Panduan Kesehatan Tubuh

1.7.08

"So? Which One Do I Use Doctor? Heat or Ice?

Heat has long been used to provide temporary relief of arthritis pain, and is used in many different forms. Contrast baths, whirlpools, electric pads, microwaveable gel packs, hydrocollator packs, infrared lamps, and hot showers are some of the different techniques used. Even warm tap water probably will meet some of your needs for heat therapy at home.

Heat can provide temporary relief of pain and stiffness, and can prepare you for physical activity or exercise. For example, morning stiffness is a common problem for many people with rheumatoid arthritis. Because your body has been still during the night you may need special help to get going in the morning. The following combination of techniques using heat can reduce the length and the severity of morning stiffness:


1. Sleep in a sleeping bag (which helps retain body heat) or with an electric blanket (following the manufacturer's instructions).


2. Take your aspirin or other anti-inflammatory medication an hour before you get out of bed in the morning. (Keep a few crackers at your bedside to take with the medication to avoid stomach irritation.)


3. Take a warm shower or bath immediately after you get up.


4. Then do limbering-up exercises after your shower or bath while you still feel warm.


Safety is important in choosing the form of heat you use. You should take great care to avoid burns or electric shocks. Heat must be used with much caution on any area of the body with poor circulation or where you cannot feel heat or cold normally. It should not be used over areas where your skin is fragile or broken.

Only mild heat is necessary to get results. You are aiming for a temperature just slightly above body temperature, and you do not have to apply heat for a long time. You will get full benefit by using heat for 20 minutes each time.

Moist heat is any technique in which water is used to conduct the heat, such as a bath or shower or hydrocollator packs. People with arthritis prefer moist rather than dry heat, such as a heating pad. Moist heat penetrates more deeply than dry. You will have to try both and see which is more effective and convenient for you.

Heating pads are available which provide either moist or dry heat, but they should be chosen and used with care. Make sure the pad is approved by the Underwriter's Laboratory. Look for those which have temperature control switches; those without temperature settings get hotter and hotter until you switch them off.

When using a pad, never lie on top of it and make sure you do not fall asleep while it is on. Severe burns can result! It may be wise to use a timer during the treatment. Check the instructions on use carefully. Regularly inspect the pad for any cracks in the plastic cover.

Hydrocollator packs are canvas bags containing silicone gel which retain heat for a long time. You can buy them in different shapes at pharmacies. Some people like them because they lose heat more slowly than most wet compresses. The pack is heated in water, wrapped in 8 to 10 layers of heavy toweling and placed over the painful joint.

The pack is heated in a large pot of water and placed on heavy towels. Place the surface with the thickest layer of toweling over the part to be treated.

Keep in mind that hydrocollator packs do have drawbacks. They are not practical if heat is needed for several joints, because each pack can be used for only one part at a time. They are also cumbersome to use and may be too heavy placed over a painful joint. If your hands are affected by your arthritis, it may be difficult for you to remove the heavy pack from the water with the tongs. So you may need help. Again, you must be very careful about burns. If you decide to try such a pack, follow the manufacturer's instructions carefully.

Microwaveable gel packs are popular. Follow the instructions carefully or else the bag containing the gel may leak? or even worse explode and cause serious burns!

Physical therapists sometimes use melted paraffin as a means of applying heat, particularly to the hands. There are units available for home use as well. Because they involve high temperatures, paraffin baths should be used with caution. Patients with osteoarthritis or rheumatoid arthritis involving the hands often find paraffin to be helpful.

You can buy nylon and spandex gloves which can reduce morning stiffness of the hands for some people when worn at night. The gloves are available in both men's and women's sizes.

It is important to wear adequate, warm clothing in cold weather. Some people find that knitted, woolen or fleece pullover cuffs on painful joints, especially the knees, ankles and elbows are helpful in keeping the joints warm and more comfortable in cold weather.

Some people with arthritis find that heat does not help them. In fact, the reverse is often best-cold compresses. Cold may be especially effective when active inflammation produces severe pain and joint swelling. Only trying different modalities will enable you to find out which is best for you.

It is easy to make a cold pack by filling a small plastic bag with a few ice cubes. A bag of frozen vegetables wrapped in a towel can be used. Place any cold pack over the painful joint with a layer of terry cloth toweling in between. The same precautions that apply to the use of heat should be observed when using cold. The maximum benefit is achieved in less than 20 minutes. You may wish to repeat this application several times a day.

For many people with arthritis an effective approach is alternating warm and cold water applications, a process called contrast baths. It is most useful for a hand or foot which can be dipped in a large pot filled with water. If you decide to give it a try, use a thermometer to check temperatures.

1. Fill one container 2/3 full with 110 degree F water.
2. Fill a second container 2/3 full with 65 degree F water.
3. Put your hands or feet completely into the warm water for three minutes; then put them into the cold water for one minute.
4. Repeat step #3 two more times.
5. End the treatment with three more minutes in the warm water; then carefully dry the hands or feet.


Finally?and very importantly? with acute musculoskeletal pain, and particularly with injuries, always use ice. The formula to remember is RICE...
Rest
Ice
Compression
Elevation

By Dr. Wei


22 Inside Tips on How You Can Make Your Arthritis Medicines Work Twice as Effectively in Half the..

This report will give you 22 important tips to make sure that you're getting the very best out of your arthritis treatment program.


1. Make absolutely sure that the nurse or doctor knows what allergies you have. Also, make sure that they know what other medicines you're taking and ask specifically about drug interactions and side effects.


2. Ask how the arthritis medicine should be taken. Sometimes arthritis medicines are taken best on an empty stomach and sometimes they're taken best on a full stomach. Also ask what time of day is best to take the medication. Some arthritis medicines should be taken in the morning and some should be taken in the evening.


3. If you have other medical illnesses, let the doctor or nurse know about that. If you have a previous history of ulcers, they should be informed.


4. Ask whether there is literature such as an Arthritis Foundation pamphlet available on the kind of medicine that you're going to be receiving. If not, ask if there are any other printed handouts. At the very least, the nurse should go over the medication with you.


5. Ask if the medicine comes as a generic. If it does not, at the very least, ask for a two-week supply of free samples.


6. If you have a common arthritic condition, ask whether any arthritis clinical trials are available in the area. This is a great way to get free medical care for your arthritis along with free medication for your arthritis.


7. Ask about other types of therapies that can be used along with the medicine. For instance, ice or heat to a painful area for 15-20 minutes two or three times a day can be quite effective.


8. Sometimes moist heat also can be effective. Ask your nurse or doctor which is better for you, ice or moist heat. If you're going to use moist heat, make sure it is moist heat rather than dry heat.


9. Sometimes assistive devices such as braces, splints, neck support pillows, canes, etc. may help your medicine work more effectively. Ask whether that's the case.


10. If no specific handouts or pamphlets are available from your doctor, ask whether you can have a photocopy of the pages from the Physician's Desk Reference made available to you. This is difficult to get through because of the vocabulary used, but contains a lot of important information that you may want to know.


11. Remember to ask about how the medicine should be monitored. Most arthritis medicines need to be monitored fairly frequently because of side effects. This is especially true in people over the age of 60.


12. Sometimes, as your arthritis gets better, it's possible to cut back on the amount of medicine you take. Ask about that.


13. Ask whether physical therapy modalities might be helpful in your case.


14. Make sure you let your nurse or doctor know whether you're taking any natural or vitamin supplements. These sometimes can interfere with the effectiveness of your arthritis medication.


15. If you see an article in a magazine about your medication, bring it into your nurse or doctor. Sometimes these articles contain good information. However, sometimes these articles contain misleading, or even worse, wrong information.


16. Ask about generic drugs. Sometimes generic drugs, while cheaper than brand name drugs, may not be as effective. Sometimes though, they can be just as effective. You need to ask.


17. Make sure that you periodically ask your nurse or doctor whether there are any new drugs available for your condition. Sometimes the new drugs are more effective, safer, and more convenient.


18. If, after you start taking your medicine, you notice anything that could be a side effect, call your physician immediately.


19. Ask if there are any Internet web sites that provide good information about the medication that you are taking.


20. Do not share medications with friends or relatives. Remember the medication that has been given to you is specific for your problem. To share your medication with another person can be extremely dangerous. Likewise, if you borrow some of your relatives or neighbors medication, you may run into a terrible problem.


21. If you smoke or drink alcohol, ask about potential problems with your arthritis medicines.


22. Make sure you get the proper monitoring. Many arthritis medicines need careful evaluation of blood And urine on a regular basis.

By Dr. Wei


"Foot Pain Relief At Last!"

"As an arthritis specialist, one area that I see people complain about more often than almost any other, is their feet." So says Dr. Nathan Wei, Clinical Director of The Arthritis and Osteoporosis Center of Maryland. "This is too bad because there are many treatments that can be helpful," Dr. Wei adds.

The foot is made up of 26 bones and 39 muscles...
The foot and ankle are designed to bear weight. The multiple joints in the feet are capable of adjusting to almost any terrain and the padding in the feet are designed to absorb shock.. The ankle joint allows the foot to move up and down, side to side, and inward and outward (inversion and eversion).

Not All Foot Pain Comes From The Foot!
Careful examination of the low back, hip, and knee should be performed because pain from these areas may affect the foot and ankle. In particular, pinched nerves in the low back can cause foot pain and weakness.

Ankle sprains are common- 25,000 people sprain an ankle every day! The goal of treatment is to relieve pain and prevent instability. Treatment of an acute sprain consists of rest, ice compression and elevation ("RICE"). Exercises to help stabilize and strengthen the ankle should be started.

