Medical Blog, News and Information

HEALTH CARE OF OLDER PEOPLE: WHEN TO CHOOSE A GERIATRIC SPECIALIST

admin — Tue, 01 Jun 2010 13:43:23 +0000

As long as you select someone who seems aware of your needs, your physician need not have formal training in geriatrics. If you have several disabling conditions or are in your eighties or beyond and need to change doctors, however, it makes sense to search out a geriatric specialist. If a doctor has been recommended as specializing in geriatrics, find out exactly what training he or she has had. Ask about plans to take the newly developed licensing examination in the field.

If you live in an urban area, explore the possibility of getting care from a hospital-based geriatric service. Geriatric services offer state-of-the-art team care for disabled older people-workers from a variety of disciplines collaborate to keep people functioning independently. If this type of service is available, the care is likely to be excellent. You will be surprised at the attention and the sensitivity to your needs. People committed to geriatrics are a special breed; they combine technical skill with heart. When necessary, they are even happy to make house calls.

Another alternative you may have is a freestanding geriatric center. To understand what services this type of institution can provide, let’s examine the offerings of one – the Metropolitan Jewish Geriatric Center in Brooklyn, New York.

The Metropolitan Jewish Geriatric Center provides what it calls an “umbrella approach” to geriatric care, addressing the full spectrum of needs of older people who are having some trouble functioning independently. It offers inpatient services and a variety of outpatient programs. There is long-term home health care for people who are housebound: all the nursing, rehabilitation, and medical services of a nursing home are offered in a patient’s own home. There is the day hospital, a center open from nine to five offering activities, meals, nursing, and rehabilitation. There is the hospice program for people who are terminally ill. (Hospices minister to dying patients and their families, offering counseling and treatment directed toward pain control and comfort rather than cure. To enter this program, now covered by Medicare, a person must be judged as having no more than six months to live and must be willing to abandon curative treatments.) There also is an Emergency Alarm Response System (EARS). For a small monthly charge a subscriber’s telephone is hooked up to a central switchboard. Someone calls daily to check in. If there is no answer, a neighbor comes by to check. The older person living alone has the comfort of knowing help will arrive in a medical emergency.

There also is Elderplan, an HMO specifically for people over sixty-five. By paying a fixed sum, enrollees are entitled to all the outpatient services the center offers plus traditional medical and hospital care and care in a nursing home.

Except for Elderplan, all the programs offered at this geriatric center are now available in many communities. They are components of what is called a continuum of care. They exist to prevent nursing-home placement, to keep people with disabilities functioning in the community.

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GENERAL HEALTH

HEALTH CARE FOR OLDER PEOPLE: THE HMO ALTERNATIVE

admin — Tue, 01 Jun 2010 13:42:32 +0000

Increasingly, rather than selecting a private doctor, you may have another choice – joining a health maintenance organization or HMO. Rather than paying a physician for each appointment, if you join an HMO you pay a fixed sum in advance that entitles you to almost all (or all) of your medical care: checkups and routine care, laboratory tests, the services of specialists, hospitalization costs. There are two major types of HMOs – group practice and individual practice.

Group-practice HMOs provide all their outpatient services at a centrally located health facility, usually staffed by primary-care doctors, specialists (e.g., in eye care, hearing, surgery, gynecology), and additional personnel such as technicians and nurses. The clinic offers laboratories, X-ray services, a pharmacy, and perhaps ambulatory surgical care. On enrolling, a subscriber selects one of the primary-care doctors as a personal physician who is responsible for coordinating care. On routine visits patients may see a specially trained nurse practitioner.

Individual-practice HMOs provide primary care in the private offices of doctors under contract to the HMO. Joining this type of HMO may make getting to the doctor easier if you choose someone with an office near your home, but you may not receive the wide range of services you would get by joining a group-practice HMO.

