By: Partha S. Sahana

In recent years, vaccinating children has become a hot topic in the world. Celebrities, doctors, homeopaths, and parents all have different opinions on whether children should be vaccinated, and if so, how often.  In the last 10 years, the rate of parents refusing to vaccinate their children has increased, with the rate of infectious diseases increasing along with it (Eby, 2017). One of the biggest problems surrounding the topic is vast amounts of misinformation.

So what is the truth behind this vaccine controversy?

MYTH: Vaccines cause autism

FACT: There is no scientific evidence that can prove a definitive link between vaccines and autism!

In 1998, an article was published by Andrew Wakefield in the Lancet paper that stated that the MMR (measles, mumps and rubella) vaccine contained toxic substances that went into the bloodstream, traveled to the brain, and caused children to develop autism (Gross, 2009). It was later determined that Wakefield had been paid by a company with a patent pending on a rival measles vaccine as well as acted unethically and participated in professional misconduct (Gross, 2009). While his paper was redacted and his findings were “debunked,” his paper created seeds of doubt that vaccines were unsafe and damaging to children.

Interesting research was done to determine if administration of the MMR vaccine showed an increase in instances of autism in children. Researchers decided to look to Japan for this information. In the span of 1989 to 1993, Japan vaccinated it’s population with the MMR vaccine. This time period is the only time in which Japanese people were vaccinated against the diseases. Theoretically speaking, if the MMR vaccine caused autism, then autism rates in Japan should have increased during the time period in which the Japanese were vaccinated. Upon studying data from before 1989 to the period between 1989 and 1993, there was no increase in the amount of people diagnosed with autism (Uchiyama, Kurosawa, Inaba, 2007). This study is just one of many that show there is no link or causation between vaccines and autism.

In one of John Oliver’s “Last Week Tonight” skits, he addresses some of the myths and issues surrounding vaccination with a twist of comedy. While he makes light of the topic, he brings up valid arguments and tries to relate the information to the viewer in a way they can understand. *Viewer discretion advised- some swearing*

MYTH: Vaccines contain harmful chemicals and carcinogens that can make my child sick

FACT: All vaccines except the flu shot are now made without thimerosal, one of the mercury-based ingredients that was a cause for concern. Even though the flu shot contains thimerosal still, Thimerosal-free versions also exist.

In 1997, the FDA was asked to measure the amount of ethylmercury (also known as thimerosal) used in vaccines. The study concluded that children were exposed to 187.5 micrograms of ethylmercury by the time they were 6 months old. At this time, there was no standard for the acceptable amount of ethylmercury a person could be exposed to. Ethylmercury is different from the typical mercury that we see in fish, that kind of mercury is call methylmercury. It was recommended as a precaution that all vaccines eliminate thimerosal as an ingredient, and as of March 2001, vaccines have been thimerosal-free (Gross, 2009).

The video below describes in detail some of the other preservatives or chemicals that are contained in vaccines that are a cause for concern to some parents such as formaldehyde and aluminum. The video explains why they are necessary to have in the vaccine as well as why they are harmless.

MYTH: Choosing not to vaccinate my child is no one’s business but mine.

FACT: There are many children and adults who are too sick or too young to receive vaccines who rely on every healthy child and adult to be vaccinated.

There are many children who may be too young to receive a vaccination against a certain disease, or that they have an illness that compromises their immune system. These children cannot get typical vaccinations and rely on what is called “herd immunity” to protect them from these infectious diseases. When a large percentage of the healthy population decides not to vaccinate their children, these unprotected individuals are put at risk (Gross, 2009). While every parent has the right to decide what is best for their child, when it comes to vaccines there is a bigger picture. The minute side effects of a vaccine are nothing compared to the illness or death that may result if a child is not vaccinated.

Below is a video which investigates how homeopaths view vaccination, as well as “alternative” vaccine treatments and how young children are susceptible to disease when people forgo vaccinations.

When trying to get information about vaccines or any other topic, be sure to look for people who have evidence to back up what they are saying. As you could see in the last video, the homeopaths and Isaac Golden do not have any clinical studies or research to support what they are claiming. Vaccines have been proven to be safe by copious amounts scientific research in various fields. Looking for scientific statements of fact is extremely important to weed through the misinformation.