Arthritis of the ankle may cause recurrent pain and swelling. Pain from arthritis typically is made worse by weight-bearing particularly on uneven ground. What this means is you should try to avoid excessive walking or running on uneven ground. Anti-inflammatory medication and proper foot support can do wonders.

Pain in the ball of the foot has many causes...



Foot strain occurs when a person "overdoes it." And the treatment is pretty straightforward. Rest.

Morton's neuroma (a benign nerve tumor usually located between the 3rd and 4th toes)

Tarsal tunnel syndrome (pinched nerve in the ankle)

Arthritis.



Other common causes of foot pain include:



Stress fractures may occur after excessive walking.

Achilles tendonitis causes pain in the back of the heel. Treatment consists of anti-inflammatory medicines, rest, a heel lift, and gentle stretching.

Plantar fasciitis causes pain in the bottom of the heel. Treatment includes rest, anti-inflammatory medication, heel cup, orthotics, stretching, and local steroid injection.

Flat foot.



Muscle strengthening exercises and orthotics are helpful. Two other common problems are:

Osteoarthritis, particularly common in the big toe. The big toe will point out to the side. When bursitis alongside the great toe joint develops, this condition is referred to as a bunion. Treatment involves proper padding and footwear. In extreme cases, surgery is required.

Neuropathy. This painful condition is particularly common in diabetics. This occurs when the small nerves in the feet are damaged. Symptoms include burning, tingling, and pain in the feet - worse at night.



Well fitted orthotics (arch supports) can alleviate not only foot and ankle pain but pain in the knees, hips, low back, and neck!!

We often take the ability to walk for granted. This ability involves the use of two engineering marvels- our feet and ankles. Because of the tremendous amount of force transmitted to the feet with walking, unique problems may develop. Attention to proper preventative care, i.e., comfortable shoes, sox, hygiene, support, along with proper prompt medical care can really put the brakes on foot pain.

By Dr. Wei


What You Should Know About Mixing Medications and Diet...

I had a call the other day from a potential client in a serious situation. He was young and had been diagnosed with CAD (Coronary Artery Disease), suffering from extremely high blood pressure and cholesterol, his doctor had put him on a medication that was suppose to lower and control these symptoms, and he had been on this medication for over 2 years.

During this time, this 24 year old man had developed a blockage in his hand that had become inflamed and eventually ruptured, causing the possibility of amputation. The situation was brought under control using anti-inflammatory means, but he remained on his cholesterol medication without adjustment even after this incident. About 6 months later, this young man was suffering from another blockage, but this time, it was in a critical area that couldn't be treated without specialization and the local doctors did not have the experience to treat him. These doctors told him that there was no one in the 4 state area that could serve him, he was desperate and afraid, and turned to me for help.

When he first called, I asked him some questions to help me understand his situation.

How old are you? (25)

Do you suffer from High blood pressure or high cholesterol? (yes)

Does your family have a history of high blood pressure, high cholesterol, heart disease, diabetes or insulin resistance? (yes)

Does you family have a history of bowel problems, colon cancer or colon polyps? (yes, my twin brother)

What is your Ethnic Origin? (English)

Are you physically active? (yes, when I can be)

Has your doctor put you on any medication (yes, and he named it)

At the time that you were put on this medication, did your doctor recommend a glycemic, low fat, low sodium diet? (no)

What kinds of foods have you been eating while on this medication? (regular foods, meat, vegetables, potatoes, you know, stuff in restaurants and stuff that is easy to fix at home)

With the condition that you currently have, do you suffer from loss of vision or blurred vision? (yes)

Are you suffering from Migraine headaches? (yes, constantly)

Are you suffering from the loss of motor skills, have difficulty walking, chewing, swallowing, lifting? (yes)

Are these symptoms constant, or do they come and go? (Constant)

Is this blockage behind your right eye? (yes)

What has your doctor recommended? (they have recommended that I be treated elsewhere, because they do not have a specialist here)

Have they recommended a place you should go or a specialist that you should see? (no, they can't even tell me what kind of doctor I should get)

My recommendations were for him to seek help immediately, within the next week.

I suggested that his doctors give him a letter of recommendation to see a Cerebral Neuro-Vascular Surgeon. He and his friends got on the Internet and found some specialists that could fit him in in the next few days. My fear was that the situation had gone on to long, and that he was in imminent danger. I told him that when he returned from his surgery, that he should call to make an appointment with me so that we could get his blood pressure and cholesterol under control, so this would not happen again.

He asked me why this had happened in the first place, he had taken his medications like they had been prescribed. I explained that when medications are used in the body, they have to not only act, but they are also acted upon.

When you use medications designed to reduce something in the body, you shouldn't add things that would cause the medications to have to compete or work harder to accomplish the goal. A cholesterol medication to control the fat in your blood, and then eat fat, or things that create fat. A diabetic medication to control blood sugar, and then eat sugar or carbs that convert to sugars. A medication used for the treatment of gout, then eat things that are high in acid or create acid. These kinds of things can make the medications ineffective, and a waste of time and money.

He said that he had been on this medication for two years, and that the cholesterol numbers had never been affected by the medication. I told him that there is a way to lower his cholesterol effectively, using a restrictive diet, exercise, and a few supplements along with his prescription, and that as soon as he returned with relative health, we would start him on his program.

For most people, when they become ill, they go to their doctors in search of a quick fix, a pill or a shot that will make things better instantly, that doesn't require any effort or discomfort on their part. The sad truth of the matter is that "possession" requires "responsibility", and "responsibility" requires "action".

By D.S. Epperson


Finally...Affordable Prescription Medication without Insurance.

If you are like many Americans, you are without health insurance. And the ranks of the uninsured are growing. According to the National Coalition on Health Care (NCHC), the number of uninsured was a record breaking 45 million in 2003. The growing number of uninsured is in large part being driven by individuals abandoning the corporate life to pursue their dreams as entrepreneurs and small business owners.

Unfortunately, this trend comes at a time when more and more medications are available to help treat the serious (and the not so serious) illnesses that many of us face today. But as you probably already know, without health insurance coverage, the prescription medications that you need are oftentimes too far out of reach; they are simply too expensive!

To make matters worse, most prescription medications cost far more in the United States than they do in other industrialized nations. These cost differences in conjunction with the fact that so many Americans do not have prescription medication coverage have spurred a national dialogue and heated debate. Despite these discussions, the needed regulatory changes have not materialized. Thus, the uninsured are left feeling that no affordable prescription coverage options exist.

Don't Give Up Hope: There Are Options!

Fortunately, however, you are not without options. In fact, it is likely that you can afford the medications that you need. How, you ask, is this possible? Well, read on!

There are two primary ways you can afford or save money on your prescription medication. They include participating in one of the many (National, State, and Pharmaceutical) assistance programs and/or purchasing your medication from pharmacies located outside of the U.S.

Assistance Programs: Save From 25% to 100%!

Most persons are not aware that there are hundreds of programs available that provide either discounted or even free prescription medications to eligible US citizens. In fact, there are over thirty different national programs, virtually every state in the U.S. offers some sort of prescription medication assistance, and there are more than 250 different assistance programs offered by the many domestic and foreign pharmaceutical companies.

As you can probably guess, navigating the many programs to find the one that best fits your needs can be difficult. Each program has different eligibility requirements, application requirements, etc. However, the work required to take advantage of the program that best fits your needs will likely pay off. If you are eligible for assistance through one these programs, you can expect to save from 25% to 100% on the cost of your prescription medication. Savings like that are hard to ignore. And luckily, there are powerful tools available to help you find the program that is best for you.

Purchasing Your Medication from Pharmacies outside the US

Assuming that you don't qualify for an assistance program, there is always the option of purchasing your medication from pharmacies located outside the US. While there are many pharmacies in many different countries that are willing to sell to US consumers, the best option is Canada. Why? The answer is twofold. First, buying from Canada is safer. The Canadian equivalent of the FDA, Health Canada, is stricter than the FDA (and other countries' regulatory agencies) in its approval of new drugs. Second, Canadian pharmacies, on average, can sell medications for far less than pharmacies in the U.S. and other countries. They can do so for the following reasons:

The Federal Patented Medicine Prices Review Board (PMPRB) regulates medications that are under patent. The PMRB dictates the maximum prices that can be charged in Canada for patented drugs.



Health insurers, such as the provincial drug benefit plans, negotiate with the major pharmaceuticals to secure more favorable pricing on the medications that they cover.



On average your $1 will buy you approximately $1.40 to $1.60 in medication from Canada.



Health Canada is much quicker to approve generic versions of patented medication. The result is generic medications, which always cost less than patented medications, are available sooner in Canada.



Although there are many Canadian pharmacies, there are only a select few that you will want to buy from. Just like in the US, there are plenty of people willing to rip you off. And where your health is concerned, you do not want to take a chance. As a result, navigating the Canadian pharmacy option can be confusing and difficult. Luckily, as with the assistance programs, there are powerful tools available to help you find the pharmacy that is best for you.

It's Simple to Start Saving

Just because you don't have health insurance doesn't mean that you can't afford the medication that you need. The many assistance programs available to US citizens combined with the viable option of buying your prescription medication from Canada present the uninsured with the ability to purchase the medication that they need. Visit Rx Savings Guide to learn more about the tools available to help you afford your prescription medication.

By Garin Clark


Integrative Medicine And Its Future

The NBC National News, quoted the Washington Post in March 2000 about the concerns that the FDA had over the mixing of supplements and conventional medications. There was concerns that millions of people are taking supplements (considered herbs, homeopathic, vitamins, minerals, amino acids, enzymes and some diet products) and having reactions when they mix these things with common and prescribed medications.