A major advantage of joining an HMO is more financial peace of mind. Your medical bill is already paid. There are no large out-of-pocket expenses you might abruptly incur. There also is no economic deterrent to calling the doctor if you are ill, since visiting four times a month costs no more than once a month. And because HMOs have to operate within a fixed budget, they have an incentive to deliver services in an economical fashion. Studies show that, on average, people who use HMOs spend less for health care.

Does this emphasis on efficiency lead to poorer service? Although doctors opposed to HMOs reason that a system where people are paid beforehand no matter what they do offers a built-in incentive to provide minimal, cursory care, the reverse seems to be true. When researchers at Johns Hopkins Medical School reviewed the literature comparing HMO care with traditional fee-for-service care, nineteen studies showed that HMOs provided better care, a handful found the two types of care comparable, and only one or two found HMO care inferior.

On the other hand, the serious drawback to joining an HMO is the lack of freedom. HMO subscribers must use a certain hospital; when they need a specialist, they must visit someone under contract to the HMO. Many people decide against joining because they are not prepared to give up the right to go to the doctor or hospital of their choice.

Furthermore, only a fraction of HMOs accept Medicare. (Some HMOs not under contract to Medicare provide what is called Medicare “wraparound,” offering coverage for current subscribers, who then become eligible for Medicare.) Probably in part because of this, only a small minority of the elderly are enrolled in HMOs.

If you are interested in an HMO and able to enroll, use the same considerations in evaluating it as you would in selecting a private physician: cost (Does the HMO accept Medicare? How expensive is joining? What services are covered?); accessibility (How easy is it to get there? Will a doctor see you promptly if you are ill?); quality (Is the clinic overcrowded and unattractive? Are the doctors on the staff well qualified? What is the affiliated hospital like?).

James Doherty of the Group Health Association of America, a national organization of HMOs, also suggests finding out if the HMO is “federally qualified.” Federally qualified HMOs are approved by the Health Care Financing Administration. Your state insurance department will also have information about the quality of a prospective HMO.

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GENERAL HEALTH

NORMAL SLEEP PATTERNS: INFANCY

admin — Thu, 21 May 2009 06:58:45 +0000

The sleeping pattern begins to change in the first 6 months. This is a time of considerable irregularity, as babies’ neurological systems mature at different rates, but in early infancy sleeping patterns tend to coincide with feeding times — that is, babies wake to feed.

By 6 weeks of age, babies are awake for longer periods during the day, as they begin to take an increasing interest in their environment and interact with their care-givers. By 6 months their sleep is less linked to feeding patterns. Rather than sleeping for most of the time, they are awake for longer periods and seem to have several naps during the day. Some infants, to the great delight of their parents, are already sleeping through the night.

Between 6 months and 1 year of age, sleep patterns change considerably. The typical baby will sleep 10-12 hours at night and have two naps during the day. A greater number of babies sleep right through the night. Some may wake several times but will often go back to sleep with a minimum of fuss. This is also the time when they begin to establish more regular and predictable patterns of sleep and feeding and playing. There is still variation, depending on temperament and other factors. This is also the time when patterns are easily disrupted by illness. Many sleep problems have their genesis during this period, with parents unwittingly interfering with their babies’ sleep cycles, for example waking him for a feed. It is important that your baby be allowed to develop his own sleep patterns with minimal parental interference.

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NAUSEA AND VOMITING – DESCRIPTION

admin — Mon, 18 May 2009 06:50:10 +0000

Nausea is feeling sick in the stomach and we all know what vomiting is!

As with all symptoms, the first thing to do if you develop nausea is to find out the reason for it. Here are some of the many possibilities. Nausea can be directly due to your cancer itself — such as when it is in the stomach area or liver, blocking the bowel or kidneys or in the brain (this last usually causes headache as well). Nausea can be due to cancer treatment — radiation, chemotherapy or too little corticosteroid hormone in the system. Cancer can also cause nausea indirectly, for example, through release of too much calcium in the blood. Anxiety can itself cause nausea and can also aggravate nausea of any cause. Of course, don’t forget that your nausea could be nothing to do with your cancer. For example, it could be caused by something you have eaten, a virus, gastritis, a stomach ulcer, or even a hangover!

