Kathy Quan 's Blog

Posted by Kathy Quan

Losing weight, exercising more and resolving to quit smoking are some of the most common promises we make to ourselves as we resolve to be healthier in the new year.

These are all noble goals, but be sure you plan carefully and set realistic milestones and goals. If you set totally unrealistic goals and time frames for yourself, you're setting yourself up to fail.

Losing weight takes time so don't expect to lose more than one to two pounds each month. As long as you're moving in a positive direction, enjoy your successes and continue your efforts.

Smoking cessation is a challenge that takes many diverse paths. It may take several different tries to accomplish this goal. Again, if progress is made celebrate your success.

Jumping in to an exercise plan may present problems if it isn't well thought out. Be sure to discuss your plans with your primary care practitioner especially if you have any underlying illnesses. There may be certain types of exercise you should or should not attempt.

Almost everyone can benefit from changes that make their lifestyle healthier. A fresh start at the new year is a good time to begin. Be sure to accept that you can't change things overnight, and too many changes can be too stressful. Work on one area at a time, and reward your progress frequently to keep your motivation strong.

Be realistic. Be well, be healthy and most of all be successful in your efforts. Happy New Year!

Posted by Kathy Quan

Stop, breathe, slow down and take a moment to enjoy the holiday season. Turn on some holiday music and sing along loudly! Force the air in and out of your lungs. Breathing is one of the most important exercises you can do for your body. It will also help to reduce some of your stress.

Make a list and prioritize the items. Which ones do you absolutely have to get done? Which ones can you delegate to someone else or at least get someone to help you with? Now be honest... which ones are simply not going to happen? Cross them off your list. Maybe next year, if you start in January.

Now repeat after me...there is no such thing as perfection at the holidays!

The holidays are about being with your loved ones, sharing time together and making memories. Stop and enjoy the smells, the crisp clean air, the beautiful lights.

It can be a challenge not to end up sick from all the stress. Stay well! Drink plenty of (healthy) liquids, eat sensibly and get some rest. Wash your hands frequently and avoid those who are sick. Don't over eat or over indulge in all of the goodies. Just take a taste, not a whole piece of everything. Eat slowly and savor the taste.

Have a great holiday season. Peace on Earth! Happy New Year!

Posted by Kathy Quan

Hospital charges in the U.S. increased by approximately 90% in the last decade according to a report from the Agency for Healthcare Research and Quality, entitled "The National Hospital Bill:Growth Trends and 2005 Update on the Most Expensive Conditions by Payer." The average yearly growth was 4.5%.

The report covers the time period between 1997 and 2005 and was been adjusted for inflation. In 1997, hospital bills totaled $462 billion and by 2005, that total had reached $873 billion.

This data includes physician fees and fees for those treated in emergency rooms who were not admitted. It was derived from hospitals throughout the U.S. which were responsible for 90% of the discharges. It includes insured patients, uninsured patients and those covered by workers' compensation.

Medicare, the primary payer, spent $411 billion during this frame for 39 million hospital stays. Private insurance paid out $272 billion and Medicaid $124 billion. Uninsured patients cost hospitals $38 billion.

The most costly conditions which accounted for one-fifth of all hospital charges were:

• coronary-artery disease
• pregnancy and delivery
• newborn-infant care
• heart attacks
• congestive heart failure

The cost of care for strokes increased by 51% while the cost for coronary heart disease increased by 44%. By these figures, the study estimates that hospital costs for these two conditions alone could cost over $1 trillion in 2008.

Resources:

Kaisernetwork.org

Bloomberg/Orlando Sentinel, 12/13/2007

Posted by Kathy Quan

Medication errors account for a large number of hospital errors. These are usually the result of carelessness that come from being under staffed and over extended. There are Five Rights of Medication Safety for nurses and healthcare professionals to observe in order to help prevent medication errors.

Many pharmacies only accept prescriptions from physicians that are printed from a computer, or if handwritten, the physicians prints in block letters. Some states have begun to incorporate this into legislation. Physicians are notorious for handwriting that is impossible to read. This too contributes to medication errors.

Patients can help to prevent their own medication errors by observing the Five Rights of Medication Safety as well.

Posted by Kathy Quan

You've seen the commercials on television advertising the different plans for Medicare and prescription drug coverage. Now is the time to explore your options for 2008.

Some prescription plans have changed their formulary, meaning they have added some drugs to the plan and taken some away. Be sure to check with your pharmacy about the specific medications you take. Will your present plan provide the same coverage as last year? Don't assume it will.

You can get answers from Medicare.gov. A comprehensive manual is available to download and print. You can also compare plans by entering your own specific information in the form and seeing what each plan will offer you.

Remember you and your spouse can have different plans all together if you have different health coverage needs. So be sure to make comparisons for each of you.

Open Enrollment continues through December 31. All policies take effect January 1, 2008 and cannot be changed. Each year Open Enrollment begins on November 15 and continues through December 31. After December 31, no changes can be made for the following year. So make sure you do your homework!

Posted by Kathy Quan

Flu season begins late fall and continues into winter. One of the best ways to avoid flu and colds is to avoid crowds, but it's also the holiday season and avoiding crowds while holiday shopping is next to impossible unless you do all of your shopping online.

There are a number of antiviral medications which work on Influenza A viruses. These need to be taken within the first 48 hours after you experience your first symptoms so you'll need to be aware and contact your primary care practitioner (PCP) for a prescription. Give him/her a list of your symptoms and when and how they began to help with an accurate diagnosis.

If the flu virus turns out to be type B influenza this year, these antivirals won't do any good. And remember that antibiotics are also not effective against viruses such as the flu. Be careful with over the counter medications. Read OTC labels carefully and remember that most cold and flu preparations contain the same ingredients. Most also contain some ibuprofen or Tylenol(R).

Other things you can do to avoid the flu or colds include effective handwashing, getting plenty of rest and drinking lots of liquids. Eating right will help to fight off colds and flu as well.

Posted by Kathy Quan

The art of caring combined with scientific knowledge and skills are essential factors in providing quality health care and achieving goals of improving outcomes for patients.

Some will argue that only nurses truly understand the art of caring and that otherwise it has become a lost art.

Caring was once seen as a weakness and one of the reasons nurses were looked own upon especially by doctors who were too busy treating and curing patients to spend much time caring.

In some countries, caring is still seen as a weakness, and is one reason why foreign-born nurses often have a hard time adapting to Western culture.

As health care has seen a shift to improving wellness and health status as well as placing more responsibility on patients for their health status, the need to be cared for and the art of caring have seen a renewed emphasis.

