Friday, August 30, 2013

Margaret Caldwell Working in Partnership with Clinical Service

Following an approach from Senior Management (NHSGG&C) Margaret has been facilitating a number of educational sessions for Community Support Workers (CSW).

As part of our wider Clinical Academic Career developments and Clinical linking these sessions involved some clinical teaching of clinical skills such as taking and recording electronic Blood pressure and manual pulse.

"Service gives so much to our students in clinical settings and here in the University and this is part of us giving something in return," said Margaret.

The sessions, supported by clinical staff were delivered in their own locality and evaluated well:

Participants indicate that the sessions were "Very informative" "Clear and simple, easy to follow" 
The Mental Health Nursing Team at GCU know the importance of developing clear links between themselves and Service and wish to support development opportunities for all grades of staff.  

"We want to work with practice rather than working in silos. This is work that we can take into the classroom with our students who now don't see us as being remote from practice. It enhances our credibility," Margaret added.

Wednesday, August 21, 2013

The Gift

I watched a mom this morning
Standing on our street
Her hand already empty
Her child was in his seat

She waved away the bus, and watched
It bounce around the corner
Then instantly the smile changed
From happy mom to mourner

"I hope he couldn't tell" she said
"I'm afraid to let him go,
His teacher's just so young this year!
What could she really know?"

"My son has allergies, you see
He's never been away
And now there's snacks and crafts and lunch
Will he be o.k. each day?"

"But I try to give him this one gift:
I show him I'm delighted
And hide my fear so he can be
Just happy and excited."

I saw them later, walking home
Her face, calm and relaxed
She stopped to show the teacher's note
Her son had just brought back

"I'm sure today was hard for you,
To have to trust a stranger
To send your precious child away
To a place so filled with danger"

But the place is also filled with love
And we'll work to keep him safe
Thank you for your precious gift
Thank you for your faith

I glanced down at her son and asked
"So how did you like school?"
His face lit up and he said "Just great!"
"My teacher is so cool!"

And as he skipped off down the street
She added one last thought
"I felt like I was falling,
Then I read that - and was caught"

"I thought letting go meant losing
But I didn't understand
In the end, you get a circle
If you all hold out your hand"

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Tuesday, August 20, 2013

New Food Allergy Action Plan from FARE...And It's...Confusing

I was very happy to see a notification in my Facebook feed that FARE has come out with a revised allergy action plan document. This one does a better job than the old form of pointing out severe symptoms. It also addresses instructions for all three of the major brands of epinephrine injector and gives important after-care instructions, the most crucial of which is that a person having a reaction should lay down and stay down.

But I do have to bitch a little about the form. Look at how the top of the form is laid out:

Do you see the issue? By putting the check boxes for when to give epinephrine inside of the symptoms boxes, it may confuse people into believing that epinephrine should be given immediately, even if the allergen was only likely eaten, for mild symptoms. What about if symptoms are severe but the allergen was only likely?

The better way to have done this would be to give each decision point its own area on a chart. All they would need to do is move the two check boxes ABOVE the severe/mild symptoms area, up in the same area where the asthma check box already is.

But my bigger-picture issue with the check boxes is that there are many more than just two decision points when it comes to deciding whether to give epinephrine. Does every allergen get treated the same? Every reaction history? How likely does the exposure need to be (especially for kids who don't get tell-tale hives)? What do you do if the kid has asthma and wheezing is the only symptom?

Here are the main three decision points (plus one I added for type of allergen) that I think the FARE form check boxes were trying to cover:

    NOTE: This is NOT medical advice! Really! I am putting this out there for discussion purposes and I expect each of you to talk this through with your doctor. 

    That said...I hope we can all agree that the first two lines are no-brainers. Personally, I think the third line should be a no-brainer, especially given the recent stories. But it's the next three lines where things get complicated. These are the situations each parent has to walk through with their own physician.

