Friday, March 29, 2013

Unhappy Nurses

I am sad to read that a new survey reported in Forbes shows that nurses are the 4th most unhappy profession in the US.  The survey evaluated 10 factors of the workplace including  work environment, relationships with co-workers, compensation, and control over one's daily responsibilities.  They required at least 50 employee reviews to qualify in a category.


 Careerbliss  found out that associate attorneys are the most unhappy followed by customer service associates, clerks  and coming in 4th on the unhappy scale was the registered nurse.  Equally sad was that teaching came in 5th on the unhappiness scale.

What workers were most happy?  Number one was Real estate agent followed by Senior Quality Associate Engineer.  Sales Reps and Construction Superintendents were also happy in their jobs.

Overwork, lack of opportunity for advancement and poor workplace culture were the biggest factors in the dissatisfied categories.  Nurses were most unhappy with the workplace culture and the people they worked with. We can only guess that that means doctors, other nurses and administrators.  Teachers, on the other hand were happy with their work and the people they work with.  They were dissatisfied with rewards for their work,  lack of support and lack of growth opportunities.

Nurses are the unsung heroes of health care.  Not enough attention is paid to increasing their satisfaction and professionalism.  This small survey should ring some alarm bells, somewhere.

Thursday, March 28, 2013

Tuberculosis Made Easy

Tuberculosis (TB) is a contageous infection that is caused by a bacterium called Mycobacterium tuberculosis. One third of the world population has been infected with TB and it caused over 1.5 million deaths in 2010.  We don't hear as much about TB in the developed world but new infections in third world countries occur at a rate of about 1 per second.    Risk factors for TB are:
  • A weakened immune system such as diabetes or HIV
  • Working in health care or refugee camps
  • Traveling to countries where TB is endemic
  • Living in overcrowded situations or extreme poverty
 The disease usually affects the lungs and is spread when people cough or sneeze and spray moisture droplets.  In the old days, TB was called "consumption" and at the turn of the century it was treated by isolating patients in sanitariums for months to years and hoping they recovered. In the 19th Century, TB killed more people in New England than any other disease.


Active TB is when a person has symptoms (fever, cough, night sweats, fatigue, wasting) and has a positive ppd skin test.  These people can spread the bacteria.

Latent TB is when a person with no symptoms has a positive ppd skin test and the bacteria is in a dormant or inactive state.  These people are not contagious.  A chest XRay can distinguish between active and latent TB.

We treat patients who have active TB with antibiotics and treatment usually lasts for 6 months to get rid of the infection.  Persons with latent TB are also treated as a preventive for the infection flaring up again.  Multidrug-resistant TB is a form of active TB caused by bacteria that do not respond to the medications most commonly used to treat TB.

Health care workers, child care workers, home-care professionals and immigrants should all have regular ppd tests to make sure they have not been exposed to TB.  Once a ppd test is positive, it will always remain positive, even if the infection has been treated and resolved.

Sunday, March 24, 2013

Ten Sleep Facts That May Surprise You

I think we all know that sleep is not only beneficial for good health, but lack of sleep can lead to a number of serious disorders and diseases.   Here are ten sleep facts that may surprise you:

1.    When we are awake our brain cells produce adenosine as a byproduct. The build-up of adenosine in the brain is thought to be one factor that leads to our perception of being tired. (Incidentally, this feeling is counteracted by the use of caffeine which blocks the actions of adenosine in the brain and keeps us alert.)

2.    Older adults need about the same amount of sleep as younger adults (7-9 hours) but seniors go to bed earlier and wake up earlier than when they were younger.

3.     We dream only during REM (Rapid Eye Movement) sleep but get the deepest sleep during non-REM cycles.

4.     It is not only important to get sleep to learn, but it is also important to get good sleep after we learn something new to process and retain that knowledge.

5.     Insomnia is the most common sleep disorder after age 60.  People with insomnia have trouble falling asleep and staying asleep.

6.    Major restorative functions in the body like muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep.

7.    Hitting the snooze button makes getting out of bed more challenging than simply getting up with the first alarm, because a few more minutes of shuteye causes the brain to enter a deeper sleep cycle.

