When Should You Go? – A Physician Perspective
By Dr. Frank Birinyi, an Emergency Department physician and Worthington resident for 19 1/2 years.
My Emergency Department (ED) is no different than the one you may have visited recently - the long wait sometimes stretches one’s patience to the max. However, some fairly common problems can be comfortably managed without a trip to the ED. To illustrate, I present fictional e-mails from my sister-in-law.
June 2006: Dear Frank, your brother is worthless. All I asked him to do last night was to help me dry the dishes (after I had washed them after I had made dinner). While he was drying the inside of one of the glasses, the glass broke and he had a small cut on his hand. I could pull the skin edges apart, so I figured it needed stitches, so off we went and spent the rest of the evening in the ED. More later. Love, Jane.
Answer: If you can pull the skin edges of a laceration completely apart, this indicates the laceration is full-thickness. In general a full-thickness laceration requires stitches. However, a small full-thickness laceration on the hand in which the edges are not under tension does not require stitches. A butterfly or bandaid may be used. Follow-up with the family doctor if you have not had a tetanus booster in the last fiveyears.
July 2006: Dear Frank, does Bob have any brains at all? We were pulling up some weeds, and I am sure I mentioned that there was poison ivy in the area. Nevertheless, he pulls up everything in sight, and he has not stopped itching since. Despite several different poison ivy lotions from the drug store, it looks like the poison ivy is spreading. He has some on his face, and I am concerned it may spread to his eye. We are off to the ED. Later. Jane.
Answer: Following one’s exposure to poison ivy itself, the rash from poison ivy does not spread. Skin in different areas of the body reacts in different time frames. Therefore over two-three days, the poison ivy rash develops at different times - giving the impression that it is spreading. The rash may involve the eyelid, but poison ivy does not spread to the eye itself. Over-the-counter remedies are effective for small cases of poison ivy. If a significant portion of the skin surface area is involved, applying a lotion becomes impractical, and oral steroids (prescribed by your family doctor) work best.
August 2006: Dear Frank, your brother is driving me crazy - he thinks he’s a doctor after doing an Internet search on vomiting. The whole family has some degree of vomiting and diarrhea, and Bob is feeding us soda crackers and ginger ale. I suggested plain water, but when Anna vomited that up too, I became concerned that she was getting dehydrated. She felt better pretty fast so we avoided the trip to the ED, at least for now. Jane.
Answer: Vomiting that runs through the household suggests a virus. Most viruses do not have an immediate remedy and must run their course, usually several days. A clear liquid diet is recommended since clear liquids are easiest for the stomach. A clear liquid diet consists of liquids that you can see through if held up to the light. Small quantities are recommended initially. Should vomiting persist, the best solution is to keep the stomach empty for two to four hours immediately after a vomiting episode. Even simple liquids like water occasionally result in vomiting if given within two to four hours of vomiting. However, even in this situation, necessary prescription medicines may be taken with sips of water; small amounts of ice chips may also be taken during this time. Serious dehydration is rarely a significant problem in otherwise healthy adults and older children.
Unfortunately the occasional long waits in the ED are unavoidable. However, as the public (and my sister-in-law) becomes more educated, perhaps some visits can be avoided.
80 Years Old and Still Running
By Judge John McCormac, a longtime Worthington resident who began running at age 53, including 36 Marathons.
My son’s Christmas present in 1978 changed my life. Mike gave me a pair of Nike running shoes accompanied by, “You’re in better shape than those other old guys, you should start running road races.”
The shoes stayed in the box until March 1. “Who runs in the winter?”, I thought. Then another motivating voice was heard. A runner who worked at the court challenged me to enter a 10 K (6.2 mile) race on April 1, appropriately named, “Fool’s Run.” Twenty-three year old Mike went out with me that same evening as I struggled through 2 miles. Given the April 1 race as my goal, I ran or walked daily for the next 30 days and completed the race. I was off and running!
In November 1979, I completed my first marathon (26.2 miles). Since then, I have run in eight states including the Boston Marathon. Now at 80 years of age, I am still running and walking and will compete in my 37th marathon this October in Columbus.
While my experience may not be typical or even advisable, the benefits I’ve received are available to most anyone. What are those benefits? Experts agree that running or walking:
· Improves health and quality of life;
· Leads to weight loss and better dietary habits with regular participation;
· Lowers blood pressure, pulse and cholesterol, all of which happen with improved cardiovascular fitness.
· Research demonstrates that even persons in their 90s can improve strength and stability rather remarkably with regular walking or weight programs designed for them.
· Fitness improves a person’s ability to be more independent, something that all of us desire.
Here are some things to remember when getting started. Proceed at your own pace. Enjoy the process and take care to not push to the point of injury.
