Monday, April 29, 2013

Christine’s story: Diagnosing Breast Cancer

I'm happy to host author Christine Lewry as she shares her first hand account of a breast cancer diagnosis. Christine-- thank you so much for sharing such a vulnerable part of your life with us today. I am humbled by your honesty and bravery and am glad you have been cancer free for over 10 years.
I felt the lump again. ‘It’s probably nothing,’ I said out loud. It wasn’t a hard lump but a knot of soft tissue under my arm. A wave of overwhelming doom made my knees buckle, I sat back on the bed.
I rang the doctors’ surgery. ‘Is it an emergency?’ the receptionist asked.
I thought for a moment. Is it?
‘Well … yes,’ I replied. She gave me an appointment for later that day. I wandered about the house, kept looking at the clock, didn’t get anything done.
 ‘I don’t think it’s anything to worry about,’ the doctor smiled. ‘But I’ll send you for a mammogram.’
My husband, Tony, came with me for the mammogram. We sat in a comfortable pink waiting room and read the newspapers. He made a cappuccino from the machine. The nurse’s hands were round and warm as she squeezed my breasts into the X-ray machine. ‘I’ll show these to Dr Wainwright,’ she said. I got dressed and returned to my newspaper – I didn’t want to look at the frightened faces of the other patients.
‘Doctor wants to do an ultrasound,’ the nurse with the warm hands said.
I lay on a narrow bed while Dr Wainwright squeezed cool gel on my chest and ran the ultrasound probe over it. The room was dark apart from the faint glow from her computer. Shadows fell on the walls like ghosts in the night.
‘There,’ she pointed to a haze of white on the screen. ‘I’ll do a biopsy, then we’ll organise a taxi to take it to the lab.’
Tony stayed home with me until the hospital rang. ‘Very sorry, but you have breast cancer.’ The words sounded so trivial and yet so profound and life changing. I tried to stay positive. Anyway, what could I do? Break down? Scream? I had to hold on tight to the belief that I was going to be alright.
The morning of my operation, Dr Wainwright and the surgeon gathered around my bed. ‘We’re going to do a larger operation than we originally planned,’ Dr Wainwright said. ‘We’ve decided to take the lymph nodes from under your arm, in addition to the lumpectomy. The lymph nodes are used to diagnose whether the cancer has spread outside the lump.’
 I signed the form, leaving it to them to do whatever they thought might save me.
The next day my surgeon came to see me. He smoothed out the starched sheet and sat on my bed. ‘I’ve got the results of the lymph node biopsy. I’m afraid it’s bad news,’ he said. ‘Of the twelve lymph nodes I removed, six have cancer. I’ll arrange for you to see an oncologist. I expect he’ll recommend chemotherapy.’
I turned over and stared at the wall, waiting for Tony to arrive. My life was slipping away, like grains of sand falling through my fingers. The thought that I had cancer spreading through my body was terrifying. What if I died leaving my children without a mother? They were so young that there would come a time when they wouldn’t even remember me. I would be that photograph smiling back from the mantelpiece, a sad remnant of a woman who died long ago, never moved or put away since she left.
The oncologist talked in percentages and statistics, about improvements in life expectancy of five or ten years, his voice set in a monotone devoid of hope or compassion. What bloody good was five or ten years? I wanted to live, not wait it out. I wasn’t going to take on his fear or negativity.
The chemotherapy made me feel sick. I tasted its bitterness in the delicate lining of my nose and at the back of my throat. It made me feel like every cell in my body had been poisoned and that I had the most dreadful hangover, yet I hadn’t even had a glass of wine.
Mentally I had to pace myself. Six times, once every three weeks. I could manage that. I counted them off. Still, it was hard for me when all the hair on the top of my head fell out despite the torture of the cold caps. I always did care too much about my appearance.
‘Do you love me?’ I asked Tony whilst having the pinky-red chemotherapy dripped into my veins. The anti-sickness medication made me constipated for days and I became frail and weak. The more ill I became, the more I thought that if I died he might find a new wife; someone younger, thinner, better than me.
When my treatment finished, I was cast adrift. All the time I had been having hospital appointments, chemotherapy or radiotherapy I had been doing something positive to fight the disease. Now I floated about, waiting to see whether I would sink or swim.
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Christine Lewry lives in Hampshire, UK with her husband and two youngest children. She worked in the defence industry as a finance director for twenty years before leaving to write full-time. Thin Wire is her first book. For more info: http://www.christinelewry.com/
 

Sunday, April 28, 2013

Up and Coming

Hello Redwood's Fans!

