Bone marrow transplants - would you consider being a donor?

This is a reprint of a blog post from 2008, but the topic is as timely now as it was three years ago.

Many people donate blood. Many people have signed organ donor cards. But how many people are registered to be able to donate bone marrow?

Bone marrow donation has a lot of misconceptions but if everyone who gave blood - and those who didn't - would register for bone marrow donation, the number of lives that could be saved would be astronomical.

According to the Canadian Blood Services, and keep in mind that the US is not that different, "About 1,500 Canadians have received transplants through the Canadian Blood Services Registry. However, even with millions of donors on registries worldwide, a perfect bone marrow match isn’t always available."

First, what is bone marrow and why is it so darned important?

Bone marrow is the soft tissue that is found inside our bones; it's the spongy tissue in the breast bone, ribs, hips, pelvis, skull and spine. The role of bone marrow is to make blood cells - white blood cells to fight infection, red blood cells to carry nutrients from the lungs to the body tissues, and platelets that allow the blood to clot.

People with diseases that affect the bone marrow die of infection or inability for their blood to clot. The most commonly known disease that requires bone marrow transplant is leukemia, although there are many more.



What is involved in being a donor?

Not too much initially, really. First, you need to register and your local blood collection agency needs to know what genetic make-up you have. So, that means providing a swab from inside your mouth or a vial of blood for testing.

After this has been tested, you are entered into the bone marrow data base. Now - you may never ever be called - or you might. If your marrow is found to be a match to someone in need, anywhere, you will be called and asked if you still want to donate. This is a critical moment - if you register to donate, you just may be called.

Waiting for a donor to be found is tough. A friend of mine waited for a donor. One was found and she was so cautiously optimistic. Something happened, however, and the donor backed out. My friend was devastated - as were we. Finally, a donor was found, but I can't imagine what must have been going through her mind while she waited for it to actually happen.

How is the bone marrow taken from you and given to the recipient?



Bone marrow donation is typically done as day surgery although you could be kept in the hospital for a day or two. There's no doubt that there  is some discomfort involved. You will feel soreness in the hip area for a few days after the procedure, but it isn't unbearable.

You would receive either a general anesthetic or a spinal before the procedure is done. The marrow is removed from the large bones of your pelvis using a needle. Afterwards, if you need, usually over-the-counter medications will relieve any pain. The marrow is then processed and the recipient gets it through an IV.

Are there any risks when donating?

Donating marrow is a medical procedure and no medical procedure can guarantee that there are no risks. However, that being said, considering the number of bone marrow donations done, it's been found that it is a very safe procedure. The risks do include a reaction to the anesthetic and infection where the needle was injected. Rarely, there may be some tissue damage.

So, we're back to the question: Would you consider becoming a bone marrow donor?

Identifying Anxiety and Seeking Help

Stress and anxiety aren't new feelings/emotions, although we seem to have tried to corner the market on it these days. People worried and stressed over life and family since time began. Hunters had to find food. Nomads had to find safe places for shelter. Farmers needed their crops to grow. Parents needed their children to stay healthy and grow up to adulthood, and the cycle continued as society changed and developed. Some eras were more filled with worry than others, but no matter what, humans always had something to worry about.

Today, our stresses and anxieties are very different, yet they are strikingly similar at the same time. Many people worry about how they are going to feed their families and keep a roof over their head, because they aren't working or they are one of the millions of working poor. People stress over their or their loved ones' health; sons, daughters, spouses, and friends are still going off to war; farmers still are at the mercy of the weather; and children still pull away from their parents, going off on adventures and spreading their wings. But what seems to be so different is how we are dealing - or not dealing - with our stresses and anxieties.


There is now more acceptance to admitting to stress and anxiety than may have been a few generations ago. There is so much acceptance that a whole industry has sprouted with the goal of helping people manage or avoid stressful or anxious feelings. But how do you find which one works for you? Do you need to spend a lot of money trying different methods until you find a way of easing your anxiety? What if you worry about never being able to stop worrying?

There's no easy solution. It's not always a terrible thing to be anxious sometimes; the problem is how often and how anxious you feel. If your anxiety is keeping you from living your life as you would like it, keeping your from trying new things, and is making you feel badly about yourself, then it's probably best that something be done about it.

Identify the cause

If possible, you need to identify what is causing your anxiety. Do you get anxious if you have to do something, like get in an elevator or meet new people? Are you worried about your performance at work, your children, or your health? Do you feel that you're anxious about just about anything and everything?  If you want to try to manage on your own, there are many options, from trying meditation and yoga to following self-help programs and reading advice books or columns. No one method is good for everyone. If you've heard of a great book that helped your cousin and when you read it, it does nothing for you - don't give up. That just means it wasn't the right thing for you.

Self-help programs

Be cautious when trying different programs or techniques. If you are reading information on the Internet, check first to see that the website is credible and that the information you are reading is helpful, not harmful. Some simple tricks to check out a site's legitimacy is by checking the "about us" section. Who is running the site? Who is writing the material? Does the site have any back up from a university or some organization that is known in the field? How long has it been running and - an important thing - are they trying to sell you something or promise you a miracle cure?

If the site is trying to sell you something, is it something that must be bought or is it something that can be obtained for free elsewhere? Google the program and read opinions and comments - not just the good ones! Is the site promising you a miracle cure or a guaranteed outcome? If so, it may be a good idea to run away as fast as you can. Nobody can guarantee a positive outcome and there is no miracle cure, as much as we would like one. It's tempting to want to believe it, but it's not going to happen. 

Asking for help

If you're not the type to go it alone or you feel that your anxiety and problems have gotten to the point that you can't deal with them alone, there are other options. Visiting and speaking to your family doctor (or nurse practitioner) is the best place to start. By doing a physical exam, your doctor may be able to rule out a physical problem that could be causing the anxiety and he or she may be able to refer you to a counselor, therapist, or psychologist to help you learn how to manage your anxiety.

Therapy

Therapy does seem like a scary word to many people. They may envision being prescribed medications that may change their personality or having to speak to someone who just mirrors back what they're told. But therapy comes in many forms and there is no one-size-fits-all approach. As a consumer, which is what you are when you are seeking help, it is essential that you find the right fit for you. This doesn't mean just finding the right type of therapy, but the right therapist. There could be three therapists offering similar approaches to helping manage anxiety, but two of them may not be the right ones for you simply because of personality differences or there just isn't that "click" that you need, and know, when you find the right person.

