DiversityNursing Blog

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Source: Youtube

By MIKE STOBBE

For more than two months, health officials have been struggling to understand the size of a national wave of severe respiratory illnesses caused by an unusual virus. This week, they expect the wave to start looking a whole lot bigger.

But that's because a new test will be speeding through a backlog of cases. Starting Tuesday, the Centers for Disease Control and Prevention is using a new test to help the agency process four or five times more specimens per day that it has been.

The test is a yes/no check for enterovirus 68, which since August has been fingered as the cause of hundreds of asthma-like respiratory illnesses in children — some so severe the patients needed a breathing machine. The virus is being investigated as a cause of at least 6 deaths.

It will largely replace a test which can distinguish a number of viruses, but has a much longer turnaround.

The result? Instead of national case counts growing by around 30 a day, they're expected to jump to 90 or more.

But for at least a week or two, the anticipated flood of new numbers will reflect what was seen in the backlog of about 1,000 specimens from September. The numbers will not show what's been happening more recently, noted Mark Pallansch, director of the CDC's division of viral diseases.

Enterovirus 68 is one of a pack of viruses that spread around the country every year around the start of school, generally causing cold-like illnesses. Those viruses tend to wane after September, and some experts think that's what's been happening.

One of the places hardest hit by the enterovirus 68 wave was Children's Mercy Hospital in Kansas City, Missouri. The specialized pediatric hospital was flooded with cases of wheezing, very sick children in August, hitting a peak of nearly 300 in the last week of the month.

But that kind of patient traffic has steadily declined since mid-September, said Dr. Jason Newland, a pediatric infectious diseases physician there.

"Now it's settled down" to near-normal levels, Newland said. Given the seasonality of the virus, "it makes sense it would kind of be going away," he added.

The germ was first identified in the U.S. in 1962, and small numbers of cases have been regularly reported since 1987. Because it's not routinely tested for, it may have spread widely in previous years without being identified in people who just seemed to have a cold, health officials have said.

But some viruses seem to surge in multi-year cycles, and it's possible that enterovirus surged this year for the first time in quite a while. If that's true, it may have had an unusually harsh impact because there were a large number of children who had never been infected with it before and never acquired immunity, Newland said.

Whatever the reason, the virus gained national attention in August when hospitals in Kansas City and Chicago saw severe breathing illnesses in kids in numbers they never see at that time of year.

Health officials began finding enterovirus 68. The CDC, in Atlanta, has been receiving specimens from severely ill children all over the country and doing about 80 percent of the testing for the virus. The test has been used for disease surveillance, but not treatment. Doctors give over-the-counter medicines for milder cases, and provide oxygen or other supportive care for more severe ones.

The CDC has been diagnosing enterovirus 68 in roughly half of the specimens sent in, Pallansch said. Others have been diagnosed with an assortment of other respiratory germs.

As of Friday, lab tests by the CDC have confirmed illness caused by the germ in 691 people in 46 states and the District of Columbia. The CDC is expected to post new numbers Tuesday and Wednesday.

Aside from the CDC, labs in California, Indiana, Minnesota and New York also have been doing enterovirus testing and contributing to the national count. It hasn't been determined if or when the states will begin using the new test, which was developed by a CDC team led by Allan Nix.

Meanwhile, the virus also is being eyed as possible factor in muscle weakness and paralysis in at least 27 children and adults in a dozen states. That includes at least 10 in the Denver area, and a cluster of three seen at Children's Mercy, Newland said.

Source: http://news.yahoo.com

By Brittany Maynard

Editor's note: Brittany Maynard is a volunteer advocate for the nation's leading end-of-life choice organization, Compassion and Choices. She lives in Portland, Oregon, with her husband, Dan Diaz, and mother, Debbie Ziegler. Watch Brittany and her family tell her story at www.thebrittanyfund.org. The opinions expressed in this commentary are solely those of the author.

(CNN) -- On New Year's Day, after months of suffering from debilitating headaches, I learned that I had brain cancer.

I was 29 years old. I'd been married for just over a year. My husband and I were trying for a family.

