Fetal Alcohol Spectrum Disorders

As a medical assistant, I am required to have continuing education in order to keep current. Otherwise, I would need to retake an exam that is pretty tough and expensive. I was fresh out of college the first time I took the thing and still had to work hard on getting it done. It has been nearly five years this time. Tonight I attended an education session on Fetal Alcohol Spectrum Disorders.

The first thing I noticed is the word “spectrum”. It is used in describing certain disorders like Autism’s wide assortment. I like this word when it is relating to light through a prism and the resulting colors. In this case it means “a continuous sequence or range” (Mirrim Webster, 2017). I do not like it so much in this context: Spectrum these days bodes ill.

The second thing I noticed is that I had some wrong ideas about drinking while pregnant. I stopped drinking after I found out I was pregnant, but like many other women, I had been drinking at the beginning of the pregnancy. My ex-husband and I were convinced that to wait to have a child until we could afford to meant to never have a child, and so we were kind of trying to get pregnant. I just never once thought about what it meant, and how soon it would happen. We rocked out and partied on the New Year’s Eve, and then, I found out I was pregnant. Just a few weeks later. So, probably at the sixth week in. Like most women.

The third thing I noticed was that there is a huge discrepancy in what pregnant women and women who are trying to get pregnant are told about drinking during pregnancy. Some physicians say just a drink of wine is safe. Just one drink every now and again. Others say no alcohol is safe. And that was the bottom line of this education event: No alcohol is safe. Not drinking alcohol is the best for the child’s safety.

Resource from the Center for Disease Control, Alcohol and Pregnancy

In the first week of development, the central nervous system is developed, and the head of the child. The face of the child. Week two is arms and legs and eyes. Week six is the development of teeth and the palate. When does a woman usually find out she is pregnant? Usually towards the end of this time frame.

Listen to this. Listen carefully. This was part of our lesson tonight. Fetal Alcohol Spectrum Disorders (FADs) are caused solely by prenatal alcohol exposure and are NOT hereditary.

During this presentation, I learned that Fetal Alcohol Spectrum disorder is caused solely by the mother drinking during pregnancy. There is no other cause. It is totally preventable, but there are pretty high occurrences.

But, we all know about alcohol. It is legal, and it even has certain health benefits! Fetal alcohol spectrum: That is caused by someone who is a drunk, someone who can’t live without their next drink. Not by social drinking, can’t be. Not by an occasional wine cooler! Look at the gals who are poor, or a certain race, or are falling down stinking drunk.  There is no reason to panic. No reason to stop drinking.

Note that this is not saying that FASd is caused only by alcoholic mother drinking while pregnant. Nor does it define the race or social standing of the mother. It is not laying blame. It is giving the source for FADs, a source that is undeniable: The mother drinking alcohol while pregnant.

While some children are clearly FASd, many do not show the physical attributes. Our speaker was saying that a lot of kids are misdiagnosed at Autistic, ADHD, or something similar. These kids have social issues. They don’t have good boundaries and are often taken advantage of by their peers, or they are pranked by their peers. They lack good judgement. They are impulsive. One of the videos the speaker showed was a young man who said he just walked across the road in traffic and got hit. He didn’t think. He has poor judgement and decision making skills. He got hit.

Depression, anxiety, mood disorders, high risk behaviors; these are all symptomatic to children who are born with FASd. They look like other disorders and are often misdiagnosed because there is not link to show that the mother drank while pregnant unless the mother specifies to her doctor that she did drink while pregnant.

“Few estimates for the full range of FASDs are available. Based on community studies using physical examinations, experts estimate that the full range of FASDs in the United States and some Western European countries might number as high as 2 to 5 per 100 school children (or 2% to 5% of the population).” (Fetal Alcohol Spectrum disorders (FASd), 2015)

The fourth thing I noticed is that some of the symptoms and attributes were similar to dementias. I asked if there were studies or information about senior citizens with dementia and FASd. This is just beginning to be looked into. People have drunk while pregnant for centuries and this is just now being looked into. This is important to me because if a patient is misdiagnosed, they then receive the wrong treatment. The wrong treatment can be catastrophic. Deadly.

My daughter is fine. She is smart and talented. She is amazing to me, a gift. Many other mothers are looking at their children and remembering that they had drank during the beginning of their pregnancy, and their kid is fine. So, this must not be a real problem, right?

But some issues don’t turn up right away. Some are only visible later in development. Some are nearly invisible. Behavioral issues can have other causes, right? Children can be misdiagnosed without the whole facts. And once again, FASd is not always visible with facial markers clearly stating this mother drank, and this child has this disorder. Another point to consider is every pregnancy is different. Every child is different. You may have “dodged a bullet” with this one, but the next child may not be so lucky.

It is not a myth. It is real, costly, heartbreaking, and documented.

The fifth and most glaring thing I noticed is this. There is a huge uproar about vaccinations being the cause of autism and other similar issues.

There seems to be no uproar about Fetal Alcohol Spectrum disorder.

Here are a few links with more information regarding FASd:

https://www.cdc.gov/ncbddd/fasd/data.html

http://www.marchofdimes.org/complications/fetal-alcohol-spectrum-disorders.aspx

http://www.nofas.org/recognizing-fasd/

https://www.youtube.com/watch?v=h7q5SiO4HBU

https://www.youtube.com/watch?v=dHRZjTiFEHs

The Rest of the Story

While looking around online, I found that the newspaper I usually read doesn’t have obituaries from a nearby town. I went online to see where to find obituaries from that town, and in doing so, discovered someone I had met and liked had passed away. He was a bit of a character. His accent made me homesick for friends from Germany I had met along the way. He was discouraged by his health and by loneliness.

