10 ways you can prevent asthma

The following was originally published at myasthmacentral.com/asthma on July 22, 2011.  Keep in mind that these are theories, and once you have asthma you can no longer prevent it.  

How can you prevent asthma?

A common concern of moms and dads - especially when asthma runs in the family - is how they can prevent their children from getting asthma.  New evidence suggests there are things you can do - or not do - to at least reduce the risk your child will develop asthma.

I think the surest way to prevent your child from acquiring asthma is to not give your child the asthma gene.  Yet there seems to be quite a bit of evidence that even folks with no history of asthma can develop asthma.  Good examples of this are premature births (immature lungs) and occupational asthma.

To get a better understanding of why the following may lead to asthma you should read up on the hygiene hypothesis that surmises asthma may be caused by lack of exposure to bacteria, and the microflora hypothesis that surmises asthma is caused by an imbalance of microbes in the intestines.

Likewise, click on the links provided in this post for further reading.

So you want to prevent your child from developing asthma.  The following are some things believed to prevent one from developing asthma:

1. Breastfeeding:  The child will be exposed to microbes in the mother's milk that the child's immune system needs to develop properly. I wrote morehere.  The U.S. Department of Health and Human Services notes here that infants where eczema and asthma runs in the family who were breastfed at least three months were 42 percent less likely to develop asthma than infants not breastfed for three months. The American Accademy of Allergies Asthma and Immunology (AAAAorg) reports that breast milk also strengthens the immune system.  Exposure to cow milk and soy proteins may cause an allergic response that may lead to asthma.
2. Vaginal birth:  The child will be exposed to bacteria for the immune system to develop properly.  In fact, studies show c-sections increase the asthma risk by 80 percent as I wrote here.
3. Attendance at daycare:  The immune system will be exposed to plenty of bacteria to develop properly and remain strong throughout childhood.
4. Large family:  The immune system will be exposed to plenty of bacteria to develop properly as proven by this study reported by The American Accademy of Pediatrics.  Likewise, The New England Journal of Medicine reports families with more than two children has declined from 36 percent in 1970 to 21 percent in 1998. As family sizes get smaller, asthma rates have risen.
5. Large intake of fruits and vegetables:  Provides your body with vitamins and minerals to keep your immune system strong.
6. Omega 3 fatty acid found in fish: Several studies as you can readhere and here show that populations with adequete levels of fish oil in the diet have lower asthma rates.  The theory is that acids found in fish oil prevent the allergic response that causes inflammation of the respiratory tract.  
7. Cats and dogs:  Early exposure has been shown to prevent dog and cat allergies, and allergies can lead to asthma. I wrote about this here.
8. Farm life, primarily pig exposure:  Studies show asthma rates for kids who live on farms are lower, and the theory is due to bacteria from pigs and other animals the kids are exposed to.
9. Community resources:   Educational and financial opportunities greatly influence asthma rates because it proveds better exposure to diagnosis, treatment, and medicine.  You can read more here.
10. Normal respiratory rate:  Studies show people who have chronic respiratory rates greater than 20 have a greater risk of developing chronic inflammation of the air passages.
11. Vitamin D:  Lack of exposure to the sun may cause asthma. Studies show people with higher vitamin D levels have better lung function because it helps the immune system function better.
12. Exercise:  Overdoing exercise can actually cause asthma due to high respiratory rates, and this may be one reason olympians have high asthma rates (may be referred to as occupational asthma.  Yet fat tissue has also been proven to release chemicals that cause inflammation in the air passages that can lead to asthma, and exercise can prevent obesity along with strengthening the heart, lungs, and immune system and mental status.
13. A healthy diet:  High fat foods may cause inflammation in the lungs. Obesity has been linked to increased asthma rates. I wrote about this here, and you can read more here.
14. Treating nasal congestion:  Sinusitis and rhinitis (hay fever) may lead to airway inflammation and cause asthma if the nasal congestion is not diagnosed and treated swiftly.
15. Treating eczema:  Studies show eczema may lead to asthma, yet if diagnosed and treated swiftly the risk may be reduced.  I wrote about thishere.

The following are things you should avoid exposure to:

1. Broad spectrum antibiotics:  They wipe our your normal bacteria your immune system needs to develop and function properly.  I wrote about thishere.
2. Inhaled chemicals and fumes:  Long term exposure to chemicals (such as at your work) can cause chronic inflammation of the air passages.  This is a common cause of adult onset or occupational asthma.
3. Air Pollution:  Long term exposure to high pollution levels (like from car exhaust and ozone) may lead to chronic inflammation of the air passages.  I wrote about this here.
4. Premature birth: If the lungs don't have a chance to develop properly this can increase the asthma risk.  Sometimes this can't be prevented, yet being a wise mom and listening to the advice of your doctor is a good place to start.
5. Mold:  It has substances in it that increase airway inflammation.  Don't leave water sitting around, clean up and prevent standing water in basements, paint moldy or repair moldy walls or floors, etc.
6. Viruses:  Keep young kids -- especially infants -- away from people with colds.  Lung infections, especially when the lungs are developing, may cause asthma (such as RSV, bronchiolitis).  Of course, accomplishing this may be easier said than done.  I wrote more here.
7. Exposure to cigarette smoke:  Studies show exposure may cause asthma as I wrote here.  Moms should also avoid 1st, 2nd or 3rd hand smoke during pregnancy.
8. Unhealthy foods during pregnancy:  AAAAI.org reports, a proper diet during pregnancy
9. Delay exposure to allergens:  The AAAAI.org reports this may also help prevent asthma.
10. Stomach acid in lungs:  Gastrointestinal reflux (GERD) should be properly diagnosed and treated. 

To this point in history better knowledge, technology and medicine has not stopped asthma rates from rising, especially in western nations. 

American Accademy of Allergy Asthma and Immunology statistics show asthma rates climbed 160 percent from 1980 to 1994, and The U.S. Centers for Disease Control reported reported 4.3 more people were diagnosed with asthma between 2001 and 2009.

Yet as technology, knowledge, and medicine continues to improve, perhaps we can prevent premature birth, provide kids at high risk for developing asthma with some sort of bacterial vaccine, reduce pollution I imagine despite our greatest efforts some cases of asthma may not be preventable, such as asthma caused by exercise, premature birth, and viral infections.

