Is that time again.  School time that is.  With the school year just beginning, sports related injuries are on the rise. Each year there are more than 25,000 cheerleading injuries, often sprains and bruises. But in 2007, one girl was not so lucky.

Elizabeth Nicks, now 15, was a cheerleader performing a human pyramid when she toppled to the ground. She was rushed to the hospital and found to have a subdural hematoma, observed for five days, and released.

A subdural hematoma is a collection of blood on the surface of the brain. Subdural hematomas are among the deadliest of all head injuries, as the bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury.

Those suffering from brain injury require extensive medical treatment which is ongoing.  Just as an example, a local head injury facility charges $1,100 per day for treatment consisting of occupational therapy, recreational therapy, psychotherapy, recreational therapy, and speech therapy services in conjunction with room and board.

A Nurse Life Care Planner can assist the family and legal counsel to determine what the lifelong medical care will consist of and it’s related costs.  This plan can then be used for budgeting purposes throughout the life of the individual.

Although a subdural hematoma can easily be diagnosed with an MRI or CT scan, the hospital chose not to do a follow-up CT scan before discharging Ms. Nicks. Otherwise, they would have seen that the hematoma was increasing in size. This near-fatal mistake cost them; to the tune of $5.5 million.

You can read more about the case at Contra Costa Times.

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A home-care nurse was awarded nearly $1.7 million in damages by a Syracuse jury to compensate her for permanent nerve damage caused when she was given an injection following the delivery of her baby. A state Supreme Court jury of four women and two men awarded Tina Holstein $140,000 for past pain and suffering plus $1,550,000 for future pain and suffering according to Syracuse News.

Many of my workers compensation patients suffer from sciatica which is a condition that refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or compression of the sciatic nerve. The nerve runs from the spine across the mid buttocks region. This plaintiff now suffers from as a result of an injection being improperly administered.

All nurses are taught to give intramuscular injections into the upper outer quadrant of the buttocks. The reasoning behind this is to prevent an injury to the sciatic nerve.

Patients suffering from sciatica have difficulty sitting at a desk to work, standing doesn’t necessarily help and the pain is nearly unbearable at times. Driving just to the corner grocery is a nightmare for some when the sciatica is at its worst, as is bending from the waist.

Given that this woman is a home health care nurse, I would expect that she drives quite a bit to visit her patients. In addition, to perform their jobs, all nurses must do a great deal of bending, lifting, etc. This is compounded when working with patients in a home setting where you may or may not have the proper equipment to aid in caring for the patient as you would in a hospital setting. Will accommodating this nerve damage by assuming awkward positions to sit, bend, lift create other health issues in the future? Those are just a couple of question that come to mind as a Nurse Life Care Planner when considering the amount the jury awarded her.

I also think it is interesting that: “…the Department of Health investigated the birth of Holstein’s child and found problems with her treatment and the documentation of that treatment during the delivery.” While those issues were not part of the lawsuit, it does seem to support that the care this patient received was not up to par.  Unfortunately this is an all too common occurrence found when reviewing medical records in my work as a legal nurse consultant.

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If you or a loved one has suffered from amputation, help is just around the corner.  Arkansas is home to the American Amputee Foundation as well as several support groups.  I highly recommend that you become a member of the Amputee Coalition of America too.  If you still cannot find the help and support you need, contact me directly and I will help you find someone to talk to.  In addition to life care planning services, I also provide care management for those with catastrophic injury and illness so I have many contacts within the amputation and prosthetic communities.

Below are several support group locations for amputees and their loved ones:

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Traditionally vitamin D has been recommended with respect to preventing osteoporosis, reasoning that improving the absorption of calcium improves bone strength making them less likely to fracture, should there be a fall.  Thereafter it was discovered that vitamin D has direct effects on muscle strength.  Severe vitamin D deficiency (as one might see in those nursing home residents who do not eat well and are virtually never in the sun) can present as muscle weakness and pain which resolves with vitamin D supplementation.  

Several early trials examining the extent to which vitamin D could prevent falls were unsuccessful.  These studies may have failed to produce the hypothesized result due to methodological issues:  low doses of vitamin D were used; vitamin D is available over-the-counter and may have been in use by those in the control group creating bias toward the null; and finally an issue we can all identify with — the difficulties associated with ascertaining the prevalence of falls due to using an unstandardized definition or incomplete ascertainment.  

