Strep Throat vs. Spinal Meningitis

 Once when I was in the fourth grade I had a fever, headache, nausea and I felt lousy. My mom tried to get me to touch my chin to my chest. I couldn't/wouldn't. My mom rushed me to the emergency room because she was sure that I had spinal meningitis. As it turns I wouldn't touch my chin to my chest because I had a nasty case of strep throat. It hurt too much. Now it was great that she took me to the doctor, but it didn't really didn't merit an ER visit. (Of course I don't remember what day or time it was, that may have been the only option.) Complications of untreated Strep can include scarlet fever, rheumatic fever, and glomerulonephritis, but those are less likely to happen if antibiotics are started in a timely manner (and don't forget to take the whole course of antibiotics, not just until the symptoms go away.)
  It was years later when I was in nursing school that I realized what my mom was looking for. She was looking for a positive Brudzinski's sign, however it isn't based on whether a child can voluntarily touch their chin to their chest. To test for Brudzinski's sign, have a child lay flat on their back on a firm surface. (A floor or table will work.) Then firmly push their chin to chest. A positive sign will result in their legs and hips flexing involuntarily. If you see this, I would recommend taking your child to the emergency room, pronto. (Of course, you may be ok, going to a clinic first, if you can get in quickly and are admitted from there. Sometimes that's faster than going through the ER (and generally significantly less expensive). Where you should go to depends on where you live, how far the hospital is from you and your average ER wait times. But don't deliberate about the matter for too long.) The point is that this is serious business. Not to say that a negative Brudzinski's sign rules out a diagnosis of spinal meningitis, because it doesn't. But a positive Brudzinski's will not be seen in any other disease.

Symptoms of spinal meningitis include headache, fever, nausea, vomiting, irritability and lethargy. (See how the two can be confused?) Although the symptoms in meningitis are often more extreme than what will be seen in strep throat and also sometimes include muscle rigidity, bulging soft spots in infants, cold extremities and abnormal skin color. Of course you don't need all of these symptoms to have spinal meningitis. Small children sometimes only have fever and irritability, which can make a "phone or internet diagnosis" difficult. The surest way to diagnose spinal meningitis is with a lumbar puncture or spinal tap. I know that sounds really scary to a parent, to think about multiple people holding your child down while a doctor puts large needles into your child's spine, but if there is a chance that your child has this disease, you need to know. Not only that, you need to know what is causing it, whether it be bacteria or virus and what kind, so the doctor can pick the most effective medication.
 Meningitis is an inflammation of the meninges, which are the protective coverings of the brain and spinal cord. If those tissues become infected, because of their location, it can lead to serious problems. Complications can include permanent brain damage, deafness, epilepsy (a seizure disorder), sepsis (wide spread systemic infection), gangrene of limbs, shock and death. Does this mean that if your child has meningitis that they are going to die or have these complications? No. I have cared for many, many kids with this diagnosis, and I have never seen one die and I can list on one hand the kids I have seen who have had serious complications. But if your child does not get immediate treatment, their risk greatly increases. Bottom line, if you remotely suspect that your child has spinal meningitis, get it checked out as soon as possible.

Thoughts about Vaccinations

Last week it hit the news that the research study that claimed that there was a link between the MMR vaccine and autism had altered facts and statistics. So the MMR vaccine does not in fact cause autism. Wow, that's embarrassing. Because of the MMR/Autism scare, there are thousands of kids who didn't receive their vaccines, and as a result measles are actually becoming endemic in parts of Great Britain.
 Now I have a few mixed feelings about vaccinations. I believe that vaccinations can be a wonderful thing. Vaccinations have saved millions of lives. However they are not without their faults. If you read the information sheets that come with your vaccinations they list some pretty daunting possible side effects including seizures, neurological problems, permanent brain damage and death. These side effects are very rare and it is more likely that your child will be afflicted by the disease by not getting the vaccine (which for some of the diseases can also lead to neurological problems and death) than that they will be affected by rare severe side effects. Severe side effects are not as common as they once were, as vaccinations have been developed and improved through the years. But those risks are still there and every parents should be aware of them.
  Another thing that many people don't realize is that vaccinations are not 100% prevention. Even if you get all of your vaccinations you can still contract the disease they are trying to prevent, it's just not as likely. I had all of my vaccinations and I still came down with the measles when I was six. It stands out as the most physically miserable experience of my childhood. (I remember having sores every where and feeling too weak to even scratch them. And I remember all of my joints aching like I have never since experienced.) But if most of a population has been vaccinated against a disease, it makes it difficult for the disease to spread. (On a side note because I actually had the measles, my antibody levels against the measles are more than six times what the average immunized person has. I only know this because my doctor's office, high school and county health department all lost the record of my booster shots and I had to lab work done to prove that I have in fact been immunized before they would let me start my first Pediatric nursing job.)
  I personally have had my kids vaccinated for everything except the flu. (Flu vaccines have proven to not go over well in my family, hospitalizing multiple relatives. For us it's easier just to deal with the flu.) It's something that I prayed about long and hard before deciding. I felt that the benefits outweighed the risks. But I can't speak for every parent. Every child is different and their reactions may not be the same. I have an aunt that when she took her daughter into get her standard vaccinations and a strong spiritual experience that told her that she should not get her child vaccinated. No one know what would have happened if she had ignored that prompting, but she didn't and her children have all been remarkably healthy. As a parent it's part of our job to determine what is best for our own children, and if we follow the Lord, He will help us along the way. I believe that for the vast majority of people vaccinations are a great thing and I highly recommend them. They have helped to decrease the incidence of many diseases that have been known to maim and kill untold numbers of children. But if a parent told me that they had prayed about it and strongly felt that their child should not be vaccinated, I would not argue with them.

