Up and Coming

Hello Redwood's Fans!

What's new for you this week? Me? Recently, I took the ice bucket challenge that is raising money and awareness for ALS. It was COLD but I do like that it's talking about a disease that needs more funding and it's been fun watching well-known types undertake getting ice water dumped them. 

I think my favorite so far is from author John Grisham. I mean, he leaves his cigar in his mouth! 

Whether or not you've participated in the ice bucket challenge-- please support a charity. There are lots to choose from and many who need financial support.

For you this week:

Tuesday: My medical analysis of TNT's The Last Ship. 

Thursday: Amryn Cross stops by to discuss how twin murder suspects could be forensically distnguished form one another.

Have a great week! 

Scary Spice: The Problem with Synthetic Marijuana

I'll be the first to say as a mother and pediatric nurse, I was less than thrilled when my home state of Colorado legalized marijuana. I think it's a very bad idea because, even though there is an age limit, we know when something is legal, the stigma with using is goes down. I have seriously heard more than one teen say, "It's legal. It can't be bad for you."

But, we'll save that discussion for another time. 

Recently, the state of New Hampshire has been in the news for 34 overdoses related to Spice. Spice is a "legal drug" of dried plant material with a chemical sprayed on it that is structurally similar to THC, the active component in marijuana. Typically, it is smoked to induce a high. 

Law enforcement if having a hard time keeping this stuff off the streets. The issue becomes, once they identify the chemical nature of the substance and make it illegal, the street chemist can simply differ the compound by one molecule and it will be legal again because it doesn't exactly match what was outlawed. Some states are trying to combat this by making a law more inclusive by saying "this compound and similar molecular structures". Thus far, they are having difficulty doing that. 

What are some of the symptoms of a Spice overdose? This list comes from the linked article. 

1. Seizures. 

2. Decreased level of consciousness to coma. 

3. Vomiting.

4. Hallucinations and paranoia. 

5. Increased heart rate and blood pressure-- enough to be dangerous. 

6. Anxiety.

7. Threatening behavior. 

8. Headaches.

9. Difficulty Speaking.

There is no reversal agent for a Spice overdose. In the ER, treatment centers around controlling the symptoms and supporting dangerous changes in vital signs. 

Are you for or against the legalization of marijuana? 

Ingestion of Mushroom

It's not unusual for kids to ingest things. Young kids put in their mouth whatever is in their environment. Question is, what do you do if your child eats a mushroom from the yard? Worry or not?

Wikipedia

Pediatric nurses face a lot of interesting scenarios each day they work because of the curious nature of their patients. When a case like this presented itself-- it was the first of its kind in twenty of years of peds nursing. And we ask ourselves the same thing-- should we worry or not?

The best resource for anyone for all things ingested is the Poison Control Center. They are our first line resource for discussing these cases. I knew I would call them but didn't really know what help they could offer. In my mind, they'd be limited to known pharmaceuticals or toxins. Something with a label on it.

I was clearly wrong.

Because the Poison Control Center I called actually had a "mushroom specialist" available by phone. Some who had worked in the field for twenty-five years.

Luckily, we had a specimen available to us. This is where my authorly skills came in-- in describing the mushroom.

What I found interesting was some of the questions she asked about the mushroom in order to help identify it and ultimately determine if it was poisonous or not.

1. Where was it found? In a "cultivated lawn" or a wooded area? From what I gather from her, poisonous mushrooms are less likely to grow on manicured lawns.
2. Did it grow near a tree? What type of tree? How close did it grow to the tree?
3. What color is the cap, stem and gills?
4. How big does the cap measure?
5. How long is it?
6. What is the width of the stem?
7. When the stem is bent-- does it bend or break?
8. Does it have gills? These are the page-like structures underneath the cap.
9. Does it have a ring? This is a structure that might cover the gills and you wouldn't know gills were present unless the ring was removed.

In this case, we were able to send photos of the mushroom to the specialist via a smart-phone. This is one way smart phones have really enhanced medical diagnosis.

Good news, in our case, the mushroom was edible. In fact, her favorite edible kind called a fairy-ring mushroom or marasmius oreades. She enjoyed them so much she wished they would start growing in her yard again.