A meta-analysis (“study of studies”) conducted by an international team of researchers, was recently published in the British Medical Journal1 to further address this issue.  The meta-analysis included 8 double blind randomized controlled trials of individuals 65 years or older receiving a defined oral dose of supplemental vitamin D3,  vitamin D2  or an active form of vitamin D and with sufficiently robust fall ascertainment.  The aim was to assess the efficacy of vitamin D supplementation for the prevention of falls among older persons by dose and serum concentration of vitamin D [25(OH)D].  The primary outcome measure was the relative risk of having at least one fall among persons receiving vitamin D (with or without calcium) compared to those receiving placebo or calcium supplementation alone.  Note that the current recommended adult daily dose of vitamin D is 400 international units. 

Results:

No fall reduction was observed for a daily dose of less than 700 IU vitamin D or achieved serum 25(OH)D concentrations below 60 nmol/l. 

Daily vitamin D doses in the range of 700 IU to 1000 IU or achieved serum concentrations between 60 nmol/l and 95 nmol/l reduced the risk of falling by 19%.   It is possible that higher doses of vitamin D or higher 25(OH)D concentrations would further reduce falls.  Results were attained with treatment for less than a year (2-5 months) and the benefit was sustained for 12-36 months.

 Preventing falls using this higher dose of vitamin D may not depend on taking additional calcium.

The authors note: “Binding of vitamin D to its nuclear receptor in muscle tissue may lead to de novo protein synthesis, a benefit that appears to precede the effect of vitamin D on bone.”  

*Since vitamin D is fat soluble and stored in the body it can accumulate to toxic levels over time and therefore periodic blood levels should be assessed.

1.  Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP and Henschkowski J.  Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomized controlled trials.  BMJ 2009; 339:b3692.

Source: CT Collaboration for Fall Prevention

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A few days ago, news broke out that several individuals had suffered from hair loss after having CT scans of the brain.  The majority of cases were reported at hospitals in Los Angeles and Glendale, California.  Then, yesterday, news broke of a young lady who had a CT scan of her brain after experiencing seizures.  Shortly thereafter, she began to lose her hair, and the doctors were dumbfounded as to the reason why.  That was until she received a letter from the CEO of the hospital.  He wanted to notify her that she was exposed to high levels of radiation.  The following link is the story from the local news station in Huntsville, Alabama.

Yesterday, a lawsuit was filed against GE Healthcare, the maker of the CT scanner that allegedly delivered 8 times the amount of necessary radiation.  The class action lawsuit, naming 16 plaintiffs, was filed in Huntsville, AL in the amount of $5 million dollars to cover future medical costs associated with the exposure.  The lawsuit  “claims GE Healthcare carelessly researched the design and failed to adequately test” its products, and that the scanners lacked safety features to warn of overdoses.” (http://www.newsinferno.com/archives/17531 ) 

 However, it is important to note that the FDA’s investigation of the CT scanners included more than one brand of scanner.  The initial report in October 2009 by the FDA, stated that this occurred at one facility.  However, there are more instances of occurring across the country.  Common immediate symptoms of excessive radiation include hair loss and a skin rash.  If you have concerns, you can contact MedWatch, the FDA’s voluntary reporting program. This can be done on-line by filing a voluntary report, by phone at 1-800-FDA-1088, or obtain the fillable form online, print it and fax to 1-800-FDA-0178 or mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787.

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The Bone and Joint Decade is, like most other preventive awareness activities, spirited towards educating the public and the medical world on the diagnoses, treatment, and prevention of bone and joint disease.  Their goal is to raise money for research, prevention, and treatment modalities that affect millions worldwide every year.  In the United States, there’s approximately $254 million spent on bone and joint diseases alone each year.

There website says it best……
Across the world, musculoskeletal conditions affect hundreds of millions of people, at a huge cost to society. Worldwide, musculoskeletal conditions are the most common causes of severe long-term pain and physical disability. Aging populations throughout the developed world will result in significant increases in musculoskeletal conditions, with attendant increases in costs to those countries.  Joint diseases account for half of all chronic conditions in the elderly. Forty percent of all women over the age of 50 years are expected to suffer at least one osteoporotic fracture in their lifetime. Throughout the world, musculoskeletal conditions and deformities deprive children of a normal development.  Road traffic injuries are increasing precipitously, and by the year 2010, is estimated to account for as much as 25% of all health care expenditures in developing nations.  In the United States alone, musculoskeletal conditions are a leading cause of disability, accounting for more than 130 million patient visits to healthcare providers annually.

This coming week, the Global Conference is being held in Washington, D.C.  Check it out, and see how you can make a difference.

