My April column was about easily preventible diseases, the communicable ones for which we have developed vaccines. Unfortunately we have no idea how to prevent many conditions and the list of autoimmune disorders is one that just seems to keep growing. There are currently more than 80 widely accepted conditions in this category. Autoimmune literally means an immune response to the self. In other words the immune cells in the body begin to attack and destroy healthy body cells. This is similar to an allergic reaction, but there the stimulus comes from outside the body and not from the body itself. One of the confusing aspects is that an outside stimulus may be the initiator. For example in Celiac Disease or sprue, the intestinal lining reacts to gluten (found in most grains) by destroying the villi necessary to absorb nutrients. Eating a gluten-free diet relieves this, but it can take some time for the intestines to “calm down” and sometimes the inflammation never entirely resolves.

Among Americans, 23.5 million people have an autoimmune disease. Women seem to be more likely to develop one than men. Some disorders seem to have a familial tendency. Environmental exposure to certain things, sunlight, chemical solvents, and even certain viral and bacterial infections can increase the risk. Your ethnicity or race can make you more or less susceptible to various autoimmune conditions and can affect the severity of the disease.

Any organ in the body can be involved. The thyroid gland is a commonly affected gland and is a good example of the ways autoimmune conditions can behave. An affected thyroid can underproduce thyroid hormone (Hashimoto’s Disease) or overproduce it (Grave’s Disease). Thyroxine affects the function of multiple organ systems so its levels are vitally important to normal function. Too much is as bad as too little. Grave’s disease also illustrates how peculiar the malfunction of our immune system can be. In this case, the body makes antibodies that mimic a hormone the pituitary gland makes to regulate the thyroid gland. TSH, thyroid stimulating hormone, is at normal levels, but the thyroid gland responds to the abnormal antibodies and goes into overdrive. This can damage the heart and eyes and cause many distressing symptoms such as anxiety and insomnia. There are several treatments depending on the severity of the condition. Sometimes it completely resolves with minimal treatment.

Many autoimmune disorders profoundly affect a person’s life even though they are quite common such as Type I diabetes. We are all familiar with the fact that just replacing insulin does not solve all the health problems diabetics face. Diet and exercise are of vital importance to maximize control of blood sugar levels and minimize organ damage.

Each autoimmune disorder is unique, but they all share some common characteristics. Most can cause fatigue, dizziness, and low-grade fever. Most are characterized by remissions when symptoms abate and exacerbations or flares when symptoms suddenly increase. Stress, both environmental (such as heat or cold) and emotional, generally cause exacerbations.

Other disorders such as Addison’s Disease, pernicious anemia, rheumatoid arthritis, Crohn’s Disease, lupus, multiple sclerosis, psoriasis, and ulcerative colitis, have been recognized for a long time, but are still hard to control. There are fairly effective medications, but balancing drugs and dosages to minimize side effects is difficult. Most drug regimens involve suppressing the immune system generally to some degree. You can imagine that this has major drawbacks. Making various life style changes and modifying the environment in some way are almost always a part of learning to live successfully with an autoimmune disorder.

Whenever there is no cure for a condition, alternative medicine practitioners become very active. This can be a good thing; the problem is that it is very hard to sort out the valid recommendations from those which have little or no good research behind them. A number of traditional institutions (like UCLA) have Complementary Medicine departments which can be an ideal source for consultation.

Having a chronic condition is never easy, but joining a support group can be very helpful. Thanks to internet technology, even those with a rare disorder can find a community of others to offer practical suggestions and a listening ear.

Adair Small, Congregation Nurse, nurseocuucorg

Resources:

Just type in the disorder you are searching for and you will find information and further resources.

Centers for Disease Control

National Center for Complementary and Alternative Medicine

National Library of Medicine, MedlinePlus

Adair Small, RN  April 2012

Why don’t infants and children die at a rate of 20 per 100 as they did just over a century ago? One word: Immunizations. Infectious disease is not the only killer, but it was number one for millenia.

