Yearly Flu Vaccines may be Obsolete ... eventually

"Have you got your flu shot this year??"  might soon be a question of the past.

The latest research at UBC (Vancouver) suggests that the testing they are now doing may eliminate the need for the yearly flu immunization.



Read their media release in it's entirety:

Led by Prof. John Schrader, Canada Research Chair in Immunology and director of UBC’s Biomedical Research Centre, the research team found that the 2009 H1N1 “swine flu” vaccine triggers antibodies that protect against many influenza viruses, including the lethal avian H5N1 “bird flu” strain.

As it says in their commentary - this research can "potentially make influenza pandemics and seasonal influenza a thing of the past".

Yay.  I can't wait.  

Although there is a whole lot worse than a needle stick -  in my opinion - - - -

The fewer, the better.

Expand Taxation: a Viable Option

I have blogged on this subject before, however, a new poll taken in Canada has surfaced that shows Canadians are in favor of legalizing a Certain Herb - 66% in fact.

It's no surprise that B.C. residents are the top supporters of legalization at 73%.  Quebec was the lowest at 61%.

It just makes good health and economic sense -  and in addition,  it takes the money and power out of the hands of the criminals.

It is estimated that $400 million is spent annually for police, courts, and prisons to enforce the current laws.


Wouldn't that money be better spent elsewhere - say nursing care or education.....? 

The taxes gleaned from governmental controls and distribution (similar to alcohol) would be enough to take a chunk out of the deficit and also remove the criminal element so those wanting the pleasure of medicinal (or otherwise) use of the Herb can do so without fear of a criminal record or the possibility of ingesting/inhaling a product that isn't safe.

The Liberals are on board, voting 77% in favor of legalization.  The Senate special committee (chaired by a Conservative) had also given the recommendation to FREE THE WEED - 10 years ago!  I had published some of the findings and recommendations in a previous blog post that somehow got taken down.

Certainly The Herb is not as damaging as alcohol, cigarettes or Tylenol .......

The age group most in favor of it's liberation?  My age group and older - age 55-64.  If people could get over the stigma and smear campaign that has been waging in the media and political field.... and if politicians can look at and act on actual  statistics that show Legalization is the best route to take - perhaps they can make the changes - before I retire -  so that I can look forward to a  *comfortable* retirement.

I happen to not like the taste of alcohol.  I like wine but it makes me turn a beet red.  I don't like the side effects.  I need pain medication for various aches and pains ( some admittedly of my own doing - skiing and occupational injuries)  but don't want the damage that tylenol/NSAIDS/cortisone injections can do.  I happen to like my liver.

The Weed is a useful herb that can be affordable if grown in one's own house.

I am all for it and even though politically I am more on the Conservative side (by the way - for the record - "Conservative" in Canada is definitely not equal to "Republican"! We are too far left)

Stats show that legalizing MJ actually helps control it's use.  Look at how education -  as opposed to prohibition has led to the decrease in smoking and drinking in recent years.

If all those kids at the Stanley Cup Vancouver Riot had been puffing instead of drinking....perhaps there wouldn't have been a riot at all!  

Definitely the surrounding stores would have benefited from the extra demand for munchies.

The Insidious Tylenol

Ok, so now the USA is on board with reducing the recommended daily dosing of Tylenol.....
why isn't Canada following suit?

thank you once again, wikipedia

It should have been done long ago.

It certainly isn't because Canadians are smarter about their use of Tylenol!

Believe me. They aren't.

I can't tell you the number of patients of mine that tell me they have just exceeded the recommended dosage by the handfuls because the normal dosage " didn't work".

Not that I have mentioned a caution about Tylenol in a blogpost previously - and the damage it can cause!


If the normal dose didn't work to reduce your extremely high fever:  get checked out by your MD (preferably before the office closes to avoid an ED visit!)  - the danger is with what's behind the fever - not the fever itself!

If the normal dose didn't work to make tolerable your extreme pain: get checked out by your MD (ditto the above in parenthesis!) - pain is there for a reason.  ( please note that I didn't say TAKE AWAY YOUR PAIN ENTIRELY)

And please, when you are dosing your children - read the labels.  There are so many products with multiple medications in them.   Try to use only those products that have single medications in them - and only if you have to.

Take the time to read the fine print. 

