Won't be long now, a few short weeks and Grandma Camp starts. What started out as a great idea to get grandkids together went straight to getting family together. Fortunately we have a place on the Allegheny river that accomodate us and we love being on the river. Of course, I love having everyone home and especially watching all of the group interact and play together. Adults and kids alike are just having fun from super soakers to camp fires and water balloon fights. It is all part of a week that will be fun, exciting, fulfilling and exhausting. Nothing makes me happier than having my family together and her comes yet another chance to be together. One of the bigger kids has decided we need a Tshirt for each year and so will be designing something that we will then try to get done in time for camp. To see grandkids playing together and spending time together that they would not have otherwise is great too. Gpa and myself need another weeks vacation when it is all done but it is well worth it even with the trips to Pittsburgh airport and back. The amount of food, cooking, cleaning, and all is beyond belief and trying to meet everyone's needs and wants... well that is another challenge. When you get a son home that hasn't been home for a year and he wants Grandma's corn and strawberry pretzel salad, well of course, I am going to make it. It is fulfilling and the best gift that anyone can give me. We all fall in bed exhausted at night, to turn around and start all over again in the morning. Well, I am gearing up and excited. I will try to keep my outbursts to a minimum as I get ready for all the challenges and yet we will all have some ups and downs and of course me crying when they all leave to go back to their lives and the quiet will be deafening. I for one am not a loner and although I know they have their lives, I love when they step back into mine. Doesn't matter they age, they will always be my kids and I could no longer stop worrying about them or caring for them anymore than I could stop breathing. So this blog is about family and sharing the good times as we have all experienced the bad. Enjoy today... that is my motto and keep on smiling and as always make it a good day.S
How The Supreme Court Ruling Affects Patients
While the political fighting commences, the more important issue is how the ruling affect patients. Here are some highlights:
The uninsured: The decision leaves in place the so-called individual mandate -- the requirement on Americans to have or buy health insurance beginning in 2014 or face a penalty -- although many are exempt from that provision. In 2014, the penalty will be $285 per family or 1% of income, whichever is greater. By 2016, it goes up to $2,085 per family or 2.5% of income.
The insured: Because the requirement remains for people to have or buy insurance, the revenue stream designed to help pay for the law remains in place. So insured Americans may be avoiding a spike in premiums that could have resulted if the high court had tossed out the individual mandate but left other requirements on insurers in place.
Young adults: Millions of young adults up to age 26 who have gained health insurance due to the law will be able to keep it. The law requires insurers to cover the children of those they insure up to age 26.
People with pre-existing conditions: Since the law remains in place, the requirement that insurers cover people with pre-existing medical conditions remains active. The law also established that children under the age of 19 could no longer have limited benefits or be denied benefits because they had a pre-existing condition. Starting in 2014, the law makes it illegal for any health insurance plan to use pre-existing conditions to exclude, limit or set unrealistic rates on coverage.
Doctors and other health care providers: Health care providers have already begun making changes based on the 2010 law, and in preparation for what will go into effect in 2014. Those plans continue. In the short term, doctors avoid "chaos" that may have resulted from the law suddenly being dropped or changed. (CNN)
This is a definite... need to know. S
Daily Exercise May Cut Breast Cancer Risk
Staying highly active may protect against breast cancer whether it's walking, running, or anything in between, researchers found. Women who got around 2 hours of exercise a day most days of the week were about 30% less likely to develop breast cancer whether pre- or post-menopausal in a population-based study by Lauren E. McCullough, MSPH, of the University of North Carolina in Chapel Hill, and colleagues.
High-intensity exercise didn't appear any better than low-intensity activity, the group reported online in Cancer. "Given that three-quarters of the U.S. population participates in some physical activity, it is conceivably one of the most important lifestyle risk factors associated with the incidence of breast cancer," they wrote. Simply getting some physical activity outside of work didn't appear to have much impact on breast cancer risk.