As we learn more, we certainly can make a gallant effort to do better.  Doctors might want to make an effort to reduce c-section rates, allow pregnancies to go to term, and encourage breast feeding. 

Better technology and regulations may reduce pollution rates.  Elilminating uneccessary use of broad spectrum antibiotics may help. 

There are things you can do to, such as educate yourself, keep your homes free from mold, wear masks when exposed to chemicals and fumes at work, encourage your kids to exercise and eat healthy, and make sure stuffy noses and colds are treated promptly and efficiently.

Asthma experts are working hard to learn about the causes of asthma.  Perhaps with all of us working together we may see asthma rates start falling sometime soon, and hopefully someday asthma may be a rare malady.

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Have people forgotten how to think?

I just had an in depth and very intelligent discussion with a patient.  The theme was:  have people forgotten how to think?  Have people become so complacent with their machines that they've lost the ability to do their own thinking?   Are kids these days too eager to accept what their teachers say without questioning them or challenging them? 

"Many people accept global warming as a fact.  Yet it's only a theory," my patient said.

I explained that when my kid came home from school the other day my son said I shouldn't squirt that spray because I might be adding to global warming.  I told him he should be careful because global warming is a theory, and while it should be respected, one must still understand it's not a fact. And people still need to use sprays.

One of my friend's kids told me that he was upset when he learned the founding fathers were racist.  They created a flawed Constitution.  I asked him what he meant.  He said that the founders created a document where blacks were only considered 3/5 of a resident of this country. 

That's what he was taught in school.  I asked him, "What do you think of the U.S. Constitution?  What do you think of your freedom?  What do you think of America?"

The boy said, "I love it all."

"Okay," I said, "If it weren't for the 3/5 rule you wouldn't have any of that." 

He looked at me cockeyed and confused, "What do you mean?"

"What I mean is that the 3/5 rule was needed to get Southern states to ratify the Constitution.  Most of the founders were not racists.  Yet they knew the only way to get the Constitution passed was the way they did.  This was why it's still called the great compromise. The flaws, they knew, would be ironed out later.  The signers knew once the Constitution was signed it could be amended, and amended it was.

When I was in school we were taught the first Thanksgiving was the Pilgrims thanking the Indians.  Yet after reading about it further on my own I learned that this wasn't true at all.  The Pilgrims threw the first Thanksgiving to thank God for teaching them about capitalism. 

The first few years they ran their little society based on socialism, and then they decided to try capitalism and let each man keep what he makes.  This worked so well crops flourished.  The Indians were there and they helped, but they weren't the only ones being thanked:  the main purpose for the party was to thank God for teaching them about capitalism, a technique that gave pilgrims an incentive to work harder. 

My patient said the following:

"How many people today just get their news from one source and accept it as fact?  If they don't do their own research there's no way of them knowing what they are reading is BS.  The same can be said of students at school.

"Do kids know how to add in their head?  Would they know if the teller made a mistake and screwed them out of $10.  Or do they simply just assume the machine was correct.  If the machines stopped working, would people be able to take care of themselves?  To feed themselves and their families?  

"Our parents grew up on farms.  They raised their own meet, cooked the meet, prepared the meet.  They killed the animals and ate the meat and used every single part of that animal.  They wasted nothing.  Then they sold the meet, and counted money, which came in bills and coins, and they had to figure the correct change." 

"They built their own houses.  Now we are so used to our modern way of living, our machines, that most of us wouldn't know what to do if the electricity went out.  We've forgotten how to think.  We've forgotten how to challenge each other.  We've forgotten how to listen to opposing opinions. Not all of us, but a good many. 

"Can you imagine how lopsided the presidential polling would be if people payed attention to politics instead of having their heads in their fantasy worlds.  In 1980 when hostages were held by Iran people cared and it influenced the election.  Today we have strife in Egypt and Libya and people sniff their noses and place their faces back in their dream world: their Facebook, their X-Box, their Wii, their Kindle, their Zuma Blitz game.  That's why Obama and Romney are tied in the polls, because people today are tuned out."

So have people forgotten how to think?

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Things my patients like about me

The following are things I often get complimented on by my patients:

1. Remove glasses before putting mask over face
2. Keep women covered during EKG
3. Remove cup prior to shaking mask (so their whole face doesn't shake)
4. Friendly
5. Sociable
6. Good conversation
7. Love to discuss the Bible
8. Love to discuss Politics (even with people I don't necessarily agree with)
9. Positive demeanor
10. Relaxed
11. Pull up a chair next to the bed and put it away when I'm done
12. Great at explaining things
13. Make patient feel good about themselves
14. Go out of my way to make sure patients has everything he needs (blankets, ice water, etc.)
15. Get things right away for patients instead of making them wait
16. Check up on patients between treatments, sometimes just for a chat
17. I make them breathe better
18. I make ABGs a gentle explerience

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Study: Exercise can help you live longer

COPD News of the Day provided a link to an interesting article about how important it is for the aging to stay active.  She blogged that:

Individuals older than 75 who were physically active and participated in social activities lived a median 5.4 years (95% CI 3 to 7.8) longer than those with a less healthy lifestyle and more limited social life, according to Laura Fratiglioni, MD, PhD, and colleagues from the Karolinska Institute in Stockholm.

And even those who were 85 and older lived an extra 4 years (95% CI 0.8 to 7.2) if they remained active, the researchers reported online in BMJ.

read this article from MedPage Today - click here

 This is just another example of useful information we can obtain by following fellow bloggers.

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Social Space Rule: How to use space properly

Every person who works with people should be aware of how to appropriately use space surrounding another person.  If you get to close to the person you're talking to things get kind of awkward.  If you're too far away a shouting match occurs.  So a quick refresher is in order on how to use up space.

As a general rule of thumb, the following rules should be followed:

1.  Social Space:  4-12 feet  (this is good for the initial introduction to the patient)
2.  Personal Space:  18 inches to 4 feet  (This is good for the interview)
3.  Intimate Space:  0-18 inches (This is good for the patient assessment)

A majority of conversations should involve the use of social space. As a general rule, as you approach someone to talk, you should be about 4-5 feet away. I think 4-5 feet is a good distance.  If you get to close take a step back.  It's actually better to be too far away than too close.  I call this the "Social Space Rule."

