Up and Coming

Hello Redwood Fans!

How has your week been? Enjoying the summer? Getting ready for 4th of July?

Please, please remember to be watching those kiddos around summer parties-- especially if there's a pool around without lifeguards-- or any body of water for that matter. From my personal nursing experience, we'd always get one kid in around summer holiday parties that had drowned or nearly drowned because the adults were having fun and no responsible adult was watching the kids in the water.

My suggestion: one sober adult watching the kids in the water at all times. Seriously-- take 30 minute shifts or something so the adults can have fun but the kids are safe. Swimming lessons do not guarantee in any way that your child is a capable swimmer. Other children (unless they are lifeguard certified) should not be expected to save your child from drowning so don't put them in a position of responsibility unless they've had specific training for these circumstances.

For you this week: answering an author's questions about injuries related to torture and just how we would handle these in the emergency department.

Have a great and SAFE week and Happy July 4th!

Jordyn

Forensic Question: DNA Analysis

This question came to me via my blog as a comment but for some reason didn't post so I put Amryn to the task of answering it but am only using the poster's initials since she didn't give permission directly to use her full name.

It is related to Amryn's post on DNA analysis that you can find here.

S.C. Asks:

I understand that it becomes more difficult with half-siblings. But with full-siblings, if say, a brother suspected that someone was his sister, could he, through a blood sample, confirm the lineage if he did not have access to the parent's DNA?

Amryn Says:

This would definitely be possible. The best way to go about it would be to do mitochondrial DNA testing which traces the mother's lineage. So a brother and sister would have the same mitochondrial DNA because they share the same mother. To try to connect two people as siblings with the more common type of DNA testing is more difficult and would involve statistical calculations. The chance that full siblings will share one of their numbers (see the example in the post) at one of those locations on a chromosome is about 50%. So, yes, the brother could determine someone was his sister, but his best bet would be to have a mitochondrial DNA test done.

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Amryn Cross is a full-time forensic scientist and author of romantic suspense novels. Her first novel, Learning to Die, will be released in September. In her spare time, she enjoys college football, reading, watching movies, and researching her next novel. You can connect with Amryn via her website, Twitter and Facebook.

Kawasaki Disease

JoAnn Asks:

I need an illness (not necessarily a disease, but I'm open to any ideas) that could potentially kill a child of 5-7 years old (a boy growing up in west Texas). He recovers and eventually becomes a world-class athlete with no later repercussions.

I was thinking of some kind of weird bacterial infection or spider bite or something along those lines. Any thoughts? I know you're busy, but if you have a minute or two to throw out some suggestions, I'd be most grateful (and you'd get a shout-out in the book, too). Thank you!

Jordyn Says:

Kawasaki's Disease might be a good option for you.

http://www.seattlechildrens.org/medical-conditions/heart-blood-conditions/kawasaki-disease/

http://kidshealth.org/parent/medical/heart/kawasaki.html

http://www.webmd.com/heart-disease/tc/kawasaki-disease-topic-overview

Kawasaki disease causes inflammation to arteries within your body. This includes the coronary arteries which can lead to some of Kawasaki disease's biggest complications.

It is characterized by high fever (over 102.2 lasting more than five days), peeling skin (usually lips and bottoms of hands/feet), very reddened eyes and rash to the trunk.

The cause is unknown.

Treatment may include an infusion of gamma globulin and high dose aspirin. The cardiac effects are the most serious and worrisome but patients do have a good chance of recovery.

Up and Coming

Hello Redwood's Fans!

How has your week been?

Mine? Well, I'm a little bit consumed by the controversy around the Washington Redskins Football Team. I really want to understand it a little bit better. From what I understand, this is a result of a petition put forth claiming the name is disparaging to Native Americans. Now the US patent office has yanked their trademark registrations which means anyone can use images associated with the Washington Redskins without penalty. This will, presumably, put financial pressure on the team to change their name.

And it makes me very nervous.

One-- there is no sports team anywhere I know that names themselves a derogatory name on purpose. They want to appear fierce, strong and respected. Perhaps this term once was not used to paint Native Americans in a positive light but we know, as time and cultures change, that the meaning associated with words changes. In one news cast I was watching they stated in a poll (and it was taken many years ago) that 90% of Native Americans weren't offended by the team's name.