Preparedness Wednesday: Emergency First Aid Supplies

Recently I have been reading a couple of books about food storage and emergency preparedness (which I will discuss in more detail later). Throughout my reading I have decided that each week I am going to a) purchase something that makes me more prepared and b) do something to help put my house in order. (This week  the doing is working an extra shift, which monies will go toward debt, but the purchasing is more interesting.)
 I put together a collection of first aid supplies based on what I know my family regularly uses, what we might use in an emergency and supplies that I often use in the hospital. This list is not all inclusive and it is what I think will meet the needs of my family for a year. But it's a good starting place. (This is in addition to the 5 first aid kits that I have around my house and car.) I listed the generic names and then their more recognized brand name in parenthesis and if the quantity is more than one, I listed it in brackets.

• 30-second digital thermometer
• 4" self-adhesive elastic bandage (Ace wrap) [2]
• calcium carbonate, 24 tablets (Children's Pepto-Bismol)
• children's ibuprofen,4 oz (Motrin) [2]
• children's acetaminophen, 4 oz (Tylenol)
• bismuth subsalicylate, 48 tablets (Pepto-Bismol) [2] 
• loperamide hydrochloride, 48 tablets (Imodium A-D) [2]
• added strength pain reliever, 275 tablets (Excedrin)
• extra strength acetaminophen, 500 tablets (Tylenol 500 mg)
• ibuprofen, 250 tablets (Motrin) [3]
• ibuprofen, 180 softgels (Motrin)
• naproxen, 300 tablets (Aleve)
• bandage roll guaze, 4 1/2"x 4 yd [2]
• large guaze pads, 4"x4" [2]
• 1" adhesive wrap (Coban) [3]
• 2" adhesive wrap (Coban) 
• elastic net stretch bandage (Spandage, actually I'm not sure if that's the actual brand name, but that's what we call it at work.)
• 1st aid cleansing spray, 5 oz (Bactine)
• bacitracin, 1 oz
• antibiotic ointment, 1 oz (Neosporin)
• alcohol swabs, 100
• hydrogen peroxide, 32 oz [2]

 Since I am not purchasing these for immediate use I was very careful to check the dates on products, the soonest being 09/2012. I bought most of these items at Target, because I have tried several generic brands of children's medicine and this is the one that my kids like best, and it tends to cost less. (I recently discover that they will not take the Western Family ibuprofen.) After I purchased these I did discover that the bacitracin and antibiotic are cheaper at Smith's. I bought a lot more ibuprofen compared to acetaminophen because I have that it is generally more effective for relieving fevers and general aches and pains.
 If you don't already have a separate first aid kit I would recommend adding adhesive bandages, bandage scissors, tweezers, 2x2's, gloves and burn gel. Other good items to have in there are lip balm, plastic spoons and a clean hand towel. Now getting this all at once can be kind of expensive. I spent $140 on the above pictured items, because I had FSA money to burn. Otherwise I would have hesitated to spend that much at once. However, I have seen most of these items for lower prices than I got at Walgreens, but not all at the same time. It's worth watching their ads and building up your first aid items a little at a time.

Folic Acid A Key To Healthy Babies

When I saw this headline on the cover of yesterday's paper (sorry I was going to link to the article, but for some reason the Sunday cover story isn't listed on the Salt Lake Trib's website, weird I know), I was a little surprised, I mean research proved this in the 1980's. The problem is that health care officials and educators assume that people know this and they stop harping on the matter, but every year a new group of women enter their child bearing years and need to hear this information. And even though I have gotten on this soapbox before, I am going to share a few important facts about folic acid and urge moms everywhere to share this with their friends and with their daughters.