So why does an Anti-Vaccine Movement exist? One word: Fear

Vaccination has been dogged by controversy for more than 200 years. There is something about injecting a healthy child with a substance derived from a deadly disease that just seems wrong to parents unless they have a clear understanding of the science and/or are faced with actual experience of the illness. Even during historical epidemics, there was major opposition to this unknown method among families of  ill, dying or dead victims. Experience and education led to the embracing of many vaccines in the last century. This has been so successful, that the rate of the “usual childhood diseases” has dropped so dramatically as to result in the eradication of smallpox worldwide and polio in Europe and the Americas. Unfortunately, the last decades have seen a significant resurgence of whooping cough and measles.

Why is this? When the vast majority are immunized, something called herd immunity occurs. There are so many who are not susceptible that when there is one case, no one else gets it. Not everyone is medically eligible for vaccination and some have religious objections. Herd immunity protects them. But as more people decline immunization, the risk of more widespread disease increases. The most contagious diseases need the highest rate of immunization to prevent an outbreak. Children are experts at contaminating themselves and others! They put everything in their mouths, play close together, share food, drink, etc. And most communicable diseases are contagious before anyone suspects they are ill.

Trying to discuss the importance of vaccination with a non-believer, is extremely difficult. It is like religion and politics. But I will give you a list of specific myths and also make this suggestion. Those who are tempted to avoid vaccination for their children should be asked if they have learned all they can about the diseases that the vaccines can prevent. It is not safe for them to assume that these diseases will remain so rare that they are not a threat.

Only since World War II, have we had antibiotics to fight bacterial infections, and they are no help against viral disease. Diphtheria, whooping cough, tetanus, Haemophilus influenzae type b (Hib), and one type of pneumonia are the bacterial diseases we are most familiar with regarding vaccination. All the rest of the commonly used US vaccinations we have today are for viral illnesses.

I talked about fear at the beginning. Fear leads people to search desperately for reasons and answers. There are risks and side effects to vaccination as there are to everything in life. I actually survived all the usual childhood diseases of my day with no ill effects: measles, mumps, rubella, chickenpox and influenza. But I had a cousin with polio, and a friend hospitalized with measles. Good medicine means a continuous study of how well treatments work and their safety. It takes many different scientific studies to determine accurate results. The field of immunization has proved a great example of misused and misinterpreted science. It has taken many studies over many years to disprove the autism scare; and many still won’t believe the results. There is a principle of human nature called “last bad outcome;” whatever you associate with a bad outcome, becomes the cause of that outcome. Eat dinner out, get sick: you don’t want to eat that or there again. But was it the restaurant or something else? Get a flu shot, get sick a day later: it was the shot. Never mind that the virus in the vial was dead! So when symptoms of autism arise shortly after multiple immunizations, well, that must be the cause.

If you can get one person to reconsider opting out of vaccination, you will have done a lot for public health.

Resources:

Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Paul A. Offit

The Risks of Skipping Kids’ Vaccines By Lisa Farino for MSN Health & Fitness

Common Concerns and Facts About Childhood Immunizations

 1. Overloading the Immune System

Every day, infants and children contact millions of particles of pollen, dust, mold viruses, and bacteria that trigger immune response. The triggers in a vaccine make up a very small part of a child’s environment.

2. Serious Side Effects

Local soreness, low fever, and a day of fussiness are the worst that most babies experience. This is extremely mild compared to the severity and duration of the illnesses being protected against. Even chickenpox can be serious. One in 500 children who get chickenpox need to be hospitalized. Mumps can cause infertility. Measles, mumps, chickenpox, Hib can cause meningitis and encephalitis among other complications.

3. “Since other children are vaccinated, my child doesn’t need to be.”

Some children have allergies or immune disorders and cannot be vaccinated. Some families religious beliefs prohibit vaccines. If the immunization level for a highly contagious disease like measles falls below 90-95%, that disease could rapidly become wide-spread once again. In certain communities where that has happened, children have died in recent years from both measles and whooping cough.

4. Testing of Vaccines is Insufficient

Most vaccines are tested in more children and for a longer time than most medicines parents give their child. The pneumococcal vaccine was tested in 40,000 children.