References

Eby, A. (2017). Impacting Parental Vaccine Decision-Making. Pediatric Nursing, 43(1), 22-34.

Gross, L. (2009). A Broken Trust: Lessons from the Vaccine-Autism Wars. Plos Biology, 7(5), 1-7. doi:10.1371/journal.pbio.1000114

Uchiyama, T., Kurosawa, M., & Inaba, Y. (2007). MMR-Vaccine and Regression in Autism Spectrum

Disorders: Negative Results Presented from Japan. Journal Of Autism And Developmental Disorders, 37(2), 210-217.

People with terminal diagnoses have the knowledge that they are going to die but don’t know when.  They have pain, they lose function, they become confused, and they lose their dignity.  These patients enroll in palliative or hospice care, where they and their families are made as comfortable and supported as possible.  Although palliative and hospice care are options, some may wonder about other options for people with terminally ill diagnoses?  In the states of Oregon, Washington, Vermont, California, Colorado, and most recently Washington D.C., there is another option, physician’s-assisted suicide.  Physicians Assisted Suicide (PAS) is an end-of-life option that allows certain terminally ill patients to voluntarily choose to end their life with dignity (Death with Dignity, 2016).

Critics claim that PAS could become a cause for abuse on elderly and mental disabled persons.  The fear is that family members or loved ones, will take advantage of the vulnerable person, such as: the elderly, the disabled, and the depressed; and convince them to die sooner via PAS (Saunders, 2014).  Regarding the law, Jennifer Popik (2016) writes, that based on experiences from Oregon residents’, government and insurance companies won’t do the right thing, meaning they would rather pay for lethal doses of medication than for treatment that may cost thousands of dollars.  Legalizing assisted suicide is a recipe for elder abuse and abuse of persons with disabilities, as critics of PAS have noted (Popik, 2016).  However, there are safeguards in place to prevent abuse and advantage of other persons.

Myth: Physician’s Assisted Suicide is going to lead to abuse of elders, disabled persons, and depressed persons.

Fact: Patient’s who choose PAS as an option have criteria that need to be met. This criteria includes: being a mentally competent adult resident of one of the five states with a law, having a terminal diagnosis which leads to death within six months, and be able to administer and ingest the medication on their own (Death with Dignity, 2016).  The patient must also have two doctors determine if the criteria above are met, and must orally request this option twice and written once with waiting periods in-between (Death with Dignity, 2016).

Myth: Besides the fives states and the District of Columbia, there are no other means of assisted suicide.

Fact: Kathryn Tucker (2015), Executive Director of Disability Rights Legal Center,  points out that there are other means of assisting in a persons’ death that are already legal such as: removing a ventilator or feeding tube, deactivating a cardiac device, and palliative sedation. With these means of death the person doesn’t have to be mentally competent and their family members can choose this for them. Other means of precipitating death include: doctors suggesting to the patient to voluntarily stop eating and drinking, stop treatment or not start treatment, or use of palliative sedation, which can take several days to weeks to months to take effect (Death with Dignity, 2016).

In conclusion, physician’s assisted suicide may be a cause of concern for some, but for others it is a way to find peace and dignity in a horrible situation.  In patients who are already facing death, a sense of comfort and control is what they want and what they deserve.  Physician’s assisted suicide is becoming a more prominent option for patients with a terminal illness.

References:

Death with Dignity., (2016)., FAQs., Death with Dignity National Center and Death with              Dignity Political Fund., Portland, OR.

Jimenez, C., (2017). What is the right to die movement? The Washington Post. Retrieved on August 13, 2017 from https://www.washingtonpost.com/video/politics/what-is-the-right-to-die-movement/2017/07/18/fd8b4ff6-6be5-11e7-abbc-a53480672286_video.html?utm_term=.7333f6f2a240

Popik, J. (2016)., Assisted suicide measures imminent in three states, more states to be targeted in 2017. National Right to Life News. Pp. 20 & 43. National Right to Life

Saunders, P. (2014). Doctors strike back at BMJ editors over assisted suicide stance. National Right to Life News. P.28. National Right to Life.

