Category Archives: HealthBleep Blog

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Newly Diagnosed with COPD: How Will I Cope?

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Newly Diagnosed with COPD: How Will I Cope?

Source: COPD Foundation Blog

Newly Diagnosed with COPD: How Will I Cope?As I was browsing the internet, I came across a blog posted on CNN. A woman who was recently diagnosed asked what COPD was, and what could she expect.

Their response:

“Chronic obstructive pulmonary disease, or COPD, is a disease that truly negatively affects quality of life. Patients with COPD are prone to asthma-like wheezing, breathlessness, chest tightness and coughing that can occur in episodes caused by chronic inflammation. They’re also prone to viral and bacterial infections.

It is the fourth most common cause of death in the United States, killing an estimated 120,000 people each year. While COPD is most noted for episodes of shortness of breath and wheezing, the disease is typically slowly progressive and persistent. Medical treatment can be successful in relieving symptoms and reducing the severity of exacerbations.

Treatment is with inhaled bronchodilators, steroids to reduce inflammation and other oral medications.”


Despite COPD actually being the THIRD leading cause of death in the U.S., this description is correct. But what’s missing from it is describing what it’s like emotionally about your COPD diagnosis.

You may have felt stunned when you first learned of your diagnosis. If you had never heard of COPD before, the explanation you received may have seemed pretty mysterious and even frightening. Or maybe you felt relieved to finally know what was causing your symptoms. Some people respond to learning about their breathing problems by diving right in and learning everything they can about it. They feel like they are taking charge and exerting some control over their condition. Other people prefer to learn about lung disease more slowly. This gives them time to let the information sink in. It gives time to think about their questions. These are just two examples of the kinds of coping styles people commonly use when they learn about their medical condition.

Psychologists have identified a set of emotional responses to loss. Known as the “Grieving Process,” it includes five stages. As you adjust to the diagnosis of COPD and some loss of lung function, you are likely to have many of these emotions. However, you may not necessarily move in a step-wise fashion from stage 1 to stage 5. Sometimes people go backwards and forwards as they move through this process. There is no set time limit for completing any of these stages.

The Grieving Process Five Phases:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

 

There are also different coping styles among people. Here are some of them.

  • Confrontive coping: Involves aggressive efforts to change the situation. It suggests some degree of risk-taking.
  • Distancing: A conscious effort to detach oneself and to minimize the importance of the situation.
  • Self-controlling: An effort to regulate one’s feelings and actions.
  • Seeking social support: An effort to seek real support such as financial assistance and emotional support.
  • Accepting responsibility: Acknowledges one’s own role in the problem along with trying to put things right.
  • Escape-avoidance: Involves wishful thinking and efforts to escape or avoid the problem.
  • Planful problem-solving: Involves purposeful problem-focused efforts to change the situation. Includes a logical approach to solving the problem.
  • Positive reappraisal: An effort to create positive meaning by focusing on personal growth. It may have a religious aspect.

 

What are some things you do to cope? What was it like for you when you were diagnosed? What advice would you give to newly diagnosed individuals with COPD?


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Fibromyalgia Dilemma: Tips on How to Sleep Better

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Fibromyalgia Dilemma: Tips on How to Sleep Better

Source: HealthResouce4u

Fibromyalgia Dilemma: Tips on How to Sleep BetterAs humans, we will instinctively avoid pain no matter how the reality presents it. But in the case of people with fibromyalgia, pain takes a different form, like a bad story told – and worse, it eventually snatches them of their lives. They just couldn’t “live” until they die.

Pain Problem

Unknown to many, fibromyalgia is a syndrome highly associated with body-wide pain including tenderness in joints and muscles. People affected by it also experience chronic extreme fatigue, to the point that they would just crawl up to their beds right after dinner.  It is more common in women aged 30-50 years old, although it can affect both sexes and people at any age. Adding insult to injury, this condition has no known cure, and many patients need to have an ample amount of supplementation of vitamins and minerals in order to battle with the syndrome.

Although pain is already a big problem among these patients, another massive issue that poses threat to their comfort is the problem they have with sleeping. Many people affected with the disease often have no way to go: for pain decreases the quality of sleep, and lack of sleep further increases pain. This is where the combination of sleep difficulty and pain takes its toll on people with fibromyalgia.

For people with fibromyalgia are more likely to experience sleeping difficulty (and thus increasing their pain), it is vital to note some points on how they can improve their night’s rest. An adequate sleep during the night could help manage the widespread pain that they feel during the morning. Go over these tips find out how to make pain management could be highly improved by a good night’s rest.

