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New Library Materials Available |
 Volume 5 Issue 2 - Fall 1998 A Publication of the TRIC/PLUK Library Editor/Librarian: LeeAnn Logan/Janice Sand |
TRIC/PLUK Library 516 N 32nd St Billings, MT 59101 1-800-222-7585 in MT 406-255-0540 (voice/TT) FAX: 406-255-0523 E-mail: plukinfo@pluk.org URL: http://www.pluk.org |
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CARBON MONOXIDE POISONING
The number one cause of poisoning in the United States is --you guessed it--Carbon Monoxide Poisoning.
Carbon Monoxide is an odorless, colorless gas that is a by-product of combustion. It can originate from a number of sources in the home. These sources/appliances are fueled by natural gas, propane, fuel oil, wood, wood pellets, briquettes, or white gas. If the appliances utilizing one or more of these fuels is properly vented, then generally, there should be no problem with carbon monoxide. However, if not, then carbon monoxide may accumulate in your home and approach dangerous levels.
Carbon Monoxide is inhaled and transmitted to the blood stream. The carbon monoxide hinders the red blood cells from absorbing oxygen and thus the body will not get the amount of oxygen that the cells need to function normally. Persons that are suffering from carbon monoxide poisoning experience lightheadedness, desire to sleep, become lethargic, experience headaches and reduced mental capacity. Some symptoms may be flu-like and misinterpreted as such. A person may realize that they need to get out of the house but not be able to. Severe cases involve the family not even waking up or severe brain damage. Children are particularly sensitive to carbon monoxide poisoning.
Some common ways that carbon monoxide poisoning occurs include cooking in the house with an unvented appliance such as a camp stove, charcoal barbecue or leaving the car running in an enclosed area. Other appliances such as heaters or hot water heaters may have a malfunction of the venting system such as a broken or plugged vent or back draft by using up the air in a house and drawing the normally vented gases back into the house. Misuse of appliances include using a gas stove to heat the kitchen or using a portable heater without venting.
There are two lines of defense against carbon monoxide poisoning. The first one is to have all appliances checked at least annually for proper venting and fresh air return. This should be done by a licensed technician. The second line of defense is the installation of a carbon monoxide detector. These are relatively inexpensive and easy to install. Be sure to follow the manufacturer's instructions. Carbon monoxide detectors are very sensitive early warning devices. Most are set to sound an alarm if the atmosphere in the house reaches 100 parts per million over 90 minutes.
The key here is not to ignore the carbon monoxide detector's warning when it goes off. don't do what some have done and take the alarm outside and go back to bed thinking you can deal with it in the morning. You might not wake up. Do get everyone out of the house. Do call the fire department and have them come to the house to determine the source of the carbon monoxide.
It used to be thought that only homes that used gas, oil, or wood fired appliances needed to have carbon monoxide detectors. Now, it is recommended that all homes have a carbon monoxide detector in order to protect you from those circumstances in which may be unusual such as using a barbecue grill in the garage in the winter or using a gas-fired lantern during a power outage.
If you have further questions, the best place to call is your local fire department. Purchase, install, check and heed any warning. These are the watchwords for protection from carbon monoxide poisoning.
&endash;Submitted by Brad Johnson, DDP in Bozeman.•••
MANDT Training
MANDT Instructor Certification/Recertification Training will be offered in Butte on 11/2/98 through 11/6/98 at the Ramada Inn Copper King. Please contact David Mandt and Associates directly at (972) 495-0755 or Perry Jones at (406) 444-2995 for more information. Enrollment will be limited.•••
QUALITY CORNER
DD Case Managers: If you have things to add to this section, please send them to me. I will compile, edit, and send articles and information on to Lee Ann. Contact: James Driggers at (406) 444-2995.
Transportation and Montana Community Partners
We have been working on a problem that Havre Day presented with regard to transportation and Montana Community Partners (MCP). The problem that Havre Day was using a psychiatrist in Great Falls, Dr. Hornby, who was working very well with some of the individuals in service. A new psychiatrist moved into Havre, which precluded Medicaid from paying for the transportation to Great Falls. The psychiatric visit was not the issue; transportation was. Havre Day did not want to change psychiatrists since the individuals had been so pleased with Dr. Hornby, and much improvement had been noted under his care. Here's what we've discovered.