Our lives devolved into hospital stays, doctor consultations and medical research. Nine days after my initial diagnoses, I had a partial craniotomy and a partial resection of my temporal lobe. Both surgeries were an effort to stop the growth of my tumor.

In April, I learned that not only had my tumor come back, but it was more aggressive. Doctors gave me a prognosis of six months to live.

Because my tumor is so large, doctors prescribed full brain radiation. I read about the side effects: The hair on my scalp would have been singed off. My scalp would be left covered with first-degree burns. My quality of life, as I knew it, would be gone.

After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left.

I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind.

Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.

I did not want this nightmare scenario for my family, so I started researching death with dignity. It is an end-of-life option for mentally competent, terminally ill patients with a prognosis of six months or less to live. It would enable me to use the medical practice of aid in dying: I could request and receive a prescription from a physician for medication that I could self-ingest to end my dying process if it becomes unbearable.

I quickly decided that death with dignity was the best option for me and my family.

We had to uproot from California to Oregon, because Oregon is one of only five states where death with dignity is authorized.

I met the criteria for death with dignity in Oregon, but establishing residency in the state to make use of the law required a monumental number of changes. I had to find new physicians, establish residency in Portland, search for a new home, obtain a new driver's license, change my voter registration and enlist people to take care of our animals, and my husband, Dan, had to take a leave of absence from his job. The vast majority of families do not have the flexibility, resources and time to make all these changes.

I've had the medication for weeks. I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms.

I would not tell anyone else that he or she should choose death with dignity. My question is: Who has the right to tell me that I don't deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?

Now that I've had the prescription filled and it's in my possession, I have experienced a tremendous sense of relief. And if I decide to change my mind about taking the medication, I will not take it.

Having this choice at the end of my life has become incredibly important. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty and pain.

Now, I'm able to move forward in my remaining days or weeks I have on this beautiful Earth, to seek joy and love and to spend time traveling to outdoor wonders of nature with those I love. And I know that I have a safety net.

I hope for the sake of my fellow American citizens that I'll never meet that this option is available to you. If you ever find yourself walking a mile in my shoes, I hope that you would at least be given the same choice and that no one tries to take it from you.

When my suffering becomes too great, I can say to all those I love, "I love you; come be by my side, and come say goodbye as I pass into whatever's next." I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully. I can't imagine trying to rob anyone else of that choice.

What are your thoughts about "death with dignity"?

Source: CNN

Source:http://www.inquisitr.com

Youtube

By Alice Gomstyn

How do you pass the time when cancer treatment means you're largely confined to your hospital room for weeks on end?

Tom Gillin, a 19-year-old college student, chose a less-than-obvious choice: He filmed a funny rap video channeling Jay-Z via the cancer ward.

"Some of the other videos I've seen about cancer patients are somewhat depressing," said Gillin, who was diagnosed with the pediatric cancer acute myeloid leukemia in April. "We wanted to flip the switch and do something that was the opposite of that."

Gillin teamed with several staffers at The Children's Hospital of Philadelphia to create "Bald So Hard." The video's title refers to Gillin's chemotherapy-related hair loss but is also a play on the phrase "ball so hard" featured prominently in a hit song by Jay-Z and Kanye West. The song is parodied in Gillin's video, as is Jay-Z's "Empire State of Mind."

The rollicking video — promoted on Twitter with the hashtag #BaldSoHard — is full of swagger. Gillin is seen mouthing lyrics such as "bald so hard my head got shiny" while dancing with his oncologist, playing basketball and even steering a "boat," a cardboard cutout made by hospital art therapist Abbien Crowley. (The actual rap was performed, mostly off camera, by University of Pennsylvania medical student David Blitzer.)

But Gillin didn't shy away from the fatigue and boredom confronting hospital cancer patients. It took him and his hospital pals some two months to complete the three-minute video since chemotherapy treatments often left him too weak to shoot.

The song's lyrics, written by Gillin and CHOP music therapist Mike Mahoney, manage to make light of it: "They gave me sleeping meds all day and I was dozing/When I got up I was so bored that I watched 'Frozen.'"