The mushroom specialist encouraged the family to keep the specimen in wax paper (definitely not plastic) for an additional 24 hours in case the child developed any other symptoms. Not because of the mushroom itself but what could be on the mushroom. She said, often kids have ingested something around the mushroom (perhaps a pesticide) that is causing their symptoms but the "mushroom gets blamed."

I guess that's a perk of being a mushroom specialist, knowing what you can eat from your lawn without killing yourself.

So, know that poison control is a good option for ingestions of these sorts but, if at all possible, pick a couple of the specimens to take with you. And, if the child is okay, feel free to call poison control before proceeding to the ER.

Often times, they can save you a trip.

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine? Good. I finally feel like I'm getting caught up on some writing tasks now that the kids are back on school.

This week we're focusing on plants. I'm certainly not a botanist by any means but plants are getting kids into trouble. Particularly plants laced with a chemical similar to the active component in marijauna. New Hampshire is having a hard time with some Spice overdoses. Do you think synthetic/designer drugs become more palatable when their counterparts are legalized?

Do you think all drugs should be legalized?

For you this week:

Tuesday: A curious case of mushroom ingestion. What does Poison Control need to know?

Thursday: The New Hampshire Spice Overdoses. Why is it so hard to keep this stuff off the streets?

Have a great week!

Head Injuries: Jason Joyner

There was that time when the editor saved the medical professional.

As a physician assistant, I enjoy having medical aspects in my story. But even medical folks can slip up and have errors in our fiction.

I have a scene where my heroine gets head trauma and wakes up later in the clutches of the villain. The freelance editor, Ben Wolf, wondered about that. He had read that if there was significant time of loss of consciousness (LOC), then it suggested a serious injury that would be hard for the victim to bounce right back from to be active.

One of my pet peeves is when characters are injured and recover too fast, so I had to look into this again.

Basically, my heroine suffered a concussion, also known as a Traumatic Brain Injury (TBI). Symptoms of a concussion can include headache, confusion, dizziness, visual changes, a blunted affect, and may or may not include LOC. (People always flash lights in pupils to check for concussion. If the pupils are affected, it is a serious sign and they won't be up and active soon.)

LOC usually is only for a few minutes, and as my editor noted, will mean a much more severe injury if it lasts for hours.

Blast. Foiled by the editor.

Except, you can use the amnesia angle.

A concussion with LOC may have retrograde (before the incident) or antegrade (after the incident) amnesia. According to one research article, the antegrade amnesia can last for a few hours after the incident. I can attest – I had a concussion in 5th grade and couldn’t remember a couple hours afterwards.

So if you need your protagonist to be out of it for a while, keep the actual LOC on the short side and use the amnesia angle to get you where you need to be. The victim may be incoherent, unsteady, with a blank expression during this time. Use these symptoms to add drama to the situation.

When your protagonist comes to, it is actually the end of antegrade amnesia. I remember with my concussion it was like I "woke up" after lunch during our quiet reading time at school. I was confused, unsure of what happened. I could remember part of the morning, but about two hours was blank. I even found a goose egg on my head later, but I didn't know how it got there.

So that was my work around. My heroine didn't have LOC the whole time. But there was enough injury to cause confusion and amnesia, keeping her from attempting escape. There you go Ben. A few minor tweaks, and all is well. Except for my heroine, who's tied up and threatened. But that's another story.

**************************************************************************

Jason loves good stories and wants to use words to make a difference. When he's not writing, playing soccer, or losing in fantasy football, he works as a physician assistant in southeast Idaho. He also tries to keep up with his awesome wife, three high-energy boys, and his little princess. He writes suspense and YA supernatural, and likes to use his medical experience to punch up the stories. You can find him on Twitter @JasonCJoyner or his blog at www.jasoncjoyner.com/blog.

Death by Spider Bite

I like to use scary medical things in my books and for some reason, Poison (my second novel), was probably the creepiest because of the involvement of spiders.

But Poison is not that far from medical fact.

Brown recluse and black widow spiders tend to cause the most problems in the US. Evidently, a Florida man was bitten on his neck while renovating his house. The problem with a brown recluse spider bite is the venom necrotizes (or eats away) the tissue.

In this man, it rotted out one of his vertebrae and eventually caused his demise.

Death by spider bite is rare. As this news piece states-- the most common cause of death related to spider bites is anaphylaxis-- a severe allergic reaction your body has to the venom.

