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HIGH-QUALITY MEDICAL CARE FOR OLDER PEOPLE: EVALUATING YOUR CURRENT PHYSICIAN

admin — Tue, 01 Jun 2010 13:20:09 +0000

Unfortunately, few doctors now practicing have been trained in geriatrics. But good physicians will have intuitively learned to adapt their approach to the special needs of patients who are older or disabled by chronic disease. Before age even enters the equation, your doctor must have the twin essentials for providing good care – technical competence and a good bedside manner.

A good bedside manner is not irrelevant to quality treatment. We are more likely to visit a doctor who is warm and accepting; we are more likely to make an appointment and to follow through on any procedure the doctor suggests. Having a doctor with a congenial personality is even more important as we grow older, because our physicians are almost destined to become much more central in our lives. These 1983 statistics are a grim testament: in that year, Americans aged twenty-five to forty-four saw a doctor an average of 4.8 times; the figure for people over seventy-five was 8.4 times.

Dealing with chronic illnesses involves ongoing collaboration. It behooves you to have a collaborator who seems caring, whom you can talk to honestly, who values what you say, who believes that something can be done for you, whom you can feel free to “bother” with any reasonable question or concern.

On the other hand, a pleasing personality can be seductive. We tend to develop an intense attachment to our doctors-, a combination of respect and adoration very like the bond young children develop with their parents. We are especially likely to develop these “transference” feelings if we have a longstanding relationship with our doctors, are seeing them regularly, and have a potentially fatal disease. But love can blind, and blind loyalty can be dangerous. It can cause us to put up with poor care beyond the time we should. We don’t get a second opinion because we are afraid it will hurt the doctor. We have been with him for thirty years, and he has always treated us so well. We may be afraid if we change doctors we will not get the same attention. “Won’t I lose my special relationship with Dr. Smith if he learns I consulted someone else?”

My husband is assertive in his business, but he is jelly when it comes to saving his own life. He has cancer of the throat. The prognosis is not good. I know oncologists differ in their skill and their ability to cure. He insists on staying with the first doctor we consulted, a man I know is second-rate. I think another doctor might be his life raft, or at least buy him more time. He is clinging like a baby to this sinking ship.

If you suspect you are getting inadequate care, harden your heart. Put aside loyalty, love, and inertia and get a consultation. What you learn may make you more secure, or you may discover your suspicions are right – that you must steel yourself and find a new doctor.

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GENERAL HEALTH

HIGH-QUALITY MEDICAL CARE FOR OLDER PEOPLE: HANDLING PHYSICIAN/PATIENT RELATIONSHIP

admin — Tue, 01 Jun 2010 13:17:58 +0000

The success rate of this program shows that to wage war against disabilities it is important to have high-quality medical care. Here are some ways to help ensure you get that care.

School yourself in the modern point of view. You and your physician are collaborators. The doctor is obliged to treat you as an intelligent person, to explain things to you carefully in understandable terms. You have the obligation to want to know and should take the following steps to be a responsive partner in your care.

Call your doctor when you experience any unusual new symptom or physical change. It is not necessary to pick up the phone at every headache or cold, but when anything unusual happens physically, give your doctor a call. If thoughts like these give you pause – “It’s old age”; “I don’t want to bother the doctor”; “He can’t do anything for me” – tell yourself, ‘ ‘Until I get my medical degree, I’ll let Dr. Jones be the judge.”

Visit or call armed with a written list of questions. Many people get flustered when they talk to a doctor and forget half of what they wanted to say. So be organized. Write down every question before you see your physician. Make your list as comprehensive as possible. Understand that difficulties such as getting to the store are also legitimate problems for the doctor to help you with.

Ask for exact information about what tests, treatments, and diagnoses mean. Do not accept “doctorese.” Insist on explanations you can understand. When the doctor prescribes drugs, know what to expect and what the possible side effects are. When your physician suggests surgery, know the risks and the nonsurgical alternatives.

Question your doctor thoroughly if anything is unclear. Squelch the thought, “She’s too busy” or “I’m being difficult.” Take all the time you need. If you still have doubts or questions after you leave the office, get more information. Don’t hesitate to call back armed with a new list.

If necessary, read about your problem on your own. Go to a library and check out some medical books. You may not have gone to medical school, but any intelligent person can become a lay expert in an area of special concern.

Report side effects of medications or treatments promptly. If a prescribed drug makes you feel bad, rather than suffering in silence or not following through, call back. Your doctor may be able to suggest an alternative treatment that works without having the side effect.

