Parish Nurse - Messages for the Body and Spirit

I hope you all had a wonderful summer and got to spend some time relaxing and meditating on the goodness of God. Now that summer is over, we return to perhaps a busier routine, with children returning to school or college and sports practices, games and confirmation classes starting at church.   There is homework to be done, schedules to coordinate and a lot of activities that demand our time and attention.   The farthest thing from your mind is probably flu season.   However, now is the time to start planning your defense.   Public health officials are concerned that there will be another surge of flu, particularly novel H1N1 flu (originally called swine flu) once school starts. Following on its heels is seasonal flu, which could be a double dose of trouble.  Take some time now to arm, educate and protect your family and yourself.   Please keep in mind that the information is changing and that I am writing this in August. Check the parish nurse bulletin board for changes and updated information.   You can also go to www. cdc. gov/H1N1flu for the most recent information from the Centers for Disease Control (CDC).

Are you embarrassed by your feet? Foot fungus is not a common topic of discussion but a common problem among people of all ages. Fungal infections can spread easily and can be difficult to treat with over-thecounter medications. The heat of the summer can make it worse. So how do would you know if you have foot fungus, how is it treated and how can it be prevented? I’ll try to answer these questions for you this month.

What is foot fungus?

Also known as athlete’s foot, it is a skin infection of the foot caused by a fungus. It thrives in warm, moist areas of the body and often starts between the toes. Although the feet are a common place, fungal infections can occur almost anywhere on the body.

I was strolling in the park one day...
Over Easter, I was visiting a friend who had a cat.   I am an animal lover but have learned that not all are friendly and want to be petted.   My friend's cat has been known to turn on people, biting or scratching them. One minute the cat is friendly, purring and the next has its fangs in you.  Even the owner has to be cautious and read her cat's signs closely.   This cat doesn't give a warning.   Dogs may give a growl or put their ears back.   Cats will often just walk away.  My friend's niece was also visiting, gently petting the cat while we talked.   It only took a few minutes before she started to cry.  The cat had unexpectedly turned on her and grabbed her arm.   Luckily, her sweatshirt protected her and she was not even scratched.  Since this is the time of year that we begin to get outside, take walks, go to parks and playgrounds, I thought it would be good to discuss cat and dog bites, their treatment and some tips for their prevention.

Many of you will be glad when April 16th comes.   It means that your tax return has been filed and hopefully, you got a refund.  But April 16th has another significance.  It is National Healthcare Decisions Day, a time for adults to talk about and document their future healthcare wishes should they be unable to express them. Although we don't like to think about or talk about this, as a nurse I have seen firsthand how families struggle with end of life decision making when a loved one is unable to express their own wishes.  By talking about end of life care with your family and friends and documenting them in the form of a living will/advanced directive, you can help ease this burden.  It's more than just saying what you would or would not want in terms of end of life care. It involves clarifying values, identifying care preferences and maybe designating someone as a durable medical power of attorney.  It's about the quality and meaning of life.  If something happened to you that left you unable to communicate, say for instance a devastating stroke and you were in a coma, would you want to be kept alive on life support?  Would you want a feeding tube?  Would you want to donate your organs?  Would you rather have comfort measures?   Would it really even matter to you?
The Federal Patient Self-Determination Act requires that all Medicare-participating healthcare facilities inquire about and provide information to patients on Advance Directives.   If you have been a patient in the hospital recently, you may recall being asked if you have a living will or medical power of attorney.  We all have the legal right to make our own health care decisions and accept or refuse any medical treatment, providing you understand the implications fully.   Let's take some time this month to explore this more. 

It's that time of year that colds and flu-like symptoms are common.  It's also common for people to get sinus
infections.  But just what does that mean?  Let's take a closer look at this subject of our sinuses and how we can prevent and treat the seemingly common infections.

