Avoiding Slow Death

Avoiding Slow Death

Pick up almost any literature source, a newspaper, magazine, or even look on the Internet, and you will likely find an article about Diabetes.  Whether it’s the horrors and related affects that develop, or the causes, preventions, new treatments, or the increased numbers who are getting Type 2, we see more about this than about the presidential elections.

And with good reason – Type 2 diabetes is a killer that can be prevented, cured, or at least minimized. All it takes is good sense and will power.  And being scared of what this condition can do.

Diabetes killed my mother, and her mother and brother.  Knowing the agonies of their lives is frightening, and knowing that we’ve come a long way to understand the causes, prevention, and treatment since my mother succumbed in 1980, makes one wonder why anyone lets themselves develop this condition.

Like most illnesses, many people are more prone to glucose difficulties than others.  It’s simple – if you mother had it, you’re in line to get it.  If your father, grandparents, or other relatives had it, you have an elevated chance.  But anyone can risk Type 2 by being overweight. Three simple precautions minimize your risk – no smoking, maintain a reasonable weight, and exercise. Seems as if these same preventative steps also diminish the chances of getting cancer, heart problems and a number of other conditions.  Seems like a good idea.

A simple blood test once a year should keep you on track.  If your physician feels you have a risk, do not wait.  And ask your doctor – do not assume you will be told.  Borderline cases, which should sound loud warning bells, are frequently neglected, yet, as with cancer and heart conditions, recognition of the increased possibility should be sufficient to get you moving.

Type 2 diabetes can lead to numbness and pain in the extremities, potentially leading to infection and amputation.  It is a leading cause of kidney failure and blindness.  Why risk it?

They Got it Wrong – Again

They Got it Wrong – Again

It is not unusual for an American administration, a Federal agency, or Congress to make mistakes.  It seems, though, that during the last seven years the current crop of politicians have had more than their share.

The latest, that we know of, was the recent announcement that Jake Liao’s life has been saved.  Although only two years of age, Nate may well go down in history as the first person to have received successful treatment for a little known disease, epidermolysis bullosa (see Slightly Creaky’s Medical Support sites for links to sites about this disease).This is (from EBAers) “a rare autoimmune blistering and fragile skin disorder which can also affect the mucous membranes. Painful injury can occur from minor friction or shearing action upon the skin as well as from even the most minor trauma. Rashes and itching are also common problems associated with this disease. The chronic inflammation, blistering, minor trauma injuries, and resulting scars can severely impair or hinder the normal activity and functioning of the EBA patient on a daily basis.”

There is no treatment, no relief from life-long disability. At least not until the University of Minnesota Medical School, defying the wishes of President Bush, his administration and followers, successfully used stem cells.  (From UMNNews) “On October 19, a team led by John Wagner, head of pediatric blood and marrow transplantation, transplanted bone marrow and cord blood cells into Nate from his brother Julian, who does not have EB. Julian is a 100 percent match for Nate. Wagner anticipates that Julian's bone marrow and umbilical cord blood will result in a new healthy blood system that produces type VII collagen, the protein missing in children with EB.” 

The treatment was a success, with Nate now able, for the first time in his life, to wear normal clothing without the blistering that results in skin diseases, and he can now eat solid food.Hopefully this is only the first breakthrough for stem cell research.  Once the current administration is no longer in office and true science can again freely produce the medical breakthroughs that the United States has been know for, there is no telling what other diseases can be cured.

Feds Insults Health Mileage

Feds Insults Health Mileage

For years, the Internal Revenue Service has recognized that traveling costs money.  Thus you can deduct mile expenses (at a set rate per mile) for traveling to find a job, traveling for business purposes, for charity work, for household moving expenses, and for obtaining medical care. Actually, it’s Congress that sets the rates, or simply ignores reality.

While energy prices, across the board, are rising at a rate never before seen, and this started more several years ago, and while Congressional candidates (this is an election year) have known about the rising cost of energy, not only have they not increased the deduction to match, but they have actually reduced the write-off in one major category. And this reflects the power of the business lobbies. xxIf you are traveling for business purposes, you could deduct, for 2008, 50.5 cents a mile.  Even at $4 a gallon that seems a huge amount – it assumes you get 8 miles to the gallon or that your car is in such bad shape that it needs other repairs. You can also deduct for tolls and parking separately and above the mileage rate.  Thus if you are traveling from my house to New York City on business (not commuting, but, for example, going from your work place to another), you can deduct the $95.95 for distance.

Yet, as my wife travels to the Hospital for Special Surgery several times a month for care of her fractured hip, and soon for a knee replacement, she can only deduct 19 cents a mile. (Charity work is set at 14 cents a mile.)  Last year Congress was gracious enough to grant medical distance at a 20-cent rate – with the huge increase in prices at the pump, what was the reason for the decline this year? xxTaking the same distance, my house to New York City, the medical deduction only comes to $30.40 round-trip.

