This day and this month

Wikipedia defines caregiver as an unpaid or paid person who helps another individual with impairment with his or her activities of daily living. Merriam-Webster defines a caregiver as a person who gives help and protection to someone (such as a child, an old person, or someone who is sick). Veterans Day is almost over and perhaps this is a good time to reflect on war injured veterans who require another individual to help them with activities of daily living.

When we think of disabilities the obvious first comes to mind – paraplegia, blindness, single or multiple amputations, maybe severe scarring. When we think further we may think about the invisible disabilities – traumatic brain injuries (blasts are the leading cause of TBI), psychological injuries, internal injuries with lasting effects. For these veterans, their war goes on. It also goes on for their caregivers. November is National Family Caregivers Month.

Family caregivers are unpaid yet they care for many, if not most, of our disabled veterans. Caregivers also care for our elderly who may have one of the dementias, such as Alzheimer’s disease, or are frail due to age. They care for our children and adolescents who may have congenital, traumatic or illness related disabilities. They sometimes care for our dying.

It’s their family responsibility you say? Maybe. But whose responsibility is it when they need care?

Caregiving is grueling work. It is physically, emotionally, and mentally exhausting. Anyone who has been responsible for a toddler for even one day knows this. But a toddler grows into a child and becomes more independent. Imagine having a toddler for all of your life. That is not to say that there aren’t rewards in caregiving. But the rewards don’t come in the form of free time or rest, things that everyone needs. These rewards are intangible and don’t really make up for disturbed sleep, postponed or forgotten social engagements, or disturbed relationships.

So today and this month and all the time, let’s thank our veterans and let’s thank the caregivers. Let’s do something for them. Are you listening Veterans Admiration? Are you listen Federal Government? Are you Listen State Government? Are you listening?

What is dementia? A quick synopsis.

Dementia is the name given to a group of disorders characterized by multiple cognitive deficits. Dementia may have many different causes. Among them are traumatic brain injury, Parkinson’s disease, Lewy bodies (small “lumps” of protein) that form in brain cells, Alzheimer’s disease, nutritional or hormonal deficiencies, infection, and tumor. This is not an exhaustive list. There are many potential causes of dementia. Treatment depends on the cause.

When someone has dementia, what are we saying? Dementia is more than memory loss. Symptoms vary among individuals. There may be personality changes, e.g., inappropriate behavior. There may be changes in mood, e.g., depression. There may be difficulty planning tasks. There may be changes in motor function. Symptoms vary with the location in the brain that is affected.

Diagnosis in the early stages can be difficult because of this variability of symptoms. Is it stress? Depression? A psychosis brought on by exposure to a toxic substance? Or is it one of the progressive dementias, such as Alzheimer’s disease?

Bottom line? Consult a healthcare professional if symptoms persist or seem to be getting worse. Treatment may be as simple as hormone replacement. If it is truly one of the progressive dementias, there is no cure. But medication can slow the process and give many quality years following diagnosis.

Be Aware of COPD

COPD (chronic obstructive pulmonary disease) is the third leading cause of death in the United States, behind heart disease and cancer. Lung cancer is the #1 leading cause of cancer deaths in both men and women. More on that another day.

Smoking is the primary cause of lung cancer and COPD. It is one of the causes of heart disease. This blog is not going to be a diatribe against smoking. You all know it’s bad for you. You all know you should quit or not start. Enough said. Oh, as an aside, smoking marijuana is as bad for your lungs as is tobacco. Think twice before you smoke marijuana recreationally.

Dying from lung disease is very unpleasant. Yes, I’ve seen it. I’ll spare you the graphic details. Instead I’ll tell you what happens to the lungs in COPD and let you think about it.

First, a very brief anatomy lesson (with apologies to my anatomy professors). You have two lungs, one on each side of your heart in your chest cavity. The lung on the left side has two lobes and extends further down that the right lung, in order to make room for the heart, which tilts slightly to the left. The lung on the right has three lobes and does not tilt downward, in order to make room for the liver, which is below the diaphragm. Each lobe of the lungs is further divided into segments.

As you breathe, the air travels from your nose into your trachea, basically a tube in your throat. The trachea branches left and right into the left bronchus and the right bronchus (plural: bronchi), which divide into ever smaller tubes, called bronchioles. Imagine a tree with ever smaller branches. Each bronchiole ends in an air sac called an alveolus (plural: alveoli – I am so glad I took Latin in high school). This is where the air you breathe ends up.

Your blood vessels also get smaller and smaller as they enter the lungs. The smallest blood vessels, which should be full of gaseous waste products, transfer the waste into the alveoli and pick up oxygen from the alveoli. So, if your lungs are healthy, you breathe in oxygen and breathe out waste.

COPD is actually a pair of lung diseases: emphysema and chronic bronchitis. In emphysema, the walls of the alveoli have been damaged and either the alveoli can’t contract enough to expel the waste or the walls are too thick to go through the exchange process. In chronic bronchitis (-itis at the end of a word means inflammation), the irritated bronchial tree secretes mucus, lots of mucus. Eventually there is so much mucus that the individual with chronic bronchitis can’t expel it all. This interferes with breathing.