The events of September 11, 2001, Hurricane Katrina and the devastating tsunami in Asia in 2005, left many with a hunger to help others and to find a purpose to their lives and their career. Many have turned to health care for career paths to provide that substance to their lives. The art of caring has begun to fill voids.

As a result, health care has seen professional growth as the need for a team approach rose from shifting of roles and responsibilities. Team members such as doctors, nurses, therapists, pharmacists, and patients have developed ways to work together efficiently and to respect each other for their skills and contributions to improved outcomes for patients.

A strong desire to help others and learn the art of caring is an essential quality for anyone seeking a career in health care whether or not your job involves direct patient care.

Posted by Kathy Quan

Career opportunities for physician assistants are growing and expected to increase by at least fifty percent over the next ten years due to the shortages of physicians, as well as a growing and aging population.

Physician assistants work under the supervision and license of a physician. They can work in most every field of medicine such as surgery, women's health, family practice, mental health, emergency medicine, etc.

Find out more about this exciting health care career opportunity.

Posted by Kathy Quan

Do you need a pneumonia shot in addition to a flu shot this year? You need to discuss taking the PPV if you are:

• over age 65
• over the age of two and have any long-term, chronic health conditions such as COPD, heart disease, diabetes, or sickle-cell disease
• over the age of two and have any underlying disease that suppresses your immune system such as cancer, HIV, or organ failure

For most, one dose is sufficient for a lifetime, however, in some instances, a booster is being recommended after five years. Check with your primary care practitioner to determine if you need this vaccine, or need a booster.

Read more about the pneumonia shot.

Posted by Kathy Quan

Nurses have to be good at math and science. Many nursing schools now require students to take an entrance examination that tests math, science, and language skills. The testing centers for these tests offer study guides and online practice tests to help potential nursing students improve their scores.

In the U.S. it is important that your nursing program is accredited by either the National League for Nursing or the American Association of Colleges of Nursing and the Commission on Collegiate Nursing education. Only graduates of accredited nursing programs can sit for the licensing exam NCLEX-PN or NCLEX-RN.

Nursing schools are impacted and have waiting lists. To improve your chances for admission, you need to score high on any entrance exam as well as meet all other entrance requirements such as having experience in the health care field.

Read more about becoming a nurse.

Posted by Kathy Quan

Last week the FDA announced it was going to hold a hearing to determine if stronger warning labels were needed on children's OTC cough and cold medicines in response to a number of deaths from misuse. The FDA advisory committee meeting will take place October 18 and 19, 2007 for further evaluation of the safety of children's cough and cold medicines.

The Consumer Healthcare Products Association (CHPA) announced on behalf of the leading makers of children's OTC cough and cold medicines that they were voluntarily withdrawing all infant formulas for theses medications. The formulas of these cough and cold medicines for children over 2 years of age remain available.

The voluntary withdrawal of these medications was made to prevent further misuse of the medications, not because the medications are unsafe or tainted.

The CHPA and its members have recommended to the FDA stronger labeling for these formulas to state "do not use" instead of "ask a doctor" for children under the age of two. They also announced that they will be launching a major parent education campaign to educate parents and healthcare providers in the safe use of their OTC products.

One of the major issues the FDA and CDC found in the reported deaths of children from these medicines was misuse. Children were given multiple doses of the same medication and, in effect over dosed, because when one brand name product didn't seem to work, another brand was given before the recommended 4-6 hours was up.

Consumers need to read OTC labels for active ingredients. Most OTC medications contain the same ingredients. Using a different brand name product doesn't give you a different medication. Make informed choices and practice safe medication administration. If you have questions, ask your PCP or pharmacist FIRST!

Posted by Kathy Quan

President Bush says he vetoed the bill because "it's too expensive." In a quote from the Washington Post, Ted Kennedy said it well:

"Today we learned that the same president who is willing to throw away a half trillion dollars in Iraq is unwilling to spend a small fraction of that amount to bring health care to American children," said Sen. Edward M. Kennedy (D-Mass.).

"The Congress has done its job, passing a bipartisan bill that meets a critical need without adding a penny to the federal deficit. The president has broken his promise to America's children."

Please contact your Congressional legislators and ask them to continue to work for better health care for all in this country. Without SCHIP. 8 million children in the U.S. are without health insurance.

Read more from The Washington Post

Posted by Kathy Quan

Avian flu also known as bird flu is present in wild birds and the risk to humans is minimal. Poultry that is appropriately handled and cooked also poses no risk. Handling infected birds and their feces does pose risk if proper precautions are not taken.

In Canada last week near Regina, Saskatchewan, an outbreak of avian influenza H7N3 was discovered. About 100 chickens on a chicken farm were found to be affected. However, this is not the same strain of avian flu that has scientists worried about a possible flu pandemic. That strain is known as HPN1.

None the less, approximately 50,000 chickens at this facility were killed and the facility quarantined and cleaned. These birds were not destined for immediate slaughter, nor had they been producing eggs for human consumption.

The Canadian Food Inspection Agency is handling the incident and updating the public with reports. It says the outbreak may have come from wild waterfowl which normally hosts the disease. The U.S. Department of Agriculture has issued a ban on imports of all poultry, poultry products and all wild birds taken by hunters from this region.

This lesser known avian flu may pose no threat to humans, but the government agencies are taking no chances. The fear of a flu pandemic has been fueled by the fact that these avian flus mutate and cause strains such as the HPN1 that has killed humans all over he world in the past few years.

Recently it was discovered that the HPN1 bird flu was actually transmitted from human to human in at least one instance involving several family members who all died from the avian flu.

Posted by Kathy Quan

In a study conducted by the CDC (Centers for Disease Control) which will be published in the New England Journal of Medicine on Thursday, September 27, 2007, the results show that thimerisol, the mercury containing preservative used in many vaccines, is not linked to neurological deficits in children.

The purpose of the study of 1107 children aged 7 to 10, was to see if there is a correlation between exposure to thimerisol in vaccines in the 1990's during the first seven months of life and neurological deficits. The children were given 42 tests which measured such things as word recall, stuttering, hyperactivity, intelligence and other neurological disorders as motor and phonic tics.

However, it should be noted that this study did not include children with autism. Parents of children with autism have been quite vocal and recently filed suit against the U.S. government over the use of thimerisol in vaccines. A separate study by the CDC will be conducted to determine any link between thimerisol and autism.

Manufacturers of vaccines removed thimerisol from the vaccines in 1999 after the government was bombarded with complaints by parents about vaccines causing neurological symptoms in their children.