So what exactly are the sinuses? -air filled pockets located in the bones of the face.   Each pocket is covered with a lining that secretes mucus to keep the nose and sinuses moist.  They are directly connected to the nose, so there is free exchange of air and mucus.  It follows that if something causes a swelling in the nose-a cold, an infection, an allergic reaction for example-it can also affect the sinuses.   Although we don't fully understand what the sinuses do, we know that they do help protect us from dust, dirt, pollutants and microbes in the air.

February is heart month, a time to increase awareness of heart disease and heart attacks.  I was inspired to not write about these but to do something fishy instead-fish oil supplements as prevention for heart disease.  Many people are taking them and when I ask why, the answer I usually get is "because it's supposed to be good for me".  Fish oil supplements are popular today, even prescribed by doctors for their benefits.  Since this is heart month, let's look more in depth at fish oils, what the supplements do or don't do and their side effects.  Fish oil contains omega 3 fatty acids, a type of healthy fat that our body needs.  There are three types of omega 3 fatty acids that are nutritionally important: alpha-linolenic acic (LNA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).  Our bodies do not make LNA so we must ensure that our diet contains a sufficient amount for proper functioning.  Dietary sources of LNA include walnuts, hemp seeds, flaxseed and soybeans. LNA is converted to the other two omega 3 fatty acids in our bodies.  These other two fatty acids (EPA and DHA) can also be ingested directly by eating certain foods, such as cold-water fish (salmon, tuna, halibut, herring, mackerel, lake trout and sardines).  Naturally, the best way to get omega 3 fatty acids is through our diet.  Since that is not always an option, another common way to get them is by taking supplements.  Fish oil capsules usually contain two of the needed omega 3 fatty acids, EPA and DHA.  Now that you know what they are, let's look at what research has shown about omega 3 fatty acids and fish oil supplements.  Benefits include reducing the following: triglyceride levels, risk of certain heart rhythm problems that lead to sudden cardiac death, development of atherosclerosis (hardening of the arteries) and blood pressure (slightly).  They have also been shown to prevent heart disease when regularly consumed. Non-heart related effects include reducing morning stiffness and joint tenderness in people with rheumatoid arthritis.  The jury is out on whether or not stroke risk will be reduced with the use of fish oil supplements.  They may raise good cholesterol (HDL) levels but might also raise the bad cholesterol (LDL) levels. The best way to get your omega 3's is by consuming them from plant and marine sources.  The American Heart Association recommends eating cold water (also called fatty) fish twice a week.  The ideal amounts for supplements are in part based on the reason for taking them, but are not clear and more research is needed.  Check with your doctor about how much you should be taking based on your health status.  The American Heart Association website (www.americanheart.org) has more detailed guidelines. FYI: there is one prescription fish oil supplement, Lovaza, approved to treat very high triglyceride levels. What about potential side effects? The most common ones are stomach upset, bloating, burping with a fishy aftertaste and diarrhea.  These can be reduced by taking your fish oil with meals, starting at lower doses and gradually increasing or trying different brands.  With larger doses, bleeding poses a risk, including nosebleeds and hemorrhagic stroke.  As with anything, allergic reactions can occur.  If you are allergic to certain nuts, avoid products that are derived from the nuts you are allergic to.  Pregnant women, women who are breastfeeding and children should check with their doctor about the safety of fish oil and the dangers of mercury from eating fish.  There are rare reports of elevation in liver function tests (blood tests), skin rash, swelling of the nose and throat, mania in people with bipolar disease or major depression, restlessness or a sensation of ants crawling on the skin.  Vitamin E deficiency can occur so many products have vitamin E added to them.  If you are a type 2 diabetic, you may see a slight increase in your blood sugar but no effect on your hemoglobin A1C test.  Probably the biggest concern of many people is the potential harm from contaminants such as mercury, dioxins and PCB's (polychlorinated biphenyls).  Generally, there is more mercury in fish than in the supplements.  The following website has a list of mercury levels in common fish and shellfish: www.cfsan.fda.gov~frf/sea-mehg.html.  For more information on the benefits of fish oil supplements, go to www.americanheart.org (search omega 3 fatty acids) or www.mayoclinic.com.health/fish-oil. 