Considering the already high cost of medical care and prescriptions, and that the elderly (retired on a fixed income) are more likely to need medical care and that most businesses actually pay mileage for business trips so it can not be deducted anyway, does it make sense for this large disparity? Top that off by remembering that you first have to reduce your combined medical deductions by 7.5% of your income prior to taking it off your income when calculating taxes and business expenses do not face any reduction.

Thus, a businessman making $100,000 a year can take his entire travel expense (including food and any overnight stays) while a retired person, on a fixed $50,000 pension, Social Security, with perhaps some investment income must reduce his medical expenses by $3,750 without any meal reduction.

Assuming 20 such trips a year, as described above, the businessman gets an annual travel-related tax adjustment of $1,919, and the retired person gets nothing.  His 20 trips result in an IRS deduction of $228, far below the $3,750 adjustment reduction. xxDo any of the Presidential or Congressional candidates want to address this issue?  If you have the opportunity, ask them. (How to contact your Congressional member.) While you’re at it, ask why there is no tax adjustment for home heating fuel, while businesses get to write it off as an expense.

Actively Disabled

Actively Disabled

Actively Disabled people, although slightly creaky, are those who have a disability that, should they wish, prevent them from being socially and physically active.  This would include those with amputated limbs, spinal disorders, joint replacements, and many diseases.

Rather than seeing themselves as a disabled person, they look at life as a person with a disability.  Although they acknowledge their limitations, they learn to work with and around them.  Stephen Hawking has been considered one of the brightest men in physics for the last 30 years, in spite of having ALS since he was in college, confined to a wheelchair, unable to feed himself, and having lost his ability to speak. There are many similar people with such conditions who continue to get all they can out of life. These are the "Actively Disabled."

My wife is a polio survivor. She developed Post Polio Syndrome in the early 1980.  It manifested itself first with a weakness and severe pain upon contact on her right shoulder.  Eventually her right leg, which was the most damaged by the polio event, became weak and brittle. Osteoporosis cased an ankle fracture, then a knee fracture, then two femur fractures, the most recent involving her hip.  One feature of polio survivors is a diminished capacity for healing, especially traumatic injuries like bone damage.  Thus, ten months after the original hip fracture, she had a hip replacement. While partial movement returned, the pain has become so severe that even medication is not helping much.

Throughout this 35-year ordeal, since the first fracture, she has not given up.  We continued camping and hiking every summer, just going slower, taking more frequent rests, and not climbing steep slopes. We continued spelunking, although in commercial caves rather than ones where crawling on your back was the only way to get through passages.

With the femur fractures more adjustment has been necessary.  We have stopped camping, and tend to fly to our vacation destinations.  But that’s not a problem as we had previously taken seven road trips around the united States and Canada, and now it was time to circumnavigate South America, to finally visit the Caribbean, and to take that cruise to Alaska (where we rented a car and visited the Iditarod Trail and several of the musher’s kennels).

After 16 months with a hip replacement, my wife is again driving short distances, taking longer walks, shopping, and looking forward to our next cruise.  This summer she will likely need a knee replacement, but we’ve already made plans for a South African safari next spring.   Many disabilities cannot be overcome, but you can learn to live with them and remain active.  It may be easier to stay at home, complain, and give up all the exciting things in life. An Actively Disabled person, though, is still living, still experiencing, still learning. To be active is to be alive.

Be All You Can Be

Be All You Can Be

Actively Disabled people, although slightly creaky, are those who have a disability that, should they wish, prevent them from being socially and physically active. This would include those with amputated limbs, spinal disorders, joint replacements, and many diseases.

Rather than seeing themselves as a disabled person, they look at life as a person with a disability. Although they acknowledge their limitations, they learn to work with and around them. Stephen Hawking has been considered one of the brightest men in physics for the last 30 years, in spite of having ALS since he was in college, confined to a wheelchair, unable to feed himself, and having lost his ability to speak. There are many similar people with such conditions who continue to get all they can out of life. These are the "Actively Disabled."

My wife is a polio survivor. She developed Post Polio Syndrome in the early 1980. It manifested itself first with a weakness and severe pain upon contact on her right shoulder. Eventually her right leg, which was the most damaged by the polio event, became weak and brittle. Osteoporosis cased an ankle fracture, then a knee fracture, then two femur fractures, the most recent involving her hip. One feature of polio survivors is a diminished capacity for healing, especially traumatic injuries like bone damage. Thus, ten months after the original hip fracture, she had a hip replacement. While partial movement returned, the pain has become so severe that even medication is not helping much.

Throughout this 35-year ordeal, since the first fracture, she has not given up. We continued camping and hiking every summer, just going slower, taking more frequent rests, and not climbing steep slopes. We continued spelunking, although in commercial caves rather than ones where crawling on your back was the only way to get through passages.

