DiversityNursing Blog

By MICHELLE CASTILLO

Pets are getting some pain relief thanks to a centuries-old method that has helped some of their owners: acupuncture.

A dachshund named Samson benefitted from the treatment. Samson was pawed aggressively by another dog at the park and needed surgery immediately. After his first procedure, it was clear he was still in some pain. Doctors recommended a second surgery, but owner Ellie Sutton wasn't so keen to make Samson go under the knife again.

"I wouldn't want to risk something like paralysis," Sutton told CBS News. She decided "to try every other kind of step first."

To her surprise, the veterinarian suggested acupuncture, the traditional Chinese medicine method of inserting needles into the skin to stimulate parts of the body.

Veterinary acupuncturists can use .2 to .3 mm needles that range in length from .5 inches to 1.5 inches on pooches.

"A lot of people come for acupuncture because they've exhausted a lot of the traditional Western medicine roots, whether it's medication or surgery," Dr. Marc Seibert, Samson's vet, told CBS News. Siebert is the owner and medical director of Heart of Chelsea Animal Hospital and Lower East Side Animal Hospital in New York City.

Seibert explained there are two main theories behind how acupuncture works. Eastern medicine teaches that energy flows through channels in the body called meridians. When the meridians are blocked, the person -- or the animal -- experiences physical pain. The acupuncture needles help direct the energy to the correct path.

Western medicine, on the other hand, suggests that acupuncture may help by bringing oxygen to the area that the doctor is trying to treat. Hormones called endorphins, which promote feelings of well-being, are released, and the anti-inflammatory parts of the immune system kick in.

"Most people think of acupuncture as a pain reliever, but it's more than that," says Dr. Ihor Basko, a holistic veterinarian in private practice in Honolulu, certified by the International Veterinary Acupuncture Society in Ft. Collins, Colo., told Paw Nation. "Acupuncture can boost the immune system and improve organ functions, and it has other benefits. It can complement conventional medicines and procedures without dangerous side effects."

Not everyone is convinced the method works. Veterinarian Craig Smith, the complementary-care expert for the American Veterinary Medical Association, told U.S. and World News Report that it's hard to know for sure if canines and felines are feeling relief from their pain.

"While many people treating pets with acupuncture report success, there isn't any data that proves it works," he said.

Ellie Sutton admitted that a lot of the "energy flow" talk is hard for her to believe. But she says Samson has definitely benefited from the treatment.

"The fact is he walks better afterwards," she said.

Source: www.cbsnews.com

By Tony Marco and Catherine E. Shoichet

 It started with a sore throat on Thanksgiving and an antibiotic from a friend who wanted to help.

Now 19-year-old Yaasmeen Castanada is fighting for her life inside a California hospital's burn unit, suffering from an allergic reaction that's so severe she has large open wounds all over her body.

"It is heartbreaking, every day is a different look. Every day, she's like, shedding away. ... Overnight, it's a whole different person that you're looking at," Martha Hughes, Castanada's aunt, told CNN affiliate KABC.

Doctors diagnosed Castanada with Stevens-Johnson Syndrome, a rare disease that can be triggered by antibiotics or other medications.

"When she took the medication, she started having a hard time breathing, and she told her mom that her lips were burning, her throat, her eyes, they got so red that she couldn't talk. So she rushed her to the ER, and that's when they diagnosed her with the disease. And from there it has just spiraled to a nightmare," Hughes said.

Now Castanada, the mother of a 4-month-old, is in critical condition at the University of California, Irvine, burn center.

Her prognosis is good, even though the disease has a high mortality rate, according to Dr. Victor Joe, the center's director.

But the situation, Castanada's family says, has been devastating.

"Just unreal, just watching your daughter burn in front of you, literally, burn in front of you," her mother, Laura Corona, told KABC. "Every day, a new blister, a new burn, a new scar. And she's just, 'Mommy, I want to go home.' And I can't take her home. I can't put water on her lips."

Mom: 'Don't share medication'

On a website created to raise funds for Castanada's care, her mother said the harrowing ordeal began soon after her daughter took the medicine.

"A friend offered her an antibiotic pill that she had from a previous illness," Corona wrote. "She was thinking that it would help her. This would be the biggest mistake of her life."

Now, Corona says she's hoping to spread the word so others don't make the same mistake.

"Don't share medication. Don't give someone else your medication. Don't offer medication," she said.

She also advises parents to find out what their children are allergic to -- before it's too late.