The CDC has promised to continue to study the links between thimerisol, vaccines and neurological diseases such as autism however it also cautions that the vaccines are necessary to prevent diseases such as measles, mumps and rubella; and note that the consequences of contracting these diseases can outweigh the risks of vaccination.

Source: The Wall Street Journal Online

Posted by Kathy Quan

According to results of an annual survey of employer-sponsored health insurance plans conducted by the Kaiser Family Foundation and Health Research and Educational Trust, the average price for a family health insurance package in 2007 in the U.S. was $12,106. For an individual the average cost was $4,479 for the year. This represents a 78% increase since 2001. In addition to the rise in premiums, the average family's out-of-pocket expenses (for co-pays, deductibles and other out-of-pocket expenses) rose by about $1500.

The average cost for deductibles for a family plan ranged from $759 for HMO policies to $3596 for a high-deductible indemnity plan. Co-payments for in-network office visits ranged from $18-$30 per visit.

According to the survey, affordability of health insurance is not going to get better. In fact 44% of employers surveyed indicated they are likely to increase the copay for prescription drugs in 2008. Thirty seven percent said they plan to increase deductibles and 42% plan to increase co-pays for office visits. On a positive note, only 3% said they are considering dropping health insurance coverage all together.

This 2007 Kaiser/HRET study surveyed more than 3000 randomly selected companies with more than three employees.

Read more about this health care affordability crisis.

Posted by Kathy Quan

The Spirit of Women Health Network and Carlos by Carlos Santana Footwear are holding an online auction through eBay of red shoes autographed by celebrities during the month of September. The auction benefits several health organizations such as the Peripheral Artery Coalition (P.A.D.) and the National Stroke Association.

The organizers of this celebrity auction hope that it will bring to women's attention the need to take care of themselves so that they can continue to care for others.

The cornerstone of "The Red Shoe Initiative" is the Celebrity Red Shoe Auction. This national organization encourages women to take care of their bodies and their hearts. Heart disease is the number one killer of women.

Red shoes in this auction are provided by Carlos Santana footwear and have been signed by such celebrities as Eva Longoria, Courtney Cox, Susan Sarandon, Nicollette Sheridan, Carlos Santana, Leila Ali, Jennifer Morrison, Samantha Harris, Brenda Strong, and Teri Hatcher.

To see the shoes and bid go to eBay. For more information about the Red Shoe Initiative, visit their website at www.redshoeinitiative.org.

Posted by Kathy Quan

The number of uninsured Americans rose to an all time high of 47 million in 2006. This number has risen consistently since 2001. Although wages have also increased, the cost of individual health insurance is prohibitive to most. An increasing number of employers have also found this cost to be prohibitive and have been eroding medical benefits for employees for several years.

Medical costs have been increasing at a rate almost twice that of wages for the past several years which gives rise to the increasing costs of medical insurance. Presidential candidates have outlined a number of possible solutions and debate this issue openly as health care is one of the top issues voters want to see addressed by the candidates.

Americans can make their voices heard as Congress reconvenes and approaches a vote on the issue of helping provide medical care for uninsured children. SCHIP expires this year and Congress is scheduled to vote by October 1.

Posted by Kathy Quan

The good news for Medicare Part D subscribers is that the projected premium for 2008 is much lower than was originally projected in 2003. The projected premium for 2008 now stands at $25 for basic coverage. In 2003, the projected premium for 2008 was $41.

This is due to the fact that there has been a serious effort for competitive bids by health and prescription drug plans for this Part D medication plan for Medicare beneficiaries. These bids have been much lower than CMS (Centers for Medicare and Medicaid Services) expected when it initially set forth plans for the prescription coverage.

This premium does however, reflect a slight increase from 2007's premium of $22, but this is said to be due to "technical adjustments required by law rather than increased bides," according to CMS.

According to CMS, most Medicare beneficiaries including over 10 million low income beneficiaries are receiving benefits from Medicare's Part D prescription drug plan. Approximately 100 million prescriptions are filled under this plan each month.

Beneficiaries still need to examine plans carefully for their individual needs.

Posted by Kathy Quan

Mattel, the world's largest toy maker has been plagued with recalls of toys containing lead lately. Toy"R"Us stores have been having independent lab tests done on baby bibs recently reported to contain lead in the vinyl.

Lead can be found in vinyl which is also known as PVC or polyvinyl chloride. In the manufacturing process, lead can be added to vinyl as an inexpensive stabilizer. Recycled vinyl can also contain some levels of lead. Lead pigments can be added to vinyl as a colorant.

Lead is a poisonous metal. It has no taste and you cannot detect it visually. For years it was found commonly in gasoline and in ordinary house paint. It can be found almost everywhere. Other common sources include:

• plumbing pipes and faucets, especially in older homes
• solder used to connect pieces of metal such as in pipes or stained glass
• pewter dinnerware
• lead glass bowls, decanters and glassware
• bullets
• fishing sinkers
• it is used in making jewelry and pottery glazes
• batteries
• toys and furniture from countries where lead use is not regulated

Swallowing or inhaling lead can be hazardous to your health. Children (including unborn children) are most susceptible and it can cause damage to developing the brain and nervous system. It can cause such problems as lowered IQ, delayed development and growth, behavior and attention disorders, kidney damage and hearing problems.

If you suspect lead poisoning, contact the National Poison Control Center for more information (800)222-1222. Contact your health care provider or seek care in an emergency room.

Source: Medline Plus

Posted by Kathy Quan

His skull was completely crushed and he was left for dead. He fell into a coma, but subsequently improved to a minimally conscious state. He has remained in this minimally conscious state for six years. His parents had lost hope and told doctors not to resuscitate him if his condition worsened. Shortly thereafter he was selected for a new deep brain stimulus procedure.

The patient remains unidentified, but the procedure was chronicled for the journal Nature by Dr, Ali Rezai from the Cleveland Clinic's Center for Neurological Restoration and a team of specialists from the JFK Johnson Rehabilitation Institute-Center for Head Injuries in Edison NJ and the Weil Cornell Medical College in New York.

A device similar to a heart pacemaker which is manufactured by Medtronic Inc. was implanted under the patient's skin on his chest and electrodes implanted deep into his brain to deliver stimuli.

Due to the deep-brain stimulation, the patient is now awake and able to eat, drink from a cup, play cards, watch a movie and now speaks 16 words. He is able to express what he wants and does not want and with the combined treatment of psychiatrists psychologists and ethicists, his quality of life seems to be acceptable and improving.