With the femur fractures more adjustment has been necessary. We have stopped camping, and tend to fly to our vacation destinations. But that’s not a problem as we had previously taken seven road trips around the united States and Canada, and now it was time to circumnavigate South America, to finally visit the Caribbean, and to take that cruise to Alaska (where we rented a car and visited the Iditarod Trail and several of the musher’s kennels).

After 16 months with a hip replacement, my wife is again driving short distances, taking longer walks, shopping, and looking forward to our next cruise. This summer she will likely need a knee replacement, but we’ve already made plans for a South African safari next spring. 

Many disabilities cannot be overcome, but you can learn to live with them and remain active. It may be easier to stay at home, complain, and give up all the exciting things in life. An Actively Disabled person, though, is still living, still experiencing, still learning. To be active is to be alive.

FDA Blunder Causes Unneeded Deaths

Another FDA Blunder Causes Unneeded Deaths

Actively Disabled people, although slightly creaky, are those who have a disability that, should they wish, prevent them from being socially and physically active. This would include those with amputated limbs, spinal disorders, joint replacements, and many diseases.

Rather than seeing themselves as a disabled person, they look at life as a person with a disability. Although they acknowledge their limitations, they learn to work with and around them. Stephen Hawking has been considered one of the brightest men in physics for the last 30 years, in spite of having ALS since he was in college, confined to a wheelchair, unable to feed himself, and having lost his ability to speak. There are many similar people with such conditions who continue to get all they can out of life. These are the "Actively Disabled."

My wife is a polio survivor. She developed Post Polio Syndrome in the early 1980. It manifested itself first with a weakness and severe pain upon contact on her right shoulder. Eventually her right leg, which was the most damaged by the polio event, became weak and brittle. Osteoporosis cased an ankle fracture, then a knee fracture, then two femur fractures, the most recent involving her hip. One feature of polio survivors is a diminished capacity for healing, especially traumatic injuries like bone damage. Thus, ten months after the original hip fracture, she had a hip replacement. While partial movement returned, the pain has become so severe that even medication is not helping much.

Throughout this 35-year ordeal, since the first fracture, she has not given up. We continued camping and hiking every summer, just going slower, taking more frequent rests, and not climbing steep slopes. We continued spelunking, although in commercial caves rather than ones where crawling on your back was the only way to get through passages.

With the femur fractures more adjustment has been necessary. We have stopped camping, and tend to fly to our vacation destinations. But that’s not a problem as we had previously taken seven road trips around the united States and Canada, and now it was time to circumnavigate South America, to finally visit the Caribbean, and to take that cruise to Alaska (where we rented a car and visited the Iditarod Trail and several of the musher’s kennels).

After 16 months with a hip replacement, my wife is again driving short distances, taking longer walks, shopping, and looking forward to our next cruise. This summer she will likely need a knee replacement, but we’ve already made plans for a South African safari next spring. 

Many disabilities cannot be overcome, but you can learn to live with them and remain active. It may be easier to stay at home, complain, and give up all the exciting things in life. An Actively Disabled person, though, is still living, still experiencing, still learning. To be active is to be alive.

Anticipating a Medical Procedure (Part 1)

Anticipating a Medical Procedure (Part 1)

It is an extremely difficult decision to agree to undergo elective surgery. If you are involved in an accident or contract an acute illness that requires immediate action, you really don’t have much time to think about potential consequences. 

I am currently scheduled to undergo a total knee replacement in September and am absolutely dreading this surgery.  Even though there is a good chance that I will be much more functional and eventually in less pain following the rehab period, there is still the feeling that something might go wrong leading to a less than satisfactory outcome.  This, I assume, is a normal response. 

Upon the realization that you need surgery, it is extremely important to contact your insurance provider immediately to see exactly what is covered by your policy.  Most carriers insist that you notify them of hospital stays, either with or without surgery, or they may have the right to penalize you either by reducing payments or refusing to pay altogether.  Be sure to get a confirmation number and the name of the authorizing person.

It may be necessary for you to need a blood transfusion during the surgery or afterwards.  Discuss this with your surgeon in advance in case you decide that you want to store your own blood.  Check out the following links for more information on this subject:
    Giving and Getting Blood
    Two-week-old Blood No Good for Transfusions

Until recently, I have always opted for local medical care, but the inconvenience of traveling afar is sometimes definitely worthwhile.  For example, in the case of a joint replacement, do you want a surgeon who does a couple of them a month or someone who does several weekly?  The same goes for hospitals, and this is especially important if you are dealing with something out of the ordinary.  Your local doctors might not have a clue as to what to do, whereas this problem might be routine for others. The following links should help you narrow down your options:
    US News & World Report: Best Hospitals
    Thomson Reuters Top Hospitals
    Best Doctors
    Castle Connolly: Best American Doctors
    The Huffington Post: Best Doctors

Everyone will need some extra help after certain procedures, some more than others. Patients who need extra assistance may require a stay at an inpatient rehabilitation facility. If you are returning home, make sure you can have someone physically able to assist you stay with you for at least several days. Consider hiring help if needed.  If it is necessary for you to be transported to a rehab facility, the hospital caseworker will make all arrangements for you during your hospital stay.
    US News & World Report: Best Rehabilitation Hospitals
    AARP: Choosing an Agency for In-Home Care

Anticipating a Medical Procedure (Part 2)

Anticipating a Medical Procedure (Part 2)

If you're chronically or seriously ill, just the thought of being hospitalized can send jitters down your spine.  Putting on that hospital gown and wristband and other seemingly easy tasks can become daunting. Getting a second opinion, figuring out what your insurance covers, and researching your treatment options can be a struggle when attempted from a hospital bed.