Doctor: Reaction causing skin to separate

At first, doctors diagnosed Castanada with Stevens-Johnson Syndrome, which refers to a condition where between 10% and 30% of the skin on the body is affected, Joe said. Now she's experiencing Toxic Epidermal Necrolysis, the diagnosis when more than 30% of the body is affected. Joe estimates that 65% of Castaneda's skin and mucus membranes have been affected.

The allergic reaction is causing layers of Castaneda's skin to separate, Joe said, creating lesions that grow into large open wounds.

"Patients can experience problems with taste, swallowing, eyesight and sexual functions can be affected. In Yaasmeen's case, we are particularly concerned because her eyes have been affected. This can cause scarring of the corneas, which could lead to permanent blindness," he said. "We are trying to prevent that from happening."

Photos on the fundraising website show Castanada lying in a hospital bed, with openings for her eyes cut from the bandages that cover her.

As part of her treatment for the disease, doctors have wrapped her body in a special dressing, Joe said.

"We have chosen to place a dressing that adheres to the open wound, which allows her skin to heal without having to remove the bandages to wash the wounds," he said.

Mortality for those suffering from Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis can be as high as 25% in adults, but tends to be lower with early treatment, according to the Merck Manual.

Though it's uncommon, Joe said his hospital has treated around six cases in the past year, because the burn center has experience treating open wounds.

"This is very sobering. The fact that you can get a life-threatening situation from taking a medication. It can happen, and most people don't think twice about taking pills for things," Joe said. "In fact, most of the time you do have some sort of side reaction to medication, just not this severe."

After recovering from Stevens-Johnson Syndrome, patients usually only have minor issues with their skin, such as dryness, Joe said.

"Hopefully new skin will come in," Corona told KABC. "I'm just there watching. All I can tell her is, "Hang on, hang on. It's almost over.'"

Source: www.cnn.com

By Dennis Thompson

Already-strong public support for right-to-die legislation has grown even stronger in the days since the planned death of 29-year-old brain cancer patient Brittany Maynard, a new HealthDay/Harris Poll has found.

An overwhelming 74 percent of American adults now believe that terminally ill patients who are in great pain should have the right to end their lives, the poll found. Only 14 percent were opposed.

Broad majorities also favor physician-assisted suicide and physician-administered euthanasia.

Only three states -- Oregon, Washington and Vermont -- currently have right-to-die laws that allow physician-assisted suicide.

"Public opinion on these issues seems to be far ahead of political leadership and legislative actions," said Humphrey Taylor, chairman of The Harris Poll. "Only a few states have legalized physician-assisted suicide and none have legalized physician-administered euthanasia."

People responded to the poll in the weeks after Maynard took medication to end her life in early November.

Maynard moved from California to Oregon following her diagnosis with late-stage brain cancer so she could take advantage of the state's "Death With Dignity Act." Her story went viral online, with a video explaining her choice garnering nearly 11.5 million views on YouTube.

A "poster child for the movement," Maynard helped spark conversations that allowed people to put themselves in her shoes, said Frank Kavanaugh, a board member of the Final Exit Network, a right-to-die advocacy group.

"I think it is just a natural evolution over a period of time," Kavanaugh said of the HealthDay/Harris Poll results. "There was a time when people didn't talk about suicide. These days, each time conversations occur, people think it through for themselves, and more and more are saying, 'That's a reasonable thing to me.'"

The poll also found that:

• Support for a person's right to die has increased to 74 percent, up from 70 percent in 2011. Those opposed decreased to 14 percent from 17 percent during the same period.
• Physician-assisted suicide also received increased support, with 72 percent now in favor, compared with 67 percent in 2011. Opposition declined from 19 percent to 15 percent.
• Sixty-six percent of respondents said doctors should be allowed to comply with the wishes of dying patients in severe distress who ask to have their lives ended, up from 58 percent in 2011. Opposition decreased from 20 percent in 2011 to 15 percent now.

"The very large -- more than 4-to-1 and increasing -- majorities in favor of physician-assisted suicide, and the right of terminally ill patients to end their lives are consistent with other liberal social policy trends, such as support for same-sex marriage, gay rights and the decriminalization of marijuana, seen in the results of referendums and initiatives in the recent mid-term elections," Taylor said.

Support for the right-to-die movement cut across all generations and educational groups, both genders, and even political affiliation, the poll found.

Democrats tended to be more supportive of right-to-die legislation, but 56 percent of Republicans said they favor voluntary euthanasia and 63 percent favor physician-assisted suicide.

Kavanaugh was not surprised. "People think of this as a liberal issue. But I find that as I talk to [conservatives], you can appeal to them on the basis of 'get the government the hell out of my life,'" he said.

