A 3-year-old embarks on a space ship journey to recovery!

Most people would give up when faced with insurmountable odds, but then again, Bella isn’t like most people. Bella Counts is a three-year-old leukemia patient who developed necrotizing fasciitis, otherwise known as flesh-eating bacteria, as a result of her weakened immune system. She was sent to Texas Health Fort Worth for hyperbaric wound treatment to heal skin grafts that were unsuccessfully healing.

Hyperbaric wound treatment exposes patients to 100 percent oxygen at below sea-level pressure. The oxygen is forced into the bloodstream at a quicker rate to promote quicker cell growth. It is a therapy typically used to treat elderly diabetic and carbon monoxide poisoned patients. Bella is the first child to undergo treatment for these types of wounds at the hospital. For her parents, the forty treatments have meant a chance to save her tiny legs from amputation.

For 40 treatments, Bella climbed into her “space suit” and “space ship” to begin the healing process. Without any complaints, she embarks on the two-hour treatment with a smile on her face and brightening the staff and other patients around her. Her bravery has been an inspiration to others and has been a big part of her healing process.

If you know a child or individual who you believe might also benefit from wound care and hyperbaric treatment, leave us a comment and we will be happy to get into contact with you!

Tissue Donation

Every year thousands of lives are saved or enhanced from the gift of tissue donation. Whether it’s a burn patient who has received countless skin grafts to heal or a athlete receiving a donor tendon so they can play their favorite sport again, tissue donation is the ultimate gift of life to those in need.

One full tissue donor can save and enhance the lives of more than 50 people with the various grafts that can be made. In 2009 alone, nearly 1,000 tissue grafts were recovered from 57 donors at Texas Health Harris Methodist Hospital Fort Worth. These grafts included skin, bone and tendons, heart valves and veins.

Skin grafts save the lives of thousands of burn patients every year. Grafts recovered are about the same thickness of a sunburn peel. They are processed and meshed to provide greater surface area. These grafts aid burn victims by preventing fluid loss and infection. The average donor yields nearly 3.5 to 4 square feet of skin, while the average severely burned patient requires nearly 40 square feet of skin. Skin is recovered from the back and front and back of the thighs. Burn victims require so much skin because the body will continuously reject skin grafts, so they have to be replaced every few days.

Bones from the upper and lower extremities are used in many different ways. They can be cut into small rings to alleviate severe back pain in spinal fusions. These bones also can be cut into cubes or crushed for orthopedic or dental surgeries. Tendons recovered from the lower extremities are used most commonly in ACL repairs. Bone and tendon grafts from one donor can enhance the lives of up to 50 people with the various grafts that can be made.

If the heart cannot be transplanted, it can be recovered for valves. These valves are used in children with congenital heart defects. Saphenous veins from the leg can be used for dialysis access in dialysis patients.

One of the most common myths about organ and tissue donation is that one cannot have an open casket viewing. However, the donor is treated with the utmost respect and reconstructed so there is no difference in appearance so an open casket is possible.
There is also no cost to the donor family for any cost related to donation.

“You have the power to donate life. Be an organ, eye, & tissue donor.” You can register your decision at www.donatelifetexas.org and to hear stories of hope from tissue donation go to www.communitytissue.org/miracles/recipients

- Amanda Williams, transplant coordinator

Bariatric Diaries 6: The dog days of summer!

The last few weeks have been HOT!! July has brought things into perspective for me on the whole recovery process from my surgery that I had in May. Over the July 4th weekend, things were business as usual with a few minor changes being made for my recovery. We went to lovely Junction, TX for some good times on the Llano River and relaxing at the ranch for the weekend. Unfortunately, there were no hot dogs and adult beverages for me this year but I was ok with that. I made due with the things I could eat and had just as good of a time. On Monday, we were headed back home and all the sudden something just wasn’t right. I was starting to feel sick and had not interest in even drinking water. By the time I got home, things were really not going to well. I tried food, and that didn’t work out. I tried water and Gatorade, and that did not work out either. The thing that scared the heck out of me was that when I got sick, I was vomiting black coffee grind type material. Just for the record, I have not eaten anything black since my surgery so you can imagine what was running through my head. I called Dr. Lorimer in a state of panic and he instructed me to not eat or drink anything the rest of the day and that I was throwing up dried blood. The real question is where the heck it came from. The next morning, I was not feeling well so I called back and moved my appointment up a day. We came to the conclusion that this sometimes happens and I needed to take it easy on food for a few days and see what happens. He also gave me a medication for stomach ulcers in hopes of being able to coat my stomach before eating. Let me be the first to admit that I hate taking pills, but it is a part of the recovery. This pill he gave me is approximately the size of a small baby so I was even less thrilled. In all seriousness, it is big but I was able to break it in half and get it down the ole windpipe. Blood work and a little but of chaos later, I am all good. Dr. Lorimer did tell me during the appointment that he felt like I was losing weight a little too fast. I am glad to report that it has now slowed down.

