Notes From The Nurse
Adair Small serves as OCUUC’s Congregational Nurse. Her regular column, Notes From The Nurse, is a topical update on health issues for the congregation. Adair also coordinates the Caring Ministry and various health related programs at OCUUC.
Upcoming Events of Interest to Seniors
Managing Medications Event for Seniors
Free three-part series at Brea Senior Center, 500 S. Sievers Ave.
Thursday, Feb. 23, 2012, 11 a.m. – noon: Help with Medicare Rx Costs
Information on premiums, deductibles, co-pays, low-cost options; Medicare Drug Plan Choices, Formulary Review
Part II: Thursday, March 29, 11:00 a.m. – Noon: Practical Tips on Medication Storage, Disposing, & Remembering
Part III: Wednesday, April 25, 10:00 a.m. – Noon “Brown Bag Medication Review” with a pharmacist. Call to register: (714) 990-7750
Alzheimer’s Disease and Other Dementias: What Does the Diagnosis Mean?
Tuesday, March 20, 2012, 4:30 – 7:00 p.m. (Refreshments 4:30 – 5:00)
UCI University Club, Irvine
Reservations mandatory: (949) 824-2382, press option 4
Notes From the Nurse, February 2012
February is Heart Month every year, not just because of Valentine’s Day! The American Heart Association and the Red Cross tie a lot of their education to this month. It makes sense; reminders about how to take care of ourselves and how we can save other’s lives are needed periodically.
Here’s a link to the AHA site which has a brief video of Hands-Only CPR™ http://HandsOnlyCPR.org/ You can also get an app for your iPhone, Android, or Palm Pre to guide you through CPR!
Sudden Cardiac Arrest
This means your heart has completely stopped effective beating; survival depends greatly on immediately getting CPR from someone nearby. Unfortunately, less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location get that help. Most people are worried that they might do something wrong or make things worse. That’s why things are being made much simpler for non-medical professionals. And the beauty is these techniques can work as well or better than “old-fashioned CPR”!
If you see an adult suddenly collapse, and he or she is not breathing and unresponsive, call 911 and push hard and fast in the center of the chest. The American Heart Association says, “Don’t be afraid. Your actions can only help.”
Heart Attack and Stroke
In a heart attack, a part of the heart can die from lack of blood. In a stroke, part of the brain can die. These are life-and-death emergencies; every second counts. If you see or have any of the following symptoms, immediately call 911. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! There are new and better treatments every day to stop a heart attack or stroke in its tracks. But to be effective, these drugs must be given relatively quickly after symptoms first appear.
HEART ATTACK WARNING SIGNS
- Chest Discomfort
- Most heart attacks cause discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
- Pain or Discomfort in one or both Arms, Back, Neck, Jaw or Stomach
- Shortness of Breath with or without chest discomfort
- Other Signs may include a cold sweat, nausea or lightheadedness
STROKE WARNING SIGNS
If even one of these signs is present, don’t delay:
- Sudden numbness or weakness of Face, Arm, Leg, especially if one-sided
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
Thanks to our partnership with Hoag Hospital’s Health Ministry program, we will be able to offer CPR and or First Aid training through the year! Let’s all be prepared to save lives if we have to.
And don’t forget prevention. Try not to gain weight; try to exercise some every day. Remember, any step you take can be the first of many in the right direction!
Adair Small, nurse
ocuuc
org (nurseocuucorg)
Congregation Nurse
Holiday Blues
Our church family has sustained more than our share of group and individual loss this past year. I wrote about holiday blues in 2010, but I think it is useful to look at again. OCUUC said good-bye to a beloved minister with the retirement of Karen Stoyanoff and has dealt with the deaths of several long-time church members. We also have members with some very serious illnesses. Sometimes we forget that illness and injury are losses too, of our good health. Whether present or past, this season can bring all these losses up with a vengeance. Someone has said, “Loss is like a scar: It will heal over, but it will also leave a mark.”
It is important to be sensitive to those who may find this a stressful period, and if you are one of these folks, to know that you are not alone.
All losses and potential losses count. How can you be full of cheer if jobless and in fear of worse? Events that happen from time to time in all our lives make celebration tougher: illness, death of a loved one, perhaps a separation or divorce.