When surgery is recommended, get other opinions. Medicare will pay for any surgical second opinion and also pays the full cost of a third if the first two doctors disagree. To get a second opinion, rather than asking for a name from the specialist who recommended the operation, call your family doctor for a referral. Or try this approach: call a top-rated teaching hospital and ask for an appointment with the chairman of the department that handles your disease (the chief of cardiology, oncology, etc.). If you cannot see that person, ask for a referral to another senior faculty member. For your own peace of mind, try to get any second opinion about surgery from the very best source. Since some of these suggestions may be difficult to implement on your own, consider asking a relative or close friend to help. Could your brash son-in-law be prevailed on to set up an appointment with that ultra-competent, hard-to-reach specialist? On your monthly visits to the doctor, could your daughter or Mrs. Smith from around the corner accompany you? Because things move so quickly during those often-rushed office visits, having a companion (that is, an ally) to step in and slow things down may increase the chance that your concerns will be heard. Meet beforehand to formulate your list of concerns and questions. And check with one another before you leave the office: “Was anything Dr. Jones said unclear?” “Do I have other things to ask?”

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GENERAL HEALTH

YOUR CHILD’S HEALTH/SLEEP AND SLEEP PROBLEMS: NORMAL SLEEP PATTERNS

admin — Thu, 21 May 2009 06:58:25 +0000

Sleep problems are among the commonest concerns that parents have with their children. About one in four of all children are said to have sleep problems at some stage. Some have difficulty in getting to sleep, others in staying asleep, while others have their sleep interrupted by nightmares or night terrors. All children, like adults, need adequate sleep to replenish energy. Insufficient or interrupted sleep has a deleterious effect on children at any age. Children’s sleep problems also have an impact on the rest of the family and they create an enormous amount of stress for parents, whose own sleep is often interrupted.

NORMAL SLEEP PATTERNS

There is a great deal of individual variation in sleep patterns and requirements at all ages. What seems sufficient for one child is too little for another. All babies, children and adults go through specific sleep cycles. They move systematically from deep sleep to light sleep to REM (rapid eye movement) sleep. This cycle repeats itself about five times in 8 hours of sleep. Dreaming takes place in REM sleep, which seems to last about 10-20 minutes at a time.

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DISLOCATIONS

admin — Mon, 18 May 2009 06:21:23 +0000

These injuries are due to violence occurring around the joints. The joint is disrupted and the bones moved from their normal position.

The earlier medical attention is sought, the easier it is to reduce the dislocation. Once the joint has been displaced for some time, rather strong muscular spasm is present, and it may be necessary to anaesthetise the patient to reduce the dislocation.

Simple dislocation of the finger joints can often be replaced by firm pulling of the end of the finger, and holding the wrist with the other hand.

It may be easier to do so immediately after the finger has been dislocated, and many sportsmen are quite adept at fixing their colleagues’ dislocated fingers.

The shoulder joint is a shallow “ball-and-socket” joint and is often subject to dislocation. Only a doctor should attempt its reduction because of damage to nerves and arteries through careless handling.

Some people develop recurrent dislocation of the shoulder, which may “come out” with only a very trivial injury. They become adept at replacing it.

An operation is available to correct recurrent dislocation of the shoulder.

A great deal of force is required to dislocate the knee or the hip, and these injuries are often seen in motor vehicle accidents. They are only to be handled by the expert.

First aid is to immobilise the injured part, relieving pain and treating shock.

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GALLSTONES – DIAGNOSIS

admin — Fri, 15 May 2009 09:02:53 +0000

Sometimes, when the gallbladder is not functioning properly, it fails to concentrate the dye and poor films are the result. However, a non-functioning gallbladder on a cholecystogram is indicative of disease. Sometimes the dye is given by injection.

Ultrasound scanning may also be used in detecting gallstones.

Once the diagnosis is made, treatment will be recommended. Of course, this will depend on the symptoms from which the patient is suffering and whether any complications are present.

Large gallstones discovered accidentally, and which are causing no symptoms, are probably best left alone. Multiple small stones are better removed.

This is because they are prone to move and enter the common bile duct, obstructing it. Operation is then a matter of urgency and is more difficult and requires a longer convalesence.

Unfortunately, operation remains the main way of dealing with this problem. It usually only involves a stay of five to seven days in hospital.

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EXCESSIVE BODY HAIR – MALE DOCTORS

admin — Fri, 15 May 2009 07:06:39 +0000

Because most doctors are male, many may not fully appreciate how severe the worry can be to the woman with an excess of body or facial hair. Not every woman with the problem needs to be fully investigated by special tests. A full history and examination usually including a pelvic examination to assess the reproductive organs, should exclude most of the serious disorders. It may be necessary occasionally to carry out hormonal assays by blood tests.