5. Vaccines contain unsafe material

Immunizations for infants and children no longer have mercury in them and have not for several years. Some preparations have aluminum, but the aluminum babies receive from formula is 10 times more than the amount in their vaccines during the first 6 months of life. Some parents have worried about the fact that serum from cows is used in some vaccines. However, the prions that cause Mad Cow disease are contained in brain tissue, not serum.

6. Vaccines cause Autism

Some people are convinced that the thimerosal, a mercury compound that used to be used as a preservative in all vaccines, caused autism. The autism scare stemmed from a very preliminary study of only 12 case reports in 1998. Millions of dollars later, extensive studies and legal reviews have failed to substantiate any cause and effect relationship between vaccines and autism.

Adapted by Adair Small, RN from: Common concerns About Childhood Vaccinations, prepared for the subscribers of Pharmacist’s Letter / Prescriber’s Letter by Therapeutic Research Center, 2009

Resources:

Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Paul A. Offit

The Risks of Skipping Kids’ Vaccines By Lisa Farino for MSN Health & Fitness

Sally has been ably assisting me with BP screenings for some time and now we have another helper, Alexis Worth, RN. Alexis has been visiting OCUUC for a while now. She is studying to be a nurse practitioner at Cal State Long Beach.

Periodic screening of your blood pressure is one of the easiest and most important steps you can take in order to live long and well! Hypertension is known as the silent killer, because symptoms don’t occur until significant damage is done. What kind of damage? Basically, imagine those microscopic capillaries, with one cell thick walls carrying oxygen and nourishment to all your vital organs. When the pressure within increases, they tend to blow out like a weak tire, leaving permanent damage behind. This occurs anywhere the blood vessels go; particularly vital are the brain, retina of the eye, and the kidney. A stroke may be the most dramatic result of hypertension, but insidious damage occurs continually.

Our blood pressure changes through out each day and across the life span, but it is a myth to think that any significant higher reading is normal as we age. It is the rare individual that does not have some atherosclerosis or hardening of the arteries with age and this does force the heart to beat harder, thus causing both hypertension and predisposing to heart failure. Ideally, our blood pressure should be below 130/80. The systolic (top) reading measures the pressure of blood in the artery in the upper arm when the heart beats. The diastolic (bottom) number is the pressure in between beats, that is when the heart is at rest. In general, the lower the numbers the better! People with true low pressure may have problems with feeling faint when standing up quickly, but otherwise low is good!

Your blood pressure is on a continuous scale and any persistent elevations need to be diagnosed and treated. Losing weight is never simple, but that, along with increased activity is the number one successful treatment for pre or mild hypertension. And if you smoke, here is another reason to quit! Stress is also a culprit. Even if you can’t eliminate stress there are wonderful, fun ways to cope with it. Yoga, Tai Chi, biofeedback, meditation and simple breathing exercises. We now know that diabetes and hypertension are linked, with one increasing the risk of the other and both increasing the risk of heart disease dramatically. No one likes taking pills, so remember that at any level of hypertension, life style changes can enable you to avoid or decrease the need for medication.

We have handouts on many of these topics at either the Caring Table or at the BP Screenings. I am also happy to provide more specific information to anyone! Some great web resources are:

www.webmd.com/hypertension-high-blood-pressure

www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502

Adair Small, Congregation Nurse

nurseocuucorg  (nurseocuucorg)  

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

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, nurseocuucorg  (nurseocuucorg)  
Congregation Nurse

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)  

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.

  Online registration is available by following this link.

Link: Who may donate?

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

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

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

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)  

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)  

The Red Cross bloodmobile is coming to the OCUUC parking lot on Sunday, August 7 from 8:30 a.m. - 2:30 p.m. Summer is a time of acute blood shortage. Most healthy people age 17 and over and weighing at least 110 pounds can donate. You can just walk in or make an appointment online or by contacting Adair Small at nurseocuucorg  (nurseocuucorg)  .

