Safety First This Fourth of July

This weekend, we will observe our 235th year as an independent nation. That is a LOT of candles to blow out! Happy Birthday USA!! Americans love a reason to celebrate. And the birth of such a grand nation is a great reason to do so! While we are a young country, we are strong in our history and heritage. Our traditions have shaped our past and at the same time they influence our future.
One tradition for many families is the 4th of July backyard barbecue. Burgers, hot dogs, baked beans, potato salad and apple pie are on many Texan’s plates. And remember the sparklers too. Of course, all of these involve some form of heat. Whether it is from the grill, fireworks, or just the outside ambient temperature, July can be a dangerous month.
With all the distractions, keeping an eye on the children can be a challenge. They are fearless and without boundaries. I just returned from a week at the beach with my grandson. I am exhausted. One minute he was under the umbrella, the next he was running after the seagulls, and yet a split second later, he was splashing in a tide pool with the fish. So the question is: How do you grill the perfect burger, flip the hot dogs, apply the sunscreen, refill the iced tea, and blow out the 235 candles on the nation’s birthday cake while tending a toddler? The grill is a tempting touch point for little fingers. As are candles and snuffed out sparklers. The answer to the question is: Take turns watching the tot so everyone can participate in the celebration and commemoration of our countries birth. Here are a few other tips to help you and your families celebrate and safe and happy 4th of July!

· Don’t walk away from a hot grill
· Pick the right location: never grill indoors, and have the grill in a well ventilated area
· Never add charcoal starter fluid once the fire has started
· Keep a fireproof pan under the grill to catch the grease drippings
· Always have water to put out fires/sparklers
· Never point fireworks at anyone
· Don’t wear loose clothing next to the grill
· Dispose of coals properly, soaking them in water until the fire is completely out
· A clean grill prevents fire flare-ups
· If friends and family are driving to your party, remember to have plenty of non-alcoholic beverages on hand

MaryAnn Contreras, RN

Trauma Nurse/Injury Prevention Coordinator

Preventing Swimmer’s Ear

Spending a lot of time at the pool this summer? Otitis externa, sometimes known as swimmer’s ear is a common problem especially among young children and teenagers. It can turn into a painful reason to avoid the pool and end up ruining summer fun. The good news is there are ways to prevent it.

Swimmer’s ear is caused by moisture in the outer ear canal which allows bacteria and fungus to grow creating an infection. Otitis externa can also result from irritation to the ear canal. This can be caused by foreign bodies, cleaning the ears with sharp instruments, and chemical irritants.
Symptoms of swimmer’s ear include ear pain, redness, itching, tenderness, discharge, and possibly muffled hearing. These are not to be confused with symptoms of otitis media or an inner ear infection. The inner and outer ear are separated by the ear drum. Since swimmer’s ear is an infection of the outer ear, tugging and prodding the ear lobe causes pain unlike an inner ear infection. Inner ear infections can be accompanied by fever and may be treated with oral antibiotics depending on the cause and the patient’s age.

Your ears have natural defenses that help keep them free of infection. One of these mechanisms is the production of ear wax. Earwax helps remove debris such as dirt and dead skin cells by moving them out of the ear. The ear canal is also slanted downward to help water drain out. There are a few simple ways to help prevent swimmer’s ear and get the most out of going to the pool this summer. Earplugs are a simple way to keep water out of the ear canal thus preventing an environment for bacteria to grow. Also drying ears and allowing water to drain from each ear can help prevent swimmer’s ear. To help remove water after swimming, over the counter drying agents and home remedies containing alcohol and acetic acid (white vinegar) can be placed in each ear and then drained to get any excess water out. They should not be used if there is a current infection, injury to the ear drum, or the child has tubes in their ears.

Swimmer’s ear should be treated by a physician. Treatment for an existing swimmer’s ear infection may require antibiotics, steroids, acidic solutions, or antifungals. These are usually prescribed by the physician in the form of ear drops since they are targeting the outer ear canal. Oral medications can also be given.

To keep an earache from spoiling your summer fun, following these simple tips for preventing swimmer’s ear and enjoy your time at the pool.

Lacey Mullins, Pharm D.

