Sunday, April 26, 2015

Up and Coming

Hello Redwood's Fans!


How has Spring been treating you so far? Even though Spring ranks low on my list of favorite seasons (it would be 3/4), I do LOVE spring thunderstorms. Anyone else? Not the hide-in-your-basement-a-tornado-is-coming scary. Just the nice gentle patter of rain with flashes of light and thunder.

Anyone else?

I lived in "Tornado Alley" for thirteen years and even though there were tornadoes in Kansas when I lived there, the only two I ever saw and one that our family had to shelter from was in Colorado.

I know, right?

For you this week.

I'm so happy to get to host authors Betsy Duffey and Laurie Myers this weeks. Both have backgrounds in the medical field. Betsy is a counselor and Laurie is a nurse. They've written a truly lovely book of intertwined tales that surround Psalm 23. As readers of this blog know, my go to genre is suspense but I truly loved this book and its sweet stories. If you like authors like Dan Walsh or Mitch Albom then I think you'll really enjoy their novel.

They're visiting Redwood's this week to celebrate the release of The Shepherd's Song in paperback but any commentors on their blog posts this week (including this one) will be eligible to win a hardback copy. Comments will close Saturday, May 2nd at midnight MST time. Winner will be announced on Sunday, May 3rd!

Their posts will discuss addictions and the stages of grief. Great information for the novelist for character development.

Thursday, April 23, 2015

Do I Have Measles?


Since immunization rates in many communities are down, the recent outbreak of measles that originated in Disneyland, CA is not going to be a rare event.

We're getting more parents in to the ER with concern that their children have been infected with measles. Thankfully, I've not seen a positive case yet. Generally, it's a rash of some other origin like hives, viral rash, or strep rash.

The best way to NOT get measles is to get immunized-- plain and simple.

But, here's some information straight from the Colorado Department of Public Health about measles infection.

Measles is highly contagious. It is a viral illness meaning that antibiotics aren't going to cure it. We can only do symptomatic support. It causes fever and a distinct rash. The incubation period is 7-21 days. An incubation period means you are infected but are not yet showing signs of illness. Measles is spread via droplets (it can live on surface areas for up to two hours) and airborne via coughing or sneezing.

Early symptoms are fever (over 101.0 F), cough, runny nose and reddened eyes.

The rash usually begins on the face after 2-4 days of the above symptoms and then spreads from the head down and outward to the limbs. The rash is red, splotchy and raised meaning you can feel it if you brush your fingers over it.

Patients who present to the emergency department should be immediately isolated and placed in negative-pressure rooms if available. A negative-pressure room sucks air into it versus pushing air out into the rest of the department. Also, the room should be cleaned and then quarantined for two hours after the patient is discharged or admitted.

Only healthcare workers who have measles immunity should care for these children.

People at risk for severe illness and complications from measles are infants less than 12 months, pregnant women who don't have measles immunity, and those who are immunocompromised.

Go here to learn more about measles infection.

Tuesday, April 21, 2015

What REALLY Happens While I'm Under Anesthesia: 3/3


Today concludes a three-part series by guest blogger and CRNA Kim Zweygardt about what really happens in the OR. Kim took on several FB questions regarding anesthesia and the OR that I thought would be great info for writers.

Thank you, Kim for sharing your expertise with us.

Follow the links for Part I and Part II.

7. How aware are you under anesthesia? And I've heard sometimes people wake up during surgery but you give a medicine so they don't remember. Is that true?

Let me answer the second part first. As I mentioned earlier, we give a combination of medicines in anesthesia and some drugs have an amnestic effect. So yes, there are drugs that we give you that provide amnesia so you don't remember what happened. They can be given as part of a general anesthetic or as a sedative. But there are times someone says they “woke up during surgery” when they were sedated not anesthetized.” So what constitutes being asleep for surgery? For us, being asleep is a general anesthetic where you are so deeply unconscious that we are assisting your breathing. But, sometimes the actual anesthetic is a spinal, another nerve block or a local anesthetic. Because most people don't want to know what is going on, we will give you sedation and you take a nap during the surgery. From our perspective, you are not "asleep," you are napping, but from your perspective, you went into surgery and "went to sleep!" That causes confusion. I have patients tell me they woke up during their surgery. When we give you medicines to nap, you may wake up and be aware of what is going on. I tell patients that the difference is if I want to talk to you, I can call your name and ask you how you're doing. You'll wake up and talk to me and then when I leave you alone, you'll drift back into your nap. But if you have a general anesthetic, I can talk to you all day and you won't answer because you are totally unconscious.  As far as awareness, it depends on whether you are sedated (you may remember some things) or have a general anesthetic (you should not be aware during the operation). We've all heard the horror stories about people being awake during an operation. It does happen but is very, very rare.

8. How do you let the doctor know you are awake during the anesthetic?

As I said, true awareness is very rare. When it happens (or when they make awful movies about it) it makes the headlines but don't forget that hundreds of thousands of anesthetics are done every day without awareness. I mentioned before that the amount of anesthetic you need is based on how much surgical stimulation there is (fancy way of saying how much it hurts). Even when you are anesthetized, your body still responds to pain if the anesthesia isn't enough. The heart rate goes up. The blood pressure goes up. You will even have tears when it hurts. That is one of the reasons we are watching you every moment. If we see those changes, we can give you more medicines so that your body doesn't have that stress response. The patient "tells" us the anesthetic needs to be deepened by all those changes in vital signs.

9) What do people say while they are asleep?

