Norovirus has become famous as the “cruise ship bug” though that is not the only place you can get it. Just this past weekend 3 cruises coming into Florida were identified as being contaminated with it and over 200 passengers were ill. In Mecklenburg County some nursing homes have been on quarantine, meaning residents have to stay in their rooms and visitors are asked to stay away. It has also been going around schools and workplaces. Just last week the NC Department of Health and Human Services released a notice about the current outbreak.

Symptoms include upset stomach, vomiting and diarrhea. Other symptoms are common, such as a low grade fever (less than 100.4), stomach pain and cramping, and general weakness. The symptoms last 24-48 hours, but a person can be contagious for up to 3 days after the symptoms subside. The virus may make you feel like you are dying, but it is generally not dangerous to a person’s overall health. You may want to call the doctor for the very young, very old or anyone with a compromised immune system.  Otherwise, try to drink plenty of liquids and slowly advance the diet to bland foods. Pedialyte is great for kids. Avoid high sugar drinks like regular soft drinks and sports drinks because they may make diarrhea worse. The biggest concern is dehydration, so look for sunken eyes, dry mouth, decreased urine output, or very concentrated urine. If any of these are present medical attention may be necessary if the person is not able to drink more liquids in a short amount of time.

It is also helpful for anyone with symptoms to be “quarantined” from the rest of the family. If there is a bathroom and bedroom that can be designated for the ill person that may be a good protection for the rest of the family (though not foolproof!)

The number one thing anyone can do to protect themselves is wash hands frequently with soap and warm water. Hand sanitizers do not work against the norovirus! Clean surfaces with a chlorine bleach solution. Just like hand sanitizers, regular surface sanitizers may not work. Click here for more info on disinfecting against norovirus.

The Mayo Clinic has a website dedicated to what you need to know about norovirus. Hopefully you and your family can avoid this annoying stomach bug!

1. Have your medical history written down. Bring this with you to all medical visits and hospitalizations. That way there is no question about leaving something out. Include major medical tests and screenings like mammogram and colonoscopy and when and where they were done. Electronic medical records that will be widely available for your health care providers are coming, but not here yet! I have attached a Word document Medical_History that can easily be edited and printed. There are also many pdf forms online that can be printed and filled out.
2. Keep a complete list of all medications with you at all times. Include prescriptions, over the counter medicines and vitamin/supplements.
3. Bring any records you have been keeping at home such as blood sugars or blood pressures. If you use an electronic blood pressure cuff you can bring it with you to be sure it is correct.
4. WRITE DOWN YOUR QUESTIONS or concerns so you don’t forget anything. This is also important if you are hospitalized. It is easy to get through the visit then realize you forgot to bring something up. Write down relevant symptoms and a timeline of when they occurred.
5. Have a second (or third) person present to act as an advocate and take notes, especially if you are going to a new doctor or specialist. (Parish Nurses are great at this!) But remember-concerned loved ones are always an asset as long as they do not interfere with the doctor-patient dialog!
6. LISTEN CAREFULLY and take notes (or have someone do that for you).
7. Ask questions and ask for anything that is not clear to be repeated in a different way. Ask for difficult words to be spelled or written down for you. Use statements like, “What I understand is…”
8. Have a form filled out so that the doctor’s office will communicate with your family or representative if needed. Because of HIPPA they are not allowed to talk to anyone unless they have it documented that it is OK or have a health care power of attorney on file. Many clinics/hospitals will have their own form you can fill out, but here is a link to an online generic form. Medicare also has a form that can be filled out so they can talk to your designated person about their coverage if you are unable to do so or have someone who is helping with this.
9. Having a copy of your living will or health care power of attorney with your medical history is always a good idea.

I would like to thank our Christ Church physicians who responded to an email I sent out some time ago asking for their input into this topic.

I appreciate any additional advice anyone has on this topic!

When celebrating the holidays, choose what is right for you, even if that means not really celebrating. Give yourself permission to be sad and to laugh, recognizing that emotions will fluctuate and where ever yours happens to be is okay.

There are many websites out there about grieving and one of my favorites is GriefNet. They have a page dedicated to Coping with Grief During the Holidays. One article that may be useful is Tips for Handling the Holidays.