Maintaining Roadway Safety

As gas prices continue to increase, so does the need for some motorists to find other means of transportation. This need has given rise to one of the more dangerous hobbies: motorcycle riding. Whether or not the sun is shining and regardless of the temperature, motorcycle riders or “un-caged” drivers can be found out riding their prized possession. Unfortunately, the Emergency Department at Texas Health Fort Worth generally encounters a number of individuals who fall victim to injuries sustained while riding out on local streets and highways. Many of the injuries can be avoided by implementing a few preventative measures.
Most people can tell you, “I heard the bike”, and can mentally imagine the bike, usually due to the distinctive and discernable sound of these vehicles. Even with the audible noises, sadly, the rider and bike are never actually seen until after an accident has occurred, in a usually less than recognizable state. Statistics tell us that hearing simply isn’t enough. Some of the worst crashes have occurred because the opposing driver simply did not have sight of the motorcyclist.
The simplest and most cost efficient thing any rider can do to help prevent an accident is to add reflective devices and wear reflective clothing. They can help increase rider visibility. State law requires all motorcycle bikes to maintain an active, lit headlight while the ignition is on. This helps to increase motorcycle visibility by attracting additional attention.
Each driver, whether a two or four wheeled vehicle, has the same responsibility: ensuring roadway safety. Simple and inexpensive devices and gadgets can help improve visibility and audibility, which can help to decrease the occurrence of an incident. According to the Texas Department of Public Safety, nearly two-thirds of vehicle vs. motorcycle accidents are caused, not by the motorcyclist, but by the driver. The driver either does not see the oncoming motorcyclist at all or does not see the motorcyclist in time to avoid an accident.
One summer day in 2010, a motorcycle collision and lack of efficient safety and protective devices put my life at risk. As a motorcycle enthusiast, it is important that I do my part to help others understand the importance of driver safety.

Tim Farris
Nursing Student

The Truth about Potassium Iodide

Due to recent nuclear events in Japan, there has been an increased interest in potassium iodide supplements. Iodine is an important nutrient in the body that aids in the production of thyroid hormones. Our body gets most of the iodine it needs from the food we eat. When a nuclear event occurs, our bodies are exposed to radioactive iodine either through the contaminated air we breathe or contamination in our food supply. Once our bodies are exposed to radioactive iodine, it is quickly absorbed by the thyroid gland, which can damage the gland and ultimately lead to thyroid cancer. Potassium iodide is the medicinal form of iodine and can be taken orally to protect the thyroid gland by blocking the radioactive iodine from being absorbed.

If a nuclear event occurs and radioactive iodine is released into the environment a public health official may advise you to take one dose of potassium iodide daily for a few days. Babies and children will likely be treated first because they are more sensitive to radioactive iodine than adults and may be more likely to develop thyroid cancer from radiation exposure. One dose of potassium iodide protects the thyroid gland for 24 hours. Taking potassium iodide for too long can lead to harmful side effects such as allergic reactions, skin rashes, and thyroid problems. People with an allergy to iodine should not take this medication. People with certain skin disorders or thyroid disease (e.g. Graves’ disease) should be treated under the supervision of a doctor.

There are three over the counter potassium iodide supplements available that are approved by the Food and Drug Administration (FDA): Iosat, ThyroSafe and ThyroShield. All other potassium iodide products have not been evaluated by the FDA for consumer safety. There is a common misconception that potassium iodide will protect a person from any and all radiation exposure. However, potassium iodide only protects a person from radioactive iodine and not other forms of radiation. Thus while the thyroid gland may be protected, potassium iodide does not protect the body’s other vital organs from the harmful effects of radiation.


For more information on Potassium Iodide please visit the Centers for Disease Control and Prevention website, http://www.bt.cdc.gov/radiation/ki.asp.



Nicole Day
PharmD

Patient’s Guide to the Proper Use of Antibiotics:

Ever wonder why directions on your antibiotics say “Take until finished” or “Complete all doses as specified”?
Why is it so important to finish all antibiotics? You must not need antibiotics when you’re already feeling better and have been for days now, right?

Wrong. Let’s take a look at why…

Antibiotics are medicines that help fight bacterial infections. Remember, antibiotics do not fight infections caused by viruses, and most common colds are caused by viruses. Antibiotics are prescribed to last for a specified amount of time. This length of time varies, but is designed for the antibiotic to last until all (or most) of the disease-causing bacteria are killed. The body’s own immune system will help in this process too, but it’s very important to take the whole course of antibiotics, regardless of how you may feel.

