Tuesday, November 18, 2014

Introducing "Ash Fall"

                    

                        My friend, Deborah D. Moore is the author of The Journal: Cracked Earth which found its rightful place on the best seller's list last year after only six weeks.    The Journal: Ash Fall is the second book in the trilogy which is now available as a kindle edition.

           Buy Ash Fall as a Kindle edition


                       Deborah is not only an expert in family and regional preparedness in her area of the US but she has also been on television in both the US and in Canada.   Her unraveling of the story of Moose Creek is not only very instructive from a standpoint of disaster preparedness, but is entertaining as well.

                     The e-book and printed version of Ash Fall will be available within two weeks and is probably most easily obtained through Amazon.com .





Saturday, November 15, 2014

A Piece of Perspective at "Black Friday, Indeed"

               


 
  When you have a chance, please visit one of my other blogs at:



http://learnedfromdaniel.blogspot.com/2014/11/black-friday-indeed.html


                This post concerns long term survival of self and of family in loss and in layered losses.

The Disc-O-Bed Cam-O-Cot

                


This is the Disc o bed Cam O Cot shown with organizers attached.




  I have promised that from time to time when I see a product that I think could be helpful to some of you, to call your attention to it.  As always, other than my very own books, I have no financial interests whatsoever in the products which I mention here.   Make sure you do your own due diligence. Ask good questions and see that you understand everything about any product you see here before investing your hard earned ever shrinking dollars on them.

      If you have a home sized even slightly larger than you need for daily needs, or if you have a dry basement, you could be called upon to be an emergency shelter for relatives or close friends.  Even a simple snowstorm on Thanksgiving could cause you to need to provide emergency dwelling for friends or family. I keep a number of sleeping bags, but many people can't sleep on them, or on a concrete floor, as would often be in most basements.  The Disc O bed Cam O Cot comes in easily stored bags.  It assembles fairly easily, or you could assemble them and leave them up if you have the space.  You can configure them, as above, as bunks, or you can configure them as separate beds.  These are particularly helpful for your own cabins too should you plan to use those in emergencies and lack the space or money for genuine beds.  These beds can be ordered either in 28 inch or 35 inch wide sizes.


These are the largest beds unassembled in their storage bags.

This is inside one of those bags.  These are easily transported.
                 

  These beds are used by the US military and are especially helpful in tough-to-bunk places.  The organizers as seen in the picture at the top of the page come with the package.  Each bed can be converted to a bench should you need a bench with a back later the next day.  No tools are required for the assembly of these bunks.

       Please let me know how you like them.



One Source of these beds starting at $299.95 per set

Cabela's Page for this Product







Friday, November 7, 2014

The Onus is On the Republicans

                     
( Rendering: fabiusmaximus.com  )



                   So, it seems that the discontent which is so pervasive with regard to the Obama Regime manifest itself yesterday by the loss of a number of Congressional and Senate seats.  People are tired of knowing lots of people who have been out of work for years.  They are tired of their adult kids looking for jobs all week, and remaining in their home for another year.  They are unhappy with a thousand dollar a month rise in their health insurance deduction from their salaries (as was the case this month for us.)  The Republicans control more than they did and I wish I believed that this was a wholly good thing. Already, the new Speaker of the House has said he doesn't know how practical it will be to repeal Obamacare.


                          When I vote, I generally vote for the individual I believe is best suited for the job, and whose ideas best approximate my own.  I am an issue driven voter, which increasingly seems to be unusual.   In much of the past, I have voted Republican, particularly during the presidential elections.  However, I must also say that I have friends who are politicians who consider themselves to be Democrats and although we might agree on some things, we often don't agree on how we might get there.   I have never voted Libertarian although more and more, I find myself agreeing with some of the things they are saying also.  I believe in federal government only for the things which are essential for them.  They need to consider national defense, national security, securing borders etc.  They do not need to be tinkering with education or health care.  States do a marvelous job of addressing the issues in their location. What is right for Texas or Louisiana might not be needed in Rhode Island, New Jersey or Alaska.  Let's let the states manage their own issues starting with education, and environmental issues.  Why are we paying for redundant agencies ?  Why does every federal agency have its very own SWAT team ?   Why does the CDC have one ?    Is the US Postal Service getting one next ?  Are they going to break down the doors of those who are late on postage due fees or post  box fees ?