In my experiences through life I've found most people follow this rule.  However, once in a while you get a space hogger. A "Space hogger" a person who feels the need to get right up close to you during even the most social of conversations.  So you take a step back and they feel the need to re-occupy your personal space.  Those conversations rarely flow smoothly because you feel uncomfortable, and are concentrating on the space rather than what that person is saying.  It's not good.

This rule was taught to me by my parents when I was a kid, and re-introduced when I was in college in sales class.  My sales teacher taught that proper use of space was 50% of the sale.  So he hashed this onto us on a daily basis. His policy was if during a fake sale I invaded his space, he'd hash my grade by 50%.  So you learned quickly of the importance of using space properly.

Don't be a space hog:  follow the social space rule.

RT Cave Rule #59:  Don't be a space hog:  Follow the Social Space Rule.  During a social conversation you should stay 4-5 feet from the person you're talking with.

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It Ain't Easy Being RICH- Hope

Anyone who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This fourth week I will focus on Hope.

Hope is the foundation on which all the other qualities rest. In the dictionary hope is defined as: “to cherish a desire with anticipation;” “to desire with expectation of obtainment;” and “the feeling that what is wanted can be had or that events will turn out for the best.”

I previously posted on Hope on 4/15/12. The focus of that post was the ways that a RICH relationship in itself creates hope, independently of the external reality.

Not surprisingly, the Risking Connection curriculum (Saakvitne, K., Pearlman, L., Gamble, S., & Lev, B. (2000). Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran) has quite a bit to say on hope. The authors maintain that holding hope is a key responsibility of the therapist. Our clients come to us hopeless, and they often experience setbacks that discourage them further. Meanwhile, we are doing this difficult work in the middle of an ineffective and inadequate child welfare system. So, it is possible for both the treater and the client to become hopeless. It is the treater’s responsibility to take care of him/herself and do whatever is needed to fight vicarious trauma in order to maintain hope. The treater’s job is to “Hold onto vision of the survivor’s potential future self,” and to “serve as trustees for the survivor’s future possibilities.” (RC pp.15-16) The treater is at her best when she can see clearly the client healed, living a productive life. The treater must maintain the tension between seeing that version of the client’s potential and also seeing the current reality of the client. The authors ask us to direct our attention to evidence of hope and resiliency in our client’s stories. When presenting or discussing a case, talk about strengths in a real rather than pro forma way. They also point out that hope is fueled by compassion for our clients. If we understand the adaptive nature of their symptoms, we feel less exasperated and less personally attacked. In other words, having a theory, a road map, that helps you understand the behavior and plan your next treatment intervention creates hope that counteracts the bewilderment and discouragement we usually feel in the face of extreme behaviors.

What is the meaning we ascribe to our client’s behaviors? When Aisha ran away and became involved in dangerous situations, Louis reacted: “How can she be so stupid! We have explained a thousand times that she is putting herself at risk. In fact, I just had a great talk with her last night about this! I told her how worried I was about her when she put herself in such danger. She told me she understood and would not run away again, and she thanked me for spending time with her. I guess she was just manipulating me to be able to stay up longer. She doesn’t care about me or anyone else. She doesn’t even want to get better. She’ll probably end up being kicked out of here just like our last two clients. Sometimes I wonder why we even bother.”

Mario was also affected by Aisha’s running away. He said: “I am so scared for Aisha. She still doesn’t value herself enough to keep herself safe. And we haven’t yet been able to teach her an alternative to running, or to make her safe enough to try it. I wonder if we set up a place on grounds where she could run and stay until she calmed down enough to come back if that would help her. And when I think of it, I realize that Aisha has been forming some close connections with both me and Louis. I wonder if that is scary to her, especially since we are guys? I’m going to talk to Tracy, her therapist, about that, and bring it to team. I don’t  know what we should do differently but maybe there is something. Aisha is so bright and has so much spunk. I know she has a great future if we can just find a way to get her there.”

The enemy of hope is vicarious traumatization (VT). Since it is the treater’s responsibility to maintain hope, it is essential that we combat this aspect of VT specifically. Some strategies, largely taken from the Ricking Connection curriculum, include:

·         Challenging negative thoughts and looking for evidence of resiliency

·         Celebrating all kinds of successes

·         Collaboration with others, within our agency, outside, and even outside our treatment community. For example, when a local business joins us and gives backpacks to all the students returning to school, it helps to know that there are others outside our world who care.

·         Noticing the advances in understanding trauma and in treatment that are being discovered through science and new technology.

·         Appreciating the gifts of the consumer movement.

·         Cultivating our spirituality, whatever that may be

·         Look for meaning and inspiration in everyday events and in natural beauty

·         Seeking and embracing the personal transformation that comes with this work. How has this job, and being involved with these clients, changed you for the better? What have you learned from them? In what ways have you grown?

There are also many ways the agency can help workers fight VT and remain hopeful- another time, another post.

Hope is an essential element of every moment of our work. In fact, our work defines hope- we embody a conviction that people can heal and change. We have seen it happen many times.  As we are presented with each new scared, snarly, obnoxious, difficult client it is our job to shine with the hope of all that they can become.

 

 

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If a patient needs a treatment he will get it...

Allow me to tell you two things about me.  If someone needs a treatment that patient will get a treatment whenever he needs it.  If the order is Q4 hours with a prn order, I won't make that patient wait until the four hour mark if the patient is short of breath. I know what it's like to be short of breath and I don't want my patients to have to suffer. 

I also know that when you're short of breath, even remotely dyspneic, you don't think straight; you second guess; you don't want to bother people.  Knowing that, I won't assume the patient's doing fine if I don't get a page.  I say this knowing some of my co-workers won't give a treatment any more often than the minimum requirement unless they get a page.  They simply assume the patient's fine, which isn't always such a good thing. 

I also say this knowing I'm lazy.  I'll do whatever I can to get out of doing work.  I'm a hard worker, yet I hate to do things that aren't needed.  So for this reason, if I'm busy in the emergency room I won't rush up to give a Q4 hour treatment I know isn't needed.  My coworkers often get all panicked when they are busy trying to rush to get every treatment done, yet not this RT. If I'm not busy surely I'll do it, yet I'm not gonna panic about getting a bronchodilator to a patient not exposed to bronchospasm.