If the current psychiatrist writes MCP and indicates that a change in psychiatrists would destabilize, set back, or otherwise be detrimental to the patient, then MCP can request that Medicaid pay for the transportation (it usually does). Of course, if the psychiatrist has a special license or expertise, exceptions can also be granted.
MCP has been very helpful in working through this and explaining it. The contact person at MCP in this regard is Carley Tuss, P.O. Box 2510, Billings, MT 59103. The phone number is (406) 254-9500, and the fax number is 1-888-685-7657.
Adult Foster Care
We have had several discussions recently concerning adult foster care, and at what point a landlord/tenant relationship or a roommate situation becomes a situation which the law would require an adult foster license. Roy Kemp from licensure has been part of some of these discussions, and will be present at the DD Conference to help provide some guidance. The law (MCA 50-5-101) describes an adult foster car home (which requires a license) as:
"A private home that offers light personal care or custodial care to four or fewer disabled adults or aged persons who are not related by blood or marriage to the owner of the home."
" 'Light personal care' means assisting the aged person or disabled adult in accomplishing such personal hygiene tasks as bathing, dressing, hair grooming, and supervision of prescriptive medications."
" 'Custodial care' means providing a sheltered, family-type setting for an aged person or disabled adult so as to provide for the person's basic needs of food and shelter and to ensure that a specific person is available to meet those basic needs."
Also regarding Adult Foster Care, you may have heard that DDP is proposing a law change which would permit an adult foster license to be granted in situations where people live who are receiving DDP funded services and who previously would not have been licensable due to inability to self-evacuate, incontinence, or inability to self-administer medications. Keep your fingers crossed, as this change would allow a nice service option for a few individuals in services that has not been available before.•••
TRIC/PLUK SURVEY RESULTS
Thank you to those of you who returned your TRIC/PLUK survey. Your input helps us to better serve your needs. The results were very positive in general. Most people who said that they did not use the library said that it was because they either didn't know what was available or that they confer with clients, use other libraries or do their own searching on the Internet. Based on combining the totals for the categories "excellent" and "good", 89% responded that the information was helpful; 82% said that the information was current; 92% responded that the information was provided in a timely manner; 100% said that the staff person was helpful; 100% said that the staff person was friendly; and 96% responded that the TRIC/PLUK Library is a valuable resource. Again, thank you for your time and input.•••
New Materials Are Now Available
QM Survey Winners
We are happy to announce that the winners of the survey contest are:
Joan White Crane DEAP Box 972 Lame Deer, MT 59043 Gary Kirberg FSS/DDP Region 4 Helena, MT 59604
Many thanks to all of you who returned your surveys to us. Next year there will be a spot for your name and address!
HEPATITIS C
What is hepatitis C?
Hepatitis C (HCV) causes inflammation of the liver. First called non-A non-B hepatitis, the existence of hepatitis C was first identified in the mid 1970's. It want's until 1989, however, that the test for specific antibodies to the virus became available, thus permitting routine testing. Each year, about 28,000 Americans contract hepatitis C, which is a more frequent cause of chronic liver disease than hepatitis B. While it was believed originally that at least half of the cases of acute hepatitis C became chronic, it is now estimated that the rate may exceed 80% and some may develop cirrhosis. some individuals with cirrhosis may also develop cancer of the liver. Long term studies are being conducted to identify those who will receive benefit from treatment.
Who is at risk?
People who are at risk of acquiring hepatitis C include anyone who has had a blood transfusion prior to 1992, IV drug users, hemodialysis patients, those with tattoos and those with multiple sexual partners. Such individuals should be tested for hepatitis C. Body piercing and cocaine snorting also are risk factors. However, an estimated 10% or more have in identifiable history of exposure to the virus.
How is HCV transmitted?
The virus is found in blood. It is not clear whether semen or saliva can actually transmit the virus. There is also no evidence indicating that HCV is transmitted through breast milk. It can be transmitted by using razors, needles, toothbrushes, nail files or even a barber's scissors, tattooing, body piercing or acupuncture needles used by an infected person. All people with HCV are potentially infectious. As many as 4 million people are believed to be infected which means that they are likely to have the virus in their system, and whether they have symptoms or not, they can infect others. Unlike hepatitis A and B, previous infection does not produce immunity. HCV accounts for 90% of transfusion-related cases of hepatitis in the past, but transfusions nowadays hardly ever transmit the infection because donor blood is tested. The potential for transmission from an infected mother to her newborn baby appears to be less than 5%. However, transmission may depend on the presence of high levels of the virus in the mother's blood. Babies born to infected mothers should be tested at one year of age.
