West Nile Virus is Back in D.C. -Things You Should Do to Stop the Spread

October 12th, 2011 by Jon Stefanuca   |   No Comments. »

Last week, the D.C. Department of Health confirmed this year’s first case of West Nile Virus (WNV). WNV is a bird disease. However, infected mosquitoes can transmit the virus to humans. Otherwise, this disease cannot be transmitted directly from a human or a bird.  Persons infected with the West Nile Virus may experience severe headaches, fever, nausea, vomiting, muscle aches, pain, and stiffness.

While the risk of a WNV infection is low, individuals who are immunocompromised should be particularly careful and seek medical attention if symptoms are present. Individuals with weak or suppressed immune systems include the elderly, young children and those prone to infections (e.g., HIV/AIDS patients).  The key is to implement measures to reduce exposure to mosquitoes. Individuals at risk should wear long-sleeved shirts and pants. Mosquito repellent should be used as well.

Every year, the Department of Health conducts WNV testing throughout the District, particularly in areas where infections have been reported. If you live in an affected area, you might receive additional information from the Department. Larvicide may be sprayed in your neighborhood. Should you require additional information about WNV, feel free to contact the D.C. Department of Health.

In the meantime, while mosquitoes are still flying around, here are a few things you could do stop the spread of the WNV:

1.  Dispose of cans, bottles and open containers properly.  Store items for recycling in covered containers.
2.  Remove discarded tires. Drill drainage holes in tires used on playground equipment.
3. Clean roof gutters and downspouts regularly.  Eliminate standing water from flat roofs.
4. Turn over plastic wading pools, wheelbarrows, and canoes when not in use.
5. Cover waste containers with tight-fitting lids; never allow lids or cans to accumulate water.
6. Flush bird baths and potted plant trays twice each week.
7. Adjust tarps over grills, firewood piles, boats or swimming pools to eliminate small pockets of water from standing   several days.
8. Re-grade low areas where water stands; clean debris in ditches to eliminate standing water in low spots.
9. Maintain swimming pools, clean and chlorinate them as needed, aerate garden ponds and treat with “mosquito dunks” found at hardware stores.
10. Fix dripping water faucets outside and eliminate puddles from air conditioners.
11. Store pet food and water bowls inside when not in use.

Please share this information with your friends and neighbors.

Simulation Labs: Helping Teach Nurses in Baltimore

September 27th, 2011 by Sarah Keogh   |   1 Comment »

From nursing.jhu.edu

Any one who has ever had a hospital stay or knows a loved one or friend who has been in the hospital knows that the nurses play a vital role in caring for patients. Nurses do many of the day-to-day activities of caring for patients in hospitals and clinics. They are also often the first ones at the bedside if a problem arises – so -isn’t it essential that nurses be well trained in all forms of emergency procedures? Even when doctors are present, nurses often play vital roles in assisting the doctors in providing life-saving care to patients.

Law and Medicine Intersect Once Again

I have recently been working on a case in which both doctors and nurses were present during an in-hospital delivery that ended with a significant injury to the child. During the delivery, a problem was encountered that has a low incidence rate during deliveries.  In considering this problem, I wondered just how frequently doctors and nurses are able to practice the skills they would need to successfully and calmly deliver a baby in a situation like this.  Faced with this “emergency” situation, how many of the doctors and nurses in the room had not experienced this problem before? For those who had –  just how much “experience” did they bring to the problem they were facing?

Simulations Rooms and Simulation Patients Provide Training Opportunities

Thankfully, technology is making it more feasible for training healthcare providers to practice handling a myriad of clinical situations during their education process that they might otherwise not experience frequently enough for their skills to develop in real world settings. In Baltimore, the Johns Hopkins University School of Nursing (JHUSON) has simulation rooms in which nursing students are able to practice a variety of procedures and techniques using simulation patients in rooms that are designed to replicate the real patient areas of the hospital. There is also a whole family of simulators to help. This “sim fam” is not like the lifeless plastic dummies you might be imagining. They are a variety of different types of “…life-like practice manikins, including Sim Man, Vital Sim Man, Noelle with newborn, and Sim Baby [that] give nursing students the hands-on experience without the anxiety of working with actual human beings.”