Finding a therapist

The best place to start to find a therapist would be by recommendation. Ask your doctor or nurse practitioner if they know of counselor or therapists that they would recommend. If you're comfortable, ask friends if they know of anyone. If you do visit someone who has been recommended, don't feel that you have to make it work if something doesn't seem right. A therapist who works well with one person may not be a good fit for another. It happens all the time - don't feel you must stick with someone just because he or she was recommended.

In addition to getting referrals, you can check lists of accredited counselors in your neighborhood, or call the licensing bodies or organizations. It may take a while to find a therapist who you trust and with whom you can work, but it's worth the effort in the long run.

Allow yourself to heal

Anxiety can be all-consuming. It can overwhelm you and seriously affect your quality of life. Learning to manage your anxiety can be just as frightening because you may discover issues that you would rather not delve into or it just may be hard work that you didn't think you would have to do. But if you stick with it, if you work with your therapist or go it alone, the results on the other side of the journey may be very surprising: happiness and contentment, with a minimum of anxiety. Isn't it worth the try?

Managing Pain Properly - No Matter What Age

Everyone experiences pain at some point in their life, be it the sudden (acute) pain from a bad cut or a broken bone or the chronic pain of a back injury or migraines, just to name a few causes. Acute pain is generally well treated because it is usually caused by something you can see (a cut, a surgical incision, a broken bone), and many analgesics (pain relievers) are meant to handle the pain. Chronic pain, however, can't be seen clearly, can't be identified easily, and certainly can't be treated easily. But is it because it *can't* be treated, or because it *isn't* being treated. There are arguments for both sides.

Throughout my work as a nurse, I saw pain (mis)management for many patients. Rarely were the patients over medicated - they were much more likely to be undermedicated. This happens for many reasons, the most common ones being:

• The person assessing the pain is using his or her own thoughts of pain as a measuring stick as to how painful a certain situation should be.
• The person assessing the patient doesn't see the patient acting in a way that he or she feels a patient in pain should be acting.
• The analgesics prescribed are not effective for the type of pain the patient is experiencing.

Not only did I see it in my professional life, I've seen it personally as well, most recently over this past weekend. My mother fell over a week ago and broke her ankle. Then we were told it was her hip too, now we are back to "just" her ankle. The thing is, she has other chronic problems - in particular a badly damaged back - that cause a lot of pain so at home, she was on a constant dose, every day, of a pain reliever that kept her pain at bay. Once she was admitted to the hospital, this constant pain reliever was discontinued because the doctors needed to assess her overall health.

After a few days of very severe pain, she was prescribed a patch of a medication called fentanyl. It's a great (in my opinion!) way of delivering medication, because the patch goes on your skin and delivers a constant dose of analgesia for three days. There is no up and down of pain reliever levels in your blood, it is always there. After three days, it needs to be replaced, but it is a simple procedure of removing the old patch and applying the new one.

In my mother's case, she had to have the patch removed the same day she was going to surgery for her ankle, so she didn't have a new patch put on. This was Saturday. I went in to see her on Sunday and she was in a lot of pain - more than just post-surgical pain at her ankle, her back was very, very painful. I wasn't sure why, so I looked for her pain patch. She didn't have one. She should have.

I went to speak to her nurse who was puzzled that I would be asking for a pain patch - she said that she would have it again in three days, when it was time for the next switch. I explained to her that she had no patch at that time - nothing. No pain relief other than the short acting acute pain reliever they were giving for her surgical pain. The nurse didn't seem to understand my argument. I kept saying, the patch should have been put back on - it wasn't put back on. It doesn't make sense that my mother (or any patient) should have to wait three days because that is what the medical record said. The medical record is assuming that she had HER PATCH ON.

After much discussion, the nurse said she would call the pharmacy (of the hospital) to see what she should do. Sure enough, she was in my mother's room within a half hour with a new patch for her. When we asked her why my mother hadn't been receiving this pain relief for her chronic back pain, the nurse answered something to the effect of "here we are only concerned with the surgical problem, not her other ones." What?

So, what was wrong with this picture? A lot.

We have an 82-year-old lady who is in a lot of pain from the new fracture and from the old back injury. She has been taking long-term pain medication for years, so her body is used to a certain level of analgesia in her system. This chronic pain medication was taken away from her and not replaced. Therefore, she was in much more pain than she had to be. Because the nurses couldn't be bothered with learning about all of my mother's medical issues, they didn't understand why the chronic pain medication (the patch now) was vital for her recovery. If you are in pain, you can't do your rehab exercises, get out of bed, or even think of getting better. Then the cycle began. Because the nurses didn't understand why her chronic pain relief was necessary, she didn't get it. Because she didn't get it, she had more pain....

Pain is not something that can be ignored, regardless of the cause. A patient who is having pain cannot heal properly. The amount of energy it takes to deal with pain is taken away from the energy needed to heal.

I will be discussing this issue with the hospital once everything has settled down. I do have to say, I was absolutely not impressed with the cavalier attitude of someone who wasn't in pain regarding someone who was.

Healthier Children Through Play

There are words of gloom and doom all over the media these days: Our children are out of shape, lazy,  fat, and developing adult lifestyle-related illnesses, such as type 2 diabetes. And, what is even more frightening, for the first time, this new generation may actually have a shorter lifespan than that of the generation before. Is it all this serious? Is this just a Chicken Little "the sky is falling" subject? Unfortunately, the answer is, yes, it is this serious and no, it's not a Chicken Little scenario.

According to the Nemours Foundation, one out of three American children are overweight or obese. In Canada, it's estimated that 26% of children are overweight or obese. This isn't just a few children. This is millions of children in North America whose health is at risk.


So, what is causing the problem? Why are so many of our children so overweight? Unfortunately, it's not just one thing. Of course, diet is a major issue - generally children who eat well-balanced and healthy portions of meals don't have a weight issue. But our society pushes high calorie, high fat, processed foods because everything has to be done fast, be ready, and convenient. And these are generally not the health choices. The other main culprit for the child obesity problem is lack of exercise. If you don't exercise, use your body, you can't burn off excess calories. Not only will the weight come on, the muscles won't get strong and the whole body suffers.


Is There Time for Play?


"But there's no time for play," you may say. Between the children being at school (sometimes with rather long commutes), at daycare, at music lessons, doing their homework, and so on, where will they find the time to be active?