Women who got 10 to 19 hours of exercise a week during their reproductive years showed an odds ratio of 0.67 for breast cancer compared with inactive women. With regard to activity levels after menopause, women in the quartile that got 9 to 17 hours a week of physical activity had an odds ratio of 0.70 for breast cancer. Every weight category showed lower breast cancer risk with more activity versus none. Substantial weight gain after menopause appeared to eliminate the benefits of exercise for breast cancer risk. (MedPage Today)
ARE WE LISTENING>>> TIME TO GET MOVING AND MAKE IT A GREAT DAY! :} S
I love animals as you can guess if you follow my blog as I have two dogs and a cat. One of my best supports through my cancer walk was my Golden Retriever, named Duke. Duke stuck with me night and day whether I was mad or happy or sick or well, awake or asleep. Duke has since lost his own battle to cancer but my love continues for him and the breed. I have now another companion besides my Toby, a King Charles Cavalier. The new dog is part Golden Retriever and part Poodle, hence a Golden Doodle that is black or shades of black, grey and even some golden hair on him.
Each day I go to work, I look around and see the love and support that patients and staff receive from our therapy dogs. These dogs come in all sizes and some with costumes, some with tricks, but all lovingly attending to our patients and you can see the smiles as the patients pat and love on these dogs. The staff can even be found doing the same and giving a treat if allowed by the owner. The dogs seem to revel in this environment and we all reap the benefits. Pet Therapy is one more way to face cancer and bring your positive side back into the picture. These dogs listen and sit with the patients and they wait till it is their turn to show that attention to the dogs. Yes, there are a few patients that aren't part of this but for the most part, it is greatly accepted. I am hoping the my new Golden Doodle will someday be a therapy dog. He is gently and sweet and has all knowing eyes and when I got him from his breeder, she called him Mr. Mellow. He is just that and brings a calm and loving air to the atmosphere. He is much bigger than I had anticipated and although that may create a problem for us in the future, we have worked on alternate plans to address this. He is so loving and is doing quite well in obedience class. I am anxious to have him spend more time with my grandkids and more time swimming in the river as Duke used to do.
What are your thoughts on pet therapy? I for one vote yes as I see and reap the benefits daily. Whatever can bring that kind of smile and acceptance is worth its weight in gold. Honor the pet therapy dogs and thank the owners for the wonderful service it provides.
My dogs, cat, kids, husband.... :} all make it a great day! S
(Not necessarily in that
Better therapies boost cancer survivor numbers
At the start of this year, there were an estimated 13.7 million survivors of cancer living in the U.S., researchers reported. And by Jan. 1, 2022, that number is expected to rise by 31% to some 18 million, according to Rebecca Siegel, MPH, of the American Cancer Society in Atlanta, and colleagues.
Despite the falling incidence of many cancers, the increases are expected largely because of the aging of the population and improvements in treatment that have increased survival rates, Siegel and colleagues reported online in CA: A Cancer Journal for Clinicians.
The wide-ranging report, commissioned by the American Cancer Society and the National Cancer Institute, discussed a range of issues of concern to cancer survivors, including recurrence, second cancers, and late treatment complications without cancer recurrence.
The researchers estimated the current and future prevalence of cancer survivors by cancer site and described median age and stage at diagnosis and survival, as well as patterns of cancer treatment. They defined a cancer survivor as "any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life."
Siegel and colleagues projected future prevalence of cancer survivors by combining data on incidence, survival rates, and all-cause mortality from the Surveillance, Epidemiology, and End Results (SEER) program, the National Center for Health Statistics, and the University of California Berkeley's mortality cohort life tables.
Future population numbers came from the U.S. Census Bureau.
In 2022, the percentage is expected to remain the same and the number is projected to rise slightly to 725,870 survivors, but in second place will be cancers of the colon and rectum, also at 8%, but with 735,720 survivors.
Lung and bronchial cancer, usually detected late and with a poor rate of 5-year survival, contributes only about 3% of cancer survivors among both men and women. In both sexes in 2012, that puts it eighth on the list of cancer survivors by site.
The projections may be underestimates; the researchers assumed that survival rates would be constant from 2007 to 2022. The report also introduced the cancer society's new National Cancer Survivorship Resource Center, which is developing tools for survivors, their caregivers, health professionals, and policymakers. Visit MedPage Today for the article.
