Post Traumatic Stress Disorder: How Common is it?

Columbine-Memorial

Research shows that 7% of American adults suffer from PTSD at some point in their lives. That’s a respectable number. Compare it to other medical/mental health issues:

1% have Celiac disease

3% have Hepatitis C

2.6% have Bipolar Disorder

30% have High Blood Pressure

Post-traumatic Stress Disorder (PTSD) is defined as:

A pathological anxiety that usually occurs after an individual experiences or witnesses severe trauma that constitutes a threat to the physical integrity or life of the individual or of another person.

Per the DSM-5, PTSD is diagnosed if a person exhibits specific behaviors, such as flash-backs of the terrifying event, nightmares, intrusive or disturbing thoughts, avoiding places that bring back bad memories, numb feelings, edginess, restlessness.  It’s normal to experience these after any life-threatening or traumatic event, but with PTSD the feelings and behaviors persist after a reasonable time.

PTSD is mostly seen in war veterans, child abuse victims, and those who have survived awful incidents such as rape, torture, kidnapping, car accidents, plane crashes, bombings, and natural disasters.

You may have it.  A relative might.  Maybe a co-worker or a neighbor does.  Without a doubt you have brushed against someone who suffers from it.  I see patients with it every day as they have turned to self-medication with either drugs or alcohol.

Here’s something to think about – because we don’t know what other folks are going through let’s be generous with consideration. Don’t unnecessarily argue. Be a peaceful driver. Hold a door. Don’t post derogatory comments on someone’s blog. Give the benefit of the doubt. Get to know people.

Harper Lee quote

It sucks when people are mean.  It sucks more to have PTSD.  If you have it, please get help.  Talk to your health care provider or a trusted companion.  There is hope and healing. If you don’t have it – be thankful, and be nice.  Look around you and remember 7%.

Are You Washing Your Hands The Right Way?

hand-washing

There are lots of things you can do to keep yourself healthy, but nothing tops regular good old-fashioned sudsy soap and water hand washing. And if your hands aren’t obviously soiled, alcohol based hand cleaners will do. Proper hand washing is vital.

No hand dipping, fingertip only splash n’dry, quick soap rinse and go stuff.  Your technique must be perfect!

  • Wet your hands, generously apply soap, lather and clean under your finger nails outside the stream of water for at least 20 seconds – about the time it takes to sing happy birthday twice – in your head please. Rinse under running water.
  • Use automatic paper towel dispensers to dry.  Avoid the air dryers – they just recirculate germs.  Use your sleeve or paper towel to open the door or patiently wait for someone else to do it for you.

germ farm

Forgo hand washing? That’s gross and you are now a vehicle of disease transmission.  Why would you want to be a germ farm?  Science tells us hand washing removes some of the nastiest bugs: Salmonella, E. coli, Norovirus, Adenovirus, coxsackie, Hepatitis A, C-diff, influenza, and more.

shareasimage-13

Do yourself and everyone else a service: Help prevent infections. Wash your hands!  

Note: there are no known data to support the claim that water temperature is associated with hand-washing efficacy.

Flu Health Advisory: Something Wicked this Way Comes

John Henry Fuseli's The Nightmare

The CDC issued a health advisory yesterday.  The vaccine for this flu season will NOT provide protection against the predominant “drifted” strain of H3N2 that is now circulating and has already caused five pediatric deaths.
shareasimage-3
Yes, you should still get the flu shot because some protection is better than none, but you also must be prepared for the worst:

Despite being vaccinated, you may still get the flu.

How do you know if you have the flu?

The flu is a nasty. Bad, horrible, agonizing…and potentially deadly.

  • It comes on suddenly.  It usually starts with a headache and fever.
  • You’re exhausted but can’t sleep.
  • You get hot and feverish and then you break out in a cold, uncontrollable sweaty spasm of shaking chills (rigors).
  • Your head and lungs fill up and you cough, cough, cough.
  • Raw, sore throat.
  • Kids may get diarrhea, stomach pains, vomiting.
  • Your bones hurt, and your body is so achy you can’t even blink without pain.  You know you’ve got the flu because the only way to describe it is,
                           I feel like I’ve been hit by a truck.