I also thought I would share with you the top things that I am convinced I will never be able to eat/drink again:

1. Potatoes of any kind. Complete mental block on them right now.
2. Cream of Wheat. This was my dining choice immediately after surgery. Just can’t do it.
3. Chicken Nuggets. This is my son’s favorite meal, he is sad that I don’t get to share it with him anymore.
4. Beans. I have tried several times in many different consistencies and they just don’t agree with me anymore
5. Grand Prairie Water. I am officially a water snob now. I keep a case of cold bottled water handy at all times.

I feel so much better after a little over 2 months since surgery. I get constant reminders from my wife and 6 year old about things I should and shouldn’t be eating. That gets a little old after some time, but I know they are doing it for my own good. My son thinks it is funny to remind me before we go anywhere to eat that I can’t have one thing or another and tries to make his food choices based on what I can have. Speaking of food, I think I am becoming a pregnant woman. I have these cravings that are so odd sometimes, but I am a little hesitant to try them out. For example, I really want lemonade one minute and then I think I just have to have a pickle. I have tried the lemonade and it has become a drink of choice this summer, I bought pickles at the store yesterday but I will try those slowly in the near future.

Other than some really bad decisions on my part a couple times, surgery has been a huge success so far. I have learned from my mistakes and try my best to not repeat them. I am stubborn and I admit that, but most of the mistakes I made have taught me that I don’t necessarily get my way when it comes to food anymore. Drink your water and lots of it. The dehydration factor is in full effect on these 100 plus degree days. As of today, I have lost a grand total of 101 pounds.

The journey continues…..

- Casey Armstrong, bariatric patient

Proper Drug Disposal: An Environmental Concern

In recent Associated Press report, over just a five-month period of time, twenty-four metropolitan areas across the U.S. were found to have detectable levels of drugs in their drinking water. Philadelphia reported fifty-six different pharmaceuticals, including pain medications, hormones, and antidepressants. The report also included data on the feminization of fish in waterways, presumably from estrogen-containing drugs, and various pharmaceuticals found in earth worms.

A common misconception is that the body absorbs all drugs introduced to it with no waste byproduct, when in fact, many of the drugs we take are excreted unchanged where they then make themselves in the wastewater system.

While much of this problem is a result of natural elimination by humans and animals, the issue of pharmaceuticals found in the environment is due to improper disposal as well. This happens most commonly by pouring or flushing unused drugs down household drains.

Most know not to throw car batteries in the trash, or motor oil down the drain, but when it comes to proper drug disposal most are unaware of the proper procedure. However, there is also little literature on how to properly dispose of medications. The Environmental Protection Agency is currently working on recommendations for patients and institutions on how to properly dispose of drugs.

Currently, there are occasional “drug take-back” programs in the community. Some are provided through participating pharmacies. Many states across the U.S. are utilizing law-enforcement in this process through organized drug “take-back” events. These programs will continue to arise as more attention is placed on drug disposal and the environment.

If no drug take-back programs are available in your area, there are recommended disposal procedures found on the Federal administration’s website:

http://www.whitehousedrugpolicy.gov/publications/pdf/prescrip_disposal.pdf

Drugs flushed down the toilet can damage the environment and eventually end up in drinking water. In order to minimize our impact on the environment, encourage those needing to dispose of medications to utilize these resources and stay aware of community events involving drug take-back programs.

Lance Ray, Pharm.D.