Cold Virus "Hitches a Ride" on Cells to Kill Cancer
In a significant step forward for the development of a potential new cancer treatment, scientists have found how a common cold virus can kill tumors and trigger an immune response, like a vaccine, when injected into the blood stream.
Researchers from Britain's Leeds University and the Institute of Cancer Research (ICR) said by hitching a ride on blood cells, the virus was protected from antibodies in the blood stream that might otherwise neutralize its cancer-fighting abilities. The findings suggest viral therapies like this, called reovirus, could be injected into the blood stream at routine outpatient appointments - like standard chemotherapy - making them potentially suitable for treating a range of cancers.
The study, part-funded by the charity Cancer Research UK and conducted on 10 patients with advanced bowel cancer, confirmed that reovirus attacks on two fronts - killing cancer cells directly and triggering an immune response that helps eliminate leftover cancer cells. "Viral treatments like reovirus are showing real promise in patient trials. This study gives us the very good news that it should be possible to deliver these treatments with a simple injection into the blood stream," said Kevin Harrington from ICR, who co-led the study and published it in the journal Science Translational Medicine.
Harrington said if viral treatments had been found only to work when injected directly into tumors, that would have been a significant barrier to their widespread use. "But the finding that they can hitch a ride on blood cells will potentially make them relevant to a broad range of cancers," he said. (Reuters)
ALWAYS INTERESTING TO FIND THESE GEMS! S
During my diagnosis and treatment, one of the questions I was faced with was what about working. I knew that there would be days that I needed to have but also knew that for me, staying at home and thinking all the time would not have been good. It seemed like an easy decisions but then there more things that fell into place when I started looking at the logistics. If I just needed random days off during certain periods of time, how do I handle that and if I need a few days off consecutively after surgery, how would that work as well?
I marched myself down to the Human Resource department and set up a time that we could discuss my options and to get a good game plan that would work for all of us. I am a nurse but I wasn't going to be doing direct patient care so that helped in the decision making process. I also learned that I had rights and job security through the Family and Medical Leave Act or FMLA. I found that I could take the days off that I needed together and also take intermittent leave as I needed it.
My thought process also included financial concerns and what kind of flexibility that I needed to do my job. I found that my employer was willing for me to flex my time as I needed it. I also realized I needed the social part of my job as well, since isolating myself at home was not going to be productive in any sense of the word for me. I would normally have treatment near the end of the week and so I had the weekend to recoup. When it came time for radiation every day, I hopped into my car at then end of the day and headed to Sandy Lake to get my treatment and then back home. I did end up in the hospital at one point when my counts became too low and I had nothing left. I was then given a shot to help with that problem, had some fluids and returned home the next day to resume work after the weekend.
I do think you have to be honest with your employer and discuss your concerns and what would be a manageable workload and also if I needed to take time off, how long would they hold my job and /or if job sharing or part-time might work till I got back to my normal self and ready to face the daily challenges of working full time.
Something that often comes up is how much do I tell me co-workers or maybe I am just not comfortable in telling them anything. I have found that most people are caring and supportive and also that they are more uncomfortable talking about all of this than you are. Know that you are not obligated to tell them anything at anytime and especially if it makes you uncomfortable. You are more than entitled to say just that, "I am not comfortable talking about that!" Many will be ill at ease with it all and humor is a great help in tearing down those barriers. There are no "RIGHT" words, just be genuine, sincere, and honest and you will be accepted and encouraged.
I would also say, be gentle with yourself. Anytime you have been off even for a short while, coming back can be a challenge not only mentally but also physically. When you need a moment to regroup, allow yourself the time to do just that. I have learned much through my own experience but so much more through the experience of others. Again, there is no right or wrong way, just find what works for you. My failsafe is always to have humor and to remember to Make It A Great Day! s
There is a word that is often bantered around and included in descriptions of caregivers. What does it mean to you though? I often sit and talk with patients but mostly I listen and I listen with my ears but also my face and my whole body. It is important to me that you know I am invested in you. I can relate to many things you are going through that I also experienced but many more that I have not dealt with myself as our walks are similar but yet different. I am invested in what you say and how you say it.