• Folic acid occurs naturally in foods like fruits and vegetables, but our bodies absorb it best in it's synthetic form. To get your daily RDA of folic acid from your diet you would have to eat 200 red apples.
• Insufficient folic acid can lead to birth defects (or defects that result in miscarriage) including defects of the brain, skull, spine, heart, arms, legs, face, hard palate (cleft lip and/or palate) and urinary tract. A mother can reduce the risk of her child having these defects by 50-70% by taking 400 micrograms of folic acid a day.
• The most crucial time for you to be getting folic acid is in the first 28 days of pregnancy. Most women don't even know that they're pregnant in the first 28 days. 
• Hince why, EVERY woman in her child bearing years should take a folic acid supplement.
• Folic acid is used to create and repair DNA (necessary for cell production), which is why it is so vital during early pregnancy. The first 28 days are when your little bundle of joy goes from 2 microscopic cells to a something with a heart beat. Isn't that just phenomenal to think about?
• Folic acid is crucial not just for the growing baby, but mom too. During pregnancy folic acid demands increase because it is needed to produce the new cells that are making up the increased blood volume, and general increased everything that come with pregnancy.
• According to a March of Dimes survey in 2009, only 11% of women took folic acid before pregnancy.
• Apparently there is a myth going around that multi-vitamins will make you fat. This is false. However, if your multi-vitamin has iron in it and you're not drinking enough water, it can make you constipated which can lead to bloating and discomfort. Stay well hydrated and you should be fine. 
• Since 1998 the U.S. Food and Drug Administration mandated that folic acid be added to white flour, bread and pasta, which has resulted in about 1000 fewer children born with neural tube defects each year. 
• Many Hispanic women have genetic deficiency that interferes with the metabolism of folic acid. Which means that they should be taking even more folic acid.
• The average life-time cost of spina bifida per person in the United States is $532,000. 
• Currently the Center for Disease Control and Prevention, the March of Dimes, and the Spina Bifida Association along with corn and flour tortilla manufacturers are working with the FDA to supplement corn tortillas, a staple for many Hispanic diets. It is estimated to cost $3 million per year, but will save $145 million in direct medical costs for defects.
• If you are a woman living in Utah you can sign up for free vitamins at poweryourlife.org 

So what is in the Healthcare Reform Act anyway?

Last week I attended a nursing education conference. One of the speakers talked about the Patient Protection and Affordable Care Act gave a descent summary of the changes that it will make on health care in the United States. I've heard a lot about what is and isn't in the PPACA, but I've heard conflicting things. There's a reason for the that. The PPACA is almost 2,400 pages long and it is very complex. 2,400 pages, that's massive. I like to read, but I don't think I have ever sat down and read anything that long. (The KJV of the Bible is only 1590 pages and I think that's the longest book I have ever read in its entirety.) I think that I can safely assume that most people aren't reading that document in its entirety, making it difficult to know what it actually says. So I thought I would sum up what I have learned and share it with all of those moms out there who are wondering how this is going to effect them and their families.
Here are some of the big changes that it includes:

• Individual Mandate
• Premium and Cost-sharing Subsidies
• Employer Responsibility
• Guaranteed Issue
• Insurance Exchange
• Medicaid/CHIP Expansion
• Wellness Programs
• Payment Reform

