Gastroparesis: A slow-emptying stomach can cause nausea and vomiting

If you have a daily commute, a backup of traffic or road work may delay you, but you’ll eventually reach your destination. Gastroparesis, a digestive condition, can be imagined as a slowed commute through the stomach. But the delay involved can cause uncomfortable symptoms, and may have other health consequences that can affect nutrition and your quality of life. Although gastroparesis affects millions of people worldwide, many people are much more familiar with other gut problems, such as acid reflux and gallstones, that can cause similar symptoms.

What is gastroparesis?

Gastroparesis is a condition that causes delay in the emptying of the stomach. When you swallow food, it travels through your mouth and into a long tube called the esophagus before entering your stomach. Your stomach serves two separate functions: The first is to relax to accommodate food and liquid until you feel full. The second is to churn the food and liquid into a slurry that then passes into your small intestine to be digested. When either function is disturbed, slower-than-normal emptying occurs.

What are the symptoms of gastroparesis?

Nausea and vomiting are two of the most common symptoms of gastroparesis, most likely stemming from the sluggish emptying of the stomach. Typically, these symptoms occur toward the end of meals or soon after meals are finished. A third common symptom is abdominal pain caused by a combination of motor nerve and sensory nerve dysfunction. When motor nerves aren’t working properly, food and liquid can be detained in the stomach. When sensory nerves aren’t working well, signals between the gut and the brain are not communicated effectively, which can cause pain, nausea, and vomiting.

A growing body of evidence suggests that gastroparesis overlaps with a disorder of gut-brain interaction called functional dyspepsia, which is recurring indigestion that has no apparent cause. Other health problems can cause similar symptoms as gastroparesis, such as gastric outlet obstruction and cyclic vomiting syndrome, or even conditions beyond the gut, such as glandular disorders. So it’s important to discuss any symptoms that are bothering you with your doctor to get the correct diagnosis.

Who is more likely to experience gastroparesis?

Many misconceptions exist about the typical person with gastroparesis. For example, it’s not true that people must have diabetes to have gastroparesis: only 25% of people with gastroparesis have diabetes. Most commonly, no clear cause for gastroparesis can be found among people who have the condition.

Additionally, people are more likely to experience gastroparesis if they

  • take certain medicines, such as opiate pain medications and some medications for diabetes
  • have had surgeries, radiation, or connective tissue disorders that affect the function of the nerves of the gut
  • are female, because women are several times more likely than men to have gastroparesis.

Thus far, there is limited information on health disparities among people with gastroparesis, although one study shows that diabetes is more likely to be the cause of gastroparesis among Black and Hispanic patients than white patients. It’s not yet clear why, although socioeconomic inequities that affect health outcomes may be a factor (as is true for many other conditions).

How is it diagnosed?

Diagnosing gastroparesis and deciding on the best treatment strategy requires a careful patient history, blood tests, imaging tests, and sometimes endoscopy. Usually, people first discuss their symptoms with a primary care doctor who can rule out some possible causes and refer them to a specialist to discuss next steps, such as imaging or endoscopy, if necessary.

A common imaging test used in the US is called a gastric emptying scan, which takes four to five hours. The person having the test eats a standardized meal, such as an egg sandwich, that contains safe levels of medical-grade radiation. At certain intervals, images are taken to see how much of the meal remains in the stomach. During normal digestion, about 90% of the stomach is emptied within four hours and 10% is left behind; more than this amount remaining meets a key criterion for gastroparesis.

It’s worth noting that the exact amount of stomach emptying in four hours may fluctuate and may be influenced by other health factors, such as uncontrolled blood sugar, or certain medications, particularly opiate pain medicines.

How is gastroparesis treated?

The main goal of treatment is to address the symptom that bothers you the most. Depending on your diagnosis and symptoms, treatment might involve one or more of the following:

  • Medications. Erythromycin and metoclopramide speed up emptying the stomach. A newer medicine called prucalopride may have the same effect. Other medications, particularly for people who are finding pain and nausea more problematic, target disordered gut-brain interaction using neuromodulators, such as older forms of antidepressants and neuropathy medications. These medicines may improve sensation of the gastrointestinal tract.
  • Procedures and surgeries. A gastroenterologist may suggest different endoscopy techniques that improve stomach emptying by disrupting a valve between the stomach and the small intestine called the pylorus. One approach, called a per-oral pyloroplasty, does not require surgery. A surgical approach called laparoscopic pyloroplasty reshapes the muscle of the valve between the stomach and small intestine to help the stomach empty more quickly. Less often, surgically implanting a gastric stimulator to help improve the signaling between gut and brain may be considered.