I only knew a little part of his story. I would have loved to know more. He came from Berlin to America, served in the military here. He loved and had a family. He played soccer. Who knew?

We, in our various jobs and activities in life, meet up with people who are at different points in their stories. Sometimes we get to know them well, but still have no idea at all who they are. Even our own parents’ stories are unfamiliar to us. The young girl who loved baseball. The boy whose father turned away from his family.

In the doctor’s office, time is so very limited to chief complaint and not much more. Vital signs are taken but no time is given for the vital questions. Hard to put into words, people tend to say to their doctors “I’m ok.” If they say “I am not ok” it is often followed with “what are YOU going to do about it? Fix me!” but it is ambiguous. Doctors aren’t really about gathering stories other than what the vital signs, labs, and physical examinations cover. There are psychiatrists, ministers, and such who are more adapt at it. If a person can be seen and heard by one or the other.

And who cares for the doctor? Who listens to their stories, holds them in their grief? Who laughs at their peculiarities?

I worked in a nursing home and had the care of some folks who were gone deep in to Alzheimers, or similar end of life prisons. So little was left of the vital and vivacious people they were. Little hints here and there: a mink in someone’s closet. A photograph.  A phrase. The fellow who had so enjoyed driving his little speedy car, the same car that robbed him of the ability to stand and walk after a bad accident over fifty years ago.

A lady there was not able to feed herself or digest food that hadn’t been processed into a paste. She was nonverbal. The food looked awful. Someone who was feeding her was playing “here comes the airplane” to get her to open her mouth.

She spat it out at him.

In her former life, she had been a cordon bleu chef.

I have met frightened, depressed people who once were alive and on fire with living. I have held the hands of folks who are getting on to the end of their story, the final page before “the end.” They are bewildered that all their life has led to this. Why this. Why like this?

Time is running rapidly and we just don’t have time to stop, remember, and listen. That is how people become things. A bother, a waste of time.  Inconvenient.  But we are human and they are human too. Would it kill us to find out a little more? To hear the rest of the story?                            

I am getting older and find I am forgetting parts of my own story! That is shocking, almost as shocking as seeing my face in the mirror and not seeing the “me” I think I am! And if I forget myself, what is there left?

So I am working on gathering stories. 

Lifeline Screening

I have been aware of Lifeline Screening for some time now. At first I pictured it for the Medicare crowd only, but now I believe it is a service that anyone could and should take advantage of. And so, today, I did go in for screening while they were here in Frankfort, Michigan.

My Dad had heart attacks starting in his early twenties and ended up having bypass surgery in 1977, when it was still new and almost theoretical. He had eight bypasses. My siblings have all three, suddenly in a very short time frame of each other, had heart issues and have had stents put in. My closest brother had bypass surgery, nothing like Dads, but still scary. My grandparents on my mother's side suffered from Diabetes and stroke. My sister has diabetes. Mom's cholesterol levels were always sky high. She had bone issues from childhood on. 

We are a genetic walking time bomb.

I am pretty  healthy except for weight issues and some structural problems. (A bum shoulder and a really bad Achilles heel problem with bone fragments.) I didn't smoke in spite of attempting to a time or two. I don't drink much anymore. Genetically, I am inclined to alcoholism and don't have time nor money for it. Mental health is pretty good too, now a days. I am post menopausal, so yes, I am somewhat emotional and depressed. My husband doesn't quite get why I am a little obsessive about heart issues. All testing I have had done previously (stress tests, EKGs) have been fine. 

I figure better safe than sorry.

So when a letter from Lifeline came in my mail I wanted to get these tests done that no way could I afford otherwise. For under $400.00, I could get bone density, carotid artery and abdominal aorta ultrasound, testing for atrial fibrillation, peripheral artery disease, c-reactive protein screening and even glucose screening. 

If nothing else, these tests will provide a baseline in my medical history. 

I had to fast, no big deal. Comfortable loose clothing was requested to be worn. I arrived early, was processed quickly having pre-registered and prepaid the testing over the phone. The crew of ladies I met were very nice and very professional and quick. 

It will be a little while for the results to come back to me, but over all I am satisfied with the experience. I recommend this screening opportunity to you for its cost effectiveness and availability and thoroughness. 

In past medical positions, I have seen people come in either immediately from Lifeline Screening events with medical concerns that needed addressed ASAP, or with results that give their physician a leg up in providing good treatment plans for them. If you have not considered it, maybe take a look at it for yourself. If your family history is like mine, this is a great tool to evaluate your health.

Here is some information from Lifeline Screenings website

Available screenings:

Testosterone Deficiency Screening

Vitamin D Screening

Heart Disease Screening

Congestive Heart Failure Screening

Carotid Artery Disease Screening

High Cholesterol Screening/Lipid Panel Test

Chronic Obstructive Pulmonary Disease (COPD) Screening

Atrial Fibrillation Screening

C-Reactive Protein Screening

Lung Cancer Screening

Abdominal Aortic Aneurysm Screening

Health Risk Assessment - 6 for Life

Type 2 Diabetes Screening

Osteoporosis Screening/Bone Density Test

Peripheral Arterial Disease Screening

Elevated Liver Enzymes Screening

Chronic Kidney Disease (CKD) Screening

High Blood Pressure

Prostate Cancer Screening

Thyroid Disease Screening

Colorectal Cancer Screening

Interlochen Immersion

Summer 2009

                The reed kids were already at their table, making their duck calls and doodle sounds.  The lights were on, the instructors were assigned rooms, and I was assigned a broom and mop.  Blessed, blessed work without stress or fear of being called once more on the carpet for errors or misjudgments.  Mine, someone else’s, it was my mistake.

