Levels of Healthcare: Homecare to ICU

Levels of Healthcare: Homecare to ICU

by | Jun 13, 2025 | Uncategorized

Many people appear truly confused about the various levels of healthcare available to people when they get sick. This blog will help end some of that confusion.

Diagnosis

Providers
There are several options for diagnosing medical problems. The best approach is to have a long-term relationship with a healthcare provider, whether it be a physician, a nurse practitioner or a physician’s assistant. Doctors are the most experienced having gone to medical school for 3 years then several more years of residency within their area of expertise.

Nurses spend 4 years in nursing school and then another 3 years learning how to diagnose and treat common problems. Physician assistants graduate from college from a variety of backgrounds and then spend 2 to 3 years of medical training.

Facilities
Clinics are also another option for care. You may or may not see a different healthcare provider for each visit and are generally more economical.

 Urgent Care centers are satellite emergency rooms that can handle most common, easy to treat problems and are generally cheaper. Hospital Emergency (ER) rooms provide more comprehensive and challenging care. Some ER’s are trauma centers with staff available for very serious acute conditions.

 For rare and unusual medical problems, it’s wise to seek care in a specialty center generally found within larger urban areas. They have physicians who’ve spent a vast number of years dealing with unique, uncommon health concerns.

Treatment
Day Surgery
Many day surgery centers are popping up throughout the US. They typically handle relatively healthy people who need a surgical procedure and is not expected to have serious complications. The operation and discharge usually occur on the same day. It’s much more economical in many cases than a major hospital operating center. However, a hospital is the best place for a major operation needing additional backup or someone who may have serious complications or possible delayed recovery.

Recovery Room 
Whether in a Day Center or Hospital patients will need to recover from the anesthesia while being monitored following surgery. Once awake and stable they’re moved to a holding area in the Day Surgery facility or a surgical floor in the hospital.

 Acute Care
Regular Floor\
When you think of being hospitalized most have visited someone on what’s known as the regular floor. Stable patients who still need registered nurse monitoring and care are admitted until ready for discharge home. The patient may stay overnight or for a few days depending on their procedure and health status.

 Telemetry Unit
This unit is needed when someone has a heart issue or irregular rhythm problem, and needs monitored while recovering. They are generally otherwise stable patients.

Step-Down Unit
Patients discharged from a critical care unit are often sent to the Step-Down unit where there are fewer patients for each registered nurse. These patients are generally monitored for heart irregularities and respiratory complications. They require greater care than the telemetry floor nurses could provide.

 Critical Care (ICU/CCU)
Registered nurses in critical care units generally have 1 or 2 patients who may be very unstable. Some surgical patients following complicated operations may be sent to ICU for monitoring for dangerous complications in the immediate post-op period.

Chronic Care
Long In-house Hospital Care
Some hospitals have a unit for patients with longer term care needs but are not stable enough to be discharged to another center. They work much like a rehabilitation center but with more closely monitoring and nursing care.

 Rehabilitation Care Centers
These centers provide a few weeks or months of nursing care while someone recovers from a medical problem.

Assisted Living Care
Another name for a nursing home is often assisted living. A registered nurse or a technician is available for medication dispensary and nursing support. The patient isn’t able to care for themself at home. All meals are provided, and staff can help with bathing, etc. Some individuals don’t require heavier medical care but need the assistance with meals and medication support.

Independent Living Care
These facilities offer meals while the individual lives in more of an apartment environment. Medication support can be arranged. Rides for activities and social events are available since most people are unable to drive.

In-Home Healthcare Options
Most people would rather remain in their home for as long as possible. Visiting or home healthcare nurses make home visits to assess patients, change dressings, draw blood or even give IV medications. Most insurance covers their time for a while. Physical therapists also make home visits to provide physical therapy. Private companies may supply nursing aide staff for basic care, housekeeping and simple errands.

Palliative Care
Most people are unaware of the palliative care program provided through hospice. When one is suffering from chronic pain nearing the end-of-life palliative nurses can be extremely helpful. They evaluate all medications and work with a doctor to prescribe overall care that improves the quality of life.

My frail mother suffered from anxiety attacks and explosive diarrhea related to her dementia a year before she died. Sometimes she refused to take any medications to help unless a family member was present. The palliative nurse ordered a cream to reduce her anxiety and a Kefir drink for the diarrhea which greatly improved her life.

Hospice
For someone in the last chapter of their life, the hospice team provides excellent care to ease the suffering. The nurses are also highly trained to assist families in the grieving process as well.

On A Personal Note:
The healthcare system in the United States is certainly complicated but there are a few things you can do to simplify your situation. First, the biggest mistake people make is not getting a second opinion when solutions to a problem aren’t getting resolved. Healthcare providers are human. The really good ones that I know are not threatened by another opinion. They welcome it! They want answers to your problem as well.