Deep brain stimulation has been used on Parkinson's patients. It has also been used successfully to treat epilepsy and some forms of severe depression. This is the first time the deep brain stimulus procedure has been used on a patient with traumatic brain injury.

The success of this treatment has encouraged researchers and physicians. More patients in minimally conscious states are currently being recruited to participate in further studies of this procedure.

Read more...

Posted by Kathy Quan

Do your friends make you fat? A new study released this week from the New England Journal of Medicine (NEJM) suggests this as a possibility for the fact that obesity has become an epidemic in the Western world over the last 30 years.

If your friends, siblings, spouse, parents, etc,. are obese, your chances of being obese are increased. For instance if your spouse gains weight, you have a 37% greater chance of doing so as well. If a friend becomes obese, your chances of doing so are increased by 57%. And if a sibling gains weight, you have a 40% chance of doing so also.

In regards to siblings and friends, where the pairs were of the same sex, the influence of gaining weight was stronger than if they were of the opposite sex.

The authors of the study suggest that the social network influence on obesity may stem from the fact that when one person gains weight, the friend, sibling or spouse finds social acceptance in doing so as well.

Although their data didn't offer statistical support, there is the suggestion that social networks may be able to harness this same force to reverse or slow the obesity. The fact that many derive support and success from social networks in giving up smoking or alcohol consumption, supports the fact that the same may be true for losing weight.

Source: The Spread of Obesity in a Large Social Network over 32 Years, by Nicholas A Christakis, MD, PhD, MPH and James H. Fowler, PhD, from data provided in the Framingham Heart Study. This was a study conducted from 1971 to 2003 of a social network of 12,067 densely interconnected people with three degrees of separation. Read more...

Posted by Kathy Quan

This is in response to the American Medical Association's call for an investigation into the conflict of interest issues of these retail clinics allegedly by driving more business into their retail outlets by housing clinics staffed mostly by nurse practitioners and physician assistants under the supervision of a physician who is not required to be on site.

ANA's Code of Ethics for Nurses states that the nurse's first priority and commitment is to the patient and not to the employer. Under this code of ethics, the NP is expected "to preserve and protect the patient's right to make an informed judgement regarding health care." ANA supports nurse practitioners and believes they are a critical component to the American health care delivery system. They site the American Medical Association's own Journal (Journal of the American Medical Association)from January 2000 which reported the results of a study of patients who were randomly assigned to NPs or MDs within the same managed care group and found that patient outcomes were comparable.

The ANA believes in, and has called for, more community based care and preventative care such as that which is provided in these retail clinic settings. By studying the retail clinic setting they found that at least fifty percent of the patients seen in the clinics didn't have a primary care practitioner. It is quite common for the working class patients and family members attending these clinics to be unable to seek medical care until after work or after school hours or weekends when most primary care practitioners are unavailable.

The nurse practitioner's role in the retail clinic is to assess, diagnose and prescribe treatment under the supervision of a physician. The NP also educates and informs patients about their health status, preventative care and wellness issues. The ANA takes exception with the American Medical Association in regards to any suggestion that nurse practitioners would do anything less than put the needs of the patient first.

For more information see the American Nurses Association site.

Posted by Kathy Quan

The most recent tests of the famous TB patient now show that he has a less severe form of TB; multi-drug resistant TB. The CDC retested its sample from Speaker and announced that their results now match with the new tests run at Denver's National Jewish Medical and Research Hospital where Speaker has been kept in isolation for treatment of his TB since he returned to the U.S. in May.

What this means for Speaker is that his prognosis is significantly improved and he will probably not have to have surgery as planned. For those people he possibly exposed on the many flights he took in May to get to his wedding in Europe and his return flight to Canada, the prognosis is improved as well. ALthough the tuberculosis strain is resistant to multiple drugs, it is treatable with other drugs that the XDR form is also resistant to and curable.

According to the CDC, it won't be known until late July or early August whether anyone exposed to TB by Speaker has actually developed TB. The CDC also said that reading the tests for TB is not a simple black and white task. It may never be known why Mr. Speaker's test was first determined to be XDR-TB.

The incident has raised awareness of the public health issues surrounding TB and the fact that dangerous forms have mutated and are resistant to antibiotics. This resistance stems from the over use of antibiotics.

Posted by Kathy Quan

What would you do if you woke up with a terrible sore throat and had to be at an important meeting today? If you had the choice to visit a retail clinic before work hours would you choose to be seen there, diagnosed and treated before work? Or would you wait and see if you can get an appointment with your personal physician or other health care practitioner?

Many factors can come into play in making this decision. If you are healthy and have no underlying chronic diseases, you would probably be the best candidate for seeking care at a retail clinic. However, if you have a chronic disease such as diabetes or MS you might think twice about not seeing your PCP. The again, if your condition is well controlled there may be no reason not to seek out care for a minor illness from a clinic.

If your health status is complicated, perhaps you will be best served to wait and call your PCP first. If you can't get in right away, then making an extra effort to ensure medical records get shared will be in your best interest. Your PCP needs to keep track of all medical issues you face in order to best treat and control your condition(s).

Next time you see your PCP you should discuss these options and decide together what is the best approach for you to take. For instance, s/he may not be aware of how difficult it can be to get in to his/her office and might give you a back door approach to use. Be proactive about your health care.

Posted by Kathy Quan

What this means is that patients have been proven to get better in their own homes. The high cost of medical care however, cannot cover custodial care. Patients have to assume responsibility for their own care as soon as possible or find a caregiver or loved one to help provide this care for them. Medicare and private insurance will pay for some instruction and supervision from a home health agency after discharge from the hospital to help you make this transition.

In a hospital setting, the discharge planner is usually a registered nurse or medical social worker who has been trained in assessing patients potential needs, assisting patients to learn to care for themselves, and helping them to transition home. Sometimes this includes arranging interim care with a home health agency, or making referrals to outpatient settings to bridge the gap between hospitalization and independence.

Discharge planners have a wealth of knowledge about community resources. If you or a loved one is hospitalized and will need assistance at home, having a visit from a discharge planner is an essential part of your hospital stay. Tell your nurse you'd like to see the discharge planner. They usually work the daytime shift.

S/he will provide you with information about such things as transportation home and to and from medical appointments, meal preparation and home delivery, durable medical equipment you can rent or purchase to assist in your recovery, shopping services, etc. If you need private duty nursing care this can be arranged. If you need continued intermittent nursing visits, physical or occupational therapy once you go home and meet criteria for being homebound, a referral can be made to a home health agency.