It used to be that children had plenty of active time at school. Between the recesses in the morning (and sometimes afternoon), plus the play period after lunch, children had the opportunity to run around the school yard, play tag, toss a ball, and just be free to have fun. Unfortunately though, recesses are being cut back in some schools. There's even talk of eliminating them in some places. In addition, many schools use recess as a punishment. If a student doesn't behave or hasn't done her homework, for example, recess is taken away - effectively eliminating any chance the child has for burning off any energy and experiencing social interaction beyond that of inside classes.


Playing at home outside after school isn't an option for many children. They either live in parts of the city where they can't safely play unsupervised; they're in daycare or after school care, so not at home; or there isn't anyone else around to play with them because either the neighborhood children are not allowed the freedom to play outside or they are themselves in daycare.



Another opportunity for exercise used to be from getting to and from school. Children would walk back and forth or ride their bikes. That's not a common sight these days. Parents are often seen driving their children to school even if they only live a few blocks away. For some parents, it is a matter of convenience - they're dropping off their children at school while on the way to work, but other parents don't want to walk (or bike) with their children and they certainly don't trust their children to go alone. The result: no exercise for either child or parent.


Finding the Time for Play


It may seem rather simplistic to say that all we need to do is find the time for children to play, but it could be as simple as that. However, finding the time itself isn't always the easy part. In order for each family to decide that they need to exercise more, allow their children more freedom in what they play and when, the family has to find out what is preventing the play time. If it's because the children have too much homework, this is an issue that should be brought up to the school. If it's lack of space, you may have to look for available play space. If it's time, then scheduling play time, free time, needs to become a priority. Our children are not as healthy as they should be and allowing them to play, to run, to enjoy being children is actually a good way to improve their health. Isn't it worth the investment?

To read about games that we used to play as children and some blog posts and article on playing, visit GamesWeUsedToPlay.ca. 

Games We Used to Play

Every generation says the generation before is different - and this isn't usually meant in a good way. The older generation complains that the newer one doesn't have the same work ethic, doesn't have the same respect for elders, and so on. Now, whether that is true, I can't say, but I do know that the children of today, in North American society, often do not have the same opportunities for free play that we did. This, to me, means they are missing out on something vital, something important in their development.

When we played for hours with our friends, without adult supervision, while we were having fun, we also had to make rules, enforce rules, mediate problems, and sometimes learn to deal with things that just weren't fair. These are all tools that we took with us into adulthood. Was it fair to always be picked last for a team? No, of course not. Is it fair when the child with the ball takes it home because he feels that he wasn't being treated with enough respect? Again, of course not. But much of this was negated by the fun of playing hours long games of tag and hide-and-seek, without being told to be careful, watch what you're doing....

There is a lot of research going on into the importance of free play and it is quite interesting. To encourage discussion of the subject, I have started a website called Games We Used to Play: A Hop, Skip and Jump Down Memory Lane.

The goal of the site is to gather as many stories of games from across the world as we can. One person from one country may post they played a certain game one way, but someone else may recognize it as a game they called a different name and they played with slightly different rules. I am also adding articles about different issues about free play and I encourage people to comment on them, to add their point of view.

Games We Used to Play also has a Facebook page, where we can share more information, and we are on Twitter, at @gamesweusedtopl.

Support Your School Nurse - Even if you don't have kids.

School nurses play a vital role in our society and most people probably don't even give them a second thought - unless they are thinking about the "cushy" job they may have. Those who think this may be surprised to learn that the school nurse they may remember from the childhood is long gone and the school nurses of today are in a specialty all its own.

In an article I wrote for GE Healthymagination This Isn't Your Mother's School Nurse, I talk about the many issues that school nurses face that they didn't exist a generation or so ago. School nurses are dealing with sick or disabled children who, years ago, would never have been able to attend a school or who may not have lived to school age.

School nurses also have to deal with children who may rarely, if ever, see a doctor or nurse practitioner outside of school. The children may either have no health insurance or may be in a family situation that doesn't allow for preventative health care. School nurses also have to deal with the realities of this generation, which include coordinating and running disaster plans for events such as natural disasters, crime and terrorism. They need to deal with children who are abused or neglected, as well as those who are homeless. And there is so much more.

It was very interesting to speak to the two nurses I interviewed for the article. There are statistics that show that schools who have nurses, particularly full-time nurses, have better attendance rates. We know that if children go to school regularly, they have a better chance of graduating and moving on to further education or finding good, productive work out of high school. School nurses do the actual nursing tasks that teachers and administrators have to do if there are no nurses - and in this day and age of education cutbacks, we can't afford to have teachers doing non-teaching work.

So, please, support your local school nurses. They need to be part of the core group of professionals students encounter at school every day. Having a school nurse is not a luxury. It's a necessity, whether you have children or not.

September is Sepsis Awareness Month

Infections - we all get them. We may get a cut on our leg that we didn't clean out properly or we may develop a urinary tract infection or even influenza. We may have surgery that has complications or develop a disease like cancer, that leaves us prone to getting infections. However we get the infection, be it viral, bacterial or fungal, there's always the chance that our body will overreact and we develop sepsis.

But what is sepsis? According to Sepsis Alliance, it's the body's toxic response to an infection. In other words, as your body tries to fight the infection, it goes into overdrive and ends up trying to kill you. Some people call it blood poisoning, but that isn't a good word for it because it doesn't accurately describe what is going on.

Once sepsis sets in, your body's organs begin to shut down and eventually, it may cause death. If not death, you could end up having a limb - or several - amputated in order to save your life.

Right now, every 1.75 seconds, someone in the world is diagnosed with severe sepsis. Many more are developing sepsis. In the United States, every 2.5 minutes, someone dies of sepsis. Thousands more are left with life-altering after effects.


September is Sepsis Awareness Month. Please take a few minutes to learn about sepsis and to spread the word. It may be a cliche, but the life you save may be your own.

What Are Advanced Directives?

Death isn’t usually a topic that someone thinks about on a regular basis, but it is one of the realities of life. When the subject does come up, most people think about funerals, burials, reading of wills, and the many tasks that come after a death. But, how many people know – and have put down on paper – how they would like to be cared for in the period before they die if they aren’t able to make such decisions on their own?

Putting Your Wishes in Writing

Living longer

As we all age and as doctors are able to cure more diseases, we in the Western world aren’t dying as young. We are living longer, sometimes with chronic or fatal diseases. This puts us in a position where we may be alive but may not be mentally capable of deciding on what sort of care we should be receiving.

Loved ones may have to choose for us, often leaving them with many questions about if this is really what we would have wanted.

Advance directives

Advance directives are important documents that can save much heart ache. These documents can ensure that you get the care that you want and expect, and that you can be allowed to die in peace and dignity when the time comes.