Brown recluse or fiddle back spiders have a characteristic marking on their back that looks like a violin. For more information on this deadly arachnid check out this link.

 Have you ever used insects in an unusual way in your novels?

Up and Coming

Hello Redwood's Fans!

How has your week been? For me-- a little more on the chill side. Kids are back in school which is making my writing life a little bit easier. Though, I did get teary-eyed taking my oldest to middle school for the first time. I mean, really, how did that happen?

I want to give a shout out to Costco for restocking Dinesh D'Souza's book America though I don't agree with all the backlash they got. If they truly stopped carrying the book for poor sales-- they had every right to do so. Even if they didn't carry it because of its political message-- they have every right to do that, too. Just like Hobby Lobby, as the courts decided, had a right to not cover certain methods of birth control.

My authorly opinion on all these instances is this-- if you can purchase the product/service elsewhere-- then you should. The market will bear these things out. It's not as if I couldn't have gotten Dinesh's book from another store. I could have. Therefore, I don't believe the author's rights or my rights were impinged in any way. Whether it was for sales or its message-- businesses have a right to decide what product they carry. Let's keep it that way.

But-- thank you Costco and I did purchase the book at one of your stores in support of your decision.

For you this week!

Tuesday: Could a spider bite really kill? I know my friend Kari will really LOVE this post. I'm just sure of it.

Thursday: Fellow medical nerd and physician's assistant (and soon to be author) Jason Joyner joins Redwood's for an interesting post on how even non-medical peeps can catch medical errors in a manuscript written by someone in the medical field.

Have a great week! 

Ebola in the USA: Part 2/2

One of the aspects I find most fascinating about the two individuals that returned to the USA for treatment of Ebola virus is the experimental serum both of them got called ZMapp. Before these two U.S. citizens became ill-- the serum had never been tested on a human subject. Ever. Before this, it had only been tested in eight monkeys. It was far from sure that the drug would actually work.

There's a lot about this Ebola outbreak that is fiction worthy and definitely has my author wheels spinning. Bringing infected patients onto U.S. soil. Do you think this five month long outbreak got media attention because three U.S. citizens were infected? This is what one editorial piece theorizes. Add to that the largest Ebola outbreak in recorded history. And on top of that, an experimental, life-saving serum tried in humans for the first time.

ZMapp was given to both these patients overseas. According to this editorial, Dr. Kent Brantley felt he was close to succumbing to the disease when he was given the treatment and had such an impressive response that he was able to walk from the ambulance when he arrived at Emory Hospital. Nancy Writebol's symptoms also improved though she required two doses.

Some of the ethical questions posed in the piece are whether or not it was fair to just give the drug to these two people? Wouldn't it have been better to give it to everyone infected? Why wasn't something tried sooner for the existing patients? The CDC states there are few doses of the treatment available. Experimental drugs are not produced in large quantities. But the other issue always is, are people who are near death able to give true informed consent? Does it even matter if they'll die? In the case of these two individuals the FDA allowed it under a compassionate exemption.

ZMapp is an engineered monoclonal antibody designed specifically to attach to the Ebola virus like your immune system normally would. In the case of the two U.S. citizens, mice were used to generate the antibodies. Tobacco plants are also being used.

To learn more about ZMapp-- check out this video.

Ebola in the USA: Part 1/2

There are few headlines right now grabbing more attention than the two cases of confirmed Ebola virus that are now being treated on U.S. soil. Even before these two arrived in the U.S. did you know that the biggest Ebola outbreak is happening and is not contained at this time?

First of all, as a healthcare provider, I think it was risky to bring these individuals back. I'm not saying the U.S. should not have provided medical assistance to these individuals but bringing the virus onto U.S. soil is, at worst, potentially dangerous and, in the least, panic inducing. There have been at least nine patients tested for Ebola in the U.S. (Mt. Sinai in NY, Atlanta, Ohio and six other non-disclosed tests.)

Thus far, these tests have been negative.

What is Ebola?

Ebola is a virus. This means it cannot be treated with antibiotics. What's left to the medical team is what is termed "supportive care" which means we support the patient and the symptoms they are having but we have to let the virus run its course. If you can't breathe, we put you on a breathing machine. Best prevention would be a vaccine. Right now, there is no available immunization for Ebola though there are some in development.