Secondly, keep escalating the healthcare providers until you get resolution. Reach out to the larger medical centers where they are experienced at dealing with what I call the weird and the rare.

My mother-in-law had miserable abdominal hives for 6 months. None of the specialists within her city could find a cause despite innumerable tests. It was definitely a weird and rare phenomenon. We took her to the Mayo Clinic in Rochester, Minnesota. In one day, she saw a dermatologist for the rash, a hematologist for the dangerously high platelets and a neurologist for her dementia. The high platelets were causing the rash. A new medication reduced them, and the rash disappeared. Her brain scan showed extensive damage and the cause of her frequent accidents. He gave her the news about no further driving.

Finally, while we all want to have our surgery the closest to home as possible, sometimes that makes life more complicated. Smaller hospitals and day surgery centers are staffed for common procedures and problems. But if you are one of those weird and rare situations you may be better off doing more homework and getting your procedure done at a major medical center where they have more experienced staff to care for your strange problem.

May God bless you with wisdom on finding excellent providers to care for you and yours…

If anyone of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him (James 1:5)

    I’m a Christian nurse who helps people navigate the murky waters of healthcare.

    Author of Wake UP Call 911: It’s Time to Reduce your Risk for A Heart Attack and Stroke (2015) and Helping the Hurting: Nursing Ministry in the Body of Christ (2022).

    You may visit my website for additional information: jenniejohnsonrn.com

    All rights reserved 2025, Jennie E. Johnson, RN-BC, PhD

    Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.

    Cholesterol, Saturated Fats & Statins

    Cholesterol, Saturated Fats & Statins

    by | Apr 11, 2025 | Healthy Living

    Recently there has been a great deal of controversy over saturated fat intake, elevated LDL cholesterol and the statin drugs to treat high levels. Does a fatty diet or high LDL cholesterol increase one’s risk for a heart attack and stroke? Should an individual take a statin to lower cholesterol? What are the risks and benefits?

    How Does Atherosclerosis (Plaque) Develop?
    When born the arteries throughout the body are smooth like the inside of the cheek. Years of risk factors begin to take a toll and damage the interior lining. High blood pressure roughens up the lining much like sandpaper. Elevated glucose or sugar scratches the lining as it travels by.

    Inflammation occurs when the body recognizes the damage and sends an army of white blood cells to heal it. The area becomes red and swollen much like any other wound. LDL cholesterol traveling through the blood becomes trapped within the damaged area, worsening the problem.

    It’s well known that if you lower the amount of LDL traveling in the blood, less will become trapped within the damaged area. Healing occurs as a fibrous cap covers the area preventing a rupture that could cause a heart attack.

    Understanding Cholesterol
    Total cholesterol is made up of HDL or healthy cholesterol, LDL lousy cholesterol and VLDL very lousy cholesterol. It’s called lousy because it can get trapped in damaged arterial walls. The HDL helps the body eliminate the LDL. The VLDL cholesterol changes and is a harder predictor and generally not discussed by healthcare providers. Cholesterol is needed in hormone production.

    Early studies looked at the total cholesterol number to predict outcomes and treatments. However, since the total number is made up of healthy and unhealthy cholesterol it was discarded. Today the focus is on the level of LDL cholesterol for treatment goals.

    Multiple studies have shown that lowering LDL cholesterol reduces one’s risk for a heart attack and stroke when abnormal risk factors or insulin resistance is present. Even those opposed to statin treatment agree on this truth. However, criticism has continued regarding potential bias of the research when most funding may have come from the drug companies manufacturing the drug.

    Insulin Resistance or Metabolic Syndrome
    When an individual ingests food, it’s converted to glucose. The pancreas secretes insulin to use the glucose for energy. Sedentary, obese people will not be able to burn off the excess glucose which will be converted to stored fat. Over time the pancreas literally wears out, excess glucose remains in the blood scratching artery linings, and one may become a diabetic. Early warning signs are Insulin Resistance or the Metabolic Syndrome.

    If an individual has 3 of the 5 signs, they are considered insulin resistant:

    1. Obesity or waist measurement over 35 inches for a woman and 40 inches for a man.
    2. Elevated fasting glucose >100
    3. High blood pressure >130/85
    4. Fasting triglycerides >150
    5. Low HDL <50 for a woman and <40 for a man

    Saturated Fats
    Since the 1980’s food manufactures have increased portion sizes. Today one restaurant entre is enough food to feed 3 people. Restaurateurs have shared that it costs about the same to make the larger portions but can be sold at a much higher profit.

    Americans have lost the ability to judge an appropriate portion size. Almost everything has been super-sized along with American waistlines and a host of diseases. The trend continues to escalate with 81% of adults either 30% overweight, 42% obese or 9% severely obese.

    Of children (2 to 19 years old) 41% are either 16% overweight, 19% obese or 6% severely obese.

