Friday, October 31, 2014

Price we pay for not sleeping

I admit it--I have a Teddy Bear.
They say that the (ahem) older people sleep less. I sure do! I have always been a spotty sleeper--couple of hours, wake up, then back, tossing around through the night.

Now daylight savings is ending. We don't go on it in Arizona, but we do have to adjust our thinking--our East Coast buds are now only two hours later, the cable shows are one hour later.

From oldies to tots, not sleeping exacts a toll. Sleep is when the body restores itself, hormones adjust, memories are solidified and the whole immune system is set in place anew.

Sleep loss in adults accumulates--and can lead to heart disease, diabetes, high BP, depression, and of course, our favorite, obesity.

The National Sleep Foundation recommends:

16 hours for infants
12-14 hours for toddlers (1-3)
11-13 hours for preschool (3-5)
10-11 hours for school age (5-12)
8.5-9.5 hrs for teens
7-9 hours for Adults

I am doomed. I get about 5-6 hours, all broken up.

I don't perform vigorous exercise within 4 hours of bedtime, I don't use a phone or tablet, I avoid medications. I do listen to audiobooks in the dark when not feeling sleepy--eventually, I drop off.

If I don't, I just "rest."

Thursday, October 30, 2014

The doctor hunt--new notes

As I reported (scroll down), my primary provider (actually a Physician Asst under supervision of a doctor) is no longer taking my Medicare Advantage plan.

Rats!

I called the plan, as reported, and got some suggestions--which boiled down from eight to one when I looked into each doctor.

I also tagged up with my insurance broker--and he is searching for a new plan that will take my old doctor.

I also requested the 2015 Provider Book from my present plan. Imagine my surprise--it is almost half the thickness of the old one!

So...did the doctors quit because of chintzy reimbursements or did they fire docs because too many of their patients would not scurry from test to test or come to their "talking physicals" or fill in health histories only the CIA could love.

So I am pending. I have until Dec 7th. The problem is I did agree to tests in December and that doctor is no longer on my plan, either. If the tests require followup, I would have to find a new specialist.

This is completely aggravating--and probably not good for my health, either.

Wednesday, October 29, 2014

Hey, doc, what level are you?

Finally--a good use for video games.

Yes, these excellent time consumers are credited with making better surgeons--dexterity, you know.

Hand-eye coordination, reaction time, problem solving skills--surgery simulators are weirdly similar to video games.

A 2001 study showed that laparoscopic surgeons, working in tiny incisions in the body using joysticks, made 37% fewer mistakes if they played video games three times a week.

Other studies have backed this up. World of Warcraft, for example, was shown to improve the team skills in the operating room.

See? Junior may become a doctor after all!

Experts say you can even ask your surgeon if he or she plays games.

Tuesday, October 28, 2014

Think of those adorable teeth!

How exciting when a kid pops a tooth...all gleaming white and perfect. Then comes Halloween.

Certain types of candy can damage teeth--and I don't mean cavities.

Martin Hogan, DDS, division director of dentistry at Loyola, says he sees parents and kids undergoing pain and expense from Halloween candy.

First, hard candy. Kids don't suck and savor--they chomp, Hogan says.This can lead to cracked teeth, punctured gums (ack), and tender roofs of mouths. Lose the hard candy and substitute bags of pretzels or cheese-filled crackers. Sealed, of course.

Bubblegum or gumballs coat the teeth in a bath of sugar and can loosen teeth or braces. Maybe a candy with xylitol would help teeth (it can cause diarrhea, though).

Caramels--not only does it coat teeth with sugar, it can lodge between teeth and stay there. Wax lips don't.

Gummies--worms, bugs--can cause decay.

Taffy--oh, don't even! Sticks in teeth and braces.

How about packets of sunflower or or pumpkin seeds. peanuts?

I know, none of these substitutes sound fun. I agree. Still, as an adult, a broke a tooth on movie candy--and that was no joy ride either.