Reading and Interpreting Food Labels

As part of nutrition education for the Bariatric Program, I often include how to read and interpret food labels. Most of us are familiar with the Nutrition Facts Panel; however, there are two areas that bear review.
1. Serving Size: My son bought a $5.00 candy bar from a little girl who was selling candy for a fund raiser. Five dollars seems high for a candy bar, even for a fund raiser, but it was a really big candy bar. I casually looked to see how many kcalories it contained. The label said 220 kcalories. Not really that bad, then, I looked at the number of serving sizes: 2 ½ servings in this bar meaning that the entire bar contained 550 kcalories. I did notice this morning that my son, not a big sweet eater, had saved most of the bar in a zip-lock bag (not the sandwich size bag but a quart size bag.)
Lesson learned: remember to look at the serving size and the number of servings on the label.
2. Trans fat: The FDA has required food manufacturers to list trans fat on the Nutrition Facts Panel since January 1, 2006. A food can be labeled as having zero trans fat but still contain .5 grams of trans fat per serving. Therefore, it is possible to eat more that the AHA recommends (2 grams a day) by eating several servings of these foods without realizing it.
Even if you are able to decipher the information on the Nutrition Facts Panel, sometimes the “front of the package” labels can be misleading. In fact, a commentary in a recent issue of JAMA reported that the front of package labels may so thoroughly mislead the public that eliminating “all nutrition and health claims from the front of processed food packages” should be considered. This action may seem drastic but I agree that something needs to be done to protect the public from these misleading claims.
The FDA is aware of this problem. Indeed, FDA commissioner, Margaret Hamburg announced last fall that her agency would be taking nutrition and health claims on packaging seriously. She stated, “some nutritionists have questioned whether information is more marketing-oriented than health-oriented”.

- Jamie Bass
Dietitian, Bariatric Services

Sunscreen 101

Sun exposure and sunburns have been linked to the development of melanoma, a deadly form of skin cancer. All skin types, from those that are fair and burn easily to those that never burn are at risk for developing skin cancer if not properly protected. The best way to protect sun-exposed skin is with sunscreen.

There are numerous sunscreens available, so how do you know what to look for? When choosing a sunscreen make sure it protects against UVA and UVB rays. UVB rays are primarily responsible for sunburns. UVA rays can cause wrinkles, leathering, and photo aging. Many people assume they are protected from the sun’s harmful effects when indoors but UVA rays can penetrate windows.

Another important factor when selecting a sunscreen is the SPF or Sun Protection Factor. SPF is the ability of the sunscreen to prevent UVB damage. The American Academy of Dermatology recommends wearing at least an SPF of 30, which blocks about 97% of UVB rays. There is currently no measure for protection against UVA rays, but this is currently being evaluated by the FDA and may lead to changes in the future.

For maximum protection sunscreen should be applied one half hour prior to sun exposure and should be reapplied every 2 hours. Water proof and sweat proof formulations are available but should also be reapplied frequently. Most people do not apply enough sunscreen. It must be applied generously to exposed skin, then rubbed in completely.

Some medications such as diuretics, certain antibiotics, and chemotherapy drugs can make the skin more sensitive to the sun. Commonly used antibiotics including Levaquin, Cipro, Bactrim, and doxycycline and diuretics like furosemide and hydrochlorothiazide are known to increase photosensitivity. While taking medications such as those, people should protect their skin by covering up, wearing sunscreen, and limiting sun exposure.

Wearing sunscreen is an easy way to decrease the risk of skin cancer. According to the American Academy of Dermatology, everyone regardless of skin type should wear sunscreen of at least SPF 30 year-round. All of this information and more can be found on the American Academy of Dermatology website: http://www.aad.org/media/background/factsheets/fact_sunscreen.htm.

Lacey Mullins, Pharm. D.

From a physician's perspective...