The holidays accentuate these feelings of loss or loneliness because of ours and others’ expectations, and anxiety about the future. I think the “other’s expectations” part is key. You should be able to share your feelings of loss with those who are close to you and scale down the festivities to something you are comfortable with. This is a time when being with family and friends can be an enormous help, as long as they are sensitive to your feelings.
One way through all this is to try to look for the joy in the present moment and to be with people who lift you up rather than drag you down. The OCUUC community is one where I have always found the love, caring and support to be very special. You already know who the folks are who make you feel good just when you see them or hear their voice. Try to be in their company. Think about the places that have always made you feel good or at peace and seek them out. I find there is nothing like a walk on the beach or at the marsh to make me feel better. Don’t forget that activity is a wonderful antidepressant and anti-anxiety tool!
It is important to be able to separate holiday blues from clinical depression. If you have been feeling an overall disinterest with your life prior to this holiday season, then you should be evaluated by a mental health professional. Call the NAMI WARMLINE, 1-877-910-WARM (9276) or 714- 544-8488, 8 a.m. to midnight daily.
If you already suffer from depression, keep supportive family and friends close during the holiday season. This can be a tough time and you should lean on all the people you can, to get you through it. I have some Tips for Handling the Holiday Blues available at the Caring Table, or I would be happy to send them to you.
I take this opportunity to wish you the brightest 2012,
Adair Small, Congregation Nurse
nurseocuucorg (nurseocuucorg)
Coming Events and Immunization Update, Part II
Blood Donation
The Winter Blood Drive will be on Sunday, December 11 from 8:30 – 2:30 in the OCUUC parking lot. This is a particularly tough time of year on the nation’s blood supply. We have members of our own congregation needing frequent transfusions. Please donate if you can. Appointments are very helpful, but walk-ins are always welcome! Sign Up at the Caring Table or online.
Blood Pressure Screening
December 11 will also be an opportunity for you to have your BP checked whether or not you are donating blood! During the Arts and Crafts Fair, Sally Cowan, RN, will be providing this service at the Caring Table, where Adair’s Heart Healthy Holiday Trail Mix will also be on sale!
Whooping Cough Vaccine
Pertussis, better known as Whooping Cough, has seen a dramatic resurgence in recent years. Although it is rarely life threatening to adults, it is not a minor illness. We are susceptible since our childhood immunity has worn off long ago and when adults do get it, they can pass it to babies and unimmunized children where it is a very serious illness. Now there is an effective new killed vaccine with no mercury preservative. Side effects are very unlikely, except for some tenderness at the injection site. The vaccine is a three-in-one: tetanus, diphtheria and pertussis.
You can get this from your health care provider or, if you have no insurance, the health department. Call them at 1-800-564-8448 for an appointment for: children, women of childbearing age (pregnant or not), any adult who cares for children or comes into contact with them regularly, and all over 64.
December Blood Drive
Link: Who may donate?
Blood Donors Must:
- Be healthy*
- Be at least 17 years old in most states, or 16 years old with parental consent if allowed by state law – see more information for 16-year old donors »
- Weigh at least 110 lbs.
Additional weight requirements apply for donors 18 years old and younger and all high school donors. - Wait at least 56 days since your last whole blood donation
- DONORS MUST SHOW ID containing given name and one of the following: birth date, blood center assigned donor number or photo.
- Eat a healthy meal before donating, even if you do not normally eat three meals a day.
- Drink 16oz of water 10-30 minutes before donating. (Soda, coffee and tea don’t count!)
Immunizations for all Ages
Our free Flu Vaccine Clinic coming up on Sunday, November 13th from 10:30am to 1:00 pm. I thought this would be a good time to review some of the latest information on immunization and what it can do for us. Since I have been in Chicago, I have enjoyed reading up on local history. I just finished a book about Jane Addams’ Hull House. It included the deadly small pox epidemic which spread from the Midway of the World Columbian Exposition (1893) through the city. Many were more afraid of the vaccine than they were of the disease and died or were severely scarred as a result.
There are side effects to vaccines, it is true, but except in rare cases they are insignificant compared to the illness. I am old enough to have had two cousins contract polio before the vaccine was developed.