If you have gastroparesis, be sure to discuss all these treatment options to see which one is best for you.

Follow me on Twitter @Chris_Velez_MD

Are You Depressed? Know The Signs

Nurses often work in high-stress environments and deal with life and death situations. This makes us almost twice as likely to experience depression as people in other professions. That’s why it is important understand the signs and know how to get help. The good news is that since we’re in the health care industry, we have access to the treatment and support needed to recover.

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 Depression vs. Burnout
“People talk about depression and burnout as if they’re interchangeable, but they’re not,” says Karen Anderson, Clinical Nurse Specialist for Patient and Family Centered Care at the Hospital of The University of Pennsylvania.

  • Depression is a psychiatric illness with clear symptoms that are outlined in the Diagnostic Statistical Manual of Mental Disorders (DSM-5).
  • Burnout is focused on your work experience, while depression is something that you will feel in all areas of your life.
  • Compassion fatigue is a type of burnout that impacts the emotional connection nurses have with their patients and causes them to disengage.

“The sad thing about throwing these words around is that there are people who rationalize that burnout is just part of the profession. However, they may really be depressed and can be getting active treatment. The treatment is different from how you would work with someone who is burnt out,” says Anderson. “It’s important for nurses to say, ‘Something is different in my life. I don’t feel the same. Depression may be a variable.’”
 
Recognize the signs
Although the symptoms of depression are not always visible, there are traits to look for, such as:

  • Sleep disturbance
  • Changes in appetite
  • Feeling hopeless
  • Irritability
  • Feeling less engaged in activities you used to enjoy
  • Feeling isolated
  • Not finding joy in life
  • Bringing less energy to work and with patients

“One of the best things we can do is to be open to feedback from the people we love, trust, or work with every day,” says Anderson. If colleagues or family members ask if anything is wrong or why you seem to be having a string of bad days, it might be time to do a self-assessment and talk to a professional.
 
How to help a coworker
Nurses often know their colleagues well because they spend so much time together. If you recognize the symptoms of depression in a fellow nurse, it’s important to talk to the person about it.
 
Timing and place are important. “You want to prep the person and set up the conversation so it’s not a surprise to them,” says Anderson. “You don’t want it to be a defensive conversation.” You may want to ask the person to lunch or to go for coffee after a shift. Let them know you want to talk to them about an issue that has been concerning you.
 
Present your concern in a non-defensive way and explain that you care. For example, you may say, “You used to be someone I could always turn to for help, but lately you’ve felt further away and harder to access. I know you’re out sick a lot. I’m worried about you. Can you talk to me about what’s going on?”
 
How to get help
Nurses are fortunate in that we have employee assistance programs with mental health components. Work benefits offer easy access to mental health treatment. Talk to a psychiatrist, psychologist, a psychiatric nurse practitioner, or advanced practice nurse, all of which are in our nursing community.
 
You can also go to your primary care provider and talk with them about what level of psychiatric support you need. If your stress or depression causes you to think about suicide or be in crisis,  call the National Suicide Prevention Lifeline at 1-800-273-TALK.
 
What treatment looks like
Treatment for depression usually consists of therapy, medication, or a combination of both.

  • Cognitive behavioral therapy is a talk therapy that focuses on how you think. If a nurse says that she’s no longer good at her job and her patients dislike her, the therapist can hear those cognitive distortions and help the person to examine them. This type of therapy helps the patient to become aware of inaccurate or negative thoughts and respond to them more effectively.
  • Therapeutic interventions are aimed at helping someone figure out where they went astray and how to re-engage in good mental health. “We know exercise is a positive behavior that helps people who are depressed,” says Anderson. “If someone used to walk regularly, and they’re not anymore, the therapist will help them to re-engage in healthy activities and relationships.”
  • Medication management can also be very effective, especially when coupled with therapy. An advanced practice psych nurse or a psychiatrist will do an in-depth assessment before prescribing a medication.

 
Recovery
With the combination of therapy and medication, a person could start to see changes within four to six weeks. Within three months, a significant improvement should be noticeable.
 
Many people stop therapy when they’ve been feeling better for a while, but they can always go back to it. If a person has a crisis or is facing a challenging situation, they may want to reconnect with a therapist for a few sessions to make sure they’re not going to relapse into depression.
 