Sorry, but it's the truth.  And I can tell you I got this way because I have asthma and I know I don't take a breathing treatment every time I'm short of breath, I use my inhaler which works just as well and costs 100% less money.  I also know I never use rescue medicine as palliative or prophylactic therapy, which is not what it was invented for.  Sorry, I'm just telling the truth.

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Poorly controlled asthma doubles cost

Well, not there's yet another reason why asthma parents need to wise up and do a better job of controlling their child's asthma -- and asthma doctors as well for that matter.  A new study reported on by UPI.com/healthnews spearheaded by asthma experts at National Jewish Health in Denver concluded that poorly controlled asthma nearly doubles costs.

It's actually common sense if you think about it.  Asthma medicines and doctor visits are expensive, yet the costs of paying for unscheduled office visits, frequent emergency room visits, nights admitted at a hospital for uncontrolled asthma and school days missed have an even greater toll.

Plus uncontrolled asthma increases the risk your child will develop severe asthma, anxiety and a host of other complications makes the added cost of controlling your child's asthma well worth the cost.

The study of 628 school aged children aged 6-12 with severe or hardluck asthma concluded that asthmatic children with hardluck asthma incurred an average bill of $7,846 and those with well controlled asthma incurred a cost of about $3,766.  Asthmatics kids with well controlled asthma incurred bills averaging $3,766.

Two years later those with hardluck asthma incurred bills averaging $8,000 and those with well controlled asthma incurred bills averaging $1,861 (costs are in 2002 dollars, and costs in 2011 would be about 25 percent higher).

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Working with pediatrics

Today we are honored to have a guest post from one of my RT pals, Paul Ritt,  who works for a pediatric unit in one of Michigans larger medical facilities.  So if you're interested in working solely with pediatrics, here's a little insight from the inside.

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Hi.  My name is Paul Ritt and I work for Better Life Hospital somewhere in Michigan.  I generally work with pediatric patients of a variety of sorts. We have a ped ICU which we refer to as PIC U for acutely injured kids, and a Peds ICU which is a long term center for mainly chronically ill kids.  The Peds ICU includes a vent dependent unit.  We also have a peds emergency room and a neonatal intensive care unit.  So there you have an overview of our facility. 

I knew from day one working in such a facility would be challenging, and sad at times, yet I love kids and I wouldn't choose to work anywhere else.  One of the neat things about working with kids is a sick kid is a sick kid.  What I mean here is there are a lot of adults who fake it just to get attention, or just to get out of work, or just to get social security.  Yet kids never fake being sick -- or fake it enough to end up in here anyway. 

I love taking care of kids because, to put it simply, I love kids.  I love their innocence.  I love the way they smile even in the face of tough sickness.  I find that kids have a way of seeing hope and happiness where many adults find dread and misery.  Kids just have a way of making life seem so simple.  I just love it.

Yet through it all you have your challenges.  For example, during RSV season we have our shot gun season.  It's based on what we like to call the shotgun effect.  I'm sure you've experienced some form of the shotgun effect where you work.  This is where you have a sick person and the doctor throws everything available at that patient in the hopes that something works.

In RSV season every patient admitted with, or suspected of, having RSV will get all of the following ordered:

• Ventolin
• Pulmicort
• Toby
• Pulmizyne
• CPT
• Suction

You can't do all those at the same time, so you are usually in the room anywhere from 20 minutes to an hour.  The nice thing is you get to spend quality time with the patient and get to know families.  You get to watch lots of Micky Mouse Clubhouse.  The down part is you are in the same room for too long doing wasteful procedures.

Another thing I hate is the PICU.  It's sad for one thing.  Yet often I think the PICU just creates patients for the Peds ICU.  We put some patients on ventilators and we create chronic lungers who require months in the ICU and then a lifetime of suffering from chronic illness. 

Granted sometimes kids need to be ventilated, yet many times I think they are just to make the doctor and nurses feel better, or to satisfy a guideline, or just to protect the airway during a flight in the medical helicopter.  Yes, the PICU is just creating a whole new group of patients, and YES the hospital makes money off these patients.

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Thanks Paul

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It Ain't Easy Being RICH- Part Three: Connection

Any one who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This third week I will focus on Connection

Connection is the central concept in a trauma-informed approach. People heal within relationships. Our programs should offer our clients RICH relationships and train staff how to utilize these relationships for the most powerful healing.

Some of the complexities of this approach become clear when we talk about the fact that relationships have two sides- the clients and ours. These relationships affect us too, and all of who we are shapes the relationship.

On April 9, 2009 I wrote about the Restorative Approach and Boundaries. In this post I discussed some of the common complexities that arise from our caring for the children and wanting to help them. People sometimes assume that because the Restorative Approach emphasizes relationships and speaking from the heart, we are throwing out the idea of boundaries. Quite the opposite is true! For relationships to be safe and healing, the boundaries must be clear, reliable and trustworthy.

Because abuse is in its essence a violation of boundaries, it is especially important that we pay attention to boundaries when working with abused clients. Our children have experienced major boundary violations, such as sexual abuse. They have also experienced many other chronic, less obvious boundary problems. Many of our children have had to handle responsibilities far beyond was is reasonable for their age, such as an eight year old being responsible for her two year old sister. They have been way too involved in adult issues, such as being worried about the rent or finding food. They have been exposed to adult sexuality and to relationship worries. They have had to parent their parents- care for a sick mother, listen to parental problems, help ease a parent’s depression.

So many tem[potations can arise for staff. We may want to give the kids gifts; take them to lunch; give things or money to the family; etc. The family may give the therapist a gift. We consider sharing personal information, either because we feel close to the client or we think it would help them. The client may tell us a secret, on the condition that we don’t tell the rest of the team. When the child is leaving, we may consider giving her our email address. We wonder if we should give this boy a hug.

In our training, we emphasize that as a staff you should TALK ABOUT every decision that is outside your job description before saying anything to the child or family. Talk with your supervisor or your team. It may be just the thing to do; it may be dangerous to the child or the group. But it is much easier to make the right choice when you step back, take time to think, and talk with someone else.

