Archive for the ‘Elderly Health’ Category

West Nile Virus is Back in D.C. -Things You Should Do to Stop the Spread

Wednesday, October 12th, 2011

Last week, the D.C. Department of Health confirmed this year’s first case of West Nile Virus (WNV). WNV is a bird disease. However, infected mosquitoes can transmit the virus to humans. Otherwise, this disease cannot be transmitted directly from a human or a bird.  Persons infected with the West Nile Virus may experience severe headaches, fever, nausea, vomiting, muscle aches, pain, and stiffness.

While the risk of a WNV infection is low, individuals who are immunocompromised should be particularly careful and seek medical attention if symptoms are present. Individuals with weak or suppressed immune systems include the elderly, young children and those prone to infections (e.g., HIV/AIDS patients).  The key is to implement measures to reduce exposure to mosquitoes. Individuals at risk should wear long-sleeved shirts and pants. Mosquito repellent should be used as well.

Every year, the Department of Health conducts WNV testing throughout the District, particularly in areas where infections have been reported. If you live in an affected area, you might receive additional information from the Department. Larvicide may be sprayed in your neighborhood. Should you require additional information about WNV, feel free to contact the D.C. Department of Health.

In the meantime, while mosquitoes are still flying around, here are a few things you could do stop the spread of the WNV:

1.  Dispose of cans, bottles and open containers properly.  Store items for recycling in covered containers.
2.  Remove discarded tires. Drill drainage holes in tires used on playground equipment.
3. Clean roof gutters and downspouts regularly.  Eliminate standing water from flat roofs.
4. Turn over plastic wading pools, wheelbarrows, and canoes when not in use.
5. Cover waste containers with tight-fitting lids; never allow lids or cans to accumulate water.
6. Flush bird baths and potted plant trays twice each week.
7. Adjust tarps over grills, firewood piles, boats or swimming pools to eliminate small pockets of water from standing   several days.
8. Re-grade low areas where water stands; clean debris in ditches to eliminate standing water in low spots.
9. Maintain swimming pools, clean and chlorinate them as needed, aerate garden ponds and treat with “mosquito dunks” found at hardware stores.
10. Fix dripping water faucets outside and eliminate puddles from air conditioners.
11. Store pet food and water bowls inside when not in use.

Please share this information with your friends and neighbors.

Health Reform: What voice does the patient have in the debate?

Tuesday, April 26th, 2011

Recently, I came across an Op Ed entitled Health Reform Requires Listening to Doctors. The very title suggests that  physicians and the health care system in general don’t have much of a voice in the discussion of health care legislation.

The question struck me – can that really be true? If the medical profession and health care industry are crying “poor us,” as the Op Ed author would suggest, that’s rather disingenuous at best. It’s well-known in today’s world of American politics that one sure way to have a voice is to hire a lobbyist. According to the Center for Responsive Politicsover $1 billion was spent on lobbying related to health care in 2009 and 2010. Who were the big players and payers in the hiring of lobbyists?

CNN Money tells the tale of the tape:

[L]obbyists for 1,251 organizations disclosed that they worked on health care reform in 2009 and 2010, according to the center and an analysis by the Sunlight Foundation. The number of individual lobbyists who reported working on health related legislation last year hit 3,154 in 2010.

Big Pharma topped the list. The Pharmaceutical Research and Manufacturers of America spent $22 million and deployed an army of no fewer than 52 lobbyists, according to the center.

Blue Cross Blue Shield, which used 43 lobbyists, spent $21 million. The biotech company Amgen (AMGNFortune 500) employed 33 lobbyists and spent $10.2 million.

Yet another source, iWatchnews.org, reports the following:

A Center for Public Integrity analysis of Senate lobbying disclosure forms shows that more than 1,750 companies and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009.

Among industries, 207 hospitals lined up to lobby, followed by 105 insurance companies and 85 manufacturing companies. Trade, advocacy, and professional organizations trumped them all with 745 registered groups that lobbied on health reform bills, illustrating the common Washington strategy of special interests banding together to pool money and increase their influence.

Seems like a whole lot of money was spent by the health care industry to have a voice.

This blog, however, is not intended to address issues relating to the Obama Health Care Reform (or as it is referred to in some circles as ObamaCare). I don’t claim to understand the in’s and out’s of that political football. I’ll leave that for the so-called pundits to address. What does strike me, however, is the travesty that recently played out in the setting of a threatened federal government shutdown.