    The flu is a respiratory illness – it is not a cold, it is not a stomach bug. Although It is caused by a virus, there is treatment for it:

    If you think you have come down with the flu, call your primary care provider as soon as your symptoms start.  If it’s the weekend, don’t wait for monday, if it’s the middle of the night, don’t wait for morning.  There are two FDA approved anti-viral drugs recommended to treat the flu: Oseltamivir (Tamiflu) and Zanamivir (Relenza) .

    These drugs work best when started within 48 hours of getting sick, but they can still be useful if given later in the course of the flu. The medications can make the flu milder and shorter. More importantly, if you are at high risk for complications, the treatment can divert a hospitalization and reduce the risk of dying.

    Now that we know what to expect, we can prepare.

    Something Wicked This Way Comes

    Something wicked this way comes and right now I feel like I just ate a cold snail raw.

Could Miss Piggy Have Pre-Diabetes?

Drop that donut. Spit out the candy. No triple-scoop chocolate indulgence drizzled with hot fudge, caramel and dusted with butterfinger bits for you or you’ll get diabetes.  You probably have heard that one before. Confession time: I too have said something similar  to my boys when they were little and gullible. It was usually around Easter or Halloween.

Truth? Sugar itself doesn’t cause diabetes. However, frequent sweet binges are a bad idea because you are robbing yourself of the nutrients your body needs to function properly.  Keep it up and your teeth will suffer, you’ll feel sluggish, maybe get headaches, and you will gain weight.  It’s carbs that are the the offender as our body  can quickly convert them to glucose.  A carb heavy diet over a long period (say a lifetime) will add to excess weight which makes one a prime candidate for pre-diabetes.

Pre-diabetes (or impaired fasting glucose) means that your blood sugar level is higher than normal, but not high enough to be type 2 diabetes. It is usually picked up on routine blood work for a physical. If you were told your fasting blood sugar (at least an 8 hour fast) was 100-125 on more than one occasion, that is impaired fasting glucose.  Your provider would next check a Hemoglobin A1c.

The A1C test measures your average blood glucose for the past 2 to 3 months. If it comes back 5.7-6.4%, that is pre-diabetes.

shareasimage-2

Consider it a blinking warning sign – because with this type of diabetes, most people don’t exhibit the  physical signs that are associated with diabetes: constant thirst, frequent urination, and extreme fatigue.

Unless you make some lifestyle changes, odds are you will progress to type 2 diabetes in about 10 years. Pre-diabetics may already have the start of circulatory system damage, so take this seriously.

Book nook: The Everything Guide to Managing and Reversing Pre-Diabetes: 

If you haven’t had your glucose level checked, get one done, and have it re-checked yearly.

If you have impaired fasting glucose, there is  good news. Research shows you can lower your risk of developing diabetes if you:

The bad news is if you don’t make these changes now, you are on the road to diabetes. Now that you know what you know, you can change your future. You can bypass the road to diabetes and take the route to health and longevity.

Does Miss Piggy have pre-diabetes? Nope. Muppets can get muppilomas and muppicitis, but not  pre-diabetes.

National NP Week is Not a Box of Chocolates

P1020681

November 9th-14th is National NP Week.  No this is not supposed to be a Hallmark holiday filled with chocolates, free lunches and thank you cards. That’s for Secretary’s or Bosses Day (which I think is bogus but that’s fodder for another post).

NP week was designed to be an Awareness Campaign to help educate the public about NPs, and to remind lawmakers of the importance of removing outdated barriers. This year is especially momental as it marks the passing of the NYS  Modernization Act: Effective Jan 1, 2015,  this new law removes the requirement of a written practice agreement between an experienced nurse practitioner and a collaborating physician as a condition of practice.

what's it like?

The one thing I was completely sure of when I began my career as a Nurse Practitoner was how much I didn’t know. The classroom time, credit hours, and clinical experiences satisfied my state’s requirement for NP licensure and national certification, but it would be a long while before I would be comfortable in my “new shoes”.

dansko

Preventative care, acute and chronic illnesses, childhood ailments, common health problems, medical mysteries, and terminal disease were to me a murky land and I was a pilgrim. When I began this adventure twenty-three years ago, there was no Epocrates, UpToDate, or other Medical Apps to sift through differentials and no google images to help identify rashes.  It was just me and my Hoole, and a collaborating physician who had faith in me.