Secondary Traumatic Stress
Many nurses can become traumatized by unanticipated events (which is known as Secondary Traumatic Stress), such as a patient’s death or a medical error. “It’s important for nurses to get support at those times,” says Anderson. “If they don’t and they’re experiencing work-related chronic stress, that erodes their mental health and can lead to depression, too.”
 
Removing the stigma
Employers and organizations need to create an environment that decreases stigma and values staff discussion about what happens to them at work, especially if they’ve witnessed or experienced a traumatic event. Anderson adds, “We need an organizational culture that says, ‘we know this happens to you and we don’t want you to be traumatized by it. We want you to get help.’”

Know a nurse you want to share this article with? Share it on FacebookTwitter, and Instagram by clicking on the links on the left side of the page.
  
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Source List:
Levtak, S. A., Ruhm, C. J., & Gupta, S. N. (2012). Nurses’ presenteeism and its effects on self- reported quality of care and costs. American Journal of Nursing, 112, 30-38.
ANA Health Risk Appraisal, 2016.

Make Healthy Substitutions

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Welcome to Day 4 of the Healthy Holidays Challenge, powered by Compass One Healthcare!

During the holidays, you can’t escape classic recipes like stuffing and mashed potatoes. Or can you? If you’re preparing the meal or bringing a dish to a gathering, contribute a healthy (yet delicious) substitute.

Cauliflower is a versatile, low-carb, low-calorie vegetable that works well in a variety of “traditional” dishes. It can boost your intestinal health and is a fantastic source of fiber, folate, vitamin C, and potassium. Studies show that cauliflower contains antioxidant properties that help protect against diseases like cancer and heart disease. Try these traditional holiday dishes that substitute cauliflower!

What healthy substitutions have you tried in your favorite recipes? Share your experience in the challenge with us in in the update thread here. You can also post a photo from your favorite day of the challenge in our private Facebook group, or on Twitter, or Instagram. Tag us with #healthynurse.

Icy fingers and toes: Poor circulation or Raynaud’s phenomenon?

If your fingers or toes ever turn pale (or even ghostly white) and go numb when exposed to cold, you might assume you just have poor circulation. That’s what I used to think when I first started noticing this problem with my own hands many years ago. It usually happened near the end of a long hike on a spring or fall afternoon, when the temperature dropped and I didn’t have any gloves handy. My pinkie, third, and middle fingers would turn white, and the fingernails took on a bluish tinge. As I soon discovered, I have Raynaud’s phenomenon, an exaggeration of normal blood vessel constriction.

Raynaud’s phenomenon: Not just poor circulation

When you’re exposed to a cold environment, your body reacts by trying to preserve your core temperature. Blood vessels near the surface of your skin constrict, redirecting blood flow deeper into the body. If you have Raynaud’s phenomenon, this process is more extreme, and even slight changes in air temperature can trigger an episode, says rheumatologist Dr. Robert H. Shmerling, senior faculty editor at Harvard Health Publishing and corresponding faculty in medicine at Harvard Medical School.

"Cold weather is the classic trigger for Raynaud’s phenomenon. But it can occur any time of year — for example, when you come out of a heated pool, walk into an air-conditioned building, or reach into the freezer section at the supermarket," he says. In addition to the hands, Raynaud’s can also affect the feet and, less often, the nose, lips, and ears. During an episode, the small arteries supplying the fingers and toes contract spasmodically, hampering the flow of oxygen-rich blood to the skin. Some of these vessels even temporarily collapse, and the skin becomes pale and cool, sometimes blanching to a stark white color.

Technically, Raynaud’s phenomenon is a circulation problem, but it’s very different than what doctors mean by poor circulation, says Dr. Shmerling. Limited or poor circulation usually affects older people whose arteries are narrowed with fatty plaque (known as atherosclerosis), which is often caused by high cholesterol, high blood pressure, and smoking. In contrast, Raynaud’s usually affects younger people (mostly women) without those issues — and the circulation glitch is generally temporary and completely reversible, he adds.

Preventing and treating Raynaud’s phenomenon

As I can attest, the best treatment for this condition is to prevent episodes in the first place, mainly by avoiding sudden or unprotected exposure to cold temperatures. I’ve always bundled up in the winter before heading outside, but now I bring extra layers and gloves even when the temperature might dip even slightly, or the weather may turn rainy or windy. Other tips include preheating your car in winter before getting in, and wearing gloves in chilly grocery store aisles.