Don’t Stay Excessively Long Hours In Bed

Many people with fibromyalgia may be tempted to go back to sleep after waking up, for the fatigue that they feel is actually worse in the morning. But they shouldn’t, because extremely long sleeps often result to fragment and shallow rest at night time. It is enough to get adequate sleep that is just sufficient to feel refreshed for the day. Oversleeping will definitely aggravate one’s condition since it’ll be difficult for you to sleep at night. It is strongly advised not to take afternoon naps, since the effect is the same.

Avoid Antagonistic Foods And Activities

It is already a general knowledge that one should get rid of caffeine just before going to sleep, but also alcohol should not be considered as a downer even. Both of the substances disturb your sleep. It’s never good to sleep hungry as well, since your tummy might just wake you up. Take a light snack of carbohydrates before resigning to help you with your sleep; it’s a natural reaction of our body to rest while digesting. However, eat light snacks instead of a heavy meal to avoid that bloated feeling. Of course, don’t take in stimulant beverages such as carbonated drinks. Stop sipping that coffee or tea late at night; coffee and tea contain caffeine that is a stimulant.

Get Active, But Not Too Much

Sure exercise could promote sleep in the evening, but it should not be done at least three hours prior to your scheduled rest. The stimulation that exercise can bring you might make it difficult for you to fall asleep. If you are still having difficulty sleeping, though you have exercised for the day, try the next tip.

Relaxation Is The Key

Deep breathing exercises, massage, aromatherapy, and a cool, quiet environment are undeniably a potentiator of a quality sleep at night. A gentle massage, especially, can help you calm your muscles right before bedtime, and thus, giving way to a better quality sleep. Aromatherapy works a lot since it does not only soothe your nerves, but it also sets the mood into a deep, relaxing feeling. You can alleviate the pain by guided imagery; imagine yourself in a relaxing setting, or you could have your partner help you imagine a relaxing scenery. Meditation works best if you can still handle the pain brought about by your condition.

It is important for patients with fibromyalgia to support their joints, and not cushion those. That is a too soft bed does really no advantage over some joint pains these people may feel. Clinicians now recommend that the best mattress for patients with fibromyalgia is a memory mattress, as these follow the contour of your body, exerting lesser pressure in your muscles and especially on your joints. However, memory foam mattress does sleep hot on the surface, that is why other doctors recommend a gel foam for a mattress which actually sinks into the foam and absorbs the heat. Some of the best mattresses in the market can cost a lot, but there are some which cost less than those in the mainstream but still give you the relief that you need.

We cannot just deny the fact that fibromyalgia has indeed been a major dilemma for those who are afflicted with it. If you have fibromyalgia, there are lots of websites offering free help and guidance for your condition. If you know a loved one with this condition, all you can give to him or her is patience, tender love, and care. During pain attacks, be the person he or she could hang onto and help him or her relax by breathing in and out. We may not be able to comprehend the pain that they are going through, but we can help them make it through the everyday struggles because of the support we give.

This is a guest post by Krisxi from DivanCentre.co.uk If you are also interested to write for HealthResource4u, Please check our guest posting guidelines at write for us.


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The Tricky Thing About Asthma

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The Tricky Thing About Asthma

Source: Harvard Health Blog

POSTED MARCH 06, 2017, 9:35 AM

Monique Tello, MD, MPH, Contributing Editor

The Tricky Thing About AsthmaIn mid-January, health headlines announced that nearly one-third of adults diagnosed with asthma don’t actually have this respiratory condition at all. This announcement appeared everywhere from Fox News Health to the Chicago Tribune.

As a primary care doc, a medical writer, and an asthma sufferer, I was very skeptical of these dramatic announcements, and with good reason. An editorial that accompanied this study provides important perspective that suggests the news headlines were exaggerated and misleading.

Taking A Closer Look At The Study

Let’s talk about the study, which is a good one, and has merit. Canadian researchers recruited 615 random people who had been given a diagnosis of asthma, and performed formal testing to see if they still had it. And in fact, 33% of those tested did not meet criteria for the diagnosis of asthma at the time of testing. The lead author of this study is then quoted as suggesting that doctors diagnosed these patients with asthma without doing the necessary tests.

Okay, as a physician who diagnoses and treats asthma (and its many variants), a medical writer and researcher who dissects these articles, and someone who is currently experiencing an awful asthma flare (or exacerbation), I take major issue with these headlines and the lead author’s press statements.

