The Different Types of Nurses

Most of us think we have a pretty clear idea of what nurses do. In a doctor’s office, they are usually the ones who take your vitals and medical history before you see your doctor, and they may even administer medication.

In a hospital, nursing home, or hospice setting, they usually take care of all the things that doctors don’t have time for, like taking patient temperatures, administering medication, and changing bed pans.

Nurses do all of these things, but they also do much more. Also, there are different levels of nursing, and each level has different responsibilities.

The Levels of Nursing

In the United States there are generally three different types of nurses: non-degreed, degreed, and those with advanced degrees.

Non-Degreed

• Non-degreed nurses are professionals who have not completed a college degree program. These nurses include Certified Nurse’s Aides (CNAs) and Licensed Practical Nurses or Licensed Vocational Nurses (LPNs or LVNs). While these types of nurses don’t have degrees, they do have to complete intensive training course and pass either certification or licensing exams to get their titles. CNAs usually have to complete an eight-week program, and LPNs usually have to complete a year-long program.

Degreed

•Degreed nurses have either associates or bachelor’s degrees.

•Degreed nurses usually become Registered Nurses (RNs) and, like their non-degreed counterparts, have to take a certification or licensing exam once they complete their program.

Whether the RN has an associate’s degree or a bachelor’s degree, the work tends to be similar. In addition to many of the responsibilities of the CNA and LPN, the RN also has the ability to choose a specialty, such as pediatrics or geriatrics. RNs might also have a greater range of responsibility when it comes to administering patient care.

One big difference between the bachelor’s and associate’s degree is that RNs with bachelor’s degrees tend to have more career opportunities; which is why some RNs start out with associate’s degrees from one institution, and then go on to another school to complete their bachelor's. Or, they start their careers and then finish up their bachelor's through an accelerated online program, like the one offered at Gwynedd Mercy, a great nursing school in PA.

Those with Advanced Degrees

Nurses with advanced degree have completed a bachelor’s program, and then gone on to complete a master’s or PhD program in a specialty field. These types of nurses can include Nurse Practitioners (NP), Certified Nurse Midwives (CNMs), and Nurse Epidemiologists.

Nurses with advanced degrees can have a variety of jobs, depending on their area of specialty. For example:

• Nurse Practitioners perform many of the same functions as medical doctors including ordering screening tests, diagnosing patients, and prescribing medication for minor illnesses. You can often find nurse practitioners at urgent care centers, or those medical clinics you find in grocery stores and drug stores. They might also work in rural communities, and other areas where medical doctors are scarce – such as a public health clinic in a mountain town. Nurse Practitioners usually work under the supervision of a medical doctor, although the doctor might not be on-site.

• Certified Nurse Midwives perform many of the same functions as obstetricians and gynecologists in that they provide care throughout all stages of pregnancy, including routine gynecological care during the pre-pregnancy stage, prenatal care during pregnancy, performing the delivery, and caring for the mother and child during the postpartum period. Like Nurse Practitioners, they can often be found in areas where the services of a medical doctor might not be available. They are also an alternative for women who prefer the services of a midwife over a hospital birth.

• Nurse Epidemiologists are a combination of nurses and research scientists. They perform regular nursing duties but they also conduct investigations, review patients for infection risks, and help develop protocols for preventing infection. Nurse epidemiologists can usually be found in hospitals and public health centers. They can also be found in the field, during disease outbreaks, providing care to the infected and working to prevent the spread of the disease. For example, Kaci Hickox, who was detained in New York in November 2014, was a Nurse Epidemiologist in Sierra Leone during the Ebola crisis.

These are just a few of the jobs that nurses can do with advanced degrees.

Conclusion

Nursing is so much more than just bedpans and thermometers. You can find nurses with advanced degrees in almost every aspect of the medical field, from the research and development in the private and academic sector, to community education.

This is a blog post by Nancy Evans.

Patient Retention: Tips to Improving Communication and Patient Experience

As physicians, you’re already equipped with the ability to communicate with your patients on a regular basis. Be that as it may, communications with doctors and patients today are not as they used to be in times past.

Why? Because as the need for medical attention increases around the country, the amount of patients you see in a given day can become overwhelming. As a result, the first things to suffer are communication and quality customer service.

As we know, communication and involvement with patients is what makes them comfortable – it’s what keeps them coming back. Statistics reported by Solution Reach suggest that doctors lose about 50% of their patients in a five year period.

So how do you lower those percentages in your practice? There are ways in which you can see all of your patients while still being an effective communicator and providing the best customer service. The key is to learn smarter ways to make use of your time. It requires the need to refine basic communication skills and make necessary adjustments that will work for you and your patient.

Make Necessary Adjustments

The average patient’s expectations have certainly changed. Therefore, having basic communication skills may not be enough to ensure patient retention. You see, the average patient wants to be a part of the health care process. They no longer want to be instructed on what to do. Patients are now more informed than ever and will want logic, reasoning, and proof as it pertains to their health and the decisions you make as a medical professional. So how do you make adjustments based on the various changes in patient expectation?

Be Reliable – Reliability is a major component of trust. An unreliable doctor essentially leads to a dissatisfied patient. So if you’ve told a patient that you will call them within a few days to brief them on their lab results, it is necessary that you carry that out. This lets patients know they can rely on you.

Be Available – Patients want to know that whenever they’re in need they can count on their doctor to be there. Being available is not always easy, but finding alternative methods for displaying your presence or concern for their needs is a must.

Quick Tip: Sometimes being physically there for your patients whenever they call is impossible. However, by utilizing technology to your advantage, you can show your patients you care whether they’re in your office or at home. Using platforms such as social media or patient portals can be a great way to do this. It allows patients to communicate with you 24/7 and view pertinent information about their health.

Provide Quality Visits – When a patient comes in to see you, they want the ultimate experience. A customer should be greeted with comfort every time they come to see you. Family Management Practice suggests that you don’t skip the pleasantries. Greet your patients with a smile, show concern, be an involved listener, and most importantly don’t rush them. The key to keeping patients satisfied is making them feel as if their needs were met and that they’re not just another dollar sign.

Quick Tip: A survey or evaluation provided to patients is a great way to measure their experience. Having new patients complete these surveys can keep you and your staff aware of all the areas in which you can improve your customer service and patient experience.

Follow-up/Stay Involved – Even after your patients have left the office staying involved as their doctor is imperative to opening up the lines of communication, building trust, and enhancing their experience as your patient. Find ways to follow up and stay involved with your patients. Whether you send out appointment reminders, send out notices of concern when you haven’t seen them in a while, and even sending out birthday emails or cards can show that you care about them as individuals.

Yes, it can be challenging at times to stay involved with each and every one of your patients, but it is absolutely necessary to ensure they prioritize their health and keep coming to you for treatment. To prevent losing your patients it is important to communicate often and provide them with the best experience possible both in and out of the doctor’s office.

This is a blog post by Nancy Evans.

Pregnancy In The 21st Century: A Non-Invasive Alternative to Amniocentesis

We're in an age ruled by science and technology, and your pregnancy is definitely going to be affected at some point in the near future - or currently - by the breakthroughs in modern medicine. One of the most popular trends in pregnancy-related science has been that of the noninvasive genetic testing. These prenatal DNA tests are able to test for multiple chromosomal abnormalities such as trisomy 21 (Down Syndrome) or trisomy 18 (Edward Syndrome).

These types of tests are most commonly performed on expectant mothers that are deemed as increased risk pregnancies, such as a mother that is over 35, or has had a previous family history of genetic birth defects. In this case, it wasn't at all uncommon for a physician to recommend an amniocentesis in order to test the baby for common genetic abnormalities. Amniocentesis is still used, but now it is just one of multiple options that your healthcare provider has in order to test for chromosomal abnormalities.