Advance directives take the burden off of your loved ones who may be stressed and unwilling – or unable – to make these important decisions for you.

Also called living wills or DNR orders

Advance directives are sometimes called living wills or DNR (do not resuscitate) orders. In some places, they may be called a power of attorney. That term, though, differs in different parts of the country and may not mean the same thing where you are. This is important because if you believe that you have a legal document and it is not considered legal in your area, your wishes may not be carried out.

To be sure that your document is legal and actionable in your state or province, it’s best to go to a lawyer and make sure it meets all the requirements of your state or province. Medical and legal people want to be sure that you have made these decisions while you are of sound mind, that what is written is truly what you want, you understand what is written, and that the decisions that you are making are truly your own.

What to include in your advance directive

When considering your advance directives, you will need to be as direct and explicit as possible. Do you want to be fed by a tube if you can’t eat yourself? Do you want to be kept on a respirator if you can’t breathe on your own? Do you want invasive diagnostic tests done if you fall further ill? Do you blood transfusions? How far do you want people to go to keep you alive? And when do you want them to let go? You may even include information about organ and/or tissue donation.

Make other people aware

Once you have made your advance directives, make sure that the important people in your life have a copy. The document won’t be of any use if no-one knows about it or don’t have access to it. Don’t keep it in your safety deposit box, for example. You can give copies to family members, your doctor or friends. You can even keep one in your wallet so you have it with you in case of emergency.

Review your choices regularly

After the advance directive has been arranged, be sure to review them regularly. Situations change and people change; how you feel when you write the initial document may not be the same as a year later. Your final will is a very important document – and so is your living will.

Accepting Palliative Care

The death of Canadian politician Jack Layton has reminded us how aggressive cancer can be. Sadly, it still claims many lives. When people are at the end of their life, they would likely benefit from palliative care - often called hospice care. This was a piece I wrote for my website and I think it bears repeating here:

When living with a chronic illness that will lead to death or a fatal disease, the time comes when you may be told that you should consider receiving palliative care.

Shock and Distress

People with chronic or fatal illnesses often live in hope that something can be done to prolong life, if not cure it, even if they do know that this isn’t realistic. When confronted with the idea of palliative care and what this care means, it can be shocking and distressing, because it drives home the point that life won’t be prolonged and that they can’t be cured. In fact, they may feel as if their doctor has given up.

This feeling may be particularly strong when children are involved. It may not be easy for parents to decide on accepting palliative care for their child, feeling as if they have somehow failed in their role as parents.

Transition to Palliative Care

The idea of palliative care shouldn’t come as a shock. If someone has a fatal or chronic illness, or is deteriorating to the point that end-of-life care is being considered by the healthcare staff, the subject should be brought up long before the transition is made.

Proper preparation is the key in a smooth transition from active treatment to comfort care. The patients and their families must come to grips with their new reality of palliative care and they have to be open and willing to accept it for the care to be of any benefit to them.

Unfortunately, the awareness of the need for palliative care isn’t always obvious to the doctors who are still actively treating dying patients because the whole idea of end-of-life care is still fairly new. While a doctor may still be in the “save the patient” mode, he or she may be reluctant to think about palliative care for the patient.

Agreeing to Palliative Care

Once a patient has agreed to transfer to palliative care, they are able to benefit from their services. But, it’s not unusual for someone who has accepted the idea of the care to become resistant or question the need again once they are receiving the end-of-life services. At this point, it’s important for the team to understand and to be able to work with the patient and the family as they go though this phase.

Family and Friends

An issue that may come up when patients enter palliative care is the difficulty that some family members and friends may have with the decision. While the patient may be ready and accepting of the end-of-life, family and friends may not be. The palliative care team is there for not only the patients under their care, but their family and friends too. They can help by talking to them, providing information, and being a shoulder for them to lean on.

It happened again: Fire deaths preventable had there been a smoke detector

It happens every year, several times a year, but people still don't get the message. Smoke detectors aren't an extra doodad for your home - they are a vital part of your safety. Yet, hundreds of people die in fires when they would likely have lived had they had a functioning smoke detector in their home.

It happened again this week in Montreal, Canada. A kitchen fire, not that big but very smoky, took the life of a father and his three year old son. The boy's mother was clinging to life, but the news just reported that she died this morning. The sad part? When firefighters arrived on the scene, they couldn't get the front door open - something was blocking it. It was the bodies of the three people inside. They made it to the front door, but couldn't open it.

Deaths send another tragic message


Senseless deaths that could have, and should have, been avoided. They died from smoke inhalation, not the fire.

According to the local news, as always after a situation like this, local firefighters and students went door-to-door to check on neighbouring homes and whether they had functioning smoke detectors. Not surprisingly, many did not. Some had detectors but no batteries. One family had something taped over the beeper so it wasn't so loud. The firefighter who saw that one said that the alarm would not have been loud enough to wake someone from a sound sleep.

The United States Fire Administration reports that there were 356,200 fires in the U.S. in 2009; 2,480 people died and 12,600 were injured. Not all deaths and injuries were due to smoke inhalation, but they do count high in the numbers.


FireSafety.gov has good information on using smoke detectors, where they should be installed and how to maintain them. If you are a renter, check your rental agreements. In many places, the building owners are required by law to provide the detectors but the tenants are required to keep them in working order.

If your landlord won't provide you with a detector, this is not something you want to be without. Consider it an investment in your and your family's lives.

On Chemo? Remember to tell your doc about herbal supplements you take

If it's natural, it's safe, right? If this statement is true, then arsenic and digitalis wouldn't be harmful. Just because a product is natural, coming from the earth or water, does not mean that it is necessarily harmless or safe.

Of course, arsenic and digitalis are extreme examples, but even the approved products sold in the stores and recommended by natural health practitioners are not safe for everyone, which is why it is important to understand what you are taking, how it affects your body, and what interactions it may have with your own medical situation and any medical treatment you may be undergoing.

People who are receiving chemotherapy for cancer are often tempted by supplements, as well as the more standard vitamins, for a variety of reasons, the most common being to deal with the unpleasant effects of chemo and to try to keep their body as healthy as possible throughout the treatment. These are good goals, but as a press release issued last month by Northwestern Memorial Hospital warns,  "Acai berry, cumin, herbal tea, turmeric and long-term use of garlic – all herbal supplements commonly believed to be beneficial to your health – may negatively impact chemotherapy treatment." The problem isn't the supplement itself, but how it interacts with everything else your body is being subjected to.