In general, it’s best to avoid behavior and medicines that cause blood vessels to constrict. This includes not smoking and not taking certain medications, such as cold and allergy formulas that contain phenylephrine or pseudoephedrine and migraine drugs that contain ergotamine. Emotional stress may also provoke an episode of Raynaud’s, so consider tools and techniques that can help you ease stress.

If necessary, your doctor may prescribe a medication that relaxes the blood vessels, usually a calcium-channel blocker such as nifedipine (Adalat, Procardia). If that’s not effective, drugs to treat erectile dysfunction such as sildenafil (Viagra) may help somewhat. You may not need to take these drugs all the time, but only during the cold season, when Raynaud’s tends to be worse.

Warm up affected areas quickly

Once an episode starts, it’s important to warm up the affected extremities as quickly as possible. For me, placing my hands under warm running water does the trick. When that’s not possible, you can put them under your armpits or next to another warm part of your body. When the blood vessels finally relax and blood flow resumes, the skin becomes warm and flushed — and very red. The fingers or toes may throb or tingle.

What else is important to know?

Some people with Raynaud’s phenomenon have other health problems, usually connective tissue disorders such as scleroderma or lupus. Your doctor can determine this by doing a physical exam, asking you about your symptoms, and taking a few blood tests. But most of the time, there is no underlying medical problem.

Is a common pain reliever safe during pregnancy?

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For years, products containing acetaminophen, such as the pain reliever Tylenol, were largely viewed as safe to take during pregnancy. Hundreds of widely available over-the-counter remedies, including popular cold, cough, and flu products, contain acetaminophen. Not surprisingly, some 65% of women in the US report taking it during pregnancy to relieve a headache or to ease an aching back.

But recently, a group of doctors and scientists issued a consensus statement in Nature Reviews Endocrinology urging increased caution around acetaminophen use in pregnancy. They noted growing evidence of its potential to interfere with fetal development, possibly leaving lingering effects on the brain, reproductive and urinary systems, and genital development. And while the issue they raise is important, it’s worth noting that the concerns come from studies done in animals and human observational studies. These types of studies cannot prove that acetaminophen is the actual cause of any of these problems.

An endocrine disruptor

Acetaminophen is known to be an endocrine disruptor. That means it can interfere with chemicals and hormones involved in healthy growth, possibly throwing it off track.

According to the consensus statement, some research suggests that exposure to acetaminophen during pregnancy — particularly high doses or frequent use — potentially increases risk for early puberty in girls, or male fertility problems such as low sperm count. It is also associated with other issues such as undescended testicles, or a birth defect called hypospadias where the opening in the tip of the penis is not in the right place. It might play a role in attention deficit disorder and negatively affect IQ.

Risks for ill effects are low

If you took acetaminophen during a current or past pregnancy, this might sound pretty scary — especially since you’ve probably always considered this medicine harmless. But while experts agree it’s important to consider potential risks when taking any over-the-counter or prescription medicines during pregnancy, you shouldn’t panic.

“The risk for an individual is low,” says Dr. Kathryn M. Rexrode, chief of the Division of Women’s Health, Department of Medicine at Harvard-affiliated Brigham and Women’s Hospital.

Chances are pretty good that if you took acetaminophen during a pregnancy, your baby likely did not, or will not, suffer any ill effects.

The research on this topic is not conclusive. Some information used to inform the consensus statement was gathered from studies on animals, or human studies with significant limitations. More research is needed to confirm that this medicine is truly causing health problems, and to determine at what doses, and at what points during a pregnancy, exposure to acetaminophen might be most harmful.

Sensible steps if you’re pregnant

Three common-sense steps can help protect you and your baby until more is known on this topic:

  • Avoid acetaminophen during pregnancy when possible. Previously during preconception and pregnancy counseling, Dr. Rexrode had warned patients against using NSAID drugs, such as Advil and Aleve, and suggested taking acetaminophen instead. “Now I also tell people that some concerns have been raised about acetaminophen use during pregnancy, and explain that its use should be limited to situations where it is really needed,” says Dr. Rexrode. In short, always consider whether you really need it before you swallow a pill.
  • Consult with your doctor. Always clear acetaminophen use with your doctor, particularly if you are going to be using the medicine for a long period of time. They might agree that taking it is the best option — or suggest a safer alternative.
  • Minimize use. If you do need to take acetaminophen during pregnancy, take it for the shortest amount of time possible and at the lowest effective dose to reduce fetal exposure. “This advice about the lowest necessary dose for the shortest period of time is generally good counseling for all over-the-counter medication use, especially during pregnancy,” says Dr. Rexrode.