It may save your -  or your child's - liver.

56,000+ dying livers countrywide due to Tylenol use must mean something, after all.

Terbutaline for Preterm Labor - Should it be used?

I did my L&D training in the East Bay Area of San Francisco.

One of the routine practices, although not approved by the FDA, was the "off label" use of Terbutaline or "Brethine" (bronchodilator) to treat pre-term Labor.

We gave sub-q injections, followed by oral pill form when stable, as routine practice.

I never really questioned it at the time because that was the standard protocol we would follow for preterm labor in those days.

When I moved back to Canada, I noticed the glaring absence of Terbutaline on the labor units.  In fact, none of the gals I worked with had even heard of it. 

I asked one of the OB docs why it wasn't used in Canada.  At the time,  his reply shocked me.

"Because" he stated, "it isn't proven to be effective in stopping labor."

I can only speak for British Columbia, but as a practice, the primary treatment for preterm labor seventeen years ago when I moved back to Canada,  was the administration of fluids and  Indomethacin  or perhaps nifedipine - in the five different hospitals I worked.  We may have even used MgS04 a time or two before it went by the wayside. "Bedrest" was a joke, really.

I remembered back to my California days when we would care for pregnant moms-to-be in what was classified  as "Preterm labor".   The monitor recorded "contractions" would quickly smooth out with the administration of Terbutaline.  So really, what was it doing, if it wasn't stopping preterm labor?

I suppose a clue can be found in this question - What is the definition of preterm labor?

True Preterm Labor is gauged only by the progressive change in the cervix by contractions (between 20 and 36 weeks gestation) -  not by the contractions alone.  

When a health care worker is assessing contractions, it is necessary to palpate contraction strength with hands on the abdomen and actually feel them.  The appearance of the bumps on the monitor isn't an indication of their strength - and yet how often do we see this as the sole determination of contractions?

There is debate that the contractions appearing on the monitor that were "smoothed out" by the terbutaline were even strong enough to do anything in the first place.  Basically, what we were actually doing with the "Terb", is getting rid of the irritability that was appearing so the mom didn't have to be kept in the hospital any longer than necessary.  No contractions = discharge = less expense.

The truth about terbutaline is that there is a lack of controlled studies that support the use and it may even do harm.

So how do we treat preterm Labor?

In B.C. there has been an increase in the number of preterm births - especially noted in the 33 to 36 wk age group, immature lung development being the most challenging problem as a result.  

Because of the advanced maternal age of the women giving birth in recent years, and also the fact that older moms have a higher instance of multiple births which in turn are also are more susceptible to preterm birth... it makes sense that the statistics have been on the rise.

But - guess what?

"Clinical trials have not been able to demonstrate a reduction in preterm births from the following prevention strategies: home uterine activity monitoring, frequent digital cervical exams, bedrest for twin pregnancies, tocolytics, and education about the signs of preterm labor among women with identifiable risks."


So, as far as tocolytics go, according to our province's policy for Perinatal Services in B.C., "there is no evidence demonstrating that the use of tocolytics to arrest preterm labor  results in a reduction of preterm mortality" - both long and short term administration. 

In our province, the only tocolytic recommended is Indomethacin - and only up to 32 weeks gestation - and the primary aim in its administration is to give Betamethasone a chance to mature a baby's lungs and to ensure a safe transfer to a facility that can adequately care for the premature infant.

I can remember a brief time when Magnesium Sulphate (MgS04) was given for pre term labor. It has since been shown to not only be an ineffective tocolytic, but its use is associated with an increase in mortality for the infant.  It is strongly advised by BC Perinatal Services not to use MgS04 as a tocolytic.

Another medication I have seen used is nitroglycerin.  Apparently there is no evidence supporting the use of nitro as a tocolytic either.

When I worked south of the border, every woman who walked in through the door in preterm labor had an IV started.  Surprisingly, there is no evidence supporting  IV hydration to prevent or arrest preterm labor. 

Definitely it can benefit a woman who is dehydrated, which, when I lived in a very hot area of Canada in the summer, we would see plenty of those.  In the hospitals I worked in North of the border, we were more likely to hand them fluid to drink rather than an IV infusion.

One will find that bedrest is still recommended for those singleton moms in preterm labor,  both sides of the border - either at home or in the hospital.  Interestingly,  there is no evidence for or against bedrest in the prevention of preterm births. 