Influenza: There are now many vaccine options, although we will only have the standard killed virus inoculation at OCUUC. The Center for Disease Control advises everyone from 6 months and up to be vaccinated yearly. Children under 9 years old need 2 shots the first time, so we will only vaccinate those who have had vaccine in previous years. Our vaccine does contain the preservative thimerosal, a mercury based preservative which some people prefer to avoid in children and pregnancy.
It is important to note that fears related to autism and thimerosal exposure from vaccines is completely unfounded. No routine vaccines for children under 6 years of age have contained thimerosal (except flu vaccine) during the past 6 years, and yet rates of autism have not changed. I do recommend that all pregnant women seek the thimerosal-free vaccine from their health care provider since it is unknown what effect thimerosal may have on the fetus. There is good evidence that influenza immunity does pass to the fetus and protects the newborn from infection and hospitalization.
The new quadruple strength vaccine is for those over 65 when one’s natural immune response begins to decrease. Medicare covers that or the regular strength vaccine if you prefer.
The intradermal flu vaccine is injected into the skin instead of the muscle. It uses a much smaller needle than the regular flu shot, and it requires a lower dose to be as effective as the regular flu shot. It is available for those aged 18 through 64. It has no thimerosal.
The nasal-spray flu vaccine is a vaccine made with live, weakened flu viruses. The viruses in the nasal spray vaccine do not cause the flu. It is approved for use in healthy people 2 through 49 years of age who are not pregnant.
HPV (Human Papilloma Virus) has been in the news a lot lately. I suspect that it is only controversial because it is associated with sexual activity. Most first sexual encounters now occur in the seventh grade and HPV is the most common sexually transmitted infection in the US. There are over 100 types of HPV virus that affect humans; two of them cause cervical, oral, throat, anal, and penile cancer. The virus is transmitted by skin to skin or bodily fluid contact. There are two other types that cause genital warts. All four strains are combined in the Gardasil vaccine which is only effective if used before exposure. Three shots over 6 months are needed for immunity; it is recommended for males and females age 9-26. Why not over 26? Statistically almost all those older than 26 already have been exposed to HPV.
Shingles (Herpes zoster) is caused by the chicken pox virus. Once you have had chicken pox (even if so mildly that you never knew it), the virus stays in your system. It tends to manifest years later as shingles with sometimes disastrous results. The vaccine can be given to anyone over age 50. The older you are, the more likely you are to develop shingles. You can get it more than once. Medicare does not cover this, but many supplemental insurances do.
Pneumonia can be bacterial or viral. There is a vaccine for the bacterial type only. This should be given once to those 65 and older. Medicare covers it. Bacterial pneumonia is opportunistic; that is it generally infects someone already sick with something else. When young children and seniors get a very bad case of the flu, it is pneumonia that often kills them.
Important upcoming dates:
Flu Clinic is Nov. 13th
Bloodmobile on Dec. 11th
Notes From the Nurse, October 2011
The AED is here!
What am I talking about? An Automatic External Defibrillator. Learning how to use one enables you to shout “Clear!” like they do on TV, and, of course in real hospitals and ambulances. We all hope we never have to perform CPR or actually use an AED, but lives are saved everyday with this technology. OCUUC’s AED comes courtesy of our association with Hoag and their Health Ministry program. Hoag is both paying for the AED and for any necessary maintenance.
Let me give you a little background. CPR can save lives, but twice as many victims of sudden cardiac arrest are saved with use of CPR in combination with an AED within a 3 minute time frame. Simply, when someone sustains a heart attack, the electrical rhythm of the heart usually changes from effective pumping to ventricular fibrillation. This is a quivering heart unable to pump blood. CPR attempts to create effective pumping by external compression; it rarely converts the heart to a normal rhythm. That is what a defibrillator does. An AED is a computer which analyzes the heart rhythm and speaks out loud to the rescuer about the steps to take to send a shock to the heart in an attempt to establish normal rhythm. You have probably all seen AED’s without realizing it. All airports, fitness centers, convention halls have them now. More and more churches have been getting them as well.
Alan Block will be our site coordinator for the AED. It is not enough to have an AED on the wall; it must be checked monthly and a report sent via computer to the company. Alan will be doing this with Sally Cowan, RN, as back up. It will also do us no good to have an AED unless a significant number of us are trained in its use!