Both emphysema and chronic bronchitis progress slowly. But the end is an inability to breath, either because oxygen and waste can’t be exchanged or because there is an obstruction preventing breathing. Breathing is not only necessary for life. It is also necessary to perform the everyday tasks of life: eating, standing, dressing, brushing your teeth, even smiling and, of course, laughing.

There is no cure for COPD. The severity of the symptoms can wax and wane. It is not reversible. But life style changes and medications can make you feel better. Consult with your healthcare provider. Don’t smoke.

For more information:

Drug Shortages

#shortages:  Fomepizole Injection (Antizol)
Methylphenidate Hydrochloride ER Capsules/Tablets (Ritalin LA)


Sanofi US #recalls all Auvi-Q (epinephrine injection, USP) lot no 2299596 thru 3037230 exp 3/16 thru 12/16
Premiere Sales Group #recalls RHINO 7 3000 capsules  ALL LOT NOs WITHIN EXPIRY & Rhino 7 Platinum 3000 Capsules ALL LOT NOs WITHIN EXPIRY.

Drug Shortages and Three Discontinuations from the FDA

October 28, 2015


Epinephrine Injection (Updated – Currently in Shortage)
L-Cysteine Hydrochloride Injection (Updated – Currently in Shortage
Leuprolide Acetate Injection (Updated – Currently in Shortage)
Levetiracetam (Keppra) Injection (Updated – Currently in Shortage)
Metoprolol Injection (Updated – Currently in Shortage)
Piperacillin and Tazobactam (Zosyn) Injection (Updated – Currently in Shortage)
Tobramycin Injection (Updated – Currently in Shortage)
Reserpine Tablets (Updated – Currently in Shortage)


Dipyridamole (Persantine®) Tablets (New – Discontinuation)
Meloxicam (Mobic) Oral Suspension (New – Discontinuation)
Oxybutynin (GELNIQUE 3%) Gel (New – Discontinuation)

I was just thinking.

An article in this week’s Science Times (NY Times, October 27, 2015) got me thinking. Do you know how your school system treats disabled students? Do you care? You should. Anyone of any age at any time can become disabled. You or a loved one can develop a chronic physical or mental “disease” or incur trauma with long-lasting consequences. A loved one can be born with a congenital condition. Imagine your child or grandchild develops a chronic but manageable illness. Then imagine that her school system refuses to allow her attendance because of it, whether she is attempting enrollment for the first time or has been an exemplary student for ten years.

Impossible! No, it is not. This is a situation that children with Type 1 diabetes face in many schools, public or private. The main reason given is that there is no one qualified to monitor blood sugar and give insulin or glucagon (for very low blood sugar) if necessary.

Type 1 diabetes was formerly known as juvenile or insulin-dependent diabetes. Type 2 diabetes was formerly known as adult onset or non-insulin dependent diabetes. However, the names were somewhat confusing because insulin-dependent diabetes can have its onset in adults and children can develop non-insulin dependent diabetes. It’s much easier to remember that in Type 1 diabetes the individual makes little or no insulin naturally in the pancreas. In Type 2 diabetes the pancreas makes insulin but the individual’s body is resistant to it and needs medication to help with the process.

So, what makes an individual qualified to test the blood for sugar levels and, if necessary, give insulin or glucagon (both injected)? Some school systems maintain (as does The American Nurses’ Association) that only a licensed nurse is qualified. Other school systems are willing to accept as qualified an adult volunteer who has been trained by a health professional. Some school systems, without a licensed nurse on staff, will not accept the volunteers or have no one willing to volunteer. Some schools say that a parent (or parent-designated adult) must come into the school to monitor the child. Other schools simply transfer the child to another school or, if a private school, simply say the child cannot attend.

Back to my thinking. If schools can do this when a child is newly diagnosed with diabetes (please read the Times article for the full story), what stops them from doing this when a child becomes disabled due to an accident? Is the problem the blood monitoring (aka, a “finger stick”) or the injection or the worry about a lawsuit? What happens to a newly disabled child who must have assistance with eating or who must have assistance to expel urine? What happens to any child who no longer fits the picture of “normal”?  What about the Americans with Disabilities Act?

I don’t know the answers to my questions, either in my school system or in any other. I’ve realized that this is a gap in my knowledge as a citizen. An even worse gap is that I don’t know where to find the answers. It’s election season. Maybe I should find out.

Mary Lou Bernardo, PhD, MSN


My Recent Tweets

  • #DrugDiscontinuations: Clopres (Clonidine Hydrochloride & Chlorthalidone) & Accuretic (Quinapril Hydrochloride & Hydrochlorothiazide) 1 week ago
  • #Recalls All lots Mrket Dict brand Apricot Logs & Poppyseed Logs prep'd & sold inside Giant Eagle & Market District suprmrkts 11-7 to11-17 1 week ago
  • #Recalls 10 oz. cans of Happy Holidays Pecan Turtledoves Chocolate Caramel Pecan Clusters at company's Wakefield, VA location; peanut alegry 1 week ago


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