I’m so pleased to host Dr. David Carnahan who will be blogging every month or so here at Redwood’s. To introduce him, he’s doing a three-part series on the Widow Maker— and I’m not talking black spiders…

Part I about why this medical condition is so deadly can be found here.

Welcome back, David!

“I need to make you aware of a situation.” The Intensive Care Unit Director, Dr. Thomas Winfield, said as he entered my office. “We have an American contractor in the ICU who is having a large anterior wall MI.”

The dream of getting published has been a long one for me. And today, that day, has arrived! The day I’ve longed wished came true.

To celebrate, anyone who leaves a comment on my blog during this weeks posts will be eligible to win a free copy! I’ll also be drawing from my followers/subscribers lists as well. So, plenty of places for you to win. Drawing cutoff will be Sunday, June 3rd. Winners announced Tuesday, June 5th. To claim, you must e-mail me with your info so definitely check the June 5th post. Must live in the USA.

Then, there’s always where real life and dream life meet in some sort of fantastic collision. What you expected is far from what happens. Both good things and bad things.

Mostly good things.

Running a medical blog for authors is a great source of fun. But even I’m not a medical expert in all areas. My first novel, has an OB physician as a major character. Now, I have never been an OB nurse nor do I have any desire to be. That’s why I had other specialists review my novel to make sure everything was authentic and not just the part that I knew about.

The best medical expert to get to review your work is someone actively working in the area currently. These are the experts I sought out and through that process I learned some important lessons that I’d thought I’d share here.

If your novel has some heavy medical aspects, it is best to have it reviewed by someone who works the area. I recently reviewed a manuscript for someone who was writing about diabetes. The character was newly diagnosed and she had done some research to try and determine what the treatment would be. Let me give some kudos here and say she was close. But close is like not scoring a touchdown when you’re on the one yard line. Wrong route giving insulin. Hanging clipboards at the end of the bed (which is not done anymore people!!) and not providing for rehydration which is the #1 therapy for DKA. It’s the little details that will trip you up.

People don’t want their profession to be disparaged. Now, as a writer, I understand characters needing to do bad things for the sake of the plot. So, how do you handle a medical person gone bad without people practicing in that profession lighting your manuscript on fire?

I recently read a contest entry where the author had two nurses doing very bad things to a patient. Even the “bad” nurses I know would never do the things these nurses were doing– very demeaning things.

Here is how I’ve determined the best way to handle the issue. You must have one character in the profession in the scene who points out the bad behavior and shows how the real medical person is going to act. It’s the seasoned charge nurse that comes into the room and dresses down the two horrible nurses. Now, beauty of this, adds conflict! Particularly if the patient is awake (which in real life should never happen in front of a patient.)

It’s okay to have bad, rogue, medical person as long as another character in the story is pointing it out. Then, the reader will know you know what you’re writing about.

What do you think? How do you handle rogue characters without people in that profession being offended?

I’m so pleased to have Tanya Cunningham back as she discusses another popular medical myth– or is it? Do pacifiers cause difficulty with breastfeeding.

I think it’s important on a couple of levels for an author dealing with these issues to be aware of both sides. A seasoned, nursing professional keeping up with research is going to know this information. Our responsibility as nurses is not to sway the patient to our belief (though, of course this does happen) but to present unbiased information to the family so they can make the decision that best suits their needs.

Welcome back, Tanya!

Pacifiers have long been vilified as major disruptors between infants and successful breastfeeding. Have they been given a bum rap, or are the accusations substantiated? Is it actually true that pacifiers
interfere with breastfeeding? If you asked me this a few months ago, I’d say, “It depends.”

Being a postpartum mother/baby nurse, I want all my patients who endeavor to breastfeed to be as successful as possible. I would discourage pacifier use if the mother had “flatter” or “inverted” tissue. However if her anatomy were similar to the pacifier (everted and firm), the risk of “nipple confusion,” I felt, was decreased.

a new mother reading this, and you’re now not sure what to do, use your mommy instincts. Trial and
error is a natural process in motherhood. Decide for yourself if using a pacifier for your little one is detrimental or beneficial.

Tanya Cunningham is a mother/baby RN and lives in Missouri with her husband and two small children. She has been caring for mothers and their newborns for almost four years, before which she was a RN in the USAF. During that time, Tanya worked on a multipurpose inpatient unit for two and a half years (taking care of ortho, neuro, medical, general surgical, and tele) and a family practice residency clinic for a year and a half. Tanya earned her BSN at Oral Roberts University.

What would you be willing to do, how far would you be willing to go to get your child the medical treatment they need?

“Yes, in a bit.” Jonas did not look away from Breanna’s face. He’d loosened the neck of her dress and Penny caught sight of the girl’s undergarment, so worn it appeared gray.


Thanks Lacy for this great post! Looking forward to participating in your Birthday Bash!


