Sandra is the Founder, Lead Legal Nurse Consultant, and Coordinator of Krug Consulting, a Legal Nurse Consulting firm. She is a Certified Registered Nurse Anesthetist (CRNA), Advanced Practice Registered Nurse (APRN), and Registered Respiratory Therapist (RRT). She has over 12 years of college ...
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Home testing important to the revealing of toxic asbestos
By Sandra Krug
Asbestos home testing is a process of testing the presence of asbestos in homes in general and building materials in particular. Asbestos is a mineral fiber resistant to heat, chemicals, and electricity. Building and insulation industries made widespread use of asbestos in their operations.
The asbestos was commonly used in homes in one form or the other. Some building materials that may contain asbestos materials are vinyl floor tiles; patching compounds, textured paints, furnace and stovepipe, insulation, stove door gaskets, roofing shingles, cement, and siding material.
Asbestos Home Testing- Prevention Is Better Than Cure
Asbestos was most commonly used until the early 1970s in various home appliances, such as toasters, clothes dryers, and hair dryers. Now, the government has laid norms for the use of asbestos and its exposure. Asbestos home testing is essential because exposure to and inhalation of Asbestos fibers are dangerous to health. Friable asbestos materials in homes, industries, and appliances could lead to serious asbestos-related diseases.
The following people are more vulnerable to Asbestos-related diseases:
Works in industries and mines
Construct Buildings
Make ceilings
Perform Ceiling insulation
Apart from these persons, all other persons who live in houses having asbestos-contaminated building material or are involved in the use or repair of appliances and products that contain asbestos can also contact asbestos diseases. This makes asbestos home testing a necessary process for all homes that are built before the 1980s and all the people who are using appliances and or products that could contain asbestos materials.
Health Hazards Of Asbestos
Undamaged Asbestos cannot cause any health hazards. When asbestos is exposed to hitting, rubbing, or extreme vibration, its wear and tear occurs and shows signs of abrasion. Asbestos is only harmful when damaged, and its fiber gets mixed with air. You can determine the status and stability of asbestos products by asbestos home testing.
Asbestos home testing is compulsory because asbestos exposure could lead to fatal diseases such as asbestosis, lung cancer, and mesothelioma cancers. Asbestos may harm you only if you inhale asbestos fiber. There are no safe levels of asbestos exposure and even short-term exposure to asbestos creates a possibility of your catching any disease caused by asbestos.
Removing Asbestos From Home
It is not possible for you to perform asbestos testing on your home. You need a qualified professional to test the presence of asbestos in your home. Asbestos abatement is the process of determining the status of asbestos material and taking corrective measures for preventing the risk of asbestos exposure.
It is not necessary that you have to remove all the asbestos material from your home. You can also opt for economic measures such as enclosures and encapsulation for preventing the risk of asbestos exposure even without removing the asbestos-containing materials.
When you see liability for pressure sore – Newsletter vol 10 2016
By Sandra Krug
This is a compelling arena in healthcare litigation.
The definitions stated in the Centers for Medicare and Medicaid Services (CMS) Guidance Document for surveyors pertain to long term care facilities.
The classifications of avoidable and unavoidable are derived on components CMS identified as within the control of the facility:
1. assessed the resident’s clinical condition and pressure sore risk-factors
2. outlined and implemented interventions coherent with resident specific requirements
and goals, and recognized standards of practice
3. screened and appraised the effect of those interventions
4. revised those interventions as appropriate
Avoidable
The nursing home resident developed a pressure sore and the facility did not do one or more of the above components.
Unavoidable
The nursing home resident developed a pressure sore and the facility did do the above components.
All healthcare professionals should have relevant training in:
• Pressure sore risk assessment and prevention
• Selection, use and maintenance of pressure-relieving devices
• Providing education and information for people vulnerable to pressure ulcers
Provide individuals vulnerable to pressure ulcers, and their care givers, verbal and written information about:
• Risk factors for developing pressure ulcers
• Skin inspection and care
• Strategies for prevention
• Use and maintenance of pressure-relieving devices
• Where to get further help and assistance
A systemic evaluation of the variables that affect liability helps the attorney, legal nurse consultants and experts evaluate a pressure sore case.