If you have been receiving care from a home health agency prior to entering the hospital, you should report this to the discharge planner as soon as possible to ensure that you will have continued care from the same agency when you are discharged.

The discharge planner's job is to assist you in making a smooth transition either to your home or a step-down level of care such as a skilled nursing facility once you leave the hospital setting. Be sure to take advantage of this service.

Posted by Kathy Quan

In China, the head of the FDA has been sentenced to death for accepting bribes from drug companies. That may seem harsh, but how many Americans have been sentenced to premature deaths because of similar issues?

The latest situations include the drug Avandia for diabetics and Trasylol which is given to cardiac bypass patients. Congressional hearings will soon be underway about each of these drugs. Did the FDA and other drug officials know they were not safe? Is the almighty dollar worth the risk?

We know that prescription medications have been shown to have side effects and to be completely unsafe. Those drugs are tested and supposedly meet strict standards. On the other hand, how many people are poisoned or die each year as the result of over the counter medications? Recently a teenage died in New York because she used an anti-inflammatory pain reliving cream presumably on her sore leg muscles. She was a cross-country runner and track star.

Too many people believe that over the counter medications are safe. Most of them are relatively safe as long as you follow the directions on the product. But sometimes those directions are not specific enough.

The average lay person may well understand that using a pain relieving cream on a small area three to four times a day may be safe. However, do they know that the more surface area of the body you spread the cream over, the larger the dose of the medication? Do they know that exercising a muscle causes it to heat up and that heat will cause the medication to be absorbed faster? It can also cause more of the medication to be absorbed as well. More importantly, does the average lay person understand that a person can overdose on pain relieving creams?

Even when the directions are specific, people don't always understand or heed the precautions. 'If one helps, two will work even better," is all too often the response given for adverse reactions that land people in the emergency room.

Most OTC medications come with a disclaimer to consult with your physician before taking, or if symptoms continue or worsen. Don't assume an OTC medication is safe for everyone. Talk to a health care professional. Ask your doctor, pharmacist, or other health care practitioner. Never give adult medications to children. You don't have to earn a medical degree or become a chemist, but be safe!

Posted by Kathy Quan

While the U.S government, the CDC and WHO continue to discuss the ramifications, issues, faults and possible ways to prevent a recurrence, what are the dangers to passengers who flew with the recently publicized TB patient , Andrew Speaker.

Tuberculosis is an airborne disease meaning it is spread from one person to another through the air. This is accomplished by releasing germs into the air through coughing, speaking, spitting, sneezing or singing. The recipient breathes in these germs.

TB cannot be spread by shaking hands, sharing food or drink or by touching surfaces such as toilets, sinks, bed linens, or other surfaces. Even kissing or sharing a toothbrush or cigarettes with someone who has TB will not spread the disease.

TB is caused by a rod-shaped bacterium called mycobacterium tuberculosis. For a person to become infected with TB, there has to be prolonged exposure in a closed environment to the infected person. On an airplane, according to WHO and the CDC, that exposure would presumably have to be a long flight of eight hours or more. The bacterium can cause tow forms of disease a latent form or an active form. Those with impaired immunity such as those with a positive HIV status are most at risk for becoming infected.

Symptoms of TB include a feeling of generalized weakness or sickness, fever, night sweats, a cough, chest pain, coughing up blood and unexplained weight loss. Mr. Speaker claims he had no symptoms and that the TB was discovered on a routine chest X-ray several months ago. Without a cough, the risk of spreading the germs is somewhat diminished despite the fact that his specific TB is a extremely drug resistant (XDR) form.

Anyone who thinks they may have been exposed to TB at any time should contact their health care practitioner or local health department to be tested. Details of the exposure should be presented to the health official.

For more information about TB see the CDC website

Read more...

Posted by Kathy Quan

Speaking, reading or writing another language is not a pre-requisite nor a requirement for healthcare education and degree programs, however it is almost always an asset and highly recommended for all students of healthcare professions.

Bilingual abilities are desired in most inner city locations in particular. Healthcare facilities are expected to have a list of bilingual employees available for use as interpreters at all times, particularly those with emergent or trauma care departments where translation services can be most needed in life and death decisions and treatment.

Under duress and stress it is quite common for patients to revert to thinking and speaking in their native or first learned language. This can be true despite the fact that they are fluent in another language that is their primary language at the present time. If they have suffered a severe trauma or brain injury it is possible that the new language skills could be lost completely or badly damaged.

Along with learning another language, customs and cultural diversity issues are often addressed in foreign language classes as well. This information can be a very important factor in providing quality health care and promoting the best possible outcomes. Very simple and well-meaning gestures can be misinterpreted and lead to dire consequences.

For instance, for a Muslim woman to make eye contact with a male other then her husband can be interpreted as infidelity. Yet in an emergency situation where a male physician needs that female patient to make eye contact and to follow an object with the her eyes to help determine her neurological status, eye contact can mean the difference between implementing life saving options or not.

In our global society, cultural diversity and language barriers present a multitude of new challenges everyday. If you are considering a career in healthcare, learning another language and studying cultural diversity issues can be one of the most influential and rewarding aspects of your career path.

Posted by Kathy Quan

The deadline to apply for the next session of online Spanish classes from SpanishNet College is June 22, 2007. Through a grant from The Enlightenment Foundation of Florida, SpanishNet College is able to offer scholarships to healthcare providers to learn to speak Spanish.

There will be 1000 scholarships granted to nurses and other healthcare providers and administrative staff to help with their tuition for this unique online learning experience.

The Basic Spanish course begins July 2, 2007 and will continue through December 28, 2007 with three two-month sessions. The session are Spanish 101, 102, and 103.

SpanishNet College has been educating students online for thirteen years. They offer a "synchronous style of study" which enables students in all time zones to experience text, live audio as well as interactive study with their professors as well as fellow students. The school offers a wide variety of courses, and one on one attention for all students.

The Enlightenment Foundation of Florida was established just this year to promote diversity in education. For nurses and other healthcare providers and staff this grant helps to provide opportunities to break down language barriers between healthcare workers and patients and improve outcomes.

The cost of the Basic Spanish course is $600. The grant pays $300 and the student receiving the scholarship pays the other $300. For more information about this opportunity, see the SpanishNet College web site, or email Elena Montemayor, School Administrator at spanishcollege@cs.com

Posted by Kathy Quan

The DASH diet, Dietary Approaches to Stop Hypertension, was developed in 1999. The U.S. government issued guidelines for a heart-healthy diet designed to help lower cholesterol and to help control hypertension.

