JoAnn Spears

Florence Nightingale Diagnosis Henry VIII: Part 3/3

/ Jordyn Redwood / Leave a comment

This has been an amazing series by JoAnn Spears. I’ve enjoyed having her and I hope you learned something new about medicine during Henry VIII’s time.

Baby blues
Nursing Diagnosis:  Sexuality Pattern, Ineffective
Nursing Diagnosis:  Role Performance, Ineffective
In Tudor times, one of the main imperatives on a king was to father sons. Henry’s inability to achieve this goal was the impetus behind the Reformation in England, and has been made much of in fact and fiction. The fact is, though, that his full complement of male children was two legitimate sons, and one illegitimate son. One of the legitimate boys died in infancy and the other, Edward VI, died in his teens. The illegitimate Henry Fitzroy died shortly after he was married, at the age of seventeen. Henry also fathered two healthy girls, Mary I and Elizabeth I. He was in his mid-forties when he sired his last child.
Rhesus or Kell issues, in which incongruent parental blood types can cause a stillbirth or compromised infant, have been suggested as causes of the many miscarriages suffered by Henry’s first two wives. However, his first healthy daughter was born subsequent to his first wife having a succession of pregnancies, which is quite the opposite trajectory to that usually seen with such incompatibilities.
Syphilis, which, untreated, can lead to mental health problems in both parents and offspring, is an embedded but unlikely part of Tudor medical lore. Henry’s impulsive and violent propensities were not described by contemporaries in a way associated with the dementia and deterioration typical of tertiary syphilis. Also, none of Henry’s surviving children exhibited symptoms of congenital syphilis.
Henry’s first three wives each conceived quickly after marriage and, in the case of the first two, conceived multiple times. None of his subsequent three wives conceived. Henry’s symptoms of substantial weight gain and compromised circulation became noteworthy around the period between Henry’s third and fourth marriages. Erectile dysfunction is another potential side effect of both diabetes and poor circulation, and would account for a lot of the personal history of Henry and his last three wives.
Exit strategy
Nursing Diagnosis:  Mobility: Bed, Impaired
Nursing Diagnosis:  Risk for Compromised Human Dignity
Henry VIII’s last years were anything but majestic. The handsome, charming, 6’2” blond athlete of earlier days was a bloated, irritable, sickly being who was largely confined to bed and chair. A mechanical hoist was required to get the king onto a horse once he donned his outsized armor. The purulence of his leg ulcers caused a nauseating stench. His very last days, in which he was confined to his bedchamber, were spent hammering out a succession plan for the progeny he and his sisters would leave behind.
Henry was in his mid-fifties when he died. During the era he lived in, his would not have been considered an advanced age, but a death at that age was certainly not considered untimely. The actual cause of his death is unknown. An embolus to the heart or lung has been suggested. However, either of these would probably have killed Henry quite quickly, and there were days’ worth of succession planning and priestly officiating before the death. Stroke has also been suggested, but the tenor of the deathbed activity around him is not entirely congruent with the suddenness of a cerebrovascular event. Given the circumstances, the eventual succumbing of a once-healthy body to years of chronic disease seems as likely an explanation as any of Henry’s death.
***********************************************************************
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.  
 Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Florence Nightingale Diagnosis Henry VIII: Part 2/3

