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Sjogren's Syndrome
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LETTERS
Sjogren’s Syndrome
I2003 am so grateful that Schoofs (September/October JOGNN) brought up the topic of Sjogren’s syndrome (SS) in nursing. Believed to be the number one autoimmune disorder, SS affects approximately 2 to 4 million Americans, mostly postmenopausal women (Carsons & Harris, 1998). Unfortunately, little is known about this syndrome. I would like to share my personal experience with SS. My 76-year-old mother had been complaining of the signs and symptoms of SS for approximately 10 years. She went to many physicians with the complaint of dry eyes, dry mouth, vaginal dryness, dry itchy skin, joint pain, fatigue, and malaise, all of which are manifestations of SS (Carsons & Harris, 1998). At first, various care providers recommended many different treatments for the symptoms. My mother was told that her symptoms were age-related and due to decreased estrogen levels. Even after treatment with plugs in her tear ducts, eye drops, vaginal estrogen, and many dry skin lotions, she still was not feeling well. So she went back to her primary physician, who labeled her a “hypochondriac.” His response to my mother’s repeated concern was, “I don’t know what’s wrong with you. What do you think I am, G-d?” One day while reading a national tabloid magazine, my mother came across an article on SS. She called me and said, “I think this is what I have.” She went back to her physician, who paid no attention to her complaint, although her dermatologist did. The dermatologist proceeded with testing that led to the diagnosis of SS. Since the diagnosis, my mother, although not completely relieved of her symptoms due to other medical conditions, changed care providers, to a rheumatologist who specializes in SS. My mother is relieved to know she is not a hypochondriac and that she has a care provider who knows about SS and is caring and compassionate. As women’s health care providers, we must demonstrate our care for our patients by becoming familiar with the signs and symptoms of SS, especially because the syndrome occurs most frequently
10 JOGNN
in women. Sometimes health care providers focus only on the common causes and treatments of dry eyes, dry mouth, dry skin, and vaginal dryness, especially in postmenopausal women. Because SS mimics the symptoms of estrogen deficiency, we owe it to our patients to explore the underlying cause of these symptoms and refer our patients for appropriate care. For those interested in learning more about SS, along with the resources in the article by Schoofs (2003), I also recommend an excellent book, The New Sjogren’s Syndrome Handbook, edited by Carsons and Harris. Cyndi Roller, WHNP, CNM, PhD Kent State University
Kent, OH REFERENCES Carsons, S., & Harris, E. K. (Eds.). (1998). The new Sjogren’s syndrome handbook. Oxford, UK: Oxford University Press. Schoofs, N. (2003). Caring for women living with Sjogren’s syndrome. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 589-593.
Preconception Care
TWisconsin he Preconception Prenatal Care Committee of the Association for Perinatal Care asked me to thank you for the excellent coverage on preconception care (July/August 2003 JOGNN). Members were particularly pleased with the emphasis on genetic counseling. This multidisciplinary committee has a long history of commitment to preconception care, emphasizing the many avenues for service delivery in addition to routine OB/GYN visits. The articles in JOGNN give more support to the committee’s work and provide new and vital information to those who believe in and practice preconception counseling. On behalf of I. Mary Anderson, chair, and the rest of the Preconception Prenatal Care Committee, we congratulate you on such excellent coverage of an
Volume 33, Number 1
important topic. Many of us are faithful JOGNN readers, and because of the coverage on preconception care, we have introduced the journal to several others. Rana Limbo, PhD, RN, CS Wisconsin Association for Perinatal Care Madison, WI
Limited Obstetric Ultrasound Examinations
I
commend the authors as well as the journal for publishing the clinical research study “Limited Obstetric Ultrasound Examinations: Competency and Cost” (May/June 2003 JOGNN). The study was well done and the information very applicable to hospital educational programs and nursing clinical practice. Unfortunately, too many nurses continue to accept the responsibility for performing limited ultrasound examinations without having completed the recommended didactic component and clinical skills competency experience. Knowing the cost
January/February 2004
required to educate nurses will certainly allow hospitals to prepare for this necessary training. In the article, it was noted that the cost for each participant to complete the 12-hour didactic component and for the sonographer educator to teach it totaled approximately $882 per learner. As stated in the article, this cost may be reduced by teaching group sessions rather than one-on-one. For institutions that cannot offer an in-house sonography didactic educational component, the 12-hour didactic portion can be completed online through Health Education Innovations, Inc. (http://www.hei-online.com). The cost for this course is approximately $250 per nurse and can be completed on a flexible time basis. There are also limited obstetric sonography courses offered on a national basis throughout the year. Again, congratulations on a study well done. Cydney Afriat Menihan, CNM, MSN, RDMS Narragansett, RI
