Nursing Perspectives

Live a Little, Laugh a Lot

Barb Bancroft, RN, MSN, PNP

The following excerpts from the author’s book, “Live a little, Laugh a Lot”, is a genuine clinical reference manual and a cover to cover, funny read packed with riveting anecdotes, strange but true facts, medical misconceptions, and advice on disease prevention and treatment.

SHIT (Ship High in Transport). In the sixteenth and seventeenth centuries, everything had to be transported by ship. It was also before commercial fertilizer’s invention, so large shipments of manure were common. It was shipped dry, because in dry form it weighed quite a bit less than in wet form. However, once the seawater hit the dry manure, it not only became heavier, but the process of fermentation began again, the by-product of which is methane gas.

As the stuff was stored below the decks in bundles the methane built up in the enclosed space. The first time someone moseyed on down into the lower decks with a lantern, KABOOM! Several ships were destroyed in this manner. After that, the bundles were always stamped with the term Ship High in Transit, which meant for the sailors to stow it high enough off the lower decks so that any water that came into contact with it would not start the production of methane.

Occupational hazards of hospital hairdressers. It appears as if Hortense, the hospital hairdresser, just might be the Typhoid Mary of MRSA (methicillin-resistant staphylococcus aureus). In a study reported in the Journal of Hospital Infections (November 2001; 49: 225-7), researchers traced an outbreak of MRSA to the hospital hairdresser and her contaminated hairdressing tools. It appears as if infection control policies in most hospitals don’t require adequate decontamination of these tools and cross-infection can occur readily between patients. And, most likely the hospital hairdresser acquired the infection from one of her patients.

Pull quote: Lawyers are 3.6 times more likely to suffer depression than other professionals.

Well, here’s an anthropological gem that will keep you up at night. Our teeth are getting smaller. Yes, and we can blame this fascinating fact on the fact that we are cooking our food instead of just ripping it off the bone or yanking it directly off the plant and chewing on it for long periods of time. Teeth have shrunk in size by about 50 percent over the past 100,000 years. Don’t worry; you won’t wake up tomorrow completely toothless. Teeth are shrinking, but only at a rate of 1 percent per 1,000 years.

Risky Business If you don’t die from falling out of bed, you can be injured while lying in bed. That is, 1 in 400 will sustain an injury, usually from some sort of structural failure, such as a headboard collapsing on the head sleeping adjacent to it, or the frame deciding to give way under all of that accumulated weight gained over the years.

It’s now time to get ready for work. Dressing for work poses special hazards. An individual faces a 1 in 2,600 annual risk of being injured by a zipper, a snap, or some other fastener. This obviously makes Velcro much more appealing as we age and our manual dexterity declines. And of course, with the zipper injuries as well as the toilet seat covers, that gender “thing” comes to mind.

It’s 7:30 a.m. and time for work. The odds of being killed while walking to work are 1 in 40,000; however, it is still safer to walk to work than to hop in the car. The risk increases to 1 in 11,000 once you’re in the car. If you are a pedestrian, your risk of dying in a motor vehicle accident is 1 in 40,000. Your combined risk of dying in a motor vehicle accident, whether as a passenger, pedestrian or driver, is 1 in 5,600.

He describes these risks with a range from one in one trillion to one in one. He also gives negative and positive numbers for these risks, so for example a one in one trillion would be a negative six risk versus a one in one risk which would be a positive six risk. The midpoint, or zero on the scale represents a one in a million risk. Paling describes the negative two to negative four risk on this scale as one-in-a-kind risks, the chance of something happening once a year in the entire U.S. He also describes this as the “Bobbitt zone,” which we all know would be the chance of a penis being chopped off by a unhappy wife. So then, here are a few examples on Paling’s so-called Richter scale of risks:
• One in 1 million to 1 in 10 million risk of dying from a lightning strike
• One in 1 million to 1 in 10 million risk of dying from cancer by eating a charbroiled steak once a week
• One in 1 million is the point below which the FDA deems any risk of cancer from a food additive too small to be of concern over a lifetime
• One in 1 million risk of a woman being killed by a husband or lover
• One in 1 million chance of drowning in a bathtub
• One in 1 in 100,000 extra risk of cancer from cosmic rays for a Denver resident compared with someone living in New York City
• One in 100,000 extra risk of cancer from eating a peanut butter sandwich every day
• One in 10,000 to 1 in 100,000 risk of cancer from drinking one ‘lite’ beer a day
• One in 10,000 risk of becoming a murder victim
• One in 10,000 risk of dying in childbirth
• One in 10,000 risk of dying from driving a motor vehicle
• One in 1,000 to 1in 10,000 risk of arriving in the emergency room for a treatment for an injury from a sink or toilet
• One in 100 to 1 in 1,000 risk for dying from some form of cancer

