This Is Us took a beloved character, but how?

If you have been following the TV show This Is Us, you've known from the start that a popular character, Jack Pearson, had died. But what the audience didn't know until this past weekend was how Jack died. Now we know. (If you haven't watched this episode yet and you plan on it, there is a spoiler ahead. Stop reading now if you don't want to know.)

The series has been following the lives of a family, three adults (Kevin, Kate, and Randall) and their mother (Rebecca), 20 years after Jack dies. His children are haunted by his death and we're given glimpses of the past throughout the episodes. On Sunday's episode, the family home burns down. Jack rescues everyone in the house, goes back to get the dog and some treasures. He comes out of the fire, but succumbs later in the hospital to a heart attack, what Rebecca was told was a widowmaker. But what is a widowmaker heart attack?

A widowmaker is a term used to describe a massive heart attack usually caused by a total blockage of the largest of the heart's arteries, the left anterior descending artery. It's frequently fatal and it strikes people in their 40s or  50s, although it is much more common among men. In the show's story line, Jack's heart attack was caused by smoke inhalation, but there is usually no one specific cause of a widowmaker. Many of us have heard of seemingly healthy men (usually) going about their day and suddenly having a massive heart attack, often with no advance warning. However, some survivors will tell you that they did have symptoms, but they just didn't put two and two together.

Since February is Heart Month, it's a good time to review the signs and symptoms of a heart attack:

• A feeling of pressure, squeezing or tightness in your chest 
• Pressure or pain radiating down one or both arms, your jaw or into your back
• Nausea, indigestion
• Sweating
• Dizziness
• Feeling of impending doom

Women may have different symptoms. They may not have that typical chest pain but more nausea or indigestion, lasting for long periods.

If you feel that you may be having a heart attack, call 9-1-1 immediately. The 9-1-1 operator may advise you to chew a low-dose aspirin if you have them on hand. Do not try to drive yourself to the emergency room because if you pass out while you are driving, you will cause an accident that could injure others. At the same time, having someone else drive you could cost you valuable time. First responders are trained to assist people who are having heart attacks and may be able to stabilize you before transporting you or during transport.

If you find someone who having or has had a heart attack, call 9-1-1 immediately. If they are unconscious, do not try to give them an aspirin. If the heart has stopped, start CPR.

Not everyone knows how to give CPR, but it is strongly recommended that everyone learn how and also to learn how to use an automatic external defibrillator machine. More public places are placing these AEDs in strategic places so they can be used in case of emergency. To learn more about CPR, even if you've not taken a course, go to the Mayo Clinic site, where they explain the steps.

Heart attacks are frightening. If you have a family history of heart disease or have risk factors for heart disease, consult your doctor about how best to reduce your risk of a heart attack. You can also visit the American Heart Association or the Heart and Stroke Foundation of Canada to learn more.

Is the flu as scary as media stories make it out to be?

The seasonal flu, influenza, is front page news across North America. Every day we are reading or hearing of someone who has died - and often it is someone young and healthy, the last person you would expect to die from the flu.

So is the flu as scary as the media is making it out to be? Yes - and no.

Millions of people around the world get the flu. They can be very sick for a few days with body soreness and muscle aches, terrible cough, fever, and more. But after a few days of rest and rehydration, they start to recover and gradually return to their daily activities. Some people may feel fatigued or have a lasting, nagging cough for weeks after the flu, but for the most part, they get better and the flu becomes part of the past.

But some people who get the flu get seriously ill. Some die. Some survive, but leave the hospital weeks and months later, with amputations or other life changing complications. And, because we can't tell ahead of time who may become so sick, this is why the flu is scary. I know of a woman who is 94 and was hospitalized last week with pneumonia following the flu, and she is now fine. Usually, it is seniors or those with chronic diseases who are the most likely to become severely ill from the flu. Yet this year, we have also heard of young children and young adults who were perfectly healthy before they got the flu, and they died.

The most common path to severe illness from the flu is pneumonia. Because influenza is a respiratory illness, it can lead to pneumonia. (There is no such thing as a gastro flu or a tummy flu.) Pneumonia can be very serious and can cause you to develop sepsis, your body's reaction to an infection. This is what can lead to death.

Every year, researchers try to come up with a vaccine for the seasonal flu. Some years, it's fairly effective. Other years, it's barely effective. And the researchers and pharma companies get a lot of flak for this. What many people don't realize is that we can't know 100% what flu virus is going to be the one to hit the hardest from year to year, so the scientists are working on an educated guess. The seasonal flu viruses change and mutate, and because it can take months to produce a vaccine, what may have been effective against a specific virus one month, may no longer be effective months later because the virus mutated and changed.