Health Care Reform – the goal of the President’s Plan

What was the stated purpose and goals of the President’s health care reform? Look no further than the online posting by the White House for the answer:

Health reform makes health care more affordable, holds insurers more accountable, expands coverage to all Americans and makes our health system sustainable.

Sounds good in principle, right? Putting aside all the politics, rancor and ranting surrounding the debate over the specifics of health care reform, don’t you find it rather ironic that when recent budget cuts to avoid a government shutdown were the topic du jour, those who had very little, if any, voice were the people who desperately need can’t afford health care?

Recent Budget Cuts and Who Paid the Price

As I learned last week, when the back room deals were struck, those without a voice were the victims of political expediency.

As our own Jason Penn reported in his blog post, Budget Crisis Avoided, But What About the Babies? Can They Live With $504 Million Less in Funding?:

At the 11th hour, cuts were made, backroom deals were struck, and Washington spoke:  there will be $38 billion dollars trimmed from the federal budget.  On a positive note, federal agencies will remain operational until the end of September. Reason to cheer? Maybe. Before we break out the party hats and noise makers, let’s take a look at how healthcare fared.  The following areas are among those cut:

-         Special Supplemental Nutrition Program for Women, Infants and Children (WIC):  $504 million

-         Community Health Centers:  $600 million

-         Substance Abuse & Mental Health Services Administration:  $45 million

-         Infectious Disease prevention:  $277 million

Total:  $1.426 Billion.  Yes, billion, with a “B”!

Isn’t the answer of who does and who does not have a voice in the bigger picture of health care legislation and so-called fiscal reform self-evident. Who was there in the back rooms of our hallowed halls of Congress protecting those in need of good primary care programs? I suspect that when it’s crunch time, political expedience wins the day. Need cuts to keep a bloated beast alive and floundering? Snatch it from the ones who will be heard the least – the ones who don’t have the ability to spend over $500,000,000 a year for lobbyists so they can have their voice heard.

As Written in the Book of Isaiah the Prophet…

Apparently it’s just “politics as usual.” For all the rhetoric about making primary health care available to all Americans and improving and sustaining programs to deliver critical healthcare to those who need it the most, the voice crying in the wilderness was not loud enough. Maybe, as the Op Ed author claims, everything the medical profession and health care industry has to say is not being heard or at least being accepted. Nevertheless, they have a voice, which is more than can be said for those they claim they want to protect. How many of the enormous lobbying dollars did the medical community and health care industry spend to protect primary care programs from the budget-cutting ax? I suspect we all know the answer.

 

Image source: fromtheleft.wordpress

 

Deadly Super Bugs on the rise.

Wednesday, April 13th, 2011

Health scares are common and are many times overblown. However, the evolution of bacteria that are resistant to antibiotics (dubbed Super Bugs) is a very real and growing danger. Yahoo Health is reporting that two especially dangerous bacteria – MRSA and CRKP – are becoming resistant to all but the most advanced antibiotics, which is posing a major health threat.

Klebsiella is a common type of gram-negative bacteria that are found in our intestines (where the bugs don’t cause disease). MRSA (methacillin-resistant staphylococcus aureus) is a type of bacteria that live on the skin and can burrow deep into the body if someone has cuts or wounds, including those from surgery.

The reason for this new resistance is likely over-use (which includes mis-use) of antibiotics by health care providers (with likely some contribution from use of antibiotics in animals). For a few years now, there has been a growing recognition that doctors are over-prescribing antibiotics, i.e., routinely prescribing antibiotics when they are not necessary. For example, in 2005, U.S. News reported a Harvard study that revealed that doctors routinely prescribed antibiotics for sore throats in children when they were not indicated. A 2007 study indicated that Dutch doctors (whom are generally considered more careful in their use of antibiotics) routinely prescribed antibiotics for respiratory tract infections when they were not indicated.

The Problem with “Overuse”

The danger this poses is that antibiotics – even effective ones – typically leave some bacteria alive. These tend to be the stronger or more resistant bacteria, which then leads to the development of more and more resistance. This occurs in a single individual body in which a patient may have less response to an antibiotic after earlier use of that same antibiotic, but because of the easy spread of bacteria in our world, it also occurs on a global scale. For certain strains of bacteria, doctors are becoming hard-pressed to treat these infections.

CRKP – worse than MRSA?

Thankfully, MRSA is still responsive to several antibiotics so it is still considered a treatable infection. CRKP, however, is of more concern because it is only responsive to Colistin, which can be toxic to the kidneys. Therefore, doctors have no good options when treating CRKP. While so far, the risk of healthy people dying from MRSA and CRKP remains very low, the most vulnerable of us (the elderly and the chronically ill) remain at risk because of their lowered immune system and because the elderly are in nursing homes or other long-term care facilities where infections tend to spread more easily than in the general community.