    There is a balance here, and clearly many FA parents need to be strongly encouraged not to be afraid to use epinephrine. The drug is woefully under-utilized during reactions: in one study, only about 1 in 3 people received epinephrine before arriving in the ER. At the same time, none of us want to be over-reacting and giving epinephrine every time our kid sniffles and might have touched a ball on the playground that another child also touched. (If you haven't read my previous post on why we hesitate to give epinephrine, now might be a good time.)

    Now, let's talk about the form.

    The form check boxes definitely need to be far simpler than the matrix above. One of my big issues with the new FARE form is this business about whether the child has actually eaten the allergen. What does "likely eaten" even mean? I definitely don't think the nurse should be running around, quizzing the kids the child ate lunch with!

    I also think the FARE group assumed that any allergy that justifies an epinephrine injector in the first place can probably be assumed to have the potential to cause a severe allergy. Finally, we want nurses to err on the side of administering epinephrine in an uncertain situation. Given all that, here is how I would have structured the top of that form:

    This form takes the decision point about whether an allergen was consumed out of the equation. It also gives a place for a doctor to indicate the need to be more aggressive with treatment in specific situations where nurses typically take a wait-and-see approach. Finally (my pet peeve), it reminds people that hives are not always present during severe reactions.

    FARE committee: if you're out there, I know you likely agonized over this form. I am being critical because I care. Because this is so very important. And because, as I said above, if I don't get it after 13 years of dealing with schools, others are also going to be confused.

    And plus, you know me. I always have an opinion. 

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    Monday, August 19, 2013

    Special Thanks to a Special Crew!

    HP employees harvesting beans for Stone Soup, our local soup kitchen
    Community volunteers are the heart of the SAGE garden; over 500 people a year come help us farm this one-acre plot of city land.  There are numerous ways to be involved; Tuesday night work parties, SAGE garden docents and numerous community groups who organize work parties.  

    HP employees
    harvesting broccoli (above)
    & harvesting beans (below)
    For the past couple of years employees of HP have been been working in the garden on a monthly basis.  As a garden manager, it is a big help for me to know that I will have a constant crew of hard workers.   Last year HP employees contributed 160 hours of service and that is a large chunk of help!  While each month the crew changes, there's always a familiar face (or two or three or four...) and of course, there is Shawn Collins, the amazing person who promotes these work parties at HP.   After our latest work party last Friday, I just wanted to tell the world "Thank You HP Employees!!!"

    I'm also excited to note that not only do HP employees help us out in the garden, they've also inspired their neighbors at the engineering firm, CH2MHill, to schedule regular work parties!  Thanks CH for making that commitment, you're help is so appreciated! 

    If you're interested in scheduling a work party for your work place or community group, please send me an email at:   We work with diverse groups and tailor each work party to the needs of that particular group.  Now that we're coming into fall, we're going to be needing a lot of harvesting help!  
    Shawn and Dave loading up mulch for pathways

    Thanks to ALL the amazing volunteers who help make SAGE a great place to learn and grow! 


    Garden Manager

    Friday, August 16, 2013

    Class of 2010 on their final day!

    Congratulations and good luck to the Class of 2010 from the MH Nurse teaching team

    Then watch as Ukulele Bill and Val serenade them on their last day by clicking here

    Wednesday, August 14, 2013

    TFA Replaces Real Teachers

    illustration by Robert Rendo

    (click image to enlarge)



    Feel free to lift this or any image from this website and use in your own advocacy material in your fight against corporate reform and privatizing public education. While I hold copyright, I am granting you a free license to use all images on this site, with the only condition that you credit the name "Robert Rendo" for the illustration. Usage includes any medium. 

    Friday, August 9, 2013

    Liberal, Overbearing, New Age, Alternative Medicine Food Allergy Moms

    My mom called the other night.

    "I talked to your cousin Donna last night. I told her she should call you. She's into a lot of the same stuff you're into."

    "Um...what stuff would that be, Mom?"

    "You know...all that stuff about the bees and GMOs and vaccines, honey. I told her you knew a lot about it and would be happy to talk with her."

    YIKES! Since when did having a kid with food allergies automatically qualify me for the willing-to-accept-every-random-theory club?