 Ok, I work in health care and I still didn't know what half of those things meant until someone explained it to me, so I'm going to try to explain them so my readers can also know what's going on with their health care.
Individual Mandate- This means that the government requires that every individual has some kind of health insurance coverage. If they don't have coverage they have to pay fines. (This doesn't begin until 2014.) Right now there are a lot of young healthy people who don't have insurance because they don't utilize health care often enough to make health insurance coverage cost effective for them. One of the principles of individual mandate is to spread the risk (cost) of insuring older sick people over a larger group of people.
Premium and Cost-sharing Subsidies- This means that there are limits on how much a person should be expected to pay for health insurance. And there are subsidies to assist people with their health insurance premiums up to 400% of the national poverty level. For example let's say you have a family of 4 and you make $42K annually. That puts you in the 150-200% of the national poverty level range. The most that you are allowed to pay for your health insurance is 6.5% of your income. This is good news for a lot of people. There are so many people that I know who make too much money to qualify for Medicare, but are fairly crippled by their health insurance premiums, especially if they are not able to get them through an employer. To see where you would fall on the  subsidy chart go here. This one also starts in January, 2014.
Employer Responsibility- This means that all companies that have at least 50 employees are required to offer some kind of health insurance to them, or pay fines. Companies with at least 200 employees must automatically enroll all of their  full-time employees in health insurance, although employees can opt out and receive vouchers that they can use for a health insurance plan of their choosing. Coming January, 2014.
Guaranteed Issue- This is a big one. This means that insurance companies can not deny you coverage for a preexisting condition, and they have to renew your policy also. I can think of dozen people that I personally know who this will help. My best friend's mom with cancer, my neighbor with diabetes, my father-in-law with a rare genetic disorder, a former co-worker whose husband has sleep apnea, a friend's son with cerebral palsy are just a few. Everyone of these people are hard-working, tax-paying Americans who because of they have "preexisting conditions" and are unable to get insurance through their employers, do not have health insurance. Some have been lucky so far, others have been almost crippled by medical bills. For children, guaranteed issue started September 23, 2010 (Hooray!) and will start January 1, 2014 for adults.
Insurance Exchange- By January, 2014 states will be required to set up health insurance exchanges, which are like marketplaces. It's a place where people can compare rates and programs, and hopefully factoring in some competition will improve the available product. But they won't be available for everyone.
Medicaid/CHIP Expansion- This means that more of those people who right now make "too much" money to qualify for Medicaid/CHIP will be eligible. And even if states have budget short-falls they will not be able to cut funding here until 2019.
Wellness Programs- All qualifying insurance companies will have to provide preventative wellness programs to infants, children and adolescents, such as well-child checks and immunizations. This is effective September 23, 2010. (I love this, because I believe that preventative medicine is more cost-effective. And I think that it is sad that some people who do have insurance still don't get these things done because it costs them too much money.)
Payment Reform- Medical billing, murg. I know that for me at my job I now have more paper work. (Although compared to some I have nothing to complain about.) I know that Medicare payments are being modified drastically. And Medicare will increase their payments to primary care providers by 10%, because they want to encourage more good doctors to be primary care providers. Having quality primary care will save everyone money. But the bottom line for most Americans is that will taxes will go up to fund these changes.
A few other interesting points- There are now no lifetime limits. So my chronic pediatric patient who burned through more than one million in health care dollars in his first year of life can actually have health insurance as an adult. There are no annual limits. So if you have something catastrophic like a mangling car accident your insurance company can't say "Sorry we won't pay for your prosthetic leg because you've already cost us too much money this year." Dependents must be eligible for coverage until the age of 26. (And if you're married and under 26 you still qualify to be on your parents insurance.) This will make getting through college and graduate school so much easier for a lot of people. When I was in college I knew a guy who only went to school one semester a year because he had to spend the rest of the year working full-time to afford the insurance that was available (and required) from the university. This would be huge for people like him. Goodness it would have made my life a lot easier going through college too. And there will also be limits on how much profit insurance company administrators can make. It's about time.

Food for Thought on Health Care Reform

As a nurse and just as a mom in general, I often get into conversations with people about health care reform. I've discussed it with doctors, nurses, parents and friends. I've yet to hear a magical solution. But there is not question that something must be done. I highly recommend watching these two fascinating mini-documentaries to anyone who cares about health care. (I find myself recommending them frequently and thought that it's about time that I put them up on my blog so I don't have to search for them anymore.) They were both done by PBS Frontline and are each about an hour long, but it is time well-spent. The first one surveys 5 health care systems around the world and talks about the pros and cons of each. The second one gives many examples of how the health care system has failed people in America.

Sick Around the World
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/

Sick Around America
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view/

What did you think of these videos? Does anyone out there have any good solutions? What are your thoughts on health care in general? I'd love to hear your input.

Anti-Itching Bath

This weekend my daughter woke up with itching bumps from head to toe. Chicken pox? It looked close, but not quite. She'd had the vaccine, but it is possible to still get the illness if you have had vaccine, the chances are just much lower. So we went to the doctor, just to see. (For the next few weeks we happen to be double covered on our insurance, so luckily it didn't cost anything.) As it turns out it's not chicken pox, but had an allergic reaction to her antibiotic. I swear I heard a dozen times in nursing school that antibiotic reactions usually happen in the first 24 hours, but as it turns out it is fairly common for children to develop an allergic reaction to amoxicillan 8-10 days after they start taking it. Sometimes even 3-4 days after they finish a 10 day course. Chicken pox or allergic reaction, the itchy bumps have to take their course and the best thing to do is ease the itching. I found this effective and simple recipe for a bath that eases the itching. (Some Benedryl helped too.) Supposedly it works for poison ivy, poison oak and any kind of itchy rash. I don't remember where I got it to give credit to.