I have been told often that I don't have a poker face and you can read all my emotions on my face and I am truly aware of that but also have realized it is something I can't change even if I really wanted to. I need to show you that I am listening and hearing everything you are saying verbally and non-verbally. I believe compassion comes in by doing so and trying to help in the situation at hand. Someone recently said to me that they had bad feelings and I truly feel that there are not bad or good feelings. It is just what it is, your feelings and I need to acknowledge what that is. How many times have you verbalized your concerns over something even a small incident and your spouse supplies a ready answer on how to handle it or just gives the accepted nod and yet you know that it was not heard and you weren't really looking for answers, you just needed heard. It is never good to hold in your feelings or block the painful thoughts. Compassion is the caring awareness of what someone else is going through. It can also bring with it compassion stress as it may drain you of all your emotional energy and in the end may drain you of your compassion and empathy.
We also hear of burnout or compassion fatigue which leads to a state of tension and preoccupation with trauma of an individual or group of individuals. Compassion fatigue can drain a caregiver or nurse of all their passion or energy and may even lead to guilt and distress. It may even lead up to as helplessness, a sense of isolation, or shock.
When you are dealing with this kind of pain and distress that patients or families continually go through, sometimes all of this can shut the nurse down and they end up going through the motions and have closed up the feeling, caring part of the experience. Nurses also can become traumatived by the indirect outcome of what is happening and add into that long hours, heavy caseloads and severely sick and or traumatized patients and you lose sight of your own feelings and shut down those feelings.Those around can suffer due to your secondary stress as well as it decreasing your ability to function and you may have loss of faith, purpose, impatience, exhaustion, illness, irritability and inability to sleep. It may even lead to a nurse quitting the field that they are working in.
So having said all that, we must do self checks and monitor stress and acknowledge when it has become to the extreem and learn better ways to cope and improve personal boundaries, and gain some control over your schedule and workload. We need good support systems and training and outlets to regroup and tackle each new day.
What are the steps that you would take to reduce your stress and deal with things on an more even basis? What stress have you dealt with personally and are they still haunting you? How do you present to work and what is your attitude at work? What subjects do you find the most difficult to deal with /and or discuss? What would you say to someone thinking about entering into your career and right there that will give you alot of insight to where you are at this particular moment in time.
As a dear friend used to say to me when all my kids were home, take care of you first and that will help you take care of them much better. I used to think that was truly selfish but as years passed by, I came to realize the value of that statement. It is not wrong to look out for yourself so that you can better give to others. Work on your Positive Thinking skills and kick the negativity out and please, have a sense of humor. We learn coping skills as life goes on and hopefully we get better at it as we do use them. Look to someone who does well in life and see that as a role model and what you have to do to achie
Red Flags: Danger! Severe sunburn in season Richard L. Pullen EdD, RN
Kelly Savage MSN, RN
Nursing Made Incredibly Easy!
Volume 9 Number 4
Pages 13 - 15 Sunburn results when the amount of exposure to UV rays exceeds the protective capability of the body's defense mechanism, the skin pigment called melanin. Shorter-wavelength UVB rays are the main culprits for the erythema (redness) that develops in sunburn, but UVA rays are much more abundant (about 95% to 98% at midday) and create most of the immediate and long-term damaging effects of UV light. UV radiation is the highest between 10 a.m. and 4 p.m. Even on cloudy days, UV radiation penetrates and can cause severe burns.
Although melanin does yield some protection, exposure to UV rays eventually causes damage to the skin. Severe sunburn is an acute inflammatory response of the body to this damage. First, blood vessels dilate, creating the erythematous rash that typically occurs in sunburned skin. Shortly after, the body reacts to the inflammation by releasing chemicals such as histamine and cytokines, creating edema and the beginning of blisters. Within a few hours of overexposure to the sun or other light sources, DNA damage and cell death are visible under a microscope. In severe sunburn, the damage to the skin goes beyond a first-degree burn, where only the outermost layer of the skin, or epidermis, is affected. Second-degree sunburn permeates the epidermis and the underlying dermis.
Who's at risk? Anyone can experience severe sunburn. Those most at risk are children, older adults, and individuals with fair or freckled skin or pale white skin, blue/hazel eyes, and blond/red hair. Lighter-skinned individuals are affected more frequently and severely. Skin types are often described using the Fitzpatrick Classification Scale, which classifies individuals according to their tendency to tan, burn, or both (see Skin type and sunburn potential).