Harvey the Cardiac Sim, SimNewB and Sim Man 3G  - All New Additions to the “Sim Fam”

From nursing.jhu.edu

Just this year, in March, JHUSON added Harvey to its collection of simulators.  While Harvey is new to JHUSON, he is not exactly new technology:

For almost 40 years Harvey, developed in cooperation between Laerdal Medical Corporation and Miami University Miller School of Medicine, has been a proven simulation system teaching bedside cardiac assessment skills that transfer to real patients, and remains the longest continuous university-based simulation project in medical education.

Harvey’s job is to be able to simulate “nearly any cardiac disease at the touch of a button: varying blood pressure, pulses, heart sounds, and murmurs. The software installed in the simulator allows users to track history, bedside findings, lab data, medical and surgical treatment.”  He joins a collection of other sim patients that enable healthcare providers to learn and practice critical life-saving measures such as CPR, defibrillation, intubation and yes – even the proper checking of vital signs. JHSON has adult, child and baby versions of these simulators. Some of them can even “talk” to the practicing nurses. (I wonder if they are programmed to be cooperative and informative or hostile and combative – hmmm.)

New Family Members Arrived this Past August

Even newer, in August, JHUSON added SimNewB and Sim Man 3G to the family. The SimNewB is:

…a 7 pound, 21 inch female baby, with realistic newborn traits. Students will be able to simulate a wide variety of patient conditions with her, including life-threatening ones. The department’s current Sim baby is the size of a 6 month old and is not as conducive to delivery room procedures.

She is also interactive, though she is not wireless like the Sim Man 3G. Some of the new Sim Man’s traits include “…breath sounds both anteriorly and posteriorly, … pupil reactions, [and] skin temperature changes.”

What about Obstetrics Cases?

So, what about the case I was mentioning that involved obstetrical care? Well, JHUSON also has a pregnant simulator, which is can be used to practice a whole host of obstetrically related procedures. These include “Leopold maneuvers, normal vaginal and instrumented delivery, breech delivery, C-section, and postpartum hemorrhaging, among other functions.” The JHUSON sim family also has the new Sim newborn – SimNewB.

The “Jury” Is Still “Out”

Can there be any doubt that additional hands-on practice opportunities with simulators is a good idea for situations that may not come up very often in everyday practice? Won’t it help healthcare practitioners gain skills and keep those skills up-to-date? Any opinion I might have on these issues is not based on evidence….yet. Luckily, JHSON is “…among 10 nursing schools nationwide collaborating on a landmark study to find out just how well patient simulators—high-tech manikins that respond to a nurse’s care—help prepare the nurses of tomorrow.”  I – for one – will certainly be interested in the outcome of that study.

What about you? Do you think that it makes sense for nurses in training to make use of simulation rooms and simulated patients? Would it be better for them to spend more time in real world situations doing real patient care under the supervision of experienced practitioners? What about techniques that might not come up very often?

If any of the readers of this post have used these sim patients in your training and can give us firsthand information as to how, if at all, it carried-over to make you more “experienced and skilled” when facing similar clinical situations with real patients, your comments would be most welcomed as well.

Attention Ward 7 & 8 Residents! Your Input is Needed!

September 12th, 2011 by Jason Penn   |   No Comments. »

Are you living in Southeast and wondering how your money is being budgeted and spent?  Concerned about the direction of the United Medical Center?  Now is the time to act!

Let’s start with a little bit of background for anyone that is not living in Southeast or familiar with United Medical Center (formerly known as Greater Southeast Community Hospital.)  For years United Medical Center has struggled to pay its bills. In 2006 and 2007, the hospital was in danger of closing, requiring the city to step in to save it.   The Not-for-Profit Hospital Corporation, commonly known as United Medical Center, was established on July 9, 2010 through special legislation. Since then, the new leadership team, its medical staff, and nurses, clinical and support staff claim to be making major improvements in their quality of care, customer service, patient safety and campus security. The facility, which serves many of the city’s poorest residents, also received a new roof and generators, major improvements to the emergency department and replacement of nearly all radiology equipment.  Putting the hospital’s claims aside, have you noticed a difference?

The hospital has replaced most patient care diagnostic, monitoring and therapeutic equipment and upgraded most hospital physical plant systems. Over 75 physicians have joined the medical staff.  With changes being made everyday, now is the time to give your input and share your experience with the City Council.