Unfortunately, there is no simple or effective treatment. If there is a definite cause for increased androgen activity it should be treated.

Drugs are sometimes used to counteract the androgen effect. Cortisone in small doses may be effective and the Pill is often used for the same reason. Sometimes, the two are combined. ”

In those who are both obese and hairy, reducing weight may restore the body’s hormonal balance and solve both problems.

In most cases, bleaching the offending hairs so they become less noticeable is acceptable only to a minority. Yet this can be combined with other treatment so that these methods need be used less frequently.

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BABY AND CHILDHOOD INFECTIOUS DISEASES: TETANUS

admin — Fri, 08 May 2009 08:31:36 +0000

Tetanus is a disease too terrible to think about. It can affect anybody, and this includes the newborn. In fact, of the million or more cases of tetanus deaths that are reputed to occur world-wide each year, about half are of infants under the age of 12 months. Inadequate hygiene and lack of specific protection are the main reasons.

The disease is produced by an organism called Clostridium tetani. This organism can produce spores which are very resistant and can live for a long period of time. They are a normal inhabitant of the bowel, and for this reason are very common in manure. That’s why persons who enjoy gardening are at special risk. Once it starts to multiply, the germ produces an extremely powerful toxin which may be rapidly fatal. Many cases occur from simple puncture wounds in which germs have been inserted. Often the wound is so small that the person is unaware of it happening. Babies in the Third World are at special risk, for their umbilical cord is a wonderful spot for the germs to dwell and multiply.

The incubation period varies from five days to five weeks. Onset of symptoms may be heralded by crampy pains in the muscles, commonly of the back or abdomen. The patient shows restlessness, irritability and difficulty in swallowing. There may be early convulsions. Gradually, the muscle stiffness and tension increases. The muscles of the jaw often are affected early. They contract, giving the false impression the patient is grinning. As time passes, swallowing becomes more and more difficult, wild tetanic spasms of the muscles occur, with the head and back retracting, and intense pain is felt. Fists and jaws clench.

The course of the disease is terrible and the agony experienced is major and terrifying. Parents should know of these symptoms in detail to understand the urgent need to prevent this awful disease from developing in their own offspring.

Tetanus is a totally preventable disease. In fact, the protection afforded by adequate immunization is remarkable. This is usually started when the baby is two months old. (Refer to the childhood immunization schedule given earlier in this chapter.) The procedure is a very simple one, but the beneficial effects are enormous.

It can totally prevent tetanus, and is probably the most amazing and complete cover against disaster that is currently available in this country. It is wise to continue with regular updating booster shots, ideally throughout life. Therefore following the initial course started at two months, boosters are offered at 18 months, then pre-school and ideally each 5-10 years thenceforth for the rest of a person’s life. If a dirty wound occurs meanwhile, most doctors suggest an immediate booster at that moment also, just to be doubly sure.

There are about twenty cases of tetanus annually in Australia. This is fairly high when it is considered that in Great Britain, a country with a population four times that of Australia, they also have about twenty cases annually.

Treatment

Treatment of tetanus, of course, is basically to prevent it by sensible immunization. After any wound that is potentially dirty—and this may include simple gardening injuries—a check with the doctor is advised to ascertain whether a booster shot is necessary, or other protective given, irrespective of the age of the child.

Tetanus itself requires particularly skilful treatment, ideally in the intensive care ward of a major hospital which has access to full nursing and medical facilities. At the first sign of any of the symptoms after an accident, irrespective of how minor, medical attention by the doctor is strongly advised.

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EARLY DEVELOPMENT

admin — Fri, 08 May 2009 08:25:15 +0000

Baby rapidly grows from the day of birth. Most babies weigh about 3333 g at birth (approximately 7 lb 5 oz). This doubles by the age of six months, and trebles at 12 months. In the second year, the baby will gain about 3.5 kg (about 7% lb), and another 2.5 kg (about 5% lb) in the third year. From this point on, the child will gain about 2.5 kg each year until reaching the period known as puberty. At this time, enormous internal hormonal changes suddenly occur, and there is a wondrous growth spurt as the child sails into adolescence and later into early adulthood.

Baby’s height also increases. This is very rapid in the first six months, after which the rate tends to slow down. Many factors play a part in the individual’s ultimate height. Inherited genetic factors, general health and many environmental considerations all come into play.