There are some antiviral drugs that can shorten the length and severity of the illness. The one most familiar is Tamiflu. However, antivirals are not effective against all viruses.

Ebola is transmitted to people from wild animals and outbreaks occur near villages close to tropical rain forests. Then it spreads from human to human via close contact with their secretions. One interesting transmission of the disease is through semen up to seven weeks after recovery from the illness. Most patients feel that once they are symptom free-- they are no longer at risk for transmitting the illness. People are infectious as long as their blood and secretions contain the virus. This comes from the World Health Organization.

While it may be hard to contract Ebola, the problem is, if you do, the mortality rate can be as high as 90%. This current outbreak seems to be running a mortality rate between 50-60%.

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms can appear two to 21 days after infection.

Which is another potential problem with Ebola spreading worldwide. You can be contagious but be symptom free Although it is hard to determine from multiple news reports if this is a hard and fast rule. Some sources say you have to be symptomatic to spread the disease. There are respected organizations (as stated above) who say the opposite which, if bears out, makes the standard of monitoring people at the airport (and other transportation hubs) for fever not 100% effective. 

Besides this, these symptoms can mimic other less life-threatening illnesses like the flu. 

After these mild symptoms-- the disease progresses and attacks major organ systems that can include internal and external bleeding. Bleeding is exhibited in about 20% of cases. Death usually results from shock and multi-system organ failure.  

Outbreaks are considered contained after there hasn't been a new case identified for 42 days which is twice the incubation period of the disease. 

What I find most interesting was the creation of a serum called ZMapp that has antibodies to combat the disease. I'll cover that next post.

What do you think? Should these U.S. citizens infected with Ebola have been brought back to the U.S. for treatment? Why or why not?

**All italicized portions come from the linked articles.**

Up and Coming

Hello Redwood's Fans!

It's back to school week! At least for us . . . which means business at the pediatric ER will be picking up. That's good for us but not great for kids. But why is that? Well, kids are now in close proximity with one another which allows for germs to be transmitted. Kids, in general, aren't super awesome hand washers and allows for another vehicle of transmission for both viruses and bacteria.

I find pathogens fascinating. Did you know that we're currently seeing the largest Ebola outbreak ever? There's so much about this current Ebola story that is fiction worthy. It's the first time Ebola has been on U.S. soil. How do you feel about that? An experimental treatment called ZMapp was given to two patients-- Caucasian patients-- some find that ethically questionable considering how many contracted the virus before these two were infected. Can you give informed consent for treatment if you're dying or think you will die?

All these are very interesting issues I'll be exploring in this weeks post. It's all about Ebola.

Dare to enter the Hot Zone?

Have a great week!

Jordyn

Book Review: Things That Matter

I am a Charles Krauthammer fan-- the paraplegic FOX news contributor and Pulitzer Prize winning syndicated columnist. The man is wicked (like MENSA) smart. Today, I'm reviewing his book Things That Matter.

His personal story is very interesting. He became paralyzed after diving into a swimming pool of water during his first year of medical school. Somehow, he was allowed to continue on in medical school and finished with his class. He specialized in psychiatry and discovered a new form a mania called "Secondary Mania" so he has accomplishments in both medicine and writing which warms my heart a little as a nurse and author myself. 

This non-fiction title is a collection of his columns written over 30+ years in journalism which should be celebrated but is perhaps a little of what I didn't like about the book. It feels dated reading about time and events that are 30 years passed. I liked his more current columns better and his essay on stem-cell research and cloning has some of the best arguments as to why we shouldn't march down this path.

Some of his arguments against cloning:

1. Research cloning gives man too much power for evil. There would be an unbalance of power or leverage over people.

2. Slippery slope. What we know about using cloned eggs for research is that they are destroyed in the process at the blastocyst stage. This occurs at about one week of development when the individual cells are removed from inside the egg. Charles's argument here is that scientists will push the removal of these cells further out developmentally. "Let me just wait until week 3 to remove the cells . . . " and so on. "Violate the blastocyst and the practice will incur you to violating the fetus or even the infant tomorrow."

3. Manufacturing difficulties. If it is allowed to use research cloning for the development of cells for research-- you are then creating life for the mere purpose of destroying it and will ultimately predispose us to ruthless utilitarianism about human life itself. You need human female eggs for the process but extracting egg cells from women is difficult, expensive and potentially dangerous. In light of this shortage, scientist are fusing human DNA with cow and rabbit's eggs because of this shortage of human egg cells.