While all of this is good advice for using acetaminophen, there are times when it’s riskier not to take it. For example, if you have a high fever during pregnancy — which can harm your baby — acetaminophen may be needed to bring your fever down. Provided it’s advised by your doctor, the benefits of acetaminophen use in this case outweigh the potential risks.

Sneak Fitness Into Your Routine

The good news is that you don’t have to be in a gym to sneak some fitness into your daily routine. Heidi Rye‍, an RN and certified group fitness instructor, has shared some great ideas on how to incorporate fitness moves into your routine, if you’re crunched for time.

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Balancing an 8-12-hour work day with the added pressures of family and/or school life commitments can be quite demanding for the average nurse. It is so difficult to squeeze in a workout, before or after work, that 49% of us don’t achieve the recommended amount of physical activity due to time constraints, fatigue, and low motivation. Test out some of these suggestions and let us know what you think and how you choose to fit fitness into your routine.

Break it down
The American Heart Association recommends that adults aim for 30 minutes of physical activity per day, five days per week. The good news: you can break it down into small bits throughout the day and any amount of activity will benefit you. Every little bit helps. As Wellnitz-Rye says, “small blocks of five or 10 minutes per day is better than zero.”

Exert yourself
The Centers for Disease Control and Prevention (CDC) suggest that the benefits of increasing your heart rate not only puts you at lower risk for cardiovascular disease, type II diabetes, and some cancers, but it also can help with controlling weight, strengthening your bones and muscles, and improving your mood and mental health. Challenge yourself to get creative in trying to increase the intensity of your daily mundane activities. For example, skip the elevator and take the stairs! Hitting the steps when taking the stairs does double duty since it increases your heart rate and works your lower body with weight-bearing exercise. Try to get up or down stairs as safely as possible, but faster than you usually do. Not intense enough? Climb steps two at a time when going up. Use CDC’s Talk Test to determine how hard you’re working. For moderate intensity activities, you should be able to talk but not sing. At a vigorous intensity, you shouldn’t be able to say more than a few words at a time without pausing for a breath. 

Use fitness aids
Get on the “band” wagon – keep a lightweight exercise band in your pocket or resistance bands in your desk drawer and do bicep curls or tricep extensions during down times or while on hold on the phone.

Sit on a ball ever considered swapping out your desk chair for an exercise ball? Trying to balance on a ball not only increases core strength but also flexes your leg and hip muscles. Just make sure that you get an exercise ball with an anti-burst rating of 500kg – you want it to be able to withstand your body-weight, plus any additional weight, so it doesn’t burst.

Step it up – get a fitness wearable, pedometer, or use that built-in health app on your smartphone to track your steps. Don’t have one? Just search for a free step tracker in your phone’s app marketplace. On average nurses can walk up to 5 miles per shift! How many steps do you think you take in a shift? Track them and challenge yourself or a co-worker to do better. 

Maximize your commute
Incorporate exercise into travel time. Don’t live that far from home? Ride your bike to work. Drive? Park at the farther away and walk a longer distance. Take public transportation? Get off one stop earlier and walk the final leg to your destination. Not intense enough? Walk at a faster pace than usual.

Stop and stretch
Get your back in the game. According to the Mayo Clinic, proper stretching can decrease your risk of injury and increase blood flow to your muscles. Doing back stretches is a great way to improve your posture and engage your core. If you can, set a reminder on your phone every hour and stretch. Try a simple stretch, reaching toward the sky, touching your toes, or pulling your shoulder blades back while standing up straight. Can’t do this throughout the day? Try some stretches with a foam roller first thing in the morning or right before bed.

Flex your muscles
The American Heart Association suggests that weight-bearing exercise improves quality of life as a result of increased muscle mass and strength, stronger bones and connective tissues, and decreased risk of injury. Stronger muscles allow us to better practice Safe Patient Handling and Mobility (SPHM) so that we don’t compromise our own health while caring for patients. Weight bearing exercises are also beneficial in maintaining a healthy weight and burning calories. The CDC’s Physical Activity Guidelines for Americans recommends performing muscle-strengthening exercises two or more days per week, but incorporating resistance training into your day doesn’t have to mean lifting weights at the gym. Use your body weight to flex those muscles! Filling out a patient’s chart? Do calf raises while you work. Mimic this at home, while doing simple chores like washing dishes or in front of your mirror or while brushing your teeth. 

