Friday, June 8, 2007

Is it time for a nap yet?

I’m an unabashed napper. I nap any time of the day if I need it. I have to because I have horrible insomnia. One of my friends feels that I can’t sleep at night because I nap, but I’ve tried going nap-less for several days in a row and I *still* won’t sleep well at night.

I don’t take long naps; they’re power naps of 10 to 20 minutes. I can jump right up when I wake, although I do have to admit that on a grey, lazy day, I just may be tempted to cuddle under a quilt and stay a lot longer.

I’ve never been a good sleeper and then, becoming a nurse and working shift work really blew out of the water any ability I had to sleep at night. For several years, I did shift work and have, at times, worked all three shifts within seven or eight days. Then, to try and regulate my body, I tried working only night shifts. Not good for the body, I’m sure. Then there were the years of babies waking in the night, followed by young children who woke up with nightmares and then get up early. None of my three kids slept entirely through the night until they were at least 2 years old. They would go right back to sleep, but they’d wake up, we’d hear them and sometimes they’d call out of fear or just wanting reassurance.

Now, unless we get a phone call in the middle of the night from one of the off spring who call to tell us they’re not coming home, we don’t get disturbed by them – but I still can’t sleep. I may fall asleep quickly sometimes, but I’m lucky if I stay asleep for more than an hour and a half; that’s my longest stretch to stay asleep. And for the rest of the night, it’s sleep 40 to 50 minutes, wake up, sleep 40 to 50 minutes, wake up… and then by 6 a.m., forget it. I’m awake for the day.

There’s some interesting research going on about chronic insomnia. While we know about the medicinal sleep aids that are available, there’s a big push on to teach people good sleep habits and good sleep hygiene. That means using the bedroom only for sleeping and sexual activity, for example. Following a relaxing routine before sleep, no heavy meals before bed time, no heavy exercising either. Another technique is not allowing yourself to stay in bed if you’re not sleeping. If you wake up and can’t get back to sleep, get up until you’re sleepy again. Don’t lie there and think about not being able to sleep.

Keeping a sleep diary is helpful to some people. By keeping track of what time you go to bed, what you were doing beforehand, how long it takes to go to sleep, how many times you wake up, etc., you may be able to recognize a pattern or trigger that wasn’t obvious before.

Now that I work from home full-time, my sleepiness during the day isn’t that huge a problem. I can be inconvenient when I need to go places or do interviews, but I can work around it. But I can tell you, it was hell when I had to work outside of the house. By 10 a.m., I’m just crying for a quick nap. I so admire the companies that now promote naps at work. I am a firm, firm believer in them.

So, is it time for a nap yet?

News for today:
Conjoined twins' surgery halted in Ohio
Alta. surgeons complete 18 transplants in 56 hrs
Vitamin D lowers cancer risk in older women: study

Thursday, June 7, 2007

Did you remember to take your pill today?

Do you remember to take your medications? If you’re prescribed antibiotics, do you remember to finish the whole course?

Getting patients to remember to take their medications or to take them correctly is a major problem in health care today. As treatment regimens get more complicated and the average age of the person taking medications is rising, so-called medication non-compliance is even more common.

I don't like that term, non-compliance, but that's what healthcare professionals use. Non-compliance, to me, implies that it’s a deliberate act: I’m not going to take my pills. But as someone who does chronically forget to take her medications, I deny that I’m non-compliant, I’m just very forgetful. Sure, I can remember for a few days, but then, forget it. I can’t even remember to take my vitamin.

So, what is the problem? First, many older people are getting multiple prescriptions, sometimes from different doctors because of the number of specialists they may see. This leads to a timing issue because some medications need to be taken on an empty stomach, some need to be taken with food, some in the morning, some at night. Oh, and don’t forget not to take some medications with grapefruit juice. Then, there’s the convenience, or inconvenience, of taking them. For someone with little appetite, it’s hard to eat regularly, in fact, they may just eat a couple of times a day whenever the mood hits them. If they’re taking pills that need to be take at each meal time, this can cause a problem.

Finally, there’s just plain forgetfulness, like me. I always say I have a great memory, it’s just too short.

That’s for the accidental, or non-deliberate non-compliance, but what of those who do it deliberately. There are many reasons for that. We have the problem of side effects. Some people start to take their medications but are not happy with the side effects they experience. They could include sleepiness or sleeplessness, decreased appetite or increased appetite; there are a whole host of side effects. While some are manageable, others are too difficult; so rather than speak to the doctor, some people decrease their dosage, change the times they take the pills, or stop taking them altogether.

