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This month represents the first National Limb Loss Awareness month.  As an Nurse Life Care Planner that specializes in developing life care plans for amputees, I am delighted that this issue is getting the attention it deserves.  Did you know 60% of limb loss is preventable?  That is due to the fact that the number ONE reason for lower limb amputation is diabetes.

Here are some statistics on amputations in the United States:

• U.S. Amputee Population Approximately 1.7 million
• 82% of Amputations Are Dysvascular Related
• 97% are  of Dyvsacular amputations lower limb
• In General Amputee Population 90% are Lower Extremity
• Upper extremity amputations account for the remaining 10% of General Amputee Population
• As differentiated from disease related and congenital amputations, 70% of Traumatic Amputations are Upper Extremity

The Amputee Coalition of America has an excellent website that provides tips for avoiding amputation, information about limb loss, how to choose a prosthetist, resource links and much more that is of interest to anyone at risk, who has a friend or relative at risk or who suffers from limb loss and for just general information.

http://www.amputee-coalition.org/Limb-Loss-Awareness

I encourage you to visit this site, particularly if you are one of the more than 24 million Americans with diabetes.

Related articles from VP Medical Consulting

• Workplace Amputation Injury at 10,000 per Year
• Electrical Amputation after 7,200 Volts
• ACA Scholarships Available for Those with Limb Loss
• No Hands No Feet
• Resources for Amputees: Amputation levels
• Limb Loss and the Grieving Process: Part 1 and Part 2

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The definition of deaf-blindness is broad and incorporates individuals with a wide range and combination of hearing and vision loss. The causes and severity of this combined loss also ranges significantly, influencing various levels of cognition and overall access to the hearing-sighted world.  Here are a few resources for your clients and patients that suffer dual sensory loss.

• American Association of the Deaf-Blind (AADB)

http://www.aadb.org

The only national organization run for, by and of deaf-blind individuals. It is a social networking and advocacy organization that provides information, resources and linkages to deaf-blind people and interested parties across the country.

• CHARGE Syndrome Foundation

http://www.chargesyndrome.org/

The CHARGE Syndrome Foundation provides support to individuals with CHARGE syndrome and their families; gathers, develops, maintains and distributes information about CHARGE syndrome; and promotes awareness and research regarding its identification, causes and management.

• Helen Keller National Center (HKNC)

http://www.hknc.org/ (HKNC)

Helen Keller national Center is the national rehabilitation center for adults who are deaf-blind. HKNC provides residential rehabilitation services at their center in addition to outreach services nationally through a network of regional representatives.

• National Association for Parents of Children with Visual Impairments (NAPVI)

http://www.NAPVI.org

The National Association for Parents of Children with Visual Impairments (NAPVI) is a national organization that enables parents to find information and resources for their children who are blind or visually impaired, including those with additional disabilities.

• National Consortium on Deaf-Blindness (NCDB)

http://www.nationaldb.org

The national federal Technical Assistance project established specifically for supporting the state projects who serve children and young adults who are deaf-blind between the ages of 0 – 21.

• National Family Association of Deaf-Blind (NFADB)

http://www.nfadb.org/

NFADB supports persons who are deaf-blind and their families. NFADB is a non-profit, volunteer-based family association and the largest network of families focusing on issues surrounding deaf-blindness.

Abbott Diabetes Care announced a recall of 359 lots of blood glucose test strips in the United States and Puerto Rico. The company issued a recall after it was discovered the strips may give falsely low blood glucose results. The false results may cause patients “to try to raise their blood glucose when it is unnecessary and to fail to treat elevated blood glucose due to a falsely low reading,” the company said. PR Newswire

Related articles

• Abbott Laboratories Recalls 359 Million Diabetes Test Strips (dailyfinance.com)
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Going to see your doctor these days can be like sitting an exam. You have to get all your information ready beforehand, and then when you are in the examination you have to try and remember everything that might be important. Effective communication is the key to getting the most out of your doctor – so how do you do that? Here are 5 top tips on how:

1)      Prepare. Before you even leave your home, list all the symptoms you can, whether or not you think they are relevant. If this is a routine check-up, note any changes since last time. List any and all medications being taken and how often, to help the doctor understand your current medication regimen.

2)      Honesty. Be up front about lifestyle choices. If alcohol, tobacco and other drugs feature then be clear about this to help the doctor to see the big picture. Do not avoid raising a subject just because you think it is sensitive or embarrassing. If you hide something from the doctor they may not be able to make the best decision for you.

3)      Pertinence.  If you do not ask questions then the doctor might assume that you understand and nothing else needs explaining. So you should pipe up with any Who / What / When / Why / How questions that you might have. Query any medical terms used that you don’t understand. Ask about treatments and procedures as well as the doctor’s general diagnosis.

4)      Persistence. If you feel that you haven’t understood what the doctor has told you, ask for clarification. Do not be rushed or made to feel stupid or awkward – it is their job to explain it to you. If necessary, schedule another visit or phone call to clarify things. And of course, you are always within your rights to seek a second opinion.

5)      Particulars. Write down everything that you’ll want to remember. Ask for literature (not just books and pamphlets, but also audio and video) that is relevant, and trusted online sources of information.

Above all, remember that for communication to be effective, both sides have to be understood. Your questions need to be heard and answered, and the doctor’s information needs to be clear and understandable.

Taking proper care of a sick person, whether it is yourself or a loved one, needs an understanding of the condition and treatment – so don’t go home without both.

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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