But the public is split over how such policies should be enacted, with 35 percent saying that the states should decide on their own while 33 percent believe the decision should be made by the federal government, the poll found.

"Most of the people I know in the field whose opinion I put stock in don't feel there's ever going to be federal movement on it," Kavanaugh said. "You're just going to have to suffer through a state-by-state process."

Kavanaugh does believe this overwhelming public support will result in steady adoption of right-to-die laws.

"I think this will become the ultimate human right of the 21st century, the right to die with dignity," he said. "There are good deaths and bad deaths, and it is possible to have a good death."

Despite increasing public support for assisted suicide, stiff opposition remains in some quarters.

"Assisted suicide sows confusion about the purpose of life and death. It suggests that a life can lose its purpose and that death has no meaning," Rev. Alexander Sample, archbishop of the Archdiocese of Portland in Oregon, said in a pastoral statement issued during Maynard's final days.

"Cutting life short is not the answer to death," he said. "Instead of hastening death, we encourage all to embrace the sometimes difficult but precious moments at the end of life, for it is often in these moments that we come to understand what is most important about life. Our final days help us to prepare for our eternal destiny."

Todd Cooper, a spokesman for the Portland archdiocese, said the debate over assisted suicide touches him on a very deep level because of his wife, Kathie.

About 10 years ago, she also was diagnosed with terminal brain cancer. She endured two brain surgeries, two years of chemotherapy and six weeks of radiation therapy, and remains alive to this day.

"If she'd given up the fight for life, she wouldn't be here," Cooper said. "That doesn't necessarily happen in every case, but it gives hope for those who struggle to the very end."

source: www.medicinenet.com

By AGATA BLASZCZAK-BOXE

Do men and women feel pain differently? A new study finds an unexpected gender divide.

Researchers found that men tend to report feeling more pain after major surgeries than women, whereas women tend to report experiencing more pain after minor surgical procedures than men.

In the study, researchers found that men were 27 percent more likely to report higher pain ratings after a major surgery such as a knee replacement, while women were 34 percent more likely to report experiencing more pain after procedures that the researchers labeled as minor, such as biopsies. (The researchers differentiated between "major" and "minor" procedures depending on the intensity of pain that people typically expect to feel after a particular procedure.)

To conduct the study, the researchers interviewed 10,200 patients from the University Hospitals of the Ruhr University of Bochum, Germany, following an operation, over more than four years. About 42 percent of the patients were male and 58 percent were female.

Initially, the study authors didn't find significant differences between the genders in people's overall experience of postoperative pain. However, that changed when the researchers distinguished between different kinds of surgeries.

The researchers are not sure where these differences stem from; however, they speculate that a lot may depend on the kind of surgery a person is undergoing. For instance, procedures such as cancer-related biopsies or an abortion may take a particularly serious emotional toll on women, and therefore exacerbate their individual perceptions of pain.

"It could be anxiety," study author Dr. Andreas Sandner-Kiesling of Medical University of Graz, Austria, told CBS News.

"This is a very interesting study," Dr. M. Fahad Khan, an assistant professor in the Department of Anesthesiology at NYU Langone Medical Center, told CBS News. "Ten thousand patients in any type of study is a huge number, and it is really great to see studies on that number of patients because it can limit a lot of the bias that some studies have."

Khan noted he found it interesting that in women, even smaller procedures "can be fraught with the development of pain problems after the procedure," which many people may not expect when they go to the hospital for a simple biopsy, he said.

Sandner-Kiesling said he did not think the findings should change the way men and women are treated for pain. "Clinically, there is no relevance," he said.

According to certain popular cultural stereotypes, women are often considered to be tougher about dealing with pain than men, but is this really the case?

"Anecdotally, people will say that women have a higher threshold for pain and they are more tolerant to pain, just because of their life experience. And perhaps, emotionally, maybe they are stronger than men," Khan said. "However, medically, in my experience, we haven't really noticed much of a difference with regard to men and women in the development of problems with dealing with severe and chronic pain."

The new study is presented at this year's Euroanaesthesia meeting in Stockholm.

Source:cbsnews.com

By JAN HOFFMAN

How well can computers interact with humans? Certainly computers play a mean game of chess, which requires strategy and logic, and “Jeopardy!,” in which they must process language to understand the clues read by Alex Trebek (and buzz in with the correct question).

But in recent years, scientists have striven for an even more complex goal: programming computers to read human facial expressions.

The practical applications could be profound. Computers could supplement or even replace lie detectors. They could be installed at border crossings and airport security checks. They could serve as diagnostic aids for doctors.