Herbal supplements, defined as plant or plant parts used for therapeutic purposes, can interact with chemotherapy drugs through different mechanisms. Some herbs can interfere with the metabolism of the drugs, making them less effective while other herbs such as long-term use of garlic may increase the risk of bleeding during surgery. While culinary herbs used in small quantities for flavoring are generally safe, consuming large amounts for prolonged periods of time may have a negative effect on the body when going through chemotherapy. "

Recent research shows that 50 percent of patients undergoing chemotherapy did not tell their doctor they were taking alternative therapies. “Some believe it’s not important, while others are uncomfortable admitting they are pursuing alternative therapies,” said [June M.]McKoy, [MD, geriatrician at Northwestern Memorial Hospital and lead investigator on the ASCO presentation]. “The truth is, integrative approaches can be beneficial for cancer patients, but it’s important to take these approaches at the right time and under the supervision of your doctor.” 

So, be safe - before taking any substances that your doctor and cancer team isn't aware of, check with them. You may want to bring the actual label of the product you want to take in case there is more in the product than you realize. Different brands may have different binders, dosages, etc. 

Back to school means colds, pain and stress... or does it?

Most parents know that when it's back-to-school time, they start seeing more colds and viruses coming home from school. Other parents see their children developing back pain (heavy backpacks may be the culprit), headaches, stress, and other ailments that they didn't see throughout the summer holidays. Much of this is preventable, with a bit of time and know how.

1- Colds and viruses: Wash your hands, wash your hands, and wash your hands some more. It's not easy to ensure your children wash their hands at school, but you can be sure they do so as they walk in the door. Make it part of the routine: come home, dump the school bag and wash your hands.

Another tip that I used at home when my children were small is we all had our own toothpaste. It was amazing how much that one new rule decreased the number of illnesses that were shared. Most of us don't share toothbrushes, right? But if one child has a cold, uses that brush on the family toothpaste, the virus is easily spread. So, every child gets their own toothpaste. This may also solve the problem that some families have: not all children agreeing on the type or flavor of toothpaste.

2- Headaches: if your child is coming home with headaches, there are a few things you can do to see if you can track down the culprit:

• Is your child eating breakfast and lunch?
• Is your child getting enough to drink and not getting dehydrated?
• Is the bus ride home long and noisy?
• Are your child's eyes ok or might he or she need glasses?

Of course, these are only a few reasons why children may get headaches, but they are common reasons. If  you can find the cause, you're one step closer to finding the solution.

3- Back pain: if your child has a heavy backpack and doesn't wear it properly, this could lead to back pain. If you're child isn't the only one with a heavy load to carry, it may be worth speaking to the school about strategies to literally lighten the loads.

4- Stress: Stress is a tough one to pin down. Some kids rarely experience it, others are stressed all the time. The important thing is to be sure that you acknowledge that your child may be stressed. It used to be that parents and teachers denied that this was even a possibility, but stress is real, no matter how old you are. If you think your child may be stressed, it may take quite a while to figure it out - sometimes they aren't entirely sure of it themselves.

To lower stress levels in the family overall, here are some tips:

• 
  
• Develop a routine for before and after school. While it may be tough to begin one, routines do help children feel secure if they are feeling out of sorts.
• Ensure the children get enough sleep. 
• Ensure good eating habits. Proper meals, sitting down and taking the time to eat them is not only a healthy thing to do, it's a good time to interact with one another.
• Allow for non-scheduled activities. Allow your kids to be kids and enjoy having nothing to do. While it may seem counter-productive in this "must hurry, must be busy" society, there's a lot to be said about day dreaming and just doing nothing once in a while.

WebQuit, a free, online smoking-cessation study

Are you trying to quit smoking and interested in participating in an online smoking-cessation study? If so, you're in luck. Until August 31, 2011  you can see if you are eligible to enroll in WebQuit, a free, online smoking-cessation study being conducted by Fred Hutchinson Cancer Research Center.


The study began in June 2010 and was designed to look at to improve effectiveness of online smoking-cessation programs. Many people who would like some help to quit smoking but don't want to or can't attend personal group meetings or help groups may choose to use an online program. However, they aren't always effective and can stand some improving, study directors say.

 Considering their easy availability and accessibility (24 hours a day), it may be surprising to learn that online smoking cessation programs aren't very successful overall.




According to a recent press release:

Study participants will learn new tools for dealing more effectively with urges to smoke. They also will receive step-by-step quit guides and create personalized plans for staying smoke-free.
Participants will be randomly assigned by computer (like the tossing of a coin) to one of two online smoking-cessation programs. The success rates of participants will then be compared. 

To participate, you will have to complete online questionnaires, including one 15-minute follow-up survey. Eligible participants must be at least 18 and not currently participating in other smoking-cessation programs, among other requirements.The study is funded by a grant from the National Cancer Institute.

To enroll in the WebQuit study or for more information, please visit www.webquit.org

Good luck!

Medical Comic Strip, Hits Close to Home!

Despite the stress and drama of working in health care, nurses and doctors (and other healthcare professionals) can often find something to laugh about. You'll notice that when a group get together and start trading war stories about things that happened during a particularly trying shift.

While some "outsiders" may think it's cruel that we laugh at these things, people need a way to cool off, to laugh at some things, or else the stress just gets to be too much. For instance, not too long ago, I was working in an office setting (not a medical office) where we had doctors come for occasional clinics. I answered the phone and someone said "I'd like to make an appointment with the doctor please." I responded by telling him that there would be no doctor available that whole week and that we were not yet sure if one would be coming in next week. His response? "Ok, I'd like to make an appointment with the doctor for tomorrow then." Um, no... you can't... there is no doctor here this week. "Oh, ok," he said. "I'll make an appointment for next week then."

Did he even listen to what I said at the beginning of the conversation?

This, of course, is just a small snippet of the types of conversations we can have, but when you get a day when most of your conversations like that, you either pull out your hair or you laugh. Luckily, most of us choose to laugh, or there would be an awful lot of bald people in health care.

All this is a run up to a neat comic strip I came across today. So far it is only in French, but there are plans to have it translated in the (near?) future. Even if you don't understand French, some of the comedy is universal, regardless of the language.

The comic strip creators are an ER doctor and nurse who are working together on this project. They are from the Quebec City region and they are drawing on experiences and stories from others. They even invite ideas. So, have a look. I believe that most people will be able to understand. But, I am very eager for them to get this translated because, as much as I enjoy their comics, I'd love for so many more people to as well.

You will find the STAT comic strip at statcomics.com and the weekly strip on the BD de la semaine.