I have studied this phenomenon for over 20 years and do know for a fact that with conventional medications, these reactions are quite common. The AMA is calling for the FDA to reverse their ruling on supplements implemented in 1997.

Is this really the best approach?

Many Universities across the nation have closed their Ethno -botany and Botany labs, disallowing many with the gift in this field to aid in the search for new cures, and to determine which plants will have adverse reactions when combined with other chemicals

A good example is the treatment of Gout.

Mediations that are prescribed by traditional medicine are normally Allopurinal or Zyloprim and Colchicine (which, by the way, is a homeopathic remedy from the bulb of the Autumn Crocus) which decreases the reaction that causes uric acid in the blood. Allopurinal and Colchicine can be enhanced by a specialized diet and the elimination of some supplements that can cause an elevation of certain enzymes in the diet. Both of these drugs can also cause serious side effects and toxicity when taken in high doses and/or for a prolonged period of time.

The deficiency of certain nutrients can provoke an attack of gout, people who take antibiotics can increase the risk of an attack and a persons diet can certainly influence not only the severity of an attack, but the frequency of attacks.

There are other reactions that need to be taken into account also, and the is that Allopurinal and Colchicine has a negative effect on the liver after 6 months of use, which will make it harder for those drugs to work effectively. If you also add some supplementation, even a regular multi-vitamin into the system when the liver is already struggling to keep up with the demands of the system, this can cause an adverse reaction to the liver, in part because the liver has to work harder to absorb the micro-nutrients given in the multi-vitamin.

The balance between conventional medicine and alternative medicine is a delicate one. Right now, both schools of thought refuse to work together, and the general public is who suffers.

For some who suffered from allergies when Seldane was prescribed, this was a very concerning issue. When taking Seldane, patients were not told that taking the medication along with certain micro-nutrients could prove to be fatal, and was in a few cases across the United States.

In 1993, the New England Journal of medicine published an article in which researchers estimated that as many as 60 million people had participated in alternative medical care. A follow-up study to that one, which appeared in a 1998 issue of JAMA, estimated that the number of visits to alternative practitioners had increased more than 47 percent between 1990 and 1997 and that expenditures in 1997 for alternative medicine services exceeded 21 billion dollars.

In our small town we had a family practitioner that took care of the community needs. He was a wonderful man that always gave of his time, energy and knowledge freely. A week after he was diagnosed with Gastric Carcinoma, he called me for advice. I asked him why he would call me and ask me for help. He told me that he had watched the patients that he had diagnosed with this same disease die slow, painful and miserable death, even while they were on conventional medications. He said he knew that the traditional medications and protocols didn't work, he had diagnosed cancers, informed the patients, watched them slowly die and he wanted something else. I treated him for 9 months; the cancer did not advance in that time, it didn't go away either, but it didn't advance. I asked him to do both treatments together, traditional and integrative, but he refused. He had a friend that was a Oncologist and this friend finally convinced him to try some clinical trials at a couple of Universities. In order to do that, the family doctor had to come off all other protocols that he had been taking. They waited a few weeks for the nutrients to leave his body, then started him on a a protocol called PP6 and Thalidomide. A few days after the first treatment, he told his closest friend, "I've killed myself". Within a few weeks, he was totally incapacitated. He passed away some 5 months later, in sever pain and agony.

It's not always conventional medicine at fault....A cancer patient in N-stage was being treated by both conventional physician and naturopathic physician. Because the patient had been put on Prednisone he had become edemic. The Naturopath told the patient to come off the drug immediately, and then left town on a business trip. I got a call a few days later, the patients breathing was labored and he had fluid in his lungs. The massage therapist that called explained what had happened. I told her to call the man's medical physician immediately, the reduction of Prednisone is not suppose to be halted immediately without the patient undergoing repercussions . The patient paid the ultimate price for the bridge between alternative and conventional medicine. There is so much that can be integrated into both schools of thought and treatment. These stories are why the public is turning to other methods for treatment, most do a combination, which, as the previous story illustrates, can be detrimental to health, unless the health care giver has a knowledge of both fields and an understanding of the chemical reactions that can occur. It is always best to be responsible for your own health and treatment. No health care professional should be given total and complete control over another man's life. The need for knowledge is a necessity when deciding to integrate different methods of treatment for the health care provider involved, it could mean the difference between the life and death of a patient.

By D.S. Epperson


14.6.08

Increasing Patient Care and Reducing Liability in Seven Simple Steps

When an unconscious patient arrives in the ED, every hospital agrees that timely next of kin notification is vital. Not only is it important to have a family member present to comfort the patient, but to make informed decisions for his care and provide the medical history that can make the difference between life and death. From a liability standpoint, as we know all too well, having a family member making medical decisions, often means that if complications do arise, the family will be much less likely to sue, than if they hadn't been in attendance.

Although most hospitals make notification calls quickly, between personnel shortages and overworked staffers, that call can often be delayed or forgotten.

That's exactly what happened to Elaine Sullivan, a very active seventy-one-year-old woman, who slipped and fell, while getting into the bathtub. When paramedics arrived, they realized that injuries to her mouth and head had made her unable to communicate, or as the hospital later discovered, to give informed consent for her own care.

Although stable for the first few days, she began to slip into critical condition. On the seventh day, Elaine died. But that tragedy was soon overshadowed by another. Despite having her daughter's phone number and contact information clearly indicated on the front of her chart, the hospital failed to notify her family that she'd been hospitalized until six and a half days after her admission, only hours before she died, unnecessarily and alone.

Elaine Sullivan was my grandmother.

In her case, placing that phone call right away, would have saved her life. Not only would my mother Janet and I have had the time to fly back to Chicago to be at her bedside, but we would have made sure she received the care she needed. We also would have been able to give the physicians treating her, the medical history they needed to prevent the complications and drug interactions, responsible for her death.

After researching our own case and others like it, we realized that failing to notify a patient's next of kin wasn't an isolated problem - it's something that's been experienced by countless families nationwide. According to the CDC, nearly one million patients come into the ED every year unconscious or physically unable to give informed consent. And with the growing number of emergency room admissions and baby boomers turning into senior citizens, the problem is only going to escalate. We began meeting with medical and trauma professionals, to create an easy-to-implement solution to this growing problem, by bringing together the best practices of successful trauma teams from hospitals nationwide. The result is the Seven Steps to Successful Notification System.

The complete system is presented in The Seven Steps Information Kit, which is available for download, free of charge, on the NOKEP web site. It's filled with tools your staff can use on the patient care floor to identify and locate your unconscious patient's family or surrogate decision makers, identify John Does and improve patient care and satisfaction by locating patient's medical histories quickly and easily, while complying with HIPAA standards.

Even better, following the Seven Steps system provides the facility with a documentation of the steps taken to find the patient's next of kin, make the notification, and the staff members responsible for making it. This releases you from subsequent liability, while providing proof that your facility has met its statutory responsibility.

Here is a quick look at the Seven Steps.

Step 1: Patient status confirmed

The moment that your staff realizes that an ED patient is unconscious or physically unable to give informed consent, and that there is no family member or surrogate decision maker in attendance, a nurse or physician is tasked with following the notification process through to completion. The staff member indicates the patient's status on his chart along with the time, date and the staffer's initials.

Step 2: Examine the patient's personal effects for emergency contact numbers

If the patient doesn't have emergency contact information in his or her wallet, the staff member looks for it in the patient's personal effects. The System has a comprehensive checklist of places to locate this information, from the usual to the downright creative.

Step 3: Retrieve patient's home number

If the patient doesn't have emergency contact information, the staff member then looks for the patient's home number, going to step five if they find it and four if they do not.

Step 4: Seek other sources for contact information

Next, the staff member looks for the patient's emergency contact information or home phone number on records from previous admissions at the facility, or by calling his personal physician's office, or other locations on the checklist. If the staff member finds the information, he proceeds to step five - if not, step seven.

Step 5: Oversee or make the notification call

When a contact has been identified, the staffer places a call to make the notification. They note on the chart when the call was placed, whom they contacted, the phone number and the result.

Step 6: Need to follow up? Recall main contact or second number

If a message had to be left for the contact, or the contact doesn't come into the hospital within two hours, the staff member places one more call, to the first or a secondary contact. If no one is reached, the staff member proceeds to step seven.

Step 7: Shift to social service or police

When no contact name or number can be located, or if the staff member doing the notification, is unable to speak directly to the contact, they give the information to the social service department or to the local police department, as per your facilities' policy, for follow up.

Along with the Information Kit, the non-profit Next of Kin Education Project has created patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

Just as doctors, nurses, and staffers from every department make up a team to improve the health of the patients in their care, family and friends can play an important part in contributing to the patient's well being. As a medical professional, you are a diagnostician, a caregiver and a healer. But most of all, you are the patient's advocate. And so is his family. This Kit contains tools that will help you and his family work together to increase his care, trust and take patient satisfaction to a whole new level.

By Laura Greenwald


Stem Cell Research

How To Buy Your Way Out Of An Early Death From An Incurable Disease.

How?... With private stem cell research, of course!?Stem cell research holds more than hope for cures. The jury is in on stem cell research. Stem cell research can offer a cure for your incurable illness. With private stem cell research a personal cure for an ill patient can be accelerated. With every michroscope in the lab tuned into your unique disease a rapid cure is guaranteed. Private stem cell research for the wealthy (that will eventually lead to cures for everyone) has arrived!