On Thursday, September 29, 2011, at 10:00 a.m., Room 500, 1350 Pennsylvania Avenue, NW, Washington DC 20004, a public hearing will be held on issues related to the financial management of the hospital.  This hearing will be open to the public; however, only invited witnesses will be permitted to provide oral statements.  Members of the public may submit written testimony which will be made part of the official record.  Copies of written statements should be submitted to the Committee on Health no later than Thursday October 6, 2011.

Sufficiently concerned?  Make certain that you attend the hearing or, at a minimum, submit your written statements to the committee.

 

FES Equipment Coming to Baltimore’s Mount Washington Pediatric Hospital

September 8th, 2011 by Sarah Keogh   |   No Comments. »

Author - Sarah Keogh

Back in February, Jon Stefanuca wrote about a study in the Journal of Neurorehabilitation and Neural Repair about Functional Electrical Stimulation (FES) and the benefits it can provide to those individuals who have suffered spinal cord injuries. He explained how FES is able to provide electrical impulses to stimulate paralyzed muscles. The study’s authors found improvements based on using FES that led them to recommend using stimulation therapy in conjunction with occupational therapy for patients with incomplete spinal cord injuries. This technology is now also being used to help people with a wide range of injuries and illnesses including, stroke, multiple sclerosis, traumatic brain injury, and cerebral palsy, in addition to spinal cord injuries. According to the Christopher and Dana Reeves Foundation website, FES works by applying “small electrical pulses to paralyzed muscles to restore or improve their function”. The benefits can be extensive:

FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores. From: Christopher and Dana Reeves Foundation website

Improved Technology To Be Locally Available

Since FES was originally developed, the technology improved from being something that was typically integrated into large expensive equipment, such as exercise bikes and wheelchair based equipment, into smaller more portable devices. The good news for individuals with neuro-motor injuries in Baltimore City and the surrounding areas is that this type of FES treatment is about to become more available locally. At the end of August, Mount Washington Pediatric Hospital announced that they have received a “Quality of Life” grant from the Christopher and Dana Reeve Foundation. The article explains:

The money will help Mt. Washington Pediatric Hospital purchase Bioness® equipment for its Adaptive Equipment Rehabilitation Clinic (the clinic). The clinic works with patients with neuro-motor disorders to maximize their movement as much as possible given their physical limitations.

From Bioness.com

The Bioness website explains that they produce a variety of “medical devices designed to benefit people with Stroke, Multiple Sclerosis, Traumatic Brain Injury, Cerebral Palsy, and Spinal Cord Injury. These products use electrical stimulation to help people regain mobility and independence, to improve quality of life and productivity.” While I do not know what particular equipment will be available at the Mount Washington Pediatric Hospital, Bioness makes equipment to assist patients with hand paralysis, foot drop and thigh weakness among other conditions.

MWPH Uses Interdisciplinary Approach Combining FES and Therapy

The article about the grant explains some of the many wonderful things available for patients at the Mount Washington Pediatric Hospital (MWPH):

  • …[an] interdisciplinary approach to the assessment and management of adolescents and children with neuromuscular impairments, paralysis and/or movement disorders
  • … [a] team of 21 experienced specialists in physiatry, occupational therapy, and physical therapy.

The new equipment at MWPH will be used along with the other occupational and physical therapy options available to patients. A study described in US Neurology looked at stroke victims and found the combination of FES and traditional therapies that include repeated motion provide the best results:

Stroke patients with limited voluntary movement could now benefit from technologies such as functional electrical stimulation (fes) combined with necessary repetition of functional tasks (use-dependent plasticity) to enhance the neural repair process and improve outcomes, thus enabling them to begin to overcome their previous limitations and to improve their physical capabilities.

From Bioness.com

The goal at MWPH for children and adolescents is based on a similar idea:

Patients whose muscles can be retrained will require several months of therapy to gain normal range of motion and strength. For those patients with more severe conditions where muscles cannot be retrained, the Bioness® equipment will be used to augment their range of motion. Using these two therapy modalities, patients will acquire greater functionality, range of motion, muscle strength, and the ability to move independently.

This multi-disciplinary approach should allow these children and teens to have the best chances of improved motor use and the most independence in their future lives.

Related Articles:

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

Spinal Cord Injury Updates: More Reasons for Optimism?

