Health Care Reform

If you’ve listened, read, or watched anything on the topic of Health Care Reform in America, you’ll notice that physicians and doctors are pretty much the only providers of health care getting the attention.  They are taking the lead in formulating plans and working to advise the president that they, alone, are the stars in this important discussion. 

People who value the care provided by Nurse Practitioners need to SPEAK UP.  Let your legislators know that your NP must be a vital part of the future of health care.  Here’s a sample letter (that I sent to Senator Cantwell).  Feel free to copy it and personalize it to let your senators, state representatives, and EVERYONE ELSE know that NP’s provide quality, cost effective health care.

 

Dear Senator Cantwell, I am a pediatric nurse practitioner with a private practice in Lakewood, WA.  In several states, including Washington state, nurse practitioners are qualified and allowed by law to provide primary care services for their patients independently.  We do not require a medical doctor on staff to provide this care.

I am concerned that Mr.. Obama may not be aware of this fact. Repeatedly, he assures Americans that health care reform will allow people to choose their own "doctor."  In order to ensure that Americans can also choose their own nurse practitioner, or keep the one they already have chosen, the language of health care reform needs to change.

Nurse practitioners have often been scorned by the powerful American Medical Association.  Their ongoing agenda to limit the ability of NP's to continue to provide independent health care jeopardizes affordable and rational health care reform and limits the ability of many patients to access health care at all.

Please don't allow the language of health care reform to limit access to qualified health care providers by referencing doctors/physicians as the primary keepers of the "medical home."

You may contact me any time to discuss this.  I also welcome you to my pediatric clinic, Fir Creek Pediatrics.  You will find a great deal of support for broadening the language of health care reform to include all providers of primary care.

Sincerely,

Michelle Hayes, MN, ARNP

Update on Jefferson Park

My last blog post was about ways to avoid diarrhea illness when enjoying splash parks.  I noted that I did not know how our Tacoma splash parks sanitized the water.  So, I emailed Metro Parks, and here’s their reply:

The water is sanitized through filtration and UV light at our three newest spraygrounds – Jefferson Park, South Park and McKinley Playfield.

At Wapato Hills the water is not recycled.

Sheree Trefry

Communications Coordinator

Metro Parks Tacoma

253-305-1059/253-305-1098

4702 S 19th St., Tacoma, WA  98405

CREATING HEALTHY OPPORTUNITIES TO PLAY, LEARN AND GROW

www.metroparkstacoma.org

Thanks, Ms. Trefry, for the very quick reply.  So, you can see that Metro Parks uses methods to try to keep visitors safe.  Cryptosporidium, the organism that can cause diarrhea illness at such parks is resistant to chlorine and chemical methods, filtration can remove up to 99%, and UV light will inactivate it entirely.

Splash Park Precautions

With the wonderful warm weather we’ve had lately, no doubt the splash feature at Jefferson Park in Tacoma is getting lots of use.  These kinds of parks are lots of fun for kids and help moms & dads keep cool too.  But there is a potential problem, which was outlined in a recent MMWR article.  Splash parks can be a great way to spread diarrhea illnesses.

Most diarrhea illnesses are spread through the dreaded “fecal-oral route.”  We don’t like to think of this, but water or food can be contaminated by fecal matter by not washing hands well after using the toilet, changing baby diapers, or direct contamination of fecal matter into the water supply or onto a surface where food is prepared. 

Water parks like Wild Waves and pools are regulated and use various techniques to sanitize the water.  Examples are chemicals (such as chlorine) and UV light.  Remember, there are some organisms that cause diarrhea illness that are actually resistant to chemical decontaminants and filtration (example is Cryptosporidium).  Contamination can occur despite the most rigorous efforts to control the water safety.  The good thing is that it doesn’t happen often, and so we don’t usually worry too much about it. 

Splash parks may also use methods to decontaminate or sanitize the water.  Usually, though, they are not regulated in the same way as pools.  I honestly do not know how Jefferson Park’s splash feature is maintained, although I do have an email out to Metro Parks Tacoma asking for details.  My grandson, Hunter, loves visiting that park as you can see in the picture above.