                I had been here before.  Well, not here; not in Thor Johnson Dorm, but on the campus of Interlochen in general, almost thirty years ago, learning the power of ammonia and Lysol brown cleaner.  Back then it seemed fruitless to talk to anyone but the other housekeepers and maids.  The students or campers were from another world from us-the world of the “haves” and we, well….

                My dream job was ending.  I felt it long before I admitted it, and felt the finality of it as well.  It wasn’t going to be just me, leaving; it would be the entire business closing like a book, The End.  My hours had been cut more than half, so Interlochen was an attempt to fill in the slack.  All summer I fought the inevitable.  I almost missed what was right in front of me. 

                The instructors, men in blue corduroy and joviality, were not what I expected.  I was timid to approach them until the cheese and the snippet of music.  The cheese was on Mike Davison’s door, a subtle hint at college days.  The music was the WYSO piece of the year:  Symphonie Fantastique.  Da! Da! Da didi Da!  Da!  Da!  Da didi Da!  Mike coached his students, emphasizing the punch of each note. Powerful!  Hmm, familiar.  What was it?  I finally asked him.  He told me, and told me the WYSO concert date, and I made plans to attend.  It is a horrifying piece of music, based on depression, hallucination, death and dying.  Mike took ghoulish pleasure in describing the piece of music that was a head rolling down the stairway, how it was written so you could actually hear the head hit each tread.  Brrrr!

                And suddenly, I had peers with amazing students and instructors. Wonderful musicians with wicked senses of humor. Quirky kids who were devoted to their goals, their instrument, their practice time, and even their reed-making.

                What amazed me is that the instructors, top of the line accomplished musicians, practiced as much if not more than the students. They were always coming in early to make funny noises on their mouth pieces or reeds. Working their lips, keeping them.. um.. pliable? Flexible? Strong? They always did scales and arpeggios. Always.  As I swept and mopped my way around these amazing people, I started noticing how much effort they put in every day. It started seeping into me.

                I had band and choir in high school, but I was mediocre at best. I didn’t understand discipline at all. Hardly had any drive to move up in chairs. If I did, it was a happy surprise. I drew and experimented with art, and got pretty good, but didn’t even try for excellent. What made these people different? I wanted to know.

                So, after working within this amazing place for a summer, I started asking questions. I interviewed my friends, the instructors. I asked the reed kids why they worked so hard. I watched, listened, and got saturated in this environment of discipline.

                Then, I went on with my life and tried a direction that was practical, but was not really my passion.  Now after all of these years, I am revisiting the interviews with these men and women, and hoping to find what I experienced while working at Interlochen. I am hoping to find something to share, a treasure to encourage others who have been in my shoes, and to maybe poke into wakefulness the dreams that we started out with as children.

More Inappropriate Songs....yada yada

da da di da di da When the stars align....

Jobs may change but the stream of music in my head never goes away. And, thanks to my daughter, the radio at work, and various friends, the file of music keeps increasing. Oh, my, do they ever.

So, I am working along, minding my own business, watching the clock and paying attention to my duties. My boss, who is more than a little crazy, had to introduce me to this. Now, I am a child of the 70's and 80's, so I am very familiar with this group, AC DC. But, not AC DC doing the  Hokey Pokey.

I lost all ability to do any kind of work for a while. I was laughing so hard. My husband told me I was going "Hokey Pokey" and then snorting in my sleep.

Currently, I do not work where the public can see me much, so I have busted a move. This is seriously challenging at my age. It is just that I have a hard time standing still for long periods of time and need to move around a bit, and fidgeting doesn't quite do it anymore. So, if there is music playing, there will be movement. Of course the music of choice at work is... Country.

Now, I have nothing against country. I was raised up on country music. I have Hank Williams Sr still singing in my mind. I watched Hee Haw, and the Porter Wagoner Show. With that in mind, I have to say country music has done changed. Boy howdie, has it ever. Some of this stuff I am unsure where to categorize. Then they get stuck on a phrase that just isn't right. "Gonna" is one of the songs that drive me bats. "Put a ring rock steady on her hand." Then there is "Rock On" which shares a similar line. There are probably more, but I just can't abide the idea of looking for more of a line that I find totally awful.

There are a couple of songs right now that make me kind of homesick, they are so very country.  Jennifer Nettles has one,  and that fellow Billy Currington. Country music is music with strong roots and a specific kind of sound. The steel guitars may not be as abundant as they were in the day, but the twang and the heart is.

My daughter has taken me to a couple of concerts this year. Aren't I lucky? She is pretty awesome and our tastes tend to run together on some things, like music and art. So, anyway, she took me to see a group named Lacuna Coil. They are named for an insane asylum in Italy. I should have  put the name and the genre "heavy metal" together, but I was caught flat footed by this concert and the other three guest bands!

I enjoyed the heck out of those bands!

Then my boss, again the crazy guy, introduces me to a group called Shinedown. Now, there is some music that one wouldn't generally want to sing when serving the public. "State of My Head" kind of reflects how I felt when changing jobs, but it is even grittier. The metal genre is full of language I pretty much detest-bands use the F word as much as they breathe-but there are some pretty good lyrics and stories within the songs. Just hard  to smile and serve the public when, you know, screaming out the favorites...

The other concert my daughter took me too was Lindsey Stirling. The only reason her music is inappropriate to sing at the workplace is, if you have ever seen her perform, you may be tempted to dance all over creation the way she does and use a violin as a weapon.

