Scared of the flu?

Flu season (November-March) is here; get your vaccine at your local well, everywhere. I am a firm believer on being an informed consumer. Is the flu vaccine necessary? What are the facts? Who should get the vaccine? What is the Flu?

The flu is a respiratory virus. There are three strains that are most common identified throughout the season, but are not limited to. There are also subtypes that arise and examples include the infamous bird flu (H1N1).

Signs and symptoms of the flu:

  1. Fever/chills
  2. Cough
  3. Sore throat
  4. Muscle and body aches
  5. Fatigue
  6. Vomiting, Diarrhea

How is the flu spread?

The flu may be contagious 1 day before and up to 7 days after the symptoms begin. Influenza is spread through droplets.


 If we just take a moment and contemplate, the likely hood of death occurring from the influenza it’s very unlikely. I could sit here a spout out statistics, yet this post is about perspective. Inform yourself and your family before walking into Walgreens or Walmart or any other place where someone is injecting you or someone you love and contemplate the necessity. Most of the time, you will recover from influenza in a few days or up to 2 weeks.

How to prevent and protect myself from the flu?

The flu vaccine statistics are available. It’s our responsibility as good stewards of our bodies to remain informe

  • Wash your hands frequently
  • Exercise regularly
  • Lower life stressors
  • Take a daily probiotic
  • Avoid close contact with those who are sick
  • If you are sick avoid close contact with those who are well
  • Cover your mouth if you cough or sneeze
  • Drink plenty of fluids, especially water
  • Get adequate sleep
  • Eat a healthy diet rich in vitamins and minerals especially ( Vitamin C, Vitamin D (2000 IU daily)
  • Spend time in the sun light

Anemia deficiencies


Drugs for Deficiency Anemias:

Iron Deficiency Anemia:: the most common nutritional deficiency affects 5% of the population:


  1. Children
  2. Iron Def (Rare before 6 mo of age)
  3. Lead Poisoning
  4. a. sickle cell
  5. thalassemia
  6. Premenopausal Women
  7. Menorhagia 2 mg/d iron lost
  8. Dietary Iron abs;1.5-1.8
  9. Pregnancy: 500-1000 mg iron lost
  10. Males and Post Menopausal Women:
  11. Colon Ca
  12. GI blood Loss
  13. gastritis
  14. .PUD
  15. Partial Gastrectomty
  16. Bariatric Surgery
  17. Diverticulitis
  18. UC
  19. Celiac


  1. PICA
  2. Fatigue
  3. Weakness
  4. DOE
  5. Light headedness
  6. Pruritis
  7. glossitis
  8. restless leg

Tx- Salts:

Ferrous Sulfate (feosol) 65mg /325mg tablet PO TID (max 200mg/d)

Children: 5mg/kg/day given over 3-4 doses

DOC for iron def, least expensive

  1. iron abs reduced 40% with meals
  2. Ideally in between meals


  1. GI disturbances – can cause PUD, UC
  2. Staining of teeth
  3. Toxicity (overdose)


Ferrous fumarate (Feostat) 33mg/100mg capsule

Ferrous gluconate (fergon) 39mg/325mg tablet

  • The only difference is their amount of elemental iron per product
  1. Macrocytic Anemia
  1. Pernicious Anemia (B12 Deficiency )
  2. Causes:
  3. decreased IF
    1. gastritis
    2. gastric bypass
    3. autoimmune parietal cell destruction
    4. insufficient IF production
  4. Malabsoption
    1. chrons
    2. zollinger Ellison syndrome
    3. whipple disease
    4. infection (tape Worm)
  5. Inadequate B12 intake
    1. Vegan
    2. Elderly
    3. Alcoholism
    4. Vegetarian mothers who exclusively breastfeed


  1. generalized weakness
  2. paresthesias
  3. leg stiffness
  4. ataxia
  5. memory impairment
  6. personality change
  7. depressed mood


5 P’S

  1. pancytopenia
  2. peripheral neuropathy
  3. posterior spinal column neuropathy
  4. pyramidal tract signs
  5. papillary atrophy of the tongue


  1. cognitive impairments
  2. gait disturnbances
  3. peripheral neuropathy
  4. generalized weakness