    Keto diets high in protein and saturated fats decrease appetite for weight loss but it is unknown what the impact will be on long term health. However, a new study by Dr. Matthew Budoff raised some interesting questions.

    Budoff’s team examined 80 healthy adults matched by age, gender, race, normal blood pressure and nonsmoker. The average age was 55 and were followed for 4.7 years. Coronary artery calcium scores tests (previously discussed in February 2025 blog) and CT angiography were done to ascertain atherosclerosis buildup.

    Comparisons were made between one group with an average LDL of 272 mg/dL on a Keto diet (high in saturated fats) while the other Miami Heart group’s average LDL was 123 mg/dL. Astonishingly, no significant difference was found between the 2 groups regarding the amount of plaque buildup.

    Budoff’s team postulated that those eating an extremely high amount of saturated fats perhaps had larger more buoyant LDL cholesterol that simply were too big to get stuck even with such high LDL levels. The other group may have had smaller denser LDL that even with lower levels may have become lodged more easily. The size of the LDL particles was not measured. They cautioned that more research is needed since this was a small sample size.

    Statins
    Statins were introduced in the 1990’s. They work by blocking an enzyme the liver needs to make LDL cholesterol. The risks and benefits of any treatment should be ascertained. Rhabdomyolysis is a rare complication that causes severe pain, liver damage, kidney failure and death. More common side effects may include annoying muscle pain (5% of adults), digestive problems, elevated glucose, mental fuzziness, etc. Statins may interact with some common medications. However, most people tolerate them very well.

    How are Cholesterol, Saturated Fats and Statins Connected?
    Dr. Paul Saladino is a prominent outspoken critic of statin therapy to lower LDL cholesterol. He advocates for a diet very high in saturated fats, minimal fruits and vegetables and several hours of daily physical activity. Most would find this lifestyle difficult to maintain.

    He argues that 86% to 90% of Americans have some form of insulin resistance which is the primary cause of heart disease or plaque build-up. LDL cholesterol may get stuck in the damaged areas, but it’s not the villain. He argues that if one does not have insulin resistance high levels of LDL cholesterol are not a health risk. However, he does indicate when statins are helpful:

    If you’re insulin resistant and we lower your LDL cholesterol, your risk for heart disease is unequivocally lower. However, we didn’t treat the real cause which is insulin resistance or a metabolic disorder.  

    On A Personal Note:
    Interestingly I met Dr. Budoff when he visited our heart institute in Chicago. He’s a pioneer and leader in the calcium score technology to detect hidden plaque that cause heart attacks and I have great respect for him. I found his study and Dr. Saladino’s comments fascinating.

    The question remains, if you have an LDL cholesterol over 100 mg/dL what should you do? Should you take statins that your doctor is recommending? I highly recommend a non-contrast coronary artery calcium score test to be your tie breaker. It’s a simple test. If you don’t have any buildup, then you have time to work on your healthier lifestyle and keep an eye on it. However, if you have buildup, you probably need a statin to prevent circulating LDL cholesterol from getting lodged into those damaged areas.

    Recently, a young 45-year-old man I know died from a sudden heart attack. He ignored his abnormal glucose levels, obesity and high cholesterol. If he had obtained a coronary artery calcium score test the dangerous plaque buildup would have been identified and treated.

    Don’t ignore your numbers either and remember the more you do with your healthier lifestyle…the less medication you’ll need to correct problems.

    God bless you as you move toward a heart healthy life.

    Whether you eat or drink or whatever you do…

    do it all for the glory of God (1 Corinthians 10:31).

    References:

    1. Wang et al. “Compounding Benefits of Cholesterol Lowering Therapy for the Reduction of Major Cardiovascular Events: Systematic Review & Meta-analysis,” Circulation Cardiovascular Quality Outcomes (June 6, 2022). https://pubmed.ncbi.nlm.nih.gov/35430872/

    “Metabolic Syndrome,” Cleveland Clinic (September 9, 2023). https://my.clevelandclinic.org/health/diseases/10783-metabolic-syndrome

    “Overweight & Obesity Statistics,” National Institute of Diabetes, Digestive & Kidney Disease (September 2021). https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity

    Budoff et al., “Carbohydrate Restriction-Induced Elevations in LDL Cholesterol & Atherosclerosis,” Journal of the American College of Cardiology, (August 28, 2024). https://pmc.ncbi.nlm.nih.gov/articles/PMC11450898/

    1. Johnson, “Heart Attack: Test to Determine Hidden Plaque Buildup,” A Nurse’s Voice (February 1, 2025.) https://anursesvoice.substack.com/publish/posts/detail/156138911?referrer=%2Fpublish%2Fposts

    “Statins Side Effects: Weigh the Benefits & Risks,” Mayo Clinic (March 11,2025). https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013

    “Paul Saladino MD: The FDA Approved Poison You Eat Every Day” (SRS #179), The Shawn Ryan Show (March 5, 2025), https://www.youtube.com/results?search_query=paul+saladino+md+podcast .