My hands shook when I wrote a prescription. My heart pounded when I heard the complaint “chest pain”.  How could I do this? I wanted to run, throw my lab coat in the dumpster, and find a job at a coffee shop. I could do that, make a good cup of coffee.

P1040133

A year passed, things started becoming easier, and I grew in confidence. Year two, I no longer felt like an alien, I had gained experience. The fog of greenness had lifted. I had become a Nurse Practitioner.

Now it’s two decades later and National NP week.  I almost forgot about it, again! Then I saw a shout-out email sent to my department with me and fifty of my colleagues listed. It read,

National Nurse Practitioner Week. Please join me in celebrating the many accomplishments of the Nurse Practitioners, Clinical Nurse Specialists, and Physician Assistants in our Department. Their expertise, commitment, and team spirit are often the wind beneath our wings.

Despite the fact that last sentence starts Bette Midler singing in my head, that was gracious, and sufficient.  I don’t need candy, or to be taken out to lunch. This week is not about recognition, it’s about awareness. There are many misconceptions about who we are and what we do. NP’s are not MD’s. We have similarities, we are different.  We are not a replacement for doctors, rather we are a branch of the same tree: health care providers.

NP,  MD, DO, PA, CNS, CNM, CRNA, RN: Our Health Care Rock Stars  who do life saving, life-changing , ground-breaking, rad work. I applaud them all!

Being a nurse practitioner is not easy work. I think only another NP can appreciate what I mean by that. I don’t work in a posh office with Stickley furniture and catered lunches. No banker’s hours for me.  I have a ten-minute walk from my parking space to the hospital entrance. And when I greet my first patient,  it’s game on.  From the first to the last it’s all about them, not me. I listen, support, hold a hand, give a hug, look in eyes, encourage, reflect, help, guide, teach, smile and do what I can, with what I have, where I am.  And when I’m extra tired or feeling worn and thinking,  I need to retire , a patient will say something to snap me back to why I love my job.

“Thank you.  Can you always take care of me? You don’t know how much this means to me. You’re the first person that didn’t treat me like an addict.  Yes, I think this might work! I’m so glad you’re still here. You are good at what you do. I appreciate your kindness.”

Now that’s recognition. Hearing those words keeps me coming back. I chose this career, if I could go back in time I would choose it again in a heartbeat.  Kudos to my fellow NP’s and let’s not worry about whether or not we get a card, a latté, chocolate, or a thank you email. That’s for Hallmark fluff holidays. National NP week is about education and awareness.

All about NP’s: Downloadable Infographic

P1090666

If I Told You the Truth You Would Think I’m a Horrible Person

P1140783 Are you smoking? Do you do drugs? How much do you drink? Are you having sex? Is someone abusing you? Do you have thoughts of harming or killing yourself? Are you having an affair? Did you steal this? Did you cheat? What’s wrong?

Providers, parents, spouses, therapists, teachers, caring friends ask difficult questions like these. But the truth – the carefully hidden secretsare not easily disclosed.

Why?

Because.
If I told you the truth

If you knew what I did, what I am doing, what I really think.
I can’t tell you.  I can’t tell anyone.

I Can't Tell You Because
I Can’t Tell You Because

We need to build trust to gain truth.
When discussing delicate subjects or asking uncomfortable questions, keep in mind what is said is not always the whole truth.

The most important thing in communication is to hear what is not being said.  Peter E. Drucker

When taking a history I’ve learned to double the alcohol and cigarettes patients admit to. Out of breath, gum chewing, coughing, clothes smell like smoke tells me my patient is smoking despite her claims to have quit.

Impossible is always probable. Pregnancy tests come back positive despite emphatic insistence there was no possible chance.
I would never do that means I’ve already, I am currently, or I’m thinking of it.

People tell you what they think you want to hear. They don’t want to disappoint you. They don’t want to disappoint themselves. They don’t want you to think they are horrible.
Deny, lie, pretend, avoid, hide, bury, run, evade, fight.
P1150490 What do we do? How do we encourage honesty? How do we gain the trust of those we love or want to help?
Furthermore, wherever we find ourselves in life, how can we help others achieve their goals?

Of all the techniques I’ve tried to help me build trust to gain truth, the only thing I’ve found that works is to be genuine. To be real. To be me.
To show my vulnerability, my humanity, to accept others where they are, for who they are, and show them they don’t have to settle, they can change, there is hope, they are not alone.  We all have baggage, doubts, sins, and scars.