Two-- we need to get over being offended and the federal government needs to stop being the henchmen over companies on stuff like this. I say-- let the market bear it out. If it is so egregious that the team has this name then stop buying tickets, stop buying merchandise, go picket the games, write op-ed pieces but can we please stop suing over every infraction? There are plenty of names I don't appreciate. I don't personally like the name of a particular gas chain. I find it offensive. I can't believe they name their stations that but do I feel the need to sue them to change it? No-- because it does not physically do me harm or hurt me financially. It's their choice. I choose not to visit their stations. Others probably don't think twice about it and would be surprised I have an issue with it.

It disturbs me how people are being put out of business for what others consider intolerable choices. That's very dangerous because your opinion may not always be on the "right side". Times change. Governments change.

If it doesn't harm you physically or financially-- is it possible to let it go? What do you guys think?

For you this week:

Tuesday: Author question-- What disease could potentially kill a 5 y/o. I pick something you might not have even heard of.

Thursday: Amryn Cross, our forensic diva, is back for a DNA follow-up question regarding half-siblings.

Have a great week!

Jordyn

Dangerous Games Teens Play

As a pediatric nurse, I've seen plenty "teen games" go awry. I write this, not only as possible fodder for fiction novels, but also as education to parents everywhere. Please, watch your children for signs they may be involved in some of these dangerous practices.

The dangerous games teens play that parents should be aware of. Click to Tweet.

1. Choking game. This is not new but comes in many forms. The simple choking game is choking yourself with your hands until you pass out in an attempt to get high. Others use ligatures to do the same thing. Be suspicous your child might be involved in this activity if they have any unusual bruising around their neck.

2. Pharming. This is also not a new game as I first heard about if nearly twenty years ago working in an adult ER. We had gotten several patients from EMS who also brought with them, literally, a punch size bowl of various pharmaceuticals gathered by various teens from their parents' medicine cabinets. They pour them all into a bowl, mix, and then swallow a handful. Often times with alcohol. Identifying pills without labels can be done but it is time consuming and it's important we know what the drug is to provide targeted treatment. If you're an adult-- be aware of the prescription pills you have-- especially narcotics. If expired, they need to be thrown out. Does it seems like there are less pills in the bottle than there should be? Are pill bottles missing?

3. The Cotton Ball Diet. A more recent filing under the dangerous dieting category that is nothing new in the teen world but swallowing cotton balls dipped in juice to stave off hunger reaches a new level. Not only is it obviously not nutritious but can actually cause obstructions in the GI tract requiring surgery to eliminate.

4. Neknomination: A drinking games fueled by competition and social media shows older teens and adults chugging large quantities of alcohol in unusual ways and then challenging a friend to do the same type of thing but more alcohol in perhaps a more creative setting. Responsible for five deaths in Great Britain so far.

What other dangerous teen games are you aware of?

Author Question: Lab Specialization

This post is related to Amory Cannon's guest blog about DNA testing that posted a few months back.

Patti asks: Why wouldn't a lab do DNA testing?

Jordyn says:

Labs specialize just like doctors do-- in a sense. All labs can't do all things. Even a hospital based medical lab doesn't test for ALL medical diseases. Some, very specialized tests, can and do go to big research centers (like the Mayo clinic.)

It just isn't financially reasonable for each lab to do all types of testing. For instance, a hospital based lab isn't going to do forensics testing. In fact, I've not been part of a hospital that did paternity testing. If even collected, these would be referred to a lab that specialized in DNA testing.

Up and Coming

Hello Redwood's Fans!

How is your summer shaping up? Kids out of school. Summer activities. Camping when it is too cold outside? Family reunions and increasing liquor consumption. I'm not necessarily talking about me . . . but . . . patients I see.

Yea, something like that.

AND-- Happy Father's Day to all the dads out there-- especially my own and to my husband who is definitely on dad duty as I'll be saving lives in the ER all weekend.

For you this week:

Tuesday: A follow-up lab question to Amryn Cross's post. Why don't labs do every test?

Thursday: Since it is summer time and there tends to be a lot more teen shenanigans happening I'm doing a post on the dangerous games teens play.