Gillin said his main motivation for making the video was to raise awareness of pediatric cancer, though he'd also appreciate it if Jay-Z — one of the teen's favorite rappers — took note of the unusual homage and paid the hospital a visit.

But don't expect Gillin to use the video to launch his own hip hop career. "I'm not that musically inclined," he insists.

Instead, he's looking forward to completing his final round of chemotherapy in a couple of weeks and ultimately returning to student life at the University of California, Los Angeles, where he's studying civil engineering.

For now, he's enjoying the happy reactions to his video, which has generated more than 20,000 views on YouTube since it debuted late last month. The Jigga Man himself hasn't yet weighed in but plenty of others say they love Gillin's jam, with one YouTube user dubbing it "best medicine in the world."

Source: http://www.today.com

Fastaff

Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.

Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.

Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.

Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip

Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.

Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.

With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!

Source: http://www.fastaff.com

By Susan Donaldson James

Raymond and Mazie Huggins, a devoted West Virginia couple with the same failing heart condition, didn’t think they would make it to their upcoming 74th wedding anniversary on Oct. 10.

But in August, Raymond or “Huggie Bear,” 96, and Mazie Leota, 93, received newly FDA-approved heart valves in a life-saving procedure on the same day.

“We went to the supper table one night and Raymond said, ‘If you have it done, then I will have it done and that’s how we will do it — together,'” Mazie said. “We went in together, had it done together and came home together.”

The couple went to the Cleveland Clinic for transcatheter aortic valve replacement or TAVR, a procedure designed for those who typically can’t withstand the risk of open-heart surgery. A catheter is wound through an artery in the groin and into the heart muscle.

This non-invasive surgery has been used on patients for some time, but the smaller valve required for the Huggins’ surgery was just approved in June after successful clinical trials.

“I’m very glad we had it and I am feeling fine,” said Mazie, a great-grandmother and former dental secretary. “I can’t get over there not being any pain afterwards.”

Now, the couple, both “with it” intellectually and otherwise healthy, can celebrate their long marriage at home in Moundsville, where they continue to live independently. They have every reason to expect to live an even longer life: Mazie’s maternal grandmother lived to be 108. 

“My father’s goal was to live long enough to get on the Smuckers jar,” said their son, Roger Huggins, 67. “Last year, even with his heart problems, he made apple butter and applesauce out of the tree in the backyard.”

Roger said his father, a former glass factory shipper and retired prison guard, is “very strong and a tremendously hard worker.” He calls his mother an “angelic” woman who worries about others and is beloved by all who know her.

“My mother protects my father to the fullest,” said Roger. “He might make her madder than the dickens, but she protects him to the fullest.”

Two years ago, his parents had stents put in their hearts on the same day.

“I was in pre-op with them,” said Roger, a retired food company sales rep. “Their tables passed in the hallways and they were awake enough to make [the medical staff] stop their beds. They held hands and kissed each other and had the whole hospital crying.”

Roger, who drives three hours each way from his home in Erie, Pennsylvania, to check in on his parents and organize their medications, persuaded them to have the TAVR procedure after doing his own research.

Raymond insisted his wife go first, then his surgery followed.

“They both were prepared to pass away on the table,” said their son. “But it very well could have been much worse if my mother had woken up and my dad had died beside her. Or harder if my father had woken up.”

“The first thing my father said when he came out of the anesthesia was, ‘Am I alive?’” said Roger. “The second thing he said was, ‘Is my wife alive?’ The third thing he said is, ‘I’ve got to go out and fix the yard.’ He’s a workaholic.”

The Hugginses may not be the oldest patients ever to undergo TAVR surgery (some patients have been 98 and 100), but they were the first couple, according to their surgeon, interventional cardiologist Dr. Samir Kapadia.

“The data suggest that 50 to 60 percent would not make it until the end of the year with their condition,” he said. “They were declining fairly fast. … When they came to us they were very short of breath and had medical problems that were unbelievably complex.”

The aortic valve is the “door” to the heart, according to Kapadia. A normal opening is about 2.5 cm. But theirs were closed down to .3 and .4 — “about 10 times less.”