Anti-Itching Bath
For each tub of water add
2 cups of oat flour
1 cup of baking soda


If you don't have oat flour handy, just throw some rolled oats in the blender or food processor and grind until powdered. I will warn you that this stuff makes a yucky film in the bath tub.

Ways that Parents Can Reform Healthcare

Yesterday at work I read a short article on ways that parents can reform healthcare. I know that I've mentioned some of these before, but I think they're worth repeating and not one of them requires an act of congress. Each of them are ways that you can improve the health of you and your children immediately and in the long-run. By taking care of yourself and your children you can decrease healthcare costs for yourself and everyone else.

1. Eat healthy- Providing healthy meals for yourself and your children is a simple way that can give you more energy and give your body the building blocks it needs to fight off infections. Improving your diet decreases your risk for cancer, diabetes and heart disease.
2. Exercise-Active kids are far more likely to be healthy. Exercise improves your blood circulation which makes the organs and processes in your body work more effectively.
3. Prevent accidents- Vigilantly watch your children. Make them wear helmets. Make them wear seat belts. Make sure that you have the appropriate car seat.  Don't let them sit on the ledge of the back of a pickup while off-roading through the country. I know these are boring suggestions, but they are so important! I have seen so many sad stories of kids whose parents didn't make them do these things.

Myths About Asthma

Yesterday was a kind of a slow day at work so I decided to brush up on my asthma education. I found several debunked myths about asthma that I thought were interesting.

Myth: Children usually outgrow asthma

Reality: How asthma effects a patient varies throughout their lifespan. Even if the symptoms go away, the tendency towards asthma is still there and can flare-up with stress and triggers.

Myth:Asthma treatments don't work.

Reality: Newer treatments are actually very effective. But in order to be so you have to have proper inhaler technique, take your medications as prescribed and be aware of environmental changes.

Myth: Mild asthma doesn't require treatment.

Reality: Asthma is a chronic disease without a cure that should be taken seriously. Even if you usually don't have symptoms right now, it is important to take care of yourself to prevent flare-ups.

Myth: The best time to give a child an inhaler is when they are crying, because they get more medicine in the lungs that way.

Reality: If you give a child an treatment while they are crying most of it stays in the upper airways, not deeper in the lungs where it is needed most. It is best to wait until they are done crying.

Myth: Steroids aren't safe.

Reality: Inhaled corticosteroids are actually very safe, even for very young children. They are great for helping to control asthma.

Myth: If you can tough it out and not use your inhaler you're better off.

Reality: Going without your inhaler when you really need it does microdamage to your lungs which decreases your lung strength and capacity over time.

If you have asthma or your child has asthma, it is important to stay on top of it. Don't wait until it gets out of hand to act. Be persistent when giving medications to your child.  If they know that it is important to you, eventually they will stop resisting. Don't make your child feel like their condition makes them weird, it's just a problem that they have that can be overcome.

 If your child's medication isn't helping, they're having a hard time breathing, they can not walk, talk or play, they're lips are blue and or their peak flow is less than half their personal best, take them to the emergency room. Do not pass go, do not collect $200, go directly to the ER. The only other direction is downhill.

For more information about asthma go to intermountainhealthcare.org/asthma. This site has lots of information and it can refer you to more resources.

New reasons why you should have fish oil in your diet

So we've all heard that we should have more fish in our diets. Studies have shown that it can help to reduce inflammation, regulate cholesterol, treat clinical depression and bipolar disorder, slow cancer growth and increase rates of survival. This week I read an article in a nursing journal that discussed two new studies about the benefits of fish oil. In the first study they gave 13 ICU patients with an inflammatory response fish oil mixed with their tube feedings. 10 similar ICU patients received the standard solution. The patients who received fish oil had improved lab values and shorter hospital stays. The researchers believe that the omega-3 fatty acids reduce the inflammatory response.
The second study involved 81 adolescents and young adults who were at "ultra high risk" of developing a psychotic disorder. Some took fish oils, the others a placebo. After 40 weeks, on 5% who took fish oils developed a psychotic disorder, whereas 28% did from the placebo group. Those who took the fish oil also showed an improvement in symptoms with no adverse reactions. Omega-3's are crucial to brain function. The researchers conclusion was the fish oil is a safe way to prevent progression of psychotic symptoms. Moral of the story: Fish oil can can help you to heal faster and save your sanity. That's reason enough for me to start taking a supplement on a regular basis. (Right now there's a coupon for $2 off the Omega-3 gummy supplements at Costco if you're looking for a way to do this that doesn't give you fish breath.)