As far as some of the other columns, you definitely gain an understanding that he loves chess and the Washington Nationals which was a little hard for this non-sport fan to relate to.

I found myself picking and choosing what to read. He says he's planning two more books about contemporary issues which I'll definitely pick-up.

But, if you've followed his career, are male and lived through the times he talks about as an adult-- I'm sure you'll have a much fonder love of the book. Also his liberal to conservative conversion is pretty interesting.

What do you think of cloning humans? Are you for or against and if for-- under what circumstances?

** All italicized portions come directly from the book.

Congenital Heart Defects: Author Martha Ramirez

Thank you, Jordyn, for having me on your blog. It's great to be here! And thank you for celebrating my new children's picture book, Broken Heart with me.

On March 11th of 2013, my life completely changed. Well, to be more precise, it was the year 2012 in October. In October, after undergoing Holter monitor testing and an echocardiogram (echo), my cardiologist discovered my heart was enlarged. After extensive testing and a conference held by the top specialists in San Francisco, they concluded open-heart surgery was needed to correct a congenital heart defect we never knew I had.

Wow. A congenital heart defect? Me?

Here I was, trying to digest the news. Trying to keep the faith. Striving to keep it together. I went from never having surgery in my life to full blown saw-through-the-sternum open-heart surgery.

If I hadn't followed up with doctors, they never would've discovered it. It definitely pays to seek medical care, even when you're well.

The doctors said I would've grown more tired each day and my heart would have enlarged until it stopped working. So here I am now, grateful to be sharing my story. And thankful God heard all the heartfelt prayers.

Photo by L.I.L.A Images

Inspired by my own heart story, my children's book, Broken Heart, is about a brave girl who learns doctors have to mend her broken heart. Seven-year-old Julia goes on an unforgettable heart journey and takes her twin sister along for the ride. And because it's very close to my heart, its debut is on the 13th month of my open-heart surgery anniversary. This book was inspired by my experience of open-heart surgery and having to stay strong and pray for the best.

I've learned a lot about the medical field in one short year. Lots of testing. Lots of patience. And lots of faith, that's for sure. In the end, it was all about listening to my body and not ignoring my intuition that saved me. That and a whole lot of prayer.

Thank God for doctors and for new technology. I'm truly blessed that I had a team of top doctors looking out for me.

May you all stay heart healthy and heart strong.

*******************************************************************
In addition to writing, Martha is a 2012 Genesis Semi-Finalist, a member of ACFW (American Christian Fiction Writers), YALITCHAT.ORG, the Muse Conference Board, CataNetwork Writers, and American Author's Association. Her articles have appeared in various places including the Hot Moms Club and For Her Information (FHI) magazine. In 2012, her blog was nominated website of the week by Writer's Digest. She looks forward to expanding her career and is hard at work on her next young adult novel. She currently resides in Northern California where she enjoys gardening and kickboxing (not simultaneously). Visit her blog at Martzbookz.blogspot.com.

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine? Fascinating as always.

I did survive my husband's 50th birthday party celebration.

Note to self: a 9 year-old may not be the best option to serve as a lookout.

My husband basically walked in unannounced! But, it was all good in the end. We did surprise him. It's always good spending time with family and friends. There was enough food and liquor for everyone and also great to hear from so many that live out of state who sent cards.

Thank you all.

Then, when I think I've survived all of that, the dog (yes, you read that right) comes down with what I'm going to call strep throat. That was a hefty vet bill but what are you to do when they don't eat for two days?

There is no rest for the nurse on the home front.

For you this week!

Tuesday: Author Martha Ramirez stops by Redwood's Medical Edge to discuss a very personal story of her diagnosis of congenital heart disease and how it inspired her to write a children's book.

Thursday: Book review of Things That Matter by Charles Krauthammer. If you don't know much about Charles's life, it's pretty interesting. He became paralyzed from a diving accident while in medical school. Even though he had this devastating injury, he recovered, and was allowed to finish medical school. He even discovered a new type of psychiatric illness. He's very smart and his thoughts on current day medical issues is pretty interesting.

Hope you have a great week!