“Five or 10 years ago, nothing could have been done for them,” he said. “We would have had to stop the heart and open up the chest, and at that age the recovery would be up to two months, with significant risk,” he said.

Mazie was prepped for surgery first at 5:30 a.m. and Raymond followed at 9:30 a.m.

“The kissed each other and were in recovery opposite each other and wanted to be together holding hands in the same room,” said Kapadia.

By the evening after surgery, they were out of bed, and the next day, they were walking. Mazie’s release was delayed because of fluid in her lungs, so Raymond insisted on staying at the hospital with her for several more days.

The couple is now back at home with a part-time caregiver, looking forward to their anniversary next month.

Mazie attributes their 74-year happy marriage to good communication.

“There have been a few ups and downs,” she said. “If you don’t agree, get it out and say it and get it over with.”

Kapadia said the family’s closeness was an important factor in the surgery’s success.

“They are wonderful people,” he said. “Their son fought for them to be treated together as the only best option. Who would take care of the other one? It would have been a disaster for their family life.”

“But more than anything else, they wanted to live and celebrate and enjoy the last part of their life together.”

Source: http://www.today.com

By Michael Martinez

A respiratory virus is sending hundreds of children to hospitals in Missouri and possibly throughout the Midwest and beyond, officials say.

The unusually high number of hospitalizations reported now could be "just the tip of the iceberg in terms of severe cases," said Mark Pallansch, a virologist and director of the Centers for Disease Control and Prevention's Division of Viral Diseases.

"We're in the middle of looking into this," he told CNN on Sunday. "We don't have all the answers yet."

Ten states have contacted the CDC for assistance in investigating clusters of enterovirus: Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma and Kentucky.

What is Enterovirus EV-D68?

Enteroviruses, which bring on symptoms like a very intense cold, aren't unusual. They're actually common. When you have a bad summer cold, often what you have is an enterovirus, he said. The season often hits its peak in September.

The unusual situation now is that there have been so many hospitalizations.

The virus has sent more than 30 children a day to a Kansas City, Missouri, hospital, where about 15% of the youngsters were placed in intensive care, officials said.

In a sign of a possible regional outbreak, Colorado, Illinois and Ohio are reporting cases with similar symptoms and are awaiting testing results, according to officials and CNN affiliates in those states.

In Kansas City, about 475 children were recently treated at Children's Mercy Hospital, and at least 60 of them received intensive hospitalization, spokesman Jake Jacobson said.

"It's worse in terms of scope of critically ill children who require intensive care. I would call it unprecedented. I've practiced for 30 years in pediatrics, and I've never seen anything quite like this," said Dr. Mary Anne Jackson, the hospital's division director for infectious diseases.

"We've had to mobilize other providers, doctors, nurses. It's big," she said.

The Kansas City hospital treats 90% of that area's ill children. Staff members noticed an initial spike on August 15, Jackson said.

"It could have taken off right after school started. Our students start back around August 17, and I think it blew up at that point," Jackson said. "Our peak appears to be between the 21st and the 30th of August. We've seen some leveling of cases at this point."

What parents should know about EV-D68

No vaccine for virus

This particular type of enterovirus -- EV-D68 -- is uncommon but not new. It was identified in the 1960s, and there have been fewer than 100 reported cases since that time. But it's possible, Pallansch said, that the relatively low number of reports might be because EV-D68 is hard to identify.

EV-D68 was seen last year in the United States and this year in various parts of the world. Over the years, clusters have been reported in Georgia, Pennsylvania, Arizona and various countries including the Philippines, Japan and the Netherlands.

An analysis by the CDC showed at least 30 of the Kansas City children tested positive for EV-D68, according to the Missouri Department of Health and Senior Services.

Vaccines for EV-D68 aren't currently available, and there is no specific treatment for infections, the Missouri agency said.

"Many infections will be mild and self-limited, requiring only symptomatic treatment," it said. "Some people with several respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy."

Some cases of the virus might contribute to death, but none of the Missouri cases resulted in death, and no data are available for overall morbidity and mortality from the virus in the United States, the agency said.