Researchers at the University of California, San Diego, have written software that not only detected whether a person’s face revealed genuine or faked pain, but did so far more accurately than human observers.

While other scientists have already refined a computer’s ability to identify nuances of smiles and grimaces, this may be the first time a computer has triumphed over humans at reading their own species.

“A particular success like this has been elusive,” said Matthew A. Turk, a professor of computer science at the University of California, Santa Barbara. “It’s one of several recent examples of how the field is now producing useful technologies rather than research that only stays in the lab. We’re affecting the real world.”

People generally excel at using nonverbal cues, including facial expressions, to deceive others (hence the poker face). They are good at mimicking pain, instinctively knowing how to contort their features to convey physical discomfort.

And other people, studies show, typically do poorly at detecting those deceptions.

In a new study, in Current Biology, by researchers at San Diego, the University of Toronto and the State University of New York at Buffalo, humans and a computer were shown videos of people in real pain or pretending. The computer differentiated suffering from faking with greater accuracy by tracking subtle muscle movement patterns in the subjects’ faces.

“We have a fair amount of evidence to show that humans are paying attention to the wrong cues,” said Marian S. Bartlett, a research professor at the Institute for Neural Computation at San Diego and the lead author of the study.

For the study, researchers used a standard protocol to produce pain, with individuals plunging an arm in ice water for a minute (the pain is immediate and genuine but neither harmful nor protracted). Researchers also asked the subjects to dip an arm in warm water for a moment and to fake an expression of pain.

Observers watched one-minute silent videos of those faces, trying to identify who was in pain and who was pretending. Only about half the answers were correct, a rate comparable to guessing.

Then researchers provided an hour of training to a new group of observers. They were shown videos, asked to guess who was really in pain, and told immediately whom they had identified correctly. Then the observers were shown more videos and again asked to judge. But the training made little difference: The rate of accuracy scarcely improved, to 55 percent.

Then a computer took on the challenge. Using a program that the San Diego researchers have named CERT, for computer expression recognition toolbox, it measured the presence, absence and frequency of 20 facial muscle movements in each of the 1,800 frames of one-minute videos. The computer assessed the same 50 videos that had been shown to the original, untrained human observers.

The computer learned to identify cues that were so small and swift that they eluded the human eye. Although the same muscles were often engaged by fakers and those in real pain, the computer could detect speed, smoothness and duration of the muscle contractions that pointed toward or away from deception. When the person was experiencing real pain, for instance, the length of time the mouth was open varied; when the person faked pain, the time the mouth opened was regular and consistent. Other combinations of muscle movements were the furrowing between eyebrows, the tightening of the orbital muscles around the eyes, and the deepening of the furrows on either side of the nose.

The computer’s accuracy: about 85 percent.

Jeffrey Cohn, a University of Pittsburgh professor of psychology who also conducts research on computers and facial expressions, said the CERT study addressed “an important problem, medically and socially,” referring to the difficulty of assessing patients who claim to be in pain. But he noted that the study’s observers were university students, not pain specialists.

Dr. Bartlett said she didn’t mean to imply that doctors or nurses do not perceive pain accurately. But “we shouldn’t assume human perception is better than it is,” she said. “There are signals in nonverbal behavior that our perceptual system may not detect or we don’t attend to them.”

Dr. Turk said that among the study’s limitations were that all the faces had the same frontal view and lighting. “No one is wearing sunglasses or hasn’t shaved for five days,” he said.

Dr. Bartlett and Dr. Cohn are working on applying facial expression technology to health care. Dr. Bartlett is working with a San Diego hospital to refine a program that will detect pain intensity in children.

“Kids don’t realize they can ask for pain medication, and the younger ones can’t communicate,” she said. A child could sit in front of a computer camera, she said, referring to a current project, and “the computer could sample the child’s facial expression and get estimates of pain. The prognosis is better for the patient if the pain is managed well and early.”

Dr. Cohn noted that his colleagues have been working with the University of Pittsburgh Medical Center’s psychiatry department, focusing on severe depression. One project is for a computer to identify changing patterns in vocal sounds and facial expressionsthroughout a patient’s therapy as an objective aid to the therapist.

“We have found that depression in the facial muscles serves the function of keeping others away, of signaling, ‘Leave me alone,’ ” Dr. Cohn said. The tight-lipped smiles of the severely depressed, he said, were tinged with contempt or disgust, keeping others at bay.

“As they become less depressed, their faces show more sadness,” he said. Those expressions reveal that the patient is implicitly asking for solace and help, he added. That is one way the computer can signal to the therapist that the patient is getting better.

Source: Nytimes.com