Even for twin pregnancy - there is no evidence supporting routine hospitalization for bedrest in the prevention of preterm birth - and until there is a study that shows otherwise, BC perinatal policy states there is no indication for this practice as routine.

So, what is left if nothing really works?

Basically, the use of cervical ultrasound and the use of fibromectin test are useful in identifying those moms in preterm labor who need to be stabilized and transported (with infant in utero) to a facility that can adequately care for a premature infant and the results can possibly be used to reduce the number of interventions done to the woman - such as the unnecessary use of tocolytics for those not at risk and more appropriate identification of those who can benefit.   Read here for the discussion on this (5.3 and 7.2).

So - what do we do when we know that evidence based medicine is best ?  When what we have done in the care of pregnant woman for since forever is not what research shows we should be doing?

Why are clinical trials and research done if it isn't going to change the way we do things?


*********************************
Thanks to the BC Perinatal Health Program for the information online.

Hold the Tylenol! Fevers do NOT cause Brain Damage!

If your little one has a fever, what is the first thing you do?

Get out the acetaminophen (Tylenol) or ibuprofen (Motrin/Advil), right?

thanks to Purdue University

It is a known fact that fevers help a body FIGHT an infection. It is a NORMAL and HEALTHY reaction to illness and shows your immune system is working the way it is supposed to.  Giving Tylenol unnecessarily may lengthen the healing process.

For low grade fevers, you can even hold off on the antipyretic (fever reducing medicine) and instead treat with sponging off or bathing with tepid water (DON'T use cold water, ice, witch hazel or rubbing alcohol!), hydrating with extra fluids, and dressing lightly - and don't pile on the blankets either!

All you are trying to do in treating a fever is - make your child comfortable.  Fevers do not cause brain damage despite what your well-meaning neighbor/relative/internet source tells you. Research says otherwise.

It's the symptoms around a fever that determine the seriousness of an illness.


Symptoms of concern:

1.   Breathing:  If your child is struggling to breathe, has flaring nostrils, sucking in between or under the ribs, muscles straining on the neck while sitting in a "sniffing" position....you will want them seen by an MD, it doesn't matter what the fever is.  Blue lips, earlobes and nail beds are serious emergency symptoms, it doesn't matter what level of fever.

2.   Dehydration: If your child has not had a pee in 12 hours or more and it is dark in color and less in amount and dwindling....that is a cause for concern.  They should pee every 6-8 hours.  You might want to consider switching over/adding Pedialyte if they are not taking in much.  Get it into them in whatever way you can - using a  spoon, dropper or whatever.  Dehydration is serious - no matter what the fever is.

3.  Lethargy:   If your child is limp like a rag doll, not responding and muscle tone poor and no matter what you do - they don't respond - it is a serious emergency - no matter what the fever is.  Yes, your child will not want to play as normal or be as active when they are ill - that's their bodies telling them to slow down so it can heal itself -  but they should still respond to you and recognize you and know where they are.

You can see the theme developing here.

A fever in of itself is not harmful.  Once again: it is the symptoms around a fever that determine the seriousness of an illness.

Children do tend to run higher fevers than adults. A body will self-limit a fever.  Your body has a thermostat that self-regulates, and despite what some well-meaning person told  you - your fever only will go so high....unless of course you are in an enclosed space with the sun beating down to over heat you - and that is something that is entirely different from a fever.

 If your child is comfortable, drinking sufficient fluids and peeing normal amounts and seems to be improving - you don't even need to give Tylenol/Motrin.  Remember: all you are trying to do is keep your child comfortable with the Tylenol/Motrin for the 3 or 4 days it takes to get better.

On the other hand, if your child has any of the symptoms above, or has a high fever that doesn't come down no matter what you do to treat it - that may mean your child may need to see an MD.
So, remember.

A fever can be your friend.  Don't panic at every little fever.  In an age that has Tylenol/Motrin as one of the main causes of liver damage - it might be a better idea to hold off on the medication.

 If there are NO OTHER SYMPTOMS, you can safely treat an axilla (underarm) fever of 40C (104) at home with medication, as long as it comes down with treatment by one degree in an hour.  If it goes up above 39.5 (103F) again after the effects of the medication wear off, take the little one to see your family MD before the end of the day or the following morning. 