So now you are all relaxed about your health's future because some countries such as Switzerland and some American states such as California are beginning to endorse stem cell research.We too are excited about this ground breaking research. Unfortunately these researchers will be working with one hand tied behind their back because these countries and California are working with restrictive legislation that forbids or impedes the cloning of human embryos. That's like giving them permission to build the fastest car in the world but with the restriction of not allowing them to put a motor in the car!

That's why the major new cures for cancer, heart disease, stroke, and other incurable diseases will ultimately come from small offshore labs working without restrictive legislation from the western world. Thank God for the sake of our health that there is a world outside the United States and the Western countries. The number one lab in the world offering excellence in medical research is Gen Cells Cures owned by Gerald Armstrong. Our motto is "Have Michroscope will travel" When a government gets in the way of our life -saving research we will pack up our michroscopes and move on.

When Alexander Grahm Bell patented his telephone in 1876 it was the difference of a half turn of a screw that put him in the patent office before Elisha Gray. With only one company in the Grand Unites States openly working on therapeutic cloning, the U.S.A is left in the dust where innovative research and future cures are concerned.The U.S. was once at the forefront of medicine and technology, research and innovation, cures and prevention. Now the job falls into the hands of the few working outside America. In many cases the work will be done by Americans. Even the Korean's who first cloned the human embryo had help from steady American hands, but the work was done in Korea by Koreans, not in America by Americans. We here at Gen Cells Cures have found that the Korean's new technique of squeezing out the DNA from the egg cell works much better than sucking out the DNA with a tiny needle. Their cloning process was a spectacular achievement.

The only American company working openly with therapeutic cloning research in the country is Advanced Cell Tech. When the cure comes it will likely come from Gen Cells Cures or some other little basement lab out in the middle of nowhere. Gen Cells Cures wants the opportunity to find cures for major incurable diseases such as cancer, heart disease, stroke, Parkinson's disease, Alzheimers disease, diabetes and other dreaded incurable diseases. The only problem with Gen Cells Cures and Advanced Cell Tech is that both of these biotechs are always running out of the money needed to do the research. Getting private funding is like pulling teeth. It's not easy work. The cure cannot come from the western world with restrictive legislation backed by ignorance and obscurantism. All that controversy over a stem cell smaller than the period at the end of this sentence. Even if stem cell research (with it's restrictive limitations) had all the funding in the world there will not be a cure found until all the research is completed and that includes the therapeutic cloning stem cell research. Through out history their have always been those people with dark age thinking who have held back scientific progress. Sadly, US President, George Bush is a victim of such limited thinking. Gen Cells Cures michroscopes already have Alexander Grahm Bell's half turn of the screw built in for success with no U.S. competition.

Non-embryonic stem cell research has produced therapies for more than forty ailments including, heart disease, lupus, spinal cord injuries, multiple sclerosis, Parkinson's disease, diabetes, Crohn's disease, brain hemorrhage, brain tumors, retinoblastoma, ovian cancer, sarcomas, scleroderma, multiple myeloma, leukemia, renal cell carcinoma, breast cancer and others. There have been no therapies from embryonic stem cell research so far simply because researchers have been using generic stem cells and there has not been one penny of public or private research money available for the real solution, therapeutic cloning stem cell research. While adult stem cell research received 190 million dollars from the U.S federal government in 2003. Therapeutic cloning stem cell research received zero dollars in funding support in 2003! What can you expect with zero dollars allotted to this life-saving research. Why hasn't there been a cure from therapeutic cloning stem cell research so far? The answer is plain and simple, fear and ignorance has restricted the research!

Gen Cells Cures doesn't like working with generic stem cells created from an egg and a sperm cell. There is no genetic match for our patient and you destroy the embryo that could have gone on to become a baby. The company likes working with perfectly matched cells created from a patient's skin cell and a human egg cell. You have a perfect genetic match and the stem cell is made young again . While we like the applications of adult stem cells and will use adult cells until we unravel the secrets of therapeutic cloning. We would rather have our cure come from perfectly matched fresh young stems cells rather than adult stem cells that are as old as our patient! We see the somatic cell nuclear transferred stem cell brought back to the beginning of life as the key to unlocking the aging clock. We just don't see a skin cell matched with an egg cell as a human being.

Fortunately for those of you with the ways and means and the vision to see the new dawn of stem cell research there is a way out for you and that way out is your own private medical research, (private stem cell research.) Gen Cells Cures is searching desperately for the funding to carry out the research that has been put on indefinite hold in the U.S. and the West. If someone knows a millionaire or a billionaire without a cause, please direct him or her to this stem cell research article. And if you know some one who is in desperate need of a cure, but is poor send him or her to us anyway. Maybe we can find their cure with our dime store michroscopes while we wait for the support to arrive to buy the high quality michroscopes we need to do the job. God tends to look after his flock. Gen Cells Cures offers stem cell research that includes a combination of an accumulation of today's best science and molecular biology that fuses therapeutic cloning stem cell research and genomics, (without political or legislative restraints.) Gen Cells Cures futuristic medical research technologies are available to the public now! Stem cell therapies and cures are just around the corner brought to you by Gen Cell Cures advanced stem cell research... No FDA approval needed! Stem cell research, stem cell research and more stem cell research is your solution and stem cell research is the solution for the world.

You have my permission to publish this article electronically or in print, free of charge, as long as the bylines are included. A courtesy copy of your publication would be appreciated.

by Gerald Armstrong


Online Pharmacies and the FDA

The FDA (Food and Drug Administration) is responsible for overseeing the testing, manufacturing, and distribution of prescription drugs in the United States.

Drug companies in the United States operate in a free market and can charge whatever they want for their medications. The United States remains one of the few nations that do not regulate drug companies to help control costs. As a result, Americans are forced to pay exorbitant amounts of money for prescription medications.

With the internet's increased popularity as a source for goods and services, it was only a matter of time before Americans began to search for online sources of prescription drugs. The FDA is trying to do its part to safeguard the public from online pharmacies that may be less than reputable. Every market suffers its share of dishonest companies seeking to make a quick buck, but in the case of prescription drugs, the effects can be more serious than just loosing money.

The FDA has stated major concerns that people choosing to use an online pharmacy should be aware of. Among the most important is the need for a one-on-one physical exam by your doctor prior to taking any medication. Though a visit to your doctor is not always required by law, it is the smartest way to insure your safety, especially if you are taking a prescription drug for the first time.

Another concern is whether or not the drugs you are buying are FDA approved. You should only buy from pharmacies that supply FDA approved drugs (This applies only to pharmacies based in the United States. All U.S. pharmacies recommended on this web site advertise to sell only FDA approved medications).

The FDA also recommends that you check to see that the pharmacy posts their address and/or phone number on the web site, and that there is a means of contacting their pharmacist should you choose to do so.

It would surprise many to see that the FDA is not as close minded as you might expect with regard to Internet prescription drug sales. They recognize the benefits the Internet can offer individuals, such as convenience, privacy, and access to drugs for the disabled.

Their biggest gripe seems to be with the fact that many people will use the Internet to circumvent important safeguards such as proper supervision by a physician. Taking a prescription drug for the first time can cause side effects that may go unnoticed by the individual. A doctor might be able to spot these effects and adjust the dosage, or recommend you discontinue taking the drug.

The bottom line is that the FDA can only do so much. It will ultimately be up to you, the consumer, to be diligent and responsible when making choices regarding your prescription drug usage.

By: Michael Casamento


Top Ten Reasons Why We Hate IBS!

Irritable bowel syndrome can be a nightmare?constant diarrhea and terrible stomach pains, or unbelievable constipation and never-ending gas. While it's good to stay positive and keep looking for help, sometimes it's even better to just have a good old moan!

So, without further ado, I would like to present the top 10 reasons why we all hate IBS. These quotes have all come from genuine IBS sufferers.

"Other people are sick for a week and they get fussed over, food made for them, blankets brought to them, and generally an amazing amount of sympathy. I'm sick for years and years and somehow I'm less deserving than they are. Is that because I'm making it up? Or because IBS isn't real? Or I should just snap out of it?"

"The pain is usually so intense that focus on school or work becomes impossible! There are many days and weeks that I spend curled up in a ball because the pain is so bad."

"I hate IBS because people think you are just a worrier looking for sympathy, and that you could just ignore it, haha."

"I am usually constipated, but when I have to go there's no stopping me. One of these unstoppable occurrences happened the day of the Chicago marathon this year - and I was a participant. During my 18-week training program, I would often think that "it" could happen that day, but simply hoped it would not. Well, it did and it truly was unstoppable. It was so angering after such long, hard training. I finished the race, but not happy with my time or my comfort."

"Walking through Wal-Mart...your heart beating faster as you approach the restroom...Will I make it in time? Only to the see the "closed" when you arrive. That horrible moment when you know you have to find a place to relieve yourself quickly or it will be the most embarrassing moment of your life."

"I can really identify with this list of how "I hate IBS" because basically it has ruined my life the past year. I have lost a job, a house, most of my family and friends due to this crippling "so-called disease" that NOBODY UNDERSTANDS. If I appear angry that is because I am, terribly so. I also have crippling migraines and I am going for surgery for a severe carpal tunnel problem. I live in chronic pain in the left side of my pelvis. It has made life very difficult to say the least."

"I just had company come from New York and I had to stay in bed during most of the visit because of IBS. They think that I am crazy. The gas and explosive bowel movements sap any living energy out of me. I am a single parent now living on social services which doesn't even cover my rent. I am sooooooo angry at my body betraying me like this."

