Epiglottitis.

I have been seeing a lot of patients with the seemingly straightforward chief complaint of "sore throat" the last several weeks at the clinic.  Some patients are diagnosed with streptococcal pharyngitis with a rapid strep test, some are diagnosed as viral, while others' sore throats seem to be more seasonal allergy related.  Spring is finally here and I have already started my daily claritin!  While sick visits can be a good challenge and are enjoyable for me, the "sore throat patient" can seem a bit methodical.  So, I reminded myself to keep an eye out for rare "zebras."  You know, a diagnosis that seems simple but turns into something crazier than usual.  That's when I remembered learning about epiglottitis.  Since I have never diagnosed an epiglottitis in my practice, I decided to look it up again and why not write about it on my blog to further seal it in my memory?

Epiglottitis is inflammation of the epiglottis, the flap at the base of the tongue that keeps food from going down the trachea and into the airway with swallowing.   It is most often caused by Haemophilus influenzae type b but may also be caused by other types of bacterial infection.  You may have heard of Hib, because it is the name of a great childhood vaccine.  Non-infectious etiologies of epiglottitis are rare but include thermal causes, crack cocaine or marijuana smoking, foreign body ingestion and head and neck chemotherapy.  Providers must be capable of diagnosing epiglottitis quickly.  While initial signs of epiglottitis can be mild, the condition progresses quickly and is life-threatening.

Case Presentation: A 19 year-old female presents to your clinic complaining or sore throat and a muffled voice.  She states that she has difficulty swallowing.  Her symptoms began upon waking a few hours earlier.  The patient is generally in good health with no significant medical history.  She has a fever with a temperature of 100.8 and is tachycardic with a pulse of 112.
On exam, you notice the patient is unable to swallow secretions and is spitting.  She is in no respiratory distress but states it is difficult for her to breathe.  Her pharynx appears normal but you note cervical lymphadenopathy on examining her neck.  Her lung sounds are clear.  Based on the patient's symptoms, you order an X-Ray of the soft tissues of her neck which shows a "thumb sign" indicating epiglottitis.

So, the diagnosis of epiglottitis is based on clinical presentation and coorelated with imaging.  While X-Ray has traditionally been used to diagnose epiglottitis, laryngoscopy is now the preferred method. And that is when I call the patient who is sitting in the xray lab and direct them to the ER immediately. The enlarged, inflamed epiglottis can cause airway obstruction making airway management of utmost importance in treatment.  Patients need to be closely monitored in the ICU and may need to be intubated if they become unstable.

Third generation cephalosporins such as Rocephin are first-line treatment for epiglottitis.  Corticosteroid use in epiglottitis is controversial and has not been shown to be effective.  Antipyretics such as acetaminophen should be used to treat fever as necessary. 

Ok, now I really need to start studying for my ACLS recertification class that is scheduled for next week!

The Disease of Busyness

As a Nurse Practitioner, I am around people all day long five days a week.  Every ten to thirty minutes, I see a different face, hear a different story, create a different plan.  Recently a theme throughout many of my visits is busyness.  People are busy.  Too busy to follow a healthy diet.  Too busy to exercise for 30 minutes.  Too busy to take their medications.  Too busy to see a marriage counselor.  The list goes on and on...  And you know what?  I believe them.  Many of my patients feel busy because they are busy - They work jobs, take care of their sick parents, have a spouse, coach their child's sports team, try to put food on the table, pay their bills.  At the end of the day, there is not much time to allocate toward their own health.  I am not only speaking of physical health, but this busyness also affects emotional and spiritual health.

There are times when I see this same busyness in my own life.   My personal busyness comes from several commitments, like the demands at my workplace or being highly involved with church or other organizations in the community.  I have also found that much of my busyness comes from my tendency toward order.  I like my house to be tidy.  I like my car to be clean.  I like my yard to look, well, not like a jungle.  While this task-focused aspect of my personality is not a bad thing, if left unmonitored it can be destructive.  I end up doing meaningless tasks much of the time.  I tell myself that after my checklist has been completed I can sit, pray, go for a run, or spend time with people.  The reality is that the checklist never ends and I end up being too tired to do anything else.