Monday, October 27, 2014

Check out 60 Minutes on nursing people with Ebola

I was very impressed--even shed some tears of admiration--for the nurses who took care of the first Ebola patient here--Thomas Eric Duncan.

You can see their story at: http://www.cbsnews.com/news/ebola-inside-the-first-united-states-diagnosis-thomas-eric-duncan/

The times I have been hospitalized, the nurses made it bearable--they were great, while the occasional doctor was often stiff and snooty.

Ebola is a horrible disease with waterfalls of vomit and feces and bleeding from every orifice. Even one virus--one!--slipping in can start up a case in someone.

These nurses had to learn on the fly--they had incomplete info on protecting themselves...they are truly heroes. They sucked it up and did it.

But if you ask me, the succeeding cases were treated more casually. I feel nurses and doctors--of all people--should be overly cautious. Instead, they waltzed around bowling and flying to try on wedding dresses and so on.

I also was irritated that one nurse did not want to be isolated. Sitting out 21 days should be part of the job. The suits should know that.

We had quarantines when I was a kid--measles, chicken pox, mumps--a big sign on the house. Maybe we need that again until this burns out.

Friday, October 24, 2014

This year's Halloween warnings

First, let me say I don't think all the nutty fears of weirdos putting razor blades in candy have ever materialized. People set their hair on fire with this every year--they take candy to be x-rayed--and nothing comes of it.

Maybe you could keep the kids from eating the treats while out on the streets--and check it over in the light--but calm down.

The really scary part, says Loyola pediatrician Bridget Boyd, MD, is pedestrian safety.

Tell the kids where they can go--which streets, how far--and drill them on it. They must use sidewalks and crosswalks.

Usually, here in AZ, the parents are with the kids, I have noticed. Kids can go alone if they can follow directions and read a map, know the neighorhood, know how to call 911, and know their own number.

This will be about junior high age.

If you child has a nut allergy be very careful of what they eat.

If a costume is black or dark, be sure it has reflectors on it.

Make sure the costume is short enough so kids can walk without tripping.

No scary contact lenses.

No candles--even in pumpkins--use battery-operated.

I know this sounds like a buzzkill-but Halloween is so much fun, it's hard to kill the buzz completely.

Boo!

Thursday, October 23, 2014

The doctor hunt is on

My doctor is no longer taking my Medicare Advantage plan. Oh, goody.

I liked this guy and rarely see a doc more than once. He is a Physician Assistant, too, not even a medical doctor.

My plan has two networks of doctors--I called the networks and tried to get lists of docs within 10 miles of me. They tried to turf me back to the plan, but I persisted. Each had four docs or physician groups.

Of that eight, five had either mistreated me in the past or my sister or my late mother. One doctor had a reprimand from the Medical Board for not recognizing a heart attack.

Of those two, one was another name for the group I had--that no longer wanted me.

So that left one.

At this point, I called my broker. He is going to see if I can change plans to one my PA takes.

So that is in play.

Are we having fun yet?

Wednesday, October 22, 2014

Some hospitals more likely to recommend C-section

According to Angela Davis, writing for CBS Minnesota, says researchers at the Univ of Minnesota and Harvard have looked at C-sections nationwide, and whether you get one depends more on the hospital than your medical condition.

They checked out childbirths at 1,300 hospitals in 46 states. The likelihood of C-Section varied between 19% and 48%.

In other words, a woman could walk into one hospital and stand an 11% chance of surgery and that same woman in another hospital could have a more than one in three chance of a section.

You may know your doctor, but you probably don't know your hospital's take on C-sections. You need to ask.

I remember my pre-delivery classes--they joked that if you didn't read the chapter n C-sections, you would end up with one.

I didn't read it--and I did.

But I also had huge fibroids--the baby could never have gotten out. They apologized for not seeing those on the sonogram.

Yeah, cool.

Tuesday, October 21, 2014

You have my permission to skip a workout day


Who am I kidding? I am too crabbed up to work out in my old age--but if you aren't, it's still OK to skip.