In some cases, medications are too expensive for the budget, so people cut down on their dose or decide not to take the medication at all. It could be that the pills are too difficult to swallow, the bottles too hard to open, or that people don’t feel sick, so they don’t feel they need to take their medications.

Whatever the reason, a big part of health care today is promoting safe and healthy medication routines. If you or someone you care about is having problems with medications, there are ways to help.

If it’s just plain forgetfulness, there are different techniques. Now, I have a week’s supply of my medication, plus vitamin, in a pill box by my computer and I take my pills ever morning. But that wasn’t feasible when my kids were young, because you can’t leave medications within reach of children. I tried calendars on the fridge – didn’t work for me, but might work for you. Stickers on a calendar? Tear off tags by the phone? Some sort of memory jogger.

If there are too many pills, you can try speaking with the doctors to see if the number of medications can be cut down. It could be that a newer, longer lasting medication has come on the market since you first started taking a particular pill. If it’s meal issues, you may need to speak with a dietician or nutritionist to find a way to be sure the pills are taken properly and when they should be taken.

If in doubt, ever, ask your pharmacist. Pharmacists are the number one source for medication knowledge. Sure, the doctors know the drugs, they have to. But pharmacists know everything there is to know about the drug, or they know where to look.

Take care of yourself. Take your meds safely. Since I began my system and finally remembering to take my medication every day, it’s made all the difference in the world.

Today’s News:
Nursing shortage a global problem, convention told
Surgery begins on conjoined twin girls

Wednesday, June 6, 2007

Measles Reappearing in Montreal, QC

Measles making a come back in Montreal

Measles (rubeola), one of the childhood diseases rarely seen in Canada today, is making a come back. Currently, 14 cases of measles have been identified in Montreal: 12 in adults and two in children under five years old.

Why is this happening considering that we have childhood vaccines now? Two main reasons: the increase in international travel and people not vaccinating their children from childhood diseases like measles, mumps and German measles.

I know that there is a debate among some parents about childhood vaccinations like MMR (the vaccine against the three diseases) and the onset of autism, but time and time again, studies have shown that there is no link between the two. The anecdotal evidence that a child begins to show symptoms of autism weeks after an inoculation is just that: anecdotal. The thing is that the age when these children get the vaccination is precisely the age that the signs of autism begin to set in. According to the many studies that have been done, it’s a horrible coincidence.

It’s devastating to find out that a child is autistic. But it’s also devastating when a child dies of a common childhood disease – as they can from mumps, measles and German measles. The arguments that they're common diseases, that we lived through them, that they’ve been around for generations and we all lived just doesn’t cut it. The kids we know lived through the disease; we lived through the diseases, but many didn’t, or did but with life-long after effects.

According to the World Health Organization (WHO), the most serious complications affect children under the age of five years and adults over the age of 20. (WHO fact sheet)

The most serious complications include:
· blindness
· infection and inflammation of the brain, called encephalitis (1/1000 cases)
· severe diarrhea possibly leading to dehydration
· middle ear infections (5% to 15% of cases)
· severe respiratory infections and pneumonia, which can lead to death (5% to 10% of cases)

Measles cause death in up to 25% of those affected in developing countries and between 1% and 5% in developed countries.

If someone who is immunocompromised, meaning their immune system isn’t working properly because of a disease like HIV or treatment for a disease like cancer, the fatality rate is as high as 30%.

Measles is very contagious and an outbreak like the one in Montreal is very serious. According to the public health officials, people who received vaccinations in the 1970s are at risk and should be re-vaccinated. This is because people born before that developed natural immunity through having the disease and people born after were vaccinated because of the massive national campaigns to have children vaccinated. The children born in the 1970s may have fallen through the cracks.

There have always been parents who decided not to get their children vaccinated against childhood diseases and they were lucky that their children didn’t get the diseases. However, chances are this was because of the “herd immunity,” or the fact that almost all the kids around theirs were vaccinated, thus leaving them with no exposure. But, these kids are now adults and haven’t been vaccinated – and are at high risk of developing measles, mumps or German measles if they are exposed to them. As more parents decide not to vaccinate, this herd immunity will wane and these diseases will become more prominent again.