Find one or more friends to accompany you. (My son saw me through my first months and a neighbor soon joined in.) You’ll be less apt to make excuses if you’re meeting someone. If you haven’t been running, start walking and add running a bit at a time. Fitness experts have shown that walking is as beneficial to your health as running.
Keep the pace to a rate at which you are still able to talk. Talking to your companion is part of the joy and makes the time go faster.
Use bike paths, parks or areas with sidewalks. Worthington has an excellent community center- a bargain for seniors - to walk, run, lift weights or swim. Walkers can utilize Worthington Square mall for indoor walking.
At three days a week minimum, you will rapidly improve. When training for a marathon, I generally run or walk six days a week. Some walkers or runners never compete but as they improve, it is surprising how many do enter races.
My joy for the past 10 years is Team In Training, an organization dedicated to raising money to find a cure for Leukemia and Lymphoma, destructive blood cancers. We run and walk as a team, buoyed by our supporters and guided by caring coaches. Many of our participants are older and start out with practically no base, and virtually everyone finishes the 26.2 miles. We celebrate afterwards with our heroes, the children and adults that we strive to save.
John McCormac served 1974 to 1993 on the Court of Appeals, and continues to serve by assignment. He has authored seven law books and served as president of both the Columbus Bar Association and the League of Ohio Law Schools. He has numerous professional honors and was inducted into the Team in Training Hall of Fame.
Guest Column
Mental Health Issues: Understanding Trauma
Mary Byrley, MA, LPCC
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For some it is a hurricane, tornado or earthquake. For others it is an event such as war, rape, robbery or abuse. Any of these experiences would probably be traumatic to anyone. Other events, such as a surgical procedure or an automobile accident, might leave one person simply upset yet another deeply traumatized. What makes the difference, then, between the person who is shaken by the event and the individual who is psychologically traumatized? The answer lies in a better understanding of trauma which can help us resolve our own upsetting life events and those of others.
There are two aspects to a traumatic event: the nature of the event and how we experience the event. The nature of the event, according to the American Psychiatric Association, is exposure to an event involving actual or threatened death or serious injury (to oneself or another). How we experience the event refers to the meaning it has to us. Both aspects contribute to our response, which can vary from a fairly straightforward recovery to a much more complicated and lengthy healing process.
An important factor that impacts our response to trauma is the availability of resources. Community resources include help with food and shelter, employment, medical care, financial aid, and emotional support. Personal resources include strengths such as optimism, resilience and determination. Successful recovery from trauma is more likely when the necessary resources are available.
There is a wide range of common responses to upsetting events; they can be physical, emotional, mental, and/or behavioral in nature. Physically we might notice reactions such as nervousness, rapid heartbeat, dizziness, sleeplessness or fatigue.
Emotional effects concern our feelings, and may not be as obvious to others as they are to us, however they can have a significant impact on our lives and the lives of those around us. Reactions can include fear, irritability, anger, sadness and guilt.
Mental responses, while also internal, relate more to our thinking and our ability to focus. We might notice problems such as distraction, difficulty concentrating, uninvited thoughts or images of the upsetting event or a heightened awareness of self and others.
Disturbing events can also impact our behavior in a number of ways, including startling easily, avoiding certain situations or places, changing eating habits, isolating from others or becoming aggressive.
Better recognition of the common responses to trauma can help us cope more effectively. Some things that can be helpful after a traumatic experience include ensuring we eat and rest, maintaining our regular activities and routine, taking time to relax, doing things that bring us pleasure and allowing ourselves the support of family and friends. Support can come from sitting and talking with someone we trust or engaging in activities we enjoy where the focus is not on the upsetting events.
How we determine how we are recovering from a traumatic experience is to monitor its impact. It is common for reactions to diminish over a period of time, ranging from a few weeks to a few months. If problems have not lessened or they intensify after one month’s time, we may be experiencing a psychological problem, such as post-traumatic stress disorder. If this is the case, working with a mental health professional can be helpful in identifying and resolving the obstacles which have impeded recovery.
Knowing the signs of trauma can help us all to work through experiences that may overwhelm us. If you or someone you know has experienced a traumatic life event and are having difficulty recovering, know that you are not alone. To contact someone about trauma or to talk to a professional, please call 211 and you will be linked to your local information and referral service.
Mary Byrley is a Licensed Professional Clinical Counselor with Touchstone Counseling Services. She has been working with adults, young children and families for over fifteen years.
Some Physical Reactions to Trauma
Nervousness
Rapid hearbeat
Fatigue
Some Emotional Reactions to Trauma
Fear
Irritability
Feeling unsafe
Some Mental Reactions to Trauma
Intrusive images
Difficulty concentrating
Heightened awareness
Some Behavioral Reactions to Trauma
Weight loss or gain
Isolation from others
Aggression
Healthy Worthington
Navigating for a healthier tomorrow for mind, body and spirit – one personal story.
by Shari Adler Wheeler
My journey of weight loss is a story of transformation. I did not wake up one day “cured” with a new healthy mentality. I evolved into a healthier place in my life
I had struggled with being overweight most of my life. After the birth of my daughter, I suffered with terrible heel spurs. My doctor told me my weight was aggravating the condition. Exercise would help the weight, but walking the cement sidewalks only worsened the pain. To go down the basement stairs to do laundry was very difficult due to my knees and joints giving into the weight. Even then I did not say, “Wow, I need to do something drastic!”