8.    Losing just a few hours of sleep a week - similar to the effects of jet lag or cramming for final exams - can lead to almost immediate weight gain.  The good news is getting extra sleep can cause those pounds to shed.

9.    Recent studies show that daylight savings time increases risk of getting into an accident by 11% and your risk of myocardial infarction by up to 10% in the three weeks after the change.  To get used to the change, experts recommend soaking in the sun in the evening with the later sunset,  getting some exercise and going to be earlier.

10.   Residents in the Southern U.S. states experience the most sleep disturbances and daytime sleepiness, according to a new "sleep map" that outlines how geography can influence sleep patterns.  Residents of the West Coast report better sleep.   Check out the sleep map here.

Here is something I just learned this week.  If you have an iPhone with Siri (4S or later) you can ask Siri to wake you in the morning at a specific time.  It is a great alarm.



Tuesday, March 19, 2013

Blogger Malaise

For the past few weeks I have experienced Blogger Malaise.  This is a little different than writers block.  I have had a number of subjects swirl through my head that I thought would be of interest, but had no motivation to translate them into a thoughtful blog.  As each day went by I made excuses not to do the research and writing.  I even started feeling a little sorry for myself and wondered if I should even continue blogging.

It didn't take much to re-inspire me, however.  I got an email from an old patient I haven't seen or heard from in years who mentioned a blog that helped her tremendously. (Thanks, Lynn).  Today at a management meeting I got unsolicited, kind,  blogging feedback from people I seldom see. (Thanks, Shaun, Richard and Susan).  And my stats show that even without writing for the past couple of weeks, I still had 2700 page views yesterday so I realized people are reading the blog and, hopefully, getting something from it.

That is all I need as a health blogger.  People ask me what I get out of this and I truthfully say I want to share information and help readers think about new things.  If I can inspire someone to get a check-up, a needed test or even self diagnose and save themselves money and time, I believe I have done a service.  If they learn something about our crazy health system that helps them with decision making, I am happy.  If they see the world differently or realize that everyone is facing some type of challenge, I have succeeded.

Blogging keeps my mind sharp and as Shaun (a communication expert) said today "Mindful blogging is darn hard".  It is.  But it's fun too.

Thanks for reading.   (Insert happy face here!)

Saturday, March 2, 2013

Ascaris Lumbricoides

The answer to yesterday's Image Challenge was #1 - Ascariasis

Ascaris lumbricoides worms were causing intestinal obstruction in this child from Kenya.  After the intestine blockage was removed, the child recovered.

Ascariasis is a disease caused by roundworms.  The parasite, Ascaris lumbricoides  is one of the most common infections in the world and it affects up to one fourth of the worlds population and up to 95% of Africans are infected with roundworms at any time.   The life-cycle of this parasite is amazing.

Infection starts when food contaminated with Ascaris eggs from feces are swallowed.  the larvae hatch in the intestine, burrow through the gut wall and migrate to the lungs through the blood system.  They then pass through the alveoli, up the trachea and esophagus where they are coughed up and swallowed.  They then pass through to the stomach for a 2nd time into the intestine where they mature into adult worms,  Adult worms have a life-span of 1-2 years.

The adult worm can be from 6-13 inches and the female worm may be as thick as a pencil.  Up to 100 worms could potentially infect the human body.

A person could be infected with Ascaris lumbricoides and have no symptoms.  In heavy infections symptoms may be vague abdominal pain, coughing, wheezing or pneumonia when they are in the lungs, or complete blockage of the small intestine.

Diagnosis can be difficult until the worms are adults, but stool samples showing eggs or live worms will make the diagnosis.  Treatment with mebendazole, albendazole, or pyrantel pamoate are effective to eradicate infection but where there is poor sanitation, re-infection is common. 

When we see these gross pics, it is hard to believe that this infection is so common in the world.  Remember that over 40% of the world's population does not have  good sanitation.  That is 2.5 billion people and women in developing countries walk an average of 6.5 kilometers ( almost 4 miles ) each day just to get water.