Please know, in no way am I against music at the workplace. Just think about the words of the songs if you are working with public. Be careful when moshing if it is outside of a known mosh pit. Play nice. Music is as essential as language and breathing.

Have a nice day!

Silly String and Light Sabers: Remembering Tim

My friend Tim. I will always see his rosy cheeks and his serious face behind which his sense of humor dwells waiting for the right timing and victim. 

It is never easy when a friend passes away. 

The Kirback family accepted me in without any qualms. I met Jon first, then Tim. Eventually, Pam decided I was ok and became my longest friend. Brenda and Lisa will always be little girls to me, even though they are grown up mommies and even grand mommies, if I remember right. Soon, anyway. George and Joyce, Mom and Dad, completed this extended family.

I was a disturbed teen, not sure why really.There were a couple of years where I absolutely flourished. But my head was not in a good place and I had suicidal thoughts. Tim basically got my attention and quite probably saved my life at that point. He shared Kahlil Gibran regarding friendship. I have to say, Tim was a very good friend at that time and forward. The whole family was, and still are.

The Prophet, Kahlil Gibran

But growing up and having your own families and life challenges. It is hard to keep right in touch all the time. I knew Tim had married: Luanna was the other half to their whole selves. They had children. The normal stuff. But, I had no idea that Tim was a clown! Shoots the Clown. Who knew?  I knew George and Joyce did rendezvous, but had not a single idea that Tim did! I didn't know how quickly my friend would be leaving us, and all the sudden, he was gone.

I asked my friends and Tim’s children if I could do a blog in remembrance of him, if I could share about the most amazing funeral I had ever been to, if I could encourage everyone to raise a cup of coffee in Tim’s memory. They said I could. I know this is a difficult thing to read, and I do not intend any harm with this.

More than anything I wanted to share how this captured Tim’s identity, celebrated his life, and that he gave laughter to his friends and family in a time of sorrow.

Tim’s daughter, Alicia wrote this for me:

About a week before my dad had his heart attack he sat me down. I'm unaware if he spoke to anybody else about his final plans and wishes He told me that I had to make a promise to him and that was that if anything happens to him and he was hospitalized, that if the doctor says there is hope, that I would chase it. But when the doctor said that all hope was gone I had to promise to be able to tell them to take him off machines. Very reluctantly I promised. I had no idea that within 2 weeks I have to make that call.

Immediately following that he said, now if anything does happen to me I don't want people to cry at my funeral. He wanted to be remembered for his crazy antics and twisted sense of humor. He then told me who was pallbearers would be:  He says his brother, and his three brothers-in-law, his best friend Tom, and a young man who he had emotionally adapted named Alex. He told me that he wanted them equipped with practical jokes and gags. He told me to find a way to put a prank everywhere I can I get something to make people laugh, or they had to make people shudder in disgust.

I met with Gaylord (Jowett) to talk about the funeral arrangements I then told him of Dad wishes for the funeral to be pretty crazy.  One of Dad's wishes was to be very naked with an elephant head covering his groin. I could not pull myself to bury my father naked. I did give him his clothing for his frontiersmen camping that he so much loved throughout my life, but I did give him the elephant had that he wanted.

 Gaylord was fabulous as helping me to arrange things that were going to be so funny that my dad would have gotten a great laugh out of it. The last thing that my dad said was, I don't want you to do flowers, so I did not. I jokingly said well what about at the ? What are we going to do, silly string? He said that would be great! So when I went to buy my preparations for the funeral, I remembered his wish to not have flowers and purchased 44 cans of silly string to meet the need. I had no idea that I needed more.

I wish I could say that this was a big elaborate plan that Dad had very carefully orchestrated but really and truly, what it was, was my dad saying he wanted people to laugh and he wanted it full of practical jokes and gags.

Honestly I thought he was insane. I look back and I think he did it for me.  When I got to go shopping for all of the crazy things for his funeral and then I got to set it all up and watch people have a good time; it took the pain for that short amount of time. I did not realize what I was going to spend a week and a half laughing and joking and remembering all the crazy things that I did with my dad. It made that week of preparing for the funeral much less painful. Do I think that my dad did that for the rest of the family? I don't know. But I know that he wanted the funeral this way so I can plan his funeral and have fun doing it.

 I only wish that he had given me something to have fun with after he was gone and after the funeral is over but I guess they didn't have time to prepare for that.

The pranks were amazing. Plastic spiders were all over Tim in the casket. The young kids found the “creeping hand” and were running around with it trying to scare people. There were light sabers. There was his Son-in-law, wearing the clown suit. There was a lot of laughter. Tears happened, but laughter prevailed. Even the pastor couldn’t help but remember Tim’s mischief over the years, and shared again with family and friends the epic story of Tim and Lana’s wedding complete with fainting and misconceptions and all.

Funerals are for those of us who remain, to remember those who go on ahead of us. This funeral was a perfect snapshot;

And now, Tim and Lana are back together, forever.

A great celebration of a good friend, loving father and son, and a wicked sense of humor. Even though he tried to avoid us grieving, well, it can't be helped. We are human, after all. 

Top of Form

But still, what a way to be remembered, what a way to go!

Be Careful What You Pray For...

"You really should be careful what you pray for. 
I am no longer employed. Though this is difficult it is not necessarily a bad thing. I am looking forward to the next thing."

This was my most recent post on Facebook. Perhaps I should explain. I had just been dismissed from my job after finishing rooming patients for my doctor. He has a short day on Thursdays. I was working on completing tasks for the day, preparing for the next day, putting out fires.

And then I was being told before the day was half over that I was being dismissed, that I just wasn't getting my work done fast enough. The patients love me, I was told. I know this: I love them back. You are a hard worker, i was told. I know that, too. There have been complaints to the board. 