Lessons:

1. Pace yourself! Especially if you are older; you will get more tired than you ever remember!
2. Stop to stretch; lie down on the floor; drink lots of water.
3. Get more packing supplies than you think you will need.
4. Beg and/or pay for help.
5. Expect past injuries to act up and have ace bandages, braces, splints available.
6. Have heating pads and ice packs available; also painkilling drugs.
7. Plan to have meals delivered. Go out for breakfast the next day.
8. Expect things to go wrong. Know who to call BEFORE you move.

We did have many of the above items taken care of, and were thankful we did. What took me by surprise was the physical pain and exhaustion as the end of each day approached. Somehow I still seem to think like I’m 38!

We are making many new friends, but it will be wonderful to see all our OCUUC friends again in June!

Your Congregation Nurse,

Adair Small, nurseocuucorg

As of today (March 21), all FDA-approved products are sold out. The brand names are ThyroSafe (tablet: can back order from KI4U.com, 830-672-8734); and ThyroShield (liquid) and Iosat (tablet): both can be ordered when back in stock from Nukepills.com, 866-283-3986. A compounding pharmacist can make tablets for you and I can provide you with more specific information if you don’t want to wait till the ready-made products are available again. There are many general KI supplements available now, but you have to have the right dose and there are side effects! No one should be dosing up unless the health department is advising you to do so. And remember, this will only protect the thyroid, not other organs that may be exposed to radiation; but it is one protective step you can take.

This is good time to review your own emergency preparation. If you have a stockpile of water, food, first aid materials, batteries, radio, flashlight – hooray for you! But please check to see if they are out of date or still operative.

Adair Small, Congregation Nurse, nurseocuucorg

Colorectal cancer is more common in men than women, and men are actually better about getting screened for this disease than women are, but women should not be complacent as they still are at significant risk, right behind breast and lung cancer.

The biggest risk factor is age, as half of all people will eventually develop an adenomatous polyp. These are what can eventually become cancerous. Other major risk factors include family history or inflammatory bowel disease. Lesser risks include smoking, obesity, diabetes, alcohol use, diets high in red or processed meats. It is important to realize that 75% of cancer occurs without any of the major risk factors!

The best way to prevent colorectal cancer is by screening to identify and remove polyps. Age 50 is the recommended start date except for certain high risk individuals who start earlier. The gold standard is the colonoscopy and it is paid for by most insurance and by Medicare. I have a chart I would be happy to provide comparing the various screening tests.

The worst part about the screening is preparing for it as your colon has to be completely flushed out by drinking a huge quantity of not the tastiest liquid in the world. Whether you have a virtual colonoscopy by CT scan or a visual one with a colonoscope, the prep is the same. And, if something is found on any screening other than a full visual colonoscopy, then you need to have one anyway for polyp removal! You are sedated for the colonoscopy, as little or as much as you like. I watched all of mine under very light sedation and even saw my appendix from the inside! I was able to ask questions all the way and found that part of the experience fascinating. And solid food tastes so good when it’s all over…

CPR Class March 19, 1 – 4 pm! One space left, contact me to enroll.

Adair Small
nurseocuucorg

This opportunity comes from our partnership with Hoag. Ginny Kivinski, Hoag Health Ministry Nurse will once again be our teacher; this time with the new 2011 techniques. There is a $5 fee for your American Red Cross certification card. Contact Adair Small at nurseocuucorg  (nurseocuucorg)   to register.

Heart Attack Warning Signs: Everyone knows about a crushing pain or pressure in the chest, but it is important to note that pain may be felt more in the shoulder, arm, jaw, upper back, and especially in women, may be felt predominantly in the upper abdomen. Also rather than pain, it may be experienced as a sense of fullness, pressure or squeezing. The sensation lasts more than 2 minutes and may come and go. Other accompanying signs may be sweating, nausea, vomiting, shortness of breath, paleness, weakness, and/or anxiety. If typical symptoms last for 2 minutes or more, emergency steps should be taken by calling 911. It is much better to act and have it be a false alarm, than to wait and perhaps experience full cardiac arrest. NEVER drive yourself to a hospital. This could result in the deaths of many if you have a cardiac arrest while driving.

