Angelite Nurses

Researchers say a link between vitamin D and a gene known to cause multiple sclerosis has been identified.

The study in this week's PLoS Genetics journal could explain one of the key environmental risk factors for multiple sclerosis, also known as MS.

The prevalence of MS is higher in countries further away from the equator, which is thought to be related to the amount of sunshine exposure and vitamin D3 production.

Neurologist Dr Bill Carroll, from Perth's Sir Charles Gairdner Hospital, says this study is the first to link the environmental and genetic risk factors that cause MS.

"What they've been able to do with this study is show that vitamin D3 is closely related to the part of the genetics of the immune system that we think is most closely related to susceptibility to MS," he said.

Dr Carroll is also chair of Multiple Sclerosis Research Australia's research management council.

Response element

The researchers focused on a gene known as HLA-DRB1, which is part of a family of genes that make up the major histocompatibility complex. This complex plays a critical role in the body's immune system and autoimmunity.

Previous studies have identified that a variant of HLA-DRB1 increases the risk of MS, but there is also strong geographic variation in risk that appears to be linked to sun exposure.

The team of researchers were able to track down a region of the HLA-DRB1 gene that contained a vitamin D "response element".

This suggests that vitamin D is directly involved in the expression of the immune system gene.

"The relationship between environment and genes has not been able to be correlated until this piece of evidence," Dr Carroll said.

Turning on itself

The discovery has implications for other autoimmune conditions such as Type 1 diabetes and inflammatory bowel disease, Dr Carroll says, as these diseases also have similar geographic distribution.

MS is an autoimmune disease that results in the breakdown of myelin, a protective fatty sheath that surrounds nerves.

Symptoms of MS vary from person to person, but can include tremors, paralysis and memory loss.

Australian researchers have previously shown that people living in Tasmania are five times more likely to develop MS than those living in Queensland.

"If you're in the northern hemisphere and you're born at the end of the northern hemisphere winter, born in May, you have 20 per cent greater chance of developing MS than if you're born at end of the northern hemisphere summer in November," Dr Carroll said.

According to Multiple Sclerosis Research Australia there are more than 18,000 Australians diagnosed with MS - three-quarters of those are women.

from Daily Herald; Arlington Heights, Ill. .. 

* Heart disease is the No. 1 killer of women age 20 and older, but it is largely preventable. 

* At least 65 percent of people with diabetes die of some form of heart or blood vessel disease. 

* One in 3 women has some form of cardiovascular disease which kills one woman every minute. 

* More women die of cardiovascular disease than the next five causes of death combined, including all forms of cancer. 

* Feb. 6 is National Wear Red Day! Join dozens of women, as well as companies and organizations in the Metropolitan Chicago area and cities across America by wearing red on Feb. 6. Its a simple, powerful way to raise awareness of heart disease and stroke. 

* Overweight children are more likely to have abnormally thick heart muscle tissue when they become adults, which increases the risk of heart attack and heart failure. 

* Visit GoRedForWomen.org and choose to take the Go Red Heart CheckUp to find out your 10-year risk of heart disease or stroke. 

* If you or someone you know shows signs of heart attack or stroke, call 911 right away. An Emergency Medical Services (EMS) team can begin treatment when it arrives. That means treatment can begin sooner than it would if the patient arrived at the hospital by car. Whats more, the EMS team is also trained to revive someone whose heart has stopped, which saves hundreds of lives each year. 

* Children of mothers who smoke during pregnancy have more damage to their arteries in young adulthood than offspring of nonsmokers and the association is even stronger if both parents smoke. 

* Choose to speak up, not remain silent. Support legislation that would improve the prevention, diagnosis and treatment of heart disease and stroke in women at HeartForWomen.org. 

* Too many lives have and will be cut short from heart disease and its risk factors; however, early detection, lifestyle changes, and other intervention can improve certain conditions. 

* Choose to beat heart disease this year. Whether its eating healthier, exercising more, reducing our cholesterol, or quitting smoking, and turn your personal choices into lifesaving actions. 

* Plan meals in advance visit americanheart.org for recipes from a number of heart-healthy cookbooks and use the online grocery list builder to quickly identify heart-healthy products to add to your grocery list 

* Schedule a doctors appointment each year and get a complete blood screen. Visit GoRedForWomen.org and download "What to Know BEFORE Your Doctor Visit." Only 1 in 5 women believes that heart disease is her greatest health threat. 

* This year about 1.2 million Americans will have a first or repeat coronary attack. About 452,000 of them will die. Coronary heart disease is our nations leading cause of death. 

* About 7.9 million Americans age 20 and older have survived a heart attack (myocardial infarction). About 8.9 million have angina pectoris (chest pain or discomfort due to reduced blood supply to the heart). 

* An estimated 25.1 million men and 20.9 million women increase their risk of heart attack and stroke by smoking cigarettes. 