SodaHead., (2015). Death with dignity approved in California. Citizens Report. Retrieved on August 13, 2017 from http://www.citizensreport.org/2015/09/21/california-approves-right-to-die/

The Editorial Board, (2015). Physician-assisted suicide laws grant dignity: Our view. USA Today. Retrieved on August 13, 2017 from https://www.usatoday.com/story/opinion/2015/10/20/our-view-physician-assisted-suicide-california-oregon-editorials-debates/74282866/

Tucker, K.L. (2015)., Normalizing aid-in-dying within the practice of medicine., Hastings Center Report., p.3., Los Angeles, CA: Wiley-Blackwell.

Are you aware that over 100,000 individuals are living with Sickle Cell disease?

Sickle cell disease (SCD)is a genetic disease which causes some of the red blood cells (RBC) to be concave or banana shaped instead of round to properly carry oxygen.  This disease is commonly found in black or African American individuals.  This disease may lead to other health problems or co-morbidities that greatly affect the life of a growing child.  Living with SCD as an adolescent can greatly affect them physically, academically and psychosocially.

Physical Challenges

Sickle Cell Disease (SCD) can cause vaso-occlusion or poor blood circulation of the vessels within the individual’s body. If there is poor circulation then that results in poor oxygen distribution which my lead to extreme pain and discomfort.  SCD teens are often hospitalized in times of sickle cell crisis, when vaso-occlussion occurs.  This can often cause them to be behind academically. They are also greatly susceptible to strokes or cerebral vascular accidents (CVA).  Unfortunately controlling the symptoms of this disease may pose a bit of difficulty as many factors may trigger pain and discomfort.

Triggers/Influential factors

Stress, anxiety, environment, sleep disturbances and infection are some of the common factors that may bring on pain symptoms that accompany this disease. In this time of growth and development who doesn’t know a teenager who is encountering some sort of stress or anxiety. Whether it may be from making new friends, knowing what to wear, school work and understanding their body, all of these factors may pose or trigger stress in some way. Environmental issues such as extreme weather can also trigger a sickle cell crisis which is extremely painful on the individual. Lastly, colds and flu’s are common amongst us all but especially individuals who are in the school setting. SCD teens have to ensure that they keep a handle on other acquired illnesses to prevent periods of worsening of their symptoms.

Psychosocial Challenges

Living with SCD can have a great impact on the psychosocial aspect of a teen’s life. At this point in life teenagers are trying to gain their independents and coming into their own. Many regular teens often join the foot ball or cheer leading team and get involved into extracurricular activities that may interest them. With SCD, affected adolescents have to take into consideration the many limitations that they may have which is not pleasing to them.  Children and adolescents living with SCD may be at increased risk for depression and anxiety. Those many hospital visits may cause a great number of absents from school. This may cause distance of their friendships with their peers.  Not being able to perform in certain activities that their peers may be into can also heavily affect them. The increase need for or protection by their parents may cause teens to feel as though they have no independence.  Continuous episodes of pain and discomfort can also contribute to heightening their anxiety.

Tips

• Allow/encourage affected teens to express themselves about their disease.
• Do not baby them (they have an illness they are not their illness)
• Encourage them to get involved in activities that are appealing yet suitable for their disease
• Determine their level of responsibility over their illness and trust that they can be responsible
• Encourage them to be a “normal” as possible.

Conclusion

It is essential that we educate ourselves on the ways in which sickle cell disease affect adolescents and to better communicate with them and help them to cope with their symptoms. Having any chronic or long term disease is never easy on any patient or individuals. Empathy, compassion and respect are necessary in caring for and contributing to the lives of these patients so they will in turn have a better quality of life. Remember these individuals have sickle cell anemia  however this does not define them.

References

Abel, R. A., Cho, E., Chadwick-Mansker, K. R., D’Souza, N., Housten, A. J., & King, A. A. (2015). Transition Needs of Adolescents With Sickle Cell Disease. American Journal Of Occupational Therapy, 69(2), 1-5. doi:10.5014/ajot.2015.013730

Graves, J. K. (2016). Continuing Nursing Education. Depression, Anxiety, and Quality of Life In Children and Adolescents With Sickle Cell Disease. Pediatric Nursing, 42(3), 113-144.