If you find this newsletter helpful, please share it with colleagues, or direct them to our website.
Remarkably deadly, cure never found – Mesothelioma
By Sandra Krug
General Information About Malignant Mesothelioma
Key Points:
• Malignant mesothelioma is a disease in which malignant (cancer) cells form in the lining of the chest or abdomen.
• Being exposed to asbestos can affect the risk of malignant mesothelioma.
• Signs and symptoms of malignant mesothelioma include shortness of breath and pain under the rib cage.
• Tests that examine the inside of the chest and abdomen are used to detect (find) and diagnose malignant mesothelioma.
• Certain factors affect prognosis (chance of recovery) and treatment options. Unfortunately, mesothelioma is remarkably deadly.
Remarkably Deadly Mesothelioma – Q&A
What is mesothelioma?
Mesothelioma is a cancer of the mesothelium.
Like most cancers, mesothelioma involves the abnormal dividing of cells of a particular part of the body — in this case, the mesothelium.
Mesothelioma is so remarkably deadly because it remains dormant for many years and then begins to rapidly expand. Cancer then begins to invade and damage nearby tissue, including the vital organs.
Where is the mesothelium?
Many of the internal organs of the body are protected by a membrane called the mesothelium.
This membrane actually consists of two layers of cells. The inner layer surrounds the organs, and the second is a sac surrounding the inner layer.
When organs within this membrane must move, expand or contract — such as the heart, lungs, bladder, and so on, they are able to do so because the mesothelium produces a lubricating fluid between the two layers.
Mesothelioma most often begins in the pleura or peritoneum.
The pleura surrounds the lungs and covers the chest cavity. The peritoneum covers most of the organs in the abdominal cavity.
Other mesothelium tissue is also vulnerable to mesothelioma.
These include the pericardium that surrounds and protects the heart; the tunica vaginalis testis which surrounds the internal male reproductive organs; and the tunica serosa uteri which is the membrane covering the internal reproductive organs in women.
Who is at greatest risk to develop mesothelioma?
Mesothelioma has a very specific cause – exposure to asbestos.
During the first half of the previous century, right up until the mid-1970s asbestos was an important material used to insulate buildings, machines, heavy equipment, and a broad range of commercial applications.
Because it was plentiful and inexpensive to mine, asbestos was used in many building products such as home insulation, floor, ceiling, and roof tiles. It was also used in commonly found commercial products such as brake linings and pipe insulation.
This meant that millions of people were coming in contact with asbestos on a daily basis.
And since the effects of exposure to asbestos fiber often do not become apparent for 30 or 40 years after prolonged exposure, companies and health officials were slow to recognize the dangers of this remarkably deadly asbestos.
As a result, shipyard workers, men and women working in asbestos mines and mills, workers producing asbestos products, workers in the heating and construction industries, and virtually all other tradespeople were exposed to asbestos fibers for extended periods of time.
Today it is understood that anyone working with or near asbestos has an increased risk of developing this remarkably deadly mesothelioma, so there are strictly controlled limits of exposure in the workplace.
But since the dormancy period of mesothelioma can often be 30 or 40 years, there are millions of workers who are at risk because of their exposure in the decades before the safety controls were put in place.
Do we know the symptoms of mesothelioma?
Pleural mesothelioma – cancer of the pleura or lung lining – causes shortness of breath or chronic coughing.
Other symptoms of pleural mesothelioma may include chest pain, chronic coughing, shortness of breath, fatigue, wheezing, hoarseness, weight loss, or blood in the phlegm from the lungs when coughing.
Peritoneal mesothelioma affects the lining around the stomach and intestines and is usually just as dangerous.