I decided to try water aerobics because it is less stress on joints. I exercised at the Worthington pool for two summers, but made no other lifestyle changes. When our instructor went on early maternity leave, the class and pool manager graciously supported my request to lead the last three weeks of class. When summer ended, I decided to become a certified instructor. I returned that next summer as the new instructor and dropped forty pounds by devoting myself to this exercise three times a week. I loved teaching and tried to make the class fun for my students. That fall I became permanent year-round instructor at the Powell YMCA and the Worthington Recreation Center.
My weight stayed the same for a year. I found myself struggling through a difficult personal time in my life. Stress had always made me turn to food, but this time I put on my walking shoes – my heel pain was gone- and walked around the block. For weeks I walked twice a day. As I got bored, I started adding the cul-de-sacs. I would challenge myself to walk one street more. I built various routes and would calculate the mileage with my car.
I had read several articles applying the theory of cross training (the mixing of two or more different types of exercise). With my continued teaching of water aerobics and walking, I was losing weight quickly. This motivated me to become more aware of what I was eating and to make healthier choices. I scaled back my portions and ate more often to spark my lethargic metabolism. I never signed up for a weight loss program, nor followed a specific diet. My somewhat rebellious nature knew I would never follow all of the rules!
I was often asked - did I cheat or fall off the wagon? Absolutely! This time my mind set seemed different from what it had been during my other numerous weight loss attempts. Previously, I would think in terms of striving to fit into an outfit or prepare for an event. I would unrealistically say in my mind, “If I can drop seventy-five pounds, then I can have some chocolate cake.” This time, if I felt like I had to eat potato chips one afternoon, I knew I would have to add or lengthen a walking session. It would make me consider how much I really wanted to eat what I was craving. I never felt deprived. As time passed, many things I used to crave simply lost importance. Today I have eliminated many starchy and sugary foods from my diet because I just do not desire them the way I once did.
My students tease me because they know I love chocolate. I eat chocolate every day! However, I try to limit it to four small pieces of Dove dark chocolate. It is good for the heart and for lowering cholesterol. Now to the next question you may be asking, “Did you ever eat too many?” Yes! I did not get to where I was overnight, and I certainly could not reform that fast! When I would overindulge, I would exercise more and try to eat better things the rest of the day. During my journey I would reach weight plateaus, but found I could break them by changing my eating patterns and the variety of food. I began to read about vitamins and natural supplements to help the body function. I talked to my father who is very knowledgeable on this subject. My next learning experience was a trip to the health food store where I felt like I had entered another world. By reading and asking questions, I obtained more information to make my body healthier.
Another article provided me information about the benefits of lifting small weights for the bones. I considered my family history of osteoporosis and decided to join a weight class for women. I learned how to utilize the weights and exercise equipment properly. This offered me some variety during the winter, in addition to walking the indoor track. By now, I had lost eighty seven pounds more!
A friend invited me to attend a Pilates class. I learned that Pilates is excellent for toning your core/stomach. Personally I did not care for Pilates, but learned an important lesson to not be afraid to try new things. The key is to find a way to exercise that makes you happy and feel good. You can feel better mentally, physically, and in spirit. Exercise reduces my stress levels and makes me a happier individual. Studies have shown that exercise boosts seratonin levels in the brain. Yes! You can enjoy exercise! For many years I had attended numerous exercise classes with a cute little instructor who seemed to live to torture overweight people, but I have also met many wonderful instructors who sincerely want to make their students feel good about themselves and exercise. Good instructors are out there! Keep looking!
My journey was blessed along the way by my family, friends, and co-workers. My students have always encouraged me; we have shared laughs, luncheons, and life’s challenges. I remember their uniqueness, eyes, smiles, and their hearts. I do not see them in terms of their size. Whoever comes to class has made a decision to leave their sofa and the security of home. They have chosen to become a part of a group with many differences, yet together have taken one step toward health, sharing self and participating in life. If I tiled a new pool floor with each small tile representing the people I have met and come to know, the water’s reflection would transform the pool into a beautiful mosaic.
The author, Shari Adler Wheeler, teaches water aerobics at the Powell YMCA, the Worthington Recreation Center, and the Swiminc. Worthington outdoor program. She is employed as an account executive with DataBase Reporting Services in Dublin. She has one daughter who is a student at Worthington Kilbourne High School.
