Archive for January, 2010

Okay, so here I am 50+, looking at the lovely “senile lentigines” on the back of my wrinkly old hand. A commercial on TV says their cream will fix my old skin and make me look like a teenager again. Could this be true?

First I had to see exactly how the skin breaks down and gets all saggy: UV radiation causes the generation of free radicals (I thought they were all in Washington, DC). Free radicals, otherwise known as ROS, cause increased levels of AP-1  a transcription factor that inhibits collagen production; and decreased levels of transformative growth factor ( TGF). (Transformative growth factor, wow, that sounds really nice! I want a LOT of that stuff!) Skin is constantly being remodeled. The body really doesn’t like stasis, only homeostasis. So it constantly tears things down and builds them back up. I guess when we get older, the body gets a little lazy, and forgets to build up so much.The  UV-caused ROS messes up the balance, more collagen being broken down than built up causes an invisible “solar scar”. Repeated UV damage eventually causes a deep scar, otherwise known as a wrinkle, and the skin is less elastic because of insufficient collagen.

Back to the creams: can any of them fix the problem and repair the damage? Maybe a little. It turns out that some studies have shown that creams with antioxidants in them actually do reverse the damage a little. Idebedone, a type of Coenzyme Q 10, and Vitamin C 5% topical actually help to stimulate collagen production, though it can take six months to show an effect. Do you think a paste made up of a Vitamin C tablet would work? Maybe I should go to the store and start peering at cream labels with my dollar store reading glasses and see if any have one of those magic ingredients. It can’t hurt, maybe in six months I’ll look 48 again.

Can you tell we are studying “the integument” this week?

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Now that I am back in classes again, I have to remember that there is a big difference between normal daily thinking and the type of thinking expected in a Master’s level class. Normally, cursory understanding and shallow involvement is all that is necessary to get through a day. How much do you really think about the box of cereal you are about to put in your shopping cart after all? A glance at the calorie levels and a cursory analysis of the potential likeability of the flavor of the product is about it. “Hmm, 110 calories and I like blueberry, it’s a go”. Done.

Now if it were an assignment to analyze the decision about the cereal, you could write a 5 page thesis on the subject, not including reference page, in APA format of course (Where did the American Psychological Association get the ability to dictate how everyone writes a paper anyway?). Start with research on the company that makes the product: is it a company with a good economic and quality rating? Have they had many recalls of their products? Is the packaging design misleading or accurate? Is the packaging harmful to the environment (too much package for too little product) and is the box truly indicative of the amount of product within. I hate it when you open a cookie box and there is a plastic tray inside so there are only a few cookies in a huge box.

Next comes the nutritional value. Is the product whole grain? Or so-called “enriched”. Is it high fat/sugar? Are there trans fats? (Oh, I recently found out that zero trans fat listed on box means less than 1/2 gram. That isn’t zero by my definition. Back to looking for hydrogenated oils again in the ingredient listing). How many calories? High fructose corn syrup?

Then there is price, Is it a good value? Are there other products similar with a better price? Does the store brand taste as good? (Hmm, taste testing coming up).

It is a whole different world, and my husband wonders why I look vaguely at him when he asks me, what do you want for breakfast?

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I am sad to hear that Montana is now the third state in the US to legalize physician assisted suicide. As a long-time hospice nurse,  I have been at the bedside of many dying people, and I have also been at the bedside of people dying without hospice. I have talked to family members devastated by the thought of losing a loved one and cried right along with them as they went through the grieving process, before and after the final day. I have listened to people who knew they were dying and helped them handle the transition, the symptoms and the fear.

I am also Dutch, born in Amsterdam, but have spent most of my life here in the US. I was proud of my country of birth, because Dutch doctors were the only ones who did not kill at Hitler’s orders during WWII: physically and mentally handicapped people were among those that Hitler wanted to “clean out” of his perfect society. Now Holland is one of the places where doctors kill patients routinely, it is only called euthanasia if the patient asked for it.

Here is a link to a good run-down on what is happening in the Netherlands, results of the 1990 Remmelink Report (it isn’t available in English, and the third and latest report from 2001 shows approximately the same numbers as the first report)http://www.internationaltaskforce.org/fctholl.htm    Please note the number of people killed each year without their consent.

I find it appalling that so many people call killing  “compassionate” or a “choice”, whether it is the unborn or the suffering dying, or even handicapped people. Physician assisted suicide is a failure of the physician to care for his or her patient in a compassionate and appropriate manner. The person begs to die, but why? Is it pain? We have excellent analgesics. Is it fear? Give them compassion and help them to cope, humor is a wonderful thing. Is it loss of dignity? Give them loving and respectful care. Are they sad and grieving? Give them hugs, touches, love. (A pill for depression doesn’t do the job at this point.) Is it not wanting to lose their independence and sense of control? Give them knowledge about their condition and treatment options, including palliative care.

With today’s modern technology and drugs, there is no excuse for euthanasia or physician assisted suicide. Patient’s don’t need to suffer pain, and actually most people who ask to die don’t do so because of pain, but because of loss of control and dignity. I have found in my service with hospice that control is given in the form of information and choices; and dignity is maintained by respectful and loving care.

Suffering in and of itself is not a reason to kill someone. Ease the suffering, don’t end the life. We all suffer, what level is then considered to be too much? Who will judge that? Your doctor? The family member who suggests “You don’t want to be a burden to your family, do you, Mom?” (Yes, I have seen that.) Killing should not be considered a health care option.

In my humble opinion, if a dying person is asking to be killed to shorten the agony, it is the people around them that have failed in their opportunity to show them they are cared about. There can be deep meaning and even joy in those final precious days. Each moment is a gift, and should not be thrown away. It is up to the health care community to provide adequate symptom control so the person can have the time to be with their friends and family.

There can be a good death, and it is not the road of suicide, but the acceptance and respect for death and dying as a special process that has its own way of healing; and the inevitable end to all of our days. Having seen so many people in their last days, I can say I am not afraid to die, but I surely hope that my family, friends and doctors don’t turn away and decide to be “compassionate” and kill me just when I need to spend time contemplating and getting ready for that final trip.

Hospice is caring. Not physician assisted suicide.

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