    As you guys know, I do a lot of reading and I have come to think there may be something to some of the alternative theories out there, particularly around pesticides and antibiotics killing off symbiotic gut bacteria. But I've also spent 25 years of my career firmly submerged in Western medicine and my mother knows this. So what the heck happened here?

    A week later, I wondered it all over again as I read this article on Slate. It's apparently debunking an Elle magazine story that links food allergies and GMO corn.
    Shetterly is the protagonist of her article, and the plight she faced that spurred her to write this story is truly sad. She was plagued for years by a variety of debilitating symptoms from headaches to fatigue to hands frozen into claws by pain. She went from one doctor to another, but no cause was identified and no cure found.

    On the recommendation of her physician, she went to see Maine allergist Paris Mansmann. Shetterly showed symptoms, he concluded, of eosinophilic disorder—a multisystemic condition in which white blood cells overproduce in response to allergens. These abundant cells release enzymes that break down proteins, which in turn damage the esophagus, airways, or other organs. But what was causing the reaction? Mansmann opined that Shetterly’s condition could be the result of eating genetically modified (GMO) corn. According to Shetterly, the Maine physician suggested she strip all corn from her diet.
    Eosinophilic esophagitis is a very real condition. However, the primary symptoms of the disease are difficulty swallowing and reflux, not headaches and fatigue. The treatment for EoE is indeed to remove foods from one's diet. But the strong impression that was left behind by this article (and which is reflected in the polarized, scathing comments section) is that allergy sufferers are crazy hypochondriacs willing to accept any theory and that allergies aren't real.

    I've talked in other columns about how food allergies have been polarized. One of my earliest columns was about how popular entertainment likes to portray kids with allergies as wusses. But how in the world did food allergies completely devolve from a medical condition to the place we're in today? Is it possible to rationally discuss the possible causes of food allergies without being immediately branded a conspiracy theorist?

    Contempt. That's the only word that describes the current state of food allergy acceptance. Education actually seems to be resulting in less acceptance, not more.

    I did end up talking to my cousin and she did run through the expected litany of bees/fluoride/plastics, etc. But the most interesting part of the conversation to me was her husband's voice in the background. If the sound of eyeballs rolling was transmittable through the phone, that's what I swear I was hearing. It was really important to this man (a corporate lawyer and a very nice, level-headed guy) to let me know he was distancing himself from the crazy broad he married.

    We're getting a strong societal message here. Don't talk about food allergies. Don't read about them. Don't consider the causes. Minimize them as much as possible. It's a political issue. It's a boring issue. No one is going to believe you anyway.

    How do our kids make sense of all this? They hide their allergies. THIS is why our teens are so much less safe than they could be. Don't believe me? Watch Louis CK's bit. He nails the contempt.

    Of course they would never hide their allergies and take big risks.

    But maybe.

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    Monday, August 5, 2013

    organic mac & cheese with butternut squash & bacon

    AColbourneNatrel Organic3AColbourneNatrel Organic4AColbourneNatrel Organic7AColbourneNatrel Organic1
             I have been thinking a lot about comfort food lately or maybe it’s more a craving? Either way with the chilly nights we've been having, it fits. So when I was approached to do another recipe for Natrel using their organic milk I immediately thought it had to be a comfort dish and what better then mac and cheese.  
    Mac and cheese has to be my go-to comfort food next to Shepherds pie and a really good lemony garlic pasta with spicy sausage and cherry tomatoes… mmm.  It’s one of those things that just seems to make everything right at that moment, even the hard ones.

    AColbourneNatrel Organic8AColbourneNatrel Organic6


    450g organic butternut squash (cut into 1inch chunks) 
    6-8 slices organic bacon
    350g organic macaroni
    1⁄2 tbsp butter

    3 tbsp flour
    3 cups of Natrel’s Organic milk
    1⁄4 tsp each of garlic powder, onion powder, paprika, & chipotle powder 1 egg (beaten)
    1⁄2 cups organic shredded cheddar cheese
    1 cup shredded jalapeno havarti cheese
    1⁄2 cup of brie, rind removed (cut into chunks)
    sea salt & cracked black pepper

    11⁄2 cups panko breadcrumbs
    1⁄2 cup of crispy fried onions*
    1⁄4 cup finely grated parmesan cheese 11⁄2 tsp chopped fresh thyme
    1 tbsp olive oil

    Preheat oven to 350 d

    Place butternut squash on a baking pan with a little olive oil and roast for 25-30 minutes or until brown and tender. On a separate baking pan lined with tin foil place bacon strips and cook on the lower rack of the oven for 10 minutes or until crispy. Drain on a paper towel and cut into half inch pieces.