Symptoms of peritoneal mesothelioma include pain or swelling in the abdomen, weight loss, bowel obstruction, anemia, and fever.
Many of the symptoms of mesothelioma can easily be mistaken for allergies or a common cold. Mesothelioma is often discovered when patients think they have one of these other common illnesses.
When is Mesothelioma Remarkably Deadly?
By the time most infected people become aware they have mesothelioma, it is no longer dormant and becomes extremely aggressive.
In its active phase, mesothelioma can travel quickly and is almost impossible to stop.
There are treatments used to keep the patient comfortable, but there is currently no cure for mesothelioma.
As many as 75% of those who develop the disease will lose their life within one year.
The remainder may last for up to an additional six months.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
• The stage of cancer.
• The size of the tumor.
• Whether the tumor can be removed completely by surgery.
• The amount of fluid in the chest or abdomen.
• The patient’s age.
• The patient’s activity level.
• The patient’s general health, including lung and heart health.
• The type of mesothelioma cells and how they look under a microscope.
• The number of white blood cells and how much hemoglobin is in the blood.
• Whether the patient is male or female.
• Whether cancer has just been diagnosed or has recurred (come back).
This makes it extremely important to detect the disease before it enters its active phase.
Why is mesothelioma hard to diagnose?
Mesothelioma is often not diagnosed until it reaches an advanced stage.
This is because of its long dormancy period, and because once it becomes active the initial symptoms are similar to much more common and less dangerous sicknesses such as colds or the flu.
If a patient has a history of exposure to asbestos, then a complete physical examination is advised.
This would normally include x-rays of the chest or abdomen and lung function tests.
An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
It might also include a CT (or CAT) scan or an MRI. Both of these tests give detailed pictures of areas inside the body.
A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
If these tests indicate the probability of mesothelioma, then it is necessary to perform a biopsy to confirm the diagnosis.
Doing a biopsy involves an oncology specialist taking a small sample of affected tissue and examining it under a microscope for signs of malignancy.
The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer.
Depending on the location of the affected tissue, doing a biopsy can be a relatively straightforward procedure. It normally involves the insertion of a small instrument into the suspect cavity.
These surgical devices have both viewing and sample taking capabilities.
So the oncologist or surgeon can look at the cavity from the inside, and then take tissue samples from different areas.
If mesothelioma is discovered, the initial tests are followed up with what is called “staging”. This involves more tests to determine how far the disease has spread.
How is mesothelioma treated?
Standard treatments include the normal options available to cancer patients: surgery, radiation therapy, and chemotherapy.
Sometimes, these treatments are combined.
If the mesothelioma is discovered at an early enough stage these treatments can sometimes be effective.
Among the treatments that are used in order to reduce the effects of the disease are oxygen, postural drainage, and pain killers.
Many alternative treatment methods are also being tested, including attempts to strengthen the body’s immune system. Gene therapy is also being tested in an attempt to attack the problem at the DNA level.
Other treatments being tried and tested include homeopathy, herbs, and acupuncture. Unfortunately, none of these have been found to be very effective once the disease reaches its aggressive stage.
As with all cancers, early detection is the best defense against mesothelioma.
Anyone who has been exposed to asbestos should be alert for symptoms and contact a doctor immediately. Detecting mesothelioma at the earliest stage possible greatly increases the chances of beating the disease.
If you found this article informative,please share with colleagues and send them to our website.
National Mesothelioma Awareness Day: this is the time to be alert to the victim
By Sandra Krug
Every year, an estimated 2,000 – 3,000 people in the U.S. are diagnosed with aggressive, asbestos-related cancer. Anyone diagnosed with the disease must face the unknown and fight one of their toughest battles.
One day each year, people around the world gather to commemorate the lives of mesothelioma victims, caregivers, and those taken from us much too soon.
Today, September 26, 2016, is National Mesothelioma Awareness Day.
The Mesothelioma Applied Research Foundation started National Mesothelioma Awareness Day in 2004, to bring nationwide awareness of the issues facing mesothelioma patients and their families. This year marks the 12th year of this nationally known day.