Amniocentesis is an invasive procedure, but until recently it was the only way to test for certain chromosome abnormalities, genetic disorders, or neural tube defects. Trisomy 21 (Down Syndrome) is the most common of these abnormalities but the test can also uncover additional chromosomal abnormalities such as those found in trisomy 18 (Edward Syndrome) or trisomy 13 (Patau Syndrome). Besides the uncomfortable nature of the procedure, another drawback with amniocentesis is that the family would typically have to wait until the fifteenth week of the pregnancy, and it isn’t unheard of to wait until twenty weeks to be able to do a safe amniocentesis. The obvious benefit to the prenatal DNA testing is both in speed (from lab to your healthcare provider's office in 5 days) and the fact that the tests are simple and more accessible than ever.

With an obvious need for noninvasive prenatal tests, doctors have begun using cell free DNA tests that can detect the some of the same sort of genetic issues as a traditional amniocentesis. Bioscience companies like Sequenom are making this sort of testing easily accessible by medical professionals who prefer a test without the risk of prenatal invasive procedures. It seems the problem in past years wasn't the procedural awareness - DNA sequencing and genetic testing has been around for more than a decade - but dealing with off-site laboratories that made this sort of testing accessible.

A simple prick from a needle and a small amount of blood now give lab technicians all they need in order to test for genetic mutation and deformities such as trisomy 21 (Down Syndrome), trisomy 18 (Edward syndrome) and trisomy 13 (Pateau Syndrome). In fact, the testing has success rates of 99-percent at detecting trisomy 21 pregnancies, 98-percent with trisomy 18, and about 65-percent with trisomy 13. With trisomy 13 tests, there is often a need for an amniocentesis or chronic villus sampling (CVS) with positive test results.

The test itself often relies on a simple blood test taken from the mother. A small amount of blood is drawn and sent to a laboratory and your healthcare provider will receive the results within 5 days from the date the laboratory received the initial sample.

The future is bright for early detection of all types of birth defects. These simple noninvasive procedures are set to revolutionize the way doctors test for complication in high risk pregnancies. In many cases, knowing about defects before the birth of the child helps the parents to prepare for the specific set of challenges they'll face after the baby is born.


This is a blog post by Nancy Evans.

Effects of Aging on the Skin

Human skin is amazing. Not only does it keep all of your organs inside your body, it performs other functions including:

•  Protects you from ultraviolet radiation and environmental irritants;

•  Prevents the moisture inside your body from escaping;

•  Helps regulate your body temperature;

•  Eliminates wastes; and,

•  Acts as the first line of defense against diseases and infections.

Because it performs so many functions, and is so exposed, your skin is often the first to show early signs of aging.

How Aging Affects Your Skin

Your skin is made up of three distinct layers, all of which help it perform its many functions.

•  The epidermis is the outer layer. It is made up of cells that overlap and stack on top of each other like tiny plates of water. When the epidermis is healthy and intact, it is water-tight and also prevents bacteria, viruses and other foreign substances from getting inside your body. The epidermis also contains melanin which contributes to your skin color and filters out UV radiation.

•  The dermis is the middle layer. It is the thickest layer and is made up of collagen, elastin, and fibrillin, which give the skin its strength and shape. It contains several structures like nerve endings for sensation, sweat to help regulate body temperature, blood vessels to feed the skin nutrients and regulate body temperature, and hair follicles. The dermis also contains glands that release an oily substance called ceramides, which moisturize the epidermis, and help form the barrier against water and foreign substances.

•  The hypodermis is the bottommost layer. It contains blood vessels to feed the skin and regulate temperature, fat cells for insulation, and connective tissue to anchor the skin to your body.

As you age, the layers of your skin stop functioning as well as they should. For example, the glands in the dermis could stop making enough ceramides, causing the epidermis to dry and crack.

Several factors can determine how quickly your skin ages, including as lifestyle, skin tone, ethnicity, and heredity. However, one major factor is UV radiation.

Although the skin is designed to be a UV filter, it is not immune to the effects UV radiation. Long-term exposure to UV radiation can damage all of the cells and structures in the skin, such as melanin cells, collagen cells, and even the glands that make ceramides. In the best case scenario, the damage prevents the cells and structures from functioning properly, leading to wrinkles, cracks, dark spots, and other signs of aging. In the worst case scenario, it can lead to cancer.

Protecting Your Skin

The best way to protect your skin is to avoid direct sunlight as much as possible, and wear sunscreen whenever you do go out into the sun. Stay hydrated, so that your sweat and oil glands have enough water to do their jobs, and moisturize your skin often.

If your skin is already showing signs of aging you could try one or more of the following:

•  Anti-aging cleansers, moisturizers, and serums that contain products that stimulate collagen production, such as peptides and Retin-A;

•  Phytoceramides. Phytoceramides are plant-based versions of the ceramides your skin naturally produces. Used topically, phytoceramides are supposed to hydrate the skin, and repair wrinkles and other signs of aging. Phytoceramides are available in the US as a dietary supplement, but they might not be available in all areas. You might have to talk to a dermatologist or skin specialist about where to buy phytoceramides.

•  Skin fillers, such as natural collagen. Skin fillers help fill in the creases and lines caused by collagen loss in the skin, and some of them also help stimulate your natural collagen production.

•  Microdermabrasion or skin peels. Both skin peels and microdermabrasion both remove some of the cells in the epidermis which immediately reduces the appearance of fine lines and wrinkles, and stimulates collagen production to help keep wrinkles at bay.

•  Laser skin resurfacing. Laser skin resurfacing uses pulses of light to plump up the skin and fill in wrinkles, lines, and ridges, and stimulate collagen production.

•  Your doctor or dermatologist. You should always consult your physician if you feel that your skin is aging too quickly, of if you are concerned that some dark spots and age marks are the sign of a more serious issue – especially if you have a family history of skin cancer.

This is a blog post by Nancy Evans.

School Shootings: Why Social Media Should be Monitored

Above: Washington school shooter's Twitter post days before the shooting. 

In the wake of the latest school shooting in the state of Washington, much attention has been paid to the shooter’s (Jaylen Fryberg’s) Twitter account. In fact, after a school shooting, social media sites are typically the first place that people go to learn about the assailant. While this is understandable, one has to wonder if any of these school shootings could be eliminated if someone had paid more attention to these shooters’ social media sites before the shootings.

Possible interventions ahead of time can include psychological counseling (outside and/or inside school) to teach adaptive and prosocial coping mechanisms to deal with stress and conflict, psychotropic medication consultation, more careful and close monitoring of the person’s emotional state by family and health care providers, and removal of firearms access by family members and others known to be close to the individual. Media accounts state that the firearm used by Fryberg belonged to his father.

Taking a look at Fryberg’s Twitter account, once can see that there is an incredible disconnect between how he portrayed himself online compared to how others appear to have viewed him in person. A student at his school, Alex Pietsch has been quoted as saying:

"It's weird to think about, because you see him and he is such a happy person." You never really see him be so angry and so upset. ...”

Yet on Twitter, here are a few of Fryberg’s comments made since June 2014, which show a disturbing trend:

On June 17, Fryberg  seems upset about something (“This Is a F***ing joke”), perhaps after doing some yardwork for a house he says “we” are not going to purchase. Or perhaps it was about something else.

The July 17th comment notwithstanding, it all seemed to go downhill on June 18 when Fryberg appeared to be having an argument with someone, suggestive of a relationship breakup. In fact, media reports state that he had broken up with a girlfriend recently. Posts that day include a long drawn out “F*** YOUUUUU!!,” and “You’re starting to piss me off” followed by an emoticon blowing out steam. Those comments were followed by:

“YOUR SO F****ING BRAVE!! JUST REMEMBER THIS IS F***ING IT!! NO MORE AFTER THIS” along with three angry emoticons.