My patients are weary.  I also feel overwhelmed at times.  No one is immune to the disease of busyness that is so prevalent in our culture.  I know, I know, busyness does not have an ICD9 code but you get the point.  Busyness prevents us from having intentional and meaningful relationship with our spouses and our families because we are already spent.  It balks at genuine friendship and community.  It eventually inhibits our ability to enjoy life and we forget to "smell the roses."  Even more importantly, busyness can keep us from communing with God.  When we neglect prayer and reading God's Word, we are more prone to fall to the temptations of our sinful nature.  At first following our sinful nature may be pleasurable, but ultimately our lives will be a wreck.  So much stress and sadness could be avoided if we started to say "no" to busyness and instead started to follow God's Word.

So, I am going to echo Socrates and say, "Beware of the barrenness of a busy life."  Let a few dirty dishes in the sink because sometimes it is worth loosening your grip on the checklist.  Don't let the disease of busyness steal what matters most.

DIY Chalkboard-Style Garden Markers.

If you have been reading our blog, you know that Josh and I are gardening this year! So to celebrate (and because I can hardly remember what I planted where without clear markers), I made some fun garden markers. You can easily access the supplies at any craft store and they end up costing less than a two dollars each. I love the white-on-black chalkboard style that I have seen done on Pinterest, but creating them with chalkboard paint and actual chalk seem so impractical. Wouldn't the chalk just wash right off in the rain? With this method, you create a chalkboard look without it being an actual chalkboard. Same effect, but much more durable.

Supplies: 

+ Wooden garden markers - can be purchased at Michaels, but Josh cut ours from pallet wood 

    using his saw.

+ Black spray paint of any kind

+ Foam brush

+ White paint pen - Sharpie brand worked great

+ Polyurethane - We used Helmsman's semi-gloss

 

1. Paint the top portion of each marker (both sides) with black paint. I loved the brand I used because it only took one coat to cover the wood well. Let these dry completely.

2. Use your paint pen to write the plant name on each marker. I wrote the names in pencil first, then trace over your pencil lines with the paint pen. Let these dry completely.

3. Once dry, use the foam brush to coat each side with polyurethane, which should keep them looking great, rain or shine. Let these dry completely, too. It helps to prop them up in a bucket so that both sides dry at once.

  4. That's it! Place them in your garden.

By the way, did you know that you can plant marigolds for pest control?  You should look it up!  It is an experiment for us, we will see if it works...

Lurgan.

More ambitious gardeners use seeds to start their plants; however, I have not had the best of luck with this method and have some time constraints.  So, I decided to go for plants this year.  

Many people recommended Lurgan Greenhouse to me for plants due to their reasonable prices, but I had no idea the magnitude of what they would offer. I am in love with this greenhouse and will likely never go back to indoor seed-starting because of it. 

Do your research before going…

The number of tomato varieties had my indecisive mind spinning. Heirloom, Big Boy, Roma, Beefsteak, Sun Sugar, Gold Medal, Green Zebra…the list goes on.  The greenhouse provides a short explanation of each variety’s best use. So, you can read briefly about which type of tomato to grow for sauces, canning, juices, cutting fresh in a salad, etc.

My favorite purchase is our mint plant. I bought this apple mint plant to put in a large pot, but spearmint, pineapple, orange, lemon, and peppermint were available. The Pennsylvania Dutch called it “meadow tea,” but this stuff is my all time fave.  It is totally nostalgic for me to drink a glass of iced meadow tea on a hot summer day. The fact that I can grow it, steep it, and chill it in the convenience of my home has me giddy. 

Lurgan also has bird baths, bird feeders, pots, trellises, lawn furniture, shrubs, trees, and hanging planters (including the largest ferns I have ever seen) with the sweetest little ladies at checkout. And, we ended up paying a fraction of projected garden budget. So fun!

Three Years.

Three years ago today, I said “yes” to becoming Josh Raber's wife.  It was one of the best decisions I’ve ever made…even better three years later than I realized then.

I know that the busyness of life seems to make time pass quickly, but I want him to know just how blessed I feel to be his wife the last three years.

Marriage takes hard work, we heard this from many people before we “jumped the broom.”  Some days we have been frustrated trying to communicate about expectations or valuing one another’s preferences above our own. Now we have experienced this hard work first hand as broken people.

I am thankful that our marriage has been redeemed.  We have had seasons of joy and a lot of peace, during which Josh makes marriage seem easy.  Having fun and enjoying each other can come naturally.  We do not just love each other, but we like each other – I can call him a friend.

Thank you for serving me and for your hard work outside and inside of our home!

Happy 3rd Anniversary, Josh.  Love you always.