We are going to prioritize church leadership for training registration for our first class. As soon as they have the opportunity to sign up, we will open to the rest of the congregation. Our first training is Saturday, October 29 from 9 to 1:30. It will be limited to 16 people. We plan to have another training in the spring to get as many folks certified as possible. You will be certified in AED and CPR for adult, child and infant.
On another note: FLU VACCINE is coming. We will have our free clinic, Sunday, November 13. However, I do recommend that those of you who can, get vaccinated as soon as possible. Physicians and pharmacies have supplies now and Medicare covers it. Children and pregnant women should also be vaccinated.
Adair Small, Congregation Nurse
Update on Alzheimer’s
We all are either old enough that we worry about our own and our friends’ memories or young enough that we worry about our parents or grandparents! Recently there was an international conference in Paris on the subject and the local chapter of the Alzheimer’s Association presented an update which I attended. I’d like to try to distill the key take-away points.
Cause: Genetics are definitely involved, but not determinative. In other words everyone with Alzheimer’s Disease (AD) has certain genetic indicators, but not everyone with the indicators gets AD. (It is important to note here that there are other causes of dementia such as blood supply changes to the brain caused by atherosclerosis or strokes, and certain other conditions.)
Head Injury: Incidence of AD is higher in boxers, ice hockey and football players
Diagnosis: It is no longer true that AD is only diagnosed on autopsy. MRI and PET scans can identify AD changes before symptoms are evident. Tests on blood and spinal fluid are also being used now in some centers when AD is suspected by clinical exam. Clinical exam refers to the assessment made by the patient’s report of symptoms and the results of written and oral memory and neurological testing.
Some Early signals to look out for that aren’t obvious:
- Sensory changes manifested in such things as falls or reaching for something and missing it
- Not bothering to balance your checkbook
- Depression can sometimes mimic Alzheimer’s, but it can also be a symptom.
- Increased irritability
The symptoms most folks recognize easily are severe short term memory problems, getting lost in familiar places, increased confusion, inability to plan, poor judgment. The Alzheimer’s Association has a wonderful list of these and how to tell the difference from normal aging. We have these at the Caring Table and they are online at http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp
Why is early diagnosis so important? The new medications that have been developed really do slow the progress of the disease. Starting them early can really maximize quality of life! Also it is never too late to make lifestyle changes to improve brain function.
Prevention that Works:
Use it or lose it, the more the better: Learn new skills constantly – dance, sing, learn a foreign language, play all kinds of games.
Avoid head trauma!
All juices (eating whole fruits is better overall for your health)
Lower stress and increase sleep time
Brain Health is Heart Health – Mediterranean Diet including Omega-3s (oily fish three times a week), walnuts; exercise (whatever feels good to you), stress reduction)
Social Engagement (keep on coming to church!)
Your Nurse is Traveling Again! Even though you may not see me at church, I am still on duty throughout the fall. Contact me via email or cell phone. And save the dates for CPR on Oct. 29 and Flu Clinic Nov. 13!
Adair Small, Congregation Nurse
nurseocuucorg
Notes from the Nurse, July 2011
What I learned about Autism
The most interesting workshop I attended at my recent nurse practitioner conference was on autism spectrum disorder (ASD) in children. I want to share some of the key points with you in this column.
- ASD is manifested by impaired socialization, delayed or unusual communication, and repetitive behavior patterns. There are many completely different causes, but all seem to be related to genetics. How the mutations occur is another question. Researchers are investigating a possible viral cause among several others.
- There is a full spectrum of symptoms and degrees of severity from extremely mild to disabling
- Statistics: 1 in 91 people in the US are affected (2009), occurrence is 4-5 times higher in males, recurrence rate within families is 10-15%
- Those affected with ASD use their eyes differently, looking at the mouth rather than the eyes. It is harder for them to look and listen at the same time. They have a heightened sense of hearing, smell, and touch.