HERE ARE WAYS TO PREVENT CONTAMINATION OF SPLASH PARKS:  as recommended by the editors of the MMWR:

1.  Use soap & water to bathe children before playing in the water—be sure to wash their bottoms also.

2.  Change diapers in designated areas such as the bathroom and use soap & water to wash the child if there is stool in the diaper.  Wash your hands after with soap & water.

3.  NEVER play at such a park if you or your child have a diarrhea illness.

4.  Don’t drink the water or swallow splashes from the water in the water feature.

5.  Don’t allow children or adults to sit on the water spraying part of the water feature.

6.  Find out how your park maintains the water safety, and don’t utilize the park if it isn’t maintained and monitored properly to prevent spread of diarrhea illnesses.

7.   Check with the local Health Department to find out if they regularly monitor the safety of your favorite park.

Sofie’s Oncology Appointment

 This week, on Wednesday, Sofie went to her first appointment with the oncology vet.  A week out from her surgery to remove the melanoma from her lip, we trekked all the way to Seattle to Animal Cancer Specialists.  We met with Dr. Gillings who is a vet of 6 years who returned to school to specialize in oncology.  She is a tiny matter-of-fact woman who was very easy to talk with.  She’d already reviewed Sofie’s pathology report on the oral melanoma tumor, and spoke with me as if I were her peer as we discussed the likely prognosis and treatment options.  I’d read about the melanoma immunization (see the melanoma link above) and had just about decided that Sofie would get it.

But earlier in the week I’d noticed a weird lump on Sofie’s hip and so Dr. Gillings did a needle biopsy of that along with her neck lymph nodes.  Just to be on the safe side (needle biopsies aren’t the most fun thing to have done), Sofie got to wear a lovely basket muzzle.  She was thrilled, as you can see by her face in this picture.  She was tense, but cooperative.  After two needle biopsies of each lymph node and the bump on her hip, she was taken back for chest x-rays.  These were all done to look for metastases.

After the x-rays and biopsies, Dr. Gillings returned to the exam room and told me her findings with the caveat that a radiologist would review the films, and a pathologist would review the biopsies.  Her impression of the bump was that it likely was a mast cell tumor.   Just the act of examining the bump and poking it with the needle for biopsy caused it to release histamine and swell.  That made it seem more likely her impression was correct.  This is what makes these tumors so dangerous.  Sofie got an injection of Benadryl for the trip home.  In the picture, she looks a little stoned from her Benadryl shot.

It took until Friday to hear the pathology & radiology results.  Dr. Gillings called me just as I was leaving work. The bump is a mast cell tumor.  The x-ray shows a shadow in the lung.  The melanoma tumor in the mouth is Grade 1 probably as it was small and the nodes were ok.

Meanwhile, I set Sofie up with Dr. Patti Schaefer of Canisport.  Dr. Patti is a holistic vet that does acupuncture, advises on diet and supplements, and does chiropractic work with animals.  Here’s Sofie enjoying her acupuncture treatment.

So, what now?  Today, we took Sofie to our vet, Dr. Mark Peterson at Animal Hospital of Parkland.  I needed to talk to him as I  was starting to feel a bit overwhelmed by the choices that needed to be made.  Dr. Mark helped us (Dale and me) sort out what the heck to do next. 

Obviously the mast cell tumor must be removed.  In fact, it has to be removed with huge margins to be sure that it is completely gone.  That’s happening next Tuesday.  That tumor and surrounding tissue will be sent to pathology for confirmation of cell type and identification of it’s stage (how fast it is reproducing and likelihood it has spread.)  Dr. Mark will also do some more x-rays to see if that shadow in the lungs is just a shadow, or if it’s another tumor of some sort.  Based on that information, we can decide how to proceed.  If the shadow is a tumor, it’s potentially melanoma.  It’s unlikely to be mast cell (they rarely go to the lungs).  We could monitor it, and if it begins to grow, and if we don’t have to worry about spreading mast cell cancer,  then the melanoma immunization would be the way to go.  