There are other factors that make a person prone to sunburn. People who want a tan from the sun or tanning salons are at risk for severe sunburn. People who live at higher altitudes tend to experience severe sunburn faster, as do people living closer to the equator, because UV radiation intensity increases with elevation. Environmental factors such as UV radiation caused by the reflection of sun by snow and ice can also cause severe sunburn. UV radiation may be transmitted through clothing, especially when wet, so sunburn may occur under clothed skin.
It's important to review your patient's medication history. Some medications can cause the skin to overreact to light sources, including the sun, photocopiers, fluorescent lighting, and other sources of indoor lighting, which can create sunburn with blistering. An overreaction of the skin to light sources related to medications is called drug-induced photosensitivity.
It's also important to assess your patient's general health status. Malnutrition and dehydration can sensitize the skin. Several diseases such as acne, systemic lupus erythematosus, rosacea, and herpes simplex virus decrease the resistance of the skin to damage from the sun and other light sources. Photosensitivity is increasingly recognized as a common development in HIV-positive patients.
Assessment musts Perform a head-to-toe assessment of your patient while you carefully inspect the skin for areas that are burned. Erythema and edema usually develop after 3 to 4 hours of exposure to the sun or other light sources, including indoor tanning equipment, and peak at 12 to 24 hours. Patients will have moderate-to-severe pain that's described as a burning, prickly, itchy, or warm-to-hot sensation. The skin will be very tender. Blistering of the skin is a sign of a second-degree burn, and skin peeling may last from days to weeks.
Your patient may experience systemic symptoms such as fever, chills, headache, nausea, and vomiting. In more superficial second-degree burns, the skin may be very painful; patients with deeper second-degree burns may have reduced sensation and permanent scarring may result. In severe cases, your patient may experience dehydration, electrolyte imbalances, secondary infection, shock, or even death. Don't forget to assess lab indicators of acute inflammation, including C-reactive protein, erythrocyte sedimentation rate, and elevated white blood cell count, especially when many areas of the body are involved.
Treatment to-dos Drinking plenty of water is important to prevent dehydration while a patient has severe sunburn. Severe sunburn increases the metabolic demands in the body, requiring more fluid and a nutritionally sound diet to prevent skin breakdown and secondary infection as the skin heals. Most severe sunburns can be managed by the patient at home.
Most severe sunburns, while painful, aren't life-threatening, and treatment is primarily symptomatic. However, when pain is severe and the patient has systemic symptoms, it may be necessary to seek medical care. I.V. fluid replacement may be necessary in the ED. Systemic steroids are sometimes used to shorten the course and reduce the pain of sunburn when given early. In extreme cases, patients may require care in a dedicated burn unit. Morbidity and mortality associated with long-term sun exposure is related primarily to the development of various forms of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.
Teaching pearls Severe sunburn is better prevented than treated!! Protection from the sun and other light sources is the best defense against the damaging effects of UV radiation on the skin. Teach these important points to your patient:
* Avoid sun exposure, especially between 10 a.m. and 4 p.m.
* Minimize overexposure to light sources, including photocopiers, indoor lighting, and computer screens.
* Wear protective clothing, including wide-brimmed hats.
* Apply sunscreen with an SPF of 30 or more every 4 hours to exposed skin.
* Wear sunglasses with UV protection. Remember that the mucous membranes in the eyes are prone to UV damage.
* Use lip balm with sunscreen every 4 hours.
* Drink plenty of fluids, especially during hot weather.
* Avoid drinking alcohol. Alcohol can cause dehydration and also impair a person's ability to discern how long he or she has been exposed to the sun.
* Avoid smoking cigarettes. Nicotine tends to decrease circulation to the skin and can make sunburn worse.
* Schedule outdoor activities carefully. Limit outdoor activities to morning and evening hours. Try to rest often in shady areas.
Encourage patients to know their skin type. Some people burn easier than others based on age, gender, ethnicity, skin type, and general physical health.
