Monday, August 21, 2017
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
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
...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 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
|Remember this one?|
March of progress!
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.
Monday, August 14, 2017
But I realize not all dogs are exuberant, kissy-face bundles of happiness...My mail man Anthony often says a dog just chased him or nipped.
One day, in her twenties, my daughter came out of her room with a huge ointment-covered bandage on her face--she had leaned over to snuggle a friend's pit bull and the dog, perhaps startled, tried to chew off her upper lip--19 stitches--the ER--and a fight with the insurance company, which wanted to get the money back from the dog owner (we supplied the info--don't know if they ever did).
More than 4.7 million dog bites take place each year--in summer. That is when dogs and children are outside and interact more.
Robert Olympia, MD, pediatric emergency medicine specialist at Penn State's Children's Hospital, says the chance of infection from a dog bite is between 5% and 15%, so antibiotics are a good idea. But before that, clean the bite with soap and water and apply pressure to stop bleeding.
If bleeding won't stop and if the child complains of pain or numbness, go to the ER. They will ask about the dog's rabies vaccine status...If this is not known, rabies shots may be recommended.
Most dogs that bite are known to the children or family, so rabies status is known.
Unprovoked attacks are rare.
--When choosing a dog, find out as much as you can about the dog's background. An anxious dog or one that shies away from humans may not be best. The more social the dog, the less chance of biting.
--Don't approach a dog you don't know. Always ask the dog's caregiver if it's OK to pet.
--Let the dog sniff your closed hand.
--Tell children to be quiet and calm.
--Dogs don't like hugs and kisses as much as we think. Wrapping your arms around a dog is not a good idea.
--If a dog runs at you, stand motionless. They will chase if you run.
--If you are attacked, roll in a ball on the ground.
Gee, this makes dogs sound like monsters...They aren't. But they are living things and have brains and preferences as to how they want to be treated. Don't overload them at first meeting.
That applies to me, too.
Friday, August 11, 2017
On the website BlackHealthMatters.com, a writer said her daughter had suddenly asked, "Mom, am I getting fat?"
The child was 10 and the author thought, "Who has been putting this in her mind?" The dance teacher? Cheerleading coach? Drama teacher?
Then she realized the messages had been coming from HER.
Do you find yourself saying things like:
--Do you think Mommy looks fat in this dress?
--Mommy is so fat.
--I am so fat.
--I look fat in this.
--I ate so much, no wonder I can't fit into my clothes.
--These jeans make me look fat.
--My butt is too big.
These statements sound innocent and slip out, often in the hearing of young girls.
Believe me, these messages are heard.
I heard much worse things when I was a child--my weight was always a family issue. My dad called me a baby elephant. My three siblings and parents were "normal."
With me, it was my stick-thin mother delicately frowning if I reached for a roll or making a point of saying, "Please put my dressing on the side--it is so fatty, you know."
Some of this can be avoided.
By the way--the woman in the pix put her child--yes, that one--on a diet at age 7.
Thursday, August 10, 2017
When you travel, you may put your identity at special risk.
--Never accept "free" health services or products requiring you health plan ID number.
--Never share insurance numbers on the phone--unless you called them.
--If you take your medical records with you, put them in a locked box or scan them and put them on an encrypted thumb drive or CD.
--Shred old records.
---If you are home or on the road, take labels off prescription bottles before tossing them.
--Make sure your purse or wallet is secure.
--Do not use public wi-fi to log onto health financial sites.
--Monitor your credit reports to see if your medical or financial information has gotten out.
When I traveled, I also purchased temporary travel insurance--I got mine from Amex--that would fly me home if I got sick and cover medical bills abroad.
I also carried a few American hundred-dollar bills--accepted everywhere, I have found. I even had to use one to pay a doctor in Madrid. Nothing like good old cash.
Wednesday, August 09, 2017
The entire sun will be covered in the southwest corner of Kentucky.
Still, even when the sun is totally blocked--and of course in areas with partial blocking--solar filter glasses MUST be worn, according to Patrick A. Scott, OD, PhD, assistant professor at the University of Louisville Dept of Ophthalmology &Visual Sciences.
Looking directly at the sun causes "solar retinopathy." The blast of UV light creates toxic free radical cells that can damage the photoreceptors and specialized pigment of the eye. There is no treatment for this--except to avoid it.
This damage can result in mild to moderate reduction in vision as well as central blind spots!
Most at risk are younger people, those with an intraocular lens implanted after cataract surgery, and those on photosensitive drugs such as tetracycline and amiodarone.
The doctor's Dept in Louisville sees 10 cases a year with solar retinopathy from laser pointers or high intensity sun exposure.
Be sure to get--and wear--glasses with special purpose solar filters. You can see some approved ones on NASA's website. https://eclipse2017.nasa.gov/safety
I already know two people who are gearing up for this--in ancient times, people thought it meant the world was ending.
Now--despite current events--we think it's a good time.
Tuesday, August 08, 2017
In recent years, more hospitals support ideas from any and all members of the team--using the human-centered approach called "design thinking."
Some aspects of this are empathy for the user (the patient), interdisciplinary buy-in, and immediate prototyping or pilot programming.