There are many resources in our community to assist you if you are grieving, and some are free, so please contact me if you need help finding someone to help you deal with your loss. Sometimes professional help is needed to deal with depression that can become debilitating or to just help you identify coping mechanisms when emotions become difficult to manage.

Everyone who is grieving deserves to grieve in their own way and celebrate in their own way too.

Fever: If your temperature is over 100.3 you have a fever and should stay home. Fever is good though-it shows your body is fighting the infection. Take something like acetamenophen or ibuprofen if you want to, but stay home until you are fever free for 24 hours without any fever reducing medications.

Sneezing and coughing: If those are your only symptoms and they are mild you are probably OK to go to work. Just be sure to sneeze or cough into a tissue or your elbow then throw the tissue away and wash your hands frequently. Sometime the sinus pressure can make you feel bad enough that you cannot concentrate and you are doing no one any good, so head home, treat your symptoms and rest. Many of these symptoms will worsen if you don’t take care of yourself.

WebMD has a great article about when to stay home. If you are unsure, head to your doctor, urgent care or minute clinic. They can give you their opinion on whether you should stay home and they can also evaluate your need for antibiotics or prescription meds for your symptoms.

If you need some help choosing over the counter medications to help with your symptoms, I have a blog post that can help. My personal favorite for any type of sinus or chest congestion is Mucinex (which is an expectorant), as many people who have asked for my advice can attest. Remember to drink lots of water throughout the day when taking it to help it work.  Using some sort of sinus saline rinse or neti pot is also a great way to help relieve sinus symptoms. Always check with your health care provider before taking over the counter medications.

I’d love to hear from you what you do to treat the symptoms or what you take to ward off cold/flu symptoms.

Monday, October 24, 9:00 AM-12:00 Noon in the Gathering Space

Wednesday, October 26, 3:00-7:00 PM in St. Francis A

No appointments are needed and these are both open to the public.Vaccines at these clinics are available for anyone age 4 years and older.

Cash or check accepted for the $30 payment

Insurances covered with no copay: Medicare Part B, PFFS type Medicare Advantage Plans, Aetna, BCBS of NC or Massachusetts, Humana Gold Choice, SummaCare, Todays Options, and Universal Health Care. Other insurance plans may cover the cost, but you must file the claim yourself.

Our flu shot clinics are managed by Maxim Healthcare so please contact them for specific insurance questions.

Pneumonia vaccines will also be available.

The current recommendations are for EVERYONE over 6 months of age to get a flu shot. This means YOU!!

Click on the picture for the CDC flu website:

There are very few legitimate reasons for not getting a flu shot.  An egg allergy is no longer a contraindication to receiving the flu vaccine, but if you have an egg allergy or experienced hives after a flu shot talk to your health care provider about the possibility of still getting one in their office where you can be observed for a while for adverse reactions.

For children age 6 months to 8 years two injections are necessary at least one month apart the first time they receive the vaccine. After that only one injection is needed annually.

The nasal spray vaccine is an option for healthy people age 2 to 49.

This year’s flu vaccine virus strains are identical to last year. This does NOT mean you can skip this year if you had a flu shot last year. It will have worn off and you will probably not be protected.

If you say you get the flu from the flu shot, think again. It is physically IMPOSSIBLE!! You may have arm soreness, but if you get any other symptoms (other than an allergic reaction) it is coming from some other source.

Be sure to subscribe to updates on the right side of this page so you can get more health and wellness info like this! I update it every 1-3 weeks so you won’t be flooded with emails!

Beginning this week I will be leading a discussion inspired by the book “A Bittersweet Season: Caring for Aging Parents-and Ourselves” on Wednesdays, October 5, 12, 19 and 26 from 7:00-8:00 PM in room M205. The book was written by “New York Times” journalist Jane Gross and chronicles the story of caring for her own aged and ailing mother.  She offers indispensable advice on virtually every aspect of elder care and candidly examines the caregiver emotional roller coaster.  We will discuss how her journey parallels and differs from ours and what we can learn from her and each other. Reading the book is not required, but recommended and I have copies available now and will have some on Wednesday.