JOGNN 11
LETTERS
Sjogren’s Syndrome
I2003 am so grateful that Schoofs (September/October JOGNN) brought up the topic of Sjogren’s syndrome (SS) in nursing. Believed to be the number one autoimmune disorder, SS affects approximately 2 to 4 million Americans, mostly postmenopausal women (Carsons & Harris, 1998). Unfortunately, little is known about this syndrome. I would like to share my personal experience with SS. My 76-year-old mother had been complaining of the signs and symptoms of SS for approximately 10 years. She went to many physicians with the complaint of dry eyes, dry mouth, vaginal dryness, dry itchy skin, joint pain, fatigue, and malaise, all of which are manifestations of SS (Carsons & Harris, 1998). At first, various care providers recommended many different treatments for the symptoms. My mother was told that her symptoms were age-related and due to decreased estrogen levels. Even after treatment with plugs in her tear ducts, eye drops, vaginal estrogen, and many dry skin lotions, she still was not feeling well. So she went back to her primary physician, who labeled her a “hypochondriac.” His response to my mother’s repeated concern was, “I don’t know what’s wrong with you. What do you think I am, G-d?” One day while reading a national tabloid magazine, my mother came across an article on SS. She called me and said, “I think this is what I have.” She went back to her physician, who paid no attention to her complaint, although her dermatologist did. The dermatologist proceeded with testing that led to the diagnosis of SS. Since the diagnosis, my mother, although not completely relieved of her symptoms due to other medical conditions, changed care providers, to a rheumatologist who specializes in SS. My mother is relieved to know she is not a hypochondriac and that she has a care provider who knows about SS and is caring and compassionate. As women’s health care providers, we must demonstrate our care for our patients by becoming familiar with the signs and symptoms of SS, especially because the syndrome occurs most frequently
10 JOGNN
in women. Sometimes health care providers focus only on the common causes and treatments of dry eyes, dry mouth, dry skin, and vaginal dryness, especially in postmenopausal women. Because SS mimics the symptoms of estrogen deficiency, we owe it to our patients to explore the underlying cause of these symptoms and refer our patients for appropriate care. For those interested in learning more about SS, along with the resources in the article by Schoofs (2003), I also recommend an excellent book, The New Sjogren’s Syndrome Handbook, edited by Carsons and Harris. Cyndi Roller, WHNP, CNM, PhD Kent State University
Kent, OH REFERENCES Carsons, S., & Harris, E. K. (Eds.). (1998). The new Sjogren’s syndrome handbook. Oxford, UK: Oxford University Press. Schoofs, N. (2003). Caring for women living with Sjogren’s syndrome. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32, 589-593.
Preconception Care
TWisconsin he Preconception Prenatal Care Committee of the Association for Perinatal Care asked me to thank you for the excellent coverage on preconception care (July/August 2003 JOGNN). Members were particularly pleased with the emphasis on genetic counseling. This multidisciplinary committee has a long history of commitment to preconception care, emphasizing the many avenues for service delivery in addition to routine OB/GYN visits. The articles in JOGNN give more support to the committee’s work and provide new and vital information to those who believe in and practice preconception counseling. On behalf of I. Mary Anderson, chair, and the rest of the Preconception Prenatal Care Committee, we congratulate you on such excellent coverage of an
Volume 33, Number 1
important topic. Many of us are faithful JOGNN readers, and because of the coverage on preconception care, we have introduced the journal to several others. Rana Limbo, PhD, RN, CS Wisconsin Association for Perinatal Care Madison, WI
Limited Obstetric Ultrasound Examinations
I
commend the authors as well as the journal for publishing the clinical research study “Limited Obstetric Ultrasound Examinations: Competency and Cost” (May/June 2003 JOGNN). The study was well done and the information very applicable to hospital educational programs and nursing clinical practice. Unfortunately, too many nurses continue to accept the responsibility for performing limited ultrasound examinations without having completed the recommended didactic component and clinical skills competency experience. Knowing the cost
January/February 2004
required to educate nurses will certainly allow hospitals to prepare for this necessary training. In the article, it was noted that the cost for each participant to complete the 12-hour didactic component and for the sonographer educator to teach it totaled approximately $882 per learner. As stated in the article, this cost may be reduced by teaching group sessions rather than one-on-one. For institutions that cannot offer an in-house sonography didactic educational component, the 12-hour didactic portion can be completed online through Health Education Innovations, Inc. (http://www.hei-online.com). The cost for this course is approximately $250 per nurse and can be completed on a flexible time basis. There are also limited obstetric sonography courses offered on a national basis throughout the year. Again, congratulations on a study well done. Cydney Afriat Menihan, CNM, MSN, RDMS Narragansett, RI
JOGNN 11