Patients are frequently unprepared for the change in routine and the lack of resources available in their new environment.  Once you're admitted, a lot of the options you relied on to help you make health care decisions, like the Internet, are suddenly not there. Complicating matters further is the state of high anxiety that usually accompanies most hospital stays. The emotional state of the patient and usually the family can be quite high even if the procedure or treatment is elective.

Although no one knows when an acute problem will strike, or when a chronic disease or condition will suddenly worsen,  taking a few simple steps to prepare and organize at least some of your health care needs can help keep you sane if and when the time for hospitalization arrives.

Whether you have a chronic condition  or you're simply getting on in years one of the best things you can do for yourself is become familiar with what your future health care needs may be and how your personal needs may change as a result. The best source for this information is your doctor. It's especially important to have this talk with your doctor if you have health problems that could worsen significantly over time.  You should know what you can expect to happen over the years and what the treatment options are.  It will be much easier to make the right choice by becoming knowledgeable beforehand.

If possible, have the support of a friend or relative who can be your health care advocate during your hospital stay.  It’s very important to have someone whom you trust be aware of what’s going on so that they can help you make decisions if the need arises. If possible have a discussion with this person prior to your hospital admission to let him know what you do and do not want your care to include.  This is especially important if during your hospital stay you are unable to communicate your desires yourself.  If you don’t have anyone to rely on most hospitals have a staff of patient advocates who can work on your behalf.

You have rights as a patient and taking the time to learn these rights can serve you well in many situations.  You have the right to receive an explanation of any prescribed treatment  as many times as necessary for you to understand the procedure and any possible risks.  You also have the right to refuse any treatment including prescribed tests. If you don't understand why a test was ordered, or why a medication was changed, or you have any question at all about your care, you have the right to refuse that care until you can find out more information. Very often it is the patient advocate who can intercede and get you those answers if you just reach out to them for help.

     The Patients' Bill of Rights

Generally if you don’t care for the food you are served hospitals offer an alternate choice of options.  You just have to speak up.  A hospital that I was recently in even had their dietitian visit me to see why I hadn’t eaten my rice.  When I explained that I didn’t care for rice she pulled out the alternate menu that listed many other types of starches that I could choose from, items that weren’t listed on the regular menu and that could be ordered at any time.

I have found that it is extremely important to rent a phone for the duration of your stay but I usually don’t rent the TV as medications can make you too groggy to comprehend what you are watching.  Also, there are so many staff interruptions that it is almost impossible to watch a complete show.  As far as I’m concerned the only purpose that the TV serves is to act as background noise. 

It is important to have your visitors respect the rights of other patients by not being too loud or staying past visiting hours.  Also don’t hesitate to ask them leave if you really aren’t up to having company.  You may not want to hurt anyone’s feelings but they should understand if you need to rest.  I enjoy having visitors in this setting but sometimes it can be quite overwhelming, especially if you are in a considerable amount of pain.

        Communicating With Patients

While ultimately your hospital stay may go smoothly, few patients are prepared for what happens when they return home.  People don't expect to leave in pain, and very often they do. They don't expect that they are going to have to find a lot of their postoperative equipment on their own,  like a hospital bed or a commode. All of this can be quite overwhelming to someone in this condition. 

Even people who have had complex surgeries may find themselves discharged from the hospital after only three or four days. Recuperation that used to take place in a hospital must now take place at home, and patients need to be aware of that, and to be aware that they will likely be going home long before they themselves feel they are ready.

It’s difficult to prepare for the unexpected but if you have a chronic illness or simply getting on in years it’s important to focus on what may happen and make arrangements for this possibility.  Doing so will make things go so much smoother allowing for a less stressful recovery.

(As this goes to print, the author is in New York's Hospital for Special Surgery recovering from a knee replacement.)

Anticipating a Medical Procedure (Part 3)

Anticipating a Medical Procedure (Part 3)

When people have recovered from an illness or surgery sufficiently or can be appropriately treated elsewhere, they are discharged from the hospital.  Most older people leave the hospital before they have fully regained their strength and ability to function. This is why making plans in advance to help people function safely after discharge is extremely important.