Yet may people don't want to break up their momentum--they feel if they skip they may lapse.

Elizabeth Quinn wrote about this on About.com. Rest days are critical to performance, she says.

Some reasons for this are psychological--but most are physical. Muscles need time to repair and rebuild.

Too few recovery days can lead to overtaining syndrome.

The body needs to adapt to the stress of exercise for the real training effect to take place.

If you don't let the tissues knit (the tiny muscle tears) and fluids to be replaced, you can feel kind of sick, stales, depressed, and not do as well with each form of exercise.

Yes, alternating strength and aerobic can help, but you also need to knock off sometimes.

Short-term recovery is at the end of a session, but long-term recovery must be built in a year's schedule, Quinn says.

Key to the short-term, especially, is getting enough sleep.

What if a day off turns into three days or more...Catch yourself and start anew.

Monday, October 20, 2014

Don't overdo the acetaminophen for kids

Acetaminophen--Tylenol in branded form--is a parents go-to medication. Yet, every eight minutes a child experiences a medication mistake in this country.

And it's the parents' fault.

A new study in Pediatrics shows parents are quick to dose kids with over-the-counter meds.

Liquid OTC preparations are as common as food now.

But they are medicine--and they can be dangerous.

Tylenol posts a safety chart and the FDA says, as of 2008, kids under age 2 should not be given OTC cough and cold medications.

Some advice a la Mayo Clinic: Be sure your child needs the medicine--a low fever can burn out an infection--why push it down right away?

Often the child is fussy or even hysterically uncomfortable--things can get chaotic. One common event is to dose the child twice.

Don't.

Friday, October 17, 2014

Going someplace? You may need shots

The big woo at the moment is Ebola--but not that many people will be yearning to go to West Africa, and world travel will continue.

The advice is--book your shots when you book your flight.

You may need to check with your doctor or travel clinic 4-6 weeks before departure to complete your vaccinations. This according to Caroline Sullivan, DNP, assistant prof at Colunbia Univ School of
                                                      Nursing.

First, find out what vaccinations are recommended for your destination. South America--You may want Yellow Fever or Typhoid Fever protection. Travel to part of Africa--rabies or meningitis. The State Dept can provide more info.

Also, be sure you have current routine vaccinations. If you didn't get Tdap--whooping cough, tetanus and diphtheria (was DTP), you may want it. If you are over 60, consider the pneumonia shot or shingles shot. Shingles on vacation could be a buzzkill.

You may also want to take along meds for malaria, altitude sickness, and motion sickness--depending on where you are going.

Insect protection is also good.

When you get there, drink only sealed drinks and fruit you peel.

Of course, there is always Disney World for the faint of heart.

Thursday, October 16, 2014

Why I got a flu shot this year

My pharmacist was a great shot giver--no pain!
Medicines tend to make me queasy or sick--I think of myself as hypersensitive. Plus, I don't drive. So some years, I have not ended up getting a flu shot, even though I never got sick from one..

Yet--infectious diseases are on the national menu this year. Ebola, D68--yes, the former is only a couple of cases, but if there are more, they will go to ERs and doctors. I want to stay out of those waiting rooms--which for the most part, will be full of flu patients.

One year, I was sick with a paralyzed intestine and everyone else had flu. Flu, flu, flu. The shot in 2012-13 prevented 79,000 hospitalizations--but 381,000 American were hospitalized anyhow. Nasty stuff.

Still, perversely, I hear people say people coming across the border are bringing disease and then in the same breath, they say THEY would never get a flu shot, that the shots CAUSE flu, why their Aunt Jane...etc...all while mad at border crossers for not being vaccinated.

Anyone who does not get the shot is depending on those who do to make enough people less likely to get the flu that they will be protected in the process. It's called "herd immunity"--vaccinating enough people to head of huge outbreaks.

If you are over six months old, you can get it. Most insurance will pay. Older people are advised to get a stronger shot--ask your provider.

Oh--and that provider may be your phamacist--no doctor appt needed.