Stroke Warning Signs: Now often referred to as a “brain attack”, strokes cause the death of a little or a lot of brain tissue. The faster a blood clot in the brain can be dissolved the better off you are so it is just as important to get immediate treatment as it is with a heart attack. Call 911 for: sudden weakness or numbness of the face, arm, or leg on one side; sudden visual changes; difficulty speaking; sudden severe headache; sudden dizziness, loss of balance especially with any of the other symptoms. A test for yourself in front of a mirror, or for you to use with others is: 1. Raise both arms in the air (are they equal in height?) 2. Smile (is it symmetrical?) 3. Say a short sentence (are words slurred or mixed up?)

Prevention: Keep your blood pressure normal, exercise, don’t smoke, eat a low saturated fat diet; don’t gain weight!

I was recently reminded of this when a nurse in the Augusta, GA church emailed to ask if I had ever done a healing service. Bells immediately started ringing! I sent off a lot of information to her and then realized I needed to share this option with you. A UU Healing Service can help anyone with an illness or situation where they feel the support of others will make them feel better. It can involve prayer, meditation, music, shared thoughts, laying on of hands, use of oils, aromatherapy; whatever works for you. At the one I participated in here, Beth played the piano, Peter Greenfield (former member and licensed hypnotist) did guided imagery, Karen Stoyanoff led a meditation and several people spoke. Friends from the congregation and outside the church attended. We held it in Gillan 3, after the service. The intimacy of a small space is very helpful.

Please remember that this is available, not just for yourself, but be alert for others who might be helped. When we a facing a difficult period in our health, this is generally not the first thing we think of.

2010 is harder for more people because of the economic situation. 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 nostalgia. Larry James has some interesting things to say about nostalgia. He says, “Nostalgia is a disorder of the imagination, where the mind is dwelling upon past memories and loses interest in the present situation: a mood disorder. It is a longing for pleasures, experiences, or events belonging to the past.” Holidays are a classic trigger. While nostalgia is not depression, it can take you there. You have to be able to recognize that the past is irrevocable. The way through this is to look for the joy in the present moment and be with people who lift you up rather than drag you down.

And forget about expectations. Look for a way to make the holiday one you can enjoy. If the family wants things to be a certain way, and you find the task is just too stressful, make it their responsibility.

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 on the Caring Table, or I would be happy to send them to you. nurseocuucorg  (nurseocuucorg)  

There are many losses, of course. We tend to think of death, but we grieve the losses involved in divorce, separations of all kinds, moving, unemployment, a difficult medical diagnosis; the list goes on and on.

Loss is not something we just “get over”. We are changed in ways from simple to profound. Our pocket is picked and we find new ways to travel more carefully. A job is lost and we discover new economies we can practice; we may even “reinvent” ourselves and find a more satisfying way to live. But the past stays with us. Good or bad, we have learned from who we were before, and can come out stronger on the other side.

Those of us who have experienced the death of someone very close usually find this the most difficult challenge. Unitarian Universalists often think that some more traditional religions with a belief in an actual heaven make it easier for those in mourning, but this is not so. For one thing, it is never comforting to be told that it is God’s will when you are in the throes of grief, and for another, the loss is still present. This person, so dear to you, so cherished, is absolutely gone from your life. No more shared jokes, stories, adventures; no reminiscences of events past.

So how do we deal with grief? Mourning is helpful. Spending time finding your own way to memorialize the dead lets us be constructive and creative after a time of destruction. Make a garden, plant a tree; no space? How about a terrarium or a bonzai? Artistic? Anything you make while thinking of your loss has a special place. Not artistic? Find a picture that reminds you of happy times together and hang where you see it often. It is okay if this makes you feel sad; you need to feel sad when you lose someone you love. That’s what gradually enables you to feel better.

It can take a long time to embrace your loss, but one day you will realize that qualities of that person are living on in you; that you have become deeper and richer and that you can spread all that wealth and wisdom around.