How has your week been? Mine . . . still mired in Peril's edits but they should be DONE by Friday which will be very good news.

I'm also hoping that the snow is gone for good for this winter. Colorado has been unwilling to let Jack Frost go home but we hope he's escaped so the flowers can bloom.

For you this week:

Monday: Author Christine Lewry shares her personal experience of being diagnosed with breast cancer.

Wednesday and Friday: Author and double Christy Award nominee Jocelyn Green returns to discuss opium abuse during the Civil War.

Hope you all have a great week.

Friday, April 26, 2013

The Civil War and Prosthetic Limbs: 2/2

Jocelyn has returned for Part II in this series on Civil War medicine and amputees. Check out Part I here.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood's and you can read those posts here and here.

Welcome back, Jocelyn!



Many entrepreneurs who developed artificial limbs were Civil War veteran amputees themselves. In fact, one of the most successful pioneers in prosthetics was Confederate veteran James Edward Hanger, whose amputation in West Virginia was the first recorded amputation of the Civil War. He was 18 years old at the time. Union surgeons discovered him wounded and performed the amputation, giving him a standard issue replacement leg: a solid piece of wood that made walking clunky and difficult. 

Hanger’s adjustments included better hinging and flexing abilities using rust-proof levers and rubber pads. He also used whittled barrel staves to make the limb lighter-weight. He won the Confederate contract to produce limbs, and by 1890, had moved his headquarters to Washington, D.C., and opened satellite offices in four other cities. The company he founded – Hanger, Inc. – remains a key player in prosthetics and orthotics today.

One of James Hanger's early patents from 1891. Courtesy of Hanger.com.


The Civil War-era commitment to support veterans continues today through programs of the VA and the Defense Advanced Research Projects Agency (DARPA) to ensure ongoing progress in prosthetics design. The war set the prosthetics industry on a course that would ultimately lead to today’s quasi-bionic limbs that look like the real thing and can often perform some tasks even better.

To see just how far we’ve come in the realm of prosthetic limbs, I invite you to take a look at the video below. This is a brief look at the story of Taylor Morris, the fifth quad amputee veteran in the U.S. Army. You will see Taylor, who is from my hometown of Cedar Falls, Iowa, go from the hospital bed shortly after his surgeries, to dancing with his girlfriend again at the end of the video. (Have a Kleenex handy!)




For further reading:

Hasegawa, Guy R. MendingBroken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs. Southern Illinois University Press, 2012.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Wednesday, April 24, 2013

The Civil War and Prosthetic Limbs: 1/2

I'm so pleased to host author Jocelyn Green again. She's an amazing woman and author of inspirational fiction surrounding the Civil War.  Jocelyn will be here over the next three weeks sharing wonderful information about her research. Often times, during war, there is a lot of advancement in medical technology which is why I'm giving her so many days.

Plus, I just love her.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood's and you can read those posts here and here.

Welcome back, Jocelyn!



“It is not two years since the sight of a person who had lost one of his lower limbs was an infrequent occurrence. Now, alas! There are few of us who have not a cripple among our friends, if not in our own families. A mechanical art which provided for an occasional and exceptional want has become a great and active branch of industry. War unmakes legs, and human skill must supply their places as it best may.”
~Oliver Wendell Holms, M.D., “The Human Wheel, Its Spokes and Felloes,” 1863

If necessity is the mother of invention, it should come as no surprise that the Civil War, which produced some 45,000 amputee veterans, also prompted major progress in the development and production of artificial limbs. One of the characters in my novel Widow of Gettysburg is the recipient of one of these limbs. Let’s take a closer look at what was involved in this rehabilitation of amputee veterans. (You can see more on amputations from a previous blog I wrote for Jordyn, here: http://jordynredwood.blogspot.com/2012/08/civil-war-amputations-and-anesthesia_31.html