- Multiple genetic changes are involved; girls seem to be protected by having 2 X chromosomes. (normal genes on one chromosome protect against abnormal genes on the other; since boys have only one X, they are more vulnerable)
- Developmental screening is very important throughout the first 2 ½ years of life. Early intervention can make a huge difference in helping children and families learn to cope with ASD, and in fact improving the outcome. With a proper program, the brain will actually grow more normally. The reason ASD is often not diagnosed until after 18 months of age is that a different set of genes is activated at that point in development. It is only then that certain behaviors or the lack of them become obvious. The sad thing is that the average age of diagnosis is still 8-9 years. (Side note: the brain is not fully mature till age 24 years!)
- Signs to watch for: no big smiles by 6 months, no back and forth sharing by 9 months, no babbling by 12 months, no gestures by 18 months, no words by 16 months, no 2 word meaningful phrases by 24 months, loss of skills at any age.
- Behavioral Signs (more than one or two of these): hour long tantrums more than once a day, doesn’t know how to play with age appropriate toys, gets stuck on things over and over, persistent toe-walking, unusual attachments to parts of toys or objects, lines things up, odd movement patterns, extremely oversensitive to certain textures or sounds, very uncooperative
- Special educational, occupational, speech therapy, social storytelling, physical activity that helps integrate the senses (e.g. horseback riding) are all techniques that actually help create new brain connections.
- There are medications that can help with various aspects of ASD. There is no cure.
- Vaccines do NOT cause autism!!
What can you do? If you are close to children of family and friends, a daycare provider or teacher, be alert to the possibility of ASD if there is a delay in normal development. If you are concerned, the parents probably are too, but are fearful and/or in denial. All parents compare their children to others. This is a subject to be very gently broached. Excellent resources can be found at www.autismspeaks.org and www.ninds.nih.gov/disorders/autism As a parent, insist on your health care provider’s doing appropriate developmental screening as recommended by the American Academy of Pediatrics.
Adair Small, Congregation Nurse, nurseocuucorg (nurseocuucorg)
Sun, Body Mechanics
SLOP, SLIP, SLAP – It’s the really sunny season again. Southern California is one of the prime areas for, you guessed it, skin cancer. Those first three words are a slogan from Australia which is the world capital for skin cancer. They refer to:
SLOP on the sunscreen; a little dab won’t do you. Really slather it on and keep reapplying. There is no such thing as waterproof sunscreen.
SLIP on a shirt; you still need sunscreen unless you are wearing one of the new UV rated shirts.
SLAP on a hat. Sunscreen works well on a clean-shaven head, but otherwise is rather unattractive. And the bigger your brim, the better. Also make sure your sunglasses protect against UV rays to help prevent cataracts.
UVA rays are the silent enemy in that they cause the kind of damage that can result in cancer, but don’t warn you with a burn or tan. UVB rays burn, tan and damage the skin in all kinds of ways.
How to Choose a Sunscreen: SPF 30 rated products seem to provide significantly better protection than lower ratings. There a two types of UV barriers, physical and chemical.
Sunscreens containing nanoparticles of zinc and titanium create a physical barrier by reflecting light before it can reach the skin. The latest research is that they do not appear to penetrate the skin. These block both UVA and UVB rays and are particularly useful for people with sensitive skin as they tend to be less irritating than chemical barriers.
The chemical barriers need a number of active ingredients as none work against the full UV spectrum. These sunscreens, which act by absorbing UV radiation before it affects your skin, can include Avobenzone (one of the few chemicals that will block UVA), Homosalate, Octocrylene, Octisalate, Oxybenzone (this last blocks both A and B).
An excellent sunscreen will combine both physical and chemical ingredients and have at least five active ingredients.
Post Scrip from last month’s column: In my discussion on “Lessons Learned from Moving”, I left out Body Mechanics! All nurses learn this from day one or we would be in trouble the first time we tried to lift, roll or help a patient to his feet. Any time you find yourself about to lift something heavy, remember to square off, bend from the knees, not the waist, get a good grip and come straight up. If it’s too heavy or awkward, get help! Try to recall your early physics lessons; sometimes all you need is a little leverage to raise the object up enough so you don’t have to bend as far to lift it. Shoving also works wonders. Our backs are too precious to fool around with!
Enjoy the summer in good health and check out our new Exercise Group,
Adair Small, nurseocuucorg (nurseocuucorg)