Bright ideas!! It's important for you to perform a comprehensive assessment of your patient's skin and degree of sunburn, and provide care as directed by the healthcare team. The most important intervention for you to implement is to teach patients how to prevent severe sunburn. Help them to "stay bright" and "think right" with the sun and other light sources.
cheat sheet Treating severe sunburn * Drink plenty of water.
* Soak in a cool bath. It may help to add bath products containing oatmeal to decrease itching and burning sensations.
* Put cool, moist cloths on the sunburned skin several times a day.
* Take anti-inflammatory medications, such as aspirin, ibuprofen, or naproxen, to help ease the pain of the sunburn. These agents also lessen damage to the skin because they reduce the acute inflammatory effects of sunburn, especially when taken at the very beginning of the sunburn.
* Put 1% hydrocortisone cream or a moisturizing lotion on the skin three times a day for a few days. Aloe vera may sooth severely sunburned skin.
* Put calamine lotion on the skin to lessen itching.
* Take antihistamines. Keep in mind that these agents may cause drowsiness; don't drive or operate machinery or equipment when taking antihistamines.
* Don't try to open blisters. Let them open on their own, when the underlying skin can better protect itself from infection. Shallow blisters can be treated with an over-the-counter antibiotic ointment for a few days. However, these blisters need air from the environment to heal properly. Don't overuse antibiotic ointment. If blisters are red or look infected after a few days of topical antibiotic treatment, contact the healthcare provider.
did you know? The results of a new survey by the American Academy of Dermatology found that a troubling number of White teen girls and young women aren't being warned about the skin cancer dangers of indoor tanning beds by tanning salon employees. The 2011 Indoor Tanning: Teen and Young Adult Women Survey found that 43% of indoor tanners reported that they've never been warned about the dangers of tanning beds by tanning salon employees.
Figure. No caption available.
When asked if they were aware of any warning labels on tanning beds, 30% of indoor tanners said no. By age group, younger tanning bed users (ages 14 to 17) were more likely to be unaware of any warning labels on tanning beds than older tanners (ages 18 to 22)-42% versus 25%, respectively.
More than 3,800 White, non-Hispanic females ages 14 to 22 responded to a nationwide survey online to determine their tanning knowledge, attitudes, and behavior. For more on the survey, visit http://www.aad.org/stories-and-news/news-releases/new-survey-finds-tanning-salon.
Learn more about it CDC. Sunburn prevalence among adults-United States, 1999, 2003, and 2004. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5621a2.htm.
Land V, Small L. The evidence of how to best treat sunburn in children: a common treatment dilemma. Dermatol Nurs. 2009;21(3):126,133-137.
McStay CM, Elahi E. Sunburn treatment & management. http://emedicine.medscape.com/article/773203-treatment.
Patient education series: severe sunburn. Nursing. 2009;39(7):31.
Sarnoff DS, Saini R, Handel A. Photosensitivity: A reason to be even safer in the sun. http://www.roadtohealthyskin.org/photosensitivity-a-reason-to-be-even-safer-in-t.
U.S. Environmental Protection Agency. Sun exposure. http://www.epa.gov/radtown/sun-exposure.html.
Hi to all, I am back. I took a much needed run to Florida and did some fun things and work things and spent time with our daughter. I didn't even get on a computer, read a newspaper or watch tv the entire time so I apologize for leaving you up in the air but it was time to shut down for a bit. You know, something we should all do from time to time! We are back now and running. I was out pulling weeds in my flower garden and token vegetable garden at 6 am this morning. What does that tell you?
Yes, there is some insanity in there but lots to get done as even picked up a birthday present and father's day present this morning before work and now catch up on computer with emails and looking ahead at the schedule and what is in store for the rest of the week. I must say that I thank you all for being such a dedicated group and continuing to check the blog while I was gone. I was amazed by the following and hope that I can continue to bring you new things, informative things, and hopefully a smile every once in a while. I do think that you need to keep an eye out on the new information coming out on ER/PR status and testing. It seems to be all a buzz and something that I will be following and try to update you as we get more information. There are Task Force Reports coming out and what the NCCN guidelines are saying. In the meantime, I need to find my desk and promise to be back with more information this week. So for today, MAKE IT A GREAT DAY! S