You are in no danger of getting Ebola, but could get the flu and then pass it on. Think about not doing that. It's not a sure thing. But what is? .

Wednesday, October 15, 2014

Painless needle may be coming

One in 10 people may have needlephobia--which can decrease blood donations and vaccinations, not to mention medical testing.

Now, some docs at the Univ of Saskatchewan, Saskatoon, Canada, have developed a needle that applies pressure and vibration before the "stick," confusing the nerves and making the stick painless.

They tested all kinds of combinations of pressure, vibration, and cooling and warming on 21 adults, using a needle that gave a sticking sensation but did not break the skin.

They are now going to test in children, who experience pain differently and are notorious for needle hating.

When will this Godsend be available--not immediately. There are some other similar devices out there.

Well, bring it on. I notice they ask at the lab--Are you weird about needles?

Tuesday, October 14, 2014

Pamper your "autumn" skin

Joshua L. Fox, MD, founder and medical director of Advanced Dermatology PC, says skin goes through a transformation as summer ends.

First, it's drier outside. And your home and office is heated--making skin even drier. Fox recommends switching moisturizers from a lotion to a cream. Use products with humectants (glycerine, sorbitol urea or alpha-hydroxy) to attract moisture to your skin.

The eight glasses of water thing? You can do it but it won't show up in your skin. Just stay hydrated.

Think about exfoliating--rubbing off the dead skin layer. Maybe even a dermabrasion peel o chemical peel.

Keep up acne treatments--but switch to a heavier, oil-free moisturizer.

Cold winds can irritate roseacea. Avoid really hot beverages.

If you have those bumps on the backs of upper arms and thighs--called keratosis pilaris--exfoliate gently and bump up the moisturizer.

Allergies can also bring on rashes in the fall. If you are allergic to pollen, wash face and hands when you come inside---and keep windows closed from 10 am to 4 pm.

Just writing this is making me itch.

Monday, October 13, 2014

More than just scary faces


Pumpkins have many aesthetic, artistic, and culinary uses--besides Jack-o-Lanterns, you have your lattes, donuts, cookies, and of course, pies. Oct 21 in National Pumplin Cheescake Day. Your course is clear.

But, of course, you should not get too excited--the food police are all over the orange gourd.

Suzy Weems, PhD, professor of nutrition sciences at Baylor, says yes, pumpkins contain fiber, a good thing.

Also, they harbor zeaxanthin, a weapon against age-related macular degeneration.

Want some phytosterols for your heart--pumpkin seeds.

Magnesium, manganese, copper, phosphorus, protein,zinc, and iron? Pumpkin.

But what about pumpkin candy? It's still candy, Weems says sternly.

The pie? Make sure it has a lot of pumpkin and is not just flavored with it.

Pumpkin in coffee or for breakfast? The latte is calorie-ridden. The doughnuts still have sugar.

Aw--have a piece of pie. You will survive.

Friday, October 10, 2014

Hiring a home health care worker--not easy

Kurt Kazanowski, a hospice, home care, health system expert and author of 7 Pillars of Growth for Hospice and Home Care, says exploitation of the elderly in their homes is a growing problem.

My sister and I cared for our mother for 18 years after her memory faltered. She was in two large assisted care places, and two accredited private homes with a couple of "memory" residents living with a family. She could not stay with either of us because we had pets and she hated animals.

Before this, our father had a stroke and was wheelchair-bound for 10 years, cared for in his home by home health care aides. He had one aide during the day, a second to manage bathing him, and then he was tucked in for the night--then the aide came again in the morning.

My mother was not able to manage these tasks. In fact, the aides also catered to her.

The aides ranged in ability and honesty. For instance, some valuables "walked." Another aide tried to sue for a hurt back. Some came from agencies, some from ads we placed.

Kazanowski recommends using an agency--ask if they do a national criminal background check, as well as a motor vehicle review every six months.

See if the agency does regular quality checks--this is an unannounced spot check.

Ask to meet the caregiver before he or she comes to your home. Speak to the families of other patients.

