PhD, Pets and Human Cardiovascular Health, Dr Allen writes, people with pets had a significantly lower basal heart rate and lower blood pressure, and they were able to do mental arithmetic at a quicker rate, as well as recover from stresses quicker, than did non-pet owners. In another study, Dr. Allen found, “Participants with dogs present in their homes had significantly reduced resting BP (that is, to within the normal range), reactivity to stress, as well as ambulatory blood pressure, even while at work, while those in the transcendental meditation program exhibited no significant changes. Lowest ambulatory BP was recorded on the day participants took their dogs to work. This pattern of response was replicated 3 months after the control group acquired their dogs. These findings suggest that control of borderline hypertension can be assisted by a behavioral intervention involving a pet dog.”

In 2005, a study appeared in the BMJ (British Medical Journal), by June McNicholas et al, which reviewed the evidence of pet ownership evidence and issues. She writes:
- “People do not own pets specifically to enhance their health, rather they value the relationship and the contribution their pet makes to their quality of life.
- Greater understanding among health professionals is needed to assure people that they do not need to choose between pet ownership and compliance with health advice.” That last point is particularly important in situations where people are chronically ill or who are dying. The presence of a pet in a palliative care setting can be an enormous comfort to both the one who is dying and the family and friends.

Why the post on pets today?

Yesterday, we welcomed another greyhound into our home. She will be 9 years old next month and is a retired brood mom. She’s gorgeous and charming and an absolute doll. If you love dogs, please consider welcoming a greyhound into your life. As a lover of all dog breeds, I never thought I would be smitten by one breed in particular, but after Oscar came into my life in 2004, I was sold on the gentle and loving nature of these dogs – and so many of them need forever homes. Please contact me if you would like to learn more about greyhounds and what they are truly like – not the myths of energetic, nervous, excitable hounds, but the loving companions they are.