If I am honest, there was plenty of warning before this day, this moment. My guts even knew something was not working right. I felt separated. 

It still felt like a punch to the gut. 

My Facebook post sounds flippant. I feel nowhere near as chipper and cheerful as I sound. I really did like my job, my boss, my team. But I struggled so much with the speed, the paperwork, prioritizing priorities. I worked hard to improve. Stayed late, came early. Wrestled with it. I just maid it over half a year. I really thought I was starting to get it. I really thought I had to stick it out, and that it would be simpler with time. 

My heart is broken and I am embarrassed by failure.

I do believe I got what I prayed for. I have been praying since day one that I would do my best, that people wouldn't get hurt. I prayed for a way to have my dreams as well as work. I prayed that my live outside work would become balanced, and my life inside my work would too. I prayed for direction.

I received experience, friendship, and encouragement. Things are moving fast. "This feels like things are moving as fast as a house of cards falling apart" I told my husband earlier today. He countered by saying "Or like things are flowing together." 

Now,maybe I can think about what I really want to be when I grow up. I know it has to do with people. And I know I will be good at it.

Phone loops and paperchases

I am a healthcare worker, and I absolutely hate health insurance.

I thought at first that this much talked-about health care reform was actually going to reform the insurance providers, not make the medical providers job more difficult.

I hoped that health-care reform would make things simpler for the consumers, too. Medicare would be easier to understand. Coverage would be better.

That's not how it works.

Within an average day, we medical  assistants prep charts, room patients, assist with minor office surgeries, clean and dress wounds, give shots and vaccinations; any number of tasks that are person to person, and will help the provider (doctor, physician's assistant, nurse practitioner) in evaluating the patient for wellness visits as well as sick visits.

We also send out on behalf of patients for various types of testing, specialist visits, surgical procedures, and even elective procedures.

The medical assistant is the one who fields patient questions, passes on refill requests,  calls patient's with results, and manages keeping supplies on hand including drug samples, vaccinations, wound care items, and gloves. This equals a full day of work. Honest. But it isn't complete yet: A huge chunk of the medical assistant's time is filled with paper chases.

This is what I hate.

A  patient who has been under care for years for a diagnosis that will not change (diabetes, lupus, chronic obstructive pulmonary disease) will suddenly be informed by their insurance that a medication that has been helping them manage their illness well is no longer on the formulary.

That sets off a bunch of activity that may include trying to call the insurance and getting stuck in the everlasting loop of doom which, no matter how many times you ask for a representative, they cannot allow you to speak to one now, and tells you here is another bunch of stuff you don't need to hear that might help.

There are forms you can download to fill out and fax to the insurance company or the pharmacy supply company to see if you can get approval for the drug that actually works best for the patient. There must be proof that these other cheaper and kind of similar drugs were tried and did not work for the patient. Sorta like the drug they use. Sorta like this.

People expect this to be an immediate process. Computers are fast, why can't things be resolved fast?

Meanwhile, someone needs a MRI done to clarify a medical issue. Some insurance companies require a prior authorization to be done, and radiology cannot and will not schedule the procedure until the PA is obtained. This is understandable.

The thing is, you practically need to be a physician or at least have an eiditic memory in order to complete the process. Certainly you need to  have the patient's history in front of you when completing these on-line questionnaires. Where is that patient's history? On you EMR, on the computer you are trying to complete the form on.

I am over simplifying these issues, and I am still learning. I will never stop learning.  I tell people that this job, being a medical assistant, is my way of fighting Alzheimer's because there is not end to learning something new. But perhaps with experience, the paperchase will become easier and less of a pain in the hiney.

And pigs may just learn how to fly yet.

Inappropriate Songs to Sing at the Workplace, back again!

If you are like me, you live in a little world where there is theme music to your life. The music sets the pace, the mood, the amount I accomplish in a day, or the amount I do not accomplish depending on the day. There is always music.

My brain radio has been set on shuffle lately, with, unfortunately,songs I wouldn't wish on my worst enemy. Not just MacArthur Park: There are other Very Horrible songs out there. Honest!

Take this song, for instance. I had years of blissfully not remembering this song only to have it turn up, volume high, one morning on the way to work. Do you remember this? You admit it??? I guess I did like it, when I was about 9 or so years old. But, what creepy lyrics!

Of course, the internet doesn't help much at all. I found this gem a few years ago; love it. I still  love Tom Jones.  You have to admit that this is way better than his cover of Prince's song "Kiss"! (ooo scary!)

While looking up songs to include in this post, I actually found some songs that would be totally appropriate to sing at my workplace, which happens to be a medical practice. Like this one and this one.  Very helpful, these medical training songs!

Where would we be without music?

Let me leave you with a very appropriate song to enjoy life to. Watch this video, just see if you don't feel something good from it. Something joyful.

Pulmonary Function Test: Breathe!

This has been the year for new medical experiences for me. I am glad to say, nothing has been seriously amiss. I am sorry to say, oh boy do I have the bills now!

I developed a sinus infection this past winter that morphed into bronchitis and then into walking pneumonia. The cough has been with me every since, sometimes as a little dry cough, sometimes as a phlegm producing nasty choking oh my goodness I am gonna die coughing spell. It really got on my nerves! Sleeping was pretty difficult. I would get up and have to eat cough drops to get the spells to stop. I finally went to the doctor about the cough just a few weeks ago. Doc had his medical assistant do a peak flow test with me. Another chest x-ray later, I am scheduled for a pulmonary function test (PFT).