• Children who did not sleep in their own beds had ADHD-like behaviors 7 times more frequently than children who always slept in their own beds.
• Children who did not sleep in their own beds hit, pushed, or kicked their parents 13 times more frequently than children who always slept in their own beds.
• Children who did not have a regular bedtime had ADHD-like behaviors 8 times more frequently than children who had a regular bedtime.
• Children who did not have a regular bedtime hit, pushed, or kicked their parents 10 times more frequently than children who had a regular bedtime.

In addition, our study showed clear relationships between bedtime habits and tantrums, self confidence, and notes home from school about behavior problems. Data collected indicated that approximately 33% of children are recommended ADHD medication, although prevalence rates of actual ADHD are only reported between 3%-10%.

Bedtime can be stressful in any household and it is crucial for children (and adults) to get enough sleep. Having a bedtime routine can really help both of these. How much sleep a child needs depends on how old he or she is and what type of bedtime routine they need can be an individual thing. One child may need some extra time to wind down and fall asleep, while another can take a bath, read a story and be asleep all in less than 30 minutes. There are many websites and books about getting babies to sleep through the night and bedtime routines for kids so you may need to try a few before you find the right one for your child. My advice is to keep it simple. The more elaborate the routine, the less likely you are to keep it up or to be able to stick to it while on vacation, during stressful times, or for babysitters or grandparents to be able to follow it.

I know one constant for my two children was their bedtime book from the time they were babies. Even when they were old enough to choose a book to be read or started reading to us at bedtime we always ended with that same book until they thought they were too old for it (sad mom face).  We ended up with 3 copies of the book so we always had one with us when traveling, but knew at least one was at home in case we accidentally left it somewhere.  Then it was prayers, an individualized “I love you” poem they helped make up when each of them was about two years old and lights out (this part continued for quite a few years after they ditched the good night book and we still do it as often as possible). All of that only took about 10-15 minutes, not including a bath which was not always a set time. They each had their own security object and one of my girls liked having a night light, but the other did not once she was in a big kid bed. So be consistent, but know if something is not working after trying it for a couple of weeks that you may need to try something different.

You may not know how much sleep your child really needs so here is a link to that information. One website that is full of info on bedtime routines and getting babies to sleep at night is www.babycenter.com. I also really like the simple “do’s and don’ts” in this about.com article. If you are looking for ideas for older children try Super Nanny’s website.

Also remember that tweens and teens need to keep some routine. Keep a set bedtime (as much as possible) and have a “tech free time” so after a certain time there are no cell phones, computers, TV, video games, etc. Personally, I do not like the idea of anyone under 18 having a TV or computer in their room (much to my children’s chagrin!) but having limits on when they can use them is important according to this article.

Hopefully some parents can use the information from the study to motivate them to establish some routines that will improve their child’s behavior and make it less likely they may be misdiagnosed and possibly put on medication they don’t really need. Not to mention just making bedtime less stressful!

A recent survey by Pew Internet found that 8 out of 10 adult internet users had looked for health information online. Also recently, I talked to someone who had received a new diagnosis from their physician who told them not to go home and “Google” their diagnosis. This person was given one mainstream website to find out general information and was told to meet with the specialist and get names of websites that have credible information from that doctor. There is so much information at our fingertips though the internet, but it can be contradictory, confusing or just plain wrong.

Being an educated patient is important and can help you and your physician plan the best care possible for you. Here are some tips to finding helpful information online:

-Ask your doctor or other health professional. Many of them use the internet to gain knowledge and they can direct you to reputable websites.

-Ask a trusted family member or friend who is web-savvy to look things up and forward you the ones that are most helpful.

-When looking at a website, look for the source. Who is putting out that information, a government agency, a university, a hospital, a business, or a health organization? Do they have a review or editorial board that reviews the information before it is posted? Is their information backed up by verifiable research? Is there easy to find contact information for the webmaster or author of an article?

-Look for the date the information was published. If it hasn’t been updated or reviewed in a year, look for more recent information.

-Be very careful about blogs, online discussions, chat rooms and other sites where lay people share their experiences. Many times they are not experts and some of these are for “worst case scenario” sharing and can lead to unnecessary anxiety. Some can be very helpful, just check out what you read with your doctor.