Book Review: Navigating Your Health Benefits for Dummies

Navigating Your Health Benefits for Dummies is actually more of a booklet than an actual book. I think that it is worth the read for most people. When I started at my first job with benefits I didn't know much about health insurance and I found that most people I asked didn't have a clue either. After several years in the health care industry, I have managed to learn most of the information that was found in this booklet on my own, but it sure would have been nice to have all of this info in one convenient place when I was starting out. You can get this handy booklet for $1.20 from Amazon, or you can get it for free by signing up at this link: http://www.planforyourhealth.com/health-benefits-dummies-guide. (The perk with Amazon is that it will get to you several weeks earlier.) It's short, easy to read and to the point. If you are just starting out or trying to get a handle on you health benefits, I highly recommend reading this book. It outlines what to expect of your health insurance, different kinds of plans, defines those crazy abbreviations you hear thrown around and gives tips on saving money. Here's a list of ways you can save money on your health care from this book.

• Find the plan that best suits you. Don't pay for what you're not going to use and make sure you have sufficient coverage.
• Maximize you health benefits. If they offer free vaccinations, use them.
• Enroll in a tax-advantaged account (HSA or FSA)
• See if your health-insurance company or employer offers an incentive program for getting fit. Many do.
• Order generic prescriptions by mail.
• See doctors from you network. This can save you a lot of money, check before you go.
• Take advantage of Open Enrollment. This is the time to make necessary changes.
• Speak up about your claims. The people at your insurance company are human. Sometimes they make honest mistakes. Recently my daughter's claims kept bouncing back unpaid. After some investigation I discovered it was because somewhere along the way her name was spelled wrong. Problem solved, money saved.
• Pursue special discounts. Sometimes you can get discounts through your insurance company on gym memberships, smoking cessation programs and massage therapists.
• Stay Healthy. Relish your good health. It's a wonderful thing and do your best to make it last.

A few things everyone should know about the Emergency Room

I have never worked in the ER, but as a pediatric nurse a large percentage of our patients come from there. So we periodically look at the ER census board for patients under the age of 18 whose condition warrants an admit. Between that and just life and general it seems that there are many people who could learn a few things about the ER (or ED as it is sometimes called.)

The Emergency Room is the most expensive way to receive care. On the unit I work on, when there aren't patients to care for, the staff get sent home, and we don't have a doctor on the unit. That is not the case in the ER. They have to pay their nurses and doctors to be there at all times, because you never know what or when something is going to walk through the door. This is the case even when there aren't any patients, because the situation can quickly change. ER charges high rates because you are paying for availability.

There are many "emergencies" that can be taken care of at an Instacare.   The Instacare is usually a little more expensive than a traditional office visit, but vastly less expensive than an ER visit. The Instacare will generally be open much later than a traditional office. A few months ago my son put a hole in his forehead with my fireplace. I managed to get him to the Instacare twenty minutes before they closed. They stitched him up and we were out within 30 minutes. It cost me $40. If I had gone to the ER, I would have had to pay a $150 co-pay, plus a percentage of the costs of whatever tests or procedures you have done. And it has been my experience that the ER would have taken me a lot longer than 30 minutes. When my patients come up from the ER, it is pretty common for them to wait for hours before anything is actually done. Once I was in a car accident and taken to the ER. I was the only patient there and I still waited for an hour before anyone saw me.
 A few of the things that can often be taken care of at the Instacare: Large cuts, simple bone fractures, sprains, food poisoning, vomiting, diarrhea, dehydration, fevers, bladder problems, headaches and blood pressure issues.

Poison Control is a great resource. If your child has eaten or drunk anything they shouldn't, call poison control. That number is 1-800-222-1222. That's the number wherever you live in the United States. Even doctors sometimes call Poison Control for advice. I'm not sure how it works other places, but I know that in Utah, the Poison Control center is staffed by pharmacy students. It's part of their training. Calling Poison Control is free and the staff can often tell you if your situation is really emergent. 72% of Poison Control callers are treated safely at home. I've called them before, they're very nice and very helpful.