There are a few reasons for taking the antibiotics that have been prescribed as directed. First, keep in mind that bacteria are “survivalists”; If there are enough harmful bacteria lingering around in the body, they will eventually “get smart” and start finding ways to change and avoid being killed by an antibiotic. This can happen through various means and is called “antibiotic resistance”. Also, bacteria will try and re-mount an attack on the body when antibiotic levels are low, or if antibiotic therapy has stopped prematurely. For these reason it is important to take every dose as scheduled to complete the entire therapy as directed.

Why is antibiotic resistance bad and how can it affect others too?
Antibiotic resistance can cause a drug to not be effective anymore. By allowing the bacteria to linger and mutate, it can now evade the antibiotic with which we are treating. In essence, you have bred a new strain of bacteria – one that is not killed by the antibiotic we might like to use. This will limit antibiotics that can be used in the future, both for you and others in the community, since bacteria can be transferred easily from person to person.

Always keep in mind that most drugs are prescribed for a specific length of time for a reason. Taking antibiotics based on how you feel is NEVER a good idea.

Lance Ray, Pharm.D.

Distracted Driving Effects Everyone

I am always multitasking. I have been that way for a long time. Being the mother of four sort of predisposes one to this condition. I can answer the phone, go over homework, throw in a load of clothes and make a mean chicken parmesan all at the same time. I say that with pride. I like to know that I make the most of every minute. I love to cross things off my list, it gives me a since of accomplishment. So naturally when I hop in my car (to do list in hand) buckle my seatbelt, and put the car in gear, my cell phone is within reach. After all, I wouldn’t want to miss a call digging thru my purse while it rings incessantly. It could be an important message, or a photo of my grandbaby, or my son calling from Afghanistan, or my best friend to schedule lunch. It might even be a tweet from my techno-proficient seventy-something year-old mother. There are a lot of people who rely on me to answer my phone. Which is why I should not answer it while I am driving. That is the point.

My friends, my children, my parents, my co-workers and even the person who is driving in front of me rely on me to pay attention to the road. Sending a text or even talking on the phone raises the possibility of crashing by 400 percent. 400 percent is HUGE. If only my stock portfolio had such a percentage. Of course we always assume it won’t happen to us. Distracted driving injured 448,000 folks in one year alone. One in five drivers has admitted to surfing the web while driving. Distracted driving is quickly becoming an epidemic. The vaccine is prevention! The safest way to get from here to there is to just put down the phone and drive. I’m making that commitment, how about joining me? After all, there are people counting on you too.

MaryAnn Contreras, RN

Injury Prevention/Trauma Nurse Coordinator

MaryAnn Contreras

Injury Prevention Coordinator

Were You Born at Texas Health Fort Worth?

Prior to joining Texas Health Resources (THR), I’d had the opportunity to work with the organization on a number of events and developed a positive impression. I began to feel like it was something I had to be a part of. I joined THR more than 11 years ago, but my connection to the organization goes back much farther.

I was born at Texas Health Harris Methodist Hospital Fort Worth where my mother also delivered my three sisters. I followed suit and delivered my two beautiful children at Texas Health Fort Worth as did my sisters. We even shared the same OB/GYN for four of our children’s births. For me, choosing to deliver at Texas Health Fort Worth wasn’t just about a family tradition. I remember growing up when someone asked, “Where were you born,” the response was always, “Harris Methodist”! It became almost “club” like. As I got older and more educated, I had a better understanding why that was the answer.

My mother chose Texas Health Fort Worth because of the level of care she knew she would receive, the tenured staff and the advanced technology. My sisters and I chose to deliver there for the same reasons. I think as the community grows, people need to feel that sense of family in knowing who their neighbors are and who they can trust.

Texas Health Fort Worth has built their reputation based on providing care for patients at their most vulnerable times and treating them as if they are family. The hospital embodies the philosophy of “treat others the way you want to be treated.” That’s something that my mother instilled in me and my siblings and something that we work to instill in our children as well. So, I am very fortunate and proud to represent an organization that places individualized care at the forefront of everything they do.