This begs the question - why bother with a flu vaccine at all then? Because it is somewhat effective. The flu vaccine can help prevent the flu for some people. It can help lessen the severity of the illness in others. But it can't claim to protect you completely - it can only be used as one tool in a toolkit for flu prevention. Compare it to wearing a seat belt. The seat belt helps reduce your risk of injury or death in a car accident - but it can't guarantee it. (When seat belt laws came into force where I live, I knew a woman who would pretend to wear the seat belt, just loop it over her shoulder, because she said that no law would tell her that she should wear her seat belt. Now, 30+ years later, you should see how fanatical she is about making sure her grandchildren are securely fastened in the car.) We know that seat belts save lives. We also know that if you do have the flu vaccine, you've decreased your risk of getting sick.

There are still people who believe that the flu vaccine can make you sick with the flu. It can't. As has been said over and over again, it doesn't contain a live virus, and you need a live virus to cause illness. That's not to say that some people don't get sick after they've been vaccinated. Some people are exposed to the flu before they have their injection - it takes up to two weeks for the vaccination to work. So if you're exposed to the flu just before or just after you have your vaccination, you're still going to get it. Other people report feeling fatigued, feverish, not well overall after getting their vaccine. This isn't the flu, but likely their body's way of coping with a vaccination. It's not comfortable and it would be best not to be sick at all, but it's not the flu.

I've read people saying that more people are dying now of the flu than before precisely because of the vaccines. They say that no one died of the flu before that. To those people, I say Google the Spanish flu. I am pretty sure we didn't have vaccinations back then yet (yes, that is sarcasm). Then Google other flu epidemics. There are others that occurred before we had seasonal flu vaccines.

How can you prevent getting or giving the flu? 

You can reduce your risk by washing your hands frequently. The flu virus can live on solid surfaces like door handles, bank machines, even store counters, for days. Wash your hands as soon as you get home or arrive at work. Clean your hands if you've been out shopping or handling things that others may have. Try to avoid touching your face, especially your hands, nose, and eyes, before you've washed your hands. Cleaning your hands will also reduce the risk of you spreading the virus if you have the flu but don't know it yet.

Get vaccinated. There's still time. Flu season can run up to the end of April, so some protection is still possible. If you don't want to get vaccinated, there's nothing I can say that will convince you, but if you do want to get the vaccine, you still can.

Stay home if you're sick. I know it's not easy. We all have bills to pay and responsibilities to uphold. But going out sick will just make more people sick. And although the chances are very likely that you'll get better and go on, someone else who gets the virus from you may not be so lucky.

Sneeze or cough into your sleeve. Your clothes are washable and less likely to come into contact with a surface that someone else will touch.

What should you do if you get the flu?

Rather than repeating what has already been written, you can go to this information I wrote for Sepsis Alliance: Sepsis and Influenza. There, you'll find not only more information on the flu itself, but the signs and symptoms, as well as when to see a doctor.

Good luck during this flu season. It's a bad one.

Cue the Music: It's a Small World (and you meet people in the most unexpected places)

I'm sending out this blog post from lovely Charleston, S.C. I was invited here on a press trip sponsored by the American Cancer Society and Extended Stay America hotels, to highlight Hotel Keys of Hope. It's a program that offers low or no-cost hotel rooms to people who are diagnosed with cancer and  must travel away from home for treatment.

It's no secret that being ill with an illness like cancer can have a significant financial impact and this program aims to help relieve some of that impact and stress. I'll write more about the program tomorrow - we have one more day (today) of this event and I have more to learn. But I was psyched about a "it's a small world" moment I had yesterday.

When you're on a press trip, you rarely know anyone else. It's like being invited to a big party and you don't even really know the host. So no matter how introverted or shy you may be, you have to put yourself out there. In this case, I have stories I have to write about the people I meet, so I really need to put myself out there.

As I was going around meeting my fellow event attendees, I saw a lovely young woman and her companion who I'd not met yet, so I went over to chat. As we exchange the usual "where are you from?" question, she told me they were from Montreal. OK. I live in Montreal. Small world. Where in Montreal. St-Henri. Ok, small world continued. My oldest son lived there for a while and my youngest son works in that area now. I told her I live in NDG (another borough). She said she had too and mentioned a street not far from me. Ok, this world is getting smaller. Then I mentioned the suburb I grew up in and raised my children (Chateauguay), and that's when things got really "woah." She went to school on our street. She is the same age as my daughter, but they went to different schools.

Nalie Augustin (she's the younger, prettier one!)

And then I realized who she was. Nalie Augustin. She is a young woman who had been diagnosed with breast cancer when she was 24 - a very unusual diagnosis at that age. She had been featured in our local news and that's where I'd seen her. You can read about her on her website and her blog.