    I’m a Christian nurse who helps people navigate the murky waters of healthcare.

    Author of Wake UP Call 911: It’s Time to Reduce your Risk for A Heart Attack and Stroke (2015) and Helping the Hurting: Nursing Ministry in the Body of Christ (2022).

    You may visit my website for additional information: jenniejohnsonrn.com

    All rights reserved 2025, Jennie E. Johnson, RN-BC, PhD

    Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.

    Ivermectin: Potential Role in the Fight against Cancer

    Ivermectin: Potential Role in the Fight against Cancer

    by | Mar 13, 2025 | Uncategorized

    The purpose of this blog is to present information on topics that are under-reported in the news using an evidenced-based, scientific, approach to the content. Potential beneficial cutting edge but controversial information is a challenge to share. However, the reader can decide whether it is helpful or not.

    The Controversy Over Ivermectin
    When the COVID-19 pandemic broke out the rush was on to ascertain if there were any medications that had FDA approval and could help reduce the severity of the illness. A great deal of research had emerged that Ivermectin had anti-viral properties and could be helpful. Many doctors on the front lines treating patients were anxious to prescribe it but encountered multiple roadblocks. Some pharmacists refused to fill their prescriptions. Americans were told it was a horse dewormer not fit for human consumption. The truth was ambiguous and Ivermectin became a political football.

    Repurposed Drugs
    Repurposed drugs are developed and approved by the FDA for one use but later found to be helpful in other conditions. Aspirin is a great example which was first prescribed to reduce fever. Years later it was found to be an effective blood thinner by reducing platelets from forming blood clots during a heart attack or clotting stroke. In some people it can lead to bleeding which is why if it came on the market today it would probably be a prescription.

    Sublingual nitroglycerin was first prescribed to treat angina or chest pain from narrowed arteries around the heart. Later it was learned it could also treat male impotence. Scientists are beginning to explore the repurposed benefits of Ivermectin to enhance immunity.

    The Benefits of Ivermectin
    Ivermectin was developed by Japanese researchers Satoshi Omura and Irish Researcher William C. Campbell, released by Merck and approved by the FDA in 1978 as an antiparasitic drug. Millions of people around the world have been safely treated for parasitic diseases such as river blindness, elephantiasis and scabies. The researchers were awarded the Nobel Prize in Physiology and Medicine for their discovery in 2015.

    In addition to the antiviral and antiparasitic benefits of Ivermectin recently some oncologists are beginning to use it as an anti-cancer therapy in conjunction with traditional chemotherapy and radiation treatments. Ivermectin inhibits cancerous cell growth and enhances immunity to destroy cancerous cells. It’s been shown to be beneficial in breast, GI, urinary, blood, brain, respiratory and melanoma cancers. Currently, it is considered promising emerging research, but large randomized controlled trials are needed to verify effectiveness over time.

    Side Effects
    Ivermectin has been tolerated very well with minimal side effects by people of all ages around the world. Although rare dizziness, visual disturbances, joint pain, fever, swollen lymph glands and allergic reactions may occur.

    Questions Remain
    If it has such wonderful benefits, one wonders why there has been such resistance to prescribing it for other nonparasitic purposes? Interestingly, Ivermectin lost its patent in the 1990’s. It could now be made in a generic form significantly less expensive than its brand name patented drug.

    Secondly, in order to get FDA approval for a new drug it’s tested in lab petri dishes, then in animals usually mice and then in people. Large randomized controlled clinical drug trials in people are needed to monitor for safety, effectiveness and potential side effects before FDA approval is granted. These are very expensive! There may be less motivation to run large clinical trials in cheaper generic repurposed drugs.

    Most healthcare providers follow their national guidelines when making decisions to prescribe a medication. Without FDA approval it’s unlikely the repurposed drug will be included in those guidelines. Ivermectin needs large clinical trials using it as an antiviral or anticancer treatment in order to gain FDA approval.

    Finally, compounding the problem is that some of the FDA members may have relationships with the very pharmaceutical companies whose drugs they are tasked to approve.

    On A Personal Note:
    In the summer of 2020, the Israelis released an important study that was overlooked by most media outlets. They examined 1,400 patients who had a COVID-19 blood test from February to April in 2020 and also had a Vitamin D level result in their chart. If the Vitamin D level was above 30 ng/ml only 10 % tested positive for COVID-19. However, if it was lower than 30 ng/ml 90% tested positive. Those who tested positive with low levels of Vitamin D and were over 50 years old were more likely to be hospitalized with COVID-19.

    This study should have immediately led to other research to confirm the validity of their findings. Governments around the world could have checked everyone’s Vitamin D blood level and encouraged healthcare providers to treat low levels to boost natural immunity. Vitamin D supplements are cheap!