                         The point is that America has spoken. They are not embracing Mr. Obama's grand transformation of America.  It hasn't worked and we are awakening to a much higher national deficit than we had prior to his presidency coupled with infringements or the dilution of many, many of our rights, often by weekend or holiday executive order.   The Republicans have a narrow window in which to begin repealing the madness gently and deliberately.   If they do not, then the infringements of our rights continue as does the economic death spiral of our nation.



                    So, please excuse that I am not dancing for joy that a party which in theory should oppose everything Barack Obama stands for now has more control.  Their election will be meaningless if they cannot grow a spine sufficient to make hard decisions which repeal tinkerings the Obama regime made which are strangling the economic machine of our once great nation.




Saturday, October 25, 2014

Ebola ? Worry About This Instead




                 As regular readers know, my daughter has been a juvenile diabetic since age 9. (Which was 1993)    No, she is not overweight. She will never outgrow this, and losing weight or any such life change or magic will never impact the fact that she will never make insulin herself again.  She does not have Type II diabetes, the current scourge of the United States, she has the rarer autoimmune variety which afflicts about 10% of diabetics, and is actually a different illness than the Diabetes Mellitus Type II which is so common now.        How did she get it ?    We do not know how all cases of Type I autoimmune diabetes mellitus start, but we do know this information, in her particular case.

                   When my daughter was 9, my father-in-law caught a virus in his office.  (He was in his fifties and worked as a engineer in a large office in the city.)   Within several days he became ill enough to be hospitalized with pneumonia, cardiac arrhythmia, and  generally was miserable with a flu-like illness.   The doctors thought he would be released by Monday, but he thought he was dying.  It turned out,  he was correct.  Despite being in a cardiac monitored intensive care stepdown unit,, he coded and died as the physician in charge was actually watching the monitor, and could therefore start attempts at resuscitation immediately.  Since this was an unexpected death, the hospital paid for a full autopsy and the results were surprising.   The causative organism to his flu was Coxsackie B4, which among other things, can invade the heart's conduction system and cause death, just as it did in this case.   We were all in shock as we made funeral arrangements, and many of the people where he worked came to the funeral although I noted many of them were sick or recovering from a viral illness also.   None of our physicians indicated that there may be implications for our family, and no one asked us about the health of the rest of our family or our kids.  They had the sniffles, but nothing more.

                 During the viewing, a room was set up in another part of the funeral home for the family and especially the kids. There was a television  and food was set up there.   In a very brief period of time, our daughter who had the sniffles downed quite a bit of soda,  and ate quite a bit.   Each time we checked on her, she seemed to be in the bathroom a great deal. This was quite uncharacteristic for her.and so I called the pediatrician to report rapid onset   polydipsia, polyuria and polyphagia,** all things that indicated that new onset Type I Diabetes Mellitus needed to be ruled out.  The pediatrician thought this was a grief reaction and tried to discourage our coming in.  When I called later to report a flushed face with a fever, she agreed to "let us be reassured" by the pediatric endocrinologist.  The endocrinologist thought she looked great and took blood for thyroid testing, but declined to get even a blood sugar. He proclaimed that she was simply in a growth spurt.  I was not okay with this. I wanted diabetes ruled out even though no one in my family had ever had it   So, on the way back from the endocrinologists office, I bought an inexpensive screening test kit at the CVS Pharmacy for glucose and sugar in urine. We didn't have to wait long on our return home to check it.  It was highly positive for glucose and ketones.  I took the time to explain to my daughter that there was no other reason this could be true that I knew of, other than a new case of juvenile diabetes.  I also told her that blood glucose monitoring devices and that teeny insulin syringes and improvements in technology have made this a much easier disease to control than it was even a few years prior.  I also told her that between the two of us, we could control it, and that after a brief hospitalization, she would give all her own insulin.  She accepted this, and while she went to pack and get her teddy bear, I called the endocrinologist and the pediatrician to arrange the inpatient emergency hospitalization.