Looking A Little Deeper

The data tells the story. Of the one-third of patients who tested negative for asthma in the study, 24 (or 12% of them) actually did have appropriate testing (that confirmed asthma) when they were first diagnosed. What’s more, 22 of the participants who tested negative for asthma at the time of the study, tested positive months later (again using appropriate testing).

What this really tells us is that asthma has many forms and, like many chronic disease, symptoms may come and go. This is consistent with what I know from professional — and personal — experience.

The study authors themselves recognize at the start of the study how tricky asthma can be, pointing out that there are many types of asthma that can look a little different, and have different triggers. They go on to say (as mentioned in the editorial) that symptoms of asthma can relapse (come back) and remit (go away).

Let’s Get Real About Asthma

When I see a patient with wheezing and/or coughing spasms, and especially whose symptoms improve after a breathing (nebulizer or neb) treatment in the office, I will tell them that they at the very least have reactive airways syndrome. This is not exactly asthma. It just means that something triggered them to wheeze — maybe an allergic reaction, or a virus. They may never wheeze again. But in my office, right then, because they are wheezing at that moment, they will probably benefit from an inhaler. If an inhaler has been helpful in the past or the neb provided immediate relief, I’m not going to say, oh wait, we need to have formal testing first, before we treat you. Nope.

But, if symptoms continue and we are worried that this is more than a one-time or occasional thing, then we may want to pursue a formal, official diagnosis of asthma.

How Do You Know For Sure If It’s Asthma?

A diagnosis of asthma requires two things: a history of respiratory symptoms consistent with asthma (chest tightness, wheezing, coughing spasms, particularly nighttime cough), along with proof of “variable expiratory airflow obstruction.” What the heck is that?

Lung function tests can show whether inflammation and narrowing of the airways is impeding your ability to breathe out. A key piece of equipment for doing this is called a spirometer, and it’s not something that you will generally find in any primary care office (it is not the same as a peak flow meter you can buy at the drug store). We refer patients to a pulmonary function lab for this sort of testing. The person breathes into the spirometer while the machine measures total lung capacity, as well as various measures of exhalation speed. They may also receive inhaled medications that can help to make the diagnosis of asthma. Sometimes medications (bronchodilators like albuterol) may be used to see if they relieve symptoms (or a different medication called methacholine can be used to carefully provoke an asthma attack). If the albuterol helps or the methacholine triggers an asthma attack — diagnosis made.

For some patients, the formal testing may be too expensive. Or maybe they can’t get it scheduled in a timely manner. If their history is as clear as mine, it may make sense to simply give them the asthma diagnosis, so that things like a nebulizer machine can be covered by insurance. Even if formal testing confirms asthma, it can resolve on its own, and repeat testing may be negative later on. Was this a misdiagnosis? No, this was just asthma.

Asthma In Real Life

Me? I was in my doctor’s office today with wheezing. I had the flu last week (more on that in another post) which triggered a prolonged wheezing/coughing episode. My doctor saw that I was struggling to breathe, measured my oxygen levels, which were low, and heard wheezing when listening to my lungs. She also tested my peak flow, which improved with a nebulized albuterol treatment in her office. This all supports a diagnosis of asthma, but for now, I’m labeled as having reactive airways, because I haven’t had any formal evaluation with a pulmonologist and I have never had spirometry.

Yet…

Because this is now the, oh, fifth time I’ve had similar symptoms, my doctor feels we need to pursue the more formal diagnosis, and guess what? I’ve got a referral for my pulmonary function testing sometime in the future. Right now, however, I’m sick, and so she’s simply treating me.

Sources


Asthma may be misdiagnosed in many adults. Fox News Health, January 18, 2017.

1 in 3 adults diagnosed with asthma may not have it, study suggests. Chicago Tribune, January 18, 2017.

Hollingsworth, H., O’Connor, G. Asthma — Here Today, Gone Tomorrow? JAMA, January 17, 2017.

Aaron, S., Vandemheen, K., FitzGerald, J., et. al., Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA, January 17, 2017.

One-Third of Adults Diagnosed With Asthma Don’t Actually Have It, Study Finds. Science Alert, January 20, 2017.

Study finds 33 percent of adults recently diagnosed with asthma do not have it. Medical Xpress, January 17, 2017.

Study: 33 percent of adults are misdiagnosed with asthma. Infowars, January 18, 2017.

1 in 3 Adults Diagnosed With Asthma May Not Have It: Study. tucson.com, January 17, 2017.