The next day, Fryberg is still angry with the following posts: “WTF EVER!!” and a long drawn out F word in all caps with angry and sad emoticons and many exclamation points. The most ominous and threatening comment that day was this one:

“I Know Your Weaknesses And What Breaks You... And When That **** Happens... Just Know There's No Coming Back (emphasis mine)” followed by a sad face.

He then said he was going to a hospital, but no reason is given. Only one person asked him why.

On June 20th, Fryberg seems to express regret coupled with anger when he wrote,

“What The F*** Did I Just Do…F*** it.!! Might As well Die Now (emphasis mine).” 

Each of these sentences was followed by a series of sad faces, broken hearts, and steam coming out of an emoticon’s nose. Prior to that posting, Fryberg wrote numerous comments expressing infatuation with someone he appeared to be dating. After the break-up, he wrote posts that appear to reflect him missing being with someone romantically (presumably his girlfriend).

Only July 3rd, Fryberg’s post became more threatening: “It’s about to go down” followed by an emoticon of wide-eyes fear.

Fast forward to August 20th, in what could be considered a foreshadowing of events to come he wrote:

“Your gonna piss me off…And then some s****’s gonna go down and I don’t think you’ll like it…Your not gonna like what happens next!!" (emphasis mine) ” followed by emoticons with steam coming out of their nose.

Some of his posts also displayed an element of possessiveness, presumably over the girl he was dating. He then wrote on the same day, “I hate that I can’t live without you. “This comment was followed by emoticons of rage, sadness, disgust, worry, and blank expressions. That day, he retweeted a comment that the first heartbreak is “unforgettable.”

On August 23rd, Fryberg is angry again, with comments such as, “Sick of this S***!!” and “Oh My God This Is So F****ing Stupid!!” followed by angry emoticons.

On September 16, Fryberg wrote “Fml” which means F*** my life. He appeared to be getting more and more despondent.

On September 19, Fryberg gets into an online dispute with someone he was apparently pretty close to about his girlfriend. In one of the posts that day, he writes:

“Dude. She tells me everything. And now. I f***ing HATE you! Your no longer my "Brother!” He appears to feel betrayed. He then wrote, “Night f***ing RUINED.” 

On September 20th, Fryberg writes: “I Hate Hearin S*** Like That.. It Just Continues To F*** Me Up. I Just Feel Stupid Now.. Exactly What I Thought Was Gonna Happen Happened..”

He followed this up with two more posts that day: 1)"I HATE THIS S***” and 2) “I'm tired of this s***. I'm sooo f***ing done!!! (emphasis mine)” each containing emoticons of frustration.

On October 13, Fryberg retweeted a post saying “I miss you, and it's killing me” followed by an emoticon of anguish and a long drawn out “F*** you” with an emoticon of anger.

On October 21, Fryberg appears to snap when he writes,

“Alright. You f***in got me.... That broke me. It breaks me... It actually does...(emphasis mine) I know it seems like I'm sweating it off... But I'm not.. And I never will be able to...” 

Consistent with this timeline, media reports state that his demeanor changed markedly and that he refused to talk about it. He then wrote, “I should have listened.... You were right... The whole time you were right..” 

On October 23, the day before the shooting, Fryberg wrote, “It won’t last…it’ll never last…”

These postings are not consistent with someone who was a happy person over the past few months. In fact, he clearly was despondent, angry, and sad. Someone in this type emotional state, especially a minor, should not have access to firearms. If a family member of a child expressing such emotional distress owns firearms, the firearms need to be locked away with no way that the child can access the key.

If children under 18 are permitted to have a social media account, it needs to be monitored closely by the parent. By monitoring, this does not mean to allow the child access to a private account with the parent peeking over the child’s shoulder occasionally but it is what too many people do. Monitoring means that you are granted access to the child’s account by being part of their social media network. It should be made as a condition to permit social media access. You can promise not to post to the child’s account so as not to embarrass them, but they key is that you are monitoring it and interfering if you see signs of cyber-bullying, threatening comments (against or from the child), and/or signs of significant emotional distress. If the child does not agree to grant you access, then no social media account.

For counselors, it is definitely worthwhile to search for your client/patient’s social media profile so that timely interventions can be made. As this case shows, children (and adults) will sometimes present differently on the outside than they will when behind the safety of a computer (or smartphone) and a keyboard. It is important to note that it is not unethical to view these social media accounts as long as you are viewing publicly available information. You also do not need to have a patient sign a consent form to view publicly available information. Many children do not put any sort of privacy setting in place and allow the entire contents of their social page viewable to the public.

What a counselor should not do, however, is hack into someone’s private (non-public) social media account. If the account is locked to private, you are out of luck as a counselor but this is where the parent or guardian comes in as a safeguard. While we may not be able to stop all school shootings by checking social media websites, more regular social media monitoring is a potentially helpful way to prevent some of these shootings in the future. This should be integrated into a regular part of clinical practice for counselors in the future.

Here's What You Need to Know About Mesothelioma

Asbestos: The Cause of Mesothelioma

You can’t watch an episode of anything on Court TV without at least one commercial about mesothelioma.

If you or someone you love has been diagnosed with the condition, and you want more information about what to do next, read on:

Asbestos: The Gateway to Mesothelioma

By now, everyone knows that asbestos is linked to mesothelioma. The only real question is why did we use it for so long. For that matter, why are we still using it? Unfortunately, the cynical answer and the true answer are one and the same. Asbestos is a tremendously useful mineral that has all sorts of industrial implications. It is still cheaper for companies to lawyer up, and fight the legal battles, than to stop using asbestos altogether.

But how much do we know, and how long have we known it? In 1970, an asbestos company’s internal memo detailed the company’s knowledge of the level of asbestos exposure that would result in mesothelioma. They had conducted intense animal testing to show how asbestos effected humans. They even learned which types of asbestos were more harmful. They continued to use asbestos.

Yet another company revealed in a letter to the Gypsum Association Safety Committee, their intention to place the blame on the employees despite the fact that the company was fully aware of the dangers of asbestos. They continued to use asbestos.

As for when we knew, it was long before 1970. Set the wayback machine to 1906, and you will find the first proven case of an asbestos-related death to be reported and confirmed. The dangers of asbestos were known well before that.

Industrialization is a powerful motivator. Once we discover something as useful as asbestos, we find it difficult to relinquish, even long after we know it is killing people. As with a drug, once we get hooked, we rationalize while the people around us suffer.

How Mesothelioma Is Contracted

Here’s the good news: You cannot inherit mesothelioma. Unlike other cancers, it is not genetic. It cannot be passed on from one generation to the next. It is also not contagious. There, the good news ends. The simple and shocking fact is that we know of only one way to get mesothelioma, and that is through exposure to asbestos.

It is important to know that asbestos is a naturally occurring mineral. But people with mesothelioma didn’t catch it from a walk in the park. This is an industrial strength, industrially manufactured disease. To put it in no uncertain terms, humans cause mesothelioma.

Cancer, By Any Other Name

Mesothelioma is cancer. More to the point, it is a type of lung cancer. Pleural is the most common of three types of mesothelioma. This type effects the lungs, and can easily be mistaken for other ailments. Peritoneal and pericardial are the other two. They attack the abdomen and the heart respectively.
As with other cancers, there is no cure for mesothelioma, and it often presents later in life. Asbestos does not go away once in the body. It can hang around for 30 years before the cancer presents.