Usually design thinking comes in when a service is fundamentally broken.
At Thomas Jefferson University in Philly, little kids could not respond meaningfully to the 1-10 pain scale, so they created the CareCube--on each face of the colorful cube was a drawing of a face in various stages of pain.
At another hospital, they noticed that the closer the sink was to patients with a contagious intestinal infection, the more likely staff was to wash hands. So they moved these patients to a new part of the hospital with handier sinks.
There is also an organization now called Clinicians for Design.
Over the years, on this blog, I have covered:
--A vending machine for doctor's offices so patients can get their first prescription without going to the pharmacy (since they may be sick or have kids in tow)
--A range of flavorings for liquid medicines for finicky patients
--Introduction of complementary therapies
--Ways to make hospitals quieter, especially at night
--Phone apps and wearables that eliminate doctor visits
--Special clothes for the disabled and wheelchair bound
To name a few.
Monday, August 07, 2017
Keeping allergies and asthma under control at school is a challenge, says Stephen Tilles, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI.org).
Parents need to work with both the child and the school.
Ask questions--now--at school. How does the school nurse handle allergy emergencies? Is there a school nurse, for that matter? Who calls 911? What if the child can't remember how to operate the epinephrine injector or can't find it? Are teachers trained in allergic reactions? Make a list of questions--meet with the nurse.
Make sure your child really has a food allergy. About 5-8% of kids have true allergies--many are misdiagnosed. You need to work with an allergist. Skin pricks are not effective unless the child has had allergy symptoms. Keep the school fully informed on a diagnosed allergy.
What about allergens hiding at school? For instance, what about the classroom pet? Or pet dander on the clothes or backpack of another child? Pollen and dust settle if classrooms are not cleaned well. Does the teacher keep windows open?
Talk to your expert. Meet with the allergist before school starts. For instance, kids with asthma under the care of an allergist miss 77% fewer days of school.
Think ahead. Be proactive.
Friday, August 04, 2017
Some researchers at Washington University says that even before they can talk, babies are keeping close track of what's happening and look for patterns that will help them guess what will happen next.
For instance, they can judge a grownup's preference for a certain toy or food. (This may explain why kids want a toy another kid is playing with.)
The tykes base their predictions on consistency. In the tests, a grownup would choose the same item over and over while the baby watched--and then when the grownup picked a different one, the baby would exhibit a longer "looking time," presumably while the baby figured out what happened.
In another test, a baby would offer an actor the same toy the actor had seemed to prefer as the baby observed.
There may be a lot going on in those fuzzy little heads. Who knows what a very small infant is picking up--a word to the wise.
Thursday, August 03, 2017
Now a University of California San Diego study seems to show that older adults who consume alcohol moderately on a regular basis are more likely to live to 85 without dementia or other (J of Alzheimer's Disease).
The studied subjects over 29 years--"moderate to heavy" consumption 5-7 days a week seemed to result in better cognitive health.
What is moderate and what is heavy?
--Moderate is one bev a day for adult women of any age and men 65 and older or up to two a day for men under 65
--Heavy is defined as up to three for women and men 65 or older, and four drinks for men under 65
Above that--not just heavy but excessive. (Few in the study drank to this level, the researchers noted.)
In fact, excessive can cause dementia.
The researchers are not sure why drinking seems to result in few cognitive issues.
Still, they say these findings do not mean people who don't drink should start. Some people have other health problems made worse by alcohol and still others cannot limit intake.
I drink a shot of vodka when I remember to buy it--it helps with my knee pain. Better for me than Tylenol? Looks like maybe. My mother had dementia (non-Alz). I sure don't want it.
Wednesday, August 02, 2017
But--the EU members are also discussing licensing the stuff in the European Union.
Meanwhile, citizens are calling for an end to its use, an overall reduction in pesticide use, and more info on safety.
European farmers are showing it's possible to be profitable without weedkillers.
California has said glyphosphate causes cancer and the UN's cancer experts say it "probably" does.
The chemical has been found in the environment and in organisms (meaning you).
You can google the research. You may want to kill weeds--but do you want the process to kill you back?
This goop is everywhere...I see people hosing down their yard with it every weekend.
Tuesday, August 01, 2017
Jennifer Gardener, MD, assistant professor of dermatology at the University of Washingon Seattle, says dermatologists, vets, and scientists can learn a lot from each other.
The UW One Health movement explores the links between humans, animals, and the environment. The idea goes back to when one "doc" dealt with both animals and humans.
Remember, both are living things and exist in the same environment.
Sometimes things from that environment that show up in animals can provide valuable info on treating people.
One example is the effort put into immune-based treatments for canine stopic dermatitis. Topical ointments don't work so well with fur. But the immune-based approach could also translate to humans.
Another area is the invisible mites that live on both humans and animals. In humans, these can cause rosacea and hair loss. The One Health people are finding out which can be passed from human to animal and back.
Thinking you can catch some stuff from your pet may cause you to be less loving and close...But what if the condition is not catchable? This would be another advantage of thinking of health of people and pets along one continuum.
When I was a kid we had a monkey that gave our new puppy ringworm--and then my brothers got it.
Just wanted to share that. You're welcome.