Gastric Surgery – A miracle cure for obestity or false hope?

There’s been quite a bit in the news lately about gastric bypass surgery and lap banding. It’s now being introduced for morbidly obese children who have no hope of losing weight in the “traditional” ways, but some people are questioning if this is really the way to go.

First, what exactly is gastric bypass surgery?

Gastric bypass surgery is surgery that is done to restrict your stomach from being able to receive more than a small amount of food. The idea is that if your stomach cannot take the food, you will not take in as many calories, thus losing weight and then maintaining a healthier weight in the future. If part of the intestine is bypassed, then not as many calories are absorbed from the food you do eat.

 One type of surgery, the roux-en-y, makes the stomach smaller when the surgeon uses surgical staples to make a pouch in the stomach that will receive the food. This smaller “stomach” is then connected to the intestines. Gastric banding involves having a band placed around the upper part of your stomach. This creates a small pouch to hold food. Because your stomach is made smaller, you are limited as to how much food you can consume in one sitting. The advantage that banding has over bypass surgery is the band can be adjusted to regulate how quickly or slowly the food passes through. This is done through a port that is under the skin. The doctor uses a needle to infect or remove water that fills the band.

Why do the surgery?

Gastric surgery for weight loss is supposed to be the last ditch attempt for people who are obese, not merely overweight. Many of those who undergo weight loss surgery have tried every diet or weight loss program they could, with little or no success. The surgery gives them a feeling that they can get control of this, lose weight, and keep it off.

Why not just lose the weight?

 It does seem fairly simple, right? Don’t eat as much, do a bit of exercise, and lose the weight. Unfortunately, this doesn’t work for everyone for a variety of reasons. Many people who are overweight do manage to lose some weight while dieting, but many also gain it right back because they haven’t addressed the problems that caused the weight gain to begin with.

 Complications

Gastric surgery for weight loss is surgery and comes with all the risks of surgery. While surgery is a risk for all people, it is even more so for people who are overweight or obese. Some common complications with surgery of any type are:

• Blood loss
• Blood clots in the legs (deep vein thrombosis)
• Infection at the surgery site
• Pneumonia

 
Complications specific to gastric bypass surgery include:

• Narrowing of the opening between the smaller stomach and the intestine
• Ulcers
• Iron and vitamin deficiences
• Loosening of the staples
• Stomach pouch may stretch after time.
• Injury to stomach during surgery
• Nausea and vomiting

Complications for gastric banding are:

• Band may cause irritation to the stomach or slip out of place
• Irritation and inflammation of the stomach lining, ulcers
• Reduced absorption of nutrients
• Nausea and vomiting
• Port may become infected

The success of surgery?

 Is the surgery successful? For some people, it is very successful. They learn new ways of eating and they change their lifestyle, in addition to having the surgery. For others, it isn’t a success, many times because they don’t make the necessary changes. Yet others experience the complications listed above and, unfortunately, some do die.

Future

A concern that many people have is we don’t know the long-term outlook for people who have had these weight reduction surgeries. While this may not be an issue for adults, it could be very much an issue for children who have the surgery. The decrease in nutrients could have a long-term effect on adult health; doctors just don’t know.

 If you are considering gastric surgery for weight loss, this is something that must be thought through and discussed with your doctor. It’s not a magic cure, but it may be the only one for some people.

This blog and link requests - usually refused

I frequently get emails asking for me to link websites, either in a blogroll or through text links in a post. The vast majority of the websites are income-producing sites. I always refuse those. Others I refuse are ones that are one-sided or promote something I don't believe is good medicine.  Let me explain why.

If you look at the sidebar on this site, you will see that my website is HON certified. This certification is valuable and it means the site meets certain standards set by the association. I am not allowed to advertise nor promote items or services that could be questionable. I am not allowed to make money from this site and I have to be very cautious about promoting any website that derives income from linking, etc., such as the nursing education information websites, from which I get many requests. Finally, any news I report must be verifiable and meet reasonable journalistic requirements.

Although I don't update the blog as often as I used to, I still monitor it every day and appreciate that I get many visitors each day because of some of the content. Every time I vow to be more present here, I get busy again with my regular work and this blog is neglected yet again. But even though I don't update regularly, some of the information, such as seniors who break their hip, remain quite popular. For this reason, it is important that it keep its status.

If I believe that a site fits mine, I will link it. If I feel that a site isn't ready but has potential, I will write back and explain why I feel this way and I will consider it at a later date. Getting angry at me (as some have) won't make me change my mind. I am often willing to help people, but I am not obligated to, so getting angry and lashing out won't really change things.

There is a lot of health information on the Internet. Some surveys say that health information is the most commonly searched information of all. The problem lies not with the searching, but in the trusting of sites. While there are many great sites out there, there are even more dangerous ones - sites that give misinformation or one-sided information. When you are looking for information, please be careful. Look to see who is writing the information. Who is sponsoring the site? Are they trying to sell something? Who do they link to? Do they link to reputable places?

Wrong information can be dangerous - be careful.

May is Fibromyalgia Awareness month

Every month is chock full of awareness dates, but this May, fibromyalgia awareness has more meaning to me. For years, I've been having issues that had me visiting doctors, trying to figure out what was wrong. The biggest problem was that all my tests all came back negative, normal. On paper, I was as healthy as could be. In person, not so much. Recently, one doctor actually sat down and listened to all my complaints - not just one or two specific to a specialty in medicine. He came out and said I had fibromyalgia.

Now, to be perfectly honest, that was not what I wanted to hear, but it was what I expected to hear. I would have preferred to hear that I was  hypothyroid or something like that - allowing me to have something that can be identified and specifically treated. But, no such luck. However, it is nice - for me - to have a name to what has been plaguing me all these years. I no longer feel like I'm lazy or worthless because I am too sleepy to get through the day without at least one nap, if not two. I no longer think I'm a wimp because something that causes moderate discomfort to one person is extremely painful to me. I no longer think I have some terrible illness because of the pain I have, because I know it's "normal" for me to have it.

There are many websites that discuss fibromyalgia and there is a lot of misinformation out there. So if you are trying to learn more, I urge you to be sure you go to legitimate places, not sites that promise you cures if you send them money. I'm not saying there aren't some things that can help manage fibro, I just don't want people falling for snake oil cures.

How can you be sure the site is on the up and up? Look at the "about us" section and see who is backing the site and where the information is coming from. How long has the site been in existence? Do other sites link to it? What sites do they link to? Do they say anything that looks too good to be true?