  1. depression
  2. psychosis
  3. optic neuritis


  1. anorexia
  2. glossitis
  3. jaundice


  1. Hyperpigmentation
  2. Vitiligo


  1. Cyanocobalamin tablets
    1. Preparations: 25 mcg, 50 mcg, 100 mcg, 250 mcg tablet
    2. Initial: 2000 mcg PO daily for 2 weeks to 4 months
    3. Maintenance: 1000 mcg PO daily
  1. Cyanocobalamin nasal gel 500 mcg each week
    1. Preparations: 400 ug/0.1 ml nasal gel
    2. Initial: 1500 mcg weekly intranasally for 3-4 weeks
    3. Maintenance: 500 mcg weekly
  2. Cyanocobalamin injection
    1. Initial: 1000 mcg IM daily for 2 weeks
    2. Maintenance: 1000 mcg IM every 1-3 months
  1. Folic Acid Deficiency (rare in the US)


  1. Inadequate Folate intake


  1. Meat
  2. Dark green leafy vegetables
    1. Spinach
    2. Romaine lettuce
  3. Dry beans
  4. Peanuts
  5. Wheat germ
  6. Yeast
  7. Enriched whole cereal grains (140 ug/100 grams grain)


    1. Alcohol Abuse
    2. Elderly
    3. Vegan Diet
  1. Increased Folate utilization
    1. Pregnancy
    2. Malignancy
  2. Medications
    1. Oral Contraceptive Use
    2. Pyrimethamine (Daraprim)
    3. Triamterene
    4. Alcohol
    5. Biguanides
      1. Methotrexate
      2. Cholestyramine (Questran)
    6. Anticonvulsants
      1. Phenytoin (Dilantin)
      2. Primidone (Mysoline)
      3. Phenobarbital
      4. Valproic Acid (Depakote)
    7. Antibiotics
      1. Sulfasalazine (Azulfidine)
      2. Sulfamethoxazole
      3. Trimethoprim (e.g. Bactrim or Septra)
      4. Pentamidine
    8. Reverse transcriptase inhibitors (HIV Medications)
      1. Stavudine (Zerit)
      2. Lamivudine (Epivir)
      3. Zidovudine (Retrovir)
  3. Vitamin B12 Related Changes
    1. Gastric acid-blocking agents
      1. Proton Pump Inhibitors (e.g. Omeprazole)
      2. Histamine H2-receptor blockers (e.g. Ranitidine)
    2. Metformin (Glucophage)
    3. Colchicine
    4. Neomycin sulfate
    5. Nitrous oxide
    6. Para-aminosalicylic Acid
  1. Management
  1. Do not initiate Folate until B12 Deficiency ruled-out
    1. Folate supplementation masks B12 Deficiency
    2. Neurologic B12 Deficiency sequelae will progress
  2. Folic Acid 1-2 mg PO qd for 3 weeks or until resolved

For maintanence doses 4mg/d

Prophylaxis during pregnancy/lactation doses up to 1mg a day

Folic acid is available in (0.4,0.8 and 1 mg) PO, injection is reserved for pts with severely impaired GI obstruction

oh Charley

Charley Horse is the real deal. It’s AKA can be something more sophisticated like electrolyte imbalance on Monday through Friday though. There’s nothing like waking up from a deep sleep to excruciating pain, or sitting through bible study and writhing on the floor as your friends toss you a banana. Science narrows it down to a potassium and calcium deficiency, as those electrolytes are known to propagate neuromuscular activity.


So unless you have been diagnosed with Vitamin D deficiency or perhaps a parathyroid deficiency some rehydration can help. Also depending on the frequency of your muscle spasms, check out you medication cabinet for any Side effect that you need to bring up to your doctor. Otherwise, Gatorade, oranges and 1 banana can help. Oh and if you live inside like I do then I would suggest a walk on the beach to collect some rays. There’s need for the emergency room, needles or radiation to diagnose, as there isn’t any true diagnosis of sorts.

Choose your heart effects


Heart failure is a serious issue, and the drugs prescribed are serious drugs. Dr. Stephen Sinatra a cardiologist promoting natural treatments for Congested Heart Failure narrows it down to four different supplements whose side effects are much more attractive than the American standards for heart failure.

The American Heart association describes heart failure as the inability of your heart to keep up with the normal work load (2015, AHA). The well known symptoms of fatigue, breathing difficulty and constant tachycardia are from the heart exuding the rest of the body to compensate. In the mean time your heart begins to enlarge from working so hard, developing more muscle mass from excess pumping while at the same time filling with fluid because the world load is too much.


Recent studies on the enzyme CoQ10 have not only raved about it’s cardiovascular benefits but its affects towards every cell in the body. Here we will focus on its affects on the heart and how it energy production to the cells in the heart has been beneficial.