Hypertension is simply high blood pressure which, if left uncontrolled, can lead to heart attacks and strokes. In addition to medications, a diet low in saturated fats and high in protein, fruits and vegetables helps to control hypertension and prevent heart attacks and strokes.

A new study shows that between 1994 and 2004 the number of Americans following the DASH diet guidelines has dropped from what it was in the preceding study from 1988-1994. In fact, only about 22% of the group studied are following simple dietary guidelines to promote heart health.

According to Dr. Phillip Mellen, an Assistant Professor of internal medicine at Wake Forrest University School of Medicine in Winston-Salem, NC, the reason for this decline is unknown. Some of the reasons speculated include cost, location and education.

Older individuals with at least high school educations were more compliant with The DASH diet as were those with diabetes. Younger participants and African- Americans were among the group with the lowest level of compliance. Availability of healthy foods also played an important part.

The DASH diet is rich in vegetables, fruits, grains and low-fat dairy products many of which require preparation and cook times that exceed the fast paced needs of our society. These foods are very expensive as well.

Another factor that Dr. Mellen presents is the fact that nutrition and dietary counseling is not reimbursed by Medicare or other health care insurance. Therefore, for physicians and other prescribing health care practitioners it is more cost effective to write a prescription for medications than to spend time counseling patients about their diet.

More emphasis needs to be placed on the significance of combining healthy eating and lifestye with medication to control hypertension.

Simple DASH diet guidelines and sample menus are available from the National Institute of Health.

Posted by Kathy Quan

Not since World War II has the VA been urged to make such major changes. The study was ordered and paid for by the VA in an effort to determine how to better treat this issue in the face of rising claims of PTSD that it was not prepared for.

The study suggests that the VA needs to broaden its definition of PTSD and standardize criteria for screening and treatment options in accordance with current scientific knowledge. The study was conducted jointly by the Institute of Medicine and the National Research Council. Additionally the VA needs to set fixed long term disbaility benefits for those who suffer from PTSD and bring them up to date and standardize them as well.

Surprisingly, the recent increase in claims is from Vietnam War veterans. The study expects that in future decades, the spike in claims will come from Gulf War veterans as well as veterans of the Iraq war and Afghanistan. The data indicates that PTSD and other mental health claims tend to come in later years after the mental conditions have taken their toll on the physical health status of the veterans, and their general health fails or another war reminds them of their own battles.

Adding to the situation is the fact that there continues to grow a shortage of nurses, psychiatrists and psychologists who have been trained to deal with PTSD. Those who remain are battling issues of burnout of their own.

Controlling the skyrocketing costs associated with this problem as well as replenishing the mental health workers are challenges the VA faces in providing appropriate health care for the veterans afflicted with this condition.

Posted by Kathy Quan

Congressional Bill HR1952 was introduced last week by Representative Charles Gonzalez (D-TX) and Phil Gingrey (R-GA). The bipartisan bill is known as the National Health Information Incentive Act. It offers loans, grants and other incentives to practitioners to offset the costs of implementing healthcare information technology (HIT).

Phil Gingrey is a physician who knows first hand that many practitioners are small businesses who are concerned with the bottom line. Spending money to support HIT would cut into their ability to provide quality patient care. Gingrey says, "Our ATMs shouldn't be more advanced then our medical records."

Gonzalez is the chairman of the Small Business Committee's Subcommittee on Regulation, Healthcare and Trade and he feels that adoption of widespread HIT will revolutionize the quality and standard of healthcare in America.

Last year these two representatives introduced separate bills to support HIT. They both failed. By introducing a combined bipartisan bill, which includes a comprehensive pay-for-performance aspect, it is hoped that Congress can support this HIT issue and provide assistance to practitioners to make their medical records accessible.

The aftermath of Hurricane Katrina pointed out the need for HIT when thousands of U.S. citizens found themselves without their medications and without access to medical history information. Far too many died or suffered needlessly because of the lack of technology in the healthcare system.

What can you do now?

• Read more about this bill.
• Write to your Congressional Representative to support this effort.
• You can start now to make your own personal medical record .

Posted by Kathy Quan

Nurses Week is coming up again soon. Take time to honor your local nurses! Here are a few facts about worldwide celebrations.

• In the U.S., Nurses Week is always celebrated May 6-12 regardless of the days of the week
• May 6 is National Registered Nurses Day
• May 12 is the anniversary of the birth of Florence Nightingale
• May 8 is Student Nurses Day
• National School Nurses Day is the Wednesday of Nurses Week. This year it is May 9.
• These dates have been permanent since 1993
• The theme for 2007 is "Nursing; A Profession and a Passion"

In Canada, Nurses Week will be celebtrrated May 7-13 and the theme is : "Think you Know Nursing? Take a Closer Look."

In Australia they will celebrate International Midwives and Nurses Week May 5-12, 2007 with a multitude of national events.

In the UK, Student Nurses Day is celebrated on May 12 each year.

The International Council of Nurses celebrates May 12 as International Nurses Day. This year the theme is: "Positive Practice Environments: Quality Workplaces = Quality Patient Care"

Read more about Nurses.

Posted by Kathy Quan

We may never have answers. Our thoughts and prayers are with the familiies and friends of all of the victims of this tragic set of events. May your memories comfort you and keep your loved ones with you forever.

Posted by Kathy Quan

In the fourth quarter of 2006, many Medicare Part D Prescription Drug Plan enrollees began to experience the Medicare Doughnut Hole. This coverage gap caught many seniors by surprise and without many options to help them out until coverage started over again in January.

Now the Centers for Medicare and Medicaid (CMS) has posted information and links to publications on their web site to assist beneficiaries in 1) avoiding the coverage gap and 2) finding resources to assist them with drug costs if they cannot avoid the coverage gap.

Seniors were encouraged to carefully research Part D Plans during Open Enrollment from November 15 to December 31 to fund the best fit for their particular needs.

One of the top 5 tips from CMS is to use generic drugs. The coverage gap begins when the patient and Medicare combined have paid out $2250 in drug costs. Using generic drugs can help prolong that point compared to using all brand name drugs which can run the bill up much faster.

Drug manufacturers offer prescription assistance programs, and most have developed plans now for Medicare Part D beneficiaries. Investigate these programs particularly if you are on very high priced drugs for renal failure, or drugs to prevent or diminish side effects from chemotherapy.

Investigate your options now to prevent a coverage gap, or to be better prepared to bridge the gap.

Posted by Kathy Quan

Zelnorm has been manufactured by Novartis and marketed in the U.S. for the treatment of irritable bowel syndrome with constipation. In recent analysis of data from clinical trials it has been discovered that a small but significant link exists between the use of this drug and serious cardiovascular ischemic events.