Tell your teen you are not there to judge, lecture, scare, or shame.
P1150503Reassure your client you are there to identify problems, accurately diagnose, propose proper treatment, and provide needed follow-up. If they are honest, you can better help.

Take an interest in a neighbor, your co-worker. Say their name, correctly. Let them know you see them.  Be a friend.
Clarify or restate what your spouse tells you when he is sharing his pain. Don’t interrupt.  It’s not time for sharing your feelings.
Remind your patient her medical record and your conversation is confidential. There are a few instances where you have to disclose what you’re told, be aware of those.
Establish trust, or you will never get truth.

I often ask my patients:

This is your life, are you who you want to be?

If not, what do you want to change, and how can I help?

What about you? What are your thoughts or reflections? Please share with me.

Hawaiian Tropic, Donny Osmond, and Tanning Beds

Hawaiian

Back in the day, I was a sun goddess.  Brown was cool and fish belly white was not.  My teenage summers were a blend of sleeping in, bumming around, swimming, and sunbathing. I’d start at Ten a.m. Dressed in my bikini – hard to fathom but at fifteen I was 5 ft 9 and 125 pounds.

Me and JeanI’m still 5ft 9.  Ok, back to the story.

Dressed in my bikini, I’d grease myself with Hawaiian Tropic Dark Tanning Oil, Turn the Radio on LOUD as living out in the country the only potential complainers would be the cows. And I would lay in the sun and bake.  Turn every thirty minutes, peel back the bikini bottom for a peek to assure good color, and call it a day before 2 o’clock.

Ah, the life of a 70’s teen.

no computers

So now I wait.  When’s the Basal Cell coming?  Is that mole a Squamous cell? Crap! I think I have Actinic Keratosis.  I’m DOOMED, I’ve established the foundation for skin cancer and all I can do is watch and wait.

And use sunscreen.

I can’t do anything to change what I did when I was young and stupid, but now that I know better, I do better.  According to The American Cancer Society, 

Most skin cancers are probably caused by exposures that happened many years earlier. The pattern of exposure may also be important. For example, frequent sunburns in childhood may increase the risk for basal cell cancer many years or even decades later.

The new bad boy on the block is tanning beds.  The tanning salons are everywhere, and the young, middle aged and even seniors are going on a regular basis for the relaxation and the joy of that golden bronze color. Sorry to be a bearer of bad news, but a new study confirms the indoor tan is a golden ticket to skin cancer.

The investigators found that indoor tanning was associated with developing skin cancer at an early age.

warning_sign

In May, the U.S. FDA announced that tanning beds and tanning booths MUST carry a visible warning stating that the devices should not be used by minors under age Eighteen.

So far so good: no skin cancer for me. Now,  I stay out of the sun, have at least two dozen bottles of excellent sunscreens scattered about for easy access for me and my family, and I think fish belly white is beautiful and Donny Osmond is still cute.

Chief Complaint: Top Reasons We Go to the Doctor

P1110588The Mayo Clinic reveals the top reasons for health care provider visits:

  • Skin disorders: acne/cysts/rash
  • Osteoarthritis, joint disorders, and back pain
  • Cardiovascular problems such as high cholesterol, stroke
  • Upper respiratory conditions: cough, sore throat, ear problems
  • Anxiety, Depression
  • High blood pressure
  • Headaches, migraine, and other neurological conditions
  • Diabetes

That’s what the research tell us. If I had kept tabs on the thousands of people I have seen over the years, my list would look more like this:

  • 6 month and annual check up: AKA you have to come in to get a prescription refilled.
  • Respiratory: cough, cold, ear ache, allergies (or can I have an antibiotic)
  • Back pain
  • Hypertension management: usually smoking and obesity related health issues
  • Routine health maintenance: vaccinations, women’s care, sports, and work physicals
  • Other: I would include depression and anxiety here.  Rarely did I see patients calling in with depression as a chief complaint.  It was something else that brought them in (joint pain, stomach problems, sleep issues), and through talking it was obvious clinical depression was the root cause.