New Treatment Holds Promise for Patients With Spinal Cord Injuries

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

DC Hospitals Step It Up During Prostate Cancer Awareness Month – FREE Resources You Need to Know About

September 7th, 2011 by Jon Stefanuca   |   No Comments. »

September is Prostate Cancer Awareness Month. To raise awareness about prostate cancer, hospitals in Washington, D.C. are stepping-up this September for a good cause indeed.  Did you know that an estimated 240,890 new cases of prostate cancer will be reported this year? About 33,720 men will die this year alone from prostate cancer. About 1 in 6 men will be diagnosed with prostate cancer during their lifetime.

Although prostate cancer is the most common cancer in American men, the good news is that the survival rate is quite high for patients who are diagnosed and treated early.  If you are a man, a key to your survival is to be familiar with the signs and symptoms of prostate cancer and to seek regular screening.

This year, Georgetown University Hospital will recognize Prostate Cancer Awareness Month by offering men free prostate cancer screening.

Who should get screened?

-          Men over the age of 35 – particularly African-American or Hispanic men over the age of 35

-          Men with a family history of prostate cancer

If you meet the above criteria, don’t miss out on this opportunity. Free screening will be offered on Saturday, September 17, 2011 from 8:00a.m. to 12:00p.m. in the Lombardi Comprehensive Cancer Center. Free parking will be available in the Leavey Center garage.  The Georgetown University Hospital is located at 3800 Reservoir Rd. NW, Washington, D.C., 20007. “The screening will consist of blood testing to determine PSA (prostate specific antigen) level, total cholesterol, and a digital rectal exam (DRE) to be performed by physicians.”

If you or someone you know has been diagnosed with prostate cancer, you might want to contact the Providence Hospital prostate cancer support group.  This group is specifically dedicated to helping patients live and cope with prostate cancer. Brothers Prostate Cancer Support Group meets every 4th Tuesday between 6:30p.m. and 8:30 p.m. at Providence Hospital’s Wellness Institute (1150 Varnum St. NE, 3rd Floor, Washington, D.C 20017).  For more information, please call 202-269-7795.

Please share this information with your friends, fans, and readers. For more information about cancer support groups in the D.C. area, please visit DC Cancer Consortium.

We’re Launching a New Facebook Page for Washington, D.C.

September 3rd, 2011 by Brian Nash   |   No Comments. »

Washington, D.C. - D.C. Court of Appeals Building

By: Brian Nash, Editor 

We are very pleased to announce the launching of our new Facebook page, DC Eye Opener. For the many thousands of readers who have read our posts in Eye Opener over the past twenty or so months, we want to let you know that we will be continuing to post there as well.

Our blawgers have been posting articles and commentaries on issues relating to health, law and medicine for almost two years now. We have had over 150,000 visitors to our site since our inception. We thank each and every one of you who have stopped by and read our posts – particular thanks to our many subscribers.

So Why Washington, D.C.?

Well, the answer is quite simple – it’s one of the primary places where we practice law.

I moved from New Jersey to Washington, D.C. in 1965 and attended The Catholic University of America in Northeast D.C. While in college, I worked at the Safeway on 12th Street (sadly no longer there) as a grocery clerk and produce man, just up the road from Turkey Thicket and Providence Hospital. After I graduated from CUA, I taught for two years at Bullis Prep in Potomac, Maryland. I attended law school at the Columbus School of Law (Catholic University Law School) and obtained my Juris Doctor in 1974. I was admitted to the D.C. bar in 1976, two years after being admitted to the Maryland bar. I have been trying cases in the District of Columbia ever since. Frankly, I’ve lost track of the number of cases I’ve handled in D.C. over the years. There have been so many trials in the local and federal courtrooms of Washington, D.C. that some suggested I give up my office space and simply take up residence in the hallways of the Superior Court or in the federal district court across the street.

A number of the lawyers I began practicing with have now become judges on the Superior Court and the United States District Court for the District of Columbia. A few of my former law partners have donned the black robe and have made quite a career for themselves in the Superior Court. I am proud and pleased to call them my colleagues and my friends.

During the early part of my career, I represented numerous D.C. individuals, corporations and healthcare providers as a defense lawyer. As you can no doubt tell from our website, we are now representing people injured through the wrongdoing of others. It has been a wonderful journey, which continues on. Our lawyers at Nash & Associates, Marian, Mike, Jon and Jason, are all admitted to the District of Columbia bar as well as the Maryland bar. (Sarah Keogh is presently admitted to the Maryland bar only – we’re working on her to add D.C. to her impeccable credentials.) Simply put – the District of Columbia is our turf. One of our offices is located on Connecticut Avenue, N.W., just a half a block from the Red Line’s Farragut North Station on Connecticut and K Streets, N.W.