A patient may need a short stay in a rehabilitation facility. They may need special equipment (such as oxygen tanks), transportation, health care at home, or help with daily activities (such as preparing meals, doing housework, dressing, or bathing). It is possible that a long-term care facility may have to be chosen. A discharge planner or a social worker at the hospital can anticipate which problems are likely, then make suggestions and arrange needed services. It is extremely important that the patient and family members should be involved in the plans to make sure they are acceptable.

Before leaving the hospital, patients or their family members should make sure that they have detailed instructions for follow-up care. Getting a written schedule for using the prescribed drugs and for follow-up appointments can help. If people are being discharged to another facility, a written summary of their treatment plan should be sent with them and another copy faxed to the facility.

If you are being sent directly home from the hospital there are several things that you can do to make your home safer and more comfortable during your recovery period.  In certain instances you may have specific restrictions such as limited motion following a total hip replacement and not being allowed to sit on low furniture.  You may have to modify your furniture in order to adapt to your specific needs.  Remove throw rugs to prevent slipping, tripping and falling. Arrange furniture so that you have plenty of room to move about.

Remove clutter and watch out for pets. A friendly pet just wanting to play can easily cause a fall.  Be aware of doorway thresholds and waxed floors as these can lead to falls. Keep electrical cords out of walkways and have a small table with frequently needed items close to your chair or bed.  You should also have a telephone within easy reach.

Make arrangements to stay on the first level if you have a lot of stairs to your bedroom and have trouble climbing stairs. Consider an alternate entrance if there are many stairs leading into your house. Arrange your cabinets so that frequently used items are within easy reach.

If you are going to be housebound for awhile, chances are that arrangements will be made for you to receive care at home such as physical and occupational therapy. Home nursing care is especially crucial if you are prescribed a blood thinning agent and this will most likely be coordinated with your doctor.  You may also have to buy or rent special equipment such as a hospital bed, oxygen equipment, raised toilet seat, walker, crutches or cane, among others.  You might want to consider installing grab bars by your toilet and shower. Set up a schedule for assistance with daily activities.

Arrange for someone to call in a couple of times a day to see if you need anything if you live by yourself.

If possible, you should check with your doctor prior to your discharge to see what your anticipated needs will be.  This will give you time to make arrangements prior to your discharge and also give you a chance to check with your health insurer to see just what is covered.

If you are having an elective procedure you have the perfect opportunity to plan things out in advance which will ultimately make it so much easier for you upon your return home.  If you live by yourself you will also have to make arrangements for any pet care, mail and newspaper pickup.  It is also a good idea to prepare meals in advance and freeze them so that you don’t have to worry about food preparation immediately upon your return home. 

As much as you may appreciate visitors both in the hospital and at home there most likely will be times when you just want to be by yourself to rest and heal in peace.  Do not be afraid that you will hurt someone’s feelings by telling them you don’t feel up to having company, as anyone who cares for you will truly understand and honor this request without getting insulted.

(As this goes to print, the author has been home from Helen Hayes Rehibilitation Hospital for two weeks. The knee replacement has been successful. To correspond directly with the author, you may write to roberta@slightlycreaky.)

An Actual Hospital Stay

An Actual Hospital Stay

I recently had the opportunity, following total knee replacement surgery, to see for myself how efficiently two well-known hospitals are run, the first being the number one orthopedic hospital in the United States and the other a supposedly well-respected rehab facility.  I had an excellent experience at this orthopedic hospital a year ago following a total hip replacement and assumed that their standards would still be top-notch.  Was I ever in for an unpleasant surprise.

Everything leading up to the surgery went well, presurgical testing, etc.  I was impressed by their efficiency in processing the surgical candidates.  It wasn’t until after the surgery that my patience was very sorely tried, and this was not due to any unforeseen medical problems.

After spending about twelve hours in the recovery room (I was told that this was because they didn’t have a room for me) I was finally moved at 1AM.  Through all the pain I was jubilant that I was finally being moved to a room.  Alas, this wasn’t the case, as I was moved to the top floor of the hospital and whisked into a tiny cubicle where there was barely enough room for the bed let alone my belongings and the CPM (continuous passive motion) machine that I had been instructed to use three times a day for two hours at a shot.  I didn’t dwell on this immediately as I figured I would be moved to a room later that morning at a more reasonable hour. 

Daylight arrived and sometime later that day I was moved again.  However, instead of moving me to a room I was wheeled down the hall to yet another cubicle, this one with absolutely no privacy as there were 8 other cubicles opposite me with both male and female patients.  My complaints fell on deaf ears and I was told that I might be stuck there for the duration of my hospital stay as there were no vacant rooms available in the entire hospital.  In the meantime, there was no access to phone, TV or a bathroom. 

Prior to surgery I had been told that I would be encouraged by physical therapy to get out of bed as soon as possible so that my new knee wouldn’t stiffen up on me and that this would help to hasten my recovery.  This necessary care also wasn’t an option on this floor as there wasn’t a therapist in sight for anyone, as far as I could see.   In addition, since this ward seemed to be off the beaten path, patients also didn’t have the luxury of choosing what they wanted for meals and were stuck with whatever was chosen for them.  In the meantime my poor husband was quite frantic that something had gone wrong since, due to lack of phone access, he wasn’t able to speak to me personally.