Help yourself, help your patients
15 years of gallup polls amongst Americans show that nurses are the most trusted profession with the highest honesty and ethical standards. We are known to lead by example. When we are physically active, we are more likely to encourage patients and family members to develop active lifestyle habits. That’s why physical activity is a pillar of  Healthy Nurse, Healthy Nation™ (HNHN), a social movement transforming the health of the nation by improving the health of nurses first.

Challenge yourself to take the next step. What are you going to do to better incorporate fitness into your daily life? Tag a nurse and challenge them to do the same. These are your challenges, your stories and your successes. Share them with us and each other. Leave a comment in our “Increasing Physical Activity” discussion or tag us on Facebook, Twitter, or Instagram with #HealthyNurse.

Source List:
Albert, N. M., Butler, R., Sorrell, J., (September 30, 2014) “Factors Related to Healthy Diet and Physical Activity in Hospital-Based Clinical Nurses” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Manuscript 5.
Bakhshi, S., Fei, S., Murrells, T., & While, A. (2015). Nurses’ health behaviors and physical activity- related health-promotion practices. British Journal of Community Nursing, 20, 289-296.
https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
https://www.cdc.gov/physicalactivity/basics/adults/index.htm
http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Strength-and-Resistance-Training- Exercise_UCM_462357_Article.jsp#.WLYxSBIrJSw
http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931
http://www.prevention.com/fitness/fitness-tips/should-you-replace-your-office-chair-stability-ball
Speroni, K., (September 30, 2014) “Designing Exercise and Nutrition Programs to Promote Normal Weight Maintenance for Nurses” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Manuscript 6.

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c987219becfc64baa8a999f8eee281c1-huge-anHave you joined the Healthy Nurse, Healthy Nation (HNHN) Grand Challenge yet? Join us today

Can vaping help you quit smoking?

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Lately it seems like everywhere I look, someone is vaping as they walk by, stand outside a store, or roll up in the car next to me at a stoplight. It’s not surprising: e-cigarette use, or vaping, has become remarkably popular in recent years. About 6% of adults in the US now report vaping. That’s about 15 million people, double the number from just three years ago. Of course, regular cigarettes are known to cause cancer and a host of other health problems.

While considered less harmful than smoking tobacco, vaping isn’t risk-free. We know some, but not all, of its risks. We also know vaping is increasingly popular among teens and young adults, and this makes the recent FDA announcement authorizing sales of three additional vaping products surprising.

A surprise announcement from the FDA

In its announcement, the FDA authorized the R. J. Reynolds Vapor Company to market and sell its Vuse Solo device with tobacco-flavored vaping liquid to adults.

The FDA denied marketing authorization for 10 flavored products made by the same company. It also reports having denied more than a million flavored vaping products from other companies.

By the way, the agency emphasizes it is not actually approving these vaping products, or declaring them safe. The announcement states that marketing authorization will be reversed if

  • the company directs advertising to younger audiences
  • there is evidence of “significant” new use by teens or by people who did not previously smoke cigarettes
  • R. J. Reynolds does not comply with extensive monitoring requirements.

Why did the FDA take this action?

The decision was reportedly based on data from the company — unfortunately not provided in the press release — demonstrating these products would benefit individuals and public health. How? By helping smokers quit.

Some studies have suggested that e-cigarette use can be modestly helpful for smokers trying to quit. For example, an analysis of 61 studies found that e-cigarette use was more effective than other approaches to quitting smoking. The study authors estimated that out of every 100 people who tried to quit smoking by vaping, nine to 14 might be successful. When only using other methods, such as nicotine patches or behavioral counselling, only four to seven smokers out of 100 might quit. A separate study suggests vaping may help smokers who aren’t able to quit reduce the number of cigarettes smoked per day — at least for six months, the duration of the study.

Does vaping harm health less than smoking cigarettes?

Despite claims that vaping is less harmful than smoking cigarettes and that it might help smokers quit, concern about its risks is well deserved.