So Why the New Facebook Page for D.C.?

What we have seen and learned in our social media activities of blogging, Facebook, Twitter and LinkedIn is that our message can become diluted through worldwide distribution. We decided we needed to narrow our audience. Put another way, so many times we wanted to post information about what’s happening in law, medicine and health in the District of Columbia, but when your readers are from around the globe, there’s not much interest in the message and information if it’s just about Washington, D.C. Now we want to share our message and get to know you, who live and work in the District of Columbia. Frankly, our readers throughout the United States – “outside the Beltway“ as they say – don’t really care much about what’s happening in D.C.  Well we do and we know you do too!

Our Mission

Simply put, we’re going to bring you information that we hope will keep you informed about topics such as your health, trends in medicine, the laws that may affect you, what’s happening on the legal front in the areas of our expertise (negligence, medical malpractice and the like) and some postings about what’s happening around the city from our legal eye perspective. Our goal is to interact with you, have some fun, provide some useful information – all the things that social media is designed to do and has been doing so well for years now.

For those in the Twitterverse, we’ll soon be launching our new Twitter name/location. Collectively, our tweeps at Nash & Associates have over 5,000 followers. We should have our DC Twitter page up and running this week – we’ll post that new location here. In the meantime, if you want to connect on Twitter, we’re waiting to make your acquaintance at NashLawFirm.

Let’s connect! We’ve met so many great people and businesses on Twitter, Facebook and LinkedIn. We hope to soon count you among our friends and followers.

So, HELLO and WELCOME, D.C. – glad we finally get to share, meet and connect with you!

 

 

 

 

 

 

For close to two years now, our blawgers have been bringing

 

Photo from loringengineers.com

 

New Study Reveals Significant Increase in Pregnancy-Related Strokes

August 8th, 2011 by Jon Stefanuca   |   No Comments. »

A new study published in the Journal of the American Heart Association this month reveals that pregnant women have a significantly high risk of developing a stroke. According to the lead author of the study,  Dr. Elena V. Kuklina (senior service fellow and epidemiologist at the Center for Disease Control and Prevention (CDC)), “the overall rate of women having strokes while they are expecting a baby and in the three months after birth went up 54% in the 12 years leading up to 2006-07.”

This is a significant finding! To put it in context, consider the following facts about stroke:

  • Stroke is the third leading cause of death in the United States. Over 143,579 people die each year from stroke in the United States.
  • Stroke is the leading cause of serious, long-term disability in the United States.
  • Each year, about 795,000 people suffer a stroke. About 600,000 of these are first attacks, and 185,000 are recurrent attacks.
  • Nearly three-quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after the age of 55.
  • Strokes can – and do – occur at ANY age. Nearly one quarter of strokes occur in people under the age of 65.
  • Stroke death rates are higher for African Americans than for whites, even at younger ages.
  • Among adults age 20 and older, the prevalence of stroke in 2005 was 6,500,000 (about 2,600,000 males and 3,900,000 females).
  • On average, every 40 seconds someone in the United States has a stroke.
  • Each year, about 55,000 more women than men have a stroke.

“A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a ‘brain attack.’” The following are well-recognized stroke risk factors: high blood pressures (hypertension), atrial fibrillation, diabetes, heart disease, high cholesterol, increasing age, and a family history of strokes.  Being pregnant is a risk factor in and of itself.

As part of the study, Dr. Kuklina and colleagues used information from 5 to 8 million discharge records from about 1000 hospitals. According to Dr. Kuklina, the increase in the stroke rate during pregnancy and in the 3 months after birth was mainly attributable to high blood pressure and obesity. The study enumerates these specific findings:

  • Pregnancy-related stroke hospitalizations went up by 54%, from 4,085 to 6,293 over the 12 years leading up to 2006- 07.
  • Strokes in pregnancy went up by 47% (from 0.15 to 0.22 per 1,000 deliveries).
  • Strokes recently after giving birth went up by 83% (from 0.12 to 0.22 per 1,000 deliveries).
  • Strokes during delivery did not change (they stayed at 0.27 per 1,000 deliveries).
  • In 2006-07, about 32% and 53% of women who were hospitalized after having strokes in pregnancy and shortly after giving birth respectively had either high blood pressure or heart disease.
  • Increased prevalence of these two conditions over the 12 years up to 2006-07 accounted for almost all the increase in stroke hospitalization after giving birth that occurred in the same period.