Hawthorne Berries are marvelous as they normalize rhythm, dilate arteries and help lower blood pressure. creating an ideal picture for a patient suffering from heart failure.

L-canitine and L-arginine Amino Acids are known as energy providers. The fatigued feeling from an over worked heart will thank the amino acids for giving the extra push.

And last but not least: Levadopa is known for strengthening the muscle. The strengthened muscle will potentially decrease the risk of a hypertrophied heart one that gets too big for its own good.

As educated individuals we must do our research because anything we put into our bodies has the potential for an adverse effect. Lets do our best to be educated on what we put into our bodies and as consumers who do whats best for us.



Millions of people are diagnosed with Idiopathic thrombocytopenia every day. Some young, some old, some acute and others more chronicly, regardless it affects the quality of life patients have and more people should understand the process of what this disease looks like and how it affects those living closely in the world around them.

Third world country Appalachia

We dont have to travel to different countries to encounter need. Discounted health care and Americas recent Affordable Care Act isnt reaching everyone is not the answer. These Nurse Practitioners are bringing hope to people, traveling to the need themselves. We need help, the need is vast, as nurse practitioners the platform to serve the needy is endless.

which do you prefer?


We are noise makers, nurse practitioners around the country are invading the primary care setting. How does the community feel about it? How do you feel about it? Where is the resistance? Georgia Southern University conducted a quantitative study where they formulated multiple hypothesis questions about the thoughts of the community as far as their primary care provider.

Do people prefer a medical doctor verses a nurse practitioner for medical issues and does age affect their preference?

Are people informed about the role of a nurse practitioners to choose them as their primary health providers?

There were 244 participants in the study of varying ages, after collecting their demographics Georgia Southern educated them on the roles of each practitioner to fill the gaps and answer their questions. At the conclusion of the study the following results were published.

The conclusion to the study was that nobody preferred a medical doctor over a nurse practitioner, the population wants more information on the roles an responsibilities of a nurse practitioner and the baby boomer population is greatly in need of nurse practitioners. More and more nurses are pursuing this role of further education and its a positive response that the community is not reluctant in embracing.

antibiotic stewardship


it is required of stewards that they be found trustworthy.

Working as a pediatric nurse, it is more often than not that I see the over use of antibiotics. In the hospital we go as far as placing central lines in infants less than a month old for long term antibiotic usage for a possible contaminated specimen. Family vacations are ruined for prolonged hospital stays, kidneys are destroyed for prophylactic antibiotic treatment and antibiotics are administered for fevers caused secondary to known pyretic causing agents. As health care providers we are creating a disservice to not only specific vulnerable children but as the video says the rest of the community and the rest of the globe. Recently the AANP joined the Antibiotic Stewardship Initiative in order to “slow the emergence of drug resistant bacteria.” Education, education, education. You must keep not only yourself informed but the rest of the community informed as well, and lets go back to the basics for a second. Why is this antibiotic being prescribed in the first place?

MacDougall, C., & Polk, R. E. (2005). Antimicrobial Stewardship Programs in Health Care Systems. Clinical Microbiology Reviews, 18(4), 638–656. doi:10.1128/CMR.18.4.638-656.2005

Nursing Student Mission Trip – Nicaragua 2011

The spring of my junior year of college I co-lead a medical mission to Nicaragua. A group of 8 girls in nursing school who committed to serving the people of Nicaragua in both mind and spirit. We went out to nursing homes and helped bathe, feed, and dance with the geriatric population as they communicated with our team through translators and motion signs. Some of the lasting lessons that we learned on this trip was that humans are more than a diagnosis. They are more than the medications they consume, the lab values that are reported on a computer and definitely more than we could ever really truly understand from and pathology book. This trip helped discover how as nurses our scope of patients is much larger than what nursing school ever led you to believe. As a team, it was marvelous to makes these discoveries together.


Nursing Student Mission Trip – Guatemala 2012

The spring semester of my senior year of college I decided to be bold enough to lead a medical mission to Guatemala. We were used in the AIDS clinic, assisted in the maternity ward, helped stich in the emergency room, learned what isolation rooms for respiratory conditions are in third world countries. We also did a lot of teaching in the villages. Teaching about a balanced diet for expecting mothers, and hand washing in the schools of children. It was my honor to translate these lessons from English to Spanish as my wonderful teammates developed skits and lessons.