The ER is not your primary care provider. Do not go to the ER for hangnails. (Yes, I have seen that as a diagnosis on the ER board.) If you are going to the ER on a regular basis, (I had a patient once, who averaged five ER visits a month.) you need to find a regular doctor. Someone who knows your story before hand, can look at the whole picture and help you with your problems.
 I realize that there are many people who go to the ER because they don't have insurance and can't afford to visit a traditional doctor and the ER won't (can't) turn them away. I think that many people don't realize that there are programs out there to help. Ask your local doctors office or your local health department. If you have a legitimate need there are resources to help. It is more cost effective for the government to assist you with your medication payments than to pay for weekly ER bills. When people go to the ER and it is not an emergency, they are increasing the cost of healthcare for everyone. Besides that, they are delaying treatment for those who really need it. Injuries and even death have been caused by excessive wait times in the ER.

Call your doctor's office. Often they can tell you over the phone is something they can treat or if it is something that must be taken care of in the Emergency Department. And they're even cheaper than the Instacare.

 Reasons you should go to the ER 

• Vomiting blood
• Symptoms of a stroke
• Chest pain that is not relieved by anatacids (suspected heart attack)
• Abdominal pain
• Trauma
• Overdose
• New onset seizures
• Respiratory distress
• Significant loss of blood
• Any health problem that is actually an emergency

Go where you can be treated. One more thing that I don't think that most people realize is that you need to go to a facility that has the capability to treat you (if you possibly can). For example there was a community hospital that I worked at occasionally in their Mother/Baby unit. Most serious cases coming to their ER are transported to another facility, because they have no ICU, no Pediatric unit and limited surgical options. I've seen many patients who go there and then are surprised and upset that they have to pay for an ambulance ride to a bigger hospital (which is where I would see them, as I worked there too). (I don't say this to disparage this hospital. It is a great hospital with awesome staff. They take very good care of their L&D patients, and took great care of my mom when she had her minor surgery there. But I wouldn't take my child there in an emergency. It's only 10 minutes to a hospital that has everything you need.)

Use your common sense. Oh, and if your instinct (not your panic mode, but your instinct) tells you that the situation warrants an ER visit, go with it. Many lives have been saved by following "instinct", when other signs did not indicate an emergency.

How to Save Money on Healthcare

These days health care costs are a big deal. So many people have overwhelming financial struggles because of their health care bills. As a nurse, and just with my interactions with people, I have heard so many sad stories of people with enormous medical bills that sometimes took decades to pay off. Some of these costs could have been prevented if people understood and were better prepared, and unfortunately some could not. But as a nurse and as a friend this is what I would recommend to try to prevent those stressful situations.

1. Wash your hands! And wash your kids' hands! This is the best way to prevent illness. Use hand sanitizer. It's not as good as a thorough hand washing, but it's still much better than an un-thorough hand washing.
2. Open an FSA (Flexible Spending Account) if your company offers one. You decide the amount to put in and the money is taken out of your check pre-tax for things you are buying anyway. (And there is an enormous list of things that qualify.)
3. Get health insurance, even if you think that you don't need it or can't afford it, try to get something. You can't predict the future and you don't know when you might need it. (However, there is an exception to this. I have a relative who has a rare genetic disease, and is considered "uninsurable". It costs him nothing to manage his disease, but if he doesn't it can lead to organ failure. He can get insurance through the state, but it's not very good coverage and when he looked into it ten years ago, premiums would cost $1200 each month for himself alone. In cases like this, you are better off paying out of pocket on an as needed basis.)
4. Shop around for your health insurance. What your employer offers isn't necessarily the best option for you and your family.
5. Understand your health insurance, especially when it comes to hospitalisations. Before you are admitted to the hospital understand your coverage. It is not your doctor's, nurse's or therapist's job to understand what or will not be covered. It is yours. There are many times in my work I see patients who I think "Are you sure you want to make that choice? Because I'm willing to bet money that your insurance will not pay for that." But I am not allowed to say that, medical billing is not in the scope of my practice. I just do what the doctor orders. Really, taking the time to understand your health insurance can save you thousands of dollars.
6. Examine all of your options. I had a co-worker who's husband was "uninsurable". He found that he could get his medical equipment from India for 1/4th of the cost. 
7. Exercise  regularly. It will help you to feel better and can save you thousands down the road by helping to prevent cancer, diabetes and heart disease to name a few.
8. Eat a well balanced diet and drink plenty of water. Same story.
9. Check out your local health department. They often offer discounted vaccinations, assistance programs, and classes on improving your health.
10. If your insurance company denies your claim, call and ask why. I have had this happen to me several times with a few different insurance companies and every single time when questioned, the insurance company covered at least part if not all of my claim. It's always worth a shot. "Oh really, that's funny, because I thought that classifying pregnancy as a pre-existing condition was against federal law." Every single time.
11. Use preferred providers. Some insurance companies have a list of providers that they are contracted with and the upshot is that when you go to these people your bill is significantly less. When you've picked someone and you want to find out what your coverage is don't ask "Do you accept X insurance?", ask "Are you a preferred provider for X insurance?" A small difference in phrasing that again can save you thousands of dollars.
12. Keep track of your receipts. For your FSA or your taxes.
13. Compare prices at various pharmacies.
14. Take care of your teeth. Floss daily and spend the extra money on a quality toothbrush. It's worth the investment of time and money.
15. Listen to your gut feeling. If you think something is wrong with yourself or your child speak out and don't be silenced until somebody listens. It really ticks me off when a doctor doesn't listen and in the end they discover something terrible that could have been treated or prevented if someone had just listened to the child's mother.