Who Is At Risk

According to the National Heart, Lung, and Blood Institute the following are most at risk:

•Miners
•Aircraft and auto mechanics
•Building construction workers
•Electricians
•Shipyard workers
•Boiler operators
•Building engineers
•Railroad workers

Add to that list anyone living in a house built before 1980. The condition of the asbestos is key, and can be assessed by a professional. To learn more about mesothelioma and lawsuits related to it, follow the link provided and check out the resources.

While Americans have greatly reduced their dependency on asbestos, it is still legal in this country, though 55 other countries have banned it. Though the dangers are as well-known as the benefits, developing nations are still using asbestos to help spur their own industrial revolution. Mesothelioma is the inevitable result of this reckless industrialism.

This is a blog post by Nancy Evans.

Common Disabling Automotive Injuries

Almost anyone who has been disabled in an automobile accident will tell you that it ultimately doesn’t matter how they became disabled, it only matters that they became disabled, and that their lives are forever changed. That being said, it’s still a good idea to understand the types of disabling injuries that can occur in an automobile accident to understand how the injury occurred, and the options for treatment.

It’s also a good idea to learn about these types of injuries to understand how they can be prevented in the future.

The Impact of Automotive Injuries

Whether or not the automotive injury results in a physical disability, it can still have a long-term physical and mental effect on a person’s life.

Accident survivors can often spend years, and thousands of dollars, recovering from an accident, and during that time, many people are unable to work or earn a living. If the injured party was not at fault for the accident, he might be able to get assistance from his insurance company, or even from the individual who was responsible for the accident. However, doing that often involves a lot of time and energy that someone recovering from an accident can’t necessarily afford.

For example, if someone is injured in an accident on the Dallas North Tollway, and the police find another driver at fault, that other driver's insurance could pay the medical costs. The thing is, no one is going to have the energy to deal with an insurance company while recovering from an accident. However, if the injured party hires a Dallas car wreck lawyer, the lawyer can focus on the insurance company, while the injured party focuses on getting well.

Automobile Accident Injuries

You can sustain almost any type of disabling injury in an automobile accident. However, there are certain disabling injuries that are more common to automotive accidents than others, specifically brain injuries; and neck, spinal cord and back injuries.

Brain injuries

Brain injuries are the most common type of disabling injury in automobile accidents. These injuries are usually the result of the head violently striking a solid object, such as the vehicle dashboard. Brain injuries can also happen to people outside the vehicle if they are hit by the vehicle or debris from the accident, or if they are thrown from the vehicle during the accident. Another type of brain injury occurs when the brain hits the interior of the skull, even if the exterior of the skull is undamaged. In some cases a brain injury could occur as a result of penetration – a piece of the vehicle pierces the skull.

The severity and long-term effects of head injuries can vary depending on several factors including:

•  The intensity of the impact;

•  The area of the brain or head that is injured;

•  The interval between injury and treatment, because the brain can swell, which can cause more damage than the initial impact.

Because the brain controls many different bodily functions, the type of disability caused by a brain injury depends greatly on the area of the brain that is damaged. For example, damage to the part of the brain that controls memory could result in difficulty learning or retaining new information. Damage to the motor center could result in a loss of fine motor skills in the hands or in the ability to walk. It is also possible to suffer damage in multiple areas.

Neck, spinal cord, and back injuries

The terms “neck injuries” and “back injuries” usually refers to damage to the muscles, bones and cartilage in the back and neck, with or without spinal cord damage;  the term “spinal cord injuries” refers only to damage of the spinal cord. These injuries could be the result of impact or penetration and, like brain injuries, the severity and long-term effects of the injury are determined by a variety of factors. Additionally, the type of disability depends on the location of the injury.

For example, a person who suffers broken vertebrae and bruising, or incomplete spinal cord damage, in the neck might have his neck bone surgically fused together, preventing him from turning his head, and might suffer numbness and mild loss of from the point of the spinal bruising down, but won’t be completely paralyzed.

Injuries are a major risk in any automotive accident, but there are ways to reduce your risk:

•  Always wear your seat belt, even for short trips;

•  Adjust the headrests to support your skull and prevent your head from snapping back; and,

•  Secure any loose items to prevent them from flying around during an accident.

This is a blog post by Nancy Evans.

Drug Side-Effects: When the Cure is Worse Than the Disease

Treating disease is not easy. For one thing, despite all of the advances in medical technology, there’s still so much we don’t know about the human body and the disease process. Many of the treatments that we take for granted have only been in use since the early twentieth century.  For example, the antibiotic penicillin was not discovered until 1928 and did not reach wide distribution until 1935.

When penicillin was introduced it was considered a wonder drug because it was able to prevent hospital-borne infections, and cure diseases that were previously considered terminal, like syphilis. However, there were also people who were allergic to penicillin, which made the drug dangerous for them to use. Overuse of penicillin also led to more resistant bacterial strains and the need for even stronger antibiotics.

Penicillin is not the only drug that has issues; in fact, most prescription drugs have side-effects of some sort. However, there are those with side effects so bad that it makes patients wonder if the cure is worse than the disease.

Risperdal

Risperdal is an anti-psychotic drug used primarily to treat schizophrenia, but could also be used in the treatment of bipolar disorder and irritability associated with autism. The drug is designed to make patients with these diseases more “even,” and less likely to harm themselves or others.

All of the diseases that are treated by this medication can be seriously debilitating and also difficult to treat.

For example: Schizophrenia causes delusions, visual and auditory hallucinations, and manic-like behavior. It’s not unusual for one antipsychotic drug to alleviate one symptom but have no effect on the others. Sometimes a patient has to try multiple drugs, and multiple drug combinations, before finding one that will alleviate all of the symptoms.

For many patients Risperdal, either alone or with other drugs, gives them relief from their symptoms and allows them to lead normal lives. Without it they could end up institutionalized, unable to function at all. But Risperdal also has its problems, some of which have made it the focus of a lawsuit.

The Risperdal lawsuit alleges that several patients have developed debilitating and even deadly side effects such as seizures, diabetes, breast cancer, and sudden changes in blood pressure. The issue is that many patients were unaware of these side effects when they took the drug. For some it might not have made any difference, Risperdal might have been the only medication that worked for them. But others could have opted to try a different drug to avoid the side effects. Additionally, it is alleged that drug reps were advised to suggest the drug for off-label use, such as dementia and anxiety, which would have meant thousands more people exposed to potentially deadly side effects.

Fen-Phen

Fen-Phen is a diet drug that was introduced in the 1990s. It was a combination of two drugs – fenfluramine and phentermine – and was touted as a miracle drug for weight loss. Fenfluramine was an appetite suppressant designed to make people eat less, and phentermine was an amphetamine designed to increase the heart rate and raise the metabolism. At its peak, Fen-Phen was prescribed to an estimated six million people, and many people swore by its effects. Unfortunately, like Risperdal, Fen-Phen also had its share of issues, and was the subject of a lawsuit.

The Fen-Phen lawsuit came about after the drug was taken off the market due to reports of heart valve damage in 30 percent of patients who took the drug. Heart valves are structures that prevent blood from flowing backwards inside the heart. The heart has four valves, all designed to keep blood flowing in the right direction. When a valve is damaged, blood cannnot flow properly and that can put you at greater risk for a heart attack. Damaged heart valves are incurable; once the valve is damaged the patient either needs to take medication and make lifestyle changes to prevent further damage, or they need to have the faulty valve replaced.

Fen-phen was also linked to a potentially fatal lung condition called primary pulmonary hypertension (PPH), or high blood pressure in the arteries in the lungs. The danger of PPH is that the arteries in the lungs can constrict and thicken, which means they can’t carry as much blood and the blood can’t get as much oxygen from the lungs.

