I heard about the proposed ban earlier this summer and while I can’t say I was shocked (it is San Fran, after all), I was annoyed. I can see their side of the issue… babies unwillingly having a piece of their skin cut off. But where do we draw the line? There are a lot of things that occur within medicine that aren’t pleasant… immunizations, IVs. If I were a boy, I would hope that my parents would have gotten me circumcised when I was an infant. I know that my grandpa was circumcised when he was 19 years old due to an infection… I bet he wished he had it done when he was too young to remember it.

Circumcision is not just a cosmetic procedure. Boys/men who have been circumcised have a lower incidence of bladder infections, reduced incidence of balanitis (inflammation of foreskin/head of penis), reduction in spread of HPV to women during intercourse, as well as improved body image and ease of male hygiene.

(CNN) — California Gov. Jerry Brown signed into law Sunday a bill that prevents local governments from banning the practice of male circumcision.

The legislation comes in response to an effort this summer by a San Francisco Bay Area advocacy group opposed to the practice to get a measure proposing a citywide ban added to the November 8 city ballot.

In July, a Superior Court judge ordered the proposed measure removed from the ballot, saying that male circumcision is “a widely practiced medical procedure” and that medical services are left to the regulation of the state, not individual cities.

The legislation signed Sunday, which takes effect immediately, prohibits governments at the local or county level from “restricting the practice of male circumcision” and “declares that the laws affecting male circumcision must have uniform application throughout the state.”

After posting my x-rays from before and after my foot surgery in my last post, I came upon this article in the local news… and this guy’s xray is WAY cooler than mine. Check out the full post on AZ Central’s website.

Last fall, I was interviewed by one of the editors of Critical Care Nurse, the magazine published bi-monthly the the AACN (American Association of Critical Care Nurses). While my job title has changed since the interview, I still consider myself a critical care nurse. I use my critical thinking each and every day to make decisions that benefit my patients :)

I’m really honored to be featured for the “I Am A Nurse” section of their June 2011 issue. They asked for a photo of me doing something outside of the hospital (so I chose a picture from surfing in Maui – what’s better to do with time off of work, right?) and they also asked me some questions about my career and memorable experiences I’ve had thus far.

I’d love for you to take a peak… Click here to view the PDF

It looks like the Susan G Komen Foundation has filed legal trademark oppositions against hundeds of  “mom and pop charities” such as Kites for a Cure,  Surfing for a Cure and Cupcakes for a Cure. Who knew that Susan G Komen could trademark the word “cure”?  Hmmmm…

This, to me, sounds very similar to Apple trying to sue small companies such as DOPi (which is iPOD spelled backwards), a company that made products used to carry the Apple products such as iPods, iPads, etc. DOPi ended up winning the lawsuit proving that Apple does not have the rights to the letter “i”.

However, in this case, I think it’s much worse. The Susan G Komen Foundation is filing lawsuits against charities that are trying to raise money for cancer. CANCER! These small charities are barely able to cover operating costs, let alone have paid employees and legal teams, so upon Susan G Komen filing a claim, many of the charities are forced to close their doors. On top of that, according to Susan G Komen’s opeating expenses, the company spends close to a million dollars a year on its legal budget – that money seems like it would be better placed towards finding a cure for breast cancer (I said “cure”, please don’t sue me).

Finding this article about the greed of the Susan G Komen Foundation almost makes me want to boycot their products. I really like Yoplait… I hope I can find some of my favorite flavors without their pink labels on them. *sigh*

*I know that this is old news (as the article I read on the subject was dated from last month), but since it was news to me, I wanted to share.

This Johnson & Johnson ad was originally made in 2007, but I’ve recently seen it in several spots on TV over the past month. I’m curious why the recent push on this video. To my understanding (of which I have no factual basis), this ad was originally created to help during our “nursing shortage”. But, then we found that the waiting lists for nursing schools were backing up and potential nurses were waiting years to start their education and the actual problem was recruiting nurses to become educators to teach the potential nurses. But now, we have nursing students graduating without jobs. Is this ad being run again to help show the public what a fantastic job nurses do each and every day? What do you all think?

Is this a crazy thought or what? I honestly don’t think that most of my friends give a thought to ever developing diabetes in their lifetime, except the rare few who have parents or grandparents that they see struggling with the disease.

Currently, 26 million Americans have diabetes and an additional 67 million Americans have prediabetes (when the blood glucose/blood sugar is above normal, but not (yet) high enough to diagnose diabetes). Experts are predicting that one out of every three children born in the year 2000 will develop diabetes in their lifetime, which will raise their risks for heart and kidney disease, blindness and limb amputation. Costs associated with diabetes are $194 billion annually, about 10% of total healthcare costs for the decade (the annual cost is estimated to be at $500 billion by the year 2020 if we continue at our current pace).

Obesity prevention and treatment is key in battling this disease. Also, precise management of blood glucose levels is important and it takes dedicated patients and physicians to work together to make this happen. As most of you reading this probably already know, blood glucose is managed by diet, oral medications, and/or insulin shots. But, the best way to manage diabetes is never to get it in the first place by having a healthy diet, exercising regularly, and keeping the BMI in the normal range (of course).

As National Diabetes Prevention Month (November) comes to a close, I think it’s a great time to think about what we, as health care providers, can do to do our part to combat this growing disease. When you’re giving insulin to a patient, do you discuss their home routine for blood glucose management? If the patient confides in you that they have a hard time getting their diabetes supplies, do you put in a referral for case management to see if they can find resources to help? Do you make sure to educate family members about diabetes so they can help remind their loved ones about all of the information they just received? What can we all do to help combat this growing problem?