It appears that an increasingly larger number of women enter pregnancy with one or more stroke risk factors. This is particularly true with respect to hypertension and obesity. According to Dr. Kuklina, “[s]ince pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk.” For this reason, it is particularly important to enter pregnancy in relatively good cardiovascular health and to reduce other risk factors, if possible. If you are pregnant or plan on becoming pregnant, talk to your OB/GYN about your stroke risk factors. In collaboration with your physician, implement a plan to manage and reduce your stroke risks before, during, and after pregnancy.

Read these related blogs:

Stroke Warnings: Most People Who Experience Minor Strokes Do Not Recognize Its Symptoms

Strokes – Family History a Significant Risk Factor

Spinal Stroke: An atypical cause of back pain

Brother, will you help me? If you don’t this stroke might kill me.

Landmark NIH Clinical Trial Comparing Two Stroke Prevention Procedures Shows Surgery and Stenting Equally Safe and Effective

Parents – be aware and read this article: Children Don’t Have Strokes? Just Ask Jared About His, at Age 7 – NYTimes.com

To view our collection of educational videos about stroke, visit us at:

http://www.youtube.com/user/nashlawatty#g/c/BDCB5099E7C9F6C4

Autism and Wandering – a constant struggle

August 3rd, 2011 by Michael Sanders   |   No Comments. »

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Asthma News: Parents Underestimate Children’s Symptoms, Placebos Effective in Improving Patient’s Subjective Improvement but Not Objective Health

July 25th, 2011 by Sarah Keogh   |   2 Comments »

image from consumerreports.org

A couple of months ago, one of my colleagues, Jon Stefanuca, wrote a post for Eye Opener entitled Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem. In that article, he explained the importance of patients proactively knowing and explaining their asthma symptoms to healthcare providers. He focused on some of the key features of asthma and the unique symptoms that each individual may experience. If you have not already read that article, I highly recommend it as a great way to become a better advocate for yourself or someone in your life that suffers from asthma.

Over the last few months, I have been thinking about Jon’s advice in relation to some work I have been doing. It makes good sense and hopefully will help people receive better care when they are having exacerbations of their asthma. However, I was disheartened to read a recent article from Reuters about how frequently parents underestimate their children’s asthma symptoms.

Parents Underestimate Their Children’s Asthma Symptoms

I am always a little leery of studies that are drugmaker-funded, particularly when the study suggests that perhaps more medications are needed to combat a problem. However, taken at face value, this is a pretty frightening idea given how many children now suffer from asthma and how serious a condition it can be for those children and families. The article points to a disconnect between the parents’ description of their child’s asthma and whether the asthma was actually being adequately treated:

While more than seven out of every 10 parents interviewed described their child’s asthma as “mild” or “intermittent,” the disease was adequately treated in only six in 10 kids.

A doctor who was not involved in the study explained it this way:

“Parents are only aware of asthma when the child is more severely ill,” Dr. Gordon Bloomberg…

“Physicians cannot just ask the parent ‘how is your child doing?’ The physician will get a global answer that doesn’t reflect the child’s quality of life,” said Bloomberg, of Washington University in St. Louis.

Poor treatment may influence asthmatic children’s quality of life, as well as that of their families.

In the survey, more than four in 10 parents reported missing work because of their child’s asthma, and similar numbers of parents regularly lost sleep for the same reason.

Children are Better Reporters Than Their Parents of Symptoms

Interestingly, “[t]he study also found children tended to be better than their parents at determining how well their asthma was being treated.” So, clearly, doctors must take the time to discuss the asthma symptoms and treatments not only with parents but also in a sensitive and appropriate way with the children patients themselves in order to receive a better indication of the disease status. The doctors interviewed for the Reuter’s article had different opinions on what this means for asthma treatment:

According to a new report, this suggests parents need more education about asthma medications.

But one expert said more medication is not the be-all and end-all for children.

“The idea of total control…is not where we should be putting our energy,” Dr. Barbara Yawn from Olmstead Medical Center in Rochester, Minnesota, told Reuters Health in an email.