Monday is the last day to enter this month's give-away.

If you were my friend, this is what I would tell you...

 Let's say that we're friends. Your child is sick and you call me for advice. Most likely I will tell you to take s/he in to see the paediatrician. He says that he thinks that the child needs to be hospitalised. Now here is where my advice will help you. I'm going to tell you right now to "pay attention and ask questions". I think I tell almost every parent that I work with to speak up and ask questions. But sometimes because of the stress of the situation, parents just go along with what is happening. Don't be afraid to make waves!  You don't have to be rude, but this is your child we're talking about, and ultimately you are the one that has to deal with the consequences. Ask what is happening. Ask why. Ask if this is the best option. Ask what possible the side effects of a procedure/ medication are. And don't be satisfied until you get some answers.
 Now I wish that this weren't the case, but sometimes medical decisions are not based on the best interest of the patient. Sometimes they are based on politics or the best interest of the doctor, availability or insurance coverage. And the details vary from case to case, doctor to doctor and hospital to hospital. The best way to make sure your child is getting the best care that they need, is to speak up, pay attention and do not be afraid to ask questions.

When Looking for a Doctor, Ask a Nurse

 Today's post is about something that I wish that I had learned much earlier than I did. When you need a good doctor for something, the best recommendation you can get is from a nurse. Even if you don't know a nurse who works with the kind of physician you're looking for, you can still call the hospital and ask for recommendations. The best time to do this is on a Sunday afternoon when things are generally slower and nurses have more time to answer all of your questions. The nurses generally know who has good or bad track records. They work with the doctors on a regular basis and can pick out the ones who know their stuff. Now if you ask them they're probably not going to say "Oh, I definitely wouldn't see Dr. A because he is terrible about washing his hands." or "Dr. B is flaming moron" or "Dr. C is in danger of losing his license", but if there is stuff going on, they'll know. Trust me. They can point you towards the someone who will take good care of you.

 Sometimes which doctor you see doesn't really make a big difference, but there are many times that having a good doctor makes a big difference in how much time and money are spent on your or your child's health, not to mention what a difference it can make on your entire life. Any time spent researching the matter will not be wasted. I have a few stories to further illustrate my point.

 When I had my first baby (and was a very brand new nurse) someone who I respected recommended that I see a particular group of certified nurse midwives. All was well until I got to the delivery, which was a disaster. The most telling moment was after she broke my water and then said "I don't know what to do now." (I wish I were kidding, but I'm not.) After that experience I started taking a poll of all of the nurses that I worked with (at the time I worked on multiple units). At least 75% went to one particular OB/GYN. So with my second child that's who I went to. She was WONDERFUL! I really don't think I can say enough good things about her. Not just because of the way she treated me as a patient, but because of what a wonderful care provider she was to the patients that I observed her with.

 With my first child I wasn't sure who to pick as a pediatrician, so one was assigned to me. He seemed nice enough so I kept going to him. However, the more that I got to work with him the less impressed I was. When my second child was very tiny, my friends told me a sad story of patient from our unit. This toddler was complaining of severe neck and back pain and running fevers. This doctor ordered IV fluids and Tylenol (which are great), but refused when every nurse who took care of this patient, begged for a lumbar puncture and antibiotics. After four days of the patient not improving, a scan was ordered. It then became apparent that the patient had started with spinal meningitis and it had spread to the brain. That poor child will be mentally delayed for the rest of his life, and this was preventable. Ug, it still makes me sick/sad/angry to think about it. Needless to say, I did not take my children back to him.

 If you can't find a nurse to give you recommendations, here are qualities that you should look for:

1. Your doctor should really listen to what you have to say
2. Your doctor should be willing to admit when he or she doesn't know something and needs to consult someone else.
3. Your doctor should never treat you like you are stupid because you don't understand medical jargon.
4. Your doctor should never seem to be "put out" to take care of you or answer your questions, that why they get paid.
5. Your doctor should keep you updated.