    Science is ever changing. It’s still unclear exactly the mechanism of how Ivermectin and Vitamin D enhance immunity. Certainly, more research is needed but what is available is encouraging. The National Institute of Health (NIH) needs to fund more research of repurposed drugs.

    For now…do your own research. Boost your Vitamin D and get it tested to ensure the level is appropriate for you. The boost to your immunity will help whether you’re fighting a cold or cancer. Speak with your healthcare provider as some people must be careful when increasing Vitamin D. Keep your eyes and ears open for new information on Ivermectin. I’ve been following Dr. John Campbell Today and found his podcast information is evidenced-based, cutting edge and extremely helpful!

    God bless you all as you deal with your own health issues. May they be small ones.

    Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand (Isaiah 41:10).

    Reference:

    1. Tang et al. “Ivermectin, A Potential Anticancer Drug Derived from an Antiparasitic Drug,” Pharmacological Research (September 21, 2020). https://pmc.ncbi.nlm.nih.gov/articles/PMC7505114/pdf/main.pdf

    “Ivermectin Systemic Adult Medication,” Memorial Sloan Kettering Cancer Center (January 1, 2022). https://www.mskcc.org/cancer-care/patient-education/medications/adult/ivermectin-systemic

    1. Lupkin, “A Look at How the Revolving Door Spins from the FDA to Industry,” Shots Health News from NPR (September 28, 206). https://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry

    Merzon, et al., “Low Plasma 25(OH) Vitamin D Level Is Associated with Increased Risk of COVID-19 Infection: An Israeli Population Based Study,” The FEBS Journal, July 23, 2020. https://doi.org/10.1111/febs.15495

    Dr. John Campbell Today Podcast, https://www.youtube.com/channel/UCF9IOB2TExg3QIBupFtBDxg

     

    I’m a Christian nurse who helps people navigate the murky waters of healthcare.

    Beloved, I pray that all will go well with you and that you may be in good health,

    Author of Wake UP Call 911: It’s Time to Reduce your Risk for A Heart Attack and Stroke (2015) and Helping the Hurting: Nursing Ministry in the Body of Christ (2022).

    You may visit my website for additional information: jenniejohnsonrn.com

    All rights reserved 2025, Jennie E. Johnson, RN-BC, PhD

    Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.

    Heart Attack Risk: Test to Determine Hidden Plaque Buildup

    Heart Attack Risk: Test to Determine Hidden Plaque Buildup

    by | Feb 5, 2025 | Healthy Living

    February is Heart Month, a time to consider one’s risk for a heart attack. The Non-contrast Coronary Artery Calcium (CAC) Score Screening test accurately detects subclinical (silent) buildup months or years before the heart attack may occur. However, few healthcare providers prescribe it for high-risk patients. Most people are completely unaware of this life saving technology.

    Are You at Risk?
    The major risk factors for a heart attack are:

    1. Men over 45, women over 55
    2. History of a heart attack in a mother before the age of 55 and a father before 45
    3. Smoking
    4. High blood pressure
    5. High blood glucose
    6. Elevated LDL cholesterol
    7. Excess weight
    8. Unhealthy diet
    9. Inactivity
    10. Stress
    11. Excess alcohol
    12. Inadequate sleep
      It’s often been said that genetics loads the gun, but lifestyle pulls the trigger. However, living a heart healthy lifestyle is a challenge for most of us. If your blood pressure, glucose or LDL cholesterol remains too high it’s time to consider medications to protect your heart, brain and kidneys from damage.

      The calcium score test is the tie breaker. If the number is 0 or low, it will buy you some time. However, if it is higher, it’s time to get more aggressive to prevent further buildup.

    How Do Blockages Develop?
    Blockages develop from a variety of factors. High blood pressure causes a sandpaper effect to occur on the inside lining of the arteries. Higher blood glucose scratches the lining as it moves through the blood. The body recognizes the danger and launches an assault to repair the damage. Those areas become red and swollen and white blood cells move in to heal it. LDL cholesterol traveling through the blood becomes lodged in the damaged areas.

    With any inflammation that has gone on long enough (TB, cancer or coronary artery disease) calcium deposits are left behind to wall off the area. Plaque buildup is just another name for this inflammatory process. The calcium deposits are measured on this test and provide a window into how much damage may be occurring.

     

    Non-contrast Coronary Artery Calcium (CAC) Score Screening Test
    This test became available 30 years ago. During one breath hold, approximately 40 images are taken of the 4 main coronary arteries that surround the heart. The radiation dose in a non-contrast CAC screening scan is about equal to a mammogram. The accuracy of the CAC score test is a strong predictor of future events.

    What Do the Results Mean?