When someone is diagnosed with mesothelioma, a loved one often steps up to take on the new role of caregiver. Today we share with you a story from one such caregiver. This is an inspirational personal account of her husband’s courageous battle with mesothelioma. This is her story, in her own words.
Lorraine Kember, author of “Lean on Me – Cancer through a Carer’s Eyes”, shared her experience.
Asbestos Killed My Husband
He was only a child when it began
And he played as children do
In his yard with his toy cars and tip trucks
But his sand was asbestos blue…
In December 1999, my husband and I were walking home from a game of lawn bowls when I became aware of his shortness of breath. I was surprised and concerned when he told me that he had experienced this on several occasions. Believing this to be due to a chest infection, I made a doctor’s appointment for him the next day.
Chest X-rays revealed fluid on the lungs, over two liters of which was drained, giving Brian immediate relief, but it was a tense wait for the pathology results. Through the Internet I had become aware of several conditions that may have been responsible for fluid on the lung; these included asbestos-related diseases. Brian had lived in Wittenoom as a child and I was afraid of his diagnosis. Not wanting to worry him unnecessarily, I did not mention my fears to him. I prayed that he had pleurisy or pneumonia but the pathology results revealed that there were cancer cells present.
When Brian finally received his diagnosis, my worst nightmare became a reality. He had pleural mesothelioma, a terminal cancer of the lung caused by the inhalation of asbestos dust. We found it inconceivable that the disease was the result of Brian inhaling asbestos dust as a child and that it had lain dormant for forty-five years before become lethal.
We were still reeling from the shock when, without preamble, the young doctor gave his prognosis. His exact words were, “three to nine months, I reckon”. That he could say this so unfeelingly amazed me. His total lack of compassion did not encourage even the small comfort of tears. I felt as if Brian and I had been shot and from that moment on we were waiting to drop.
Undoubtedly, we were mortally wounded. We suffered shock, disbelief, anger, helplessness, and utter despair; in fact, all the symptoms of grief one feels when a loved one has actually died. Suddenly, we had no control over our lives, our journey through terminal illness had begun.
Throughout the course of our married life, my deep love for Brian and my determination to resolve difficulties had seen us through many trials. I found it hard to believe that nothing could be done to save his life and begun surfing the Internet for information regarding mesothelioma, all the time praying for a miracle, hoping against hope to find a doctor who had successfully operated on or cured someone of it.
It was a sad realization to discover that for Brian there were no miracles; however, I learned a lot and it helped me to accept that he was dying. With my acceptance came a fierce determination to ease his burden. I continued to seek information regarding mesothelioma and the pain and symptoms Brian would experience, due to the progression of his disease. In this way, I came to understand the importance of pain management and symptom control and realized that although I could not stop Brian from dying – I could help him to live.
My acquired knowledge regarding pain and symptom management enabled me to communicate with Brian and to understand the type of pain he was experiencing and the intensity of that pain. I was then able to work hand in hand with his doctors, to bring his pain and symptoms under control. As my efforts resulted in his improved quality of life, I lost my sense of helplessness and gained strength.
Together, we achieved for Brian, a quality of life few thought possible, considering the nature of his disease. A testament to this, despite his prognosis of three to nine months, Brian survived for 2 years, remained active and alert, drove his car for eighteen months after diagnosis and was not bed bound until three short days prior to his death.
Brian’s courageous battle with mesothelioma came to an end on the 24th December 2001; he passed away at home surrounded by his loved ones. He was 54 years old.
