Monday, August 21, 2017

Better care for those with dementia

My mother had senile dementia--not Alzheimer's--just the old-fashioned kind. Basically she outlived her brain by 20 yrs--she looked cute, we made sure she had nice clothes, hair, nails, etc. But she was vague on the past, to say the least.

I moved from DC to AZ to help take care of her--she lived in various facilities (she had means), but my sister and I oversaw her care, selected places, and of course, managed her funds.

In one large facility, run by a well regarded company, she was drugged, we think. Also, in the same place, assaulted. This was on the second day--all this. There was no third day--we found a new place in a single family home accredited by the state of Arizona.

However, in many cases, even in extremely pricey nursing and assisted care places (think $10K a month), residents with dementia are "snowed" with antipsychotic drugs.

Rutgers Today spoke with Olga Jarrin of the Rutgers School of Nursing, and Stephen Crystal, of the Institute for Health, Health Care Policy and Aging research, about this.

Why is reducing use of anti-psychotic drugs important for patient safety?

Crystal:  ...(They are) associated with significantly increased mortality. The FDA has a "black box" warning on these meds.

What is being done in the US to address this--has it been effective?

Crystal: In 2012, the Centers for Medicare and Medicaid Services moved to reduce antipsychotic prescribingm stregnthened regulatory oversight, educated nursesm abd formed state bodies to oversee this.

 By 2016, use of thes meds had decreased by one-third. Some states cut it by 40%.

Where can consumers get info on where to get the best care?

Jarrin: Go to:https://www.medicare.gov/nursinghomecompare/search.html?  Homes get 1-5 stars. Detailed info is available, including how many patients are restrained or given antipsychotics.

How can pressure ulcers be reduced? 

Jarrin: Risk factors for these include poor mobility, poor nutrition, poor circulation, and  incontinence. Nurses can encourage residents to move, change position. One technique is to play music in the facility to remind residents and nurses people need to move.

How about unintentional weight loss? 

Jarrin: Patients may require asistance to eat. Hand feeding is recommended. If the patient refuses food, there are techniques to counter that.

I think too often "big drugs" are used to keep patients quiet and compliant. As people age, and I have found this myself, they metabolize drugs differently from younger people. This needs to be taken into consideration--not the ease of running a facility.

Friday, August 18, 2017

FDA reveals adverse cosmetic reports

The WEN hair products have apparently attracted thousands of complaints...I know when my hair fell out in handfuls a year ago and I considered WEN, people I knew said no, no, not that stuff.

But these complaints did have one effect--the FDA has released its Adverse Reporting System database.

The most commonly implicated products are hair care, skin care, and tattoos. Through 2014, complaints numbered under 400--but the WEN outpouring kicked that up 78%.

Many other people probably have reactions to cosmetics--but go back to the doctor and don't consult a govt agency.

If you have a beef, you can report directly to: www.fda.gov/cosmetics/complianceenforcement/adversereporting.

One dermatologist, who says he lives and breathes cosmetics day and night, said he has not thrown out  out all the soaps and creams in his house.

He also said he was not in favor of overregulation, which could result in higher prices.

So--I guess we're back o buyer beware--and now, maybe buyer report.

A month ago, my daughter was distraught--some new eye cream had made her eyes swell shut. Turns out it was a new nail polish--she had been touching near her eyes.

Thursday, August 17, 2017

Weight discrimination can affect health


...And health care.

Recently, a team from Connecticut College surveyed studies and found that disrespectful treatment and fat shaming to get people to change their behavior can cause patients to avoid treatment or even consulting a doctor altogether.

I am, ahem, no skinny and at age 40, gave up on the constant dieting. I also refused to get weighed at the doctor's office, because I had had doctors blame every complaint and symptom on my weight (one time even a strep throat) . I got a number of reactions to this refusal...One physician said get weighed or leave. I left. Another made me turn my back to the scale. Recently, because I was facing surgery and drugs based on weight, I had to return to the scale--the nurse said it's in kilograms, don't worry about it. Another said she never wanted to know the number, either.