Weinberger, S., Silvestri, R. Treatment of subacute and chronic cough in adults. UpToDate, March 29, 2016.

Fanta, C., An overview of asthma management. UpToDate, May 31, 2016.

McCormack, M., Office spirometry. UpToDate, June 6, 2016.

Gerald, L., Carr, T. Peak expiratory flow rate monitoring in asthma. UpToDate, December 22, 2016.


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Healthcare at The Tipping Point

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Healthcare at The Tipping Point

Source: FixIt: Healthcare at the Tipping Point

A powerful new documentary that reaches across the political and ideological divide to expand support for major healthcare reform.

The film was two years in the making, with more than forty voices advocating for reform, including: activists, health policy experts, economists, physicians, nurses, patients, business and labor leaders.

This documentary takes an in-depth look into how our dysfunctional health care system is damaging our economy, suffocating our businesses, discouraging physicians and negatively impacting on the nation's health, while remaining un-affordable for a third of our citizens.


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Alzheimer’s Linked To Too Much of This In Your Diet

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Alzheimer’s Linked To Too Much of This In Your Diet

Source: PsyBlog

Alzheimer’s Linked To Too Much of This In Your DietThe researchers studied samples of brain tissue from people with and without Alzheimer’s disease.

Excess sugar in the diet could play an important role in the development of Alzheimer’s disease, new research finds.

Too much glucose (sugar) in the diet damages a vital enzyme which helps fight the early stages of Alzheimer’s disease.

Dr Omar Kassaar, the study’s first author, said:

“Excess sugar is well known to be bad for us when it comes to diabetes and obesity, but this potential link with Alzheimer’s disease is yet another reason that we should be controlling our sugar intake in our diets.”

The researchers studied samples of brain tissue from people with and without Alzheimer’s disease.

They found that sugar can damage an enzyme called MIF (macrophage migration inhibitory factor).

Professor Jean van den Elsen, a study co-author, explained:

“We’ve shown that this enzyme is already modified by glucose in the brains of individuals at the early stages of Alzheimer’s disease.

We are now investigating if we can detect similar changes in blood.

Normally MIF would be part of the immune response to the build-up of abnormal proteins in the brain, and we think that because sugar damage reduces some MIF functions and completely inhibits others that this could be a tipping point that allows Alzheimer’s to develop”.

MIF helps to fight the build up of abnormal proteins in the brain, which are characteristic of Alzheimer’s.

The reduction of MIF activity by glucose could eventually lead to a ‘tipping point’ in Alzheimer’s progression.

Dr Rob Williams, a study co-author, said:

“Knowing this will be vital to developing a chronology of how Alzheimer’s progresses and we hope will help us identify those at risk of Alzheimer’s and lead to new treatments or ways to prevent the disease”.

The study was published in the journal Scientific Reports (Kassaar et al., 2017).


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4 Ways Seniors Can Stay Young

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4 Ways Seniors Can Stay Young

Source: eldercareblog.com

Posted by Ron Burg

4 Ways Seniors Can Stay YoungRetaining youthful exuberance can be quite a steep task for many aging adults. Physical and mental exhaustion both contribute to seniors losing the vibrancy and effervescence that they used to put on display during their younger days. Just because the odds are stacked against them does not mean that aging adults have to resort to a sedentary lifestyle where they are confined to their beds, couches, and chairs, with little or no recreational activity and social interaction.

As long as a person has the determination and the enthusiasm to make life enjoyable, he or she can succeed in doing so regardless of the age and the health complications that come along with it. After all, it’s not how old you are, but rather how old you feel. As far as aging adults are concerned, here are 4 simple ways in which they can feel young again:

1) Eating Healthfully

If you are what you eat, then eating healthfully will allow seniors to stay far away from mental and physical disorders. With age, human beings are required to alter their diet in order to eliminate as much unhealthy food from the menu as possible. The ideal diet for an aging adult should consist of cooked fruits, vegetables, yogurt, nuts, and small portions of white meat protein or beans. Regular meals based on these foods will keep their bodies supplied with sufficient energy and allow them to gain the physical strength required to carry out their favorite indoor and outdoor activities. Eating healthfully also reduces the risk of anxiety disorders and untimely mood swings.

2) Socializing

One of the simplest and easiest ways of staying and feeling young is by socializing with people of similar ages and backgrounds. If seniors refrain from socializing and keep themselves bound within the four walls of their house, then they are simply asking for a bunch of mental and physical illnesses to infiltrate their bodies. The more they communicate and converse with people, the easier it will be for them to tackle the hardships of aging.