CRKP has now been reported in 36 US states—and health officials suspect that it may also be triggering infections in the other 14 states where reporting isn’t required. High rates have been found in long-term care facilities in Los Angeles County, where the superbug was previously believed to be rare, according to a study presented earlier this month.

It is essential that we rein in the casual use of antibiotics before we are left with infections that have no cure. Doctors must be better trained to know when antibiotics are necessary and when they are not. For example, antibiotics are useless against viruses (such as the common cold), but how many of you have been given an antibiotic by a doctor “just in case” or because your symptoms have gone on slightly longer than a typical cold would last? It is unfortunately a more common occurrence than we realize. The past success of antibiotics has naturally led doctors to want to give them to patients to relieve suffering. No one wants to turn down a patient who is seeking relief.  However, it makes no sense to give antibiotics to a patient who has no bacterial infection or whose illness will clear up on its own.

Patient Awareness is key

The problem, however, is more than just educating doctors. Patients share some blame too. We – the public – need to learn that antibiotics are not always needed, which can be a difficult lesson to learn when we’re sick. Everyone knows that antibiotics are a quick and effective remedy against common bacterial infections. Antibiotics have saved countless lives over the years and have relieved untold human suffering. So naturally, when we are sick (or our child is sick) and we go to the doctor, we want to see results. We want something that will alleviate the pain and symptoms, not simply be told to wait for the illness to run its course. Sometimes, however, that is the best course when you consider the side-effects of antibiotics and the dangers of over-use. That being said, who wants to hear that when you’re in pain and want relief? It is very easy to demand of doctors that they use all available means to treat a sick child. Doctors need to be able to stand-up to patients and educate them on why antibiotics are not necessarily the best course of treatment in a specific situation.

Don’t kill the good ones!

Doctors also have to teach patients that antibiotics are not targeted killers.  The body contains a lot of good bacteria that are vital to our body’s functioning.  Antibiotics kill those bacteria as well, which some researchers believe can adversely affect health by allowing harmful bacteria to proliferate.  (If you have seen “probiotocs” advertised on certain food products – like yogurt – that is an attempt to introduce good bacteria back into your body.).

Some basic steps to take

In order to protect yourself (or a loved one), good hygiene remains the most effective method of remaining infection-free.  Thankfully, neither MRSA or CRKP are transmitted through the air.  They are typically transmitted through person-to-person contact, or else through hospital equipment such as IV lines, catheters, or ventilators.  If you have a loved one in a hospital or nursing home, be vigilant with your hand-washing and those of the healthcare providers caring for your loved one.

Also, if you are a patient who has been prescribed antibiotics, follow your pharmacist’s orders scrupulously and take the medication in the proper dosage and for the proper amount of time.  Stopping antibiotics too soon can leave bacteria alive, which contributes to the evolution of more resistant bacteria.  You may feel better and want to stop the medication, but it is important to take the full dose.

So – now that you know the risks of over-using antibiotics, are you willing to forego antibiotics when you are sick in order to do your part for the greater good?

UPDATE: (Editor – Brian Nash) Within an hour of posting Mike Sander’s blog on MRSA (and CRKP), I came across a tweet about Manuka Honey is being used for dressings to fight the spread of Super Bugs – particularly MRSA.

Researchers now believe that it can also put a stop to the rates at which superbugs are becoming resistant to antibiotics.

Anyone know of this practice being used in your area hospital or clinics? Does anyone know if this really works? If so, most interesting and useful. Here to spread the word – how about you spreading it too?

Most Doctors Don’t follow Colon Cancer Screening Guidelines

Monday, October 18th, 2010

Each year in the United States, colorectal cancer causes over 50,000 deaths.  Despite the obvious seriousness of colorectal cancer, a new study published in the Journal of General Internal Medicine reports that 81 percent of doctors are not following all recommended colon cancer screening guidelines.  While approximately 40% of doctors follow guidelines for some tests, a shocking 40% don’t follow recommended guidelines for any colon cancer screening tests.

First off, what are screening tests?  A screening test is a test for a certain disease that is given to patients who do not have symptoms of the disease.  This is different from a test that a doctor orders in response to a specific symptom, e.g., a finding of blood in the stool that results in a colonoscopy to discover the cause of the bleeding.  The purpose of a screening test is to catch a disease early, before it gets to the point where it starts to cause symptoms.  The earlier colon cancer gets detected, the better chance the patient has for a successful outcome.  Knowing this, it is difficult to understand why doctors are not following recommended guidelines.