(Up to Your Armpits in Alligators? How to Sort Out What Risks Are Worth Worrying About. John and Sean Paling, January 1997)

Rely tampons, super absorbency, and Toxic Shock Syndrome. The Tampax company was the reigning tampon titan through the 1960s; however, by the early 1970s the competition was heating up. All of the big companies wanted a piece of the action. Proctor and Gamble, Playtex, Kimberly-Clark, and Johnson and Johnson all decided to throw their products on the market. So, how could they trump the competition? What would make their product special?

Kegel exercises for a bigger, better orgasm. Now this is one exercise you might just want to partake in daily. The pubococcygeal (PC) muscle group, which supports the pelvic floor, is the one that spasms when you have an orgasm. If it’s in good shape, more blood will flow to the pelvic area during arousal and the PC muscle will contract more strongly, making orgasms last longer and feel more intense. Kegel exercises are a simple way to strengthen PC muscles. To do the Kegel exercise, squeeze the muscle you use to voluntarily hold back your urine. Hold for two seconds and then release. Repeat 20 times, three times a day. You can actually do this anywhere and at anytime. You don’t need to go to the gym; you don’t need to lie on a floor mat. You can drive to the store and while you’re at a stoplight, just tighten up. A few times at the stoplight, a few times before you get out of the car, a couple of times going around the block and before you know it, you will have performed 60 Kegel’s throughout the day. While you’re thinking about it, go ahead; contract those muscles, two, three, four…and again, two, three, four.

A case of anabolic steroid use and athletic prowess. Will the will to excel ever end? When will the doping violations for major sports events cease to exist? Well, it appears as if doping with anabolic steroids is not just limited to weight lifting, wrestling, bicycling, professional football, professional baseball, and professional basketball. It has now entered the cutthroat world of table tennis. Yes, dear readers, the scandal continues to involve athletes in every venue. Table tennis player Barney Reed Jr. of New York has been suspended for two years following a doping violation. Reed tested positive for anabolic steroids at the 2001 North American Championships in Ft. Lauderdale and his suspension is retroactive through July 6, 2001. This, of course, means that his winning results since that time have all been erased from the record books. And, from what I understand, Barney was a mean doubles player in the world of table tennis. Must have been the massive biceps and unfettered aggression.

A little foreskin goes a long way. Here’s the answer to that question, “What do they do with all of the circumcised foreskin?” Organogenesis, Inc., of Canton, Massachusetts has been using human foreskin cells to produce human skin grafts for patients with venous leg ulcers and diabetic foot ulcers to patients with multi-thickness burns. One foreskin, the size of a postage stamp, snipped from an unsuspecting neonate, can produce as many as 200,000 grafts. The foreskin cells are separated at birth, so to speak, and multiplied in culture banks. Foreskin actually contains various types of cells, not all of which are useful for skin grafting.

The separation process discards the “immune-stimulating” cells, and saves the fibroblasts and keratinocytes for the culture plate. The fibroblasts help stimulate the growth and regeneration of the dermis of the skin while the keratinocytes provide the protective top layer or epidermis. The fibroblasts are mixed with proteins, such as collagen, from the tendons of the bovine species. It takes approximately six days for the layer of dermis to grow, after which the keratinocytes are tossed into the culture plate. The keratinocytes form the tough outer layer known as the stratum corneum, the layer capable of resisting injury and infection. Twenty days after the initial “snip” in the newborn nursery, the tissue is ready for use. Voilà!

The skin graft is grown in an individual shallow dish approximately three inches wide. This produces a perfectly round ready-to-wear patch of tissue. It takes a grand total of 15 minutes to apply the patch to the area of need (a venous ulcer for example), and bind it with the gauze patch. The graft stimulates the host’s tissue to regenerate and heal the vascular ulcer without having to use a patch of skin from another part of the patient’s body.