  • Nicotine addiction. Whether in cigarettes or vapes, nicotine is highly addictive. And the amount of nicotine in many vaping products is much higher than in regular cigarettes. Side effects include reduced appetite, increased heart rate and blood pressure, nausea, and diarrhea.
  • Harm to lungs and heart. Vapors from e-cigarettes may contain cancer-causing toxins, metals, and lung irritants. Vaping raises risk for lung diseases, such as emphysema, asthma, chronic bronchitis, and chronic obstructive pulmonary disease. It’s also linked to an increased risk of heart attacks. Even secondhand exposure to e-cigarette vapors may trigger asthma.
  • Severe, potentially fatal lung injury. In 2019, doctors began seeing people who had recently vaped and developed shortness of breath, cough, fever, and extensive lung damage. Dubbed EVALI (e-cigarette or vaping product use-associated lung injury), more than 2,800 cases and 68 deaths were reported. The condition has been linked to vapors containing THC and a form of vitamin E (called vitamin E acetate) used as a thickening agent when vaping THC. Cases have fallen markedly since 2020. Possibly because of falling case numbers, the FDA announcement of new vaping products didn’t even mention EVALI, which seems odd. If you do vape, see these recommendations to reduce the risk of EVALI.
  • Health risks during pregnancy. Nicotine can damage a baby’s developing brain and lungs; some flavorings may be harmful as well. As a result, experts recommend that people who are pregnant not vape.

For teens and children, vaping has additional risks

An alarming number of middle-school and high-school age kids report vaping, despite the nationwide prohibition against selling e-cigarette products to anyone under age 18 (21 in some states). Its popularity is partly related to the marketing of flavors known to appeal to minors, such as bubblegum and berry-flavored products. According to one national survey, approximately 85% of teen vaping involved non-tobacco flavored products.

It’s important to know that

  • nicotine negatively affects the developing brain
  • the high exposure to nicotine and other toxic chemicals through vaping may be particularly harmful to kids because of their smaller body size
  • the addictive potential of nicotine may mean that kids who vape are more likely to become cigarette smokers.

The bottom line

For nonsmokers and teens, there is no controversy: don’t start smoking and don’t vape.

If you’re an adult smoker trying to quit, be aware that the balance of risks and benefits and the long-term health consequences of vaping are uncertain. We need more solid research to help people make decisions. Meanwhile, the FDA has come down on the side of a limited authorization to help adult smokers quit. We’ll know only in retrospect if that was the right move.

The Case For Taking A Break

Jacklynn Lesniak MS BSN RN NEA-BC, Chief Nursing Officer and the Senior Vice President of Patient Care Services at Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center (Midwestern) shares the case for taking a break. CTCA has pioneered innovative practices around nurse rest and rejuvenation and has seen significant results.
 

8bcabe93e5c7ae8c998e98e2357a9507-huge-taEmployers and nurses need to work together to ensure that every nurse gets – and takes – adequate break time during their shifts. According to the American Nurses Association’s (ANA) 2016 Health Risk Appraisal, over half of nurses work through their breaks. Not getting adequate time for rest and renewal can cause adverse health consequences and can impact patient safety as well. Before you skip that break and try to work through any opportunities to pause and rest, consider Lesniak’s points below.
 
One strategy that has worked at CTCA at Midwestern is a staff-driven concept of a renewal room. It’s a quiet space that includes forms of self-care such as aromatherapy, music therapy, a massage chair, space to write in a journal, and even a small waterfall.
 
Initial survey data revealed that 96 percent of the nurses on staff reported using the room – and at least three of the relaxation techniques within it – to greatly reduce their stress level. The rooms proved so successful that the administration supported the creation of six additional renewal rooms in various locations throughout the hospital.  What’s more, the hospital renamed traditional break rooms. They are now called “serenity rooms” to remind staff of the importance of self-care and renewal.
 
The nursing staff at CTCA at Midwestern also implemented a new role they call the “unit shift leader.” This person is a highly skilled and experienced nurse who usually does not have patient assignments. Instead, his/her role is to relieve other nurses, so each member of the staff can get adequate renewal time.
 
Take control of your breaks
The ability of nurses to get adequate rest and rejuvenation should be important to all employers, but individual nurses do not have to wait for management to make improvements.
 
Make self-care a priority with these four strategies:

  1. Buddy up “Think about the highest quality of care you expect to deliver and what you need to make it happen. Once you come up with that list, find a mentor or a buddy who can help you meet your expectation,” says Lesniak.
  2. Find a mentor Find somebody that you can reach out to for advice. It may be your supervisor but it may not be.
  3. Turn off your cell phone When you take breaks, make sure you’re getting high-quality personal time. One of the reasons the renewal rooms at CTCA at Midwestern work so well is because nurses don’t take their pagers or cell phones into the room. This gives them time to focus on self-care and regroup.
  4. Think outside the box  Consider small ways you can help relieve stress on the job, like these Simple Ways to Relieve Stress Today. At CTCA at Midwestern, nursing staff developed a nurse-driven aromatherapy protocol, including hand massage and aromatherapy for patients. Even though the protocol was designed for patients, nurses report the practices help them slow down and recharge as well.