    0 CAC Score                          Encourage a healthy lifestyle, consider a statin if LDL cholesterol >190 mg/dL, repeat in 3 to 5 years depending on risk factors.

    1 to 99 CAC Score                 Healthy lifestyle, treat LDL cholesterol to <100 mg/dL and treat high blood pressure and other risk factors.

    100 to 299 CAC Score           All above + treat LDL cholesterol to <70 mg/dL and consider low dose aspirin (some people are at risk for bleeding- always check with your doctor before taking).

    300 to 999 CAC Score           All above + treat LDL to < 55 mg/dL and use low dose aspirin in people who can tolerate it.

    Over 1,000 CAC Score         All above + consider other tests and treatment options.

    It indicates the level of plaque buildup (none, small, moderate or large amount). It doesn’t mean there is a blockage but the higher the number the greater the buildup and the bigger the problem.

    However, remember the best stress test may only detect a blockage > 70%. Heart attacks may occur in much smaller blockages. If someone has a normal stress test and several risk factors, it’s a good idea to get a CAC score to rule out potential buildup unseen by the stress test.

    Who Should Get a Calcium Score Test?

    —Men 55 to 80 years old, women 60 to 80 years old.

    —People 40 to 55 years old with multiple risk factors.

    —People with abnormal cholesterol levels concerned about taking a statin.

    Who Should Not Get a Calcium Score Test
    If you’ve already had a heart attack or stroke you have plaque buildup and should be treated aggressively. The score will not add any value.

    Where Can I Get the Test?
    Most radiology centers provide this screening. It may be covered by insurance or Medicare if you have a strong secondary plan. The cost out-of-pocket is around $200. Some states require a healthcare provider’s order while others do not. The test is ordered as Non-contrast Coronary Artery Calcium Score Screening or simply Cardiac Calcium Score. The screening non-contrast test has a much lower dose of radiation exposure than the contrast test.

    On A Personal Note:
    I counseled nearly 1,000 people in Chicago after they had this test. We measured their blood pressure, cholesterol and glucose, asked them about their lifestyle habits and provided information on their findings. We found many people who were living normal lives completely unaware of the silent danger building up in their arteries.

    In the early 2000’s minimal research existed on what happens when you give people that information. I enrolled nearly 200 high risk people and measured how the results changed their lives.

    Whether they were CEO’s of major Fortune 500 companies, farmers or housewives they had similar questions. I found that the higher the CAC score motivation to take prescribed medications and make healthier choices was enhanced. 

    Frankly, I’m frustrated that physicians in my area are not ordering this test for at risk people. It’s quick, easy and painless and provides incredible information. The guidelines recommend it in high-risk individuals.  

    If you’re at risk…speak with your healthcare provider today. Provide a hard copy of this article. If you’re in a state that doesn’t require an order…call and get more information. I’d love to hear your experiences in the comments below and answer any questions.

    Finally, my book Wake Up Call 911: It’s Time to Reduce your Risk for a Heart Attack and Stroke is available through my website for $10 (jenniejohnsonrn.com), email (ask@jenniejohnsonrn.com), Amazon or Ebay. It includes the information that I gave my patients: the simple steps to change your life.

    The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown(science fiction writer, H. P. Lovecraft).

    Reference:

    Lifestyle Changes to Prevent a Heart Attack, American heart Association (January 2, 2025). https://www.heart.org/en/health-topics/heart-attack/life-after-a-heart-attack/lifestyle-changes-for-heart-attack-prevention

    1. J. Maron et al. “Coronary Artery Calcium Staging to Guide Preventive Interventions: A Proposal & Call to Action,” JACC Advances (November 11, 2024). https://www.jacc.org/doi/10.1016/j.jacadv.2024.101287

    Cardiac Stress Testing: What It Can & Cancot Tell You, Harvard Health Publsihing, Harvard Medical School (April 15, 2020). https://www.health.harvard.edu/newsletter_article/cardiac-exercise-stress-testing-what-it-can-and-cannot-tell-you

    1. E. Johnson et al. “Does Knowledge of Coronary Artery Calcium Affect Cardiovascular Risk Perception, Likelihood of Taking Action, and Health-Promoting Behavior Change?” Journal of Cardiovascular Nursing (2015). https://pubmed.ncbi.nlm.nih.gov/24434820/

      I’m a Christian nurse who helps people navigate through the murky waters of healthcare.

    Beloved, I pray that all will go well with you and that you may be in good health,

    Author of Wake UP Call 911: It’s Time to Reduce your Risk for A Heart Attack and Stroke (2015) and Helping the Hurting: Nursing Ministry in the Body of Christ (2022).

    You may visit my website for additional information: jenniejohnsonrn.com

    All rights reserved 2025, Jennie E. Johnson, RN-BC, PhD

    Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.