                 The endocrinologist was flabbergasted that a parent who called his attention to something was actually correct.  "I should have listened to you, because you are a nurse !"  he said.  " That's not why you should have listened to me", I said.   When any parent tells you that something is really wrong with their child, then you should listen, because the parent is the expert historian on their child."    When my daughter was admitted to the hospital with a glucose level of 547,  (70-120 being the desirable range.)   we were told that she likely escaped death in her sleep because we had acted so quickly.   When I brought up whether this could have anything to do with the virus that had killed my father-in-law just a few days before, initially I was pooh-poohed.   My daughter's fever made it harder for them to brush me off.    Eventually the labs were done which indicated that my daughter too, had Coxsackie B4, and that it had likely activated the autoimmune chain of events which wiped out her ability to make insulin on the beta cell level.     I did not know of Coxsackie B4 virus at the time, but I learned that it can both invade the conduction systems of hearts and cause lethal arrhythmias, or it can cause a cascading effect which can cause the patient to attack and destroy their own beta cells, the functional unit in the Islets of Langerhans in the pancreas.  Both my father-in-law and my daughter were severely impacted by the same virus !  The link between viral exposure and Type I diabetes has been known for 40 years, yet is seldom discussed, even by nurses or physicians.

              This leads me to my concern in the present day.   While many are obsessing about Ebola, they are ignoring Enterovirus, which is much more common and much more easily transmissible.  A large nationwide study in Taiwan, published recently, indicates that children with enterovirus have a whopping 48% increased likelihood of developing Type I (autoimmune, juvenile) diabetes mellitus !    This is the first such study of its kind and the implications to the world are staggering.  No antiviral strategies are yet effective against it.   The article postulates that perhaps we can develop a vaccine for Enterovirus to try to head off some of these cases of Type I diabetes mellitus that will be heading down the pike. We are already seeing an increase in the incidence of the Type I variety of diabetes mellitus.   Learning to control this chronic illness is time consuming, expensive, and it can be life limiting. Not all of the children who develop it, survive. This needs to be a major focus of public health.


    So, think a bit about taking your baby or young child out to crowded places.   The old strategy of masks on visitors to babies, and frequent handwashing is a good one.  Perhaps a smaller daycare is a better idea than a large one.Perhaps having someone who does good daycare for only two children in her home has merit. Perhaps you are one of the lucky ones who can sidestep all the germs and viruses in daycare altogether.  Can you or your wife work from home ? Can one of you stay home with your young child ?

             Before you bet the farm on bugging out due to Ebola, please realize that there are far more common and more likely infections out there, which can be physically and financially devastating, and can change your child's life and your own forever.

                As for my daughter, it was hard work for us all controlling her blood sugars, even with the insulin pump she eventually received.   She grew up, went to college, graduated with honors,  drives a car, and has a life partner and a new home.  She has survived the birth and  the first month of her own new baby's life.   She realizes how layered viral exposures can adversely impact her child's life and is taking steps to limit those exposures.  I don't think my daughter will be taking her baby to the Coliseum to watch Sesame Street on Ice, as I did when the kids were toddlers.   She uses a pediatrician where sick children are segregated from those who are ill as they all wait.   Please think about doing the same. We need to do more to keep our children from layered viral infections.


**  Polydipsia means drinking liquids a great deal, polyuria means urinating frequently and in larger amounts, and polyphagia means eating a great deal.  These are earmarks of new onset diabetes, especially Type I.


More information:


http://www.healthline.com/health-news/could-enteroviruses-be-behind-type-1-diabetes-rising-rates-102214

http://www.medscape.com/viewarticle/833474?nlid=68107_3042&src=wnl_edit_medp_diab&uac=49270BG&spon=22



Friday, October 24, 2014

A Tribute to Gerald Frantz


Gerald and Jane Frantz       Photo courtesy of John Wesley Smith


                             
I have been away from the computer for several weeks as I have stayed with my daughter helping her with her new baby, her juvenile diabetes, shopping, and care of her animals.  I am home long enough to take care of my horses and other animals and then I flit back again until she is better able to manage.  There is progress, but she needs rest and routine sufficient to control her blood sugars during a time of hormonal turmoil. I will also be starting my new job teaching college again soon.

       Yesterday afternoon, while I scrubbed out horse water buckets, mucked stalls, and measured out their grain, Gerald passed from this Earth to the next life.   I had the incredible good fortune to have phoned him two days ago, and we had a very lengthy conversation, which I will always cherish.