This was a Friday and since my husband and son would be visiting me the next day I knew that I would finally have someone to speak out on my behalf for decent treatment and a room.  This was a long trip for them and a couple of minutes after their arrival the nurse (my cubicle was right next to the nursing station) asked them to leave after my husband started to speak out on my behalf.  All he did was to quietly (remember there was no privacy here) request that I be sent to a room where I could receive proper treatment and for his efforts he was treated with total disrespect. 

It had been almost three days since the surgery and I still hadn’t seen a physical therapist nor had I been allowed to use the CPM machine as much as I was supposed to.  Finally my husband’s pleas to speak to a supervisor were answered and she reluctantly told him that they would have a room available for me in a couple of hours and even went so far as to give him the room number.  As that time drew near I noticed that other patients were being moved and when I inquired why they hadn’t done anything with me yet I was told that there was a delay.  My husband and son had left by then and I totally blew up telling them that they had better move me soon or there would be repercussions.  A patient should not have to deal with anything like this.  I have undergone many previous surgeries in many different hospitals and have never been in a situation like this before. 

I finally arrived in a room and still encountered what I perceived as substandard care (at least I had privacy and a nice roommate).  I didn’t get to see a physical therapist until Sunday nor did anyone really appreciate being inconvenienced to set me up on the CPM machine (I did insist on using this because it was a very important part of my treatment).  In the meantime, my knee got stiffer and stiffer and I was afraid that I would lose all my range of motion.  One thing I should mention is that they were excellent in providing pain medication, probably because it caused the patients to sleep most of the time and not be so much of a bother.  Even the physical therapists couldn’t care less.  I was not at all encouraged to try to do much of anything and wasn’t even provided with a list of exercises that I could do in bed.  These were things that had been provided during my previous stay.

It is my understanding that allergic reactions can be life threatening and call for immediate action.  Therefore when I noticed that my entire body had broken out in severe hives, shortly after receiving a blood transfusion, I Immediately buzzed for help.  When no one showed up I started to scream that I was having an allergic reaction and it still took several minutes for anyone to appear.  The staff’s reaction was totally unexpected as they just stared at me and seemed to have no idea as to what to do.  Fortunately my breathing wasn’t affected and the Benadryl that they finally gave me took care of the problem. 

Tuesday arrived and I still hadn’t had much in the way of any therapy.  After breakfast I had taken a few steps with a therapist, and shortly afterwards was told how great I was doing (I hadn’t even used the bathroom yet) and that they were discharging me to a rehab facility.  I protested that I didn’t feel ready yet because at rehab you have to be able to get up and mostly fend for yourself from the beginning, and to that point I had only taken a few steps.  The pressure to leave was unbelievable and I really didn’t have any choice at all in the matter. 

I had chosen the same rehab facility for the third year in a row.  Although the nursing care could have been better during my first stay the therapy staff was excellent and really helped to get me up and moving again.  Last  year’s nursing staff was really good but I had noticed a definite decline in the quality of the therapy provided.  However, I felt it was still sufficient and opted to go there again this time.  Unfortunately, this was a big mistake.

During my first evening at rehab I requested to use the CPM machine and was discouraged from trying to use it.  I insisted and it became very quickly evident that no one had a clue as to how to set it up properly.  One aide did turn it on at an angle much higher than what I was capable of, causing considerable pain.  Also, the machine stalled in this high position with my leg stuck in it with me screaming in pain for them to release the leg.  It took what seemed like forever for anyone to help me as all they did was stare at the machine wondering why it wasn’t going down. 

When I questioned the aide why she set it so high she responded that it was “doctor’s orders.”  I found this quite strange since I hadn’t even been evaluated by anyone yet and told her as much.  I was afraid that this mishap might have caused additional damage due to the higher intensity of pain and they reluctantly sent the “house doctor” in to take a look.  He simply stated that nothing was wrong.  This “evaluation” was made without any examination of the knee other than him staring at it from several feet away.

The next morning I was visited by a therapist who evaluated me and brought the wheelchair that I would be using for the remainder of my stay.  One of the leg platforms wouldn’t fit on the chair due to the fact that it was from a totally different model.  As I was wheeled to the therapy room for my first session I was told that another therapist would get me a usable chair.  I requested this and was told by another therapist that the current chair was totally usable if I were to place both feet on the same platform and use it that way. This was especially outrageous because, in addition to being very uncomfortable, this would have put a considerable amount of unnecessary extra pressure on the hip replacement that I had had the year before.  I stated my objections, stood my ground and refused to leave the therapy room until I received something operable. 