When I became a CRNA, we used Sodium Pentothal which was famous in movies as "truth serum." It was a common question then about what they might say during an anesthetic. For “truth serum” very small sedative doses were given so the person was groggy. The thought was they were too drowsy to lie! But for anesthesia, a large dose is given so the patient is asleep in minutes with no time for conversation! I once interviewed a man who questioned me extensively seeking assurance he wasn't going to say anything because of "that truth serum!" He even sent his wife out of the room while he questioned me further! I always wondered what he wanted to hide! Now we use a drug called Propofol. It works even quicker than Pentothal so rest assured, if you are going to sleep (general anesthetic), you're not giving away any secrets!

10. What is the strangest thing you've heard someone say under anesthesia?

I once put a known psychic to sleep. The case was added on to the end of a long surgery day because the patient had forgotten to come for surgery the day before. (Which I found funny since she was a physic. Those of you who know me personally, get my sense of humor!)  She was a very pleasant woman and when questioned didn't mention anything about having problems with anesthesia in the past. She was completely anesthetized when the surgeon stuck his head in the door to ask, "Did she tell you she has a history of recall during anesthesia?" Well, no, she hadn't mentioned that small detail to me! I immediately turned up the anesthetic gas and gave some other medicines and but as I did, in a spooky séance' type voice said, "If you can hear me, let me know!" As soon as the words were out of my mouth, her pulse went up significantly and I am sure she was doing exactly that although I never had the heart to ask after I woke her up! Years later I read a fascinating article about the subconscious mind and anesthesia awareness that made me think of her but that is another post!

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Kim Zweygardt always knew she wanted to be someone special.  Her heart’s desire when she was 7 was to be a famous ballerina but when she read their toes bled from dancing on them, it became a less desirable career choice. Then Kim decided to be a famous lawyer solving mysteries and capturing the bad guys just like Perry Mason, but as she got older she discovered sometimes it was hard to tell just who the bad guys were.

Instead Kim chose a career in medicine practicing the art and science of anesthesia as a Certified Registered Nurse Anesthetist in rural Kansas, Colorado and Nebraska.

Kim is married to Kary, the man of her dreams, who has done a fabulous job of making all her dreams come true. They have three children but an empty nest and enjoy conversation with friends over good coffee and great food. They enjoy travel, the arts and taking a nap.
Member American Christian Fiction Writers, International Speakers Network, www.bookaspeaker.netwww.womenspeakers.net






Thursday, April 16, 2015

What REALLY Happens While I'm Under Anesthesia: 2/3


I'm continuing with a three part series written by guest blogger Kim Zweygardt on what really happens while you're under anesthesia. Great information for authors. 

You can find Part I here.

Welcome back, Kim!

4. Why is my throat so sore after anesthesia? (The actual question involved us ripping your throat out under anesthesia but I niced it up!)
With almost all surgeries, you are breathing extra oxygen that isn't normally humidified and can really dry your throat out and cause it to be sore. Sorry about that! With bigger surgeries, we insert devices to maintain your airway. Anesthetics depress your breathing and these devices allow us to breathe for you to make sure your body gets all the oxygen that it needs. They are made of soft plastic, but they can irritate and cause a sore throat after surgery. And some people have anatomy that makes the insertion more difficult and that can also cause a sore throat. As a general rule, the sore throat is gone in about 24 hours. Treat it like a normal sore throat--pain meds and warm fluids help lots.

5. I love going to la-la land, but why is it so hard to wake up? (I've also heard this--"I just wanted to sleep and the nurses kept making me wake up in the recovery room! How come?")

I could give you lots of technical mumbo jumbo about how drugs are metabolized but I think the more important thing to remember is this: We give you medicines based on your weight and that health history we took but also based on what type of surgery you are having and how uncomfortable that surgery is! It's not the same amount of pain to have eye surgery or your gall bladder out. We give you these drugs so you will be comfortable and/or asleep, depending on what the surgeon is doing--that even varies at different times during the surgery because some parts of the operation may be more pain producing than others. A few minutes later, the surgery is over and what was the perfect amount of anesthesia now has you really sleepy because that stimulation is gone. We can reverse some of the medications but we also let your body gradually metabolize them so you are groggy and comfortable after surgery. And just like when you are fast asleep at home and someone wants to bug you? You'd rather be left alone!

6. I was told to think of something pleasant as I went to sleep and I woke up great! The doctor said how you go to sleep is how you wake up. Is that true?

There is a lot of truth to this. When you are anxious you release all kinds of stress hormones into your bloodstream and that can translate into a very rocky anesthetic including wake up. Thinking of something pleasant causes you to release endorphins which is like the body’s own morphine. That sense of wellbeing carries over as well not to mention the power of positive thinking! One technique I use with teenagers who tend to wake up wild is to explain to them pre-op how it will feel waking up and what I want them to do. Because they have had a chance to think about it ahead of time, when I tell them surgery is over and they should lie still, they do it because even through the “waking up fog” their subconscious remembers my words. Anything we can do pre-op to allay anxiety makes for a smoother waking up.

Tune in next post for Part III. 

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Kim Zweygardt always knew she wanted to be someone special.  Her heart’s desire when she was 7 was to be a famous ballerina but when she read their toes bled from dancing on them, it became a less desirable career choice. Then Kim decided to be a famous lawyer solving mysteries and capturing the bad guys just like Perry Mason, but as she got older she discovered sometimes it was hard to tell just who the bad guys were.

Instead Kim chose a career in medicine practicing the art and science of anesthesia as a Certified Registered Nurse Anesthetist in rural Kansas, Colorado and Nebraska.

Kim is married to Kary, the man of her dreams, who has done a fabulous job of making all her dreams come true. They have three children but an empty nest and enjoy conversation with friends over good coffee and great food. They enjoy travel, the arts and taking a nap.
Member American Christian Fiction Writers, International Speakers Network, www.bookaspeaker.netwww.womenspeakers.net