Lacy also did a great series here at Redwood’s Medical Edge last July on historical medicine. You can find them here: Part I, Part II, Part III, PartIV.
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I write historical romantic suspense. I love the history of all things medical and try to incorporate them into my novels. However, I’m no expert when it comes to knowing all that much about the poultice. I’ve been looking around the internet and I’ve found a few interesting sites. Here’s one that will give you a description. http://www.healing-from-home-remedies.com/make-a-poultice.html

If you are an expert on the making of a poultice during the Regency era, please jump in here and help me out. I’m especially fond of learning how to make a poultice for wounds, something that will help with infection yet not burn or irritate the skin.

Now, I’m also intrigued with alternative medicine, acupressure, acupuncture, herbs, etc. but I better save that for another time. So if you’ve ever used a poultice I want to know. If you’ve put the use of a poultice in your books please share and if you actually know a bit about using the poultice during the Regency please jump in and share your knowledge. I’m wondering what type of cloth they would have used and how they got the poultice to remain in place.

Last post, we discussed generally the disease of asthma. Today, I’m going to focus on emergency treatment.

The three major problems with asthma are the airway constriction, the inflammation and the mucous production.

Therapy is targeted at reversing these issues.

Treatment starts as follows:

1. Connect the patient to the monitor, determine baseline oxygen level. Normal oxygen saturation is 90-100%. Anything less than 90% is considered hypoxic. If the patient’s oxygen saturation level is less than 90% then they should be placed on oxygen. Now, there are some caveats to this but for your novel, this should suffice.

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 2. Give breathing treatments. Generally, Albuterol and Atrovent are given together in three back to back nebulizer treatments. This is a medication that is inhaled. Both act to relax the tightened muscles around the airways to ease breathing.

3. Give steroids. This targets the inflammatory response. Most often these are given orally in the form of a syrup (for the little ones) or pills if the patient can swallow. If unable to swallow, then it is given IV.

4. Keep the patient hydrated. This will help clear mucous. The thinner mucous is, the easier it is to cough up.

That’s basic treatment. Now, if the patient doesn’t improve with the above treatment then we will go further. Often times, we will place them on a continuous Albuterol nebulizer. There are also medications that can be given intravenously (IV) to relax the smooth muscle of the airways as well.

Remember, Albuterol is a stimulant. It will be normal for the patient’s heart rate to be elevated and for them to feel quite jittery. These are expected side effects of the medication and it is helpful to explain this to the family.

Asthma pearl: Doctors try very hard not to place an asthma patient on a breathing machine and it is generally considered a last resort to keep the patient from dying. This is a different viewpoint in treating a lot of different medical conditions because generally early intubation is preferred to stabilize the patient.

In respect to asthma, the endotracheal tube (ETT– the thing they stick in your throat) aggravates everything we are trying to reverse. The ETT can cause bronchospasm and increased secretions. Remember, the problem is air trapping. When a patient is on a ventilator– breaths are pushed into the patient via the machine (positive pressure ventilation). This can lead to more air being trapped in the lungs which puts the patient at risk for pneumothorax (which is when the lung get a hole in it and deflates). These patients are ususally medically paralyzed and sedated so their breathing can be totally controlled by the machine.

Have you written an ER scene with an asthmatic in distress presenting as a patient?

Recently, I did an overview of diabetes. Here are the links to Part I and Part II. As authors, I think it’s good to have a general understanding of the major illnesses so you have a background of whether or not you’d like to afflict your character with it.

Asthma AKA reactive airway disease. Generally, when we think about respiratory disorders, we divide them between the upper and lower part of the respiratory system. The division between the two is generally your larynx or voice box. Upper airway disorders are things such as croup, foreign body, and epiglotitis. Disorders of the lower airway are asthma, bronchiolitis and pneumonia.

There are several things happening in the lowers airways during an asthma attack. There is constriction of the airway as well as inflammation and increased mucous production. It’s easier for air to get in than to get out.

Symptoms of asthma can include some or all of the following: Difficulty breathing, wheezing, coughing, low oxygen levels, air hunger, tripod positioning, and pale or blue lips.

In pediatrics, there is reluctance to diagnose asthma under the age of three years. So, even if a child presents with multiple episodes of wheezing, they are likely to be diagnosed as having “reactive airway disease” until they are older and their clinical picture becomes more clear.

The other thing to keep in mind is that all wheezing is not asthma. An upper airway issue can lead to wheezing in the chest. These sounds are deferred. Think a balloon that is stretched to the point where it squeaks as air passes through the tight opening. This can happen in the lungs as well if the larger upper airways are having a problem.

Sometimes, an infection in the lungs (either viral or bacterial) can also lead to wheezing and we will target this wheezing with asthma like therapies. It doesn’t mean the person will end up with asthma. It is possible it was just a symptom related to their illness.

However, if the patient develops a picture of wheezing consistently with every viral illness– then an asthma diagnosis becomes more probable as viral illnesses can be a trigger for the disease.

Next post: Emergency Treatment of Asthma.

Do you have a character that suffers from asthma in your ms?