But if the mast cell cancer is widespread, it would not make sense to do the melanoma immunization.  In that situation, keeping Sofie feeling happy and pain-free would be the game plan.  

So, that’s where we are in the dog pack scheme of things.  Sofie’s eating a cancer-dog diet with low grains.  She gets pre & probiotics, vitamins, and other supplements to help her fight the cancer and maintain her health as much as possible.  She’s not getting any more immunizations (except maybe the melanoma one).  She gets quercetin, organic apples, blueberries, and wild salmon oil.  And she’s getting 50 mg Benadryl three times a day.  She gets to play, swim, go on walks and chew on bones and every other dog joy that is available.  And we’re going to love her as long as we have her to love.

Swine Flu Update

Now that we’re a couple weeks into the Swine Flu Outbreak it appears that swine flu is the same as the regular seasonal flu in its virulence and its transmission rate.  It may even be LESS deadly than the regular flu.  Symptoms are about the same as the regular flu too, with high fever, cough, and sniffles.  Death from the flu generally happens when complications of the flu occur.  These complications include pneumonia, meningitis, or sepsis.  And the complications are more likely in people with immune compromise, asthma and respiratory chronic illness, and other chronic illnesses.

So, it’s still a good idea to use the typical infection control measures that are common sense.  Wash hands before eating and after touching potentially infectious items.  And stay home if you are sick with a fever & cough.

Swine Flu Epidemic?

The current swine flu outbreak represents infection by a novel strain of influenza.  It is composed of subtype H1N1 influenza A that typically affects humans and several subtypes of influenza that generally affect pigs and North American birds.  Mexico health officials report that over 1000 people have been infected.  80 deaths have been reported, but only 20 of them had laboratory confirmation of the novel swine flu.

Cases reported in the US have been less serious.  There have been no US deaths at this time.  There have been only 19 confirmed cases, but about 202 suspected cases across five different states.  Some of the infected people had visited Mexico.  None had contact with pigs; therefore the infection can pass from person to person.  Undoubtedly we will hear of more cases over the next months but hopefully very few deaths.

Several key points have raised international concern.

1. Just as in the 1918 influenza epidemic, mortality seems greater among young adults.  The usual influenza that hits us each year is hardest on young children, the elderly, and people who have an immune compromised state. 

2. Cases are being confirmed across a wide geographical span—Central Mexico to Mexico’s border with the US to Texas, California, Minnesota, New York, and Kansas.

3.  A strain of animal influenza not seen before is causing illness in people and is transmitted person to person via respiratory route.  This is actually an unusual situation—animal viruses tend to spread through contact with the animal and then stop there.

4.  This influenza virus is resistant to a couple of the usual antiviral medications typically used for influenza.

Because of these facts, international health officials are gathering and doing some serious investigations.  US scientists are working with the virus to develop a “seed strain” that can be used to make vaccine in case that is needed.  And investigators are scrambling to determine if we’re facing a serious pandemic.

Here’s what we don’t know yet but are trying to find out: How infectious is this strain of swine flu?  How easy is it for someone to catch from an infected person?  How virulent is the strain?  If you catch it, what’s the likelihood of serious complications or death for the average healthy adult?  Who is most vulnerable?  And what’s the best way to protect those most vulnerable people?

WHAT CAN WE DO WITH THIS INFORMATION?

Everything comes back to protecting your own health and that of your family.  Things we do every day to prevent illness can help protect you from Swine Flu.  Eat a balanced diet and get the rest you need.  Wash your hands before eating and after touching things that could potentially have germs on them (ok, you don’t have to get OCD about it but use common sense when visiting, shopping, hanging out in groups of people).  Don’t go among groups of people when you have an illness with a fever.  Avoid hanging around people with fevers & coughs.  COVER YOUR COUGH and WASH YOUR HANDS.

For more information & tips, check out the CDC website:  http://www.cdc.gov/swineflu/

Good Dog Ted

It’s a beautiful day at work and so at lunch Teddy and the gang enjoyed a game of chase the ball in our little grassy area behind the clinic.  Hunter watched from his stroller.  Ted ran and ran until he couldn’t run any more.  Here he is resting between chasing episodes.