Millions of people were exposed to these side effects because it was prescribed so freely, even though many health experts warned that the drug should only be prescribed to the seriously obese.

This is a post by Nancy Evans.

Water Safety at the Jersey Shore

As the summer season winds down, we’re heading away from the many beaches, and toward drier fall activities. Although we’re heading away from the water, we shouldn’t lose sight of the dangers that can lurk on the many beaches along the Jersey Shore. New Jersey has roughly 130 miles of coastline that offer everything from boardwalks and fishing to swimming and surfing, and with all those activities come the risk of drowning. This is not to say that the beaches are dangerous, but safety should always be a concern whenever you get near the water.

The CDC reports that ten people die each day from unintentional drowning, and roughly two in ten are children aged 14 and younger. Additionally, drowning is the fifth leading cause of unintentional injury and death in the US. Roughly 81 percent of water incidents are attributed to riptides – strong, narrow currents that form as waves and travel from deep to shallow water. Riptides move away from the shore and anyone getting caught in one could be easily pulled into deep water. Although many beaches have lifeguards on duty, it is important for you to understand what to do if you, or someone you know, are caught in a riptide, as well as how to administer CPR in the event of drowning.

Responding to a Riptide

For many people, the first response is to fight against the tide to remain close to shore. While this might seem like a reasonable reaction, doing so can actually make the situation worse. Riptides are so strong that even a Michael Phelps-level swimmer can be easily overcome. Fighting against the current will actually tire you out, making you unable to return to shore once you are out of the current’s grip. That exhaustion will make you more prone to drowning. The following steps can actually increase your chances of escaping the riptide safely:

1.  Remain as calm as possible. Panic can lead to poor decision making;

2.  Riptides are shaped like a funnel with a wide base at the shore that tapers to a narrow neck, then widens to a head at the deep end. Swim along the coastline, which will take you across the current instead of against it, and eventually out of the riptide. Keep your eye on the coastline to make sure you are swimming in the right direction;

3.  When you are out of the riptide, swim toward the shore.

If you are unable to swim across the riptide, remain calm and float on your back or tread water and let the tide carry you out until you either exit the tide naturally, or are able to start swimming across. Always keep your eyes on the coastline.

If you are unable to escape the tide at all, draw attention to yourself by waving your arms and yelling to shore.

If you see someone else stuck in a riptide, do not attempt to enter the water to help. Call 911 or find a lifeguard.

It’s also a good idea to be aware of the conditions that could cause riptides, such as offshore storms.

Finally, you should always take care never to swim on a beach that is deserted or does not have a lifeguard on duty.

Learning CPR

CPR, or Cardio-Pulmonary Resuscitation, is not only handy in drowning situations, but in any situation where someone might stop breathing. You can find several online CPR references for adults and children, but they won’t give you all the information you need. CPR is a delicate procedure that you can only really learn through practice and there are several CPR classes in NJ that can teach you the correct way to administer adult, child, and even infant CPR.

The great thing about these classes is that they are offered year-round, which means you can earn your CPR certification during the off-season and be prepared when you head back to the beaches in the summer.

If you do choose to get CPR certification, you will need to keep it up to date by taking refresher courses every year or so. This is because the America Red Cross is constantly updating the procedure to make it safer, more efficient, and save more lives

This is a blog post by Nancy Evans.

The Woman Who Claimed She Urinated a Bullet

While urinating a worm is physically possible as described in a recent blog post, there is an early medical report from 1668 of a woman urinating something even more incredible…a bullet. The story goes like this.

A large, pale, woman by the name of G. Eliot in Suffolk, England was tormented with intestinal problems for many years. She was persuaded by a neighbor who had similar problems to swallow two bullets.  It is not stated what the logic was behind how swallowing bullets would supposedly help. The woman claimed that she felt better initially after swallowing the bullets but that the pains returned and increased.

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After 15 years of continued symptoms, she presented to Dr. Nathan Fairfax’s pharmacy.  He prescribed her something called Lady Hollands powder that was mixed into a hot drink. She vomited over night.  When using the bathroom the next morning (which was referred to as the chamber pot), she urinated when a thwang was heard on the side of the vessel.  This reportedly surprised her and led her to wonder what it could be. So she poured the urine and saw a heavy gravelly stone that was yellow-red in color and as big as the end of a thumb. However, this is based solely on self-report.  She reportedly took a hammer, knocked off the outer crust, and found a bullet enclosed in it. She then reportedly cut it a little with a knife and found lead within it.

Dr. Fairfax asked her if she had ever urinated bullets before and she said no, including the other bullet. Recollecting back to when she swallowed the two bullets, she stated that she checked her feces slightly for days afterwards and never found the bullets and so she gave up. She stated that the bullet was smaller compared to when she originally swallowed it.  Before and since that time, she stated that she urinated an abundance of red gravel.

Ms. Eliot stated that when she voided the bullet that it felt like a kidney stone but that it lasted longer (i.e., weeks),  caused her to bow forwards, and led to vomiting.  She claimed to feel it move lower from the kidney to the bladder.  Dr. Fairfax asked her if she was sure that the bullet came from the urine and she assured him that it was and that she was not mistaken. Dr. Fairfax stated that the bullet did have a gravelly coat. Since she passed the bullet, she stated that she still had kidney stone pains but not as bad as before.

Dr. Fairfax stated the tale strengthened his belief that there must have been a passage from the stomach to the bladder but in reality, there is no such passage.  He believed that nature had found a way to finally rid the body of something it found offensive. Basically, his argument was that the body works in mysterious ways.

This story is a good lesson that highlights the problem that arises when health care professionals rely on self-report , despite claims that the self-report is definitely not mistaken. What this woman described is actually anatomically impossible. There is no known mechanism by which someone can swallow a bullet or any other foreign object and have it passed from the stomach to the kidneys. When solid objects and liquid enters the stomach from the esophagus it goes directly to the small intestines. The blood picks up excess fluid and is filtered by the kidneys but there is no way for the blood to transfer a solid object from the small intestine to the blood and into the kidneys.

Thus, either Ms. Eliot made the story up and showed the doctor a bullet that was not the one she swallowed or she or Dr. Fairfax misperceived the middle of a kidney stone as a bullet. Incidentally, there is no report in the modern medical literature of a foreign object being passed out of the body through the urine.

Fairfax, N. (1668). An Extract of a Letter, Written by Dr. Nathan. Fairfax to the Publisher, about a Bullet Voided by Urine, Philosophical Transactions, 40, 803-805.

How a Flower Can Kill a Rattlesnake: The Medical Dangers of Pennyroyal Oil

While doing some historical medical research from the 1600s, I recently came across a fascinating account of how people in Virginia used a common flower to kill rattlesnakes. The story was relayed by Captain Silas Taylor to members of the Royal Society in England, who were always interested in hearing new discoveries from places overseas.

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Captain Taylor spoke about how colonists in Virginia used a plant known as pennyroyal (pictured below) to kill rattle snakes. He noted that the leaves of this plant produced a very hot sensation when placed on the tongue.  So the colonists took some of the pennyroyal leaves, tied them to the end of a long stick, and held them by the nose of the rattlesnake.

When exposed to the pennyroyal leaves, the rattlesnakes would turn and wiggle and do whatever they could to avoid it. But the colonists were persistent and eventually the rattlesnake died in less than 30 minutes from the scent of these leaves.

How is this possible? Medical science has the answer. As it turns out, the essential oil in pennyroyal is very high (up to 90%) in pulegone. This oil is highly toxic, particularly to the liver, even at very low levels. (e.g., one ounce). The rest of the oil is made up of similar toxins. Human consumption of just a half a teaspoon of the oil can result in death.