This article was written by Lorraine Kember – Author of “Lean on Me” Cancer through a Carer’s Eyes. Lorraine’s book is written from her experience of caring for her dying husband in the hope of helping others. It includes insight and discussion on Anticipatory Grief, Understanding and identifying pain, Pain Management, and Symptom Control, Chemotherapy, Palliative Care, Quality of Life, and Dying at home. It also features excerpts and poems from her personal diary. Highly recommended by the Cancer Council. “Lean on Me” is not available in bookstores – For detailed information, Doctor’s recommendations, Reviews, Book Excerpts and Ordering Facility – visit her blog https://lorrainesblog.blogspot.com/ or email her at [email protected][email protected]
Asbestos.com asked Loraine Kember: What Do You Wish People Understood About Mesothelioma?
Here is her response:
“I wish people understood that there is no safe level of exposure to asbestos. Anyone, including themselves, who has been exposed to this deadly mineral, has the potential of being diagnosed with mesothelioma (or another asbestos-related cancer) at some time in the future. The “it won’t happen to me” attitude has led to complacency here in Australia where DIY renovation of older homes is very popular. Men and women are putting their health and the health of others at risk by attempting to remove asbestos from these buildings themselves rather than employing a qualified asbestos removal company to do it safely.”
To Mrs. Loraine Kember we at Krug Consulting say: You are amazing. You are strong. You are a survivor.
Show your support of National Mesothelioma Awareness Day
Krug Consulting encourages everyone to wear blue on National Mesothelioma Awareness Day.
Blue is the official color of National Mesothelioma Awareness Day. Supporters are encouraged to wear blue clothing or wristband from a charity to raise awareness about the struggle and hope survivors and their families go through.
On this day, citizens and those directly affected by mesothelioma will band together to bring awareness about this rare cancer.
For some, it is a yearly tradition to attend the taping of the Today Show. Many people will gather at the Rockefeller Center in New York holding mesothelioma awareness and mesothelioma warrior signs.
Regulations of Asbestos
Asbestos, fibrous mineral, is extremely durable and a good heat conductor. The leading cause of mesothelioma is high asbestos exposure or inhalation. Asbestos regulations began in the 1970s, but, it is not yet banned in the U.S.
Later this year, the EPA will be selecting the first ten chemicals to evaluate under the Toxic Substances Control Act. Anti-asbestos activists have high hopes that asbestos will be considered as one of those chemicals to be picked by the EPA.
A Pressure Sore is the Ugliest Thing I’ve Ever Seen – Newsletter vol 9 2016
By Sandra Krug
Pressure sores, also known as pressure ulcers, bedsores, decubitus ulcers, or decubiti are sections of damaged skin produced by staying in one position for too long. It only takes a few hours (sometimes less) to form because the unrelieved pressure impedes blood flow to that area.
As the skin and the underlying tissues are deprived of blood supply, they are also deprived of oxygen and nutrients, and cellular death occurs. These sores often are preventable.
Prevention of pressure ulcers is one of the chief healthcare challenges in terms of reducing patient harm. The literature shows that although abundant documents have been published, pressure ulcer prevention remains an ongoing challenge.
Pressure sores usually form where bones are close to skin, such as ankles, back, elbows, heels and hips. But, a pressure ulcer can develop anywhere on the body. Examples are, underneath a cast, or underneath a brace. Some of the braces for spinal stabilization are a chin piece, so there can be rubbing, or friction, and a little pressure under the chin. A pressure sore may develop in that area.
Preventing pressure ulcers is complex and involves skin care, the provision of therapy mattresses, repositioning, the management of incontinence and adequate nutritional support.
Nutrition must be an integral part of any pressure sore prevention and treatment plan. The National Institute for Health and Care Excellence states that adequate risk assessment of pressure ulcer development includes the role of malnutrition.
Adequate nutrition is fundamental for the prevention of pressure ulcers. Malnutrition will also hinder healing when pressure ulcers have developed.
The risk of malnutrition should be assessed with a recognized tool, such as the Malnutrition Universal Screening Tool, and appropriate treatment plans should be drawn up for patients identified as being at risk of malnutrition to improve their nutritional state. For example, the dietary intake of patients with poor appetite can be supplemented with nutritious snacks between meals.
If you find this newsletter helpful, please share it with colleagues, or direct them to our website.
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