It is really quite sad when a therapist, someone who is supposed to be helping you gain your mobility, is too lazy and uncaring to make sure that you are using proper and safe equipment.  Another complaint I had was that I always made sure that I was on time for all the sessions but several classes were started late because sometimes the therapists wouldn’t show up on time.  All this and several other incidents made this a very frustrating experience.  Add to that the fact that the doctor who was assigned to me forgot to remove one of the staples and covered it with a Steri-Strip (something that I didn’t discover until I had been home for more than two weeks when the strip fell off) I definitely had a lot less than satisfying experience at that facility.

One thing you should remember when faced with a situation such as this is to remember that patients do have rights and demand that you are treated fairly, and, if it becomes necessary, file a complaint with the proper department. 

Health Insurance Companies

Dealing With Health Insurance Companies

When you are ill, you probably have no interest whatsoever in dealing with your health insurance company. In fact, they are probably the last people that you want to talk to. Unfortunately, if you delay calling, you may find yourself eventually fighting with them while they attempt to deny you coverage because you didn’t call them soon enough.

In an emergency, dealing with a health insurance company probably doesn't seem like it may be on the top of your list of things to do. In fact, if you are ill, you probably should do things like rest, drink plenty of fluids, and concern yourself with a swift recovery.  However, I can’t stress enough the importance of calling immediately, or if you can’t, make sure that someone else can do this for you.

If you do end up calling your provider while you are ill, remember that you are definitely going to need a lot of patience and a cordless or speaker phone. This phone is going to be indispensable, especially when you get put on hold for the fifth time, while they decide whether or not you can go to a specialist or if you have to make do with the limitations of your general practitioner.  This also applies to prescription drugs as most plans limit what medications they will pay for. While you are waiting on hold to have your questions answered make sure that you have something to do as you might be tied up for quite some time.

If dealing with your carrier seems like something that is going to make you feel even worse, you may want to ask your doctor, spouse or other family member to deal with it. Making sure that you get the right answers before you go to the doctor, and before you get an expensive treatment, will save you from a lot of possible future headaches.

Review your policy handbook, including all the fine print, to see if you have any questions about your policy before you even get sick. This is very important so that you know how to go about getting authorization for treatment and what to do when you are in an emergency situation and need health care quickly. If you ask and get the answers to all of your questions while you are healthy, you are going to save yourself a lot of pain and suffering and be able to feel better about yourself sooner.

In some situations you might find yourself having a claim denied even though you were promised that the procedure would be covered.  Always document everything, including getting the names of people with whom you speak to. Don’t believe everything that you are told, as I have discovered on numerous occasions.  Sometimes it is the fault of the physician for not including an accurate diagnosis code and this can usually be rectified with a call to the doctor’s office.

If a professional other than the physician has more information about your situation (such as a physical therapist may know more about your functional limitations or the specifics of equipment being requested than the prescribing physician), get something in writing from that professional and submit it to the prescribing physician so he or she can add it to their letter of medical necessity.

If you go through all these steps and are still denied coverage then you always have the option to appeal the insurance company’s ruling.  You must do this in a timely manner as your right to appeal does have an expiration date.  It is always in your best interest to appeal as you have nothing to lose and have a good chance of winning your case.

Choosing Elder Care Facilities

Choosing Elder Care Facilities

It is a hard decision to move into or move one’s parents or spouse into a care facility. No one wants to admit that s/he can no longer take care of oneself independently, yet in many cases it is not only inevitable, but also necessary. There are a multitude of  factors to consider prior to making the decision, before selecting a care facility, and once the move has been made. 

Fortunately, there are many web sites to help obtain the information needed and to avoid the pitfalls some facilities present. In addition to those listed here, Slightly Creaky has a listing of many more on our Medical Information page.

Determining the Need for Care:  It is best to have medical advice and social worker input prior to making any significant decision.  Too often, the determination of whether to care for a loved one is made with emotional and economic considerations rather than health as the goal. While your primary doctor will provide significant input, most people do not realize that senior health care social workers are trained in this field and may be better at judging needs and circumstances.

Do not seek advice from a health care facility or someone living in one, although seeking the opinions of residents will be an important factor in selecting a facility should that decision be made.  Opinions of employees are, obviously, highly biased.  Even some health care workers may have hidden links to specific facilities.

     Paying for Care
     The Gilbert Guide
    AARP Nursing Home Fact Sheet
    Senior Lifestyles Directory

Selecting a Facility: There are several types of care establishments based on how independent the patient is.  These include independent living, assisted living, nursing care, and hospice.  Each is better suited for a different type of need.  Some facilities offer several types of care and patients can occasionally remain in one living area while obtaining greater assistance as the need arises.

The greatest concerns in making a selection must be the quality of care available and the quality of the employees. Although all states regulate such establishments, few have sufficiently trained staff to handle the vast and ever growing number of senior care units.  In addition, where violations are found, there is frequently insufficient follow-through by the licensing bureau.