She and her boyfriend, Vee, are taking videos and lots of photos of their time here because that's what they do. Nalie has a YouTube show, in addition to her site, blog, and other social media presence. She offers tips to others who are living through cancer.  She has a mission:

"As a Writer, YouTuber and Speaker, I share my journey for 3 reasons:

Inspiration: I want to inspire you to NEVER GIVE UP! Whether it’s cancer, or whatever it is you wish to conquer, take whatever you can from my crazy journey and let it catapult you into LIVING the life you’ve always dreamed of.

Aspiration: I have big dreams and I refuse to let cancer stop me from achieving them. Knowing that life is short and clearly, we have no idea what tomorrow will bring – every day, I aspire to be better, do better and make a difference in this world for as long as I’m in it.

Awareness: It is my duty to prove that breast cancer doesn’t just happen to elder women. That even the healthiest people are not exempted. Generation X- Y – Z: Check your boobs! I vow to leave as much information as possible for women who may follow my footsteps by providing knowledge that I wish I had!"

She's an amazing woman with a great message to share. I'm glad I met her.

Do Nurses Have a Role in Complementary Therapies?

Last year during the Olympics, the practice of cupping was brought to the forefront. Many athletes were spotted sporting large round welts on their their back, shoulders, and upper chest that were caused by cupping. This caught the attention of the sports analysts and reporters, and the Western world quickly became interested in this new-to-them practice.

Cupping is an old traditional form of Chinese medicine, often used in conjunction with acupuncture. I went for acupuncture last week to help deal with a headache I had since January. It was a sinus-type headache but tests and scans showed that there was no infection, allergies, inflammation, nothing. So, I returned to an acupuncturist I'd visited a few years before. I forgot that she did cupping after the acupuncture session:

Cupping mark on my shoulder

It doesn't hurt while cupping is done and while it looks like a nasty bruise, it's only tender if you press hard on it. It looks awful but - my headache is virtually gone. It's down to about 10% of what it was before. I'll be going for another session later this week. So was it the acupuncture? The cupping? Both?

Practitioners claim that cupping can treat many disorders, including asthma, arthritis, GI upsets, and chronic pain, among others. Generally, the practitioner heats the air in a cup, usually with a flame, and the cup is placed on the skin. This produces suction. It’s believed that this suction promotes blood flow to the area, resulting in better health. When the cup is removed, a red or bruising mark may be left behind.

Regardless of what we may personally believe about complementary and alternative medicines, patients are using them. An article I wrote for Oncology Nursing News in 2015 stated that, “53% of American adults used CIT [complementary and integrated therapies] at some point in their lifetime, and 42% said they used it within the past year. People with cancer reported even higher use: 65% of cancer survivors used CIT at some point, and 43% used it within the past year.”

As nurses in North America, we generally work in facilities that focus on evidence-based medicine. Some facilities have developed integrative therapy departments, where patients can benefit from complementary medicines, such as acupuncture or massage therapy, along with Western medicines. These include facilities such as Johns Hopkins, Cleveland Clinic, and Mayo Clinic. I wasn’t able to find any similar departments associated with Canadian hospitals, although many major cities do have integrative medical clinics. So what do we say if patients ask us our opinions on complementary medicine?

The College of Registered Nurses of Nova Scotia published guidelines for nurse practitioners and registered nurses on the topic. The document reviews the nurses’ role in therapies, the nurses’ ethical and professional responsibilities, and how nurses might have a role in practicing complementary therapies. The college concluded: “Registered nurses and nurse practitioners can be actively involved in the delivery of CAHC therapies or simply help clients access appropriate information and make treatment decisions. Regardless of their role, RNs and NPs must be well informed and possess the appropriate knowledge and skills to provide safe care. Having evidence informed knowledge of potential benefits and risks of particular therapies is crucial. As RNs and NPs strive to provide comprehensive care for their clients, they must always ensure that they practise CAHC within the context of a nursing framework and within their standards of practice and code of ethics.”

Personally, I believe in some types of complementary medicine, but not necessarily alternative medicine. I have used acupuncture and massage therapy with good results. Complementary means that the treatment is in conjunction with evidence-based medicine practices. Alternative implies that the treatment is instead of. However, regardless of our own beliefs, it is vital that our patients trust us enough that they tell us if they are undergoing other forms of treatments or therapies. They may be more willing and open to telling their nurses than their doctors, for fear that their doctors will insist that they stop their treatments. As nurses, we can help them understand why it’s important that they be open with their treating physicians.

Do you see a role for nurses in complementary health practices?