Is the latter a change of attitude? I don't know.

More serious is the attitude you can detect in a doctor--of disgust, disdain, impatience. The study revealed that fat patients are often told to just lose weight, while the so-called normals are given batteries of tests.

In a study of over 300 autopsy reports, obese patients were 1.65 times more like to have undiagnosed conditions, indicating missed diagnosis.

Some doctors also prescribe the same doses for an overweight person as a normal weight person--resulting in underdosing.

And then there are the microaggressions. Doctors are people out in the world--they may share the same distaste for overweight people as many in the rest of the population. They may refuse to even touch a fat person to examine them. They may see the weight in the chart and wince or roll their eyes.

Medicalizing weight means weight is seen as a disease and loss as a cure. This assumes that weight is well within a person's control--more weight thus means poor health habits. Many, if not most, overweight people do not eat cheeseburgers r whole cakes all day. Many exercise. Other predictors of illness--notice, I say predictors not cause--are genetics, diet, stress, and poverty. And maybe bearing the weight of stigma?

Fat shaming is also prevalent in the social media--resulting in bullying.

All this leads to stigma, to feeling "less than" all day.

I once had a doctor tell me to walk an hour a day. I could not think of a good reason not to, so I did--for years. When I went back to her after a year, I said, I am walking. She said, well, I hadn't lost weight so she didn't buy it.

Never went back to her.

Wednesday, August 16, 2017

Binge-watching can be bad for ya

Research at the University of Michigan and the Leuven School for Mass Communication Research in Belgium found that high amounts of binge-watching leads to poorer sleep quality, more fatigue, and more insomnia than regular TV watching.

Binge-watching defined as watching "excessive" amounts of one show in one sitting.

The team surveyed 423 adults between 18 and 25 in 2016. They were asked about sleep, fatigue and insomnia and their frequency of binge-watching.

Most--81%--said they did binge-watch. Of that group, 40% had done it in the last month. Twenty-eight percent said they had done it a couple of times. Seven percent had done it every day during the preceding month!

The subjects slept on average seven hours and 37 minutes. Those who binge-watch reported more fatigue and poor sleep quality.

Too, bingeable shows tend to have plots that keep the viewer tied to the screen. The viewer becomes intensely involved.

This means a longer period is needed to "cool down." Or they may watch "just one more episode." (J of Clinical Sleep Medicine)

I binged on the first season of Breaking Bad--I would say it was disturbing but I don't remember sleep problems.

I guess there is such a thing as an overdose of horrible images.

Tuesday, August 15, 2017

We might get rid of the SQUEEZY BP machines

Remember this one?
March of progress!
It's ever so trendy now for the doctor's assistant who "rooms" you to slap on an automatic blood pressure cuff that then, in my experience, squeezes your arm until you scream for mercy and goes down just as slowly. Often, the reading is inconclusive.

Can you tell? I hate these! I often insist on my BP being taken with the manual soft cuff and by a non-sadist.

Now, researchers at the Jerusalem College of Technology and the Shaare Zedek Medical Center have developed a better way to take systolic blood pressure.

Systolic is the top number, diastolic the bottom one. The customary manual or automatic methods can be affected by "white coat syndrome"--the tendency of being the doctor's office creating a higher reading.

Sometimes patients are asked to take their pressure at home to avoid the white coat effect.

Still, the automatic is less accurate than the manual.

An incorrect high reading can lead to the prescribing of meds the patient does not need and which might be harmful.

This team therefore developed a new device using a pressure cuff on the arm and an electro-optic device on the finger. Similar to that finger clamp that measures oxygenation, the finger device sends light through the finger and picks up the pulses of the heart rate.

At the same time, the cuff is inflated. When the cuff pressure increases above systolic blood pressure, the pulses disappear. When the cuff pressure goes below the person's systolic, the pulses reappear.

Anyhow--it works. How soon can we see it in use? Who knows? And will the cuff part be so alarmingly tight?

Maybe it could use some more work...but stay tuned.

Of course, there are many variations on sale now...lower arm cuffs, finger alone, on your phone, etc.