That we even have these dilemmas illustrates how much the kids and family matter to each of us. And so, with each of these real connections comes our exposure to the pain the child is feeling.  When a sad thing happens to the child, we feel it too. It is often hard to stay with that pain- we often just wish to fix it. Part of that impulse is to sheil ourselves from really experiencing the painful worlld of the child.

And we experience losses. We don’t talk much about what it is like to take these children into our hearts, and then have to discharge them- often to a less-than-optimal situations. One person in my agency used to say (when we had residential) “You know they are ready when you don’t want them to leave.” But they do leave, and staff are expected to be ready to open their hearts to the newest snarling child. It’s a hard thing to do, and one aspect of Vicarious Traumatization. It’s good to talk about this in our teams, especially every time there is a significant positive or negative discharge.

One more thing about connection and our part of the relationship. We cannot open our hearts to these clients if we are feeling lousy. If we feel hopeless and incompetent; if we feel mistreated by our boss or the agency; if recent encounters with clients have been scary or hurtful. We will not be available for new relationships. A new admission will be greeted with cynicism or distant formal interactions. This is why a trauma-informed relationship based approach cannot work unless we take care of our staff. How do we do that? Imbed discussion of VT. Schedule time to think, reflect and get support. Provide regular supervision for everyone. Utilize a clinical road map to make sense of the behavior. Have retreats, Have many systems for staff recognition. Do fun things together like potluck lunches and sports.  Time spent in these activities will be completely repaid in more effective treatment, less physical interventions, and less turnover.

Connection. It’s been a scary thing in the children’s lives. It has its complications in our own lives. Yet it is what makes us human and what builds our brains. Let’s look at our settings and consider how we are supporting connections in the way we do things.

I’d love to hear your ideas about ties. Just click on “comment.”

 

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The butt buzzers are coming!!!!

Being I'm the #1 RT blogger on the Internet I was sent the following pre-release advertisement select for nurses and respiratory therapists. Perhaps you'll see it soon in one of your favorite RT Magazines.

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Coming to a hospital near you....  The BUTT BUZZERS® are coming for nurses and RTs.  The BUTT BUZZERS® are coming for you and me.  Doctors don't get them because they're refusing, but the rest of you are coming along for the... BZZZZZT!!!!

The butt buttons are coming.  YOU will be hooked up with a BUTT BUZZERS®.  And as soon as a new worker gets hired... that's right!  It's a BUTT BUZZERS® for that person too.  He or she will be sent right down to the operating room to have a BUTT BUZZERS® inserted just below the skin surface of the buttock. 

Why?  Well, that's simple.  With a firmly inserted BUTT BUZZER® -- small chip just under the surface of your skin -- your bosses will be able to track you wherever you go. 

Why would they want to do that, you ask?  Well, it's to protect YOU -- of course (somewhere a boss snickers).  Your bosses will be able to protect you better this way because they will always know where you are or were.  They will also know exactly how long you were in the room of a patient, and that you were in the room. 

Think of it this way...  This will be essential if the patient says you did this or that to them.  Maybe the patient fell and it's your fault.  Your boss can see on the computer tracker that you weren't even in the room...or that you were on Facebook.  And since the hospital will be reimbursed for services rendered, it will show you had x amount of time at the patient's bedside.

It will also protect your boss from having you not making use of your time.  As soon as you enter the waiting room an alarm will sound.  As soon as you sit an alarm will sound.  You will no longer be able to sit around and Facebook or blog. Humiliating health bloggers like RT Cave will no longer be able to blog from work (Is that that main reason for the BUTT BUZZERS®?  Somewhere an RT boss snickers).

It's also nice for nursing because as soon as they enter a room with a call button on the nurse alarm will automatically go off.  When you are not working, and it is busy at work, your boss will know that you are home and not answering the phone. 

This is all for your benefit, of course, because you should be at work anyway making money to support the hospital and keep it in business and keep patient's happy.  Yes, the BUTT BUZZERS® will be pressure activated, so if you want to fall asleep you'll have to do so standing up -- at least while your on company time.

Coming soon!  To a Hospital near you!!!!  The BUTT BUZZERS®.  (Patent Pending)

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Fret not, though, my friends. Because I talked to the folks who work at one hospital that has this system and -- when the bosses are away -- they rip out the buzzers -- yes, it can be done.  These folks tape them to their remote control cars and airplanes.   All the members of the crew get to watch TV, and they rotate turns buzzing around the remote control vehicles up and down the hallway and in and out of rooms.

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Real indications for EKGs

So the following are indications for EKGs as taught at John Hopkins University School of Medicine:

Yellow cheese under breasts
Arm pain
Yeast infection
White lint under breasts
Maggots in groin area
Nausea
Oozing abscess
Sycopal episode
Pt unable to bathe
Light headed
Pt unable to brush teeth
Cardiac history
Black teeth
Short of breath
No teeth
Stomach pain
White flakes over clothes and skin
Palpitations
Excessive body oil
Electrolyte abnormalities
Bloody nose
Fell
Weakness
Stroke symptoms
Pt skin comes off in sheets
Malaise
Jaw pain
Poverty
Vomiting
Homeless
Over 90
PE
Malaise
COPD
Confused and belligerent
Bloody nose
Headache
Drug overdose
Mental changes
Parkinsons (extreme shakiness)
Diarrhea
Blurred vision
Larygorhhea (loquacious)
Sore toe
Diabetes
Abscess on butt
Cirrhosis
Because
Bad feeling about patients
Don't know what else to do
Cover your ass
It's Monday

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Rule for Hospital Scrubs

The following invisible sign hangs over each drawer with hospital scrubs at Shoreline Medical Center:

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Hospital scrubs are only for people that are financially secure, such as doctors and admins.  RTs and RNs must buy your own scrubs.  We do not have enough money to pay for scrubs for everyone!!!!

Thanks:  Laundry

*ER and surgery personnel are exempt from this ruling.

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Pla-monia

Plamonia:  (n) A faux diagnosis of pneumonia for a patient admitted to the hospital awaiting placement to a nursing home; pneumonia for pacement

Faux diagnosis:  (n)  A fictitious diagnosis to assure patient meets criteria for reimbursement.

Faux pneumonia:  (n)  A fictitious diagnosis of pneumonia simply because pneumonia is the most reimbursable diagnosis.