The high toxicity of pulegone is mainly due to methofuran, an organic chemical that the body converts the oil into. Pennyroyal oil can cause seizures, fainting, failure of multiple organs, acute (sudden) kidney and/or liver failure, brain damage, hallucinations, paralysis of respiratory muscles, failure of the heart and lungs, coma, and as mentioned, death. In humans, the toxicity usually occurs a few hours after ingestion, but if one held the flower over the rattlesnake for 30 minutes, the constant exposure to the oils in the flower could explain why death occurred during that time frame.

Pennyroyal oil causes damage to organs by depleting levels of glutathione, a natural chemical in the body that prevents damage to cells. Thus, when not enough glutathione is present, cellular damage occurs quickly.
Humans need to make sure not to ingest pennyroyal oil. For example, in 1996, two infants died because they drank a tea that was made with pennyroyal.  Dogs have died after licking this oil off of their fur. A college student who drank two teaspoons of pennyroyal oil in teas died two days later in 1994. Thousands of years ago, pennyroyal oil was actually used to terminate unwanted pregnancies. It is also used as a powerful insect repellent.

Reference: 1665 (author unknown). Of A Way of Killing Rattle-Snakes. Philosophical Transactions, 3, 43.

Worms in the Urine: Strange Facts

Many people have heard of parasitic worm infections in their animals and even in humans. In those cases, people generally are familiar with worms being found in the fecal matter. However, many people are unaware that people can actually urinate worms. The reason is because some types of worms can infect the urinary tract.

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One type of worm infection is trichomoniasis, but these worms are microscopic. Another worm infection is schistosomiasis, which is caused by a worm called a fluke. This can cause severe kidney failure, blood in the urine, blockage of urine flow, and can eventually result in bladder cancer. In cases of fluke infection, worm eggs are released in the urine from the worms that live in blood vessels around the urinary bladder.

 Another parasitic worm infection is filariasis, which is threadworm infection. This can cause lymph fluid to enter the urine and a severe enlargement of tissues (elephantitis).  Yet another parasitic worm infection that can rarely present in the urine is strongyloidiasis which is caused by a type of roundworm.  Sometimes, the worms are living and swimming freely in the urine.  Identification of worms such as these in urine samples can sometimes prevent fatal health outcomes as these conditions are often treatable and reversible with medication.

Another type of roundworm infection that can rarely present in the urine is Ascaris lumbricoides (see picture above, image copyrighted by the Journal of Postgraduate Medicine).  These worms can live in the body for 12 to 18 months and can produce 240,000 eggs.

One of the earliest accounts of a worm present in the urine occurred in 1677 by a man named Matthew Milford. Mr. Milford noted that worm he passed was snake-headed and alive. He noted that it was small at the tail. He noted being very ill before hand and that since that time he had blood in the urine. He reportedly probably had urinary retention for some time. The worm presented on the second urine, leading the writer of the article to hypothesize that it descended from the kidney to the bladder initially and then out into the urine stream. The worm was then noted to be dead, dry, and a dull red color, with a thickness of 1/12th of an inch. It is unclear exactly what type of worm this was.

Reference : Ent and Milford (1677). A Relation of a Worm Voided by Urine; Communicated by Mr. Ent: to Whom It Was Sent by Mr. Matthew Milford. Philosophical Transactions, 140, 1009.

Babies that Turn to Stone: Meet the Lithopedions

Stone Baby from 1897

Earlier this year, an 84-year old woman in Brazil was found to have a 44-year-old fetus inside her (of 22 to 28 weeks gestation). The fetus had become calcified to protect the mother from the fetus’s dead tissue and possible infection. The calcified fetus is known as a Lithopedion, which is Greek for “stone child.” Lithopedions are commonly referred to as Stone Babies. They occur when a fetus develops outside of the womb, dies, is too large to be absorbed by the body, and calcifies inside the abdomen when medically undetected.

Stone Babies are extremely rare, occurring in 0.0054% of all pregnancies.One is pictured above from 1897 (copyright Bulletin of the Johns Hopkins Hospital).

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Women who carry a calcified fetus for decades generally do so unknowingly, as incredible as this may sound. See the case from 1677 discussed at the end of this article, for an exception. Although a Stone Baby can develop from any time between 14 weeks and full-term, the larger it is the more likely it is to be discovered. Age of diagnosis in the mother of a Stone Baby can vary across the life span, from 20 to 100 years.

Women can have additional future uncomplicated pregnancies while the Stone Baby is present because the uncomplicated pregnancy develops inside the womb unlike the presence of the Stone Baby outside of the womb.  However, the presence of a Stone Baby has been known to interfere with fertility by distorting the structure of the pelvis, impairing the pick-up of the egg cell.

While such women can have stomach pains from the calcified fetus, the pains usually go away at some point or are intermittent and can improve with pain medication. If the woman seeks medical care and an imaging study (e.g., x-ray) is not performed, then the real source of the problem goes undetected. If imaging is performed, a Stone Baby or a tumor may be suspected. Stone Babies are more common in counties where there is limited access to healthcare and in settings where health care providers are unaware of their existence. 

Various features of Stone Babies, including the face, can still be recognized even 44 years later. A 40-year-old Stone Baby was discovered in 2013. The oldest Stone Baby known was 60-years-old, found inside a Chinese woman in 2009. The youngest was less than 18 months in 2014. Ultimately, surgery is needed to remove it.

Fewer than 300 cases of Stone Babies have been reported in the past 400 years of medical literature, although the Arabic physician, Albucasis, described one for the first time in the 10th century. The earliest known Lithopedion dates to 1100BC. The first “modern” reported case dates back to 1582 when a 68-year-old French woman named Madame Colombe Chatri was found to have had a 28-year-old Stone Baby. Early physicians used to think that the cause of Stone Babies was a mystical force as they had not yet developed the scientific knowledge to explain their development.

In 1880, the German physician, Friedreich Kuchenmeister, published a review of 47 cases of Lithopedions, beginning in 1582. However, he missed a case from 1677, which is now summarized and referenced below. The case involved a Lithopedion that remained in the mother (Margaret Mathew) for 26 years. She was in the 9th month of her pregnancy and her water broke, but the baby did not come forth. Over the next 20 years, she had the perception that the child was still inside of her along with unspecified “troublesome symptoms.” She desired a surgeon to open her abdomen and relive her of the problem. However, over the next six years, she did not perceive the child to move.

The woman eventually passed away at age 64 and the surgeon then opened her abdomen. At this point, the Stone Baby was discovered, weighed 8 pounds, was 11 inches long, and was not joined to the mother. The head was downward and the skull was broken into several pieces. The brain and the flesh was red or yellow. The tongue was pink. The heart was red but contained no blood. The inner organs were blackish, The back part of the child was covered with a membrane that could only be separated with a knife. When this was done, barely any blood came forth. The forehead, eyes, ear, and nose were covered with a callous substance. The teeth were like those of an adult. Three days after it was removed, no bad smell was noted.

Reference: Bayle, M. (1677). A Relation of a Child which Remained Twenty Six Years in the Mothers Belly. Taken out of the Journal Des Scavans; Being the Extract of a Letter Written from Tolouse 22. June to the Author of That Journal, by Monsieur Bayle, M.D. Philosophical Transactions, 139, 979-980.

What Was It? The "Monstrous Birth" from 1677

Conjoined twins are identical twins who are joined together in the uterus. They have the appearance of one body with two heads.  If the faces are pointed in opposite directions, they are referred to as janiceps, although those can rarely survive due to severe brain abnormalities. Conjoined twins are rare, occurring between 1 in 49,000 to 189,000 births.  Most are stillborn (deceased at birth) and a smaller percentage dies soon thereafter.