Are you prepared for the New Year?

One of my priorities in 2009 is to be better prepared when it comes to emergencies.  I recently completed a disaster response class as part of my training as a volunteer with the Bucks County Emergency Medical Corp.  The instructor really made us think as we went through a drill mimicking a real disaster.  I realized that I’m not as prepared as I thought I was.  A disaster can happen anywhere, at any time, so here are some things I learned.   My challenge for you and me is to create an emergency bag or box so that you are ready for almost any emergency that might happen in your home or community. 

On the 1st day of Christmas my parish nurse gave to me a tip: remember to check the water in my real Christmas tree.

On the 2nd day of Christmas my parish nurse reminded me about the two hour food rule:  foods should not sit at room temperature for more than two hours (these are foods you wouldn’t put under the Christmas tree).

On the 3^rd day of Christmas my parish nurse reminded me to dial these three numbers 9-1-1 in case of an emergency.

On the 4^th day of Christmas my parish nurse gave to me four batteries for my smoke detectors in case I forgot to water the Christmas tree.

We need to learn to thank the Lord for closed doors just as much as we do for open doors.  If he didn't close the wrong door we would never find our way to the

right door.  Even when we don't realize it, God directs our paths through the closing and opening of doors. When one door closes, it forces us to change our course. Another door closes; it forces us to change our course yet again.

"The steps of a good man are ordered by the Lord, and He delights in his way." (Psalms 37:23, NASB)

As I write this, thinking about all that is happening in the country and the world, I could easily be depressed.  The stock market has been a roller coaster ride, the government is trying to bail out financial institutions and there are cut backs being made in almost every company I deal with.  There have been several major disasters both in this country and in the world; everyone seems to be facing harder times.  In the past few days, I have known two people who will lose their jobs by the end of the year and more that face that potential.  Everywhere, people are tightening their belts and wondering how they will make it through the winter, much less to retirement.  Those who are retired may be facing worries about their future also.  Now that I have thoroughly depressed all of you, don’t stop reading because there is some good news.  By the time you read this, we will have elected a new president and hopefully gas prices are still under $3.00/gal. But the best news is that no matter what else changes, Jesus is still there to carry us through whatever we are facing.  There are endless stories in the Bible; I encourage you to read some of them, as times get tougher.  There is the story of the widow who was going to use the last of her flour to bake a small cake and then lay down to die with her son (1 Kings 17:7-16, NIV).  Maybe you have a story to share of how God provided for you in a difficult time; Share those stories with those in need.  You might not think it’s much, but it can be a powerful testimony.  When I was going through my cancer treatment, my co-workers asked what was getting me through this and I was able to share how Jesus was providing what I needed.  My cancer journey was the turning point in my learning to totally trust in the Lord.  He was all I had that I could 100% rely on to get me through the next step, the next day, the next week.  My hope still remains my trust in Jesus because “in all things God works for the good of those who love him, who have been called according to his purpose” (Romans 8:29, but read on through to verse 32, NIV). I pray that you can also trust in Him.  If you have never done that, try it, because He is faithful, even to the end of the age. 