These events include unstable angina, heart attack and stroke. They primarily occurred in patients with prior history of such cardiovascular disease and events or those with risk for cardiovascular events.

Patients taking Zelnorm should speak with their prescribing health care practitioner about alternative options at this point.

Novartis will refund out-of-pocket costs to patients for any unused and unexpired Zelnorm tablets returned. For more information about how to return tablets for refunds, contact the Novartis Customer Interaction Center at 888-669-6682.

Novartis states on their web site that they still believe this drug is quite beneficial to patients with irritable bowel syndrome with constipation and they will work with the FDA to find a way to continue to manufacture and market the drug safely.

Pending further investigations from the FDA, all patients who are currently taking Zelnorm should consult with their health care practitioners and discontinue taking the medication. If they experience any cardiovascular events they should seek medical attention immediately and state thet they have been taking Zelnorm.

March 30,2007 resource: Novartis

copyright 2007 Kathy Quan, all rights reserved

Posted by Kathy Quan

The California Department of Managed Health Care reported that it has fined Blue Cross of California $1 million for these violations. Blue Cross continues to contend that it did nothing wrong. California state law allows insurance companies to deny coverage to individuals with preexisting health conditions.

Coverage cannot be denied to members of group health insurance policies. Individual policies are for consumers who cannot get group coverage.

State investigators found that Blue Cross was using computer programs as well as a dedicated department to investigate claims for chronic illnesses and pregnancy made by individual policy holders. Regardless of whether they could prove that the policy holders lied about these conditions on their applications, Blue Cross began cancelling coverage.

The investigation was prompted by stories in the Los Angeles Times newspaper about individuals suffering hardships and even the loss of their homes due to the fact that they got sick and Blue Cross cancelled their health insurance policies.

California state regulators plan to investigate other health plans for similar accusations of canceling health insurance policies. They will review Blue Cross in 18 months to ensure they have cleaned up their act.

Posted by Kathy Quan

Today more and more simple medical procedures are being performed on an outpatient basis. Additionally, patients are released from the hospital as soon as is humanly possible to minimize health care costs and to improve patient outcomes.

As a result, simple wound care and dressing changes are becoming common place in the home setting. Patients, family members and friends are being expected to assume responsibility for changing dressings.

A couple of important things to remember are to protect yourself as well as the patient. Wash your hands before and after, and wear gloves.

Non-sterile gloves are available even in grocery stores. Your loved one or best friend may not have something like AIDS or HIV, but there could be germs brewing in the wound that won't surface for awhile. You also want to exercise standard precautions to prevent infection or contamination to the wound.

Don't assume that wearing gloves means you don't have to wash your hands. Always wash your hands before and after any dressing change.

Posted by Kathy Quan

How does Daylight Saving Time affect your health status? For some it will take a couple of weeks to adjust to the loss of an hour's sleep as we move our clocks forward one hour at 2 AM, Sunday morning, March 11.

Plan mentally for a short night's sleep and even try a nap Saturday afternoon to help avoid the effects of less sleep. A nap on Sunday can also help you to reorient to the time change.

For others the "added hour" of daylight will help with symptoms associated with light deprivation issues such as SAD (Seasonal Affective Disorder.)

Not all countries have a daylight savings program. Here in the U.S. it was decided to extend the period by a few weeks this year. Daylight Saving begins two weeks earlier and will last one week longer. You'll gain that hour back, the first Sunday in November instead of the last Sunday in October now.

If your computer was built before 2005, you will most likely have to adjust the time manually. You can do this in "Control Panel" for Windows based computers. If your time is not correct, some programs and Internet connections may not work correctly. Think about how your body doesn't feel quite right for a few days after the time changes.

There are also some warnings being issued about scams connected to the time changes. This year because the change is early and some computers may not automaticaly change, scammers may attract your attention by telling you there are problems with your bank or credit card accounts. Be wary of such scams!

Posted by Kathy Quan

After March 31, 2007, you will be locked in to the Medicare plan you are in until the next Open Enrollment period (Nov. 2007). In the past, Medicare beneficiaries could switch plans once a month. Some of the managed care plans (Medicare Part C) offer more benefits and lower premiums. Beneficiaries sometimes found themselves in a plan that didn't fit their needs.

Now if that happens, you won't be able to switch once you are locked in to your plan for 2007. So be sure to investigate and compare plans to be sure you have the one that fits your needs. For married couples, you need to be aware that you could possibly choose a different plan for each of you depending upon your particular health care needs.

You can find information on plans ofered in your geographic area by visiting the Medicare website. Be sure that the plan you choose is one that your physician accepts, or you will have to switch physicians.

Posted by Kathy Quan

Did you know that more women die from heart disease each year than from breast cancer? In fact, more women in the U.S. die from heart disease than men. Women past the age of menopause are at even greater risk. These facts are not well known to physicians which increases the risks for women.

The World Health Organiztion (WHO) estimates that more than 16 million people worlwide die from cardiovascular disease each year. Heart disease knows no borders. It kills the old and the young (yes even teenagers have been found to have major artery blockages due to fat). Socio-economic factors do influence risk factors, but wealth does not protect anyone from heart disease.

WHO also estimates that 15 million people will suffer strokes each year. Five million of them will be left permanently disabled.

Smoking, obesity, lack of exercise, poor nutrition, diabetes and high cholesterol are all risk factors for heart disease.Lifestyle changes at any age have been shown to reduce risks and improve outcomes.

Posted by Kathy Quan

May 6-12, 2007, is National Nurses Week in the U.S. In Canada it will be May 7-13. Worlwide celebrations honoring nurses take place during that week. May 12 is the anniversary of Florence Nightingale's birth. Ms. Nightingale is fondly known as the founder of the nursing profession.

During this time frame you can send a "letter to the editor" of your local newspaper to ask for your community to honor nurses. You can ask local politicians to make a proclomation honoring the nurses in your community. The American Nurses Association has a sample letter you can copy and paste to send to your newspaper. They also have a long list of celebration suggestions as well as information about the history of Nurses Day and Nurses Week.

Nurses are vital members of the health care team, and there is a growing shortage of nurses worldwide. The American Nurse Association's theme for Nurses Week 2007 is "Nursing: A Profession and a Passion." The Canadian Nurses Association's theme for 2007 is "Think You Know Nursing? Take a Closer Look."

Read about Australia's celebration of Nurses Week in 2006.