         Some years ago, I became acquainted with Gerald when he appeared on a friend's blogroll.   He penned a blog called "The Last Robin" which were both musings of his life, and observations.   He was clearly an incredibly gifted writer, and quite a Biblical scholar, and teacher.   His eloquent writings however, were not the reason we became friends.  He periodically commented here on this blog, and was a good friend to me, and I know to others as well.   Who was Gerald Frantz ?     To most observers he might have appeared as a widowed older man who spent the last couple of years in a nursing home while writing a poignant blog.   However, I don't think that's who he was.   I think Gerald was a true creature of light.   Most of us come to Earth in infancy as a creature of light who is all at once encased in a small human flesh suit.   Our knowledge of light and all that we know becomes deflected by the complexities of maintaining that suit.  We must eat, then we must endure other functions, and then we must sleep. As we move through life and we grow, we learn to manage sleeping and eating, but by then, the trappings of the world have seduced us.  In youth, our friends, our schools, our families all take us farther from being the creatures of light we were meant to be.  Our worlds give way to anxieties and for thoughts of perhaps not being good enough to stand beside the other "flesh suits".  Then as we venture into adulthood, where there may be losses and events we perceive as failures, we may fall farther and farther from the people we were meant to be on our journey, which is egregiously short.     Gerald did not let a stroke, the loss of his beloved wife, or his leukemia interfere with his being a creature of light.   He had an uncanny memory for the things you had told him.  Even though he recalled scripture better than almost anyone I've known, this did not motivate him to be judgmental.   He was wholly supportive.  He was also bright enough to follow what you were saying and anticipate the extension of what you were saying, along with its implications.

         He chose not to fight his leukemia, but to go home when the time came.  This always leaves nurses in a difficult position.  On the one hand, we must honor the wishes of human beings and be supportive, and on the other, we must wonder whether we have done a good enough job of explaining how far cancer treatments and treatments for leukemia have come, in order that each patient can make the most informed decision for themselves.   I remember Gerald telling me about one of his physicians who some time ago visited him and spent a great deal of time explaining the treatment options for Gerald's cancer.  Gerald listened and no doubt left an indelible print on the doctor.  When Gerald eloquently explained why he was choosing to take the natural course with regard to the illness, the doctor hugged him, no doubt impacted by Gerald's eloquence, bravery, and most of all, his golden faith.

         Gerald believed different things about Heaven than I do, and yet he never corrected my perceptions.  He knew that I am a child on a journey, and also that I might need to believe what I do, in order to make sense of what happened when I lost my youngest son at 12. Perhaps he thought there is still some time for me to grow and learn more.

          Gerald passed at 5:25pm Central Time yesterday, and did not wish a funeral. Today he was buried  with the least amount of fuss, as was consistent with his wishes.

         Should you wish to memorialize this wonderful man, you may consider a gift to his last stop while on Earth, which was:

        Hospice Compassus, 3050 I-70 Drive SE, Columbia, MO 65201.

He conveyed what a wonderful job they did for him, especially with regard to controlling his pain with sufficient skill to allow him to still be clear enough to continue to communicate via phone with his many friends.  I will always be most grateful for the conversation we had, just two days ago.
 
         My favorite recollection of Gerald's was the story of the "Library Cat".  It so epitomized his personality and generous spirit, and it also reminded me of something my own father might have done.


          I will remember this remarkable man and creature of light for many things, for the funny anecdotes, for the sad ones, and for a golden faith.  Gerald believed that those who accepted God would meet again but only upon the resurrection.    Once again, I need to be comforted by knowing that today, he will see God and his beloved bride Janie.  In the time which follows I imagine, or perhaps I hope that my beloved father and my son can meet with Gerald and share stellar conversations.  It comforts me to think this.