October is breast cancer awareness month.  If you are a man reading this, don't stop because you think this is a woman's problem and doesn't involve you.  It does for two reasons: men do develop breast cancer so you are not totally immune and if there is a woman in your life that you care about (be it your spouse, girlfriend, mother, aunt or close friend), you need to encourage them to follow the American Cancer Society's recommended guidelines: yearly mammograms starting at age 40, breast exams by a health care provider every three years from age 20's-30's then every year once you are age 40 and older and monthly self-breast exams.  Many women I know will ask why they should bother doing monthly self-exams because they have normally lumpy breasts. It is important to get to know your normal lumps and bumps so do your monthly exams.  If you need to, draw a picture of each breast and mark the spots where you have lumps.   If you have a family history or had breast cancer yourself, talk to your doctor about the benefits and limitations of earlier mammograms, ultrasounds or MRI's. Just because you do these things though, doesn't mean you are immune to getting breast cancer.  All women are at risk, regardless of family history and unfortunately, the older you get, the greater the risk.  Someone recently told me the unfortunate story of her friend who died from an aggressive, less common breast cancer, despite doing all the things we just talked about.   She had inflammatory breast cancer (IBC).  Because this is not as well known, let's take a closer look at IBC.
This form of breast cancer spreads rapidly to other parts of the body because it tends to spread in a mesh-like fashion (rather than forming a mass).  It presents itself like an infection of the breast-redness, swelling, and warmth when touched and can easily be mistaken for an infection. The breast tissue may appear bruised, reddish- purple, pitted or have ridges.  The breast may ache, burn, feel heavy; the nipple may turn inward.  The breast may change appearance quickly over a period of a few days or weeks.  There may or may not be a breast lump and initial treatment most likely will be antibiotics.   These signs and symptoms can be from other conditions of the breast such as infection (mastitis) or injury, to name a few.  That is why it is often treated first with antibiotics.  African American women are at higher risk and there is a greater tendency for younger women to develop it.  If you or someone you know develops any of these symptoms, get to a doctor and get checked without delay.   Don't think it will go away on its own.  If there isn't improvement or if symptoms continue to worsen or spread despite treatment, ask for a referral to a specialist or get a second opinion.  If it is inflammatory breast cancer, it needs early diagnosis and aggressive treatment. Be informed about this and other forms of breast cancer. Seek early medical attention.   Don't bury your head in the sand.   The sooner any form of breast cancer is treated, the better.   More women are living longer because of early detection, advances in the understanding of the disease and newer treatment options.  I am excited because I think of how far we have come in the ten years since I was diagnosed, because women are living longer and beating this disease.  When I go to conferences, I hear excitement in the speakers' voices as they talk about the latest research.  We are so much closer to a cure, to newer treatments and to greatly improved and earlier diagnoses, all of which improves outcome.  I am fortunate to be among the survivors and blessed to be celebrating 10 years of survivorship.   I will be celebrating in a special way this year by walking 60 miles over the course of three days October 17-19 in the Philadelphia Breast Cancer 3-day.  I walk to make a difference; I walk for all those who have lost a cancer battle, especially a breast cancer battle, for all who are in the midst of treatment for breast cancer and for those who have yet to face this disease.   I walk for a cure and I walk to celebrate life.   It is the precious gift God gave to me and it's available for you.  Please pray for me and the women and men who will walk the 3-day journey with me. Pray for those who are or have battled breast cancer and for their loved ones.  Pray for a cure.  Pray to the God who loves us all and gives us this wonderful gift of life both here on earth and with Him forever in Heaven-just because we chose to believe in his Son Jesus and his sacrifice at the cross for our sins.  And give him thanks for each and every day.

Did you enjoy the Olympics?  Ever wonder what makes a champion?  Everyone who competed was a winner in my book.   Just to get to the point where they are picked for a team says so much.  Some of you know I am training for the Breast Cancer 3-Day, a 60-mile walk over 3 days in October.  The training is intense, but nothing compared to what the Olympians go through.   Part of training and being fit involves proper eating and for me that means starting my day with breakfast.  I certainly don't eat what Michael Phelps, the star Olympian swimmer, does.   Did you eat breakfast today?  When I was growing up, it was a must in our household to eat breakfast.   My mother had the luxury of being able to cook for us every morning and I learned the importance of starting the day right.  Yet so many of us skip this important part of our diet.  Research has shown that eating something within the first 30-60 minutes after arising can actually jump-start your metabolism and help you lose weight.  Research has also shown how important breakfast is for children.   Children who eat breakfast:

• Do better in school
• Concentrate better (be more focused on the task at hand)
• Have better problem solving skills
• Have improved hand-eye coordination
• Are less likely to miss school
• Have better weight control
• Take in more vitamins and minerals
• Have a lower intake of fat and cholesterol

 Many of these apply to adults as well.  So if you find yourself skipping breakfast and wondering why you are more tired, less able to concentrate and eating more during the day you might want to get into the habit of eating breakfast.  A known side effect of skipping breakfast-you will consume more calories during the day than you would if you ate breakfast.