Adair Small, Congregation Nurse
nurseocuucorg  (nurseocuucorg)  

If you or someone you know needs mental health information or a trained person to talk to, Orange County has a new Warmline organized by NAMI, the National Alliance on Mental Illness. Call 877-910-WARM (877-910-9276) daily from 8 a.m. until 12 midnight; also LiveChat is available at www.namioc.org.

OCUUC’s annual free flu vaccine clinic will be on Sunday, November 14. This year’s vaccine contains two strains of the usual seasonal influenza plus H1N1. All virus is inactivated. The vaccine is recommended for everyone over 6 months of age. We will not be giving it to infants at OCUUC. I won’t know what our lower age limit is till I know the exact vaccine Hoag is providing.

For those of you at high risk, I recommend getting vaccinated in October. If you are on Medicare it is free at most pharmacies. Call yours to check when they are giving it. If you have insurance, expect that you will have to pay for a visit, although the vaccine should be covered. Get it if you have to go the doctor anyway. If you want to avoid a copay or visit fee, the shot is free at a number of community clinics and the Orange County Health Care Agency. Find information at:(800) 564-8448 or http://www.ochealthinfo.com/public/flu

Measles has been in the news recently. Its prevalence is increasing in Europe, Asia, and Africa. Travelers are being warned to get immunized before a trip. California has had a number of cases this year, first in northern California, but lately in San Diego. Measles is one of the most highly contagious infectious diseases. It is spread by contact with an infected person and through coughing and sneezing. Measles virus can remain active and contagious for up to 2 hours in the air or on surfaces.

People with measles usually have a rash, high fever, cough, runny nose, and red, watery eyes. Some people who become sick with measles also get an ear infection, diarrhea, or a serious lung infection, such as pneumonia. Many times people with measles are hospitalized. Although severe cases are rare, measles can become severe enough to cause swelling of the brain (encephalitis) and even death. Measles can cause especially severe disease in infants and in people who have weakened immune systems. I want you to have this information so you can be alert to the symptoms. Measles has been so rare that people don’t think of it right away. The all over body rash and high fever are the big tip-offs.

Here are handy links for vaccine schedules.
http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

Whooping Cough (Pertussis) is still making the rounds. See my column from July 21 on this. Once again, the Health Care Agency can provide vaccine if you are not insured.

Keep Well!
Adair Small, nurseocuucorg

Clemson University food scientist Paul Dawson believes in a zero tolerance policy and states bacteria like salmonella can survive on a dry surface for up to 4 weeks and be immediately transferred to food. The answer may lie more in the location of the drop. Kitchen and bathroom floors are the most at risk of harboring disease-causing viruses or bacteria. I take some issue with Dr. Harley Rotbart at the University of Colorado who believes a bagel dropped on pavement is OK because there are fewer disease causing germs there. All I have to do is take a walk in my neighborhood and see the local dogs’ calling cards to nix that. They can carry pinworms and cats carry toxoplasmosis, a cause of birth defects if contracted during pregnancy.

My personal policy: Never eat something wet that is dropped. Think twice about anything dropped outdoors. You know when you last scrubbed your kitchen floor and with what and if you have been dripping raw meat or poultry juices around. Act accordingly. People with compromised immune systems, that includes the very young and old, should avoid putting themselves at any risk.

Exciting new program, Healthy Living with Chronic Conditions. A series of free interactive classes led by trained individuals who have ongoing health conditions themselves. Topics include healthier eating, relaxation techniques, exercise and fitness tips, appropriate use of medications, strategies for managing fatigue, new ways of dealing with anger and depression, and how to communicate more effectively with your family physician. Emphasis on peer support, goal driven planning, shared experiences, helping each other to solve problems encountered in creating and carrying out your own program developed to improve your quality of life. Contact Ericka Danczak, 714-836-3331 or ErickaDanczakoccrocgovcom for more information. Classes start soon in Costa Mesa, Irvine, Mission Viejo, Brea.