Musumadi, L., Westerdale, N., & Appleby, H. (2012). An overview of the effects of sickle cell disease in adolescents. Nursing Standard, 26(26), 35-40.

Opioid Addiction

It is important to know that addiction is not gender specific. Most recently, females have had a higher increase in a shorter period of time, however, there is a higher incidence of male addicts than females.  The most popular age range is 18-25 years of age.Their are more non-Hispanic whites than other ethnicities, and It is shown to be more prevalent in households where annual income is lower than $20,000. It is also more prevalent in people that are uninsured. With, opiate use especially Heroin, it has increased among all demographic groups.

Their is both pharmacological treatment and psychological treatment options. It is very important to encompass the whole individual. You need to take into account a patients mental health along with their addiction. Ignoring this can make treatment and recovery unattainable.

Risks of Heroin use:

Death, HIV, serous health conditions including collapsed veins, infection of heart lining and valves, abscesses bacterial infections, arthritis, and other rheumatologic problems, constipation, GI cramping, liver and kidney disease, various types pf pneumonia and spontaneous abortion.

If you suspect someone you know is using heroin or has an opioid addiction You can purchase Narcan which can be administered nasally in case of overdose. You can give them the treatment referral line phone number 1-800-662-HELP which is available 24 hours a day, 7 days a week. Learn the signs and symptoms of overdose, call 911 for a overdose, get rid of all unused, expired or unneeded prescription drugs in your home, and you can visit the Office of National Drug Control Policy which has prepared a helpful guide on how to prevent opioid deaths in your community.

The increasing availability of prescription fentanyl has provided a supply stream in which criminals can steal the drug from hospitals, pharmacies and patients’ medicine cabinets and sell it on the streets. As well, Chinese labs are making and selling cheap fentanyl, which North American drug dealers import and cut into other substances to increase their pro ts. According to Serr, one kilogram of Chinese fentanyl that costs $12,000 can be made into a million pills worth as much as $80 million.

What happens in a fentanyl overdose…

Fiction: A fentanyl overdose isn’t any different then any other overdose.

Fact: A fentanyl overdose has the same clinical symptoms as any other opioid overdose, except that the onset is often faster. The patient is often unresponsive, breathing is slow or has completely stopped. They usually will have an erratic, weak, or no pulse at all. They will lack oxygen, causing blue lips, and fingernails. They will have a dusky (grey) colored skin, and it will be very clammy to the touch. This is a respiratory emergency, they are almost completely derived of oxygen due to the brain basically shutting down.

How to treat a fentanyl overdose…

Fiction: A person who overdosed will come back on their own without medication

Fact: When a person overdoses on fentanyl, the drug Naloxone is often used. Sometimes if the patient has stopped breathing or their heart stopped CPR is also performed. If the first dose of Naloxone does not work, more doses can be administered every 3-5 minutes. A person who is overdosed on fentanyl is often much more difficult to revive then someone who overdosed on a less potent drug. Naloxone used to only need to be used once for the patient to become responsive again, it is now becoming more popular to use 2-3 doses of Naloxone to bring the patient back to consciousness. Naloxone is most commonly administered through the nasal passages, as shown below. You can also give it via intramuscular or through an IV

Are other street drugs laced with fentanyl…

Fiction: Marijuana, cocaine, and heroin can’t be laced with fentanyl.

Fact: Fentanyl has now become an additive to other street drugs without peoples knowledge. The drugs that are laced with fentanyl have street names such as Drop Dead, Flatline, and Lethal Injection. Healthcare workers started to notice a spike in overdoses and overdose deaths last year. Toxicology reports of autopsy materials began to reveal the presence of fentanyl, which is why police began to test heroin from the streets for the presence of fentanyl.

Reference:

Administer Naloxone

JAIMET, K. (2017). The Fentanyl Crisis. Canadian Nurse, 113(1), 23-25.