And then there were the surprises that made for a challenging day: thoracic outlet syndrome, lacerations, shingles, really big hemorrhoids, genital warts, foreign body in ear or other body openings (always very interesting), mono, deep vein thrombosis, melanoma, scabies, lice.  Why did I always start to itch after seeing a kid with lice?

As much as you hate the automated phone tree, co-pays, wait time, and general inconvenience of going to the doctor, don’t neglect your health.  If you take good care of it will repay you in kind.

heart health

 

Top 10 Reasons to Keep Smoking Cigarettes + 1 Bonus

cigaretteI love to help my patients quit smoking.  Both smokers and non-smokers agree: smoking is a terrible habit and is horrible for your health.  Smokers tell me that all the time!

I know this stuff will kill me, and it’s nasty.  My kids are on my case to quit.  Why haven’t I quit yet? Well, I plan on it, yessiree.  BUT….

…right now’s not a good time.  One addiction at a time for me.  I’m under a lot of stress. I can’t afford to gain any more weight.  I have four cartons left, I have to use them up first.  My husband refuses to quit with me, as long as he smokes I can’t quit.

Those are actual statements patients have said to me.  I respond with empathy:

Yes, quitting smoking is hard work.  Certainly, you are under considerable stress. True, I want you to be successful in your opiate addiction recovery. Definitely, a partner who quits along with you helps tremendously.  Maybe next time we can revisit this?

Am I helping by being understanding, and reassuring?  Or am I just dancing around the truth.  The truth is

quote

The truth is: you like smoking and don’t want to quit.

Can’t you just tell me the truth instead of coming up with the lame excuses? How can I help someone if they don’t want to change? Maybe I should reconsider my approach and try something like:

Top 10 Reasons to Keep Smoking:

  1. You keep me in business
  2. You keep dentists in business
  3. You keep tobacco companies in business
  4. You keep the government in business
  5. You get moody when you try to quit smoking –  keep smoking and stay happy
  6. Your Uncle Frank smoked 3 packs a day for over 50 years.  He lived to be 99
  7. Your wrinkles and puckered lips make me look better
  8. A husky voice is sexy
  9. You like being sick. It feeds your need for attention
  10. You already tried once to quit and you failed, why put yourself through that again, sheesh

Bonus: You get more frequent, longer work breaks than your non-smoking coworkers.

I don’t mean to sound harsh. Nah, maybe I do. When you see pregnant women smoking, dads hanging a butt off their lip while holding their child, teens parading their smokes in public, and folks in their prime of life dying from lung cancer, you get tired of the excuses.

And for the record, the average person only gains 10 pounds with quitting.

quit smoking

It is better to offer no excuse than a bad one. George Washington.

5 Common Health Beliefs Busted as Myths

vitameatavegamin

Have you ever believed some health claim over the years and thought it was true because everyone repeats it? Did you ever question – really, where did you read that?  Or, how do you know that’s true?

P1120693

It may be common knowledge, but it doesn’t mean it’s true.  Let the believer beware: next time your workout buddy tells you your exercise routine stinks because you didn’t break out a sweat, ask where he learned that from.

Debunked: 5 common health beliefs busted as myths

  • You must drink 64 oz of water a day to stay healthy or lose weight

Fact: you should gauge your fluid intake based on your thirst and the color of your urine. Clear non-yellow hues is what you are “aiming” for. Dark yellow, amber, cloudy indicates your fluid intake is inadequate.  And no, your fluid doesn’t just have to come from plain water –  liquid beverages and the water in foods all help hydrate. However, if you drink calories, you are setting yourself up for weight gain.

  • You’ll get sick if you go out in the rain or cold without a jacket.

Fact: You’ll feel colder but you won’t catch a cold.  We do lose heat through our heads, so  wearing a hat or drying your hair makes sense if you want to feel warmer.

  • Don’t swallow your gum: It will never digest.

Fact: It will digest just fine and will come out your other end in about two days.

  • You should take a daily multi-vitamin.

Fact: Studies have shown multi-vitamins don’t improve your health.  What does? Eating a colorful, balanced diet.  What you would spend on vitamins spend on real, non-processed food.

  • Never read in dim light or you will hurt your eyes.

Fact: Your eyes may get tired but you won’t damage your eyes or permanently affect your vision.

For tons more medical myth busting, visit UAMS or email them your question: medicalmyths@uams.edu

Mencken quote