I’ve seen questions raised in the news recently about the new body scans that are being used in airports around the country to prevent weapons and bombs from being carried on airplanes. I can see why so many people have an issue with the scanners (as the picture on the left shows, the images can easily be inverted to show a very real image of the human body). But more so than the body scanners themselves, I have issue with the training that many of the TSA employees appear to have.

I heard a story about a man getting patted down in a manner that the TSA employee broke the seal on his urostomy bag. He then had to endure an entire flight soaked in his own urine. It wasn’t clear whether or not the person spoke up about the urostomy bag prior to the pat down, or whether the worker was being cautious and it was an accident, but either way I believe that it happened.

I value my safety on a flight and I hope that everything is done to prevent terror in the skies, but at the same time I think there is a line of what is “too far”. We may just be sliding down that slippery slope. When passengers are forced to choose between having their body exposed as shown above or having a full body pat down, it’s too far. If I set off the metal detectors, then I expect the TSA to use the metal detector wand. But a mandatory body scan or a full body pat down? That’s not how I expect my vacation to begin.

The TSA process is already more difficult for patients with medical conditions, such as those patients with pacemakers or other implanted devices who are unable to pass through the metal detectors. I can only foresee the process becoming more and more difficult for our aging population.

AJN (American Journal of Nursing) has recently posted an article discussing whether a patient has the right to choose their healthcare provider based on race. After reading the title, my mind went to an issue that I’ve seen at the hospital several times. Our elderly white population have often made comments about some of our non-native English speaking physicians. Patient have expressed that they cannot understand what the physicians are saying and would like to have a different physician (in most cases, patients are able to obtain the desired information from another physician that same day and it does not become a lasting issue).

The posted article discusses a case in a nursing home where a patient did not want any black healthcare workers to enter her room. The nursing home complied with this wish and was sued by a black CNA who was upset that the facility complied with the patient’s request.

This is such a difficult topic as we have all seen certain patients/families have clashing personalities with staff members and the hospital cease to assign these staff members to this patient’s care. But, in that case, the staff member does not generally feel discriminated against as it is most likely a mutual feeling of not wanting to be placed together for another 12 hour shift. If the patient/family member is uncomfortable with the staff member caring for them, at what point can we decide that it’s okay to agree with their wishes. A male nurse in an L&D unit? A nurse with a thick accent taking care of an elderly patient with hearing loss? Where is that line drawn?

Approximately 5 million people in the United States have been diagnosed with heart failure, and about 300,000 people die each year from this disease (according to Medline). Heart failure is when the heart is unable to pump an adequate amount of blood to the body, often due to coronary artery disease, high blood pressure, and diabetes. Symptoms of heart failure include blood and fluid backing up into the lungs causing shortness of breath, blood and fluid backing up in the extremities causing swelling or edema, and quick onset fatigue.

The Boston Globe recently published an article titled “Gene experiment may offer hope for those with cardiac failure“. In this article, the author discusses how scientists in San Francisco have discovered that they are able to take fibroblasts, which are connective tissue cells that make up about half of the heart, and regenerate them back into working heart cells. This new ability gives them hope that they can use this as a new way to treat heart failure by repairing the damaged tissue.

“After a heart attack, the blood supply to the organ is cut off, leaving sections without the oxygen they need. Cells in the oxygen-starved areas die, form scar tissue, and no longer contract properly, impairing the heart’s pumping. Patients with this kind of damage, known as heart failure, can become exhausted by walking or climbing stairs.”

They’re hoping that clinical trials will begin in the next 5 years. I’m hopeful for any advances in heart failure as I can see the intense effect it has on peoples’ lives after their cardiac function begins to decline. Here’s to hoping for a cure.

I’m sure that you’ve seen an abundance of the hand sanitizer dispensers everywhere; hospitals, the gym, grocery stores, day care centers, etc. But, the real question is whether these actually protect you from the dangerous viruses you see all over the news (ex. H1N1/Swine Flu). Well, sure… but only if used correctly.

Getting specific:

Hand sanitizer works when the alcohol (it’s active ingredient) dissolves the cellular membrane of the bacteria, which then inactivates the cell and does not cause a resistance to be formed to the alcohol. Washing your hands works by physically removing the germs from your hands, but this is only effective if it’s done correctly.

When purchasing your hand sanitizer, check the concentration of alcohol – at least 60% is recommended to properly disable the bugs.

Directions for use:

When used correctly, hand sanitizer needs to coat the skin 100% – it can only deactivate the germs it touches. Generally a dime-sized amount of gel will cover the hands. Rub hands together until completely dry. If hands appear soiled (dirt, blood, etc), it’s time to break out the soap and water.

WebMD goes through these 5 steps for proper hand washing:

1. Wash your hands with hot running water and soap. Children should use warm running water.
2. Rub your hands together for at least 20 seconds.
3. Pay special attention to your wrists, the backs of your hands, between your fingers, and under your fingernails
4. Leave the water running while you dry your hands on a paper towel.
5. Use the paper towel as a barrier between the faucet and your clean hands when you turn off the water.

The biggest downfall of soap and water:

The steps for sanitizing are visibly easier than the steps for proper hand washing, so it makes more likely for people to use the sanitizers, which is important. If no one is washing their hands, it’s not going to do any good.  We can keep small bottles of hand sanitizer in purses, cars, etc.

My personal opinion is that we should all wash our hands with soap and water whenever possible, but especially as we’re coming out of the bathroom, cooking in the kitchen, or after finishing up an afternoon of working outdoors. But, for those times when washing our hands isn’t feasible, hand sanitizer is a great alternative to doing nothing. I keep a bottle of sanitizer in my purse at all times and use it while I’m at the grocery store, leaving a friend’s house who has kids/dogs, or after touching something that makes me nervous (yes, those things are out there… have you seen peopleofwalmart.com?)