Jeanine Andersen

Marketing Manager

The Only Thing Constant

Most likely you have heard the maxim that the only thing constant in life is change. Change is always with us. Like it or not a great many things that we have, know, and even hold near and dear will be transformed, modified, and morphed into something completely different. That fact is usually proclaimed as a lament, a sad truth we just have to live with. I hope you will allow me to offer a different, and hopefully refreshing, approach to this poser we call change.

It is true that we live in a world of transformation. But is that really so bad? I want to be brazen enough to suggest that we consider welcoming change into our lives. Constant sunshine, just like constant rain and dreary skies, does become lackluster. I have lived in the land of blue skies and an ever-present sun. Trust me when I tell you that we longed for the crack of thunder and a good downpour. It most likely will not surprise you then when I declare that it is likewise good and healthy for our emotions to change. Constant happiness, smiles, and pure glee will become nothing special, indeed trite after a while. Sadness is not my first choice, but it sure helps me appreciate the joy in my life.

Change is an ever-present companion in our hospital. Our patients and families arrive because something has changed, shifted in their world. As a team of healthcare professionals our goal then becomes to bring about yet another alteration, albeit for the better this time. It is in this change journey, this process focused on healing and fueled by hope that we ourselves change. Striving together as agents of change our goal becomes the restoration of peace in what is often perceived as a storm of chaos by our patients and families. And when the skies clear, when everyone involved breathes deeply once again, we realize we have survived this tempest of change. Dare I suggest that we perhaps might even be better as a result of what we have been through?

Allow me to offer a reminder, therefore, that change will always be with us. It waits just around the corner. The ebb and flow of life will not evaporate, will not cease, but is indeed a constant on which we can depend. Life bristles with a flux all its own. But, within this maelstrom of modification we can, and in fact are challenged, to find good. Change often does feel like bedlam run amuck. But good things frequently are birthed in the cauldron of chaos.

And finally permit me to challenge you to have something in your life that is beyond change. For me it is tending to my spiritual yearnings and needs. My Creator has simply and significantly declared I AM. That is enough. Bring on the change, transformation, modification, and the whirlwind of chaos. When the dust settles, the battlefield of adjustments is surveyed, and the wounded tended to, my Comforter is there ready to encourage and convince me that perhaps whatever is new is not so bad after all.

So, let the change begin—we will not have to linger very long l assure you. But do not fear. It is standard equipment with this thing called life. And, we will endure.

Carey Reynolds

Staff Chaplain

Use over the counter products to really quit smoking in 2011

According to the World Health Organization, tobacco kills more than five million people a year. The CDC reports that smoking is the leading preventable cause of death in the United States today. Of the smokers in the United States, 70% desire to quit. Smoking cessation success rates double when tobacco use treatment is utilized.

Fortunately for smokers, there is a wide variety of OTC (over-the-counter) nicotine replacement products to assist them in their quest to quit. Nicotine replacement therapy dosage forms include patches, gum, and lozenges. As soon at these OTC nicotine replacement therapies are started, the smoker must completely quit using all tobacco products.

Nicotine Patches
Nicotine replacement patches are the only OTC product to provide a constant release of nicotine throughout the day. The downside of this constant release of nicotine is that the patches do not allow the smoker to respond to acute cravings throughout the day. Therapy with nicotine patches is available in three steps that included the dosages of 21 mg, 14 mg, and 7 mg patches. Smokers that use fewer than 10 cigarettes per day should start on the 14 mg patch for 5 weeks and then decrease to the 7mg patch for 2 weeks.

It is important to never cut nicotine patches or wear more than one patch at a time. Nicotine patches should be applied to clean; dry skin area and the application site should be rotated on a daily basis to help decrease skin irritation, which is the most commonly reported side effect. Some nicotine patch wearers have complained of insomnia and vivid or abnormal dreams . To prevent these side effects, the nicotine patch can be removed at bedtime and a new patch can then be applied every morning.

Nicotine Gum

Nicotine gum is available in 2 mg and 4 mg strengths. For smokers who smoke fewer than 25 cigarettes per day, the 2 mg strength should be used. Those smokers who smoke more than 25 cigarettes per day should use the 4 mg strength.
During weeks 1-6 of nicotine gum therapy, one piece of gum should be chewed every 1-2 hours with at least 9 pieces of gum used per day. During weeks 7-9, one piece of gum should be chewed every 2-4 hours. Finally in weeks 10-12, one piece of gum should be chewed every 4-8 hours. The most common side effects of nicotine gum include upset stomach, unpleasant taste, hiccups, and jaw soreness.