Instead of just giving children with stubborn breathing problems more medication, she said better communication is needed to determine how children’s lives are affected, and what it will take to prevent their symptoms.

New Study Shows Receiving Treatment, Even with Placebo, Important for Asthma Patients – But Does not Improve Objective Health

image from 123rf.com

In another recent study, reported in the New England Journal of Medicine, researchers looked at how asthma patients responded to a medication (bronchodilator), two different types of placebos (fake inhaler or fake acupuncture), or no intervention at all. An objective measure was taken of the patient’s ability to exhale after each intervention (or lack of intervention) and the patient’s own rating of improvement was noted. What was so interesting about this study were the different outcomes between the objective (spirometry) and subjective (patient’s self-reporting) measurements of improvement.

The bronchodilator provided markedly better objective treatment over the placebos or no treatment – a 20% improvement rather than 7% for the placebos or no treatment. However, the subjective measure of improvement found that patients were almost the same, 45-50% improvement, whether the patients received the actual bronchodilator (50%), the placebo inhaler (45%) or the sham acupuncture (46%).  All of which were higher than the 21% improvement reported by those who did not receive intervention.

An article about the study in medicalnewstoday.com explains the outcome this way:

Now a study of asthma patients examining the impact of two different placebo treatments versus standard medical treatment with an albuterol bronchodilator has reached two important conclusions: while placebos had no effect on lung function (one of the key objective measures that physicians depend on in treating asthma patients) when it came to patient-reported outcomes, placebos were equally as effective as albuterol in helping to relieve patients’ discomfort and their self-described asthma symptoms.

The study’s senior author, Ted Kaptchuk, Director of the Program in Placebo Studies at Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School explained it this way in the article:

“It’s clear that for the patient, the ritual of treatment can be very powerful…This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”

However, I wonder if it cannot also be understood another way – which is that patients are likely to feel like their symptoms have been improved after a visit to a doctor, even if objectively their airway is still compromised.

How Should this Impact Asthma Treatment?

So what can be done with this new information? I think that Jon’s advice about patient’s knowing their own symptoms and expressing them clearly to their doctors is critical. I also agree completely with his advice that patients should ask for an objective measure of their respiratory improvement before leaving a health care facility. These two steps seem key to making sure that patients objective health is being improved – not just their subjective opinion of improvement. Finally, I think that it is critical that parents act as the best advocates possible for their children – which may include making sure that the children are heard on their own symptoms since parents are not the most reliable reporters.

What do you think? Are there other tips for asthma patients and their parents out there? How do respond to these new studies?

Related Videos:

Videos about Asthma

Related Articles:

Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

Service dogs in school — a fresh look

July 22nd, 2011 by Michael Sanders   |   No Comments. »
Service Dog and Boy

service dogs

A while back I wrote a piece on the topic of service dogs for kids and mentioned the use of service dogs in schools. A regular reader of our blog then wrote in with a number of comments and questions about the propriety of dogs in schools. To help answer her questions, I recently spoke with Nancy Fierer, who is the Director at Susquehanna Service Dogs in Harrisburg, Pennsylvania, which is an organization that trains and places service dogs. Susquehanna is the organization that placed two of the dogs mentioned in this NPR story.

The ADA and dogs in school

I also did a little more research on the Americans with Disabilities Act (“ADA”) and its impact on the issue. The ADA requires that all public facilities allow a disabled person and his or her service dog (not pets) to enter the premises just the same as a non-disabled person. So is a school considered a public facility? It’s an interesting question. On the one hand it is accessible to the public in the sense that parents and students can freely enter a school. However, if you’re not the parent of a child at the school, can you just walk into a school and roam the halls like you might roam around a mall? I think if you tried that, you would get stopped pretty quickly and asked to leave if you had no valid business there. However, the law appears to be settled that schools are considered public facilities at least for those areas that are open to the public such as administrative offices, gymnasiums during sporting events, and auditoriums during public events. Therefore, schools must be accessible to service dogs in these public areas. For class rooms, however, it’s not so clear. While the law appears to favor allowing service dogs in class rooms, it is being decided on a case-by-case basis because there are other considerations as well – the age of the child, the disability at issue, the ability to control the dog, etc.

How much school assistance is necessary?