    Lessons Shared from Knee Replacement Surgery: What You Should Know

    Lessons Shared from Knee Replacement Surgery: What You Should Know

    by | Jan 15, 2025 | Healthy Living

    Recently, my husband and I had total knee replacement surgeries… his left and my right. Even though I have a PhD in nursing I was stunned how much I didn’t know about it and wanted to share our lessons with you. Aging causes arthritis to develop, destroying the joint cartilage that separates bones. Pain follows and one wonders if surgical repair is needed? What’s involved? How long before I’m back to normal? What are the complications? What can I do to have a positive outcome?

    When Is Surgery Needed?
    At first the damage is barely noticeable. It’s annoying but overtime the pain worsens. It’s a good time to see an orthopedic physician to learn strategies to protect the knee to delay surgery. Various injections ease the pain for a very short time, but it returns when the drug wears off. Physical Therapy helps to strengthen the muscles around the damaged joint to reduce pain and discomfort. Braces are also recommended to support and strengthen the injured knee. Ultimately a knee replacement operation may be required. When the pain begins to interfere with sleeping or normal daily activities, it’s a good time seek options.

    10 Point Questionnaire
    Our surgeon Dr. Joseph Bowen developed the Measuring Impact of Diagnosis 1 to 10 scale to help determine if we were ready for surgery. The lower number 1 meant – Nothing will keep you from the activity while 10 meant –  The pain is so bad that you avoid the activity. I loved to go for walks while listening to music but eventually that ended (10). I hated entering big box stores for fear of pain from long walks finding an item (8). The 1 to 10 scale provided clarity. If I answered a 1, 2 or low number the surgery would probably be more traumatic than helpful. Other strategies would be more useful. However, if I answered 8, 9 or 10 the surgery would improve my quality of life.

    Physical Therapy (PT)
    The most challenging and least understood aspect when facing a knee replacement operation is what one will face in the post operative period. Immediately after surgery healing begins and scar tissue forms which can freeze or limit range of motion (ROM) in the joint. Strategies are employed to start moving the impacted leg. While some activity begins immediately after surgery, you can expect to start outpatient PT at the center within a few days after surgery.

    The battle continues to prevent scar tissue adhesions from forming. Each day the activity increases as healing occurs. The goal of the PT session is to bend and straighten the surgical leg and lasts 2 months, generally twice a week and is invaluable! I was shocked to learn that some orthopedic surgeons don’t even order it. However, if you want to get back to an active life… you must get the range of motion back and that takes work. Life will return to a more normal routine after 2 months but allow 3 months before you’re able to help someone else. 

    The Best Surgeon
    The first most important step is to find the best orthopedic surgeon in your area. We had 2 opinions which were covered by insurance. Ask other healthcare providers who they would have do the surgery. The second appointment was invaluable. We found an amazing surgeon. Literally everywhere we went nurses and other staff told us, He is the only one who’d do my surgery. Do they treat you kindly and answer all your questions? How many do they do in a year? You want someone who focuses primarily on the knee for the best outcomes. 

    Importance of Protein for Healing
    Another orthopedic surgeon told me to begin drinking a protein shake daily 1 month before surgery to promote healing. My appetite was poor after surgery. The daily supplementation provided the extra nutrition needed. It’s also important to increase fluid intake as well. However, if you have any kidney, heart or diabetes disease be sure to get clearance from your healthcare provider before you push fluids and protein.

    Pain Control
    The post operative pain was well controlled. Between the numbing agents used prior to surgery and the narcotics given during the operation, pain was greatly reduced for 24 hours. Tylenol and Tramadol were ordered around the clock every 6 hours initially. Oxycodone which is a strong narcotic is used for breakthrough pain. Despite taking Tylenol and Tramadol, if the pain consumes you and it’s all your thinking about…it’s time for an Oxycodone. I weaned myself down to ½ which took the edge off when the others weren’t working.

    However, during PT at certain points in the bending and straightening… pain returns. It’s a helpful idea to premedicate before PT to get the most motion and progression out of it.

    Tramadol and Oxycodone are addictive. Opinions vary on how long it may be needed following knee replacement surgery. Our surgeon wanted us using the pain meds, so we’d do the PT to keep the knee bending and straightening. It’s a good conversation to have with your surgeon.

    Reduce Swelling
    Swelling limits motion and increases pain. It’s important to focus on reducing it as much as possible. Our physical therapists highly recommended above the knee compression stockings. My husband is 6’4” tall and it was difficult to find them long enough. A wonderful company in North Carolina sent them out which fit him perfectly.

    Everyone recommended ice after any kind of PT activity for 20 minutes applied above and under the knee. Our PT team recommended 2 Comfort Gel packs (from Amazon). In addition, several orthopedic surgeons recommended the continuous Breg Polar Care Circulating Cold Water Flow system. It doesn’t damage the skin like direct contact from ice but keeps cool water circulating to reduce swelling and pain. You can insert frozen water bottles in the Breg Cube instead of ice.