So you think you’re sleeping alone? After collecting dust samples from beds in 800 homes, U.S. Government researchers found dust mite droppings in excess of 2 mg per gram of dust, a level known to trigger allergies, in 44 million homes. In half of these homes they were five-fold higher—enough to keep you wheezin’ and sneezin’ into the next century. So, what to do? Turn that humidifier on, wash those sheets in scalding water, and zip up those duvet covers and pillows in allergy-proof covers. Whew! You’re safe again…oops…not so fast. The U.S. government researchers also found another friend in bed with you. Cockroaches and their excrement are present in approximately 6 million household beds. And, cockroaches with their dander (skin cells) and their excrement are also potent allergens. You’ll never sleep alone, again. (American Lung Association/American Thoracic Society Meeting 2000)

Chickenpox. Chickenpox is not called “chicken” pox because it comes from chickens. The term, “chicken” has been used for centuries for connotations that mean “weakness” or pettiness, as in “chicken-hearted” and “chicken-feed” and in “ya’ big ol’ chicken.”

Dr. William Heberden (1710-1801), an English physician, used the term to distinguish the typically mild or “weak” clinical course of chickenpox from the more virulent course of smallpox.

Sex after sixty. Sexually transmitted diseases (STDs) in the 65-plus age group have increased by more than 300 percent according to a report by British researchers in The Medical Post, October 2001. The researchers attribute this rise in STDs to healthier lifestyles, enabling older adults to maintain their sexual prowess, as well as the Pfizer Riser, Viagra, which as we are all aware, enables males to have erections soon after taking the little blue pill. In addition, high divorce rates have tossed more seniors into the dating circles and with the threat of pregnancy being zero, extracurricular sex has become quite the rage. Woohoo! Our safe sex classes will have to commence with Sunday school and finish with the centenarian swingin’ singles clubs.

Pull quote: Flies spread disease. Keep yours zipped. —Anonymous

Counting calories to lose weight?

Kissing burns six to twelve calories, depending on the intensity of the kiss. A wild ride in the hay might burn 125 to 300 calories, depending on just how wild that ride gets. If you’ve been married for 35 years that ride in the hay no longer uses the adjective “wild” and you might burn 125 calories. However, if you have been married only two weeks most likely the encounter will burn at least 300 calories. If you passionately kiss your beloved three times per day and make mad passionate love twice a week, you could theoretically burn 32,000 calories in a year, the equivalent of a 9-pound weight loss. Why are you sitting here reading this book? Don’t you have some calories to burn?

Can you gain weight by just looking at food? Well, yes. From personal experience, I know this to be true. But also, in a recent Yale University study, insulin levels increased dramatically in individuals exposed to the sight, smell and even the mere mention of charcoal-broiled steaks. Participant’s bodies started converting glucose to fat even before they had taken their first bite. Here is an example of yet another incredible mind-body interaction. Unfortunately, this one has detrimental effects on the waistline.

The bubbly and the brain. The bubbles in the champagne are responsible for moving the alcohol into the bloodstream and straight to the brain faster than other types of booze. It only takes five minutes for bubbly champagne drinkers to have a blood alcohol level of .54 mg per ml. The control group, drinking flat champagne, had blood alcohol levels of only .39 mg per ml after five minutes. After forty minutes the bubbly group had blood alcohol levels of 0.7 mg per ml, just 0.1 mg short of the legal limit for driving (in England) whereas the flat champagne drinkers had only reached .58 milligrams. (University of Surrey in Guildford, U.K., 2002)

Historical Highlight: The manufacturers of Old Grand-Dad bourbon were able to produce their whiskey during Prohibition by labeling the beverage “for medicinal purposes only.”

