Will neglect from gov't school re:MRSA stop me as LPN

[rmet4nzkx]

I'm sure that gravy on bread was well appreciated during the depression. I take so much for granted. Even in the poorest of days, I had cheese sandwiches and hotdogs. You know those modern poorboy specials. Everyone has their favorite I guess.

I was told coconut oil wouldn't be banned, they just wanted to know what it would be used for... they were leary at first. lol.

Dermadoc did the I&D and rushed the C&S, so results should be back before the weekend. If it proves to be MRSA we'll have to look at what further tests are needed, and methods of containment. I just went to the store for supplies... extra washcloths and towels, clorox spray, gloves, hand sanitizer, gauze, antibacterial body wash... all the goodies from last time. Thanks for asking.

Great they will let you have coconut oil, you want the virgin oil not a lotion that is combined with other things that might irritate it is antiviral, antibacterial, antimicrobial, and antiprotozoal properties amazing stuff, I get skin irritations easily after a bad case of stevens johnson syndrome, coconut oil works as well maybe better than Bactroban and much cheeper! But you will need something to moisturise with all the hand washing and the skin's natural protective barrier. The great thing is it can be taken internaly too in place of oil or butter, check it out on the net.

 

[kjcclpn]

Great they will let you have coconut oil, you want the virgin oil not a lotion that is combined with other things that might irritate it is antiviral, antibacterial, antimicrobial, and antiprotozoal properties amazing stuff, I get skin irritations easily after a bad case of stevens johnson syndrome, coconut oil works as well maybe better than Bactroban and much cheeper! But you will need something to moisturise with all the hand washing and the skin's natural protective barrier. The great thing is it can be taken internaly too in place of oil or butter, check it out on the net.

Will do. Stevens Johnson... oooh, bad stuff. I didn't realize it left one more susceptible to irritation afterwards though. It was miserable tho, huh? You poor dear.

The doc here tried to blame my skin funk on my Lamictal, which carries the rish of SJS with it, and change my meds without culturing. Boy am I glad I fought that one!

You've been greatly helpful, thanks for being so nice. I wasn't going to post on here at first, because it seemed like a lot of the senior members were kinda rough around the edges. But then again, there's probably a lot of frivilous questions/cases posted often here. May I ask what brings you to this site?

 

[rmet4nzkx]

Will do. Stevens Johnson... oooh, bad stuff. I didn't realize it left one more susceptible to irritation afterwards though. It was miserable tho, huh? You poor dear.

The doc here tried to blame my skin funk on my Lamictal, which carries the rish of SJS with it, and change my meds without culturing. Boy am I glad I fought that one!

You've been greatly helpful, thanks for being so nice. I wasn't going to post on here at first, because it seemed like a lot of the senior members were kinda rough around the edges. But then again, there's probably a lot of frivilous questions/cases posted often here. May I ask what brings you to this site?

Why are you taking Lamictal, seizures or off lable use?
You keep talking culture, have you had a biopsy?

We should take this off line, go to the profile option and enable PM feature and send me a PM.

The fact that you had the reaction to the sulfa related ointment and take Lamictal opens up a can of worms making your long and frustrating journey more understandable. It is most appropriate to D/C Lamictal at the first sign of rash according to the warnings from the FDA and on the box, while you may have some form of staph infection you may simply be hypersensitive and more suseptible to the normal exposure in the environment. Here is the warning.
......
treated with LAMICTAL® develop a potentially life-threatening rash, as compared with a rate of approximately one in every thousand adults.

These revisions to the labeling, agreed in consultation with the US Food and Drug Administration, reflect additional information obtained through worldwide clinical experience in an estimated 600,000 patients and the ongoing Glaxo Wellcome clinical development program for LAMICTAL®.

Other related changes have been made in the INDICATIONS, WARNINGS, PRECAUTIONS, ADVERSE EVENTS, and DOSAGE and ADMINISTRATION sections of the labeling. A full copy of the revised package insert is attached (PDF file); the major changes are summarized below:

A boxed warning has been added, as follows:


SEVERE, POTENTIALLY LIFE-THREATENING RASHES HAVE BEEN REPORTED IN ASSOCIATION WITH THE USE OF LAMICTAL®. THESE REPORTS, OCCURRING IN APPROXIMATELY ONE IN EVERY THOUSAND ADULTS, HAVE INCLUDED STEVENS-JOHNSON SYNDROME (SJS), AND RARELY, TOXIC EPIDERMAL NECROLYSIS (TEN). RARE DEATHS HAVE BEEN REPORTED, BUT THEIR NUMBERS ARE TOO FEW TO PERMIT A PRECISE ESTIMATE OF THE RATE.