    Complications
    Baby aspirin is ordered to reduce blood clot formation along with hourly movement and flexing of the feet. Frequent walking is very important. Walkers are used for the first weeks to prevent falling.

    Bleeding may occur but is less common due to improvements in surgical techniques.

    Infection is a major concern. You will monitor your temperature and report any elevations to your surgical team. Constipation also occurs. We were given daily doses of Senokot to promote the emptying of the colon slowed down by narcotics. Two glasses of prune juice a day was ordered along with Milk of Magnesia if needed for constipation. 

    Medications
    Keep track of all your medications, especially the pain meds. Write the times beginning with 7am through the next 24 hours in rows on the left side of a page. Create columns across the top of the page for each medication. There will be many new ones and it’s far too easy to get confused. It’s important to be accurate. Add a 1 or 2 in the time slot for how many pills you are to take with each scheduled dose. Record when all pain meds are taken as well. You may have to print a new page each day as the pain med times may change.

    If you have high blood pressure, diabetes or kidney disease work with your healthcare provider to maintain balance in your numbers. This is a major surgery with a great deal of temporary medications that can make these problems worse. Monitor those numbers and report any concerns to your doctor. 

    Metal Allergies
    If you are someone who developed a rash from cheap jewelry or any metal, you need to have a conversation with your surgeon. After 25 years of wearing a white gold wedding band the protective coating rubbed off and I developed a nasty itchy allergy under the ring. I was concerned about what metal would be in the orthotic implant and did a lot of homework on this issue.

    Unfortunately, the information is uncertain. There hasn’t been much research on this concern. Over time orthotics may fail. One wonders, was it related to an undiagnosed allergy to the metal in the device? Some orthopedic surgeons don’t think this is a real issue. However, one surgeon told me that he uses a hypoallergenic orthotic in all his patients. Another minimized my concerns. Our surgeon listened and placed a hypoallergenic implant in me.

    Metal testing is an emerging area of research. I believe one day it will be standard practice especially in people with a history of a metal allergy. An orthopedic nurse in Oklahoma told me they offer metal testing to all their knee replacement patients before surgery. You can search Orthopedic Analysis for more information on the test they use. My test showed that I was highly reactive to nickel.

    Interestingly, I also developed a rash underneath the dressing the surgeons used to cover the knee. Apparently, I’m also allergic to the adhesive used to secure the dressing. Let your surgeon know if you have any tape allergies as well.

    On A Personal Note
    My husband developed a severe knee injury while playing basketball in college 50 years ago. Over the years he saw many orthopedic doctors and physical therapists who helped him buy time. He reinjured it last summer and finally needed it repaired. I injured my knee 8 years ago playing my first and last game of Pickleball. My severely bowed leg altered my gait causing hip pain too. We never expected to have surgery just 5 weeks apart to say the least.

    Remember that this is a major operation unlike any other one you may have had because it’s a joint and bone operation. Realistically, you should have help for at least 2 weeks after surgery.

    You will be working very hard to get your range of motion back and relearn how to walk with a normal gait. Most of the work is simple stretching exercises but the final bending and straitening is painful but mandatory. By week four I was doing 1 hour of PT at home or the center twice a day followed by 20 minutes of ice packs on top and below my knee. Listening to music really helped.

    Interestingly, we learned that when the weather changes…knee discomfort increases, and the Lord created bodies that heal unbelievably rapidly. Each day we saw improvements.

    Life is returning to normal and we’re looking forward to more active lives. If you have questions or comments, please share your thoughts and experiences. You can also email me, and I’d be happy to talk one on one as well.

    May this new year  bring a more peaceful world.

    For I will restore health to you, and your wounds I will heal, declares the Lord (Jeremiah 30:17).

    References:

    “Knee Replacement,” Mayo Clinic, (November 15, 2024). https://www.mayoclinic.org/tests-procedures/knee-replacement/about/pac-20385276.

    Dr. Joseph Bowen, Kootenai Clinic Orthopedics, (2024). https://www.kh.org/.

    1. Nguyen Pharm D. & D. Synder MD, “Tramadol and Oxycodone: What are the Differences?” Very Well Health, (July 24, 2023). https://www.verywellhealth.com/tramadol-vs-oxycodone-7508613.

    Rescue Legs Medical Compression Stockings. https://www.rescuelegs.com//.

    I’m a Christian nurse who helps people navigate through the murky waters of healthcare.

    Beloved, I pray that all will go well with you and that you may be in good health,

    Author of Wake UP Call 911: It’s Time to Reduce your Risk for A Heart Attack and Stroke (2015) and Helping the Hurting: Nursing Ministry in the Body of Christ (2022).

    You may visit my website for additional information: jenniejohnsonrn.com

    All rights reserved 2025, Jennie E. Johnson, RN-BC, PhD

    Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.