And--this is crucial, we found--do your own spot checks--we called them pop-ins. Is your loved one clean, groomed, clean clothes, even makeup in the case of women. We took Mom for weekly hair appts and out to lunch once a week as well. We sometimes ate with her at her place, too.

Still, we had issues over the 18 years. Even if you live in town with your loved one, this is not easy. You really can't turn this over to anyone.

Thursday, October 09, 2014

Ebola "care" or Ebola "scare"

I am not sure what to make of this epidemic (so far in Africa not the US). It has been known for a long time but suddenly we are being "informed."

I see those lines of bureaucrats waiting to gloss and lie, and my heart sinks. If you listen to what they say, they are pretty clueless. The virus has already mutated hundreds of times--who says no symptoms means not contagious. Who says a sneeze won't convey particles?

A nurse in Spain, presumably properly garbed, got it she says by touching her face with her gloved hand. That seems pretty spready t me!

That freelance camera man was supposedly washing a car that had held a patient. Why would he be doing that...but that might be what our precious soldiers would do...How safe are they? My BS alarm went off on that one!

Now were are going to check temperatures at five airports--but not stop traffic to those with W. African passports, no matter where they come from on an earlier leg of their journey here. There are already reports of people loading up on Ibuprofen so they will have no fever and can get to a good American hospital.

About that temp-taking. Will they use that electronic thing that goes across your forehead? What if the takers are sloppy--and spread sweat from one person to another? What happens if you do have a temp--frogmarched to a hospital or holding pen in the airport?

See where I am going? None of this is thought through.

I recently contacted the AZ public health people about my kid's paralyzed arm--could it be a case of the other scary virus D68 in an adult? Some nurse wrote back that it couldn't be because there were no cases in AZ. Well, maybe this was one...

Oh, she also told me to take my daughter to a doctor. My daughter had already taken herself to one--they had no clue what was wrong with her. But thanks for the tip.

Don't forget--those doctor waiting rooms and those hospitals are full of sick people, too.

Wednesday, October 08, 2014

Test writeups becoming more patient-friendly

I always thought doctors knew the normal and abnormal numbers on all those tests they like to make you get--but the info is printed on the sheet by the lab.

Laura Landro, WSJ, Sept 16, 2014, says more patients are asking for their results sheets and providers are trying to make this info more accessible to the layperson. A federal rule allowing patients to get results went into effect in April.

Quest allows patients to dial up their results online. Since the new regulation went into effect, 700,000 Quest lab results have been accessed.

The hope is patients will spot abnormal results that docs might miss--an estimated one in 14 cases.

Quest's reports include charts and graphs putting results in context.

Kaiser does this, too--and when doctors explain how it works, patients have a better time using it.

For one thing, you can minimize those in-person doc visits to "get results." This is tiresome and expensive and with the new approaches, can be eliminated in many cases.

In any case, the doctor has only 30 days under the new regs to meet with you if he or she thinks this is warranted.

In some instances, say an HIV test, the doctor may want to be present to explain and reassure.

Tuesday, October 07, 2014

Some radiologists trying to cut the confusing jargon

Adult male, juvenile, stuffed ursus minor

 
There are few things more frustrating than submitting to an x-ray or imaging and then not having a clue what the doctor found.

Laura Landro, WSJ, Sept 15, 2014, says more people are getting their medical records--then freeze at the absolute mumbo jumbo.

"Purposefully opaque," "sloppily written." These are two terms used.

At Penn State, some physicians even take a writing class.

An "ill-defined lesion" makes it sound like they have no clue. "Epicenter of the mass" makes it sound like a tumor is spreading outward.

Radiologists also get training in sensitivity.  They are trying in some venues to quit using the word "gross." "No gross abnormality" thus becomes "no obvious abnormality."

Unfortunately some of this is prewritten into templates the docs fill in.

They may also try to make patients feel better about themselves. Instead of "refused" a test--this could become "had concerns" about a test.