THE INCIDENCE OF SEVERE, POTENTIALLY LIFE-THREATENING RASH IN PEDIATRIC PATIENTS, HOWEVER, IS VERY MUCH HIGHER THAN THAT REPORTED IN ADULTS USING LAMICTAL®; SPECIFICALLY, REPORTS FROM CLINICAL TRIALS SUGGEST AS MANY AS 1 IN 50 TO 1 IN 100 PEDIATRIC PATIENTS DEVELOP A POTENTIALLY LIFE-THREATENING RASH. IT BEARS EMPHASIS, ACCORDINGLY, THAT LAMICTAL® IS NOT APPROVED FOR USE IN PATIENTS BELOW THE AGE OF 16 (SEE INDICATIONS).

OTHER THAN AGE, THERE ARE AS YET NO FACTORS IDENTIFIED THAT ARE KNOWN TO PREDICT THE RISK OF OCCURRENCE OR THE SEVERITY OF RASH ASSOCIATED WITH LAMICTAL® . THERE ARE SUGGESTIONS, YET TO BE PROVEN, THAT THE RISK OF RASH MAY ALSO BE INCREASED BY 1) COADMINISTRATION OF LAMICTAL® WITH VALPROIC ACID (VPA); 2) EXCEEDING THE RECOMMENDED INITIAL DOSE OF LAMICTAL®; OR 3) EXCEEDING THE RECOMMENDED DOSE ESCALATION FOR LAMICTAL®. HOWEVER, CASES HAVE BEEN REPORTED IN THE ABSENCE OF THESE FACTORS.

NEARLY ALL CASES OF LIFE-THREATENING RASHES ASSOCIATED WITH LAMICTAL® HAVE OCCURRED WITHIN 2 TO 8 WEEKS OF TREATMENT INITIATION. HOWEVER, ISOLATED CASES HAVE BEEN REPORTED AFTER PROLONGED TREATMENT (E.G., 6 MONTHS). ACCORDINGLY, DURATION OF THERAPY CANNOT BE RELIED UPON AS A MEANS TO PREDICT THE POTENTIAL RISK HERALDED BY THE FIRST APPEARANCE OF A RASH.

ALTHOUGH BENIGN RASHES ALSO OCCUR WITH LAMICTAL®, IT IS NOT POSSIBLE TO PREDICT RELIABLY WHICH RASHES WILL PROVE TO BE LIFE-THREATENING. ACCORDINGLY, LAMICTAL® SHOULD BE DISCONTINUED AT THE FIRST SIGN OF RASH, UNLESS THE RASH IS CLEARLY NOT DRUG-RELATED. DISCONTINUATION OF TREATMENT MAY NOT PREVENT A RASH FROM BECOMING LIFE-THREATENING OR PERMANENTLY DISABLING OR DISFIGURING.

The WARNINGS section has been revised to include the following information regarding hypersensitivity reactions:

"Hypersensitivity reactions: Hypersensitivity reactions, some fatal or life-threatening, have also occurred. Some of these reactions have included clinical features of multiorgan dysfunction such as hepatic abnormalities and evidence of disseminated intravascular coagulation. It is important to note that early manifestations of hypersensitivity (e.g., fever, lymphadenopathy) may be present even though a rash is not evident. If such signs or symptoms are present, the patient should be evaluated immediately. LAMICTAL® should be discontinued if an alternative etiology for the signs or symptoms cannot be established.

Prior to initiation of treatment with LAMICTAL®, the patient should be instructed that a rash or other signs or symptoms of hypersensitivity (e.g., fever, lymphadenopathy) may herald a serious medical event and that the patient should report any such occurrence to a physician immediately."