One factor that the study’s authors noted was the age of the doctor.  Younger, board-certified doctors were the most likely to properly follow the guidelines.  Older doctors, on the other hand, were less likely to do so.  It appears that older doctors may be following guidelines that were in effect at the time of their training rather than keeping up to date with current guidelines.  This is not to suggest that the non-compliant doctors are all failing to recommend any screening tests.  The study indicates that some doctors are actually over-using the tests.  This, however, can result in additional risk (e.g., risk of injury from a colonoscopy) as well as unnecessary tests and higher medical costs.

From the patient’s perspective, it is wise to know yourself what the recommended guidelines are so that you can have a meaningful discussion with your doctor about what tests you should be getting and when.  As reported in the linked article:

Here are the American Cancer Society’s current guidelines on checking for colorectal cancer and polyps (often precursors to cancer). Starting at age 50, men and women should follow one of these testing schedules:

To detect both polyps and cancer (preferred) :

To primarily detect a cancer:

Some people may require a different screening schedule due to personal or family history; the cancer society recommends that you talk with your doctor to determine which schedule is best for you.

“Hospital Delirium” – a true concern for our society!

Friday, June 25th, 2010

There is a concerning report posted today by JusticeNewsFlash.com regarding “hospital delirium” in elderly patients. While it has long been recognized that elderly patients in hospitals are many times confused during their hospital stays, “contemporary resarch has indicated that such episodes may be accompanied by significant negative consequences” – longer hospitalizations, delayed procedures, increasing health costs, dementia later in life and a sginifciant rise inpremature death.

The American Geriatrics Society estimated that approximately one-third of patients over the age of 70, experience hospital delirium. Intensive-care and post-surgical patients also have an increased tendency to endure such cognitive lapses.

Though the cause of hospital delirium, more often reported as “confusion,” remains unknown, doctors have become more aware of its potential triggers. These included infections, surgery, pneumonia, medical procedures such as catheter insertions, among others.

All of these cases and procedures have a tendency to incite apprehension in many elderly patients. Certain medications have also been linked to hospital delirium.

McKnight’s, an online source for long-term care and assisted living, reports in a posting on June 24th:

A study has been underway by researchers at Indiana University. The report’s author, Dr. Malaz A. Boustani, referred to delirium among elderly patients as “more dangerous than a fall.”

On June 20, 2010, Pam Belluck, a reporter for the New York Times wrote a piece entitled “Hallucinations in Hospital Pose Risk to Elderly.” She recounts a chilling story of exactly how an 84 year old patient, Justin Kaplan, a Pulitzer Prize-winning historian with a razor intellect … became profoundly delirious while hospitalized for pneumonia last year. For hours in the hospital, he said, he imagined despotic aliens, and he struck a nurse and threatened to kill his wife and daughter.”

Doctors once dismissed it as a “reversible transient phenomenon,” thinking “it’s O.K. for someone, if they’re elderly, to become confused in the hospital,” said Dr. Sharon Inouye, a Harvard Medical School professor.

This thinking is now becoming significantly modified.

Some hospitals are adopting delirium-prevention programs, including one developed by Dr. Inouye, which adjusts schedules, light and noise to help patients sleep, ensures that patients have their eyeglasses and hearing aids, and has them walk, exercise and do cognitive activities like word games.

On a personal note, a very close relative of mine had undergone a knee replacement operation. Within a day of surgery, this elderly woman became so disoriented that she was convinced that she was being attacked by a strange man entering her room in the middle of the night. Fearing for her life, she picked up the nearest ‘weapon’ she could find – the bedside telephone – and struck the ‘intruder’ with the phone. It turned out that this ‘intruder’ was a male nurse coming to take her vitals. Hearing of this incident and shocked that this woman – my mother – would ever do such a thing (since she was the embodiment of the description -”wouldn’t hurt a fly”), my sister and I asked the hospital to check her electrolytes. It turned out that they were wildly abnormal. She was administered the necessary replacement therapy and returned to her normal, sweet self – having absolutely no memory of this incident whatsoever.

It is no secret that as the Baby Boomer population ages, the number of people in our country over the age of 70 will soon be very significant. We can only hope that physicians such as Dr. Sharon Inouye and Dr. Malaz Boustani will continue their research and efforts to learn what can be done to minimize the incidence rate of “hospital delirium.” It is good to see recognition of this problem now exists and that the concept of “it’s OK – it will pass; they’re just confused” is becoming a thinking process of the past.