What are the triggers of childhood asthma? Use the mnemonic ASTHMA:
A Allergy (the house dust mite, pollens, dander [cat, dog, cockroach])
S Sport (exercise, play)
T Temperature (cold, wet, windy weather)
H Heredity (familial tendency to asthma; gene locus)
M Microbiology (viruses, mycoplasma, etc.)
A Anxiety (stress, worries)

Why are circumcisions performed? Use the 6 Ms:
M Moses (Jewish religion)
M Mohammed (Muslims)
M Mother wants it
M Money
M Mythical reasons
M Medical reasons (phimosis, paraphimosis)

Coffee enemas for detoxification—doin’ it the old-fashioned way. Nursing textbooks from the 1920s through the 1950s touted the beneficial effects of coffee enemas for a variety of conditions ranging from arthritis to schizophrenia. The Merck Manual included coffee enemas as recommended therapy for detoxification until 1977. Coffee enemas were dropped from the Merck Manual in 1977 because they had fallen out of fashion with the changing technological advances. Today, however, with the re-emergence of complementary and alternative therapies, daily coffee enemas have re-emerged as detoxifying agents in a alternative cancer therapy program known as the Gonzalez/Kelley treatment regimen for pancreatic cancer. In addition, various alternative practitioners favor coffee enemas as a means of enhancing liver function and removing metabolic toxins and waste.

The mechanism of action is presumed to be smooth muscle relaxation of the hepatic ducts resulting in increased secretion of toxins from the liver into the GI tract and out of the body. This only occurs when the caffeine is administered rectally—drinking coffee does not have the same effect on the biliary system.

Leeches. Leech is the common name for a bloodsucking worm of the class Hirudinea, but it also was, in the past (and, rarely in the present), used to designate a physician. In fact, the latter meaning came first, being derived from the Anglo-Saxon laece, “one who heals.” “Bloodletting” or “leeching” for the purpose of treating disease caused by harmful “humors” has been utilized since before the days of Hippocrates. Since the leech was used to consume the harmful “humors” from an inflamed lesion, it was given the name “the healer.” One of the most famous uses for multiple leeches was in the treatment of “dropsy,” yesteryear’s equivalent of today’s congestive heart failure. In the 1830s bloodletting reached its peak of popularity, when 20 million leeches a year were used as bloodsuckers.

Rectal suppositories. Which end is up? Well, which end should be inserted first? The head of the suppository (the thick bulbous end) or the base (the skinny end)? Traditional insertion recommends that the apex has the privilege of entering the rectum first. However, a study with 100 subjects (60 adults and 40 children) compared apical vs. base insertion and found that 59 adults and 39 children preferred the base to be inserted first. Besides patient preference, two other advantages were found. One, there was no need to insert the finger into the rectal canal when the base was inserted first. Two, the incidence of expulsion (having it come right back at ya’), occurred only with apical insertion. The authors of the study (Lancet, Vol. 338, 1991) theorized that the arrangement of the muscles around the anal canal and rectum facilitate the insertion of the torpedo-shaped suppository with the base first. So, it’s bottom’s up instead of heads first.

Rethinking needle size for adult vaccines. Another consequence of our “growing” society just happens to affect the size of needles used for vaccination purposes. Vaccines are being given into fat tissue instead of muscle tissue. Since our society continues to gain weight, many of the standard immunization needles won’t penetrate deep enough to hit a muscle. Subcutaneous fat tissue is less vascular than muscle tissue; hence the immune system doesn’t stand much of a chance in recognizing the foreign substance and therefore is unable to mount an appropriate immune response to it. The standard 5/8-inch needle isn’t long enough for about 17 percent of men and nearly 50 percent of women. How embarrassing is that? Ladies, we need to join Weight-Lifting 101 classes to build up our deltoids. For IM injections, use a 1-inch needle for average size adults, and a 1.5-inch needle for women over 200 pounds and men over 260 pounds. (British Medical Journal 2000; 321: 1237)

Pull Quote: A survey of 2,212 members of the International Conference of Symphony and Opera Musicians indicated that propranolol (Inderal) is to contemporary classical music as liquor was to bebop, LSD was to late-1960s rock, or marijuana is to reggae. (Fishwein, M, Middlestadt, SE. Medical problems among ICSOM musicians: Overview of a national survey. Med Prob Perform Artists 1988; 3:1-8.)

Barb Bancroft, RN, MSN, PNP has captivated audiences during seminars on nutrition, health and disease for over twenty years. She conducts more than 120 seminars annually. She has been a keynote speaker for many prestigious conferences and has held graduate faculty positions at the University of Virginia, University of Arkansas and Loyola University of Chicago. She is also the author of “An Apple A Day: The ABCs of diet and disease (2001). You may contact her through her web site www.barbbancroft.com