I dunno on this--I do hate having to go from site to site to figure would what the patoot the report is saying.

But I also think, like tribal witch doctors, some physicians maintain their distance and superiority with the Latin and jargon. This must make them feel better or something.

Monday, October 06, 2014

You can do your best parenting when kids are sick

I always felt like a real Mom when my daughter was sick. We had "sick" food I would get--pudding, crackers, Ginger ale, chicken soup. She looked forward to that even if she felt terrible. I would get out the little bed table we got at a yard sale.

Sometimes, I would give her back rubs or wash her with warm washcloths.

Here are some other tricks to make sick days go by faster.

Create a fort in the bed. Stack up pillows around the sick child and put a sheet or net over the top. Like a cave.

Make Jell-O in fun molds--this also gets liquid into the sick child.

Get out the coloring books, even if they have been outgrown.

In giving medicine, mix liquids with applesauce or a fruit smoothie--not too much, though--you want the child to finish it. Or find syrup that is already flavored--check out www.DrCocoa.com.

My daughter remembers being home during the day--"I loved watching 'I Love Lucy,.'" she just told me.

Friday, October 03, 2014

App lets you volunteer to save a life

I saw a news story about an infant who stopped breathing. He and his mother were in a store. They tried everything to help him--but a man who knew CPR in an office a block away had a phone app that alerted him when someone needed CPR--he ran the block and saved the baby!

Sometimes there is no time to wait for am ambulance.

There are at least two of these apps--GoodSAM and PulsePoint.

The GoodSAM has two versions--the alerter and the responder. Those with an emergency can call for help with the Alerter--giving their exact location and calling the EMTs. The Responder is owned by people with specialized training--so they can be alerted.

PulsePoint is aimed mostly at cardiac events--those who can resuscitate are wanted.

We need more of this. It takes a village...

Go to www.goodsamapp.org or www.pulsepoint.org for more info.

Finally--a good use for those darn phones!

Thursday, October 02, 2014

My daughter's paralyzed arm--I wonder...D68?

While everyone is screaming and clucking over Ebola, another mysterious virus is attacking little kids, putting some in the ICU.

Hundreds if not thousands have been affected thus far.

They call it non-polio enterovirus D68--it begins with cold/flu symptoms, then can cause a "limp" or as one doctor said, more accurately, a paralyzed arm or leg.

Sometimes this does go away, I heard some "expert" on TV say--the whole thing is most weird.

Some months ago, my 32-yr-old daughter complained of a stiff neck--then she could not lift her left arm above shoulder height.

We gave it plenty of time to resolve--6-8 weeks...She could not fix her hair, get things from a shelf...etc.

I cried my eyes out everyday.

Finally, on her day off from Wendy's, she went to the ER--they called in neurologists (who showed up!), did an MRI etc. They were stumped. They said get on Medicaid then get a nerve test called an EMG--to see which nerves were affected.

I paid cash for her to get an orthopedist consult--they said it was not orthopedic.

She did not qualify for Medicaid--$7.50 an hr is too princely--and now there is a stack of bills...

But--the virus or whatever it was let loose--one day, her arm would lift. She walked in, "By the way, Mom..." She raised her hand all the way up!

So--doctors--could this not affect adults, too. Somehow get through immune systems?

I think there is a chance. Pass it on.

Wednesday, October 01, 2014

Dialysis may get a new "look"

 Christopher Weaver, WSJ, Sept 15, 2014, reports that some kidney dialysis places are upgrading their ambiance.

They don't want to look like a hospital, said one spokesperson.

KidneySpa in Miami opened in 2008. uses natural materials, nature sounds, and earth colors.

Dialyspa (spa again) has a crushed-ice bar, whatever that is.

High bandwidth internet is another feature. Heated chairs are nice.

But--warn the experts--don't confuse amenities with medical quality. Ask patients what their experience has been. Go to several places--get a feel.

Dialysis still involves invasive tubes, handling of blood. Aromatherapy and New Age music are nice but you don't want an infection.