But how does the average Australian baby develop month-by-month in the early days? Here is a general guide as to what you may expect during the first six months. Every baby, being an individual, will differ. But the general development usually occurs along these lines. Do not be alarmed if your child does not measure up to this pattern exactly, for differences are often considerable. Conversely, the child may seem to be developing at a much faster rate. But in the long term, it all averages out. The great majority finally fit into the norm which makes up the average Australian child, and finally the average Australian adult.

You might wish to keep a record in the margins of this book of the age the baby achieves each milestone. Also, add any other activities you notice. Later on, especially if other babies follow in your family, you will have a record of the child’s development that can be compared with others to lessen parental worries.

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DISEASES OF BLADDER

admin — Wed, 29 Apr 2009 09:32:57 +0000

A bladder sign is typically found in the fourth minor zone—the muscle zone, in the right iris at 22′, and in the left iris at 37′.

Bladder signs in the right iris are of organic origin and usually hereditary. Those in the left iris arise from infection. With bladder signs in the right iris one should give attention to signs in the ear areas, following the rule: Forefathers with bladder troubles—children with ear troubles. Children having dark bladder signs in the right iris are usually found to have signs in the ear area. Such children tend towards aural disturbances.

In the case of bladder signs in the left iris, look for an aortic sign. If both areas—bladder and aorta—are indicated, then consider the possibility of luetic infection. In such a case a heart sign is usually found as well.

1. Cystitis: inflammation of the bladder: shows white wisps, clouds or lines in the bladder area, or also a dark sign with a surrounding white border. If cramp occurs with bladder troubles (vesical spasm), then the appropriate area will show interrupted cramp-rings

(contraction rings = nerve rings).

2. Atony of the bladder: is a muscular weakness and shows as dark oval lacunae or dark wisp signs in the fourth minor zone (muscle zone) of the bladder area.

3. Cystic paralysis—danger of: is indicated by an extension of this weakness-sign (lacuna) out over the fifth minor zone.

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CHILDREN’S HEALTH: BOTULISM

admin — Tue, 28 Apr 2009 09:23:56 +0000

Botulism is a specific type of food poisoning. Botulism is caused by the toxin (poison) produced by Clostridium botulinum, a germ which is related to the tetanus germ and prevalent everywhere. The botulism germ grows in anaerobic (no oxygen) environments (such as in tightly closed jars that were not properly sterilized). Its toxin can be destroyed if it is heated for ten minutes at 82° Ñ Botulism poisoning is primarily caused by improperly prepared canned or preserved foods that have not been adequately heated before they’ve been eaten. The foods most likely to cause poisoning are seafood, mushrooms, meat, and vegetables. The toxin and germs are undetectable. Foods contaminated with botulism look, smell, and taste normal.

With improvements in commercial food preparation and the decline in home canning in the first half of the 20th century, botulism had become a rare illness. With the increased interest in home canning and “natural” foods (those without preservatives), botulism is threatening a comeback.

Adults and children past infancy can be poisoned by botulism only if they eat food in which the botulism germ has already formed the toxin. Recent cases of fatal botulism among infants, however, suggest that the botulism germ can grow in an infant’s immature intestines to form the dangerous toxin within the infant’s body. The only natural food so far identified as a source of botulism germs for infants is honey. Therefore, you should not give honey to an infant. However, other raw or improperly cooked foods may eventually be identified as potential sources of the germ.

Signs and symptoms

Symptoms of botulism are nausea; vomiting; diarrhea; abdominal pain followed in 12 to 48 hours by double vision; dilated pupils; and difficulty speaking, swallowing, and breathing. There is no fever and no loss of awareness or alertness. Death may result.

Suspect botulism if your infant develops symptoms within a week of eating raw or home-prepared foods. Suspect the disease if more than one member of your family develops similar symptoms after eating the same prepared food. If symptoms of stomach or intestinal upset are followed by paralysis that starts at the eyes and moves downward, botulism may be the cause. Home diagnosis, however, is totally unreliable. Consult your doctor immediately if possible symptoms of botulism occur.

Home care

None. Call your doctor immediately if you suspect botulism.

Precautions

• Do not give babies unwashed, unpeeled raw foods or improperly cooked foods.

• Do not give honey to infants.

• Do not use foods in damaged or dented store-bought cans. Damaged cans may have developed leaks through which the botulism germ can enter the food.

• When canning or preserving foods at home, follow preparation and sterilization directions carefully.

Medical treatment

Diagnosis is made by cultures of the food eaten, stomach contents, and stools and by identifying the toxin in the patient’s blood. Treatment includes injection of the antitoxin (a substance that counteracts the effects of the poison). Stomach washing, laxatives and enemas, possibly antibiotics, and hospitalization may be necessary. Immunization to prevent botulism is available, but only for persons at high risk.

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