When Ashley asked me to write a blog, my first thought was, “Holy Cow! What in the world do I talk about?” I could talk about my fellowship or the Palliative Care Unit or something random. What I eventually decided to do was highlight a group of individuals that have impressed me to no end. I recently graduated from residency last June from a rival hospital, and through my rotations have worked at hospitals around the country, so I have seen a wide variety of teamwork.
The first thing I noticed after spending a few days here at THFW is the nursing staff at our Palliative Care Unit. Wow! What an amazing and dedicated group of people. As a fellow in Palliative Care, I am learning to relate with patients and their families in ways that never really were an option during residency. The nurses and nurse practitioners on the Palliative Care Unit are among the best I have ever seen. Every day I learn more about being compassionate and caring, and they are my number one example. We frequently have patients transferred out of the PCU for a variety of reasons, and many times patients ask to be transferred back because they miss that compassionate care.
I have never seen such a giving and loving group of nurses, and they deserve all the accolades that can be given them, but it’s not just the emotional aspect of these men and women that impress me, it’s also the technical aspect. The Palliative Care unit is also an acute med-surg. unit, and these nurses excel in that respect also. They provide quality, accurate care that rivals any other med-surg. unit in any hospital I’ve worked with. If you see any of these amazing nurses about the hospital, please pat them on the back and tell them, “Good job!” The work they do is not only physically draining, but emotionally draining, and they do it with style and grace.

- Dr. Stephanie Sun
Internal Medicine Physician

Have a Safe 4th of July !!

Independence Day honors the birthday of the United States of America and the adoption of the Declaration of Independence on July 4, 1776. It's a day of picnics and patriotic parades, a night of concerts and fireworks, and a reason to fly the American flag.
Typically this weekend is a time filled with family reunions, backyard cookouts and road trips. I have great memories of piling the kids into the car, playing car bingo and answering a myriad of questions, with the most popular being “are we there yet?” Keep in mind this was all before personal DVD’s were invented. With all these trips, I never realized that summer is the most dangerous time of the year to be on the road. In fact, according to the National Highway Traffic Safety Administration, and the Fourth of July weekend is historically the deadliest for road travel in the US. Interestingly enough, an overwhelming percentage of Americans consider winter to be the most perilous driving season. Rural roads are particularly hazardous. Fifty seven percent of highway deaths occur on these back roads.
Alcohol is a factor in almost half of these holiday crashes. Emergency room visits for underage alcohol use will nearly double this weekend. Texans lead the nation in alcohol-related fatalities. This weekend, local police will be out in force helping to keep us safe. The best defense against a drunk driver is your seatbelt. Put it on. Even in the back seat. Do it for your family so you can spend even more holidays together answering those questions like “are we there yet?” Happy Fourth!


Mary Ann Contreras RN
Injury Prevention

The Circle of Life

The circle of life begins and ends everyday for many within the walls of this hospital. Tears of joy and tears of sorrow are shed as people experience a wide range of events from the birth of a new child to the loss of a loved one.

But for some, the circle of life does not stop with the end of one’s life; rather it continues through the life of another through organ and tissue donation.

Texas Health Harris Methodist Hospital Fort Worth, together with LifeGift, has created the “Wall of Life” to recognize and honor the many mothers, fathers, sons, daughters, grandparents and many others who gave the ultimate gift – the gift of life. This precious gift completes the circle of life and further extends the legacy of each individual.

In addition to recognizing those who gave life, the wall also recognizes those who received it through the precious gift of kidney transplants. These recipients are here today because a family – deep in sorrow and grief – had a heart big enough to say “yes” to organ and tissue donation, passing on the gift of life. At the same time, we also honor a different type of donor – a living donor.

Living donors are people who are healthy enough to donate a single kidney so that someone else might be freed from the confines of dialysis and resume normal life. Living donors do not always donate their kidneys to family members. They may also donate to a perfect stranger simply because they can.

If the world had more people and more families like the ones we are honoring with the “Wall of Life,” the national waiting list for lifesaving organs would not exceed 108,000. Nor would there be a shortage of life-enhancing tissue.

Created by Rebecca Low, a local Fort Worth artist, the wall depicts a man, a woman and a child. In essence, these figures represent everyone – mothers, fathers, brothers, sisters, you and me. The figures are linked together by a ribbon and surrounded by doves representing peace, love and the miracle of life. Most importantly, the wall carries the names of those who have given the gift of life and those who received that precious gift.

I hope that you will take some time out of your busy schedule and stop by the “Wall of Life” located in the main lobby in the alcove just past the gift shop. I hope that the “Wall of Life” will inspire you to say “yes” to organ and tissue donation, continuing the circle of life.

Amanda Williams
Donation Clinical Specialist
LifeGift