A Peak Flow test  or spirometry is done to determine how strong a person breathes out. It is used to help manage asthma, and to evaluate lung function with patients who have emphysema or chronic bronchitis. A person breathes out forcibly into a device that measures the force of the exhalation. I hit 320, then 300, then 298. Doc said that was pretty bad. He hits 700 when he does this test. I pointed out that he was athletic and fit, and I am not. Non the less, he had me go for the PFT  to do further evaluation on how I was breathing.

So, I went. The technician took me into a room with a transparent booth. I immediately felt like I was on the set for Get Smart.

Before a person takes the pulmonary function test, they are supposed to stop inhalers and certain medications (Spiriva, 24 hours before, and inhalers, Flovent, Symbicort, Asmanex, Pulmicort, Advair,  4 hours before) so the test provides accurate results. A regular small meal can be eaten before the test. Caffeine, smoking, and vigorous exercise are to be avoided before the test.

This was my tech. I regret that I don't recall her name. She was very helpful and nice!

I was shown the mouth piece that I would be using and given a nose plug. The mouth piece was similar to a snorkel used for swimming but it also had a device to keep the tongue down and out of the way during the test. That was uncomfortable but not bad. The technician explained how I was to breathe and that she would be repeating the instructions to me during the test so I didn't have to worry about remembering all of it. That is a good thing. My memory is full.

At first the booth was left open for the testing. There was a lot of "breathe, breathe, breathe, DEEP breath, hold, BREATH OUT keep going keep going keep going keep going...good... breathe, breathe, breathe.  Then the test got serious. The booth was closed and I had to do more of the same, but then the tech instructed me to pant but that the device would be closed so I would feel like I was panting against a wall! That was scary and I kept messing up because I COULDN'T BREATHE! The tech worked with me to help me relax and finally, I was able to do this part correctly.

I was then given a different device that had a mouth piece and an inhaler of albuterol was squirted in. I took three puffs of albuterol, and then did this same test again to measure the improvement given by this bronchodilator.

If a person has asthma or COPD or any kind of severe breathing problems, this test is really valuable in evaluating lung strength and effect of treatment. It is  hard to imagine doing this test if a person has severe issues. It was hard enough for me, with a little breathing problem!

It was a good experience all in all, and both the xray and PFT came back good. Some things just take time to pass. Getting older means some things take MORE time to pass. Sigh.

On to the next thing.

Mom and Lewy Body Dementia (DLB)

This is a story about my Mom.

Young Ruth, before crutch

               Mom never liked going by her first name. We kids were careful to instruct people to call her Ruth, her middle name, and not Mattie. It was kind of a southern thing, anyway, to go by middle names.

My Mom and I had fun together. I will never forget her taking me to Interlochen to apply for a job and ending up driving on the sidewalks. They looked like roads!  When we got caught in major thunderstorms in the car, it was always at Chum’s Corners in Traverse City.

Mom's first and only snowmobile ride. 

               It was so much fun to hear her and her sister Charlene when they got together for overnight visits. They were like teenaged girls, talking and laughing all night, telling naughty jokes and just being so silly.

               I remember Mom talking to herself under her breath while doing laundry. It must have been a way to deal with things. Sometimes she sounded like a tea kettle, hissing away! I am told that she had a difficult time with menopause. I know that her hip caused her lots of pain, especially during wet and cold weather.

               Then, slowly, she started changing.

               Life stops making sense when a person has Lewy Body Dementia.

               It gets mistakenly diagnosed as Alzheimer’s disease, or Parkinson’s, or even a psychiatric disorder. It looks like these diseases in some ways: the person is unable to care for themselves, they are forgetful. They are old. They don’t move well, motor skills are diminishing.  

Treating DLB with drugs that work well with Alzheimer’s, particularly sedatives like Ativan, can cause horrible problems. My Mom had become reclusive and depressed. When my sister went to Mom’s doctor, he gave her Ativan for Mom to try. The drug triggered a psychotic response from Mom. In spite of being dependent on a crutch to walk, Mom kicked my sister in the stomach hard, twice.

Family photo with Mom, Dad, me (Lin), Pat, Doug, and Sandy

               It was terrifying to know that there were physical altercations going on at Mom’s house. It was no longer a refuge or home. It finally got so bad that my brother took Mom to his house. It wasn’t long before the issues Mom had become too much for him to care for.

Mom had auditory hallucinations: Music was in the walls of the house, and it wouldn’t stop. Someone kept telling her bad news: The house had burned down, my sister and her son were in trouble, all we married kids were getting divorces. It never let up.  One day, when I was visiting her and playing cards with her, she looked at me and got a really ugly angry look, and growled “who are you?” I told her it was me, and she argued and got angrier. I laughed nervously, and she suddenly knew me again.

Calm and happy Mom

               At the nursing home, Mom was taken off many medicines and had one pill, Aricept, which worked well with her especially for the sundowner syndrome, the hour when most dementia patients get restless and angry that they are not in their own homes. She became more social and enjoyed taking care of a niece who has a disease of the myelin sheaths that incapacitated her. She had always wanted to be a nurse. She was a wanderer, though, and that is what led to the fall that eventually ended her life. She was 82.

She didn't like this picture. I love it.

               Some things that seem typical to DLB:  Auditory and/or visual hallucinations, Periods of fluctuations in attention; Illogical thinking. Sleep disturbances. One article states: “They often develop visuaspatial problems and find it hard to navigate or perceive distances, so that they lose their way in familiar settings or misjudge distances and fall.”

               If more families were to know what to look for in their older family member, if Lewy Body Dementia was more recognized, it could help to endure the changes they see in their family member a little better. If the incorrect medicines or treatments are given, the results can be horrific, the family can be divided by anger and misunderstanding and fear. There is a little comfort in that it is rarely genetically transferred. There is no cure, but there is at least a possibility of understanding things a little better, and finding medication that gives the elderly patient some peace from the voices.