    Grate your cheeses and set aside.

    Bring a large pot of water to a boil. Salt water generously and boil pasta until al denteh, 8-10 minutes. Drain and toss with a little olive oil to prevent sticking.

    While the water is boiling, in a large pot over medium-low heat, melt the butter then sprinkle in flour. Whisking constantly cook the mixture for 3-5 minutes or until the mix has turned light brown.

    Add the milk and spices to a small bowl and slowly add to the butter flour mixture whisking continuously until the mixture become thick. Reduce the heat to low.

    Add the beaten egg to the mixture making sure to whisk as you pour in the egg to avoid scrambled egg bits. Once combined add the cheeses in two batches until melted and creamy.
    Add salt and pepper to taste.

    Combine the breadcrumbs, crispy onions, parmesan and thyme with the olive oil, set aside.
    In a deep baking dish add the macaroni, butternut squash and bacon. Cover with the cheese sauce, stir to combine and top with the breadcrumb mixture. Place in the oven under a low broiler until the top has turned golden brown.

    *Crispy onions can be found pre-packed in most local grocery stores.

    Saturday, August 3, 2013

    The Food Allergy Herbal Formula-2 (FAHF-2) Laundry List

    So in all the time I've been writing about our experience with FAHF-2, I have never done a comprehensive post with all the links/info I've found over the years. Consider the situation rectified! I'll add to this as I find new sources. If you have good ones, please feel free to add them to the comments as well.

    My FAHF-2 Posts

    FAHF-2 Trials In Chicago!

    We're In

    BTDT, Got the FAHF-2 Food Allergy Clinical Trial T-Shirt

    Brief FAHF-2 Update

    Halfway There...But the Second Half Is All Uphill

    FAHF-2: The Holy Grail?

    Waiting in the Wings for the Show to Begin

    Other People's FAHF-2 Experiences (from around the web)

    Chinese pharmacy vs. through Dr. Li

    For severe eczema/MRSA

    New York Times article

    For asthma (Vitality magazine)

    An asthma patient's personal experience

    Description of Dr. Li's treatment plan

    What Is FAHF-2?

    Patent application (contains all ingredients)

    Phase 1 Clinical Trial Report (has very specific info about formula ingredients)

    Yellow Emperor's Inner Classic

    Page from Dr. Sicherer's book about Chinese herbal medicine

    Breakdown of ingredients (see chart)

    Wu Mei Wan (the traditional name of the treatment) - with pictures! 

    Ling-Zhi (added to Wu Mei Wan formula for FAHF-2)

    Very detailed breakdown with formula percentages (scroll down to "Chinese Herbals for Peanut Anaphylaxis" section)

    Sourcing it yourself (article about ezcema natural treatment in Canada) NOTE: I am not recommending do this  - simply providing a link

    Dr. Li profile (new patient appointments: Sharon Hamlin, at 212-241-1755)

    2012 AAAAI presentation summary (Allergy Notes)

    Research Articles

    Possible mechanism for how FAHF-2 works (added 8/23/2013)

    Change in PBMCs (immune blood cells) seen in kids in FAHF-2 trial (added 8/23/2013)

    Information About Future Clinical Trials

    All open clinical trials related to food allergy

    FAHF-2, Phase 3 (should it occur)

    FAHF-2, Phase 3 in Dallas - coming soon (link added 8/4)

    Xolair + FAHF-2?

    2012 Clinical Trial Summary (Dr. Sampson)

    FAHF-2 for Crohn's disease

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