It is important to consider every possible explanation. For example, just because you are having chemotherapy, you should not jump to the conclusion that any nausea you have is due to it. Chemotherapy-caused nausea usually follows a similar pattern for each course of treatment. If your pattern changes drastically, another reason should be looked for.

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FRACTURES – SCAPHOID; COLLES’ FRACTURE

admin — Mon, 18 May 2009 06:26:56 +0000

Is easily broken. This is a common injury following a fall, for instance from a horse. It is recognised by a swelling and a deformity over the collarbone. Often a grating may be felt or a grating sound may be heard when the arm is moved.

Falls on the extended hands of young adults often fracture a bone in the wrist, known as the scaphoid. This will produce tenderness and pain near the base of the thumb. Although the wrist may still be used, this fracture is often missed and is regarded as “just a sprained wrist.”

It is a serious condition and requires at least 12 weeks in plaster. If neglected and not immobilised for at least two or three weeks, the bones may not heal quickly and could require five or six months in plaster, or even an operation at the end of that time.

Elderly people, particularly women, when they fall on the wrist, may break the lower part of the radius, the main forearm bone. This is obvious by the formation of a particular type of swelling at the lower part of the forearm, just before the wrist. It looks like and is in fact called the “dinner-fork deformity.” As the two broken ends may be driven one into the other (impacted), there is often still considerable mobility left in the wrist, and it doesn’t just hang limp. Put the arm in a sling and seek medical aid.

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GALLSTONES – CONCLUSION

admin — Fri, 15 May 2009 09:06:14 +0000

The drugs need to be taken for as long as a year and the stones may re-form when they are stopped.

The main use, then, of CDC, is in those with cholesterol stones for whom surgery is a considerable risk or who have stones in inaccessible areas such as deep inside the liver.

While the concept of dissolving gallstones is an intriguing idea and seems more attractive to sufferers than operation, it is a possibility for only a few and operation remains the most effective treatment.

Most sufferers lose all their symptoms following removal of the gall bladder and can function satisfactorily. The bile is produced at a constant rate and drips down into the duodenum rather than being concentrated and entering in spurts.

Unfortunately, a few people will not lose their intolerance to fatty food and we are not sure why.

My advice is that, if your gallstones are causing trouble, you will be better if you and your gallbladder are parted.

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FIBROADENOMA OF BREASTS – INTRODUCTION

admin — Fri, 15 May 2009 07:07:02 +0000

Not all lumps in the breast are due to cancer.

A frequent finding, particularly in young women, is that the lump is due to a fibroadenoma.

These are benign, that is, non-cancerous tumors which consist of both fibrous and glandular tissue. They are smooth, hard and freely moveable in the surrounding breast tissue and rarely become larger than a pea.

The doctor may be confident of the diagnosis, yet breast cancer is so common, so feared, and its treatment has such poor results if the diagnosis is made late, that most surgeons agree all breast lumps should be examined.

Small cysts may form in the breast and these can both be diagnosed and treated by inserting a needle into the cyst and withdrawing fluid for examination.

Even before removing what appears to be a benign lump, the surgeon will talk to his patient to find out her wishes should he discover that the tumor is malignant.

The normal procedure is to operate, remove the lump and subject it to frozen section.

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TREATMENT OF SYMPTOMS – INTRODUCTION

admin — Fri, 15 May 2009 06:39:13 +0000

Symptoms are what you feel— things such as pain, nausea, lack of energy and breathlessness. In this chapter we will talk about how to tackle symptoms that worry you for any reason.

Of course, now that you have cancer, I know that every symptom you get will worry you to start with. You probably feel a stab of panic whenever you notice any minor discomfort in your body because this could signal that your cancer is active. This reaction is natural and normal.

I suggest that whenever you get any new symptoms, you stop and ask yourself these questions:

Is this symptom one that I would have worried about before I had the cancer?