If you wish to read some of the writings of a creature of light, then these are links to specific posts:


http://thelastrobin.blogspot.com/2012/12/the-library-cat.html

http://thelastrobin.blogspot.com/2012/12/who-do-you-work-for.html

http://thelastrobin.blogspot.com/2014/10/degrees-instead-of-knowledge.html

http://thelastrobin.blogspot.com/2014/10/will-you-please-shine-light-over-here-i.html

http://thelastrobin.blogspot.com/2009/12/no-more-death.html



The entire anthology of this great man can be found at:

http://thelastrobin.blogspot.com


Godspeed, Gerald

Saturday, October 18, 2014

Interesting Updates in US Hospital Managed Childbearing

          




        My last child was born eighteen years ago in an excellent hospital in Richmond, Virginia.   Just recently, I attended my daughter during her labor, her delivery  and in her week of hospitalization afterward, in a major university medical center.  Both of our pregnancies and labor and deliveries were high risk, but for very different reasons. The evolution as to how childbearing women are managed since then has been quite interesting.

                 Often in medicine, something that is done as custom, completely reverses in a few years in response to the latest and greatest new study on the subject.  Sometimes, change is for very good reason, and sometimes, well, not so much.  Sometimes, the studies which change the tides of practice are not that large, and perhaps should not be taken quite as seriously.   Often I think that rather than embracing the other side of the pendulum's swing that we should simply approach childbirth, child rearing and general medical care using a more flexible mindset in the beginning. Each patient, each family, and each baby is an individual, and one size fits all, is rarely a healthy medical treatment strategy.

                   In 1996, only those families who had attended the full Prepared Childbirth classes (often Lamaze styled training given in hospitals by specially certified nurses) were permitted in the delivery room.  This helped to ensure that the participants knew where to stand and when to stay out of the way in an emergency. It also meant that they understood enough about the process to accept an emergency cesarean section if rapidly necessary.    In 2014, this was not even a point of inquiry.  Whomever the woman wished to have with her in the delivery room was just fine.  In 1996, the hospital also provided scrubs to the individual who would remain in the delivery room with the laboring woman.  This time, there were no scrubs offered.

                    In 1996, there was a paper medical record and everyone caring for us knew the prior medical history and the plan of care.  In 2014, there was a wholly electronic medical record. However, it would only update periodically (leaving prior medical history out, upon admission, until the software update occurred) and as a result, my daughter was in labor several days without a number of members of the team knowing her entire medical history.   Since only one screen of data is available at a time, many health care workers are unaware of the entire picture, and know only the snippet they need for each task.  In a complex case, this can be a problem.  The function or dysfunction of the electronic medical record resulted in a Type I diabetic who requires insulin on a real time continuous basis, to experience seven hours after labor and delivery without any form of insulin whatsoever, when she was assumed to be a "gestational diabetic" who might not require continuous insulin reordered immediately. (Go ahead, and tell me again how much safer we are with an electronic medical record !)

                    In 1996,  I saw a regular obstetrician, a high risk obstetrician for my thyroid issues, and an endocrinologist.  These were on different days and in different locations in the same city. Non-stress tests, labwork, other tests were done in different locations. It was hard work getting a pregnant and hypertensive woman (me) to all those appointments safely, and I was driving and had small children with me for most of the appointments.    In 2014, high risk pregnancies came to one hospital location where my daughter saw an obstetrician, a high risk obstetrician, an endocrinologist, the lab for labwork, an ultrasonographer and a technician for a non-stress test in about the same location, and  often on the same day.  This meant that she did not become exhausted simply in the course of getting intensive medical care during pregnancy.  The prenatal high risk health care system was a vast improvement over the experience in 1996.

                   In 1996, in labor, we were allowed nothing to eat or drink for the duration of labor, except for a few lemon barley lollipops which our prepared childbirth classes told us to buy and bring to the hospital.  This was done because digestion of food does not occur during labor anyway, and anesthesiologists in particular, if they must attend a patient having an emergency cesarean section, prefer to be working on a patient who has an empty stomach and cannot aspirate stomach contents while under a general anesthesia.      In 2014,  my daughter was allowed to have clear fluids through the course of her labor, even if she were vomiting. This is done now to keep the woman comfortable and aid in hydration. It also permitted her labor to go on longer and was part of how she was able to endure such a long trip and avoid a cesarean section.

                    In 1996, most women still received an episiotomy.  Toward the end of labor, the obstetrician cuts an incision on the posterior vaginal wall at a 90 degree angle with scissors, thus widening the opening and preventing potential deep vaginal tissue tears during delivery. (These are quickly sutured closed after delivery and the straight clean incision usually heals quite quickly.)  Although this is still practiced as a method of preventing serious tearing in a great deal of the world, it is no longer routinely practiced in the US.   Now, a first degree vaginal laceration itself,  which occurs during childbirth is stitched up afterward.   I had several episiotomies which healed quite quickly.  I am noting, that my daughter is still quite uncomfortable without one, three weeks past delivery.
    