Boddiger, D. (2006). Fentanyl-laced street drugs ‘kill hundreds’. Lancet, 368 North American Edition(9535), 569-570.

Lifestyle Changes To Help Manage Depression & Anxiety

By: Mark Ingle

Depression and anxiety disorders are different, but people with depression often experience symptoms like those of an anxiety disorder, such as nervousness, irritability, and problems sleeping and concentrating. But each disorder has its own causes and its own emotional and behavioral symptoms.

Depression is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

Two of the most common forms of depression are:

• Major depression
• Persistent depressive disorder

 Other depressions that occur under certain circumstances:

• Perinatal Depression
• Seasonal Affective Disorder (SAD)
• Psychotic Depression

Anxiety is a common emotion, often accompanied by physical feelings of uneasiness. These feelings urge us to escape or avoid a seemingly threatening situation.

Types of anxiety disorders:

• Generalized Anxiety Disorder
• Social Anxiety Disorder
• Panic Disorder

Anxiety and depression are common and each being associated with significant functional impairment and future mental health problems:

• Reckless behavior
• Poor School/Work Performance
• Relationship Problems
• Health Concerns
• Suicide
• Addiction
• Self-injury

Comorbidity means the presence of two or more distinct, co-occurring disorders in one person at the same time.

Individuals who are generally suffering from both anxiety and depression co-morbidly have been found more likely than those suffering from one or the other to use mental health services and to report more suicide attempts, periods of disability, greater life dissatisfaction, less job satisfaction, and less social stability.

Many people who develop depression have a history of an anxiety disorder earlier in life. There is no evidence one disorder causes the other, but there is clear evidence that many people suffer from both disorders.

Treatment for Anxiety & Depression

• Medications called antidepressants can work well to treat depression. They can take 2 to 4 weeks to work.
• Psychotherapyhelps by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression.
• Electroconvulsive therapy (ECT) and other brain stimulation therapies may be an option for people with severe depression who do not respond to antidepressant medications. Yes, this is the brain shock thingy however ECT is the best studied brain stimulation therapy and has the longest history of use

Medication treatment of anxiety is generally safe and effective and is often used in conjunction with therapy. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions, and other individual circumstances.

Nor anxiety or depression is curable however there are ways to help yourself cope and manage the symptoms along with taking prescribed medication.

• 5 X 30: Jog, walk, bike, or dance three to five times a week for 30 minutes.
• Set small daily goalsand aim for daily consistency rather than perfect workouts. It’s better to walk every day for 15-20 minutes than to wait until the weekend for a three-hour fitness marathon. Lots of scientific data suggests that frequency is most important.
• Find forms of exercisethat are fun or enjoyable. Extroverted people often like classes and group activities. People who are more introverted often prefer solo pursuits.
• Distract yourselfwith an iPod or other portable media player to download audiobooks, podcasts, or music. Many people find it’s more fun to exercise while listening to something they enjoy.
• Recruitan “exercise buddy.” It’s often easier to stick to your exercise routine when you must stay committed to a friend, partner, or colleague.
• Be patientwhen you start a new exercise program. Most sedentary people require about four to eight weeks to feel coordinated and sufficiently in shape so that exercise feels easier.
• Be creative. Direct your focus into something constructive. Rediscover your strengths. If you have a long-lost talent or interest, dive back into it. Try poetry, music, photography, or design.

Watch to see how exercise helps change your mood

Top foods to eat to help with depression/anxiety

Here is a link to screening tools that can be shared with your health care provider:

https://adaa.org/living-with-anxiety/ask-and-learn/screenings

Take a deep breath and H.O.P.E (Hold on Pain Ends)

References

Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological bulletin, 140(3), 816.

https://adaa.org/tips-manage-anxiety-and-stress

http://www.ulifeline.org/articles/396-the-dangers-of-depression

Pandey, S. C. (2014). Anxiety and Alcohol Use Disorders: A Perspective from Molecular and Epigenetic Studies. In Neurobiology of Alcohol Dependence (pp. 451-466). Elsevier Inc.. DOI: 10.1016/B978-0-12-405941-2.00022-5