"I am sick of living with constant fear and never being able to plan anything in advance. My long-suffering husband has to book holidays as late as possible, cancel theatre trips, and always go for aisle seats or none at all. I'd just for once like to say "Yes, I will definitely be able to go that day" and do it."

"Eating becomes something I must plan for fear of making a run for the bathroom immediately after (or even during) a meal."

"I am 12 years old and last year I found out I had IBS. It stinks because I have to go to the doctor more than all my friends and I have to go to Wisconsin children's hospital every month or so. I have REALLY BAD days and I can have GREAT days but the bad ones are hard to deal with. I HATE IBS and I wish I never got it!"

By Sophie Lee


The Pharmaceutical Drug Cartel and the FDA

According to the Los Angeles Times, the California Association of Physicians and Surgeons, and even the Center for Diseases Control's own admission, well over 100,000 people in this country die each year from "properly" administered prescription drugs. This is absolutely shocking!

One study has shown that more than two million American hospitalized patients suffered a serious adverse drug reaction (ADR) within a 12-month period and of these, over 100,000 died as a result. Likewise, roughly 36,000,000 adverse drug reactions are reported annually, resulting in more than 33.6-million admissions or hospitalizations all from drugs that the FDA has pronounced "safe effective." Sources for these statistics can be found at: http://www.cancure.org/medical_errors.htm.

The media is not doing a very good job of reporting this ADR crisis. Instead, we hear the constant media drumbeat about the dangers of firearms, which are currently politically incorrect yet represent a miniscule fraction of the deaths in this country. Doctors who want to politicize gun deaths should clean up their own glass houses first. The real crisis is the failing health care or more accurately described as the sick care system. There are numerous reasons for this crisis.

One reason is that conflicts of interest represent a very real problem for public servants and those entities which have relationships with various government agencies. Numerous researchers have reported that the FDA receives money from the very entities it is suppose to be regulating and one consequence of this is the suppression rather than advancement of disease cures. Consider the following:

"According to a USA Today study, more than half of the experts hired to advise the government on the safety and effectiveness of medicine have financial relationships with the pharmaceutical companies that will be helped or hurt by their decisions. These experts are hired to advise the Food and Drug Administration on which medicines should be approved for sale, what the warning labels should say and how studies of drugs should be designed. The experts are supposed to be independent, but USA TODAY found that 54% of the time, they have a direct financial interest in the drug or topic they are asked to evaluate. These conflicts include helping a pharmaceutical company develop a medicine, then serving on an FDA advisory committee that judges the drug.

The conflicts typically include stock ownership, consulting fees or research grants.

Federal law generally prohibits the FDA from using experts with financial conflicts of interest, but according to the article, the FDA has waived the restriction more than 800 times since 1998." (1)

The corruption of undisclosed financial ties to the pharmaceutical companies by supposedly unbiased researchers along with the staggering cost involved in bringing new drugs to market, which conveniently eliminates competition from all but the cartel heavyweights has been sparingly reported in the mainstream press. Consider one exception to this silence:

In the book a "World Without Cancer" by G. Edward Griffin. Griffin describes the politics of cancer therapy, in which he blows the lid off the all powerful international chemical and drug cartel that has dominated the direction of health care since early in the Twentieth Century in the United States. Griffin argues that not only has the Rockefeller-Farben cartel (2) been instrumental in fostering chemical based drug treatment as the basis for health care and they have been the dominant adversary against safer non-drug treatments. If Griffin is correct, who is the FDA protecting and serving? Clearly, not the consumer!

It should be noted that pharmaceutical drugs have absolutely no nutritional value, and at best offer temporary relief of symptoms while doing nothing to address the root causes of disease. Additionally, pharmaceutical drugs should be used very carefully because of the toxicity factor also known as the LD50 rating. LD stands for "Lethal Dose" and LD50 is the amount of a drug, given, which causes the death of 50% of a group of laboratory test animals. Also, it is well known that drugs can damage the liver and kidneys.

Do not forget, as sited above, adverse drug reactions are responsible for over 100,000 deaths each year plus the pain and suffering for those lucky enough to survive an ADR. The way to good health does not necessarily include the ingestion of toxic chemicals. Likewise, the reason for disease is not that we are deficient or lacking in deadly debilitating pharmaceutical drugs. In many cases, disease is the result of nutritional deficiencies and the resulting weakening of the immune system.

The recent ongoing attempt to abolish and subvert the Dietary Supplement Health and Education Act (DSHEA) of 1994, which brought a measure of freedom back to consumers, in regards to their personal choices in the area of nutritional supplementation, should raise the ire of everyone who is concerned about their own health. This is an example of the pharmaceutical cartel and their political cronies within and along side of the FDA at work. Never forget, America is about freedom, especially freedom to make informed decisions concerning our own health care information, services we choose, our choice of treatments and products that we believe to be beneficial for our own health and wellbeing. See the National Health Freedom coalition web site (3)

36,000,000 adverse drug reactions and 100,000 deaths annually is a crisis!

Notes:

1. An article by Dennis Cauchon, the USA TODAY Newspaper, Sept. 25, 2000

2. G. Edward Griffin, World Without Cancer, Westlake Village, CA, American Media, 1997.

3. National Health Freedom Coalition at: http://www.nationalhealthfreedom.org/

By Jack Kettler


Emotional Effects of Irritable Bowel Syndrome

Irritable bowel syndrome sufferers often find that they have to deal with two sets of symptoms. The physical symptoms of diarrhea, constipation and pain form the main part of IBS, but sufferers may also develop emotional problems such as mild or moderate depression and anxiety because of the strain that IBS places on their lives.

There's no doubt that IBS can have a huge impact on your mental and emotional health. One of the reasons why people assume that IBS is caused by stress is that IBS sufferers can appear so stressed and unhappy. But is this really surprising? If you had explosive diarrhea, never-ending constipation or stabbing stomach cramps you'd be a bit stressed too!

The nature of IBS symptoms can mean that they are very difficult to deal with, both practically, in terms of being afraid to go out because of fear of diarrhea, and emotionally, because of embarrassment and the sometimes unsympathetic reactions of others.

Sufferers find that their social lives quickly diminish to nothing, or that they can no longer eat the food at restaurants or dinner parties without ending up in pain. Work or school can become a chronic struggle as you drag yourself in on days when you feel ill, knowing that if you didn't you'd get fired or kicked off your course.

You may also feel that you have to pretend to be healthy most of the time in spite of how you really feel, because people get tired of hearing about your condition or begin to say things like "Well why don't you go to the doctor" or "My mum had that and ate lots of bran and now she's fine. That's what you should do."

It can be very hard to bite your tongue and stop yourself answering back. "Oh, go to the DOCTOR, I see, that's where I've going wrong all this time, I thought you had to go to the hardware store. I shall now be cured."

What is important to remember is that anyone who is battling with IBS is going through a very difficult time, and deserves some genuine support, as does anyone with a chronic, long-term condition.

Hopefully, if you explain your condition to family and friends, support will be forthcoming, but if not you should ask yourself how much misunderstanding you are willing to put up with, and whether it is hazardous to your health.

This is what Heather Van Vorous says in The First Year - IBS: "You may even have friends or family dismiss your problem as 'all in your head.' It's up to you to educate these people, and then dump them if they persist in their ignorance at the expense of your health."

If they are truly your friends then they will want to learn about the condition and be ready to accept that their views are based on prejudice and assumption rather than fact.

But if they still believe that you're exaggerating then ask them to explain exactly why they believe that IBS is psychosomatic or 'all in your head', what scientific studies they are basing their views on, and how they explain the success of new drugs such as the selective 5-HT3 antagonist Lotronex. That should keep them quiet.

By Sophie Lee


Three Questions People Are Asking About Health Care in America

Q. Why is there so may uninsured people in America?

A. There are over 44 million uninsured people in this country and over 75 million underinsured because of three main factors:

1. Insurance rates continue to rise each year by 10-25% forcing many people to drop their health insurance.

2. Layoffs in the job market have left many people in a difficult situation when it comes to protecting their families. Many of those that aren't laid off are seeing their insurance benefits cut.

3. More Americans today are facing health challenges that virtually make them uninsurable.

Q. How is America coping with this growing problem?

A. Not very well. The only alternative so far for many thousands of people is to seek medical care in overcrowded, understaffed, county hospitals where they virtually have no choice as to the quality of the Health Care they receive.

Q. So what is the answer to this growing problem for those trapped in the Health Care Crisis?

A. Well, if someone finds themselves trapped in the middle of either not being able to afford traditional major medical insurance, or not able to qualify for insurance because of pre-existing conditions, the alternative is to participate in a health care savings benefit program. These programs allow you to purchase your health care at Managed Care Prices which are the reduced rates that traditional insurance companies pay the doctors and hospitals. The better programs also offer additional membership insured benefits as well like accident benefits, daily hospital benefit, office visit benefit, and accidental death benefits to name a few. The key to finding a program to fit your needs is to look for a company that has been in business for a long time with a track record of assisting people attain these kinds of savings. A program with feature driven benefits is your best value when looking for non-insurance alternative health care solutions in today's market.