Hope you are having a fantastic summer!

Jordyn

The Caleb Fund

Last post, I handled a writing related medical question that pertained to our military.

At times, I'll do public service posts and I think this one is important enough to share as it relates to our service men and women.

We know there is a gap in services when military personnel return to the States. Many suffer from PTSD. There are not enough mental health services to go around. I can speak strongly to this on the civilian side where we have patients who can't get inpatient mental health services unless they are a danger to themselves or others at the time of admission. This doesn't necessarily ensure the patient will be safe over subsequent days and months as this article concerning Senator Creigh outlines (whose son nearly stabbed him to death.) They had been to an ER over mental health concerns the day before.

Southeast Christian, a local church in our community, is trying to do something about it by starting a fund (called The Caleb Fund) that raises money to offer reduced counseling services to members of our military (past and present.)

For more information, contact Heather Nelson at Heather.Nelson@sechristian.org or follow this link

And for all military members-- past and present-- thank you for your service!

Author Question: Amputations and Infections

Kariss Asks:

A Navy SEAL team is on a mission in Ukraine. One of the guys gets shot in the leg by a sniper and then gets debris in his leg when the boat explodes. They dive into the Black Sea to get away before getting to the getaway boat. He is sent to a military hospital in Germany and then sent back stateside to make decisions with his wife. In the story, I need him to have his leg amputated but also be a potential candidate for a bionic leg/prosthetic down the road.

A few questions in that regard…where would he need to get shot in the leg for that to be an issue? I thought a major artery. But I'm not sure that is accurate. Would infection be a problem from the dirty water and wound? If so, how long would that take to set in? Since I need amputation to be the final outcome, how long would doctors deliberate and monitor issues before choosing to amputate? I think my timeline may be too long in the book and I want this to be accurate.

Also, I have one of the SEALs call the wounded warrior's wife to let her know there is a problem and they are coming home. Because of mission sensitivity, he can't tell her what happened, especially over the phone. My editor thinks a doctor would be the one to contact the wife instead of someone on the team. But I'm not sure that would be true in the case of classified special forces ops. Any input on this?

Jordyn Says:

Thanks for your question. It's an excellent one and I've pulled in several people to help so thanks Tim (who serves as a military chaplain) and Angelique (a physician co-worker) for your insights.

Question #1: There are many indications for amputation-- only one being lack of blood flow to the extremity. So damage to a major artery doesn't necessarily have to be your mechanism of injury. Top three reasons would be trauma (the extremity has lost too much muscle, bone, etc), infection, and vascular insufficiency (damage to the blood supply that keeps the tissue alive.)

Question #2: Is infection a concern because he was swimming in gross swamp water? Yes, this will be a concern. Infection could show up in as little as 12 hours. More commonly is 48 hours. Of course, there are always outliers. What you could research is common skin infections, microorganisms, and such in the geographical area your incident happens. You might find something better that fits your time frame.

Question #3: How long would the doctors take to make a decision? Here, you could basically make the medical scenario fit your timeline. If you want them to amputate right away-- go with major loss of tissue from the extremity. It's basically not salvageable. Or-- longer (days to weeks) then you could use a scenario where infection sets in, he doesn't initially respond to the antibiotics, they try a different antibiotic-- maybe surgical debridement, etc. That process could take a week or more.

Question #4: Notification. This is directly from the chaplain's e-mail to my query.

I can only speak based on my experience in the Navy, and please recognize that the various military branches handle casualty notifications in different manners. That being said, a doctor would not be the one to call giving the nature of the incident. A command representative in addition to a chaplain would generally make an in person visit to the primary next of kin, in this case, the spouse. Also, if this is really a soldier, then he's Army, whereas, the other branches would refer to themselves as Airmen, Sailors, or Marines. 

As a side note, in discussing your question with the physician, she said below the knee amputations are easier to fit with a prosthetic versus an above the knee amputation so consider this as well for your story.