Be careful, do your due diligence. It's bad enough having a syndrome that isn't understood, you don't want to be scammed either, right?

Walnut recall in Canada due to e. coli contamination

This is a press release issued by the Canadian Food Inspection Agency.

CERTAIN BULK AND PREPACKAGED RAW SHELLED WALNUTS MAY CONTAIN E. coli O157:H7 BACTERIA

Related alerts: 2011-04-04 | 2011-04-03

OTTAWA, April 3, 2011 - The Canadian Food Inspection Agency (CFIA) and Amira Enterprises Inc. are warning the public not to consume certain bulk and prepackaged raw shelled walnut products described below because these products may be contaminated with E. coli O157:H7.
All raw shelled walnuts sold from bulk bins, all package sizes and all lot codes / Best Before dates of the following raw shelled walnuts and products containing walnuts are affected by this alert. The affected products were available for purchase from January 1, 2011, up to and including April 4, 2011. The raw shelled walnuts are imported from the USA.

Brand	Product
Amira	Raw shelled walnuts sold from a bulk bin*
Amira	Prepackaged raw shelled walnuts (Halves/Pieces/Crumbs)
Tia	Prepackaged raw shelled walnuts (Halves/Pieces/Crumbs)
Merit Selection	Prepackaged raw shelled walnuts (Halves/Pieces/Crumbs)
Amira	Mistral Mix containing walnuts
Tia	Mistral Mix containing walnuts
Amira	Salad booster containing walnuts
Tia	Salad booster containing walnuts

*The brand name Amira may not be marked on the raw walnuts sold from the bulk bins.
Consumers who have purchased walnuts from bulk bins are advised to contact the retailer to determine if they have the affected product.
These products have been distributed in Atlantic Canada, Quebec, and Ontario. However, they may have been distributed nationally.
This is an ongoing food safety investigation. The Public Health Agency of Canada (PHAC) is investigating a multi-provincial outbreak of E. coli O157:H7 illnesses in collaboration with provincial health authorities as well as federal health partners including the Canadian Food Inspection Agency and Health Canada.

• Public Advisory: E. coli outbreak - At this time, the outbreak investigation indicates that several individuals have reported consuming raw shelled walnuts.
  

Food contaminated with E. coli O157:H7 may not look or smell spoiled. Consumption of food contaminated with these bacteria may cause serious and potentially life-threatening illnesses. Symptoms include severe abdominal pain and bloody diarrhoea. Some people may have seizures or strokes and some may need blood transfusions and kidney dialysis. Others may live with permanent kidney damage. In severe cases of illness, people may die.

Amira Enterprises Inc., St. Laurent, QC is voluntarily recalling the affected products from the marketplace. The CFIA is monitoring the effectiveness of the recall.
For more information, consumers and industry can call one of the following numbers:
Amira Enterprises Inc. at 1-877-383-9823 or info@amira.ca
CFIA at 1-800-442-2342 / TTY 1-800-465-7735 (8:00 a.m. to 8:00 p.m. Eastern time, Monday to Friday).

For information on E. coli O157:H7, visit the Food Facts web page at: http://www.inspection.gc.ca/english/fssa/concen/cause/ecolie.shtmlhttp://www.inspection.gc.ca/english/fssa/concen/cause/ecolie.shtml

Faces of Sepsis

22-year-old JonyRose Filip died of sepsis following a urinary tract infection.

Read her story on the Faces of Sepsis.

Migraine Rates Rising?

Could it be that more people are experiencing migraines than ever before? If a recent study from the Norwegian University of Science and Technology (NTNU) is right, then it's true: migraine sufferers are becoming more numerous.

According a press release discussing the study, there was a 1% increase in people who reported having migraines - now 12%, up from 11%. The issue that seemed to puzzle researchers the most was why the increase occurred. They couldn't find one particular cause for the rise.

What is the difference between migraines and headaches? Here is a video that does a good job of explaining the difference.

In a previous blog post about migraines, I gave some basic information about migraines:

Migraines are very common. According to statistics, up to 17% of women and 6% of men have had at least one migraine. Some people have occasional migraines, but some experience chronic migraines. These, according to the MayoClinic.com, are migraines that occur 15 or more days per month. The National Headache Foundation reports that 80% of migraines are severe and up to 24% of people with migraines have had to go to the emergency room.

What causes migraines? We don’t really know but we do know that there are many triggers. The most well-known ones are migraines that occur with a woman’s menstrual cycle or the ones that occur when some people drink red wine or eat chocolate. Other triggers can be:

- Alcohol
- Allergies
- Bright lights
- Changes in weather patterns
- Lack of or too much sleep
- Loud noises
- Skipping meals
- Stress (physical or emotional)
- Strong odours

Do you have migraines? What do you do about them?

Diabetes "Hotspots" in the US

An interesting study has identified 10 states as being hotspots for type 2 diabetes. They are:

1. California:  6.6 million people with diabetes;
   
2. Texas:  5.5 million;
   
3. Florida: 4.2 million;
   
4. New York:  2.9 million;
   
5. Ohio:  2.1 million;
   
6. Illinois: 2 million;
   
7. Georgia: 2 million;
   
8. Pennsylvania: 1.9 million;
   
9. North Carolina: 1.9 million; and
   
10. Michigan: 1.6 million.

The sad and frustrating thing for healthcare professionals is that many cases of type 2 diabetes are preventable. Unlike type 1 diabetes, which often, but not always, begins in childhood, type 2 diabetes can result from being overweight and inactive.

According to the CDC, type 2 diabetes (previously called adult-onset or non-insulin dependent diabetes) accounts for 90% to 95% of all diagnosed cases of diabetes. Let me repeat that: 90% to 95% of all diagnosed cases.

The American Diabetes Association reports: In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.

Diabetes is more than just a disease that affects your blood sugar. High blood sugar levels affect your whole body drastically. Having diabetes increases your risk of developing heart disease, nerve pain (particularly in your feet) and inability to fight infection. Having diabetes can lead to an often fatal illness called sepsis. Diabetes can cause kidney disease, too.

The cost of diabetes is enormous. From the financial aspect of dealing with the supplies to manage the disease, to the lost days of work. Diabetes affects the community as a whole.

Are you at risk for diabetes? Take the ADA Risk Test to find out.

Are iodine tablets necessary?

With all that is going on in Japan right now, the world is focused on the radiation that appears to be leaking from the crippled nuclear power plants. This is scary because we know that radiation is very harmful to us - and as a result, some people are panicking who maybe don't need to panic.

