Friday, January 26, 2007

Police Suicide Foundation

One of my favorite bloggers, Maddog Medic has lost a friend. This friend died by his own hand, with his own service revolver. Those of you who work in emergency medicine, in EMS, as police officers and those who love them - you know that this happens far too often. I never met Maddog's friend, but his death is a loss to all of us.

I have a friend who is trying to make suicide, but especially police suicide less common. He started the Police Suicide Foundation . He says that statistics aren't easy to find, but that police officer death by suicide occurs at 2-3 times the rate of line-of-duty deaths. He spends much of his time trying to call attention to this fact and to try to increase the level of support provided to law enforcement and emergency personnel. This is a subject about which Reverend Douglas knows a great deal. He is a police chaplain and a retired police officer. He was very nearly a statistic himself. His story is on the PSF web site. There is also contact information there.

The Police Suicide foundation has counselors available to talk to families who have lost loved ones to suicide -- and to those considering suicide. Warning signs of impending suicide are included - but can be subtle and difficult to interpret. One thing I learned many years ago while working a crisis hot line - never be afraid to ask someone if they are considering suicide. They may act as if they are offended, but they will know that you care enough to ask.

Suicide is not a subject often discussed. The subject makes people uncomfortable. We'd rather not think about it, but we must. Suicide most often results from depression - a treatable illness. If we do not discuss it, we will never be able to reach the people most likely to succumb.

Thursday, January 25, 2007

Fetal MRI - More Accurate Prenatal Diagnosis

I work in the Level III Neonatal ICU of a community hospital. We care for some really some sick kids, but we transport out most infants with complex congenital anomalies which need immediate surgical intervention.

Neonatal transport is really not the best way to deal with these babies. In a perfect world, you want them delivered in the same hospital where care will be given -- or at least very close to that hospital. To accomplish this, you need prenatal diagnosis. That's not always possible for a variety of reasons, but when there is reason to suspect an anomaly, there are some excellent diagnostic modalities available.

Ultrasound is still the first-line tool for screening in pregnancy and probably will be for a very long time. It is quick, cost-effective, and visualizes the baby in real time. It is still the best way to visualize cardiac anatomy. It does have some limitations, though. For example, it's difficult to see what's going on inside the skull. Also, if the mom is very large, there may be some limitations to its usefulness.

I received a newsletter from Children's National Medical Center in the mail this week with an article about fetal MRI. I couldn't find a link to their article, although it may be online next month. I did find this one in Radiology Today, though. Both articles outline the advantages of prenatal diagnosis for planning interventions in the immediate neonatal period -- including changes in location of delivery, if that is indicated. Anomalies which typically aren't repaired at birth, and which can be managed in a community hospital NICU wouldn't require a change of venue. For more complicated anomalies, especially those requiring immediate intervention, families can plan the birth at or near the hospital where treatment will occur. In addition to being better for the baby, this is less stressful for the family as it minimizes separation at birth.

MRI provides better definition of neural tube defects, thoracic structures and craniofacial anomalies than is possible with ultrasound. This makes it helpful in planning intrauterine interventions as well as initial post-delivery treatment. There are diagnostic advantages for craniofacial anomalies, neural tube defects, diaphragmatic hernias, and an assortment of mass lesions in the head, chest, and abdomen.

There is no evidence of adverse effects from MRI, so it is considered safe throughout pregnancy. Ccontrast is not used because it crosses the placenta. I think there is a typo in the Radiology Today article. It states "Since ionizing radiation is involved" -- I believe the word "no" was left out as that doesn't match what I know of MRI or the statement that "risk for any delayed sequelae is extremely small or nonexistent."

With older equipment, maternal sedation was sometimes used. Occasionally the fetus was paralyzed by injecting pavulon via the umbilical cord when it was necessary to suppress fetal motion. This is no longer necessary, although some moms fast for several hours prior to the procedure to decrease fetal movement. The latest generation of ultra-fast MRI scanners can acquire an image in under a second. Researchers believe that the next generation of scanners will be even faster. Other research in progress when the article was published last year included studies of fetal oxygenation and pre-eclampsia. It is fascinating to see where the research will lead.

Monday, January 15, 2007


My friend, Deb Conrad, writes a military blog called Marine Corps Moms. Deb also runs a charity that sends Christmas care packages to deployed Marines. It's called Operation Santa, USMC. She also works with another charity called the Marine Corps Family Foundation
which works to support the families of deployed Marines.