Is there a vaccine for hepatitis C?
There is NO vaccine for HCV and vaccines for hepatitis A and B do not provide immunity against hepatitis C. There are various strains of HCV and the virus undergoes mutations. As a result it will be difficult to develop a vaccine. Also, there is no effective immune globulin preparation.
What are the symptoms?
Most people who are infected with the HCV do not have symptoms and are leading normal lives.The incubation period varies but averages about 7 to 8 weeks. Liver tests may range from being elevated to being normal for various lengths of time (from weeks to as long as a year). Even if infected persons have normal liver tests, they may carry the virus and can transmit the disease to others. The virus is in their blood and can cause liver cell damage. If symptoms are present, they may be very mild and flu-like: fatigue, nausea, loss of appetite, fever, headaches, and abdominal pain. Most people do not have jaundice (yellowing of the skin and eyes); however, it can sometimes occur along with dark urine.
How will I know if I have HCV?
Infection by the hepatitis C virus can be determined by a simple and specific blood test that detects antibody against HCV; however, it does not distinguish between acute or chronic infection. This test is not a part of a routine physical and people must ask their doctor for a hepatitis C test. If the initial test is positive, a second test should be done to confirm the diagnosis and liver enzymes (a blood test) should be measured. The current enzyme immunoassay teas (EIA) that detects anti-HVC has a sensitivity of about 95% in chronic hepatitis C. Antibody may not be present in the first four weeks of infection in about 30% of patients. HCV infection may be identified by anti-HCV testing in approximately 60% of people as early as 5-8 weeks after exposure.
Will I get well?
Few people are able to clear the virus from their blood, which is necessary for complete recovery. Over 80% of cases reported each year become chronic, which means liver enzyme levels remain elevated for six months or more after the initial acute infection. The enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are released when liver cells are injured or die. Elevated ALT and AST levels may appear and disappear throughout the course of the infection. Current tests can indicate that the infection is chronic. The terms chronic persistent hepatitis or chronic active hepatitis are not longer used because doctors now believe that the persistent form, formerly thought to be harmless, can sometimes progress to more severe liver disease, including cirrhosis.
What does chronic hepatitis mean?
Chronic HCV refers to infections that do not clear up within six months after the acute infection. The disease may gradually progress over a period of 10-40 years. High ALT and AST levels reveal ongoing liver damage, but they do not reliably predict the severity of liver injury. A liver biopsy can identify the type and degree of damage and can determine the severity of the disease. It is believed that 20% of patients with chronic hepatitis C will develop cirrhosis (scarring of the liver resulting from the death of liver cells). Of these patients 25% (5% overall) may develop liver failure even though it may take 30-40 years after infection. Patients with chronic hepatitis C in whom cirrhosis develops appear to have increased risk for developing hepatocellular carcinoma (primary liver cancer), which also may occur 10-40 years after the initial infection.
What is the treatment?
Currently, there are three types of interferon used to treat hepatitis C. Selection of patients for treatment may be determined by biochemical, virologic, and when necessary, liver biopsy findings, rather than presence or absence of symptoms. The treatment must be given by injection, and has a number of side effects including flu-like symptoms: headache, fever fatigue, loss of appetite, nausea, vomiting, depression and thinning of hair. The medication may also interfere with the production of white blood cells and platelets by depressing the bone marrow. Periodic blood tests are required to monitor blood cells and platelets. The severity and type of side effects differ for each individual. Treatment of children with HCV is under investigation.
While 50-60% of patients respond to treatment initially, lasting clearance of the virus occurs in about 10-20% of patients. Treatment may be prolonged and given a second time to those who relapse after initial treatment. Available treatments include:
Currently, almost one quarter to one third of all liver transplants in the US are performed for end-stage hepatitis C. However, reinfection of the transplanted liver by the virus appears to occur at a high rate. Fortunately, this infrequently requires a second transplant.
Anyone with hepatitis C should be vaccinated against hepatitis A and B and should not drink alcohol.
Try to maintain as normal a life a possible eating a well balanced diet, exercising and keeping a positive attitude. Avoid depressing or overwhelming tasks and learn how to pace yourself, rest when you feel tired. Plan physically exhausting tasks in the morning when your energy level is at its peak.
How can I protect others and prevent hepatitis C?