/ Jordyn Redwood / Leave a comment
Today, JoAnn Spears continues her nursing evaluation of Henry VIII.
The King’s pains.
Nursing Diagnosis:  Tissue Perfusion, Ineffective, Peripheral
Nursing Diagnosis:  Pain, Chronic
Nursing Diagnosis:  Skin Integrity, Impaired
Henry VIII and his bandaged, suppurating, painful legs are the stuff of Tudor legend, as is “the gout”. Gout was common in Henry’s time, when diets were high in triggering, purine-rich foodstuffs such as beer, ale, and organ meats. Gout does cause excruciating pain in the lower extremities, but it tends to be episodic and associated with inflammation, rather than chronic ulceration. If Henry did have gout, it may have been the least of his problems.
Poor peripheral circulation seems a more likely explanation of Henry’s lower extremity woes. The weight and immobility that were part of his life after the age of about forty could certainly have caused or contributed to this condition. The weight gain may in turn have been either the cause or the effect of type 2 diabetes. This is the type of diabetes which is acquired later in life. To continue a sad spiral, diabetes also contributes to lower extremity problems such as easily damaged skin, neuropathic pain, and ulcers that will not heal and become chronically infected.
Size Matters.
Nursing Diagnosis:  Nutrition, Imbalanced: More than Body Requirements
Diabetes is a disorder of glucose metabolism, and type 2 diabetes is associated with excess food intake. Henry’s much vaunted gluttony and his weight in middle age—estimated by some to be as much as five hundred pounds—argue strongly in favor of this diagnosis, but not exclusively.
Hypothyroidism is also associated with weight gain and mental irritability such as Henry displayed. This condition is, though, more commonly seen in women than in men.
Tudor portraiture makes a strong argument for Cushing Syndrome as the cause of Henry’s obesity. Pituitary tumors which disrupt normal cortisol activity are a frequent cause of this disease. Portraits of Henry in later life feature the typical moon face of Cushing’s Syndrome and the characteristic distribution of excess fat deposited in the core rather than the extremities. Ironically, Cushing’s Syndrome can also cause or exacerbate mental status changes and diabetic processes, as well as erectile dysfunction
**********************************************************************
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.
 Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Florence Nightingale Diagnosis Henry VIII: Part 1/3

/ Jordyn Redwood / Leave a comment

I’m so excited about hosting JoAnn Spears and her series on Henry VIII’s medical issues. I have my own personal theories as to what caused Henry’s demise. What are yours?

Welcome, JoAnn!

Henry VIII never had nursing care as we know it today.  In his time, care of the sick fell to family members or servants, generally female.  Henry’s last wife, Katherine Parr, certainly fulfilled this role for Henry.
Obviously, the modern medical testing which can categorically confirm or rule out disease cannot be brought to bear on Henry’s case.  Nursing diagnosis, which evaluates the human responses to alterations in health status, can be, and can elicit useful medical information about Henry VIII for those writing Tudor fiction.
A mind is a terrible thing…
Nursing Diagnosis:  Risk for Injury
Nursing Diagnosis:  Thought Process, Disturbed
Nursing Diagnosis:  Violence, Risk for
Henry VIII excelled in all of the sports and athletic activities enjoyed by the Tudor nobility.  He wrestled, hunted on horseback, played tennis, jousted and danced.
Henry VIII suffered a serious fall from a horse while jousting in 1536, at the age of forty-four.  He lost consciousness for a period of time after the fall, indicating that a significant brain injury may have occurred. 
This event coincided with the beginning of Henry’s divesting himself of his second wife, Ann Boleyn.  As is well known, he eventually went on to execute Ann, another wife, and numerous friends and political advisors.
It has been suggested that this head injury ‘turned’ Henry VIII violent.  In view of his track record prior to the injury, this theory is not 100% supportable.  That track record includes the executions of Bishops More and Fisher and the ruinations of Henry’s first wife and of his erstwhile friend Cardinal Wolsey.
Porphyria, a genetic condition of the metabolism, has also been mooted as a cause of Henry’s mental proclivities.  The disease causes numerous physical and mental symptoms, including mental irritability and derangement. Arguments that porphyria caused the “madness” of George III, a distant Tudor relative, bolster the porphyria theory, but not convincingly. McLeod Syndrome, a genetic blood disorder with some similar symptoms to porphyria, seems a likewise distant possibility.
Of course, there is no physical evidence extant to support any argument for a genetic condition causing Henry VIII’s various symptoms.   A look at his family tree, though, might shed some future light on such a possibility.
Henry’s elder sister, Margaret, was, like Henry, significantly overweight.  A descendant of Margaret’s, Queen Anne the Good (1665-1714), is probably the Tudor relation whose health issues most closely resemble Henry’s.  She suffered severe obesity later in life, lower leg pain and ulceration, functional immobility, and a very sad reproductive history.  She had at least seventeen pregnancies, which produced only four live children who died in infancy and one very frail hydrocephalic boy who died in his teens.  Her possible medical diagnoses have never aroused the interest that Henry’s have, but a thorough comparative study of Anne’s and Henry’s health issues might prove informative.  Diabetes, hypothyroidism, and Cushing’s Syndrome would all likely feature as “rule in/rule out” diagnoses in such research.
***********************************************************************
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration.  Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.   
Six of One was begun in JoAnn’s native New Jersey.  It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.