Tuesday, March 31, 2015

Miracle or Experience?

I can't tell you how many times a day I run into parents at the hospital who don't believe what I tell them in triage. Now, as a nurse I can't diagnose an illness but when I try to relay their fears-- I often get the quizzical one eyebrow raise.

This happens a lot with abdominal pain. Abdominal pain in kids is most often constipation and it fits a pretty consistent pattern. Most parents who present with their children to the ER for abdominal pain think their child has appendicitis. That also fits a fairly consistent pain pattern. This is not to say you can put ALL kids into one of these two camps (because sometimes kids actually have both or one presenting like the other) but you can reassure parents who feel like the next step for their child is the OR by saying something like:

"This could be appendicitis but based on my experience, your child's symptoms fit more into a constipation issue. You'll get a doctor's exam and they'll diagnose you but you will not be going to the OR in say . . . the next ten minutes."

And then I get that knowing eye roll that says . . . "Well, why believe her. She's just the nurse."

And nine times out of ten do you know what the discharge diagnosis is? Constipation.

It's not rocket science. I don't have a crystal ball. But what I have is nearly twenty-two years in nursing . . . almost twenty years in pediatric ER and critical care. What that says is I've seen, literally, thousands of kids present with abdominal pain. I know the classic signs of constipation. I also know the classic signs of appendicitis. They do present differently. I can educate (this is a nurse's job) on the signs and symptoms of these two illnesses and what the doctor will likely choose to do-- to prepare the family for what they face.

After an ER shift, I got home and the first thing my husband says is, "Harley let out the weirdest yelp when he was just lying down. We have no idea what it was about."

Harley is our dog. Harley has pretty bad hip dysplasia so it's not unusual for him to tweak a hip if he's been moving but in this instance he hadn't which raised my husband's suspicion.

I call Harley over and immediately notice blood in his fur near his neck. Now, it wasn't a lot of blood and my husband hadn't noticed it. Why did I? Because I see blood every day and am in tune to noticing even the smallest amounts of it.

I comb through his coat with my fingers and there isn't a cut underneath. How else would a dog get blood on his coat in that area? We're used to asking ourselves this with kids-- because kids may not always be developmentally able or willing to tell us.

Which led me to think that he'd scratched himself and the blood came from a paw. Then I see droplets of blood on the floor-- like when we accidentally cut his toenail too close. Yes, I had done this myself.

I see one of his toes looks bloody.

"Where was he laying?"

My husband points to the spot and I see a full-length toe nail on the carpet. He'd been scratching himself and caught the nail in his chain collar which ripped it fully off.

Mystery solved in under five minutes. My husband was somewhat baffled.

Not me. It's not a miracle. It's my experience in injury mechanism that I practice every day.

This is how it can be for your medical characters. Have them use their experience in other situations to make them come to life in your novels. They don't just have to stay in the hospital.

Monday, March 30, 2015


A quick note to announce the winner of Bethany Macnanus's e-book Nerve . . .

Congratulations Mattie P!

Hope you enjoy the novel and thanks so much to Bethany for your insight into genetic analysis and how it inspired your story. Can't wait to read it myself.

Sunday, March 29, 2015

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine? Feeling a little overwhelmed lately. My writing life is gearing up in a good way but trying to fit all that in with working part-time is anxiety producing. Any other author in that boat with me?

Colorado is in what a good friend of mine calls "the teasin' season" when she can't really decide if it's still winter or spring. One day this week, we had a few inches of snow and then by evening it was sunny and all melted. Anyone else live in a state like this?

For you this week I thought I'd give you a glimpse into what really happens behind the scenes in the ER.

Tuesday: Are ER nurses smart about medical things?

Thursday: Just why can ER wait times be sooo long?

Tune in and find out.

Have a GREAT week.


Thursday, March 26, 2015

Can Peanut Allergies Be Cured?

There are few things that make me nervous in the ER anymore. After spending twenty plus years in nursing, I've seen and handled most everything.

One exception is peanut allergies. When a patient signs in with that complaint it is emergent because of the concern of anaphylaxis which I posted about here. There is a point of no return when it comes to an allergic reaction where the patient will die despite all efforts. 

The other question becomes just how do we protect these children? An Epi-pen should be kept with these children at all times. For one, some parents won't do this. Also, parents are uncomfortable giving these injections. 

Another reaction is to create a peanut-free environment. In reality, I don't know how feasible this is. Peanuts and peanut products are prolific and I feel like this gives parents a false sense of security. 

Recently, researchers developed a study to see if they could inhibit the body's response in a peanut allergy. They gave small but increasing amounts of peanut protein along with a probiotic every day for eighteen months. The test group was split in half with half of the participants receiving a placebo that looked and smelled like the treatment. On the last day of the study, the participants were given a double dose of peanut protein with the probiotic. Twenty-six of the twenty-nine children didn't have an allergic reaction whereas only two of twenty-eight in the placebo group demonstrated the same.

Of this group on non-reactors, after a two-five week period of being peanut free, they were retested and twenty-three of twenty-five still had no reaction.

Over time, it is possible for the body to build up tolerance but this method has been found to be twenty-times more effective.

The next step is to see how long this effect will last. Will it be a cure?

It might be too early to tell but it might well be a very good step in the right direction. 

Would you try this for your child if they had a peanut allergy?