Would I have contacted my practitioner about it?

Is there a commonsense explanation for it?

(For example, unusual activity that could have caused muscle pains, something you ate that could have caused nausea or indigestion, tension that could have caused a headache.) The answers to these question will help you to decide what action you should take. For example, if you would, have waited a few days to see how it went before you had cancer, that’s probably still what you should do.

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THE G.I. FACTOR AND WEIGHT REDUCTION: WHAT FOODS DO CAUSE PEOPLE TO BECOME OVERWEIGHT?

admin — Fri, 08 May 2009 13:51:29 +0000

It was widely (and wrongly) believed for many years that sugar and starchy foods like potato, rice and pasta were the cause of obesity. Twenty years ago, every diet for weight loss advocated restriction of these carbohydrate-rich foods. One of the reasons for this carbohydrate restriction stemmed from the ‘instant results’ of low carbohydrate diets. If your diet is very low in carbohydrate, you will lose weight. The problem is that what you primarily lose is fluid, and not

fat What’s more a low carbohydrate diet depletes the glycogen stores in the muscles making exercise difficult and tiring.

Sugar has been blamed as a cause of people becoming overweight largely because it is often found in high fat foods, where it serves to make the fat more palatable and tempting. Cakes, biscuits, chocolate and ice-cream contain a mixture of sugar and fat. However, the primary sources of fat in our diet are not sweet. Fatty meat, cheese, French fries, crisps, butter and margarine contain no sugar.

Current thinking is that there is little evidence to condemn sugar or starchy foods as the cause of people becoming overweight. Overweight people show a preference for fat-containing foods rather than a preference for foods high in sugar. In a survey performed at the University of Michigan where obese men and women listed their favourite foods, men listed mainly meats (protein-fat sources) and women listed mainly cakes, biscuits, doughnuts (combinations of carbohydrate-fat sources). Other studies have found that obese people habitually consume a higher fat diet than people who have a healthy weight. So, it appears that a higher intake of fatty food is strongly related to the development of obesity—not carbohydrate-rich foods.

Whether you are going to gain weight from eating a particular food really depends on how much that food adds to your total kilojoule intake in relation to how much you burn up. To lose weight you need to eat fewer kilojoules and burn more kilojoules. If your total kilojoule balance does not change—there will be no change in your weight People who consume a high fat diet automatically eat a high kilojoule diet because there are more kilojoules per gram in fatty foods. This is why eating low-fat foods makes weight loss much easier.

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PHYSIOLOGICAL ADJUSTMAENT AND FAT LOSS: IMPLICATIONS

admin — Fri, 08 May 2009 13:15:04 +0000

1. Maintenance requirements in a fat loss program may be more demanding and may differ significantly from actions leading to initial fat loss.

2. Energy restricting diets alone should not be used for fat loss over an extended period as these lead to physiological adaptations which can counteract the fat loss.

3. Energy restriction below 1200kcal per day should not be used over an extended period except in special cases of supervised dietary restriction for severe obesity.

4. Except where contra-indicated, physical activity should play a significant role in long term maintenance of fat loss.

5. Resistance training may be indicated in the maintenance stage of a fat loss program to ensure a counterbalance to the adaptations that occur to slimming.

6. Clients who have been on very low energy diets for extended periods may need to be gradually re-fed until daily energy intake is around 1200-1500kcal per day.

7. Clients should be made aware that long term continuous fat losses will only occur with increased changes in energy balance and/or alterations to the type of food intake and energy output.

8. The proportion of LBM to fat loss following a diet is likely to be much higher in people with a lower initial body fat level, hence people who are only mildly overfat and who use dietary restriction alone to treat this, are actually likely to finish with an higher proportion of body fat than at the start of a slimming initiative.

9. Physical activity should form a more significant part of the initial fat loss and fat loss maintenance regimes of those with a relatively low fat to total body mass ratio.

10. Behaviour modification principles utilised for fat loss should be continued in the maintenance stage.

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