I have to admit that when I first wrote on this topic, I had envisioned that the dog and child were a self-contained unit that required little in the way of adult assistance. Ms. Fierer indicated that that is usually not the case. Depending on the age of the child and the level of disability, the child may be able to care for the dog independently. However, in most instances an adult (teacher’s aide or nurse perhaps) is required to pitch in with help giving the dog water and taking it out for bathroom breaks. Ms. Fierer indicated that the dog does need water breaks during the day (feeding can be done at home before and after school). This is usually accomplished by keeping a water bowl in a nearby room – perhaps a nurse’s office or a counselor’s office. Several times a day, either the child (if he/she is old enough) or an adult can take the dog for a drink. The same is true for bathroom breaks (pee only; No. 2 is usually taken care of at home). Again, service dogs do require assistance from the school but from what Ms. Fierer told me, the disruption is fairly minimal and can be worked out with proper planning.

Controlling a service dog

A larger issue is the child’s ability to control the dog. Even though service dogs are highly trained, the owner (in this case a child) must still be able to control the dog before being permitted to take a dog into school. These include such basic commands as making the dog sit, stay, come, leave it, and walk on loose leash. These are some of the common commands that all service dogs must know. In addition, a service dog also receives additional training in a particular disability and learns specific commands unique to that disability, e.g., retrieving specific items, pulling a wheelchair, responding to seizures, search and rescue. These commands must be mastered as well. For example, if an autistic child is in need of the dog to put its head in the child’s lap to help calm him/her down, the child (or a trained adult) has to be able to give the dog that command. If the child cannot give that command to the dog, then it undermines the usefulness of the dog in school.

Because of the demands that service dogs place on the child, very young children usually do not take dogs to school unescorted. Ms. Fierer said she would be surprised to see a six-year-old, for example, taking a dog to school alone. Older children can, with proper training, be permitted to take a dog to school alone. To ensure that the child is capable of caring for the dog, Susquehanna utilizes the Assistance Dogs International Public Access Test. This test requires the owner and the dog to perform multiple tests in a variety of settings to ensure that the dog is well-trained and that the owner can properly control the dog. For children, Ms. Fierer indicated that the testing is usually administered with the parent and child because she uses the team approach – the parent, child and dog are a team. For a child taking the dog to school, however, the parent is usually not there so the child must be able to control the dog independently. Only when a child is adept at controlling the dog should the child be permitted to take the dog to school. Even then, parents have to work closely with the child’s teacher and other school staff to coordinate the details of how the dog will be cared for.

Other concerns

Our reader also asked questions about whether service dogs are a distraction in school and whether they can pose a danger to other children. After talking to Ms. Fierer, it’s my opinion that these are not major concerns. As for being a distraction, Ms. Fierer said that is usually not the case. Service dogs are generally introduced into the school gradually, starting with maybe a half-hour per day and building from there. The children get accustomed to the dog and the novelty soon wears off. Also, the other children need to be educated that this is a service dog and not a pet to be played with. Children can easily learn this lesson. As for being a danger to other children, Ms. Fierer said she has never heard of a dangerous incident happening at school such as a dog biting a child. These dogs are amazingly well-trained and the trainers allow zero tolerance for aggressive behavior. If a dog shows any aggression, that dog does not make the cut for being a service dog. Therefore, I don’t believe this concern is a valid reason for denying a child a service dog.

Training a service dog

In terms of the actual training given to the dogs, Ms. Fierer said that when a puppy is eight weeks old, it starts living with a dedicated puppy handler who is responsible for teaching the dog basic manners.  This time includes classes at Susquehanna twice per month.  This arrangement goes on till the dog is 18 months old, at which time the dog receives about six months of intense training.  About 50-60 percent of training is the same for all service dogs. The rest is devoted to the unique needs of each disability. Before a dog is placed, Susquehanna spends about 2 and ½ weeks training the family that is receiving the dog. Even after placement, Susquehanna continues to do follow-up training – at first on a weekly basis and then gradually declining over the next six months. It even does annual re-testing.

I hope this follow-up addresses our readers’ concerns. Ms. Fierer emphasized that service dogs are not the solution for every child. Susquehanna actually does therapy sessions with families before even agreeing to place a dog to ensure that the dog and the family are a good fit. She indicated that it is a big responsibility to own a service dog and it is not a decision that is made lightly by the dog trainers. However, for the right child and the right family, a service dog can be an amazing asset.

Related Nash and Associates Links:

Service Dogs for Kids

 

photo from servicedogtraining.wordpress.com