The medical community can further our understanding of LAMICTAL® by reporting adverse events to the Glaxo Wellcome Product Surveillance Department at 1-800-334-4153 or to the FDA MEDWATCH program by phone 1-800-FDA-1088, by FAX at 1-800-FDA-0178, by modem 1-800-FDA-7737, or by mail:

MEDWATCH HF-2
FDA
5600 Fishers Lane
Rockville, MD 20857

Glaxo Wellcome is committed to helping you treat your epilepsy patients, and encourages you to familiarize yourself with these changes to the package insert so that the proper use of LAMICTAL® may be facilitated through your clinical care and treatment of patients. If you have any questions about the new information in the package insert for LAMICTAL® Tablets, please contact the Drug Information Department at Glaxo Wellcome (1-800-334-0089).

Sincerely,

Richard S. Kent, MD
Vice President and Chief Medical Officer
Glaxo Wellcome Inc.
Five Moore Drive Telephone
PO Box 13398 919 483 2100
Research Triangle Park
North Carolina 27709

 

[troubleddaughte]

Shocked

I am from Virginia.

I was shocked to read the post with regard to the LPN and MRSA. My mother died last week under hospice care and we were told by several doctors we went to for screening that MRSA was not a big deal. Some of us, family members, were refused screening for MRSA.

Did not know it could be that serious.

 

[kjcclpn]

just my opinion..

I am from Virginia.

I was shocked to read the post with regard to the LPN and MRSA. My mother died last week under hospice care and we were told by several doctors we went to for screening that MRSA was not a big deal. Some of us, family members, were refused screening for MRSA.

Did not know it could be that serious.

MRSA is only serious when the wrong person gets it. It's a strain of staph bacteria that is medication resistant, specifically to medications in the group with Methicillin. Many people come into contact with MRSA and sets up colonization on their skin, but never becomes an active infections.... basically these people are carriers. Usually only when the bacteria has a way into the body does it become active. IV's, urinary catheters, wounds.... these are the kinds of things that give the bacteria the direct route into the body so that it can start to set up camp.

Even in this case, a healthy person can fight the infection off with the help of other antibiotics... usually Vancomycin. It's when a healthy person that's colonized with MRSA comes into contact with someone who is ill or has a weakened immune system, that true problems begin. Those with weakened immunity have a difficult time of fighting off the infection. It might get under the skin, to cause boils (my case). It could infect the lungs to cause pneumonia. Sometimes, it might spread throughout the body to become a systemic infection within the blood, which is extremely hard to treat. In such people who aren't immediately treated with the right medication it could potentially be fatal.

Children, the elderly, post-surgical patients, people with immune disorders, and people on chemo are the most suceptible. This decsriptions just about covers all of my clincal patients, hence my concern. I had it, was made to work with it, without treatment. Once I got treatment, I thought I was all clear and now it seems to be acting up again. Which means that I'm probably a carrier, but also that I'm one who is suceptible to active infection from it. (Not a good combo.) So you see, it's terrible for me to have. I could potentially transmit it to my patients.

But what does this mean for you. MRSA is not serious unless the wrong peolpe get it, but are you in contact with those people? Do you have any family in the healthcare field? Does anyone in your family work in the food industry? Are there little children at home? Does anyone take care of other elderly members of the family?

Should you be a carrier of MRSA without active infection, you more than likely won't be treated for it anyway. To treat it while inactive increases the chance of the bacteria building up resistance to the only drugs we have that work on it right now. However, it would be nice to know if you have it or not, so that you might avoid transmitting it to the prone people mentioned in the above paragraph. If less of them get it, less need for antibiotics, less cases of the new strains (VISA-vancomycin intermediate-resistant staph aureus, and VRSA-vancomycin resistant staph aureus). These strains we are inventing new antibiotics to treat.

There's lots of info on the web about it. The CDC has an info page, if you'd like to look it up. Oh, and the only suggestion I can make is that should you come down with any type of infection (respiratory, skin... whatever), demand a culture. State that you were exposed to MRSA. Make the doctor find what microorganism is causing the infection and what medication will work against it, so that we have fewer superbugs like MRSA running around. Just ask for a Culture & Sensitivity (C&S), it's a routine procedure that just isn't done often enough.

 

[Heather2]

The doc here tried to blame my skin funk on my Lamictal, which carries the rish of SJS with it...

I'm just nosey, are you bipolar?