Symptoms include coughing, difficulty breathing and rash. Sometimes they can be accompanied by fever or wheezing.

Jackson said physicians in other Midwest states reported cases with similar symptoms.

"The full scope is yet to be known, but it would appear it's in the Midwest. In our community, meticulous hand-washing is not happening. It's just the nature of kids," Jackson said.

'Worst I've seen'

Denver also is seeing a spike in respiratory illnesses resembling the virus, and hospitals have sent specimens for testing to confirm whether it's the same virus, CNN affiliate KUSA said.

More than 900 children have gone to Children's Hospital Colorado emergency and urgent care locations since August 18 for treatment of severe respiratory illnesses, including enterovirus and viral infections, hospital spokeswoman Melissa Vizcarra said. Of those, 86 have been sick enough to be admitted to the Aurora facility.

And Rocky Mountain Hospital for Children had five children in intensive care and 20 more in the pediatric unit, KUSA said last week.

"This is the worst I've seen in my time here at Rocky Mountain Hospital for Children," Dr. Raju Meyeppan told the outlet. "We're going to have a pretty busy winter at this institution and throughout the hospitals of Denver."

Will Cornejo, 13, was among the children in intensive care at Rocky Mountain Hospital for Children after he came down with a cold last weekend and then woke up Tuesday night with an asthma attack that couldn't be controlled with his medicine albuterol. His mother, Jennifer, called 911 when her son's breathing became shallow, and her son was airlifted to the Denver hospital, she told KUSA.

Her son was put on a breathing tube for 24 hours.

"It was like nothing we've ever seen," Jennifer Cornejo told KUSA. "He was unresponsive. He was laying on the couch. He couldn't speak to me. He was turning white, and his lips turned blue.

"We're having a hard time believing that it really happened," she added. "We're much better now because he is breathing on his own. We're on the mend."

Restricting kids' visits with patients

In East Columbus, Ohio, Nationwide Children's Hospital saw a 20% increase in patients with respiratory illnesses last weekend, and Dr. Dennis Cunningham said patient samples are being tested to determine whether EV-D68 is behind the spike, CNN affiliate WTTE reported.

Elsewhere, Hannibal Regional Hospital in Hannibal, Missouri, reported "recent outbreaks of enterovirus infections in Missouri and Illinois," the facility said this week on its Facebook page.

Blessing Hospital in Quincy, Illinois, saw more than 70 children with respiratory issues last weekend, and seven of them were admitted, CNN affiliate WGEM reported. The hospital's Dr. Robert Merrick believes that the same virus that hit Kansas City is causing the rash of illnesses seen at the Quincy and Hannibal hospitals, which both imposed restrictions this week on children visiting patients, the affiliate said.

"Mostly we're concerned about them bringing it in to a vulnerable patient. We don't feel that the hospital is more dangerous to any other person at this time," Merrick told WGEM.

Blessing Hospital is working with Illinois health officials to identify the virus, the hospital said in a statement.

While there are more than 100 types of enteroviruses causing up to 15 million U.S. infections annually, EV-D68 infections occur less commonly, the Missouri health agency said. Like other enteroviruses, the respiratory illness appears to spread through close contact with infected people, the agency said.

"Unlike the majority of enteroviruses that cause a clinical disease manifesting as a mild upper respiratory illness, febrile rash illness, or neurologic illness (such as aseptic meningitis and encephalitis), EV-D68 has been associated almost exclusively with respiratory disease," the agency said.

Clusters of the virus have struck Asia, Europe and the United States from 2008 to 2010, and the infection caused relatively mild to severe illness, with some intensive care and mechanical ventilation, the health agency said.

To reduce the risk of infection, individuals should wash hands often with soap and water for 20 seconds, especially after changing diapers; avoid touching eyes, nose and mouth with unwashed hands; avoid kissing, hugging and sharing cups or eating utensils with people who are sick; disinfect frequently touched surfaces such as toys and doorknobs; and stay home when feeling sick, the Missouri agency said.

Source: http://www.cnn.com