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Conjoined twins are three times more likely to be female than male. Some are successfully separated through surgeries. Other live connected together throughout their lives. Some hypothesize the condition is caused by a fertilized egg not completely separating. Others believe the fertilized egg completely separates but that stem cells from one twin find similar cells on the other twin, fusing them together.  Most conjoined twins are fused from the upper chest to the lower chest although some are joined via other body parts.

The earliest known depiction of conjoined twins dates back to ceramics from the Moche culture in Peru from around the year 300 AD. St. Augustine of Hippo also wrote about conjoined twins in 450 AD in his book, City of God. It is unclear, however, if these descriptions and depictions were fictional or not. The earliest known documented case of conjoined twins dates to 942 AD when a pair was brought from Armenia for medical evaluation in Constantinople. 

Some other early descriptions of conjoined twins exist, such as from Arabia and England but the vast majority of case have been documented in the 20th century and beyond. This includes Chang and Eng Bunker (1811-1874) who were born in Siam (now Thailand) and thus became known as “Siamese twins.”

The Famous Siamese Twins

Because early documented descriptions of conjoined twins are hard to come by, I wanted to present how a London doctor in the late 1600s described a pair of conjoined twins he delivered (on 12/20/1667) when writing in a medical journal.

One of the most interesting descriptions is the title, “A Relation of a Monstrous Birth.” Such a description, while likely apt to the doctor who delivered the baby, would never be allowed in medical journals today because it would be considered offensive and pejorative.  Because English was written and spelled differently back in the 1600s, I will offer a modern translation of some parts of the article.

The first thing the author noted is that “It had two heads,” which sounds more like a sci-fi movie title to describe a monster (e.g., “It Came From Beneath the Sea”) rather than the opening line of a medical article. Modern journals would stick to using the gender, which in this case was female. Also interesting is that the name of the mother (Joan Peto) is listed, which would never be allowed today due to confidentiality protections.  She is also described as the wife of a butcher.

Both of the heads were described as very well-shaped, which is not unusual if this was a full-term delivery.  The left face looked swarthy (dark-skinned) and did not breath. The right head was perceived to breathe but not cry. Thus, one side appeared to be a stillbirth with the other side surviving to birth. The left head was bigger. This type of discordance between the left and the right is not uncommon in conjoined twins, likely due to genetic, environmental, and abnormalities in the placenta and/or in the circulation of the fetus.

The author says that between the heads was a protruberance, like another shoulder. The clavicles and breast were very large, about seven inches wide. The conjoined twins were of the parapagus variety, meaning they were fused side by side with a shared pelvis. There were two hands and two feet, although other conjoined twins are known to be born with four hands and feet.  The brain in each head was described as very large, indicating that the heads must have also been quite large, perhaps macrocephaly (abnormally large head), which is a known malformation in some conjoined twins. There were also two spinal cords, two pairs of lungs, and two hearts (on each side of the chest, the left heart being bigger). The lungs on the left were blackish and the other lungs looked well. 

The esophagus was divided into two branches, with one branch projecting to each throat. There was one aorta (the main artery in the human body) and vena cava (two large veins that bring blood to the heart).  The aorta and vena cava were divided into two parts, bringing blood to both hearts in the shape of a Y.

There were also two stomachs. One was shaped naturally but the other was shaped like a “great bag,” resembling what would be found in a cow or sheep.  The intestines contained a substance like meconium (early feces), similar to newborns.  The intestines were also large, as was the liver, spleen, uterus, and left kidney. Overall birth weight was 8 pounds. It is unknown what happened to the conjoined twin who was breathing.

Reference:  Morris, S. (1677). A Relation of a Monstrous Birth, Made by Dr. S. Morris of Petworth in Suffex, from His Own Observation: And by Him Sent to Dr. Charles Goodall of London; Both of the Colledge of Physicians, London, Philosophical Transactions, 138, 961-62.

Why Exercising Outdoors is Better

Gyms are awesome. They’re climate-controlled environments with machines that can work every body part, and a place to shower at the end of your workout. Some even have snack bars where you can buy smoothies, cold-pressed juices and supplements to boost the effects of your workout. If you belong to a 24-hour facility, you can work out at any time, day or night.

The thing is, as awesome as gyms are, there are a lot of reasons why exercising outside is actually better.

You’ll Get a Better Workout

One of the biggest problems with the cardio machines at the gym is that they are predictable. Even if you can set them to a random program, it’s still a program and it’s not nearly as random as you think. In fact, if you do the same “random” program at the same level and for the same duration every time you use the machine, you will notice that there is definitely a pattern. Your body gets used to these patterns and will adjust to perform those motions more efficiently. This means that you will no longer be getting as much out of your exercise routine.

Doing your cardio outdoors brings that element of unpredictability back to your exercise routine. Even if you travel the same route very day, weather conditions, the texture of the road surface and other factors can make subtle changes to the route from day to day.

Outdoor exercise also causes you to use your muscles differently than you would on a machine. People tend to flex their ankles more, when running outdoors. Also, studies have shown that people who run on a treadmill expend less energy than those running outside, because they don’t have to deal with wind resistance and other factors.

Similarly, with the right set of rollerblades, you will expend more energy exercising outdoors than on a flat, indoor track.

You’ll Exercise Longer

Exercising outdoors can actually make the exercise seem easier, allowing you to do it longer. Some of this is attributed to studies that indicate people feel a greater sense of happiness and well being when exercising outdoors. In one study, two different groups of volunteers were asked to walk for the same duration or distance – one indoors on a treadmill, and one outdoors; the group that walked outdoors shows significantly higher levels of vitality, enthusiasm, pleasure and self-esteem than the indoor group. They also showed lower levels or depression, tension, and fatigue.

You’ll Make More Vitamin D

Your body makes vitamin D from sunlight. People who live in colder climates often have lower vitamin D levels than people from sunny areas. For this reason, it’s crucial to get a little direct sunlight whenever it’s available, and outdoor exercise can do that for you. The vitamin D has two major benefits, it helps strengthen your bones and it can actually help elevate your mood.

The best part is that a little goes a long way. A mere 15 minutes of unprotected sun exposure is enough to jump start vitamin D production, after which you can apply sunscreen to protect your skin.

It’s Cheaper

Exercising outdoors not only saves you on the cost of your gym membership, it can also save you transportation costs. For example, if you hop on a bike or strap on a pair of rollerblades, instead of driving your car, you'll save gas when running small errands. If your city has a good transportation system, you can walk and bus to and from work and save money on gas and parking.

Also, because you’re using your car less often, and not using the gym’s electricity, heating and cooling, and water, you are reducing your environmental impact with fewer emissions, less use of non-renewable energy.

It’s Healthier

Believe it or not, gyms can be hot-beds of germs, bacteria, and other infectious materials. Colds, flu, jock itch, athlete’s foot, and even MRSA can be found at any gym.

While gyms do have staff members who clean the equipment, there is no way they can keep up with everyone. Additionally, because the air is often recycled, even if you religiously clean every piece of equipment before you use it, there’s still a chance you could get sick just from someone sneezing – like you would in the enclosed environment of an airplane.

You can actually avoid a lot of that by exercising outdoors.

Conclusion 

All of this is not to say that you should completely ditch your gym membership. As we stated before, there are a lot of reasons why gyms are awesome. Also, people like the elderly and the ill need gyms because they are safe and controlled environments. However, even those who need the safety of the indoors can benefit from getting outdoors once in a while.

So, if you want to be healthier and get more out of your exercise routine, get yourself outside.