                    In 1996, the nursery filled with lots of babies, where families could visit and compare still existed.    Since I was breastfeeding, my baby was brought to me fairly frequently after delivery, and then he returned to the newborn nursery with nurses in attendance.  As I recovered, he spent more time with me in the room, and less in the newborn nursery.  I remember being a few doors from the elevator and in my slight post partum anxiety, I was afraid to go to sleep with the baby in the room.  I feared someone coming up the elevator and taking the baby while I slept.     In 2014, my daughter was moved from labor and delivery where she also completed her recovery to a Mother Baby Unit.    Both she and her baby remained in the room 24/7 to facilitate breast feeding.   The Mother Baby Unit is high security and is a locked unit, a bit like a modern day psychiatric unit.  Family members with a pass must be buzzed in each time they wish to enter.  To prevent babies being kidnapped, each baby is not only double labelled, but is fitted with an RFID tag.   The baby remains in the room with the mother and cannot ambulate outside her room with her, as I so often did, in 1996.   The RFID tag causes a loud alarm to go off in the unit anytime a baby leaves the desired area, and there are sensors throughout the unit and on the elevators outside.

                   In 1996, the emphasis was on having new mothers ambulate as much as possible on the hallways of the post partum unit to avoid blood clots, to hasten recovery and in order to get to the small kitchen on the unit to get tea or milk.   (Probably also a way of helping to transition a woman going home from the hospital who will take on the tasks of caring for other children as well as her new baby, on arriving at home.)   In 2014,  my daughter was discouraged from leaving her room or interacting with any other patients.  There was no on unit kitchen, and she had difficulty getting hot tea when she wanted it, which she actually needed for diuresis. In addition, being confined to the room meant that when she was discharged after a week, she required an evaluation for deep vein thrombosis and pulmonary embolism. (medical speak for blood clot which can travel to the lung and potentially cause death)

                  In 1996, if you were discharged and your baby needed to stay, then you were thrown to the wolves sitting in a rocking chair until your baby was discharged, and this was not helpful to milk production.  In 2014, my daughter was discharged a day ahead of her son, but she was allowed to remain in their room as a "boarder" with him with her own bed, breastpump, and meals provided, as it is now understood that this is best for both of them.  This new strategy was very much appreciated.

                 In 1996, there were no specific directions about positioning newborns (other than avoiding suffocation with blankets, softtoys or crib bumpers) but now, the American Academy of Pediatrics is very clear that studies indicate that a baby should be put down on his back to avoid SIDS.   I am not sure what they do with newborns who turn their heads or bodies to the side after you place them on their backs.

               The last and most interesting difference is the stance on breast feeding.  In 1996, I was a curiosity. I was a nurse who had chosen to breast feed, and I was indulged as this was considered "quaint".   How could a working woman keep up with breast feeding ?  Why, it's so difficult !!    Now, the pendulum has swung and the attitudes are quite different.  Now, there is a "take no prisoners" attitude toward breast feeding.  The Obama administration now requires health insurers to pay for at least some types of breast pumps via insurance.  There are no more formula samples given to families.  There are no pacifiers permitted.  Babies are to be breast feeding !   Even mothers who endure daily visits by 74 medical students, interns, residents, fellows, attendings, attending physicians undertaking studies of childbearing women etc.,  and a bevy of registered nurse lactation consultants are to be either breast feeding their baby, or using the rolling breast pump.  No one seemed to know though, that Type I diabetics, or those with hypothyroidism or other endocrine issues tend to get a lactation response a bit later than other women, and so my daughter was guilted by some of those on the pediatric service.    I am actually a proponent of breast feeding, but again, a forced inflexible response to any situation generally does not work well for most patients.

              In conclusion, some of the approaches and procedures in 2014 at a major world class medical center were far better than those in 1996.  However, some were not.  In future, I think my daughter will chose to be a "non-teaching patient" and will sidestep all the extra physicians.   Consistency can be a wonderful thing.