By Marc Eskew


Prescription Drugs from International Pharmacies Save Elderly Money

As pointed out by *Jack Shapiro, an internationally-known healthcare marketing consultant "For the first nine months of this year, the U.S. imported $40 billion in pharmaceuticals and exported only $21 billion. In 2003, we imported $50 billion and exported $23 billion." So what makes buying from your local U.S. based pharmacy any safer then purchasing from Mexico or Canada?
Many of today's elderly (U.S.) cross the borders of Mexico and Canada in order to get their prescriptions filled at a huge discount. For some it has become a necessity because they simply can't afford necessary drug treatments any other way.
But what about those who don't live near the borders; how can they take advantage of these savings? Fact is there are a lot of prescription drugs that can be purchased online from international locations for a fraction of the cost people pay here in the United States. A good example of this is www.rxmex.org where many of today's best known brand drugs can be found such as Viagra, Cialis, Levitra, Zocor, Zoloft, Propecia and more. However they not only offer name brand drugs at sharp discounts they also give seniors the opportunity to buy generic versions of most of these name brand drugs for savings that can reach up to 80% less then their name brand counterparts!
When a drug company first invents a drug (eg. Prozac) that company is the only one allowed to make that drug for a certain number of years (approximately 10 years in the US). After this time period, other companies are allowed to make the same drug. These drugs are called generics. The original drug (eg. Prozac) is called a brand name drug. Brand name drugs and their generics are IDENTICAL in terms of active ingredients. The generic pills may look different (because they are made by a different company) but inside is exactly the same active ingredient which works in exactly the same way. The only difference between brand name drugs and generic drugs is that generics are always less expensive.
Most all drugs found at www.rxmex.org require a prescription so this licensed pharmacy can fill most orders by having the purchaser fax them their prescription and the shipped order can be tracked online. Another benefit to ordering this way is that there is no tax to be paid and orders are shipped internationally.
While some headway has been made in the last year or so in regards to reducing prescription drug costs for seniors, for now it's simply not enough for so many of our elderly. With the political clout of today's drug companies who converge on Washington D.C. like vultures I'm not sure the costs will ever get to the point where it should be. Until then places like www.rxmex.org with their name brand and generic low cost versions of many prescription drugs will continue to be another excellent low cost source for today's seniors.
By Stephen Dayton


Pain in the Butt. How to Deal with Hemorrhoids?

This is very sensitive area of your body. Too private. Nobody likes when something is wrong over there. However it happens.

Hemorrhoids occur practically in everyone. Though hemorrhoids cause problems in 1 out of 25 people. Mostly those are people between 45 and 65 years of age.

You find a blood on toilet tissue. Bright red blood. Ok, now what? You do not know why you bleed. It could be rectal cancer by the way. It could be hemorrhoids.

So? What are the hemorrhoids?

They look like cushions. They contain blood vessels, some muscle and elastic fibers. People often call them piles.

Not everything over there is a hemorrhoid. There could be other problems. Fissure, abscess, fistula, pruritus (itching), condylomata (sort of hanging skin caused by viral infection), viral and bacterial skin infections can happen in that, so sensitive area.

It is worth to talk to your doctor.

How would a scenario of hemorrhoids look?

A 46-year-old female presents with complaints on rectal discomfort, occasional bright red blood on toilet tissue and prolapsing tissue in of anal area. This is probably internal hemorrhoid.

Another scenario brings a patient who complains on severe rectal pain and prolapsed tissue. The severe pain happens in external hemorrhoids. The pain follows thrombosis (thrombosis is the blood clot in your blood vessels).

There are four degrees of internal hemorrhoids.

It may be interesting for you to know because first, second and sometime third degree can be treated by banding only. Fourth degree and sometime third degree requires surgery.

Do not forget non-hemorrhoid causes of symptoms. To check with your doctor is worthwhile because there could be other problems, including cancer or anal fissure. (By the way for anal fissure medical treatment alone may heal it in 90% of cases).

How are hemorrhoids treated?

Well first you need to understand how do hemorrhoids happen. Several reasons lead to hemorrhoids:

Constipation and extra straining
Chronic Diarrhea and loose stools
Long sitting or standing
Weight lifting
Obesity
Pregnancy and childbirth
Inherited tendency to hemorrhoids.

So, avoid all this and you are free.

Obviously this list of reasons is too wide.

The list of measures is wide too.

Increase the fiber in your diet.

Eat more cereals, fruits, vegetables, grains, etc

Psyllium and methylcellulose are supplemental types of fiber.

Exercise, avoid long standing or sitting, don't strain, keep the anal area clean.

Increase liquids in your diet.

Use stool softeners, stool-bulking agents (not a tasty ones, but what can you do).

Treat diarrhea with anti-motility drugs and fiber.

Not every of these methods are proved scientifically. Nonetheless they are included in the standard recommendations for hemorrhoids treatment.

To treat itching or discomfort you may use suppositories, ointments, creams, and gels. You may find that all in your local pharmacy.

These products contain protectant and anesthetics (pain relievers). Local anesthetics numb the area and decrease burning and itching.

Remember that local anesthetics may cause allergy.

Analgesics (menthol, camphor) relieve pain and itching as well

Vasoconstrictors reduce swelling in the perianal area. Though they may have side effects. Better discuss with your doctor.

Protectants (kaolin, cocoa butter, lanolin, mineral oil, starch, zinc oxide or calamine, glycerin, etc) create a physical barrier to prevent contact of stool and the skin. This reduces irritation, itching, and burning.

Similarly, some agents - astringents - dry the skin. That helps to relieve burning, itching, and pain as well.

To kill or at least suppress bacteria and other organisms use antiseptics. Boric acid, phenol, resorcinol and many others can be used. Again better to discuss with your doctor or at least pharmacist. Many of these drugs are sold over-the-counter.

Corticosteroids. Corticosteroids decrease inflammation and relieve itching, but may cause skin damage. They should be used for few days only.

Sitz bath may also help in relieving the symptoms.

When those methods fail your doctor may perform one of the following:

Sclerotherapy (causes scarring of the hemorrhoid).

Rubber band ligation. The rubber band cut off blood supply and hemorrhoid heals with scarring.

Side effects of any of the treatment may be infection of fat and other tissues surrounding the anal canal, especially if patient has diabetes cancer, AIDS.

Another option - electrotherapy and infrared photocoagulation. Works the same way, cause scarring of the tissue. Cryotherapy uses cold to cause inflammation and scarring. Practically the same, though more time consuming.

Let say your medical treatment fails. What do you do then? Well, you go to surgeon and treat it surgically.

Operations are done in less than 10% of patients. Though it depends.

Surgical procedures include Dilation. It is when surgeon stretches your anal sphincter.

Ligation. Often a Doppler probe helps to measures blood flow and finds the individual artery.

The doctor ties off the artery.

Sphincterotomy. It is when sphincter is partially cut. Whole idea is to reduce the pressure.

Hemorrhoidectomy. Hemorrhoidectomy makes sense for patients with third- or fourth-degree hemorrhoids. The hemorrhoids are cut out.

Stapled hemorrhoidectomy. Stapler cuts off the ring of expanded hemorrhoidal tissue.

There are different considerations why to do this and not that type of treatment. And vice versa.

There are complications (pain, difficulty urinating, bleeding several days after surgery, scarring, infection, stool incontinence). Complications happen relatively rare, but they are still there. Better talk to you surgeon.

I hope you be OK.

You were not alone.

It looks like Napoleon Bonaparte, Carter, Hemingway, Tennyson, Lewis Carroll also were suffering from hemorrhoids.

By Aleksandr Kavokin, MD


Web Therapy: Enhancing Patient Communication with Web Access

According to Jennifer Lyons' chart, she's just a bad slip and fall who's lucky enough to be on her way to a full recovery.

But to Jennifer, who is lying in bed with a broken mandible and broken limbs, nothing could be further from the truth. Jen was visiting the city on a business trip when her accident happened, and now she's lying in a bed 2,000 miles away from her family. Although her husband is flying in later tonight, never in her life has Jennifer felt more disconnected. That is, until her nurse points out the revolutionary screen standing next to her bed. Even though she can't move her mouth, two minutes later, Jennifer is catching up with her children.

Two floors down, Rebecca Forrester is also lying in bed with no family members around her. She's in her eighties and the fall she took is already developing a complication - pneumonia. Her daughter is working in Tokyo and will take a day to get to her side - a day Rebecca may not have. With no telephones in this ICU, Rebecca knows if her daughter doesn't make it to her in time, she may never be able to speak to her again. Until a nurses' aide enters with a wireless web pad. A minute later, Rebecca and her daughter are talking.

In a growing number of hospitals nationwide, hooking up your patients has just taken on a whole new meaning. Whether via wireless web pads, or bedside units, patient Internet access is revolutionizing patient care and patient communication.

Originally conceived as a way to reduce boredom and facilitate patient education, the units quickly began to add other features including relaxation videos, local TV channels, video games and telephones, besides videos and information patients can access on specific healthcare issues. Feedback is already showing what medical professionals have suspected for years -- people simply feel better when they're active and connected with the world around them. Even video games - just a welcome diversion for the rest of us - help patients take theirs mind off pain, requiring less pain medication. But patient Internet manufacturers didn't stop there. They also found a way to add a host of applications that increase bedside patient care in ways never before possible, by bringing the information age right to the bedside.

Many systems now integrate electronic medical record systems, bar code medication systems and even digital imaging directly into the web screen units. This means that doctors and nurses can do chart notes, look up lab results and in some cases order or dispense medications without leaving the patient's bedside. The web screens also make it easy to view diagnostic images or go over them with the patient. Not only does this save time and energy, it increases patient privacy.

But for the patients, it's all about facilitating communication whenever they need it - with loved ones, with friends or even with work. Just because someone is hospitalized doesn't mean they have to be isolated. For Jennifer Lyons, being able to communicate with her children means everything. Not only does she feel connected, because she can check in with them a few times a day, she feels more able to relax knowing that everything is fine at home.