While the Japanese who are close to the incident do have reason to be fearful, those of us in North America are at very little risk. According to the experts who have been interviewed, even if radiation does get into the atmosphere, by the time it would blow over to the west coast of NA, the radiation levels would be minimal. So, is the rush on potassium iodine tablets justified? Not likely.

Iodine tablets don't protect you from overall radiation exposure. They protect your thyroid from damage, which is important, but only one part of your body that can be damaged. And, it can't reverse any effects - it is only preventative. But another thing to remember is that it is a salt and considered a medication - and it can be harmful to some people, so it shouldn't be taken without consulting with your physician.

According to the CDC:

Taking KI may be harmful for some people because of the high levels of iodine in this medicine. You should not take KI if
• you know you are allergic to iodine (If you are unsure about this, consult your doctor. A seafood or shellfish allergy does not necessarily mean that you are allergic to iodine.) or
• you have certain skin disorders (such as dermatitis herpetiformis or urticaria vasculitis).
People with thyroid disease (for example, multinodular goiter, Graves’ disease, or autoimmune thyroiditis) may be treated with KI. This should happen under careful supervision of a doctor, especially if dosing lasts for more than a few days.
In all cases, talk to your doctor if you are not sure whether to take KI. 

For more information on potassium iodine, check out these sites:

• CDC
• Medline Plus
• LA Times

Charlie Sheen, Brittany Spears, are we seeing any similarities?

With the entertainment world sitting in a front row seat, watching Charlie Sheen’s self-destruction, isn’t anyone reminded of something similar happening to Brittany Spears not all that long ago?

At first, Sheen’s behaviour looked like typical spoiled brat behaviour – just as Spears’ behaviour did. But as Sheen is spinning further and further out of control, it’s like watching Spears all over again.

While we don’t have an official diagnosis on Spears and nobody has diagnosed Sheen, it seems pretty obvious to the average person that there is much more going on than just bad behaviour.

According to the National Institute of Health, one in four American adults have a mental disorder. The Canadian Mental Health Association says that 20% of Canadians will experience a mental health issue at some point in their lives.

While some mental illnesses are depression and anxiety (which can be life threatening), they include other types, such as bipolar disorder, schizophrenia, and obsessive-compulsive disorder, among many others.

Mental illness is not anything to laugh about. If it turns out that Sheen is just being a jerk, then well, that’s what he is. But it doesn’t seem that way and rather than laughing at him and giving him all this attention, maybe we should walk away and hope that he gets the help it looks like he needs.

Earthquake in New Zealand

Although Canada is a half a world away from New Zealand, many of us here feel shock and horror at what happened in Christchurch again yesterday - another earthquake. Whenever an earthquake strikes a populated area somewhere in the world, my heart goes out to the many people who lose their homes, their livelihood, and all too often - loved ones and friends.

My thoughts also go out to the health and medical needs for the survivors and the healthcare personnel who must provide them. To be a nurse, providing care to wounded survivors, is difficult enough, but when the nurse's home may have been destroyed or if she may have lost loved ones herself, that makes it all that more difficult.

Are you prepared in case of an emergency? The Canadian government often puts out information on producing emergency kits and keeping them close. Here in Montreal, we experienced the big ice storm in 1998, when much of the province lost power and, sadly, some people did lose their lives. Many of us said we learned from that experience and that we wouldn't be caught without emergency supplies ever again. But how many of us have kept that promise to ourselves? I have a strong feeling that would be not too many of us.

Here is what the Canadian government says should be in a minimal emergency kit in every home, from the Health Canada website:

Put together an emergency kit with enough basic supplies for at least 72 hours. Make sure your kit is easy to carry. Keep it in a backpack, duffel bag or suitcase with wheels, in an easy-to-reach place, such as your front door closet. As a minimum, the kit should contain the following:

• two litres of water per person per day, plus water for pets;
• a three-day supply of food (including pet food) that will not spoil, such as canned food, energy bars, dried foods (remember to replace the food and water at least once a year);
• a manual can opener;
• flashlight, batteries, candles and matches or lighter;
• a battery-powered or wind-up radio, plus extra batteries;
• a first aid kit, including such essentials as ASA, ibuprofen, anti-nausea and anti-diarrhea products;
• special items, such as feminine hygiene products and prescription medications (In an emergency, pharmacies may be closed for some time. Talk to your doctor about preparing a "grab and go" bag with a two-week supply of your medications. Also, ask how often you should replace the medications with a fresh supply);
• some cash (or travellers cheques) in small bills, change for telephones;
• copies of your emergency plan, contact information and other important documents (license, birth certificate, passport, etc.) stored in a waterproof container; and
• a change of clothing and footwear for each family member

In addition to preparing a kit, it is also a good idea to stock up on non-perishable items (e.g., toilet paper, paper towels, more candles, dried or canned foods, etc.) in case stores remain closed or you are unable to leave your home during an emergency.

Another important issue is to know where to go and what to do in case of an emergency. Do you have a "safe spot" designated for you and other family members to congregate in case your home is not accessible? Do you have phone numbers (cell phones, most likely in emergencies) of people who you would need to get in touch with?

Now is as good a time as any to get your things together. As we can see at what happened in NZ or in fires in California late last year, we just never know when we may need to take care of ourselves.

It has been way too long since my last post

Where has the time gone? I could have sworn I just posted lasted week, but imagine my shock when I saw the last time I posted, it was in December?

I can only say, I keep meaning to post, but then I get distracted and the thought flies out of my head as quickly as it entered. I am being kept busy with my Sepsis Alliance work - although not so busy that I don't have time to post here.

I think what happens is I write so much health stuff, either for Scrubs, Nursing Link, or any of my other clients, that when I think about writing here, I'm out of steam. Luckily for me, there is a lot of content on this site, so I still get a lot of hits. Most people, though, only come by through finding a particular topic on Google or some other search engine. They find what they're looking for and then they don't come back. Perhaps it's time to start working on that loyal reading audience again!

Something this blog has brought me are interesting connections. It seems there are many nurses who would like to get into writing. I receive emails every so often from nurses who would like to start writing but don't know where to begin. I don't mind taking the time to answer - after all, the best way to learn something is to ask questions, right? Most of the time, people are very appreciative, but there is the odd person - now and then - who can't be bothered to even say thank you. Really. I can't imagine writing a total stranger to ask for help or advice only to not acknowledge that this person took the time to write back. Thankfully, they're in the minority.

So, we're near the end of February and let's see if we can get this blog kick started yet again, shall we?