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.
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
nurse
ocuuc
org
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)
Summer Blood Drive
We Need Your Blood!
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 Learned from Moving
There is no doubt that moving from a tiny apartment to a house one mile away is harder at age 66, than moving two households across country was at age 38!! Our Chicago move this past month was harder on body, mind and spirit than I had expected, but we do love our 85 year old house with its 77 trees.
Lessons:
- Pace yourself! Especially if you are older; you will get more tired than you ever remember!
- Stop to stretch; lie down on the floor; drink lots of water.
- Get more packing supplies than you think you will need.
- Beg and/or pay for help.
- Expect past injuries to act up and have ace bandages, braces, splints available.
- Have heating pads and ice packs available; also painkilling drugs.
- Plan to have meals delivered. Go out for breakfast the next day.
- 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
Radiation Exposure Preparedness?
There has been plenty in the news about radiation exposure lately. With San Onofre just down the freeway, what should we be doing to prepare for possible radiation leaks in the event of earthquake or other disaster? Standard emergency preparedness will go a long way; supplies of water, canned goods, etc. In addition, if you have children, it is especially important to have potassium iodine or potassium iodate on hand. Potassium iodine (KI) blocks accumulation of radioactive iodine in the thyroid. This helps prevent thyroid cancer. Because a child’s gland is rapidly growing, it is much more susceptible to damage and risk of later cancer development than an adult gland. It won’t hurt to have KI available for adults as well, but adults only need it when there is much greater radiation exposure.
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
Calling All Colons!
I just passed my every ten year colon cancer screening and promised my gastroenterologist to spread the word about colorectal cancer. March is the month to promote education about the third most commonly diagnosed cancer and third leading cause of cancer death in both men and women in the US.
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
CPR Certification at OCUUC – Saturday, March 19
CPR certification at OCUUC will be held Saturday, March 19 from 1-4 p.m. One spot left!
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.
February is Heart Month
Heart Month: February is traditionally about all things heart, and that goes for health as well. This is a good time to remind ourselves about warning signs for heart attack and stroke. Caring friends, family or bystanders can often be especially helpful because denial often plays a significant role in making these events worse.
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!
What Is A Healing Service?
What is a Healing Service? Part of my Parish Nurse training involved learning how to organize a healing service for members of the congregation who desire it. This is fairly common in more traditional denominations, and Unitarian Universalists don’t have to be shut out of this opportunity. We did such a service here shortly after I became your congregation nurse, but in the intervening time I actually forgot about it!
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.