Bone and Joint Decade Global Network Conference

Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost – Presenting a compelling argument for greater understanding and expanding research

Experts in Arthritis – A Free Public Seminar for People with Arthritis and People who Care About Them

Fit to a T – An Education Program on Bone Health and Osteoporosis

Medical school curriculum recommendations

National Action Week - October 12-20

PB&J – Protect Your Bones and Joints – A High School Education Program

Ponseti Clubfoot Clinics

Rare Bone Disease Patient Network

USBJD Newsletter

Young Investigators Initiative

We here at VP Medical Consulting are currently working on a life care plan for a young lady with a traumatic brain injury. In developing the plan we consult many resources and thought I would share them here. If you have a resource I have missed, please let me know and I will be sure to add it.

ABLEDATA

Source for Assistive Technology Information
www.abledata.com/abledata.cfm?pageid=19327

America’s Heroes at Work

Employment Challenges of Returning Service Workers
www.americasheroesatwork.gov/

800-526-7234

American Speech-Language-Hearing Association

Resources for Communication Disorders
www.asha.org

American Veterans with Brain Injuries

Support to the families of American service members and Veterans who have TBI
www.avbi.org

Blinded Veterans Association (BVA)

Helping Veterans and their families with challenges of blindness
www.bva.org

Brain Injury Association of America

National organization serving individuals and families with TBI
www.biausa.org

800-444-6443

Brain Injury Chatroom

Peer support for people with TBI
www.braininjurychat.org

Brain Injury Partners: Navigating the School System

Advocates for school-aged children with TBI
free.braininjurypartners.com

Centers for Disease Control and Prevention

Online source for health information
www.cdc.gov

800-311-3435

Defense and Veterans Brain Injury Center

Serving active duty military, their dependants and veterans with TBI
www.dvbic.org

800-870-9244

Disabled Sports USA

National nonprofit organization serving war veterans through sports rehabilitation
www.dsusa.org

301-217-0960

Epilepsy Foundation

National organization dedicated to the welfare of individuals with epilepsy
www.epilepsyfoundation.org

800-332-1000

Family Care Navigator

State-by-State Help for Family Caregivers
caregiver.org/caregiver/jsp/fcn_content_node.jsp?nodeid=2083

Give an Hour

Nonprofit organization providing free mental health services to U.S. Military personnel and their families
www.giveanhour.org

HDI Publishers

Resource for Brain Injury books
www.braininjurybooks.com

Health Resources and Services Administration

U.S. Dept of Health and Human Services
www.hrsa.gov

301-443-3376

Illinois Warrior Assistance Program

Confidential assistance for Illinois Veterans
www.illinoiswarrior.com

866-554-4927

International Society for Neurofeedback & Research

Nonprofit professional association promoting excellence in practice, education & research for neurofeedback.
www.isnr.org

Journal of Head Trauma Rehabilitation

Resource for publications
www.headtraumarehab.com/pt/re/jhtr/home.htm

Lash & Associates Publishing/Training, Inc

Resource for publications

www.lapublishing.com

LEARNet (Living Education and Resources Network)

Resource for teachers, clinicians, parents and students of brain injury
www.bianys.org/learnet

MedlinePlus

Online health information provided by the US National Library of Medicine
www.nlm.nih.gov/medlineplus/headandbraininjuries.html#cat57

Model Systems Knowledge Translation Center

Summarizes research, identifies health information needs and develops systems for sharing info on TBI
msktc.washington.edu

National Association of State Head Injury Administrators

Assists state government in promoting partnerships and building systems to meet the needs of TBI patients
www.nashia.org

301-656-3500

National Brain Injury Research Treatment and Training Foundation

Nonprofit foundation providing support for research, training and treatment for TBI
www.nbirtt.org

434-220-4824

National Center for Medical Rehabilitation Research

Foster development of scientific knowledge needed to enhance the health, productivity, independence and quality-of-life of people with disabilities.
www.nichd.nih.gov/about/ncmrr

800-370-2943

National Dissemination Center for Children with Disabilities

Research based information on effective educational practices of children with disabilities
www.nichcy.org

TBI Community

National Information, Educational Resources, Dissemination and Technical Assistance Center for the Community Integration of Individuals with Traumatic Brain Injury
www.tbicommunity.org

National Institute of Neurological Disorders and Stroke, NIH

Reducing the burden of neurological disease

www.ninds.nih.gov

800-352-9424

National Institute on Disability and Rehabilitation Research

Provides leadership and support for a comprehensive program of research related to rehab of persons with disabilities
www.ed.gov/about/offices/list/osers/nidrr