3) Exercising

The benefits of physical exercise cannot be stressed enough, especially in the case of seniors. Exercising keeps the body rejuvenated and the mind refreshed. It prevents seniors from being inflicted with a number of different diseases. Heavy workout sessions are not recommended for aging adults. Rather, light exercises such as brisk walking, slow dancing, and stretching (in the form of yoga, perhaps) can help them rise above the physical restraints and limitations that accompany old age.

4) Learning

One of the reasons why seniors feel old is because they lose the excitement and zeal that comes with learning something new and discovering something extraordinary. Since most seniors stay detached from the workplace and academic institutions, it becomes difficult for them to come across new sources of learning. Enrolling in a library or joining a book club can solve this problem. There is no end to learning, and the sooner seniors realize this, the faster they will develop the desire to engage in intriguing learning activities. Besides, joining a book club or a library offers a getaway from the monotony and boredom of retirement
life.

Some say that age is only a number. We like to think of age as a perception of who you are. As long as seniors believe that there is a lot more that they can take from life, and give back to it, they will continue to feel young in their hearts.

Ron Burg is a writer for Alreadyhomecare.com and he primarily writes about senior care and home care.

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Will you need Home Care or Home Health Care

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Will you need Home Care or Home Health Care

Source: EldercareABCBlog

It’s confusing and sometimes difficult to know which care is needed, home care or home health care. Do you know the differences?

A good way to quickly assess which care will serve your relative, follow these simple suggestions.

The first thing to remember about receiving help, you don’t need to be frail, unable to care for oneself, nor does one require to have an illness. Even if a person can take care of self properly, have a quick mind, and agile body, there may come a time they choose a little help around the house. That’s when a person will select home care.

But if the individual develops an illness or a chronic condition and becomes frail and weak, they may need help managing medications, measuring vitals or receiving injections, that’s when home health care is called for assistance.

 

How to Find Care

If seeking home care, you have a couple of options: hire an agency or hire a private in-home caregiver.

Home Care

A good checklist to use when evaluating for home care, ask if the care recipient needs help with one or more of these activities.

  • Needs help with eating and feeding, taking a bath, going to the bathroom, getting dressed, walking around, and transferring from chair to bed or elsewhere?
  • Needs help with cleaning the house, washing clothes, going to the market, running errands, cooking meals and reminders for medication?
  • Needs help with incontinent care?
  • Needs help to maintain a social life and companionship for social outings?
  • Needs help with transportation and making appointments?
  • Does the family member need a break from giving care?

 

Home Health Care

  • Needs help managing pain?
  • Needs help learning medication adherence and management?
  • Needs skilled assessments and training?
    Needs disease management and education?
  • Needs help with injections and IV infusions?
  • Needs catheter care and tracheotomy care?
  • Needs help with a ventilator?
  • Needs help with managing diabetes?
  • Needs post-op rehab?
  • Needs occupational and speech therapies?
  • Needs help with discharge planning?
  • Needs help with wound care?
  • Needs assistance enabling durable medical equipment?

 

Home health is administered by a medically trained staff

 

Paying for care includes:

  • Out-of-pocket
  • Long-term care insurance
  • Medical health insurance
  • Medicaid and Medicare
  • Cash and Counseling Programs
  • Veterans Administration

 


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Is Aspirin A Wonder Drug?

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Is Aspirin A Wonder Drug?

Source: Harvard Health Blog

Posted December 22, 2016, 9:30 am
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publication

 

Imagine that after years of painstaking research, scientists announced the development of a breakthrough treatment that costs pennies a pill, saves lives, and could reduce healthcare spending by nearly $700 billion in the coming years. And you wouldn’t even need a prescription to get it. Perhaps this all sounds too good to be true. But, according to a new study, we already have such a drug: it’s called aspirin.

 

An Analysis Of Aspirin Use

Based on current recommendations, only about 40% of people who should be taking aspirin are doing so. In this new report, researchers asked: what might happen to population health, longevity, and healthcare costs if aspirin use were more widespread? To answer this, they analyzed reams of health data from thousands of patients and estimated the impact of more widespread aspirin use on their health and survival.

Their findings were striking. For people in the U.S. ages 51 to 79, routine aspirin use could, over a 20-year period:

    •    prevent 11 cases of heart disease for every 1,000 persons
    •    prevent four cases of cancer for every 1,000 persons
    •    lengthen national life expectancy by about four months, allowing an extra 900,000 people to be alive in 2036
    •    save $692 billion

 

Is There A Downside To Aspirin?