Double Amputees of the Civil War


Once the stump was healed after amputation and the patient able to do without dressings, the surgeons' work was finished, and the patient was left to shift for himself in securing the best apparatus. But not everyone was a good candidate for a prosthetic. If the limb was taken off at the joint, such as the hip or shoulder, there was no stump to which an artificial limb could be attached. The surgeon may have performed the operation too high or too low on the limb for a good fit to be possible. Also, if the stump was prone to frequent infection, it would have been too painful to attach an artificial limb to it.

For those who could pursue a prosthetic, in the North, the most popular artificial leg was a “Palmer” leg, named for Benjamin Franklin Palmer, who patented the design. A previous design by James Potts was made of wood, leather, and cat-gut tendons hinging the knee and ankle joints, and dubbed “The Clapper” for the clicking sound of its motion. Palmer improved upon this design with a heel spring in 1846, and his “American leg” was produced continuously through World War 1.

Palmer’s leg cost about $150, a prohibitive amount for the average private, whose pay was about $13 per month. Add to that the cost of travel and lodging expenses to see a specialist, and the number of amputees who could afford it went down even further. The cost of an artificial limb for Confederate veterans was between $300-$500, due to the soaring inflation.

Since the majority of veterans had been farmers, planters, or skilled laborers before the war, the need for artificial limbs was, indeed, a crippling problem. To help address it, the U.S. government appropriated $15,000 in 1862 to pay for limbs for maimed soldiers and sailors. In January 1864, a civilian association in Richmond was established to pay for artificial limbs for Confederate amputees.
After the war in 1866, North Carolina became the first state to start a program for thousands
of amputees to receive artificial limbs. The program offered veterans free accommodations and transportation by rail; 1,550 veterans contacted the program by mail. During the same year, the State of Mississippi spent more than half its yearly budget providing veterans with artificial limbs.

 Return for Part II on Friday.

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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Monday, April 22, 2013

Motor Vehicle Collision: Dianna Benson, EMT

I love this post by Dianna Benson, EMT written in first person about the treatment of a patient involved in a MVC. A lot of information presented in such an interesting way.

Dianna's debut novel, The Hidden Son, released in March.

Welcome back, Dianna!

EMS #16 and #22 MVC at Park Avenue and Green Street.

I toss the rest of my sandwich into a trashcan, and rush out of the fast food joint toward my ambulance, my partner behind me.

Less than five minutes later, we roll up on scene behind an arriving ladder fire truck. I slip mybright orange reflector EMS vest over my head and lurch toward two cars mangled together in a huge intersection, their hoods now one. The EMS #22 crew heads to the one patient in one car, so my partner and I bolt for the two patients in the other.

civilian is leaning inside the driver’s door.

“Sir?” I say, approaching.

He looks at us, eyes wide, face pale. “Glad you’re here. I’m a doctor, an urologist, but I see patients in my office. I don’t deal with emergency—”

“It’s okay. We got it.”

Blowing out a sigh, he backs away.    

Unconscious, the driver’s face is buried in the deployed air bag, arms dangled around it in a laxhug.

“Sir?” I feel his pulse. It’s thready and rapid. Blueness surrounds his mouth and colors his lips, his chest not rising and falling. Respiratory arrest,” I say to my partner who’s assessing the unconscious passenger, the lifeless patient’s head caught in the shattered door window.

Frowning, my partner shakes his head. “Cardiac arrest over here. Facial skin ripped away. Neck twisted 180 degrees and split open. Bled out.”

Code for: We can’t do a thing for her.

My partner rushes our equipment-loaded stretcher around the trunk to the driver door, as I wave a firefighter over to climb into the backseat. With both hands, the firefighter stabilizes the patient’s head straight against the headrest as I assess the minor facial wounds caused by flying glass. Another firefighter grabs the airbag, punctures it and rips it out of my way.  