202-245-7640

National Resource Center for Traumatic Brain Injury

Providing info for professionals, patients and family members of TBI
www.nrc.pmr.vcu.edu/

National Resource Directory

online source for wounded, ill and injured service members, Veterans and their families.
www.nationalresourcedirectory.org

National Resource Directory

An Online Partnership for Wounded, Ill, and Injured Service Members, Veterans, Their Families, and Those Who Support Them
www.nationalresourcedirectory.org

North American Brain Injury Society

Organization for Brain Injury Professionals

www.nabis.org/

703-960-6500

Traumatic Brain Injury Central

Rehabilitation Research and Training Center on Traumatic Brain Injury Interventions
www.tbicentral.org

Safe Kids Worldwide

Global network of organizations whose mission is to prevent accidental childhood injury
www.safekids.org

Sesame Street Workshop — Talk, Listen, Connect: Deployments, Homecomings, Changes

bilingual educational outreach initiative designed for military families and their young children to share.
archive.sesameworkshop.org/tlc

Social Security Administration

Social Security services

www.ssa.gov

800-772-1213

TBINET

online support groups for TBI
tbinet.org/support1.htm

The Bob Woodruff Family Fund

resources and support to service members, veterans and their families to successfully reintegrate into their communities
remind.org

ThinkFirst

National Injury Prevention Foundation
www.thinkfirst.org

What resources do you use most often when researching head injuries? Have we covered them all?

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If you are looking for information on particular diseases that affect our older population, check this list for resources which might be of interest.  These are specific to Arkansas.  National resources are also listed in this blog section of the site.  Please feel free to share you own in the comments section below.

Alzheimer’s Alliance – Texarkana Area: Non-profit organization offers support services to adults affected by Alzheimer’s disease and their families. Services include:
• Caregiver support groups
• Education and training
• Survey for an Alzheimer’s Safe Home (S.A.S.H.) program
• Ask the Attorney program
• Free memory screenings
Provides services in Texas (Bowie, Camp, Cass, Marion, Morris, and Red River Counties), Arkansas (Clark, Columbia, Hempstead, Howard, Lafayette, Little River, Miller, Nevada, Ouachita, Pike, Sevier, and Union Counties), and Oklahoma (McCurtain County).
Eligibility varies by program. (877) 312-8536 OR (903) 223-8021
http://www.alztexark.org

Alzheimer’s Arkansas: Non-profit organization offers support services to adults affected by Alzheimer’s disease and their families. Services include:
• Support groups
•Toll-free 24-hour telephone support for caregivers
• Financial assistance for caregivers (Respite)
• Education and training programs
• Monthly newsletter
Eligibility varies by program (501) 224-0021
http://www.alzark.org

Arkansas Prostate Cancer Foundation (APCF): Non-profit organization offers support services to men affected by prostate cancer and their families. Services include:
• Free prostate cancer screenings
• Support groups
• Online newsletters
Men of any age (800) 338-1383
www.arprostatecancer.org

Epilepsy Education Association of Arkansas: Non-profit organization provides information and assistance to people affected by Epilepsy and their families. Services include:
• Resource center with educational materials for loan
• Support groups
• Epilepsy awareness programs
Individuals with Epilepsy (501) 772-4788
www.epilepsyarkansas.com

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I have mentioned on more than one occasion that I have a latex allergy which is one of the reasons I left the bedside. I recently learned of the Exceptional Nurse, a site dedicated to assisting nurses with disabilities. Several resources are available for those like me with latex allergies.

American Academy of Allergy, Asthma & Immunology
The Academy provides information about latex allergy and a brochure and newsletter.

Latexallergyresources.org
This site provides educational materials, support groups, publications and product information.

Medic Alert
A 24-hour Emergency Response Center for members who wear the Medic Alert bracelet or neck chain.

MedWatch (FDA)
This organization provides safety information on medical products regulated by the U.S. Food and Drug Administration.

National Institute for Occupational Safety and Health (NIOSH)
This is the federal agency responsible for conducting research and making recommendations for the prevention of work-related disease and injury.

The Sustainable Hospital Project
Provides technical support to the health care industry in selecting products that reduce occupational and environmental hazards including latex, mercury, PVC and glutaraldehyde.

Workplace Safety Series: Living with Latex Allergies
By Robert Scally
Latex allergies drove a registered nurse from the clinical setting and forced her to alter the course of her nursing career.

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• Non-clinical Jobs for Nurses