News for Today:
Greater Montreal area confirms measles outbreak
Strokes kill more Canadian women than men: study
Folic acid supplements do not appear to reduce risk of colorectal tumors
New Study Suggests Number of Pills Not a Factor When it Comes to Daily Adherence to Medication

Tuesday, June 5, 2007

I love my work

Have I mentioned lately how much I love what I do for a living? I have to give my husband a lot of credit for not saying anything when I announced to him that this is what I wanted to do – freelance full-time. Whether he had reservations, he never said. He knows that I can do a good job, but doing a good job and translating it to a full-time income isn’t always the same thing. I’ll always be grateful for his support.

Over the past two weeks, I’ve worked on so many different things that I can’t get bored; I don’t have time! Right now, I’m writing some patient education material (my favourite work), procedure summaries, wellness messages, nursing articles and article/study summaries. I’m editing a CME newsletter and gathering together information for an up-and-coming website. And that’s just the main stuff. I have a few other things in the works as well and I’m really enjoying it.

It’s funny because I have worked from home since the late 1990s, but I was never as happy and relaxed as now. I’ve always said that I’m not organized enough to do this because it’s more than just writing. You have to market yourself, you have to keep track of your clients, you have to keep track of your projects, and you have to make sure you invoice your clients and get paid. Oh, and then there’s the taxes and expenses, and everything else. When I was freelancing on the side, I was right – I wasn’t organized to do a good job keeping things straight. While I kept my clients straight and the work, I was awful at keeping my records straight. But now that I’m doing it full time, I’m as organized as can be. Everything is being logged in the right places and paper work is done on time as it should be. I barely recognize myself. Now, if I could figure out how to organize my office so it doesn’t look like a tornado hit it.

Making the jump to full-time freelancing is scary. There’s so much of “what if” that it can start playing games with your mind. What if you can’t find the clients? What if the clients aren’t happy? What if you can’t deliver? And on and on. Of course, there’s also the other worries like, what if you get sick and can’t work? What if…..?

But, if the what ifs start to get too overwhelming, it’s time—I think—to ask, what if I get too much work? What if I have to start turning down work? What if I can’t take a vacation? Wouldn’t those what ifs be so much more fun to ask?

I’m determined to make this work. I would really like to spread out though. Although the medical and health writing is interesting and can be fun, I would love to be able to write more general things. I’ve started querying some magazines with some ideas I have. It probably won’t be easy being able to switch mindsets sometimes, but it will be worth it. I’m sure of it.

Today’s News:
Calgary Health Region issues TB alert
Caught sleeping on the job? No worries
Antipsychotics increase death risk among seniors

Monday, June 4, 2007

Strokes 4th leading cause of death in Canada

How much do you know about strokes? Did you know that stroke, or CVA (cerebral vascular accident) is the fourth leading cause of death in Canada today, killing about 16,000 Canadians per year? And that more women die from stroke than do men?

I found this information from the Heart and Stroke Foundation’s website. They have other sobering stats too. As you reach the age of 55, your risk of stroke doubles, but you don’t have to be older to have a stroke. Out of every 10,000 Canadian children under the age of 19, there are 6.7 strokes. Once you have had a stroke, you have 20% chance of having another stroke within 2 years. The average Canadians spend an average of 3 million hospital days because of to strokes and their effects.

Pretty scary stuff but if that’s not impressive enough, how about the fact that strokes cost the Canadian economy 2.7 billion dollars a year and the average acute care for a stroke, per person, is about $27,000.*

When I worked on a medical floor, I cared for many patients who had strokes and they ranged from completely recovering to dying – and there was an incredible range in between.

One of my favourite comic strips is For Better or For Worse by Lynn Johnston. One of the characters, Elly’s elderly dad, had a stroke. He is aphasic (can’t speak) but she draws strips of him as he tries to come to terms with his lack of motion and slow progress. Some of the strips can bring you to tears, they are so poignant.

I should worry about stroke. Heart disease runs in my family. I’m not in shape and I’m not exactly the healthiest eater. And yet, knowing that, I still am finding myself not trying all that hard to prevent anything from happening.

So, starting yesterday, it’s weight loss and get fit time. I’m not all that overweight. In fact, according to my body mass index, I’m just fine. According to weight charts, I’m about 10 pounds over. I’m not dieting per se, just cutting back and behaving a bit better when it comes to food I love. And, now that it’s summer time again, I have no excuse not to get out and walk my dog.

Let’s see how it goes. We have to bring those stroke numbers down, one by one.

News for today:
Herceptin could cut mastectomies
Doctors say roller shoes injuring kids
Less radiation OK for breast cancer