               It is encouraging that there are breakthroughs being found in diagnosing and treating Alzheimer’s disease and related dementias. It always seems to come late for some of us, but please, God, let these breakthroughs be a gift for many others.

               A short while before Mom passed away, while she was at Munson for her fractured shoulder and other issues that spang from the trauma, my sister and I were in her room when the nurse came in to check her vitals and give medication. She asked Mom her name, but Mom didn’t hear her. We repeated the question to her, and she said clear as day, “ it’s Mattie Ruth.” Sandy and I about fell off our chairs. “What is your name?” we asked again. “Mattie Ruth.”

Newlyweds in the basement house 

Perhaps she was years back, down in Arkansas with her beloved Grandma and Grandpa Johnson. She was talking about babies, too. Perhaps she was with her little sister, Shirley, or brother, Bernice (pronounced Bernis) who both died so very young.

Howard, Nina, Charlene, Jim, Betz, and Ruth (Mom) moving up from Arkansas.

The following links are here to provide more information regarding Lewy Body Dementia, Alzheimers, and breakthroughs: 

Lewy Body Dementia Association, Inc.

Alzheimers Association

Eight Exciting Alzheimer's Breakthroughs

The Fall of, well, Me.

Just three months ago and some weeks, I fell down. There was no ice to slip on, the sidewalk was dry. I didn't trip over a crack or stumble over a pothole. The days of wearing elephant leg pants have long since passed, and I did not fall off my platform shoes. I just fell. And kind of rolled. And managed to get back up again. Then I stiffly kept walking back to where I was going and didn't think much of it.

My left leg gave me a reminder the next day

. Bruises such as I have never experienced before showed up. Even on my arms, which I don’t remember being much involved in this falling down thing at all, had very colorful bruises on them. Wow, I thought. Maybe I ought to get this checked out.

By the time I did, my left leg was not only very colorful, it was very swollen. I had to wear my too big rubber shoes to work, which I do not feel is proper. The PA took a look at me, and then sent me for an X-ray.

The results? Nothing broken or fractured in any way.

That was in November.

1: Bruises
If you are human it is very likely you have had bruises in your life. Some are very painful, like a bruise on your bone. Those take a long time to feel better! Some are mild, like accidentally bumping into the corner of a counter.

Did you know there are different words for bruises? Contusion, hematoma, owie…It is defined as an unopen injury under the skin, characterized by pain, swelling, and discoloration.

Why did I have Xrays to check for a break? Bruises are a symptoms. They could mean a sprain, a strain, or  a break. The amount of swelling was a symptom, too.

It took a month or two for the bruising to fade. It went all the way down to my toes! I was impressed! When it finally faded, I didn't expect any more trouble. But trouble came in the form of swelling  on my left knee, redness, heat and pain. I finally went to a doctor to have another look see, and he told me I had to go get an ultrasound to check for blood clots.

I have had ultrasounds before, and they really were no big deal. But the ultrasound to rule out deep vein thrombosis was painful! The tech checked my good leg first, to have a guideline or baseline to judge the bad leg by. In order to prove there were no clots, she had to press down pretty hard on the veins. The femoral vein, at the top of the leg and near the pubic bone, hurts like absolute heck when someone is pressing down a device to prove there is no blockage! It has to be done. Blood clots are nothing to take lightly.

I didn't have any clots.

what happened next is the big golf-ball sized lump on my left knee burst open over night. It was messy and ugly and gross. The doctor I had seen had also started me on antibiotics, thank goodness, because my knee was badly infected! So I went in to see another PA (physician's assistant) and she had me get another X-ray to verify if the bone was infected (a terrifying thought!) and also who recommended me to see an orthopedic specialist.

The stuff pouring out of my knee was reddish orange and thick. Very scary stuff.

Exudite, or wound drainage.

There are three main kinds of exudite: Serous exudite is clear and water, and it is what usually comes out from blisters or burns. Sanguineous exudite is from an open wound and it is kind of another way to say you are bleeding from a cut or other kind of open wound. Then there is purulant exudite. Yep, Pus. Nasty, stinky, thick stuff which can range in color from greens to yellows to really to gross to talk about. My exudite was a combination of the last two, purosanguineaus exudite, which meant that I had an infected wound.

So, the orthopedic specialist took a look at my knee and kind of looked like he was expecting really bad things. He drew up samples of the stuff to send to the lab and find out just what kind of infection he was dealing with. Then he drained my knee and packed it.

Oh, holy cow. It was like going to the dentist, having a stubborn tooth pulled, and then having the dentist pack the stuffing into the empty socket. It hurt!

Two days later I heard that I had a staph infection. Glad it wasn't worse! How did I get an infection any way?  I have a bad habit. I cannot leave sores alone. It is one of the ways I show a low self image or nerves. If nothing else motivated me to stop doing that, this sure as heck did!

The next appointment with the orthopedic specialist his face showed something akin to awe at how much better my knee was looking. He suggested surgery to take out the remaining fluid underneath but we both felt that the skin tissue wasn't strong enough to hold stitches. Also, I had just started a new job and really cannot afford more time off than I have already had! He ordered another round of antibiotics and I will be going in for another evaluation soon to see if it looks like it will heal without surgery.

What have I learned?

Listen to my body. Pain is a symptom, swelling and redness, all of these are signs not to be ignored.

Stop picking sores!!! I am embarassed to admit that I do this. It is a bad habit, one that I am making great strides in stopping especially after all of this happened!