Plan ahead.  If the fever lasts for 72 hours, make a trip to your family MD or Local walk-in clinic just to keep ahead of the game and avoid a possible Emergency Department visit.  Don't be disappointed if the MD tells you your child is "OK" or he/she "doesn't do anything" - after all, the last thing you want the MD to do is give an Rx that your child doesn't need or say is that your child is deathly ill, right?

If you do decide to give medication:  READ THE DIRECTIONS CAREFULLY.  Acetaminophen/ibuprofen, although seemingly innocuous - can - if used incorrectly - cause more damage than a fever.  Remember to give the medication an HOUR to work.

AND - NEVER NEVER NEVER give aspirin/asa to anyone under age 20.





Disclaimer:    Always follow your MD's advice. The above info is GENERAL info ONLY.   I am only a blogger, a retired nurse,  not your doctor.  I am not a substitute for a visit to your MD.   For babies under 6 months old, please consult your MD, as different standards/symptoms apply.  Information taken from reliable up-to-date sources.

Post operative Incision Care Drama

I am so glad that when I had surgery last year,  I didn't have to have one of these put on me.   But I guess I wasn't about to lick my wounds "clean" or mess with them in any way......

HOWEVER.

It's amazing what people will do with their wounds - including scrubbing the incision with a rough facecloth, applying outdated polysporin they fished out of their "medicine drawer" that they had used previously on a dirty wound from ages past (applying with their fingers!), picking off their steri-strips the day after, taking a bath the same day, applying hydrogen peroxide or Mercurochrome or iodine to their  incisions.........

People! Don't do it!!! Leave it alone!  And just because you see a teeny spot of blood on a dressing doesn't mean you need to rip it all off!! A tiny bit of blood does not equal "dirty"....

Watch, of course, for increased swelling, pain, warmth, red streaks leading away from a wound, fever, drainage of pus, excessive bleeding (and ask what is excessive if you don't know!) or a wound that is gaping or extending.  ASK about when you need to change the dressing, if at all and make sure you get a print-out of instructions upon release from the hospital or MD office......and clarify anything you don't understand before you leave.

And, please - if your wound HURTS increasingly so - rather than taking  handfuls of ibuprofen or Tylenol -  there is a REASON for the pain....please go back to your healthcare provider for an assessment (don't wait until you have left yourself no choice but emergency care ).    Excessive amounts of these drugs can harm your liver /kidneys/stomach and overdosing (intentionally and unintentionally)  on these OTCs are the number one cause of hepatic (liver)  disease/failure in the USA.  Especially if you are liberal with your alcohol consumption or have Hep C and the like.

Please. If you are taking medications - read the instructions.  You would not believe how many people think that MORE is better.  It isn't.

There. That's my public service announcement for the day.

ASPIRIN: not as effective as we thought

Here is a new study out of UBC (and St Paul's Hospital) that suggests that ASA is not as effective as once thought for preventing first time MI's - the benefits are only "slight" and the side effects from regularily rx'd asa to certain groups may outweigh the side effects.

However, it does benefit those who have had an MI already - reducing a subsequent MI by 20% - and it also may prevent Strokes in women. Apparently ASA doesn't reduce the risk of MI with diabetics and women - as previously thought.

"Some have postulated that ASA may be ineffective in women because of male-female differences in salicylate metabolism or interactions with hormones" - so the article says.

Read about it here in the BC Medical Journal.

It isn't going to stop me from grabbing a tab and chewing on it if I ever thought I was having an MI.

The Posting that Got Me Into Trouble....

This is the posting that had me remove my blog for a while.  I have since edited it...and hopefully it will keep the powers that be away.....

My Friend Mary...Wanna..

I notice that prop 19 in California may not only decriminalize marijuana but also legalizes the growing and producing of cannibus. It also allows the government to tax said recreational drug. I suppose California is in such a bad financial state that the government needs the extra cash it assumes this will generate.

Massachusetts has already decriminalized it.

The USA is sounding more and more like B.C. all the time.

What are my thoughts on this? Well, those who are my age I am sure that at one time or another have "inhaled".......or eaten that brownie - at least once. (Ok. Except maybe my friend Jan) Especially in this province well known for it's "B.C. Bud".