I insert an oropharyngeal down my patient’s throat to protect his airway. I cover his mouth and nose with a BVM—bag valve mask—connected to oxygen tubing and a D-tank running at 15 liters per minute. As I squeeze the football-size bulb every five seconds to oxygenate his system,I assess his legs. Right femur appears fractured, left is covered with bleeding abrasions and lacerations, but no hemorrhage threat.

I strap a C-collar around his neck. Keeping his spine in-line, my partner and two firefighters place his body on a backboard on top of the stretcher, as I continue to bag him. I check his pulse again. Still present. I check for spontaneous breathing. Still nothing, although cyanosis no longer blankets his lips. I brace his entire right leg in a traction split to assist with hemorrhage control.

Inside the ambulance, my partner hooks our patient up to the cardiac monitor via a 12-lead, a firefighter bags the patient, and perform a rapid trauma assessment, head to toeAfter I find no other significant trauma or issues, I spike a bag. Less than a minute later we have an IV bolus in place, running high fluids.      

Spiked and dipped lines display on the monitor screen. “Normal sinus rhythm,” I speak out loud. “But hypotension and tachycardic.” Meaning low BP and high pulse rate. I’m thinking it’s possible this patient is headed to hypoperfusion (shock) due to internal blood loss.
   
“Ready?” another firefighter asks from the ambulance’s driver’s seat.

“Yep, take off.” I listen to our patient’s chest. Heart beating rapidly but strong. Lungs sounds absent on the left side. Diminished on the right.

I eye my partner. I’m thinking left pneumothroax. Right may be heading in that direction.” I read the monitor screen. “Severe hypotensive now. How about administering Dopamine?”

Already on it,” my partner says, filling the IV catheter with the med. “He needs chest decompression. Let’s—

“I’m having trouble bagging,” the firefighter says. “You wanna intubate him?”
   
“Do you have full resistance or only some?” I ask.

“Full.”

Blood quirts out of the patient’s mouth.

I gain my partner’s eye contact. “Cricoid intubation?”

“Yep. Chest decompression can wait.”

I locate the cricothyroid membrane, and prep the area with betadine. My partner punctures the skin with a needle while aspirating for air with a syringe, then slides a cannula along needle and syringe. I secure the cannula with a neck strap, and osculate for breathing with my stethoscope.

I hear solid breath sounds. “We’re good, I say then eye the firefighter. “Continue bagging.

snag the radio and switch the channel to the number one trauma hospital.

“Wake Med? This is EMS #16. We’re en route with an MVC patient. Unconscious. Absent left lung sounds. Diminished in right. Surgical trach in place. O2 saturation 90% with BVM at 15lpmBolus IV in placeDopamine dose administeredBP 90/50, pulse 162.  ETA 15 minutes.”

“Chest decompression,” my partner says as he arranges equipment.

To prep the site, rub iodine to the patient’s second intercostalin the mid-clavicular line. My partner inserts a 14-guage catheter into the skin over the third rib. He advances the catheter through the parietal pleura.

“Pop,” he says indicating he felt a pop, which is the goalHe advances the catheter to the chest wall, then removes the needle, leaving the catheter in place.

I secure the catheter to chest wall with dressings and tape.

Six days later, I see the patient exiting the hospital in a wheelchair, his right leg casted. Two hospital employees assist him into an awaiting car. I smile huge and thank God.

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Dianna T. Benson is a 2011 Genesis Winner, a 2011 Genesis double Semi-Finalist, a 2010 Daphne de Maurier Finalist, and a 2007 Golden Palm Finalist. In 2012, she signed a nine-book contract with Ellechor Publishing House. Her first book, The Hidden Son, released in print world-wide March 1, 2013. 

After majoring in communications and a ten-year career as a travel agent, Dianna left the travel industry to earn her EMS degree. An EMT and a Haz-Mat and FEMA Operative since 2005, she loves the adrenaline rush of responding to medical emergencies and helping people in need. Her suspense novels about adventurous characters thrown into tremendous circumstances provide readers with a similar kind of rush. Dianna lives in North Carolina with her husband and their three athletic children. Learn more about Dianna at www.diannatbenson.com.