I live a blessed life.

The Power of Music

“The rhythm of life is a powerful beat, puts a tingle in your fingers and a tingle in your feel, a rhythm on the inside, a rhythm on the street: The rhythm of life is a powerful beat”

Sweet Charity, Rhythm of Life.

Yesterday, our community bid good-bye to a man who had a huge impact on many lives, a teacher, a musician, a minister in many ways. Robert Fisher has closed the keyboard for the last time here, in this place, anyway. In the photo displays put up to celebrate his life, I found a photo with me in it. I saw a really skinny young man with a huge bassoon at the Interlochen Bowl, I believe. I saw brothers together over the years. The rumpled hair and broad smile over the years. The spark in the eyes, mischief and pure joy of life.

The influence of music is universal. Music is spoken worldwide but with different dialects. It can create, unite, divide, soothe or cause fear. It is a language that is mathematical and factual as well as being emotive and fantastic.

I have been so privileged in my life to have such wonderful and extensive exposure to music, theory, and the power of song. I may joke about inappropriate songs to sing at work, but the plain truth is music is so powerful and so deeply absorbed. It can be healing, soothing. 

Please enjoy some of the music that Mr Fisher had introduced to us choir kids over the years, and think about music that has meaning in your lives.  

Peace Peace with Silent Night

Rhythm of Life

Movin' On

Creation: A Rock Cantata

Drugs of Abuse, the next part

Recently our local county sheriff was interviewed and communicated this idea: That while heroin is a growing problem for our area, prescription drug abuse was a greater and more harmful problem. http://www.upnorthlive.com/news/story.aspx?id=905806#.VE9zv_nF9yw

More harmful than heroin. 

Most prescription drugs that are abused are opioids. That is, they come from the same family as heroin. Prescription drugs are easier to find without the seedy drug dealer, right in your own home or a friend's home or someone's purse or...well, the possibilities are endless.

Washington, D.C. October 7, 2013 - Michigan has the 18th highest drug overdose mortality rate in the United States, with 13.9 per 100,000 people suffering drug overdose fatalities, according to a new report, Prescription Drug Abuse: Strategies to Stop the Epidemic.

The number of drug overdose deaths - a majority of which are from prescription drugs - in Michigan tripled since 1999 when the rate was 4.6 per 100,000. Nationally, rates have doubled in 29 states since 1999, quadrupled in four of these states and tripled in 10 more. (http://www.healthyamericans.org/, 2014)

At a seminar for continuing education that I attended last year, a state police officer described how people, not just kids, were grabbing prescription drugs from their grandparents or sick relatives and taking them to parties where they would put all of the pills into a container. Then they would reach in and take pot luck whatever pill they happened to grab. It could be a mix of blood pressure medication, thyroid meds, pain killers, water pills; it didn’t matter. This is a new and scary kind of Russian roulette.

Someone described to me how a family member was so addicted to pain killers that they would take topical pain patches and open them up and lick the medication from them. People crush painkillers and inhale or inject them. There are new forms of certain prescription drugs that are crush proof to try to stop this practice and make the drug less desirable.

And then there is the money question. In the light of the economy and the uncertainty involved with being able to receive medical care, people are taking advantage of selling their prescription drugs, whose cost in the first place is hard for these same patients to manage.

NEW YORK (CNNMoney) -- Prescription drug abuse, now the fastest-growing drug problem in the country, has created a ballooning street market for highly-addictive pain relief, anxiety and depression drugs. Given the money involved, it's no wonder.

Here's a sampling of the street prices for a single tablet of some commonly trafficked drugs, compared to their retail prices:

-Oxycontin: $50 to $80 on the street, vs. $6 when sold legally

--Oxycodone: $12 to $40 on the street, vs. $6 retail

--Hydrocodone: $5 to $20 vs. $1.50

--Percocet: $10 to $15 vs. $6

--Vicodin: $5 to $25 vs. $1.50 (CNN, 2011)

These are per pill prices, not per quantity. Most people I know are strapped for money. This is pretty temping. Big bucks for hardly any effort. 

So, what can we do about it?

Do not share, sell, or give away prescription drugs. There are so many reasons not to, but let’s see if saving a person’s life is a value you can work with.

Turn in out-dated and unused prescription drugs to your police department. I know Benzie Police Department has a locked container to drop drugs in for safe disposal. Some pharmacies have yellow jugs for disposal of old drugs.

(http://www.munsonhealthcare.org/News/Default.aspx?sid=1&nid=340, 

http://www.michigan.gov/msp/0,4643,7-123-1579---,00.html)

Do not flush your old prescriptions down the toilet, particularly if you have city water. What goes around comes around, and traces of prescription drugs are showing up in city water supplies as well as non-prescription drugs.

Don’t assume someone will not steal your drugs. 

.

For your information: There are a lot of people contesting which drugs are controlled substances. As of October 2014, this is the current standing:

Definition of Controlled Substance Schedules

Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules.  An updated and complete list of the schedules is published annually in Title 21 Code of Federal Regulations (C.F.R.) §§ 1308.11 through 1308.15.  Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused.  Some examples of the drugs in each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").

Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone (Dilaudid®), methadone eperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).  Other Schedule II narcotics include: morphine, opium, and codeine.

Examples of Schedule II stimulants include: amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®).

Other Schedule II substances include: amobarbital, glutethimide, and pentobarbital.

Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.

Examples of Schedule III narcotics include: combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin®), products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and buprenorphine (Suboxone®).

Examples of Schedule III non-narcotics include: benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such as Depo®-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and ezogabine. (US Department of Justice Drug Enforcement Administration, 2014)