As is true for all medications, aspirin has its downsides. Among other side effects, allergic reactions may occur. And, aspirin is a blood thinner and can irritate the stomach. Episodes of bleeding and stomach ulcers can be serious. So, the researchers took these into account; the estimates above include these side effects of taking aspirin.

It’s important to emphasize that this study assessed the impact of low-dose aspirin, such as the 85 mg daily dose often found in baby aspirin; higher doses may be recommended for other conditions (and come with added risk). In addition, aspirin can interact with other medications.

For example, if you take low-dose aspirin for your heart and ibuprofen for arthritis, it’s important that the ibuprofen be taken at least 30 minutes after or more than eight hours before the aspirin; otherwise, the benefit of the aspirin may be lost.

 

Who Should Take Aspirin?

For those at highest risk of future cardiovascular problems, including those who have had a prior heart attack or stroke, aspirin is routinely recommended to reduce recurrence.

For everyone else, recommendations vary. Some experts recommend low-dose aspirin for everyone over age 50. Other guidelines make a more conservative recommendation based on age (e.g., 50–79 years old) and cardiovascular risk factors that predict a heart attack or stroke occurring in the next 10 years. Well-studied risk calculators, such as the one developed by the Framingham Heart Study, are available to estimate 10-year risk.

In addition, aspirin is routinely recommended to lower cancer risk in people with certain genetic conditions, including hereditary nonpolyposis colorectal cancer.

 

Why Don’t More People Take Aspirin?

It’s not entirely clear why many people forego aspirin use. My guess is that it’s a combination of factors, including:

    •    a lack of awareness that aspirin is recommended
    •    it wasn’t specifically recommended by their doctor
    •    a greater concern about side effects from aspirin than its potential benefits
    •    a previous bad experience with aspirin use, such as an allergic reaction
    •    an aversion to medications in general

It’s worth emphasizing that when it comes to any treatment — and especially preventive treatments — individual preferences matter a lot. As a result, many reasonable people who would be good candidates to benefit from aspirin will choose not to take it.

 

What Does This Mean For You?

For all the effort to identify new and better drugs, it’s remarkable that we aren’t taking full advantage of what we already have. This new study suggests that large health benefits are not being realized simply because not enough people are taking aspirin.

But each person has his or her own set of circumstances that can affect the both the risks and the benefits of aspirin treatment, as well as his or her own preferences. The decision to take or forego aspirin is a big one — so add this to your list of things to discuss at your next appointment with your doctor.


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Keeping The Human Connection In Medicine

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Keeping The Human Connection In Medicine

Source: Harvard Health Blog

Posted December 12, 2016, 9:30 am
John Sanford Limouze, MD, Contributor

 

Last month, the New England Journal of Medicine published a thoughtful essay by David Rosenthal and Abraham Verghese on the many changes in how doctors are trained and how they practice medicine. Efforts to improve efficiency and accuracy — including the introduction of electronic medical records — offer benefits, and pose some complicated problems.

 

 


Doctors Need To Learn And Do More, More Than Ever

The health care system strives to deliver better care while keeping costs down. Advances in medical science and technology mean there is ever more information for a doctor to know, and policies to curb waste have limited the amount of time we have to learn it all.

Monique Tello wrote about this issue last month; it’s why your doctor is always at the computer. But more than that, these competing goals have had real consequences for how doctors work, how we think, how we relate to our patients and colleagues, and how we feel about our profession.

An example: I’m a hospitalist. It’s a relatively new field in medicine, a product of exactly these forces. Two decades ago, when patients were hospitalized, their primary care doctors would see them in the hospital, in the morning, before returning to clinic for the day. Residents or nurses, often without immediate supervision, managed minute-to-minute affairs. But the culture and standards of practice have changed.

We’ve decided that it’s better to have fully-trained doctors in the hospital all day. In an emergency, I can be at the bedside in an instant. Residents and nurses get more active supervision. Primary care doctors, who have seen their reimbursements cut, can spend more time seeing patients.

But there are downsides. The people I see in the hospital often don’t know me, and I don’t know them. And when a person leaves the hospital, his doctor may not know what I’ve done and why. So, we’ve replaced one set of challenges with another: making sure that there’s good communication between hospitals and clinics.


Electronic Medical Records Can Make That Communication Easier

When a patient comes to me in the hospital, I have immediate access to their entire chart. I can see records from every clinic visit, lab test, x-ray or CT scan, a list of all their possible diagnoses and the medications prescribed to treat them. It’s useful to look at this information before I meet someone new.