June is a time to celebrate the men in our lives. It is also a good time to talk about men's health issues. If you are a woman, don't think you can stop and just hand this article over to a man. You need to read this also because men's health issues affect you. Women live longer than men, an average of five years longer, so there is a chance we may see our brothers, fathers, sons, husbands die prematurely. Experts say that half of these deaths are preventable, which means our knowledge and awareness could be the influence that spurs them to take action. So, read on men and women to learn more about the common health problems in men.

Prostate problems: Enlarged prostate (BPH), prostate cancer and prostatitis (inflammation of the prostate)
The prostate is a small gland, about the size of a walnut that sits below the bladder and surrounds the tube (the urethra) that the urine passes through on its way out of the body. As men age, the prostate can enlarge, leading to an increased need to urinate or difficulty passing urine. BPH, benign prostatic hypertrophy, is a very common, noncancerous enlargement of the prostate gland, found in older men. BPH generally begins in a man's 30s but often doesn't cause symptoms until age 50 or older. Half of all men over 50 develop symptoms of BPH, but only 10% will require treatment. Prostatitis is a bacterial infection of the prostate that can occur at any age. Symptoms include fever, chills, and pain in the lower back and between the legs. This problem also can make it hard or painful to urinate. The treatment is antibiotics. Prostate cancer is a malignant (cancerous) tumor of the prostate. It usually grows slowly and stays in the gland for many years. It can spread to surrounding tissues and to other areas of the body. Most of the signs and symptoms are from the advanced spread. Because it is such a common cancer in American men, some experts recommend yearly screening for prostate cancer beginning at age 40, while others recommend beginning at age 50. The screening tests for prostate cancer are a blood test called a PSA, prostate specific antigen, and a rectal exam by a health care practitioner who checks the prostate by feeling it. The PSA is a blood test that detects the presence of a protein that the prostate releases into the bloodstream. The best protection against prostate problems is to have regular medical checkups that include a careful prostate exam. See a doctor promptly if the following symptoms occur: a frequent urge to urinate; difficulty urinating; dribbling of urine.

There are many reasons to celebrate in May. The flowers and trees are blooming creating beautiful scenery. Isn't God amazing? Just take a moment and enjoy the beauty that He created. May is also National Stroke Awareness Month, Older Adults Month and then there's Mother's Day and Nurse's Day. So where do we begin for this month's newsletter article? Let's start with Mother's Day, when we honor our mothers. When it came to your health, what did your mother tell you? Probably things like button your coat, wash your hands, eat your vegetables. So what would your mother say about preventing stroke? Since women are uniquely impacted (even though a stroke can happen to anyone regardless of age, gender or race), let's take a closer look at stroke, or what is now being called a "brain attack".

I am writing this a few days after we turned our clocks ahead one hour.  Many of my friends are complaining about being more tired since we switched to daylight savings time.  Since I am among those who feel this way, I thought I'd spend some time this month discussing Melatonin, a supplement used to help people sleep.  Hopefully, I won't put you to sleep!

What is melatonin? Melatonin is actually a hormone, produced in the brain by a gland called the pineal gland.  Darkness causes the gland to produce melatonin; light causes production to be suppressed.  The highest levels of melatonin are just before bedtime.  This suggests melatonin plays a role in our sleep/wake patterns.  It also has some antioxidant properties.  Antioxidants help reverse damage to our cells and are found in many foods.  There is some evidence that melatonin may help boost the immune system, our body's natural defense against disease.  Melatonin also plays a role in menstruation, including frequency and length of cycles as well as when menstruation ends (menopause).