Which brings me to this funny story - Or maybe not so funny:

I was preparing to work in Washington state approximately 10 years ago. I transferred my license from California to WA state and then applied at a Nurse Agency, I had to go to Seattle, write a plethora of exams and then - submit to a drug test.

Now, in B.C. there is no regular or initial drug testing required for any nursing personnel. I know some occupations here do, but not nursing. Actually - that's interesting, come to think of it.

Anyway.

I gave the typical sample for testing. The gal did her thing, then squinted carefully at the results. Apparently it came up "equivocal". I looked over her shoulder, oblivious to what the interpretation meant. Since it was my first time (drug testing) I wasn't sure of the problem. Or the results.

"Hmm? What does that mean?"

"TCH" she said

"Does that mean I am positive?"

"Well, not really, sort of - borderline"

I laughed. Thought it was funny. A joke. There was absolutely no way. My husband even laughs at me because I don't recognize the smell of that funny smoke.  "Whew....there's a skunk around here...."

Luckily the girl shrugged it off and said - " Oh well, I guess it's OK....."
I must have sounded naive enough.  Which I was.

Then I thought of where I was on the weekend prior to the testing. Could it have been affected by inhaling second hand smoke? Most resources say no. HOWEVER. They DO say they wouldn't rule it out completely if it was inhaled in great abundance second hand.

I happened to be out the evening before at a bar for a drink with my then husband. There was heavy smoke in the air - being that this was before the outright ban of smoking in public areas. Some of it was that funny smoke. Or should I say - most of it.

From what I understand.....if one is in an enclosed area (which I was) and it was filled with so much smoke that the eyes were bothered by the smoke (which they were) there is a possibility of registering positive (which I wasn't). Testing is dependent on the "threshold" for positive.

That makes sense. "B.C. bud" is in abundance here. It is the provinces' unofficial number one industry and export. It is openly used. Police don't even bother with you if they see you smoking a joint, as long as you look like a reasonably law abiding citizen and give them no cause.

And - It wasn't as if I had "flunked" the test, after all. It was just equivocal. And definitely I know I haven't touched the stuff lately.  I am in need of every brain cell I can corner and corral. I am not wasting one synapse needlessly.

Then I came upon this test kit site that claims there can be false positives for Marijuana if you take these drugs: Aleve, Ibuprofen, Ketoprofen, Promethazine, Riboflavin, Marinol and if you happen to have a kidney infection, liver disease or diabetes. Ya, any one of the first four, I could have taken.

But - gone were the good ol' days when we would have Baileys in our coffee in the am at the nurses station while the girls lit up their cigarettes - when we would go out all night and come to work in the same clothes we left in - all smokey.......but now ? Not a chance. I don't even drink a glass of wine 24 hours before a shift never mind sneak a toke - ever.

And what about the legalization of MJ?

I think in the past convictions for one ounce and under has created a criminal record for a lot of people who did stupid things when they were younger and now regret having a permanent history that shadows them 50 years later. This is unfortunate and can be tragic (almost kept my husband from immigrating to Canada from the USA!) and I don't think this lapse of judgement should be held against them.

I see a lot more abuse with alcohol than I do with MJ. Definitely there is more violence associated with alcohol abuse than with MJ.

I don't advocate it for underage groups. I don't advocate it in public places similar to the regulations for cigarettes and alcohol. I don't advocate its abuse in the same way alcohol is now abused ie. - I don't condone operating vehicles or going to work under the influence of anything.

I do see that it is medically useful in some cases, and in fact I remember to giving it out in pill form (nabilone) for nausea back in the early 1980s. I can see that the decriminalization will free police time that is spent on one-ounce-cases so it can concentrate on the more serious crimes. There is no point in clogging up the courts/justice system with minor things like this - never mind the expense involved.

Yet, what message does it send?
Are we heading down that steep and rocky slope of flagrant drug use?

Coming from a province that has typically a long history of shrugging and turning the other way when MJ is in use.....I am not shocked by the introduction of these laws and removal of criminalization. Even my parents, who are law abiding, very strict religious people (church 3 times a week!) are pro-decriminalization - and these are people who adamantly speak up against drinking beer or hard alcohol (a glass of wine is fine though!) and won't step into an actual Government Liquor Store.

It will be interesting to see what happens this November in California.