After all, if you’re sick and uncomfortable, you don’t want to have to repeat the same story to every new doctor you see. And it’s reassuring to know that the doctor you’re meeting for the first time has taken the time and effort to get to know the particulars of your situation. What’s more, those records make my job easier. My patients may not remember the names and doses of all of their medications. No problem, I can look it all up.


But The Things That Make Us More Efficient May Challenge The Ability To Develop And Maintain Personal Connections

But something valuable gets lost. Maybe there’s a reason a patient can’t remember the names of her medications. Sometimes digging a little bit further can turn up a clue that there’s something more going on. But those clues come up in face-to-face conversations, and over time, not with a glance at a computer screen.

Dr. Jerome Groopman describes another challenge in his book How Doctors Think. Seeing what other doctors have written about a patient can trap us into thinking about their illness in the same way, and blind us to alternative diagnoses. Sometimes the best way to work is to start fresh, and to let your patient tell her story from the beginning.


And Then There’s The Problem Of Distance

We have more and more tests that promise more accurate diagnoses, but require time to coordinate and review. Computerized notes and emails make it easy for doctors to communicate with each other, but have replaced conversations between colleagues. As doctors are increasingly isolated from both patients and each other, they have become demoralized and burned out.


At Its Best, Being A Doctor Is An Extraordinary And Intimate Privilege

We build relationships with our patients and see them through times of both joy and suffering; our relationships with each other help us through the same. It’s hard to do that in a way that’s truly satisfying when we spend most of the day at the computer screen.

Rosenthal and Verghese don’t see an easy fix for these problems. They are largely structural and built into the practice of medicine. But they charge us to remember that the meaning of medicine is in its human connections. Whatever comes next, both doctors and patients should fight to hold on to that.


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Exercises For The Bedridden

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Exercises For The Bedridden

Source: healthresource4u

By Krisxi

 

If you look at the current situation of patients in hospitals nowadays, you will be surprised to see that the number of bedridden patients is increasing. You can also notice that those who are taken at home for palliative care are mostly bedridden individuals, too. There are many reasons why they end up being like this: some have debilitating disease such as multiple sclerosis or fibromyalgia, others have encountered a vehicular accident, while some patients have reached the worst case—being in a coma.

Limited Mobility Bedridden: How Can You Perform Exercises?

 

Since bedridden patients have very limited mobility, it is highly encouraged that they perform even only range of motion (ROM) exercises. Even for a short duration, if performed regularly (like three times a day, for example), it greatly reduces the possibility of these people getting contractures or bed sores.
Contractures are painful in nature, and it doubles the burden a bedridden patient carries. They may make it difficult for especially for the elderly to even turn to the other side of the bed.
A bed sore, on the other hand, often occurs in bony prominences such as the sacral part (the bony part just above the buttocks) or the heel, and it predisposes patients to infection due to an open wound. It may start out as a reddened area, but it can go worse and proceed to a deep, painful ulceration.

Another complication that bedridden patients might get is atrophy of muscles. This takes place when the muscle group is left unused, therefore, shortening and weakening occur. A mobile person prevents this from happening through walking, jogging, and running in treadmill; even simple activities such as lifting a glass of water or cleaning windows will prevent the occurrence of muscle atrophy. But these easy activities are far from easy to be performed by people who are bedridden.


Perform Exercises for Bedridden Clients

These highlight the importance of bedridden individuals’ maintaining mobility amidst of being in bed for very long periods of time. Here are some exercises you can safely do to prevent complications of being bedridden.


 

Palm Stretch

When beginning your exercise regimen, you can start with the most distal extremity. It is also good to start with small parts of the body since it helps build your tolerance to mobility little by little. You can practice first with your hand, since this is the most accessible part of the most bedridden patient.

  1. Bring your entire hand in a first for a couple of seconds.
  2. Open your palm, and stretch your fingers freely for five seconds.
  3. Touch each finger to your thumb.
  4. Repeat the same process on the opposite hand.

palm-stretches

You can do this simple exercise for a couple of times on each hand, but numerous repetitions should not be considered as critical. As long as you are able to move the joints between your fingers and your hands, then, you will do fine. This will prevent stiffness in your joints and also exercise the little muscles you have in your fingers. A reminder though: remember to ask for help if you are too weak to perform it. A caregiver or a loved one can assist you as you please.