* One of the best ways to reduce your risk of cardiovascular disease is to start getting regular, moderate exercise, at least 30 minutes a day, most days of the week. 

* Some heart attacks are sudden and intense, causing someone to gasp dramatically, clutch her heart and drop to the ground. No one has any doubts about whats happening. But most heart attacks start slowly, with mild pain or discomfort. Often the people affected arent sure whats wrong and wait too long before getting help. 

Source: American Heart Association 

(c) 2009 Daily Herald; Arlington Heights, Ill.. Provided by ProQuest LLC. All rights Reserved.

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When we talk about compassion in medicine, most of the focus is on doctors. But what about nurses? I asked Theresa Brown, a nurse and writer, to share her experiences caring for — and caring about — her patients.

Theresa Brown (Photo credit: Arthur Kosowsky)

By Theresa Brown

In medical oncology our patients stay in the hospital often for weeks or even months. They leave and come back, again and again, with this or that complication, or because they need more chemo, or because they’ve relapsed. We get to know them, their families, even their friends. And because we know them so well, in such an intense and intimate setting, we end up caring about them. 

Recently I was assigned to a patient I had gotten to know well, a guy in his fifties who’d lived and worked in the same small town in rural Pennsylvania for years. I had been his nurse off and on since his initial diagnosis the previous spring, and had cared for him more recently after an autologous stem cell transplant. But now he was deteriorating. His abdomen was bloated, due to a problem with his liver, and he also had a huge blood clot in the vein where his permanent IV line was placed. For two days he had been saying, “I feel terrible,” a non-specific complaint that is scary and ominous. 

“If he dies I don’t know what I’m going to do,” I confided to the dayshift nurse. She looked at me, then looked down at her papers and nodded.

This is what it means to be a nurse in oncology, a no-win situation where compassion routinely gets hijacked by grief. On TV or in the movies, dying patients are usually tended to by physicians. But if you die in a hospital, the person caring for you in your last days, hours, and minutes will be a nurse. The doctors care, too, of course, and check in and write orders, but we’re the ones who are always there. We watch over the patients as they struggle against their disease, and we’re there, too, if they decline, beginning their slow embrace with death.

When I did my initial assessment of the patient that afternoon, something just seemed off. I asked him to follow my finger with his eyes and to push up and down against my hands while I pushed back. These are basic tests of neurological function and his grip was good, but his ability to push down was almost nonexistent. I asked him again to follow my finger. 

“He’s not doing it, is he?” asked his wife. “No, he’s not,” I said. She had remained calm and kind throughout his many hospitalizations, but I could hear the worry in her voice.

I called the doctor. She was leaving the hospital for the day when she got my page, but she came back and examined the patient. His ammonia levels were rising due to his failing liver, something that can cause “mental status changes.” He was getting large doses of heparin, a blood thinner, because of his clot. Could the heparin have caused a bleed inside his head? The doctor’s exam, like mine, showed some deterioration in neurological function. She ordered a CT of the patient’s head and she prescribed a treatment to bring down his ammonia levels.

The next time I went into his room, I bent over him to give him a shot. When I finished he grabbed my hands. His grip was strong, and for those few seconds at least, he was completely lucid. “So am I gonna live or am I gonna die?” he asked me.

“I don’t know,” I told him, turning away to put the used syringe in the sharps container. My voice seemed small and tinny. “I wish I could look in a crystal ball and find out, but I can’t,” I said, forcing myself to turn back around and look at him.

Why did this patient matter so much to me? This was the patient who thought I looked like a “Phyllis” more than a Theresa, so “Phyllis” became a joke between him, his wife, and me. One of the first days he was in my care, when he still looked healthy and felt pretty robust, he told me a hilarious story, supposedly true, but unprintable in a family newspaper, about infidelity, obesity, and why it’s good to have a cellphone handy if you’re trysting in the backseat of a car. The first time he spiked a temperature I called the intern in a panic. “He’s got a fever!” I said, as if it was the first fever in the history of the world. Later I apologized to her, but she understood.

Now, though, he was struggling. I had several days off following that shift and I called work on my third day at home to ask about him. “C.M.O.,” our secretary told me, and I swore into the phone. C.M.O. means “comfort measures only”: they were withdrawing care. He had a cerebral bleed; he’d “seized” the night before and was now in the Neuro I.C.U. Without even thinking about it I decided to go to the hospital where I knew his family would be gathered.

The lounge to the N.I.C.U. was filled with his family members, all sad, some crying. I saw his wife, who hugged me. She asked me if I wanted to see him, but I said no, since he wouldn’t have known me. Instead, we talked about the two of them, about trying to pick up her life, about making sure that he wasn’t suffering. When I left she said the same thing she had said to me the last night her husband was my patient: “I love you.” He died later that day.

It hurts even now. A nurse on my floor said, “You girls get too attached,” and she’s right, of course.