I love Deb's blog and I think her charities do great things. She's been nominated by to the VA Mortgage Center's "Best Military Blog" contest. There are a number of cash prizes, any of which would be very useful to Deb in her charitable work in support of our troops.

So go read her blog -- and then go vote for her!


Thank you to those who voted for Deb. She finished in 6th place which means $250 for the Marine Corps Family Foundation. If you didn't get a chance to vote, or if you voted for someone else, you can still go read Deb's blog and support her good works.

Friday, January 12, 2007

Baby's got a cold?

Those over-the-counter remedies that say "consult a physician before giving to children under 2" or perhaps even "Do not give to children under age 2" -- they mean it. The CDC has recently published a reminder of that fact. Babies are dying because parents ignore that warning.

If your infant or toddler has a cold, use a bulb syringe

or even better a nasal aspirator (easier to clean)

Saline nose drops won't hurt either -- you can buy them at the pharmacy or ask your pediatrician for a recipe. But for your baby's sake, do NOT give them medication designed for older children unless the pediatrician has given you very specific instructions about dosage and frequency. Then do NOT add other medications without the pediatrician's instructions.

Monday, January 01, 2007

Childhood Immunization

Reasonable, rational people of my acquaintance have made a choice I believe is ill-considered and based on sloppy science at best, but possibly on outright fraud. They are choosing not to give their children any immunizations. None.

I understand those who choose to reject the chickenpox vaccine. Few healthy children ever died from complications of chickenpox and I am very concerned that my immunized youngest son will actually face greater danger as an adult if his immunity from the vaccine wanes. He is immunized, but I worry.

I can understand religious objections to immunizations made with cell lines from aborted fetuses. My church has stated that those cell lines are so far removed from the original abortion that the immunizations are morally acceptable, but I understand those who choose to avoid those immunizations. There are so-called ethical immunizations made without aborted fetal tissue in any part of the development, but these people reject them as well. I do not understand that choice.

I fear that they simply do not understand the risks to which they are subjecting their children. I have seen Hemophilus influenzae meningitis. They are too young to have any memory of that virtually eliminated disease. I have seen an infant with Pertussis (whooping cough). They have not. I survived measles and mumps with minimal damage, but I am well aware of the potentially lethal complications of both.

I was fortunate to have had Rubella at an early enough age that it did not risk damage to my children -- my mother was pregnant with my youngest sister at the time. Fortunately, she suspected the pregnancy and her doctor gave her gamma globulin to ward off the danger. The danger was very real. Mom caught rubella a few years later when my younger siblings did.

I have never seen polio, but I know people who limp and those who lost siblings to that once dread disease. It was easy for me to choose to immunize my children, because I know the risks and the benefits.

Sadly, many people are declining to immunize their children out of fear of Thimerosal -- even though Thimerosal has been eliminated as a preservative in virtually all children's immunizations. It was eliminated even though there is no evidence linking it to autism. Many of the "links" were made by people like this physician who was well-paid by a lawyer's group for his services. He was part of their unsuccessful suit against vaccine manufacturers and the children in his study were parties to the suit. Conflict of interest, anyone?

Dr. Flea is writing a series of posts on childhood immunizations. The links follow. I'll be adding links as he adds posts. Thanks, Shinga, for the suggestion.

Just so you know. I have comment moderation turned on. I won't be publishing any anti-vaccine comments to this post. Feel free to put them on your own blog.

Dr. Flea's Immunization Posts (unfortunately not currently available - I'll re-link if he reposts)

* A Very Great Fright (smallpox)
* On My Left Shoulder (smallpox)
* The Can From Hell (polio)
* Go Home and Die (Haemophilus influenzae type b)
* Strangling Angel (diphtheria)
* Risus Sardonicus (tetanus)
* The Cough of One Hundred Days (pertussis or whooping cough)
* Dew Drops on Rose Petals (chickenpox)
* Yellow Alert (Hepatitis B virus)
* Rota-gate (The facts on RotoTeq and intussusception)
* The Chicken Pox Vaccine Sucks (One he doesn't like)

Change of Shift and Grand Rounds

NeonurseChic has done a great job with the latest edition of Change of Shift. Volume 1 Number 14.

Grand rounds is up at Musings of a Distractible Mind

Plenty of good reading both places.