Vitamin D: Why do I say versus the sun? Well, we know that our skin can make all the vitamin D it needs if exposed constantly to the sun. Unfortunately, the sun will also encourage skin cancer and premature aging unless we load up with sunscreen and that prevents the vitamin D from forming… Thus, it is generally recommended that adults take a supplement of up to 2000 IU/day. Infants and children need 400 IU/day. Don’t use a children’s liquid that is 400 IU/drop, as it is too easy to give more and cause an overdose. Because the body stores vitamin D, you can take a once a week (14,000 IU) or once a month (50,000 IU) dose of D3 (cholecalciferol) which is more stable and better absorbed. And diet? Except for babies on formula or children drinking 1 quart of fortified milk/day, vitamin D is not available sufficiently from diet. If a breast-feeding mom is taking 2000 IU/day, her baby will get sufficient vitamin D from her milk.

And while we are talking about the sun, please remember the cardinal rules in this climate: Slop, Slip, and Slap! Slop on the sunscreen, Slip on a shirt, Slap on a hat!! Pick up some free travel packs of sunscreen at the Caring Table.

Insect Repellant Latest News: First, put sunscreen on first so it can bond with the skin. Don’t use a combination product. Sunscreens need to be slathered on and repellants should be used sparingly.

• DEET is safe for all over 2 months of age at a 30% concentration. 10% lasts a shorter time, but still for about 3 hours.
• Picaridin (Natrapel) 20% works up to 8 hours for mosquitoes and ticks. Kids should only use 5-10% and only if over 6 months old.
• Lemon eucalyptus oil works up to 6 hours, but has not been tested on children under 3 years.
• Soybean oil (Bite Blocker) works for 2-4 hours and is safe for all.

There is a handout at the Caring Table on this subject!

Latest Research on Dementia: There was a recent International Conference on Alzheimer’s Disease and the findings will be presented and discussed by Jim McAleer of the Alzheimer’s Association Orange County Chapter, 17771 Cowan, Suite 200, Irvine 92614, on Tuesday, August 10 from 6 – 8 pm. There is no cost to attend but seating is limited. Light refreshments provided. RSVP to rsvpalzocorg  (rsvpalzocorg)   or 949.757.3769 by August 6.

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.

A typical case of pertussis in children and adults starts with a cough and runny nose for one-to-two weeks, followed by weeks to months of rapid coughing fits that sometimes end with a whooping sound. Fever is rare. 122 cases have been reported in Orange County this year compared to 10 last year. Two infants have died. Children are usually infected by adults.

There will be handouts available at the Caring Table on Sunday on this subject.

Adair Small, nurseocuucorg  (nurseocuucorg)  

More information can be found by clicking on the flyer.

The retina lines your eye and you can’t see without it. The most serious problem occurs if the retina detaches from the eye. If treated immediately, most often by laser, vision can be saved, although it will not be the same. Warning symptoms include those involved in a retinal tear: multiple floaters, flashes of light, blurry vision and, if the tear progresses, an area of shadow, followed by seeing a darker curtain or veil come down in your eye. This is a medical emergency and you should contact an ophthalmologist immediately. Your primary care caregiver or optometrist can refer you. Risk factors include having a positive family history, being very near-sighted, a blow to the eye, head, or face, cataract surgery and aging.

Flashes are caused when the gel-like filling of the eye (the vitreous) pulls on the retina. This happens most often to near-sighted people and as the vitreous shrinks with age. Floaters are debris that accumulates in the vitreous from embryonic days onward. They can look like dark specks, clouds, threads or spider webs. My new floater has changed a lot in a week and now is a black dot in an amorphous cloud and significantly less noticeable. It was caused by a small retinal hemorrhage. This little blood clot may be with me for the rest of my life, but it doesn’t interfere with my vision, although I do keep trying to wave it away with my hand! Retinal hemorrhages are often seen if you have high blood pressure or diabetes, or – guess what? – are getting older. This is the summer of my 65^th birthday and I think someone is saying, “Welcome to the Club!”

Adair Small, Congregation Nurse

nurseocuucorg  (nurseocuucorg)