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12 tips for newly diagnosed COPD patients

So you've been recently diagnosed with chronic obstructive pulmonary disease (COPD).  Now you're wondering what you should do next.  The following are some tips to help you through the next several months.  These are things you should do (or should not do).  

1. Stay calm:  Take your time and get all the facts about your illness.  Let it sink in what's wrong with you and what you can do about it before you make major life changing decisions.  
2. Quit smoking:  This is the one change you must do.  It won't heal your lungs, but it will prevent further damage.  
3. Work with your doctor:  You'll need to do this to get your COPD under control.  Once you get it under control...
4. You can live a normal life with COPD:  Yes, it's true!  You don't have to quit living just because you have COPD.  You can still keep your chairmanship of the city council.  You'll just have to pace yourself.  Besides, you'll need to continue doing things to keep your mind at ease.  Yes, living as normal a life as you can is essential.  Please, don't quit!
5. Stay active:  Along with living as normal as you can, you will need to get exercise.  Your body is not meant to be sedentary.   Exercise makes breathing easier.  Trust me, I say this from personal experience as an asthmatic.  It's no coincidence most asthma and COPD bloggers champion how much they exercise.  
6. Eat healthy:  This is also essential.  This is especially important if you are overweight, as shedding extra pounds can make breathing easier.  Eat several small meals a day instead of just the three large meals.  This is also important because a bloated stomach will push up on your diaphragm making it harder to breathe.  If you need to, ask your doctor to refer you to a dietitian.  
7. Avoid second hand smoke:  DO NOT LET ANYONE SMOKE IN YOUR HOUSE.  DO NOT LET ANYONE SMOKE OUTSIDE YOUR HOUSE.  DON'T ALLOW PEOPLE TO COME INTO YOUR HOUSE SMELLING LIKE SMOKE.  THE FACT I'M MAKING THIS ALL CAPITALS SHOULD SIGNIFY THE IMPORTANCE HERE.  IT DOESN'T DO MUCH GOOD TO QUIT SMOKING IF YOU LET PEOPLE SMOKE NEAR YOU.
8. Avoid smelly body stuff:  Many COPDers complain that strong smells can trigger an attack.  So it's wise not to use strong deodorants, perfumes, aftershave, laundry detergents, etc.  
9. Avoid candles and incense:  These can also clog up the air making it hard to breathe.  
10. Stay positive:  Having COPD is not a death sentence.  You can live a long time with the quality of life you have now, so long as you follow the tips here and stay positive.  Be optimistic.  Keep charging forward.  
11. Educate yourself:  I should actually put this #1.  This is essential.  Go to websites like healthcentral.com and copdnewsoftheday.  These sites will lead you to COPD communities and/or lead you to information and the latest wisdom you need to know about your disease.  
12. Participate in COPD communities:  It's good to know what others like you think.  It's good to know you are not alone.  Check out these links to learn from voices like yours.  

Note:  I'm writing this post as a respiratory therapist who works with COPD patients on a daily basis, a life long asthmatic, and friend to many COPD patients.  I'm writing this in particular to a good friend who tried to quit living and I wouldn't let him.  So this is an extemporaneous list, not one I conjectured from other websites.  Yet the information here is probably similar to what you'll learn from any trusted website or blog.  

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Asthma medicine market risky but profitable

My monthly asthma medicine supply -- which includes Advair, Singulair, Ventolin -- costs me about $100 every month.  Once we add in what the insurance company pays, we're talking about $400 a month.  So you can see asthma is a pretty expensive disease.

It's no wonder those in poverty have a hard time managing their asthma.  Even if an impoverished asthmatic is well educated he may not be able to afford the best asthma medicines, if any medicine.  Yet the pharmaceutical companies are making a profit nonetheless.

According to thepharmaletter.com "Asthma and COPD drugs revenues to reach $43.8 billion by 2015.  This is the same market that made $23.1 billion in 2010.

I want the pharmaceutical companies to make money.  If you guys know how much money was involved in the making of just one medicine you'd be amazed.  Actually I can tell you because an article in the July issue of RT Magazine provides us with this information.

The article is called "What's in the Pipeline?  A brief look at some of the compounds in the pipeline for the treatment of asthma and COPD."    It notes the following facts:

• Drug discovery and development can take up to 15 years
• Drug discovery and development can cost up to $1 billion
• Applications for new drugs was 150 in 2009
• Applications for new drugs was 125 in 2010
• Right now there are 54,000 clinical trials in the U.S. alone
• 0.2 percent of drugs currently in clinical trials will be approved by the FDA

So you can see that for each medicine that reaches the pharmacy almost all of them are dead ends.  This means that pharmaceuticals risk a ton on the slightest chance their medicine will be approved.  And even then that it will be prescribed by doctors.

Pharmaceuticals can set any price they want as far as I'm concerned.  Still, I also believe that a fair price should be set so that poor people, or people who don't have health insurance, can gain access to this medicine.  Likewise, I wouldn't mind a lower cost to myself. 

Surely you're like me and want pharmaceutical companies to continue the quest to discover better medicine.  While lower prices may mean better access to better asthma care, higher prices may be the reward pharmaceutical companies require to continue the risk.

Some people say it's not fair medicine prices are so high.  I'm not one of them. 

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Tips for the good RT Boss

The following is a guest post from Will Lessons, retired RRT

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I worked with Bob for 16 years.  He was a fun guy, and we would spend hours on slow days tossing EKG stickers at the clock or seeing how far our spit would drop from the stairwell. I mean, you have to be fun to do something like this.  Then we'd go out to the nurses station at 4 am and flirt with the female nurses.  On our days off we also had fun together.  

I also remember when it was really busy once Bob and I were taking care of a critical patient.  We so happened to rush into the supply room at the same time, and we realized there was no oxygen tubing.  Bob said, "Watch this!" as he ripped open a venturi mask and took out the oxygen tubing.  "Now we have oxygen tubing."

A few years later Bob became an RT boss and he completely forgot what it was like to be an RT.  It was like he completely morphed from a peasant to a dragon.  Instead of having fun with us he put a stop to all fun.  He was still nice, but he was meticulous at enforcing the rules set forth by the administrators.  He morphed from all fun to all no fun.  Everyone hated him.  He was great at managing the department, but his communication skills dropped off the southern end of the map.