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Kariss Lynch began her writing career in third grade when she created a story about a magical world for a class assignment. Chasing her dream into college, she received a degree in English at Texas Tech University and fell in love with writing faith-based fiction about characters with big dreams, adventurous spirits, and bold hearts. Her first novel, Shaken, book one in the Heart of a Warrior series, released in February 2014, with the second book, Shadowed, scheduled to release in Winter 2015. Kariss is a diehard Texan, born and bred in Dallas, where she now works as a writer for a local communications ministry.

Up and Coming

Since we just celebrated Memorial Day and there has been a lot in the news about the VA scandal I thought this week we'd focus on the military.

Tuesday: Friend and author Kariss Lynch stops by with a medical question related to trauma sustained on the battle field and exactly how families are notified.

Thursday: If you live local in Colorado and are interested in finding some counseling services for our military (past and present) then the Caleb Fund might be an answered prayer for you.

Have a great week!

Jordyn


And on the lighter side-- a medical school parody to the song "Let It Go". If you're in medicine-- you'll definitely appreciate it!

Interesting Cancer News

Of course, me being the big medical nerd that I am, I am fascinated by advances in medicine and there were two interesting discoveries of late that got my mind brewing about new medical thrillers and what this could mean for cancer treatment.

First of all, I have to give a shout out to Grey's Anatomy who had a recent plot line of using genome therapy to cure a child with Severe Combined Immunodeficiency (aka SCID.) In order to deliver the therapy, Bailey used deactivated HIV virus to get it into the T-cells-- and she did it without the parents permission. The child was cured but the parents were angry and threatened to charge her criminally with assault and battery. Which, by the way, can happen to a healthcare provider if they do something to a patient without their consent.

But I digress . . .

Not soon after this story line was a news piece about how a researcher used a mega dose of measles virus (enough to inoculate 10 million people) to cure a woman's cancer. She became ill within minutes with a headache and over several hours suffered shaking, vomiting and a fever of 105 degrees.

Then, something interesting began to happen at hour thirty-six, a visible tumor on her forehead started shrinking and eventually disappeared and so did the other tumors in her body until they could not be found.

Evidently, using viruses as cancer treatment (oncolytic viral therapy) has been used since the 1950s but this is the only case where it has been successfully used in disseminated cancer.

The article states they learned two things-- a big dose is needed and the patient doesn't have to have antibodies to the virus.

Sadly, it only worked in one of the two patients injected so further study and more clinical trials need to be complete.

In other cancer news-- evidently there has been some thought in cancer circles that there are "cancer stem cells" and even when you get most of the cancer during treatment, if these "mother stem cells" still exist for the cancer, this leads to reoccurrence and metastasis.  The hope is that by killing off the mother cells-- you will get a cure for cancer. At this point in time, they've been located in blood cancers but the hope is that they exist for all cancer types and targeting these mother stem cells of cancer could provide a new and more effective avenue for treatment.

Medicine is cool.

What do you think about these discoveries? Do they generate in book plots in your mind? 

Retraction and an Apology

Hello all,

This is one retraction and apology I am very glad to have to write.

The article I had posted here today highlighting that the NHS had relaxed its rules regarding hand washing and Muslim care providers is not entirely true. I had concerns about this information as stated in the piece because it was mainly posted in conservative leaning websites. For me, if only one ideology carries the story (right or left) then it's likely agenda driven anyway.

However, I had found the article as well at the Mail Online. I actually got a tweet from someone that stated those that live there find this paper highly unreliable.

So, I did some more checking and found this fact sheet that states that the dress rules were relaxed for Muslim care providers but not when they were caring for patients. They still must adhere to strict hand washing guidelines in those instances which makes me a very happy nurse.

Because medical accuracy is so important to me I am writing this retraction for the blog post's inaccuracy and I sincerely apologize to anyone who was distressed by this particular blog post.

And I'm really happy for patients that this is not true.

Jordyn

Up and Coming

Hello Redwood's Fans!

My love affair with Spring has been short lived because now it is TOO HOT! We moved from the midwest for this very reason-- the heat and humidity-- although Colorado doesn't have that compared to the midwest. What I've learned is that my temperature comfort zone is very narrow.

What are you guys doing this summer? Any exciting plans?

For you this week:

Thursday: Cool cancer news. I know-- those two words should not go together but you'll definitely want to read this post for some interesting advances in cancer therapy.

Hope you have a great week.

Jordyn