Simple Lifts

It does not take a long time before a group of muscle weakens, and performing muscle-strengthening exercises even while on bed can arrest the occurrence. For patients who are recovering, extremity lifts can be done independently. However, there are some who cannot still perform exercises on their own. Like the previous exercise, the family or caregivers can assist them on this, thus, lessening the effort and paving the way to an eventual regaining of health.

For arm lifts, you can do the following:

  1. Begin with your dominant hand. Lift your arm as high as you can. If this becomes too difficult for you, you can settle with resting your upper arm on the bed and lifting your elbow instead until it creates a 90-degree angle.
  2. Hold up your arm for 10 seconds. You can extend for 30 seconds if you do not feel any pain going beyond 10 seconds.
  3. Repeat the exercise on the other arm.

simple-lifts

 


For leg lifts, follow these steps:

  1. Bring both of your legs flat on bet together.
  2. Start with your left leg. Slightly lift it up, maintaining it in a straight alignment.
  3. Bring it to your hip joint slowly. Hold it on that lift for 10 to 20 seconds.
  4. Return the leg to its original position. Repeat on the opposite leg.

 

Side Rolls

Pressure ulcers or bed sores are the main complication each bedridden individual should try to avoid. Similar to contractures, this damage is irreversible. But unlike contractures, this brings much more deformity because of deep wounds. Primary prevention of bed sores is frequent turning, like side-rolling, with two hours being the maximum interval between turns. Bedridden individuals can be turned every 15 or 30 minutes. The more frequent, the better; but it pays to make sure that the patient’s comfort is not compromised.

Steps how to do side-rolling:

  1.  Start on your back. Turn to your right and maintain that position for 30 minutes. You can ask a family member to position your limbs for comfort.
  2. Get back on your back again. Maintain the position for 20 minutes to 30 minutes.
  3. Turn to your left. Stay in this position for another 30 minutes.
  4. Repeat process throughout the day to reduce pressure on bony prominences and as to halt the occurrence of pressure sores even before they occur.

 

You can maintain on a certain side (e.g. On your right) for longer than 30 minutes but not more than two hours. Make sure, however, that your limbs on that side such as your hands and feet as well as your hips are being mobilized often so as not to concentrate the pressure on these parts.

Strengtheners

Isometric exercises are also good for bedridden patients for these stretches or lengthen the muscles. Aside from being lengthened (such as when you do hamstring stretch), muscle groups also need to be strengthened to prevent atrophy. Some of these strengthening exercises are thigh-squeezers and butt-tighteners.

How to do thigh-squeezers:

  1. Lie on your back, with your legs together.
  2. Put a towel in a lengthwise position between your knees. For variation, you can use a moderately soft, long pillow for this.
  3. Squeeze in the towel or the pillow with the use of your knees and hold it for 10 seconds. Release the squeeze and rest for 10 seconds.

 

thigh-squeezes

 

You can perform this exercise both in the morning and in the evening. You can repeat it for five to ten times. But it is important not to strain yourself.

Butt-tighteners are good for bedridden individuals recovering from hip surgery. According to the American Academy of Orthopedic Surgeons, this type of exercise help patients regains strength of the muscle groups around the hips and the glutes while lowering the risk of blood clots.

Follow these simple steps:

  1. Start by lying on your back with legs slightly apart.
  2. You can begin with your right butt muscle, then, strengthen it. Hold this for 5 seconds. Rest for 10 seconds.
  3. Repeat on your left glute muscle. You can repeat this exercise 10 times.

 

Use of Special Equipment’s for Exercise

 

Since astronauts need a lot of exercise in the space to counteract with the absence of gravity, specialized equipment for them have been devised. A good thing, however, is that these equipment’s have been made available also for bedridden patients.
One example is the vertical treadmill that lets an individual to climb up a wall, but with the specialized supports attached to each limb. This requires greater strength of bedridden individuals, thus, ability to exert effort is a main consideration.

Another is fly wheel devices that can be used as a leg press for the bedridden. This effect of fly wheels has been commended by the Human Performance Laboratory at Indiana.

Exercise: Not Only for the Body, But Also for the Mind

 

Performing these exercises can greatly affect the independence level as bedridden patients recuperate with their conditions. Not only that they are spared from acquiring bed sores by being a little more mobile in their beds, but also they get to exercise their muscles, therefore, preventing its gradual decay.

They have to remember, though, that their ability to perform these exercises highly depend on their energy level. So strenuous exercises for the bedridden can be done at their peak energy levels, while those that require minimal efforts can be performed through the day repeatedly. It is important as well that they should stop exercising before they get tired to conserve some energy.

 


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