So when he moved on and I became the RT Boss, I decided I wanted to be everything Bob was and everything Bob was not.  During my interview I said to the admins questioning me:  "Bob was a great boss.  He did many great things for this department.  I want to continue all he did.  Where Bob failed was he was a poor communicator.  He made decisions and forced them on us, or at least it appeared that way.  When someone approached him he did all the talking.  The result was a low morale.  I think we would all be better off if we all felt like we were a part of the process.  That's the best way to get the best results, at the best cost, and the lowest amount of waste."  

And then I added, "At least that's what I think.  And I understand you may not hire me because I'm being truthful here, but I think this is important in a boss.  This is from my observation."  

I was hired.  And I kept my door open at all times.  And I kept my voice off.  The sign on my door read:  "Come in and be heard."  That's my advice for prospective and current RT bosses.  Work among the staff, not above them.  

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Thanks once again Will.

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12 things that cause babies to develop asthma

The following was originally published at MyAsthmaCentral.com/Asthma on July 11, 2011.

12 Things That May Cause Asthma Near Birth

So what exactly causes asthma anyway? The truth is scientists still don't know for sure. Yet a growing stack of evidence suggests events that occur before birth, or just after birth, may increase the risk of your baby getting asthma.

Thus, according to various studies, the following are now believed to cause asthma (Learn more by clicking on the links provided):

1.  Cleanliness:  The hygiene hypothesis and microflora hypothesis both propose lack of exposure to bacteria may set off an immune response that causes asthma.  This is especially true in the first year of life when the immune system is developing.

2. Antibiotics: Kids who received even one dose of antibiotics before 6 months were 40 percent more likely to develop asthma and allergies. The theory here is antibiotics wipe out bacteria that are needed to help the immune system develop. (I wrote more about this here.  Also, to learn what bacteria have to do with causing asthma, click here and here for a quick refresher)

3. Cesarean sections may cause asthma: A study showed that children born by C-Section are 80 percent more likely to develop asthma. The theory here is these kids are not exposed to bacteria that kids born vaginally are exposed to. (for more click here)

4. Slow growth in utero: Fetus's that are slow growing late in pregnancy when the lungs are developing are 27 percent more likely to develop asthma later in life. The theory here is lungs that develop more slowly may be narrower and more prone to be susceptible to irritants that might result in airway hypersensitivity and therefore narrowed airways (or asthma).

A more recent study at the University of Aberdeen found that a fetus that's 10 percent smaller than average at 10 weeks gestation and stayed small during the pregnancy was five times more likely to develop asthma.

5. Premature birth: Kids born prematurely at weights of 2.2 pounds had a 21 percent chance of developing asthma, compared to a 9 percent risk for those born a normal weight. The theory here is the inability of the lungs and immune systems to develop properly.

6. Not breast feeding: Children breast fed at least six months had a reduced risk for developing asthma. The theory here is these children are exposed to maternal bacteria needed for the immune system to develop properly. Other studies, however (like this) show breastfeeding might actually cause allergies.

7. Smoke inhalation: Infants exposed to cigarette smoke before birth and after birth had almost a 50 percent increased risk for developing asthma and allergies by the age of four. Smoke exposure in early childhood also increases the risk for allergies, in some cases as much as 50 percent over kids not exposed to second-hand smoke.

This is a sure sign that chemicals inhaled by mom before birth, and passive smoking after birth, can damage the immune system and the lungs of babies.

8. Obese moms: Maternal obesity increases the risk of the child developing asthma by the age of 8 by as much as 65 percent compared to asthma moms who were not overweight. The theory here is that fat tissue produces chemicals that cause inflammation (swelling and redness), and suppresses chemicals that prevent inflammation. This is important, because airway inflammation is a key component of asthma. I wrote more about this here.

9. Moms breathing pollution may cause asthma: Chemicals in the air moms breathe may cause changes in their unborn babies that may cause asthma. Chemical compounds created as a byproduct of vehicle exhaust has been linked to asthma. It's believed certain chemicals may "disrupt the normal functioning of genes," or "reprogram" genes in a way that leads to inflammation in the air passages of the lungs.

10. Abuse may cause asthma: Children who are sexually and physically abused have a 50 percent greater risk of developing asthma and allergies as opposed to other children. The theory here is that stress may alter the brain in a way that it becomes unable to suppress chemicals that cause inflammation.

11. Low vitamin D:  This study shows that infants born with low levels of vitamin D have an increased risk of developing lung infections like Respiratory  syncytial virus (RSV) than those with normal vitamin D levels.  RSV is the most common cause of bronchiolitis during the first 12 months of life, and RSV has been linked to asthma.

12.  RSV:  It's a common virus that causes a head cold in adults, yet in kids it can cause respiratory complications. As I wrote in this post, RSV can fool developing immune systems into turning on the asthma gene instead of fighting off the infection.

Conclusion:  Sure these are all just studies.  Yet all these studies point in the same direction:  decisions made the moment of conception -- or maybe even before conception -- may cause a child to develop asthma.

Likewise, this is further evidence of of the importance of following your doctor's advice, and keeping up on the latest wisdom on how to raise a healthy child.

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The history of labor day (a celebration for us)

About a hundred years ago the first Monday of September of every year was dedicated as Labor Day, a day to celebrate all the people who labor to keep the United States afloat.

The first person to come up with the idea is continually debated, although on September 5, 1882, the first Labor Day celebration was held in New York City as organized by the Central Labor Union.  A similar celebration was held on September 5 the following year, and in 1884 the first Monday of September was selected as the annual celebration of Labor Day.

The idea of such a celebration was appreciated by other labor unions, and by 1884 such celebrations were held in many cities around the United States.  Between 1887 and 1891 legislators in New York, Colorado, Massachusetts, and New Jersey passed laws recognizing the holiday.  By 1894 23 other states passed similar laws, and it was that year Congress passed a law honoring Labor Day as a national holiday.

A parade and family amusement activities were the main feature of the original celebrations, and later on speeches from prominent men and women were added.  The general purpose of the celebration is as follows:

The vital force of labor added materially to the highest standard of living and the greatest production the world has ever known and has brought us closer to the realization of our traditional ideals of economic and political democracy. It is appropriate, therefore, that the nation pay tribute on Labor Day to the creator of so much of the nation's strength, freedom, and leadership — the American worker.