Help be part of the solution and increase awareness of nursing as a profession. Plan, implement and honor nurses in your community this year.

Posted by Kathy Quan

Apparently this is a little known fact because less than 45% of Medicare beneficiaries with diabetes has had an eye exam. This coverage has been available since 1998. The Medicare Glaucoma Detection Act was passed in 2001 to ensure those at risk could have an annual screening, yet it is not a well-known benefit.

According to the results of a study published in the February issue of the trade journal, Opthamology, Medicare is paying out more than $2 billion annually in non-eye related illness (such as depression) and injuries; some of which require skilled nursing home care.

The major causes of vision loss in this study were Age-related Macular Degeneration (AMD), cataracts and glaucoma. All of these are treatable, and when diagnosed early, the adverse effects can be minimized.

The study points out the need for CMS, the Centers for Medicare and Medicaid Services, to increase awareness of the coverage for eye exams and glaucoma screening, as well as the need for primary physicians to screen all patients for vision problems. Early detection and treatment can help to reduce costs significantly. Thirdly, Medicare beneficiaries need to be educated in the prevention of eye related diseases as well as non-eye related complications.

For more information visit the Medicare website.

Posted by Kathy Quan

Friday, Feb. 2, 2007, is national Go Red For Women Day, sponsored by the American Heart Association. One in three women gets heart disease. Heart disease is the Number 1 killer of women in the U.S. today.

The American Heart Association sponsors this campaign to help raise awareness of heart disease and the need for women (and men) to have yearly checkups. On their website, you can take an online assessment of your own heath status to help determine your risk for heart disease. It is not meant to diagnose you. You must see your health care practitioner for an evaluation.

To learn more about the Go Red For Women campaign, you can download their brochure here. You will need Acrobat Reader.

Make a promise to yourself today.

• Get a Checkup... schedule an appointment now
• Get More Exercise...go take a walk
• Stop Smoking...don't start, and help a friend stop
• Lower Your Cholesterol, Fat and Salt Intake
• Resolve to Lose Weight (if needed)

Posted by Kathy Quan

Rep. Lois Capps (D-CA), herself an RN, intoduced The National Nurse Act of 2006 (HR 4903) last March. This act would establish an office of the National Nurse.

The National Nurse Team lead by Teri Mills RN, a nurse educator form Oregon, has recently received 501c4 non-profit status as a legislative advocacy organization. With donations from supporters, the team will visit Washington DC again this March to deliver information packets to Representatives in the House from their constituents who support this legislation.

An Office of the National Nurse would bring recognition to the nursing profession and help to resolve the nursing shortage. It would develop education programs to improve the health status of Americans. It would also establish a corps of volunteers who would be prepared and ready to respond in the event of national disatsters such as Hurricane Katrina.

To read more about the National Nurse Act, or to hear a recent radio interview with Teri Mills and the National Nurse team see the National Nurse website.

Posted by Kathy Quan

Yesterday my mother called to tell me how pleased she is that her blood pressure crisis is over. Her blood pressure has been in the 110/70 range for over a week now. So she can stop taking her blood pressure medicine. NO!!!!!

She had an episode during the holidays where it was as high as 236/110 after a minor procedure was performed in the hospital outpatient department. Subsequently she was started on medications to control her blood pressure. Her BP has been borderline for awhile and now she needs medication.

We've had this conversation many times when I have complained to her that my patients (I never revealed identifying information about them) just don't seem to understand that the blood pressure medication doesn't cure the high blood pressure; it keeps it under control. My mother is an intelligent and highly educated woman. Why is she making this same error? Why is she thinking she can just stop taking the medication?

Even highly educated people can be considered "illiterate" when it comes to the health care. She doesn't understand that the blood pressure medication is not like an antibiotic. You don't just take it until the bottle is empty.

Blood pressure medications come in many different varieties, but they do not cure high blood pressure. They control it, and they must be taken for the rest of your life, unless you are directed otherwise.

Occassionally, an episode of high blood pressure can be due to extenuating circumstances, and after a period of treatment, it may resolve. However, this is not the norm. The vast majority will have to continue on the medication for the duration.

• When the bottle is empty (and preferrably before then) you have to refill the prescription.
• You need to monitor your blood pressure to ensure the treatment is effective.
• Sometimes the dose will need to be adjusted if your blood pressure remains high or if it drops too low. But you will most likely continue to need medication.
• You will also need to see your physician at regular intervals for medication management.

Always ask your physician or pharmacist how long you'll need to take a medication. Follow directions carefully and ask questions. Report reactions to the medications. Some will be normal, but your health care provider needs to know about them.

Never stop taking a medication without consulting your health care provider!

(Note: Yes, I have permission to discuss my mother's health care issues.)

Posted by Kathy Quan

All LPNs and LVNs are encoursaged to take the online survey at NAPNES website. NAPNES is considering a joint venture with the Infusion Nurses Society Certification Corporation. This venture would create a national IV certification.

NAPNES needs data from all practical and vocational nurses in the U.S. to determine the need for such a venture. They also need the information to help create a scope of practice for IV certified practical and vocational nurses.

Please take the 5-10 minutes needed to complete this survey whether or not you are an IV certified LPN or LVN.

What's the difference between an LPN and LVN? In Texas and California, practical nurses are called vocational nurses. In the rest of the U.S. they are called practical nurses. Each state licenses the nurses and sets the scope of practice under the nurse practice act of that state. Parameters can vary from state to state.

A national IV certification process could help to open up opportunities for practical nurses in states where LPNs/LVNs are not allowed to provide IV care.

Posted by Kathy Quan

Setting urealistic resolutions only sets you up to fail. If you want to lose weight, set a realistic goal. Remember you didn't gain weight overnight; you won't lose multiple pounds very quickly either.

I hope you will all resolve to live a healthier lifestyle. Take changes in stages. Drastic changes can cause problems and make it difficult for your body and mind to adjust.

For example, slowly cut out trans fats. Step up your exercise program slowly so you don't strain or sprain anything. Learn a stress relieving technique. Take time for you at least once per week.

If you have a desk job, get up and walk around your office at least once per hour.Drink some water, and take a few deep breaths. Stretch your legs, back, shoulders arms and neck. If you can, go outside for a few minutes at least twice each day.

Buy fruits and veggies and cut some up each night and put in baggies or other containers to take to work with you. (Even if you don't brown bag your lunch.) When tempted for a snack, you'll have something healthy to indulge yourself.

Think about small steps to achieve your ultimate goals. Take it in realitic stages and you'll get there.

Here's to a very happy and healthy 2007!