Nicotine Lozenges

Nicotine lozenges are available in 2 mg and 4 mg strengths. It is recommended that patients who smoke their first cigarette within 30 minutes of waking up should start with the 4 mg strength lozenge. For all other smokers, it is recommended to start with the 2 mg strength lozenge. It is important to dissolve the lozenge slowly in the mouth and never to chew or swallow the lozenge whole. Food or drink should be avoided for 15 minutes prior to, during, or after using the lozenge. Two lozenges should never be used at one time.

Never use two nicotine replacement therapies at the same time unless directed to do so by your primary care provider. It is generally not recommended to use the nicotine patches, gum, or lozenges longer than 2-3 months, but talk to your primary care provider to assess if a longer amount of therapy is needed.

Alisia Baker, PharmD

Texas Health Fort Worth

2011 Shouldn’t Hurt

Now is a time for resolutions and new beginnings and I want to challenge you all with a goal that you don’t have to take on alone.

The goal is to initiate a change in the rapidly increasing numbers of domestic violence crimes that are occurring in our community. Domestic violence, as defined by Webster's dictionary, is the inflicting of physical injury by one family or household member onto another. Violence takes many forms and usually leaves the victim traumatized for life if they survive.

At Texas Health Fort Worth we are dedicated to caring for patients mind, body and spirit, but the number one weapon against domestic violence is education. The Domestic Violence Task Force seeks to improve how we provide compassionate and caring service to the victims of domestic violence who come through our doors. Through the assistance of the continuous improvement department, the task force has developed a threefold strategy:

• Research the latest trends in domestic violence


• Educate Texas Health Fort Worth staff, physicians and volunteers on how to sensitively approach a potential victim


• Provide a resource manual for victims to find long-term support

If you suspect a loved one is a victim of domestic violence, please contact a health care professional.

Angelo Betancourt

Staff Chaplain

Well, it is nearly here. Everyone is gearing up, parties are being organized and I’m sure there are a few wagers out there regarding who the next Super Bowl champs will be. Cowboy Stadium is ready, all 73 acres. Did you know the entire Statue of Liberty and its base can fit into the stadium with the roof closed? And if that isn’t big enough, the stadium holds the world’s largest high-definition video display. The parking lots open at 10AM while the kick off is scheduled to begin at 5:30PM, so you know that local traffic will be hectic to say the least.

Much preparation has taken place to keep all 110,000 fans safe at the stadium. While we are all aware of the times we live in, not all the risks are at the game. Young males, ages 21-34 who are the core audience for major sporting events, are most likely to be involved in car crashes, to drive impaired and not wear seatbelts according to the National Highway Traffic Safety Administration. You have heard me say before that a seatbelt is your best defense against an impaired driver, so buckle up!

Personally, I am enjoying the game (and the innovative commercials) at home with friends. I can’t boast of having the largest high-definition TV, but I have a primo parking spot and reserved seating. If you are having friends and family over, remember to designate your driver early. Serve lots of food, including non-alcoholic beverages. In the third quarter, put the adult beverages up and bring out the coffee and desserts. It’s also a great idea to have the numbers for local cab companies handy. Enjoy this event without penalties, fouls or calls of unsportsmanlike conduct, because in real life there aren’t instant replays.

Mary Ann Contreras, RN

Injury Prevention Coordinator

Bariatric Diary: Happy New Year!

I for one have never been happier to start a new year. This past year has brought on lots of changes in my life. I come into 2011 with a renewed spirit and a new body to go with it.

The holidays are one of the many challenges you will come across as a bariatric patient. You have the fears of what you will eat, when you will eat it, and how your body will be affected. I am a big believer that the whole process of recovery is a mental game. I told myself going into the holidays that it was just going to be business as usual and that it wouldn’t be a big deal to watch everyone around me eating the normal foods and enjoying what might have been my favorite dishes from the past. I have to admit that those things didn’t bother me so much. The thing that did get under my skin a little was everyone being so darn concerned with my diet. I quit counting how many times people would ask what I could eat, if it was hard for me to pass up certain foods, or if there was anything special I needed for food options. I would have never thought my eating habits would affect so many people!!