As for Rebecca, she didn't fare as well. The pneumonia took hold and her daughter was unable to get to the hospital quickly enough to be with her before she passed away. But with the wireless web pad and a little help from her nurses' aide, Rebecca and her daughter spent the rest of the day writing back and forth, telling stories, sharing memories and making sure they said everything to each other, that they wanted to say. And to them, that made all the difference. Priceless.

For tools you and your staff can use to facilitate patient communication download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


When Your John Doe Is Homeless

The patient, known only as John Doe, was difficult to see under the hodgepodge of tubing, the quiet clicking of the ventilator the room's only sound.

From all appearances he was homeless, but in the opinion of his nurse, who has had vast experience in dealing with patients just like him, everyone has a mother or a father, a son or a daughter, and homeless or not, it's a nurse's responsibility to do what he can to help find them. Usually it's just a matter of taking that extra few minutes to connect the dots. "Homeless people are very savvy and self-sufficient when it comes to survival skills," he explains. "They write important phone numbers on the insides of a hat, put them in their shoes, or sew numbers inside the seams of their coats. I go through every stitch of clothing."

If that doesn't turn up any emergency contact numbers or personal information, he examines the patient's body for needle tracks, scars or tattoos and if necessary, sends fingerprints to the police for a background check.

Sometimes the police's theory is that the homeless person had a desire to be a loner, and they see no need to reconnect them with their family after they are injured or dead. But the nurse is quick to disagree.

"Things change, [and] these people are still human beings. I believe that every homeless person is still a father or mother, [or a] son or daughter to somebody out there. These people may have done things they are not proud of, they may have mental illness, but their family has a right to know what happened to them."

From a hospital's perspective, a patient without an identity is a patient without funding. But once a nurse or a social worker positively IDs a patient as a US citizen, the hospital can help the patient apply for Medicaid and then get reimbursement for the bill.

"Identifying people is a reasonable endeavor. It is part of a holistic approach. When you locate family, you find a surrogate to speak on behalf of the patient, to be an advocate. The family should decide on the patient's follow-up and if the patient has died, the family should decide where they are buried."

For tools you and your staff can use to identify John Does download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Pediatric Emergency Contact Notifications Made Easier

For the head of the trauma department at one of America's top pediatric facilities, Chicago's Children's Memorial Hospital, having to notifying parents that their children have been the victims of trauma or identify pediatric Jane Does, is an every day occurrence. But just because they look like they're handling it well, doesn't mean that it ever becomes routine.

When a child comes into the ED without a parent, it's usually the result of an accident or traumatic event. Even though their first priority is to tend to the child's medical needs, their next priority is to identify the child. They need to get his parents or guardian down to the hospital, to give consent for his treatment, provide vital medical history and most importantly, to be at their child's side when he needs them most.

You'd be surprised how often a child is brought into Children's Memorial without anything pointing to his or her identity. Many times it's the result of a car accident, where the parents are injured as well as the child, and are taken to another hospital, while the child is brought to Children's for specialized pediatric treatment. Since children don't have driver's licenses or checkbooks, identifying a child can be challenging.

Just the other day, three children ranging from 8 months to 3 years were brought into the ED after a serious automobile accident.

Their parents, who were in bad shape, were taken to another hospital and the paramedics had no clue about their names, ages or medical history. The trauma team began their medical evaluation and as they always do when dealing with an unidentified child, opened a trauma pack for each, using a patient number to identify them. We estimated their ages, did a full physical description including any identifying marks and clothing, then ordered a full set of x-rays, which helps to identify any conditions or injuries that aren't readily apparent.

The team's biggest asset in this situation was the solid relationships that they've built with police, fire department, and other local hospitals - as they work together to get the children identified as quickly as possible. After a major accident like this, the police and fire department were already in the ED coordinating efforts. With their special emergency landline system they're instantly linked by phone with any local hospital they need to reach. As the team began calling to find out where the children's parents were taken, hospitals began to call them, to say, "I know you're looking for the mom and dad of the accident victims. They're not here," saving them precious time. In this case, we found the hospital relatively quickly and found out that even though the children's parents had been seriously injured, the children's caregiver who had also been in the accident, was fine. The hospital sent her over to Children's and she - and later on the parents - were able to give them all the information theyneeded to identify and treat the children.

In the case of a completely unidentified child, especially babies, they depend on our procedures. Usually the fire department, police or DCFS dropped the child off, so they are already aware of the situation and have already begun going through the child's clothing and personal effects to gather evidence and identify the child. The trauma team will send the police or paramedics right back to the scene to gather additional information, medicine bottles, names, and to canvass the area. There is almost always someone who saw something. Someone from pastoral care automatically comes down and a social worker will get involved if it looks like any abuse was involved. Together, they take care of figuring out where to go from here, while the team takes care of the child medically.

If these steps don't elicit any clues to the child's identity, the hospital will get media affairs involved. Children's will never show the face or reveal the name of any child. Instead, they photograph the child's clothing and personal effects and release it to the media along with the child's estimated age, description and the vicinity in which she was found. They work closely with detectives and DCFS to give them all the details they need to chase down any leads they get from the public. Many times just calling DCFS or the police will locate parents or bring about an identification. In the case of severe trauma, abuse or inflicted injury, Children's always balances treating the child, with carefully gathering as much evidence as possible, to help the eventual police investigation. They had a young girl a few years ago, whose brutal attacker was convicted mainly on the evidence gathered and catalogued in the trauma room.

When it comes to providing emergency contact information, kids aren't always the best source. They have seven or eight year old kids come in everyday, who I'm sure are sophisticated in every other way. But get them in a trauma situation and ask them what their mom's name is and they'll say it's "mom". In this case, the first thing they'll do is look at whatever they brought in with them. School-age kids almost always have a backpack. If they don't find anything there, they'll check our records to see if the child is in the system and begin to gently probe the child for information. They ask them where their house is, what their school looks like, information about their friend's houses, maybe a familiar landmark on the corner like a 7/11 or the name of a park. If you can't find their contact information right away, try to find the name of their school. Their books will probably have the name of their school stamped inside.

Schools are also a great source for emergency contact information. They'll often even list alternate people to call in an emergency if the parents are at work or hard to reach. In an emergency, schools will usually send someone directly down to the hospital with the child's emergency card and emergency consent forms. If the injury occurs at school, most schools will send someone from the school along with the child to the hospital, while someone else is calling the parent. For parents, I would suggest that every parent name someone else on the child's emergency card, who knows the child well and would be able to step in to help out during an emergency if the parents can't get there right away.

So once you identify a child, how do you know if the person who comes to the hospital is really his parent or relative? It's not always easy. Remember that the parents didn't expect to have to come to the hospital today, and probably won't be carrying three forms of ID and their child's birth certificate. For people that come in and say they're related to a child who's been in the media, they get as much ID as they can, be it a driver's license, pictures or other proof. With kids, the biggest test is to watch their response when that person goes in the room. Usually you'll here a resounding "Mom!" or "Daddy!" and you know you've got the right person. If there's no response from the kid, or if they're not sure of the adult, it's probably not the right person. Or worse, the child might recoil from the adult, which could indicate an abusive situation.

Treating kids also means caring for their parents. When Children's has to make a notification call they'll begin by telling the person on the phone who they are and ask them how they are related to the child. If it's the mom or dad, they'll tell them that their child has been brought to Children's Memorial Hospital. Of course the parent will immediately ask how the child is. This is always the hardest part of the call. If the child is clearly fine, they'll say "Don't worry, they're fine, we just need you to come down here." But if there is a more serious injury, or if the child hasn't survived, they say that the child has been in an accident, that they need to come down, and if necessary, that they need to get their medical history. If they refuse to get off the phone until they find out what's wrong, the trauma coordinator will say that they're very concerned about their child's health and that they need to come down right away. They'll always try to calm the person down as much as they can - tell them to go and get a pencil and paper to take down the address of the hospital, to take down the hospital's name and they're direct number. They tell them to ask for them right away when they get here so they don't have to waste any time at the desk and then try to make sure they have someone to drive them over. And they finish by reminding them that they need to drive carefully and slowly and to make sure that they get there in one piece!

At Children's the top priority is the restoration of the health of every child who comes through our door, no matter who they are and where they come from.

For tools you and your staff can use to facilitate pediatric notification, identification and communication, download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Patient Communication: Picking Up Where Medicine Leaves Off

We've all seen patients who were far beyond the reach of medical treatment suddenly defy the odds and recover. We've also seen patients who were well on the road to recovery, take a turn for the worse for seemingly no reason at all. No matter what the technology or how terrific we are at our jobs, sometimes medicine just isn't enough.

Case in point, a few years ago, I saw a woman in her sixties after she had had a moderate CVA. No matter what her doctors did for her, she still wouldn't regain consciousness - defying explanation. Her daughter was thousands of miles away at the time and when the doctor reached her, he told her that her mother mighty not live long enough for her to get to her side. After several minutes, the daughter finally convinced the head nurse to put a phone up to her mother's ear, so she could talk to her. The nurse put the phone by the patient's ear and could hear her daughter talking to her, telling her that she was on her way and that everything was going to be fine. The moment her patient heard her daughter's voice, the nurse watched in amazement as her vitals stabilized, her eye lids began to flutter and her eyes opened, looking straight up at the nurse! Two weeks later, she was out of the hospital and on her way to rehab.

That's the miracle of communications.

Whether a family member, a friend or just a familiar face, our patients need to have the people they love surrounding them, when they're ill, in pain, or afraid. As caregivers, it's part of our job to realize that patients might be too ill or physically unable to initiate the contact they so desperately need, on their own.