This is a blog post by Nancy Evans.

Anorexia Nervosa and Treatment

Anorexia nervosa is a type of eating disorder in which purposely restricted food intake causes significantly low body weight compared to what would be expected based on the person’s age, gender, and height. The significantly low body weight can result from weight loss or failure to gain weight. People who are anorexic fear gaining weight or becoming obese and they have a distorted view of their body. For example, an anorexic would incorrectly view oneself as overweight whereas an objective observer would view the person as significantly underweight.

Whereas some patients with anorexia lose weight by restricting the amount of food they eat, others engage in binge eating and purging behaviors. In binge eating, excessive amounts of food are consumed over a short period of time. The food is then purged (released) through vomiting or through the use of laxatives and/or diuretics. Although anorexia has been traditionally associated with women, men can be anorexic too.

For those suffering from anorexia, the condition has serious health risks due to poor nutrition and can lead to death in extreme cases. People who are anorexic usually deny that there is a problem with being so underweight or make excuses for it. As a result, family members and friends often feel helpless when watching someone they care for who suffers from anorexia.

Fortunately, many excellent anorexia treatment programs exist, such as Rader programs. These programs often involve inpatient stays at a specialized treatment facility. Length of stays vary, with shorter stays typically focused on medical stabilization and longer stays typically focused on weight restoration.

Some programs try to involve the family with a formal family-based treatment approach, although not all patients allow family members to be contacted. Family based treatment programs are known to be effective treatments for anorexia in medically stable patients. Individual counseling for co-occurring mental health conditions (e.g., major depressive disorder. may also be needed. Medications are sometimes used as part of treatment. Due to the diverse healthcare needs of patients with anorexia, many treatment programs have multi-disciplinary care teams available.

After an inpatient stay, follow-up outpatient treatment sessions are common. As with all therapies, treatment works best when the patient is motivated to attend the sessions and to make positive changes.
In severe cases of anorexia when the patient refuses life-saving treatment, compulsory (forced) treatment may be needed. This involves compulsory re-feeding, which can be beneficial in the short-term but does not appear to worsen the therapeutic relationship.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manualof mental disorders,
5th edition: DSM-5. Arlington, VA: American Psychiatric Publishing.

Elzakkers, I.F. et al. (2014). Compulsory treatment in anorexia nervosa: A review. Int J Eat Disord. doi: 10.1002/eat.22330. [Epub ahead of print]

Maden, S. et al. (2014). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med.. [Epub ahead of print]

Choosing the Right Hospital

Depending on several factors, including your geographic area and your insurance plan, you could have a broad or narrow number of hospitals to choose from. Additionally, you choice of hospital could also hinge upon where your personal physician has hospital privileges.

However, if you ever have to change insurance plans, you might have a choice of plans that don’t include your preferred hospital on their provider lists. There’s a chance you might never use the hospital benefit, but it’s important to make the right choice in case you ever do.

Hospital Ratings

The official hospital site can tell you a lot about the services they offer, the doctors they have on staff, and other things associated with their brand. Unfortunately, these don’t often have patient-centric information. In fact, Becker’s Hospital Review indicates that there are only 10 top hospital websites with patient-centric information.

Ratings by an independent evaluator, like Consumer Reports and The Agency for Healthcare Research and Quality, are the best way to evaluate future hospitals. These companies evaluate patient-centric factors like patient experience and outcomes, hospital practices, their safety score, and heart surgery.

Patient Experience: 

The patient experience rating reports the likelihood that patients would recommend this hospital to others. It is based on a government survey of patients across the country and includes such criteria as pain control, room cleanliness, room quietness, staff helpfulness, and communication with nurses and doctors.

Patient Outcomes:

The patient outcomes rating reports how well hospitals prevent hospital-acquired infections, and how many patients have to be readmitted within 30 days of being discharged, based on data that the hospitals submit to state or federal agencies.

The patient outcomes rating also measures surgical mortality rates – including mortality from post-surgical complications, like deep vein thrombosis – and medical mortality rates, based on Medicare patients admitted for heart failure, heart attack, or pneumonia.

Hospital Practices

The hospital practices rating is based on the number C-sections performed at the hospital and the appropriate use of scanning.

The C-section rates in the US are considered too high and the American College of Obstetrician and Gynecologists have guidelines for preventing unnecessary C-sections. The C-section measurement uses state-based billing data and calculates to calculate the score.

Appropriate use of scanning refers to the number of CT scans performed twice on a patient – once with dye and once without. These double scans have been deemed unnecessary and also potentially dangerous because they expose patients to extra radiation. The appropriate use of scanning measurement uses billing data submitted to CMS to calculate the score.

Safety

The safety rating refers to multiple categories regarding patient and hospital safety many of which overlap with the previously listed ratings. The criteria for the safety rating include: hospital acquired infections, mortality, patient-medical staff communications, readmission rates, and appropriate use of scanning. Some rating systems may pull this information from the patient outcome and hospital practices scores, or they may have a separate data collection system.

Heart Surgery

The heart surgery rating is based on coronary bypass procedures and aortic valve replacements. Both categories measure patient survival rates, and the rate of post-surgical complications. The coronary bypass category also rates used the best surgical technique, which improves long-term survival, and it rates whether or not patients received the correct medications before and after surgery.

Some rating services might require you to have a subscription to access hospital rating information. However, some insurance companies can also provide hospital ratings to both current and potential customers.

This is a blog post by Nancy Evans.

Vital Signs and the Brain

Vital signs are an important measure of basic bodily functions and are part of most physical examinations. The main vital signs typically reported are body temperature, blood pressure, pulse (heart rate), and respiratory rate (breathing rate). Vital signs fluctuate throughout the day but a significantly high or low deviation from normal indicates the presence of some type of medical problem or situational stressor.

Many times, these medical problems or stressors are relatively mild and can be easily managed or treated. Sometimes, however, abnormal vital signs can indicate a problem with the brain or spinal cord.

Although many people may think that vital signs are solely controlled or influenced by the heart , blood vessels, and lungs, it may surprise you to know the brain plays a major role in regulating vital signs. For example, core body temperature is largely regulated by the preoptic area of the anterior (front) hypothalamus (see picture below). The brain communicates to the rest of the body through the spinal cord and vice versa, which establishes an important and continuous feedback loop.

Another area you will see in the above image and below is the brainstem. The brainstem is an area in the lower part of the brain that connects to the spinal cord. The brainstem consists of three parts: the pons, midbrain, and medulla (from top to bottom).

The brainstem contains structures that regulate arousal and the most basic of life functions such as breathing rate. More specifically, there is an area in the pons and medulla that contains special nerve cells that regulates blood pressure control. This area is known as the lateral tegmental area and is located towards the back of the brainstem. The pons, medulla, and spinal cord also contain nerve cell projections that help regulate breathing rate and temperature control.

But wait, you say, I thought that part of the hypothalamus was involved in temperature control. It is, but there are actually multiple areas within the brain and spine that help regulate vital signs. As another example, there is a group of nerve cell bodies known as the solitary nucleus of the medulla that helps regulate heart rate, breathing rate, and blood pressure by sending messages through other parts of the brainstem and spinal cord.

For this reason, the solitary nucleus is also known as the cardiorespiratory nucleus. This nucleus is a good example of the feedback system that takes place between the brain and spinal cord. That is, in addition to sending out information, the solitary nucleus receives information from special sensory receptors located in major blood vessels that are excited by stretching of blood vessels. The stretching generates a nerve impulse that results in information being communicated to the brain.

This basic tutorial shows the importance of the brain for vital sign functions. The next blog entry on this topic will discuss types of damage to the brain and/or spinal cord that can cause abnormal vital signs.