So as I start this New Year, I have for the most part overcome any difficulties I once had from my surgery. If you remember, a few months ago I had to have a couple endoscopies to dilate my stomach due to a stricture. It’s a miracle, it worked!! My food options have expanded greatly and I am maintaining my weight without any major fluctuations. There are still foods that I cannot eat and others that I have psyched myself out from eating.

One thing I will mention that I have found to be the most challenging part of the surgery is shopping for clothes. One thing you take for granted many times when you are bigger is the options your smaller counterparts have when clothes shopping. Before, I would head straight to the big and tall section and pick from a limited supply of clothes in one of a handful of colors. Now, I actually have to shop through the entire store. Don’t get me wrong, I like having more options and more trendy clothing but who would have known shopping was such hard work. This probably isn’t an issue for all bariatric patients, but I have never been a big shopper. This is slowly changing with my new body and my shrinking closet.

Now the information you all want to know. I started off in January 2010 at 354 lbs. Based on being 6 foot tall I had a BMI of 48. I was wearing a size 50 waist in pants and 4x in shirts. As of today, I weigh in at 198 lbs with a BMI of 26.9. I am now wearing a 38 waist in pants and XL in shirts. So as you can see I have made a big transition in less than 8 months since surgery.

The journey continues…..

Rev Up Your Metabolism in 2011

Are you sick of being 10, 20 or more pounds overweight and ready for a change? Let’s rev up your metabolism in 2011 so you can look and more importantly, feel great! Many people want a quick fix and get caught up in all of the fad diets and temporary weight-loss eating programs, but the problem is they cannot maintain it and end up gaining weight back. One goal of starting a new eating program should be to get your metabolism burning and make lifestyle eating changes. It’s often not the easy way, but is a healthier form of weight loss that tends to outlast the fad diet results. It’s not rocket science! There are 3 easy ways to get the metabolism burning:

Eat Small Frequent Meals

Many people think skipping meals is the way to lose weight. Not true!!! Your metabolism actually raises each time you eat to digest the food you are eating. Thus, eating 6 times per day versus 3 times per day keeps the metabolizing up and running. Your goal should be to eat 3 small meals and 2-3 snacks per day. Each meal should contain nutrient rich foods to help you stay full and satiated throughout the day.

Eating frequently does take some time and effort. Just remember, if it was easy everybody would be doing it! So, in order to be successful, consider making your meals and snacks on the weekends so it does not cause extra work during the week. Grab some snack baggies and bag up nuts, whole grain crackers, turkey, raw veggies, etc so they are ready to grab. Make it a habit and it will get easier!

Pay Attention to What You Are Eating

Each meal should contain a serving of whole grain carbohydrate (granola bar, whole wheat crackers, 1 slice whole wheat bread) or fruit. Carbohydrate will give your body energy over the course of the day. However, eating carbohydrates along will spike your blood sugar and cause it to drop more drastically. So, pair your carbohydrate with a lean protein (2% cheese, yogurt, cottage cheese, deli meat) or healthy fat (peanut butter, nuts, avocado, egg). Protein and fat slow down digestion, help prevent blood sugar from spiking and keep you feeling full longer.

Be sure to include non-starchy vegetables (starchy = corn, peas, potatoes, winter squash) in as many meals as possible. Veggies are full of vitamins, minerals, antioxidants and fiber! They will help you feel full for little calories.

Exercise

If you want your metabolism to rev up, you gotta get moving!!! Exercise not only speeds up metabolism, but also burns calories. Cardiovascular and strength training togetherburns calories and builds lean muscle mass. Lean muscle mass is more dense than fat and thus takes up less space. So the more muscle you have, the smaller and leaner you look! In addition, exercise has a variety of cardiovascular benefits from helping lower blood pressure and bad cholesterol to increasing good cholesterol and decreasing triglycerides.


The American College of Sports Medicine recommends 60-90 minutes a day of moderate exercise, most days of the week, for weight loss. So if you are not moving at all, let’s get started! Aim for at least 30 minutes of activity most days of the week to get your metabolism up and burning!













Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian

If you have a question for the dietitian, visit www.texashealth.org/askamy