 
Adequate breaks help patients
After CTCA at Midwestern implemented these break room changes in addition to an ongoing focus on employee engagement, patient satisfaction scores were higher and the organization received the prestigious Guardian of Excellence award from Press Ganey. Plus, Lesniak points out that nurses need to be role models in practicing self-care so that they can teach healthy habits to patients.

Time for renewal
The amount of time nurses get to step away isn’t as important as how they use it. “We need to rethink the definition of break time,” says Lesniak. Caring for patients isn’t like working in a factory where everything is timed perfectly. A nurse’s role is intense and unpredictable. The same healing environment available to patients needs to be felt by the nursing staff as well. Consider taking a break outside. Researchers have concluded that “taking daily work breaks in an outdoor garden may be beneficial in mitigating burnout for nurses working in hospital environments.” Learn more here.
 
The bottom line  Restorative breaks help nurses better serve their patients, families, and communities.

What makes taking a break so difficult?  Join in on our discussion or make a commitment to taking more breaks and tag your friends and co-workers and us with #HealthyNurse. Know a nurse you want to share this article with? Share it on Facebook, Twitter, and Instagram by clicking on the links on the left side of the page.

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Evoking calm: Practicing mindfulness in daily life helps

It’s easy to say you simply don’t have time to be mindful. With so much going on in daily life, who has time to stop and be present? But everyone has at least 10 minutes to spare to practice mindfulness.

The point of these brief, daily reflections is to help you tap into calmness whenever life gets too hairy. Practicing everyday mindfulness can also improve your memory and concentration skills and help you feel less distracted and better able to manage crises like dealing with the pandemic.

There is more than one way to practice mindfulness. Still, any mindfulness technique aims to achieve a state of alert, focused, relaxed consciousness by deliberately paying attention to thoughts and sensations without passing judgment on them. This allows the mind to focus on the present moment with an attitude of acceptance.

Three easy mindfulness exercises to try

Here are three simple exercises you can try whenever you need a mental break, emotional lift, or just want to pause and appreciate everything around you. Devote 10 minutes a day to them and see how the experience changes your outlook. It’s time well spent.

Simple meditation

A quick and easy meditation is an excellent place to begin practicing mindfulness.

  • Sit on a straight-backed chair or cross-legged on the floor.
  • Focus on an aspect of your breathing, such as the sensations of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.
  • Once you’ve narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas. Embrace and consider each without judgment.
  • If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
  • Take as much time as you like: one minute, or five, or 10 — whatever you’re comfortable with. Experts in mindfulness meditation note that the practice is most helpful if you commit to a regular meditation schedule.

Open awareness

Another approach to mindfulness is “open awareness,” which helps you stay in the present and truly participate in specific moments in life. You can choose any task or moment to practice open awareness, such as eating, taking a walk, showering, cooking a meal, or working in the garden. When you are engaged in these and other similar routine activities, follow these steps.

  • Bring your attention to the sensations in your body, both physical and emotional.
  • Breathe in through your nose, allowing the air to fill your lungs. Let your abdomen expand fully. Then breathe out slowly through your mouth.
  • Carry on with the task at hand, slowly and with deliberation.
  • Engage each of your senses, paying close attention to what you can see, hear, feel, smell, and taste.
  • Try “single-tasking,” bringing your attention as fully as possible to what you’re doing.
  • Allow any thoughts or emotions that arise to come and go, like clouds passing through the sky.
  • If your mind wanders away from your current task, gently refocus your attention back to the sensation of the moment.

Body awareness

Another way to practice mindfulness is to focus your attention on other thoughts, objects, and sensations. While sitting quietly with your eyes closed, channel your awareness toward each of the following:

  • Sensations: Notice subtle feelings such as an itch or tingling without judgment, and let them pass. Notice each part of your body in succession from head to toe.
  • Sights and sounds: Notice sights, sounds, smells, tastes, and touches. Name them “sight,” “sound,” “smell,” “taste,” or “touch” without judgment and let them go.
  • Emotions: Allow emotions to be present without judging them. Practice a steady and relaxed naming of emotions: “joy,” “anger,” “frustration.”
  • Urges: When you feel a craving or an urge (for instance, to eat excess food or practice an unwanted behavior), acknowledge the desire and understand that it will pass. Notice how your body feels as the craving enters. Replace the wish for the craving to go away with the specific knowledge that it will subside.