It was a holiday created by unions, back when unions were necessary and useful to protect the labor force.  Little did they know when the holiday was created that America would go on to become the world's leading economy. And you and I, as hard working nurses, doctors, x-ray techs, EMTs, and respiratory therapists, are a part of this.  We are being celebrated today.

We are the unseen worker who work hard around the clock, even on holidays, even on weekends, to keep people healthy so they can continue to labor.  Yes, folks, you should sit back a moment, take a deep breath, and feel proud that you are a part of the great American labor force -- the greatest labor force in the world.

Reference:

1. The U.S. Department of Labor, "The History of Labor Day,"  http://www.dol.gov/opa/aboutdol/laborday.htm

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It Ain't Easy Being RICH 2: Information

Any one who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This second week I will focus on Information.

This might seem like the easiest one- just give our clients information. Tell them things. But I would like to explore four areas of complexity: collaborative treatment including the use of medications; sharing information with the team; psycho-education about trauma; and information and heartbreak.

Collaborative Teatment Including the Use of Medications: When working with trauma survivors it is essential to be collaborative. They have had so much experience of things being done to them, and of having no control, and they are exquisitely sensitive to such treatment. Also, trauma survivors have not had a chance to develop a voice, learn to speak up for themselves and advocate effectively. In treatment settings, especially with children, we tend to repeat the same dynamic. We make the decisions and when a child tries to object we call that “resistance” and respond with a punishment or at the least disapproval.

One area in which this happens is in the use of medications. We all (I hope) do discuss with a client why we are suggesting a certain med, what the benefits could be, and what the side effects are. We often give them and their families an information sheet. Yet do we truly respect any hesitation or objection the client has to the medication?

Did you know that even accounting for race, social situation, and other variables foster children receive 2-3 times as many medications as other children? I understand it this way: children handle stress and achieve emotional regulation through strong relationships. Connection is the antidote to stress. If a child does not have the strong connections to help her regulate, medication is used instead.

Back to information. It is important to REALLY be collaborative about medication with the child If the child refuses to take her medications she should NEVER be punished (or consequenced) for this choice. It may be an appropriate decision not to take her on a long trip if staff is concerned about her safety and the safety of those around her. But if a child does not want to take her medication, the therapist will be talking with her trying to understand her reality and what the meds mean to her. Why does she not want to take the red pill when she will take the others? Because it has a bitter taste, because her friend told her it was poison, because ever since that one started she can’t sleep. The therapist will get important information and in working with the psychiatrist perhaps something better can be found. And in collaborating with the child the therapist will be developing self awareness as they together monitor how she feels and acts. So, information about medications is not just giving the client a fact sheet. It is a truly collaborative exploration of the suggested meds and the client’s valid needs and wants.

Sharing Information with the Team: I believe that in a residential treatment center or hospital or any congregate care setting, the line of confidentiality should be around the Team, not just around the individual therapist. Some therapists have difficulty with this belief. In our theory, everyone who interacts with the child and family is a treater and contributes to healing. Therefore, they all have to know what is going on. They need to know the child’s discharge plan and destination and what their goals are. They also need to know what is currently happening in the child’s life. In my consulting I have encountered situations in which the full time child care workers have no idea about either the child’s history or their discharge plan. In some situations, such as when the child is disclosing sexual abuse, she may not want everyone on the team to know about it. Her therapist will create with her a phrase that the therapist can tell the team, such as “Nina is talking about some difficult things from her past right now, so she needs some extra support.” The therapist will help Nina to expand the circle when/if she feels ready. But in general, the team is all there to treat the child, and all need to know what is happening. This policy should be clearly explained to the child and family (and documented) when they are admitted. In order to gather this information and discuss its significance, the child care worker must be able to spend time in Treatment Team to learn about the client and understand their reactions.

Psycho-education about Trauma: How many of you in your programs are teaching the biology and psychology of trauma to the children and their families? Even younger children can learn something about their brain and body and why they act the way they do. This knowledge can be extremely important to our children. It helps them feel less crazy. When they learn that the body reacts a certain way to stress, and the same thing happens to soldiers, and policemen, and the workers in the program, it combats that conviction that their crazy behavior is their own fault. I will never forget Colleen, who when reading The Courage to Heal (Bass and Davis, Morrow, 2008) said: “This is me! In a book!”  For her it was so normalizing to know that others understood her.

Of course, there is my Blub book on “A Kid’s View of Trauma”. This book uses the Risking Connectionâconcepts to explain trauma to kids, including how they can heal. It can be found at www.blurb.com.  Some trauma-specific treatments, like TARGET, also explain the biology of trauma.

Another part of this is the parents. As we know most of them are also trauma survivors, and many have never worked on their issues. When we do psycho-education with them to help them understand their child, many parents immediately relate this information to themselves. Like Mrs. Jennings they say: “I wish I had had this information years ago!”

Information and Heartbreak: When we form caring relationships with children in the child welfare system, we are constantly dealing with heartbreak- the child’s, and hence our own. We often struggle with when to tell the child disturbing information. At what point do we tell Marvin that the foster family he is visiting is beginning to have doubts that they can take him? When does the DCF worker tell Melissa that her mother has dropped out of the drug treatment program? Or does she tell her at all?

I have seen people, especially state social workers, be so reluctant to tell a child bad news (you are not going home) that she hedges and leaves the child with an unwarranted sense of hope. This prevents the child from being able to explore new alternatives.

One are in which we struggle with imparting information is when a beloved staff is leaving. How long in advance should we tell the children? Some feel we should wait until the last minute to tell the kids, as otherwise they will get upset and have melt downs. Yet, if we do not give them time to process this departure, we will be repeating their past trauma in which people came and went without explanation.

In all these situations we have to tell the child in a straight way what is happening, and be prepared for some appropriate emotions of despair and hopelessness. If we can stay with the child through their reactions, and witness and empathize with the painful situation they are in, they will eventually, if reluctantly, be able to move on to the next plan. Their reactions are not inconveniences for us. They are the child’s legitimate protest against an unfair world.

What other dilemmas around Information can you thinkof? I didn’t even get to sharing personal information. Click on “comment” and share your information dilemmas.                                                                                                                                        

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