-If something sounds too good to be true, it probably is! Be skeptical of websites that use only testimonials from “Joe in Idaho”. If the claims cannot be verified by medical research by multiple sources, then beware.

Medical literacy is an important goal while trying to maintain health or dealing with an illness. No website can be a substitute for a health care professional, but you can gain knowledge through the internet that will assist you in being an active participant in your own health care decisions.

Next, look at the serving size. Are you eating 2 cups of pasta or cereal when a serving size is 1/2 or 3/4 cup? Add fresh fruit to your cereal or veggies to your pasta to make it much healthier.

Another “carb” is sugar. Limit sugar in your diet-this includes sweets, sugar, regular soft drinks and anything else that has sugar in it. Again, read labels. Some cereals that you might not consider “sugar cereals” still have lots of sugar added. This is critical if you are trying to lower triglycerides!

Since you have added more fresh fruits and vegetable to your diet, look at those as the main portion of your plate and the pasta or rice and protein as the side dishes instead of the main course.

Some suggested reading:

WebMD’s Cholesterol Management Center

Helping Loved Ones With Heart Disease Eat Right 

How What You Eat Affects Your Cholesterol

One of my favorite recipes uses spaghetti squash in place of spaghetti noodles ( I also add cooked spaghetti squash to soups):

Spaghetti Squash Casserole

1 Spaghetti squash cooked and pulled apart (instructions) (my tip-cook it ahead of time so it can cool well before you try to pull the “spaghetti” out ,then let it sit in a colander to get as much water out as possible)

1 Jar spaghetti sauce (Look for one that has lower sodium)

8 ounces Ricotta cheese (low fat)

8 ounces part skim shredded mozzarella cheese

Optional: cooked chicken cut in cubes or cooked ground turkey; I also doctor it up with whatever fresh herbs I have or dry italian seasonings.

 Instructions:

Combine the spaghetti squash, sauce, ricotta cheese and meat in a casserole dish. Cook covered in a 350 degree oven until bubbly and ricotta is melted-this usually only takes about 20-30 minutes. Stir occasionally. When it is nice and bubbly, spread the mozzarella over the top and cook until it is melted. I usually cook it for the last couple of minutes under the broiler to slightly brown the cheese, but you have to watch it!

 Hope this helps! Let me know if you have other suggestions for lowering cholesterol or recipes that are “heart healthy”.

• Pediatricians should highlight the difference between sports drinks and energy drinks with patients and their parents, and talk about the potential health risks.
• Energy drinks pose potential health risks because of the stimulants they contain, and should never be consumed by children or adolescents.
• Routine ingestion of carbohydrate-containing sports drinks by children and adolescents should be avoided or restricted, because they can increase the risk of overweight and obesity, as well as dental erosion.
• Sports drinks have a limited function for pediatric athletes; they should be ingested when there is a need for rapid replenishment of carbohydrates and/or electrolytes in combination with water during prolonged, vigorous physical activity.
• Water, not sports drinks, should be the principal source of hydration for children and adolescents.

www.aap.org, May 30, 2011

Read the article here

Now let me give you my take on it as a nurse, and as a mother. I totally agree with these recommendations! I don’t think energy drinks are necessary for anyone, much less children. There is way too much caffeine or other stimulants in them and in many cases they are loaded with sugar. Make sure if your children are asking for something that is sold with the soft drinks that it is not an “energy drink”. That is, if you allow soft drinks at all. Read more about energy drinks.

As far as sports drinks are concerned, I am a little more forgiving as are the recommendations. Most of the time they are not necessary, but some of the time they are permissible. When it is really hot and they are active outside, or they are sweating a lot a small size sports drink is OK, along with lots of water. Do not buy the large sizes-kids will drink the whole thing! Read more about sports drinks.

The bottom line is, encourage your children to drink water and drink lots of it. If they are outside and hot and sweaty, offer them water and some cold fruit. What’s better on a hot day than ice cold watermelon! When picking them up at day camp pack a cooler with some fruit in it for them to have in the car.

Remember to practice what you preach and drink plenty of water yourself!