No vaccine is available for hepatitis C at this time. Care should be taken in handling anything that may have the blood of an infected person on it such as razors, scissors, toothbrushes, nail clippers and files, tampons or sanitary napkins, etc. Clean up blood spills with household bleach. Although it is believed that HCV is transmitted only occasionally through sexual contact, safe sex practices (use of a latex condom) are recommended for individuals with multiple sexual partners. Notify your physician and dentist that you have HCV.
Advances in understanding this disease are being made every day. For information about HFI's PATS (support network by phone) or referral to specialists, call 1-800-891-0707. HFI will keep you informed on new advances in research and education programs through HFI's newsletter, Hepatitis Alert.
Hepatitis Foundation International 30 Sunrise Terrace Cedar Grove, NJ 07009•••
Effective Interpersonal Communication
Nonverbal Communication
What can you learn from facial expressions, vocal expressions, posture and gestures when conversing with a person who has a disability?Do you ever notice any discrepancies between what their body language is saying and what they are actually saying? How about your body language?
Do you notice anything about your body language that may be a barrier to open communication?
Verbal Communication
Is your voice empathatic without being condescending?Do you give firm, clear responses to questions or requests?
Do you consider the feelings of the other person when formulation your answer?
Can you accurately read what the other person is feeling?
Do you use language that is understandable, clear and relevant?
Can you become a better communicator using these questions as a guide?•••
Recreational Adventures Vacation Experiences
Vacation programs for people with disabilities are nothing new. What is new is that Regional Services for South, Central and Eastern Montana (RS), is now providing this service in Montana.
Regional Services is a private nonprofit corporation serving the needs of adults with disabilities in Billings, Red Lodge, Lewistown and Hardin since 1974. RS is currently providing residential and day services to 150 adults in these four communities.
In September of 1997, the staff of RS began exploring the idea of providing people with disabilities a locally run program that would provide vacation and recreational programs beyond those traditionally available. Through this exploration came the idea for Recreational Adventures Vacation Experiences (R.A.V.E.). R.A.V.E. would be designed to provide safe, affordable vacation and recreational activities for those looking for new and different adventures.
In March of 1998, R.A.V.E. provided its first adventure. Twelve people with disabilities and three guides left Billings and traveled to Thermopolis, Wyoming for two days of swimming, relaxing and socializing. From this two day adventure we have moved on to a five day trip to Disneyland, Universal Studios and Sea World. Other adventures have taken us to the Black Hills of South Dakota and to watch the reenactment of the Battle of the Little Bighorn. We also enjoyed front row seats at the Badboys of Wrestling and experienced the beauty of Bighorn Canyon cruising on pontoon boats.
In August almost 100 people with R.A.V.E. spent the day water sliding at Big Splash and then had a picnic and toured the local zoo. On that day people from all four communities came to share in the thrill of sliding, exploring and spent and enjoyable day meeting old and new friends.
R.A.V.E. has just completed its new fall and winter brochure which outlines many upcoming vacation opportunities. Vacations range from shopping at the "Mall of America" to skiing adventures in the Canadian Rockies. Also available are cruises, professional football games and an additional trip to Disneyland.
For more information concerning R.A.V.E. and any of the vacation and recreational activities, or to be placed on our mailing list, please contact Jim Uecker at (406) 252-1927 or e-mail juecker@abs.wtp.net or call the Regional Services main office at (406) 652-5443.•••
Visiting the Doctor? Here are some tips. . . . .
&endash;From the CDC Express in Missoula
Making a list of questions ahead of time and reviewing them with your doctor can save time and ensure all your concerns are addressed. The following list may be helpful as you plan your next doctor's visit. A special thanks to Dr. Ned Vasquez, CDC's Medical Director for these questions!
If tests are ordered:
If medication is prescribed:
If a procedure is ordered:
TRIC/PLUK LIBRARY RELOCATES
On September 15, 1998, Parents, Let's Unite For Kids and the TRIC/PLUK Library moved into our new location. The move resulted in a temporary closure of the library while the materials were in transit, but we are now available to receive your requests again! We sincerely hope that we did not inconvenience you, and are certain that you will like the accessibility of our new location. Please stop by and visit us when you get a chance. We love showing off our new home. Our new address is:
516 North 32nd Street Billings, MT 59101 1-800-222-7585 (406) 255-0540 (406) 255-0523 fax
Copyright © 1998 Parents, Let's Unite for Kids, all rights reserved.