I wish that were the end of the story. A few years later, the same woman was injured after a bad fall and taken to a different hospital. Despite being in stable and then good condition, a few days later a lack of the most basic medical care caused the woman to spiral into critical condition. When the hospital called her daughter to notify her of her mother's hospitalization days later, she learned that her mother was now unconscious and may not survive. While trying to get a flight back, she begged the nursing staff to put a phone next to her mother's ear, so she could talk to her, possibly for the last time. But at this hospital, the nurses and doctor refused. In fact her doctor said that she was suddenly opening her eyes and looking around. But despite her daughter's pleas to let her talk to her mom while she could still hear her, he tells her that he has no way to get a phone to an ICU patient. "We'll try and figure something out in the morning," he says. Unfortunately the patient didn't have that much time and she died hours later, never again hearing her daughter's voice.

The next time you're caring for a patient with compromised communication ability, take a moment to see their surroundings from his perspective.

· If your patient can speak, is the telephone close enough to them?

· Do they need help dialing, or able to see well enough to read a number out of their address book?

· If your patient is unable to hold a telephone would they benefit from a speakerphone?

· If your patient can't speak, have a patient representative or volunteer ask them to write the name of someone that they would like to have called for them and hold the phone up to their ear to facilitate communication.

· For patients who cannot speak, patient Internet access can be a real lifesaver, because they can type an email message or have one typed for them.

· Is your patient unable to see or unable to hear? Then take a moment to call a department or caregiver who can bridge those problems to enhance communication.

· Since many hospitals still don't have a means of patient communication in the ICU, you may have to get a bit more creative for patients in care units.

Many hospitals now have low emission wireless phones that can be used in critical care units. Wireless web pads also work well, or what about a regular phone, kept at the nurses' station that can be plugged into an outlet in the patient rooms when needed. Communication isn't just a patient's right - for many it can be their only link to the outside world, or a life-renewing source of strength and love.

Combine that with terrific medical care and watch the miracles flow.

For tools you and your staff can use to facilitate patient communication download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


Family Notification in Seven Quick and Easy Steps

The Seven Steps to Successful Notification is an easy-to-use system based on time-tested tools successfully used by hospitals nationwide. It provides your hospital staff with all of the steps necessary to:

? Identify and locate your unconscious patient's next of kin or surrogate decision maker.

? Improve patient care by locating your patient's medical history, personal physician, and insurance information.

? Provide the facility with a documentation of the steps taken to find the patient's next of kin, to make the notification, and identify the staff members responsible for making it, thereby releasing you from subsequent liability.

? In states with Next of Kin Statutes, provides proof that the facility has met its statutory responsibility.

Let's see the seven steps in action, through the eyes of the nurse manager of Care Central's Trauma Unit, Carolee Cummins.

Carolee comes on duty this morning just as a hit and run is pulling up at the emergency bay. She meets the gurney and runs along side, paying rapt attention to the paramedic's bullet, while she and her staff do their own evaluation. The paramedic's last comment stops her cold. This pretty thirtysomething, woman who is in grave danger of bleeding out, has no identification with her. Carolee starts a John Doe chart for her patient and turns her attention back to the trauma.

1) Patient Status Confirmed

When a patient like this comes in, Carolee is glad that she and her team use the Seven Steps System. She looks down at her chart page and begins the notification process right in the trauma room, by answering the first question. Is the patient unconscious or physically unable to give informed consent? Had her patient been alert and oriented, she would simply have checked the box marked no, skipped the notification section on the chart and proceeded as usual. After the team confirms that the patient is unresponsive to everything but deep pain, Carolee checks "yes" and asks one of the aides to check the waiting room to see if any family members came in with their patient. "No", the aide confirms, "she came in alone". And so the notification and documentation procedure begins.

2) Examine Personal Effects For Emergency Contact Numbers When Care Central began to use the Seven Steps, they appointed the nurse manager on duty, as the point person for NOK notifications. So as point person, Carolee begins to look for the young woman's emergency contact numbers or clues to those numbers, by examining her personal effects. Most of the time, Carolee finds the emergency information quite easily, right in her patient's wallet, on a driver's license, emergency contact cards, insurance cards or personal phone books. When she finds what she's looking for, Carolee documents on the chart that the contact has been found, and skips down to Step 5.

In this case her search only takes a moment - the only thing the woman had with her were her house keys. If she had a wallet or a purse, it was destroyed in the accident. Carolee goes through the pockets of her patient's jogging shorts and finds one small clue to her identity - a few message blanks from work that she must have stuffed in her pocket to take care of later. They're all made out to Katherine McCauley. Progress.

If Step 2 had turned up nothing and her patient had still been a Jane Doe, Carolee would have skipped down to Step 7, involving Social Service in her search. But since Carolee's patient now has a name, she goes directly to Step 3.

3) Retrieve Patient's Home Number

Now she'll have to get a bit more creative. As Katherine found out the hard way, life can present major challenges for patients, not to mention an emergency department staff. A quick run to the store without taking your ID, interrupted by a sudden heart attack, can put even the most conscientious person into jeopardy. In upcoming sections of this Kit, you'll find details on traditional and untraditional ways of find that contact information quickly and easily. But for now Carolee, goes through her mental checklist of ways she's found contact information in the past: checking the speed dial of a patient's cell phone for numbers labeled "home" or "work"; the contact pages of a Filofax, or the address book of a PDA. Even a briefcase can contain a patient's business card, or a company letterhead on documents.

If Carolee had found a home number or an emergency contact on any of these items, she would have gone right to Step 5. Since Katherine has none of these things with her, Carolee documents that fact and proceeds to Step 4.

4) Seek Other Sources For Contact Information

Carolee almost never gets to this section, but when she does, she knows it's time to crank her investigative skills into high gear! Since she knows her patient's name, her next step will take her to the hospital's medical records department.

Chances are, if Katherine lives in the area, this probably isn't her first visit to Care Central. Even if the old records don't include the patient's next of kin or surrogate decision maker, Carolee will be able to get it, by phoning Katherine's home number, physician or insurer.

If Carolee still hadn't been able to find information on her patient, she would have gone directly to Step 7 and turned the investigation over to Social Service or to the police (depending on her facility's policy).

But Carolee quickly locates Katherine's name on a year old chart, when she was admitted for the birth of her son. Success! Now on to Step 5.

5) Oversee Or Make The Notification Call

Normally, Carolee would turn the actual notification phone call over to one of her RNs. But she's so invested in Katherine at this point, that she places the notification call to Katherine's home herself.

Since her first priority is notifying the patient's next of kin or surrogate decision maker, her aim is to get a hold of the right person as soon as possible. She is disappointed to hear the answering machine pick up. Carolee hates doing a notification this way. She leaves a message for Katherine's husband, hoping that he'll pick it up quickly. Many times the only person Carolee has been able to reach is a relative or friend, so she is always careful to document the name and relationship of any person she talks to. Occasionally the only information she finds is the patient's family physician or insurance company.

In that case she makes sure they know that she needs to speak with the family ASAP and then follows up within an hour or so. Carolee has learned the hard way, never to assume that a third party is going to take care of a notification. Since Care Central is the facility treating the patient and is the one in need of medical history to give Katherine the best care possible, it's Care Central's responsibility to make sure the notification takes place.

Even though Care Central's responsibility is technically met the moment Carolee left the message for Katherine's husband, she feels that it's a good practice to follow up with another phone call if Katherine's husband doesn't arrive or return the hospital's phone call within the next two hours. She documents the results, initials that the section is complete and notes the time that the call occurred.

The entire process has taken Carolee less than ten minutes, and by using Care Central's special chart page, Carolee's hospital now has a documented account of her efforts. If her patient or her patient's family were ever to question that notification was attempted, the hospital will be able to prove that their regulations were properly followed.

6) Need To Follow Up? Recall Main Contact Or Second Number

Answering machines and voice mail are wonderful and no one can imagine life without them - unless it's an emergency and you can't get a hold of the person you need to speak with!

Two hours later, the husband still hasn't arrived and Katherine's condition is worsening. Doctors are wondering if she has an undetermined, underlying condition that is keeping her BP from stabilizing despite their efforts. Carolee quickly proceeds to Step 6. Carolee found Katherine's work number on the old chart, but before she tries it, she redials the home number. A breathless Scott answers. Only minutes before, he'd forgotten an important brief and ran back home to get it, allowing him to pick up Carolee's message. A short while later, he arrives at the hospital and fills the trauma team in on his wife's medical history. Changes in her treatment are immediately made and hours later, Katherine, now alert and stable, is on her way to a full recovery.

Had Carolee not been able to reach anyone at Katherine's home, she would have called the second number, then documented the results on the chart, with the time and her initials. If she still hadn't been able to reach anyone in person or if the relative hadn't shown up at the facility, she would have noted that on the chart and proceeded to Step 7.

7) Shift To Social Service Or Police Every once in a while, despite Carolee's best efforts, she has to shift her notification efforts to social service. Even so, she has met the hospital's legal responsibility by making reasonable efforts to notify her patient's next of kin.

The bad news is that her patient still needs intervention. By shifting the notification process over to her social service department or to the police, Carolee is confident that everything possible will be done to find her patient's family. In upcoming sections, you'll find tips and tools to help you deal with identifying Jane/John Does and handling the effort quickly and easily.

For a free copy of the complete Seven Steps to Successful Notification System, in PDF download format, visit the Next of Kin Education Project web site. A sample version of the form is also available on our web site, along with forms you can purchase to use in your own facility. Along with the Information Kit, we've created patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

By Laura Greenwald


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