Several independent organizations monitor senior facilities, and most states list violation histories on the Internet.  There are also comparison sites where perspective enrollees can judge what may be best for them.  Armed with a list of “best” possibilities, personal visits must be made, and current and former residents and families of those residents spoken to.

While all care facilities provide for medical care, be sure that a doctor is available at short notice and that a registered nurse is on duty at all times.  It would be best if the patient’s own doctor has visiting rights, especially if it is not easy or reasonable for the patient to travel to his/her own doctor regularly.

Ask the company that runs the facility for their hiring guidelines and make sure that background checks are conducted on all employees.  Drug tests should be required, not only prior to employment, but throughout the year.

     Nursing Home Info
    Medicare: Nursing Homes
    Medline Plus; Nursing Home
    A Guide to Choosing a Nursing Home (PDF)
    Nursing Home Directory

Monitoring: Of vital importance to the person in a health care facility are regular visits by family and friends.  In addition to providing a vital link with life, such occasions will give the visitors a chance to assure themselves that the facility is maintaining a high standard.  Listen to the concerns not only of the person you are visiting but also of other residents.  Do not be put off by comments of the employees, but take your concerns directly to the administration.  Document everything; take pictures. Record all medications taken and require that a list of medications be provided. 

If you notice any unusual health condition or change in staffing, be concerned.  In addition to discussing these issues with the staff, bring in a social worker or request that the state, county, or city monitor a specific condition.  If your concerns are not totally addressed, move to a different facility as soon as reasonably possible and register a complaint with the appropriate governmental bureau.

     Residents’ Rights
    Nursing Homes and Personal Care Facilities
    Nursing Home Abuse Resources
     In the Hands of Strangers: Are Nursing Home Safeguards
        Working?

A Matter of Degree

A Matter of Degrees

Weight loss is an overused topic, a frequent filler when there is space in a magazine or newspaper.  Go to any magazine stand and browse through the health, women’s, and fitness magazines and probably half of them will have front page headlines for improving your sex life and losing weight (yes, they do go together).

Then pick up one of those magazines and look through the ads.  The dozens of ways there are to lose weight, all of them guaranteed and most of them taking little effort, would amaze any off-planet visitor.  Medications, drinks, diets, exercise machines, and hypnosis.

Collectively, humans probably lose tons daily, and gain back more (on average) the next day.  We all know there is no sure, magical, or easy way to lose weight, yet we all know that this is one of the greatest medical and health problems we have.

Weight loss is a combination of many factors: hormones, metabolism, exercise, diet (types of food selected), calories, fat content (for both the food and the person), and attitude.  Rather than attacking all of them at once, though, or using one of the miracle cures found in magazines or infomercials, reading through the medical articles shows there is a way to take weight off and keep it off.

It’s not easy, and it takes will power. There are three components: the honest desire to lose weight, a small memo pad, and tiny changes. 

Find two reasons to lose weight – long term and short goals.  For the long term it should be health-related. Short-term goals should not exceed three months, and a few pounds: a social event, a doctor’s visit, or a physical activity. 

Purchase a memo pad (actually get a half-dozen, it’s far less expensive) and keep it with you at all times.  Write down all you eat, no exceptions.  There is no need to list amounts or research calories, just eat within reason. Then, when you “feel hungry” or want to snack, look back at what you have already eaten that day, and yesterday, and consider what you have planned for the remainder of the day, and tomorrow.  Also record any physical activity: 10,000 steps, a swim, climbing stairs instead of using an elevator.  No need to join a gym, as there are plenty of activities you can easily do throughout the day.

Make tiny changes in your routine. No more eating four hours before you go to bed.  Eliminate one type of unhealthy food.  Buy yourself a special (small) snack and don’t eat it until you reach, or exceed, a goal.

Losing weight is a matter of small degrees, a combination of activities.  It is also a matter of healthy survival.

Getting A Second Medical Opinion

Getting A Second Medical Opinion

Patients today are taking more responsibility for managing their own health care. They are becoming more informed about their medical problems and treatment options and playing an active role in every decision with their doctors. Increasingly, consumers are seeking second opinions, showing the strong value that we place on being in control of our health.

Because of the increase in medical knowledge and new treatments it is difficult for any one physician to be aware of all the latest information. One result is that patients and their physicians together are seeking second opinions so better and more informed decisions can be made.

For minor health problems, second opinions are usually unnecessary. However, a second opinion is probably a good idea under the following circumstances:
1) Having major surgery
2) Questioning whether surgery is the only option.
3) Unhappy that your regular doctor can't diagnose your problem
4) Having trouble talking with your current doctor
5) Not seeing improvement in your medical condition
6) Diagnosed with a life-threatening disease such as cancer, heart disease or brain tumor
7) Told a second surgery is recommended
8) Having multiple medical problems

Some physicians disagree about whether you should get a "blind" second opinion (when medical records, test results and the first physician's opinion are not made available to the second doctor) or if this information should be shared with the second opinion doctor.

The advantage of the "blind" second opinion is that it cannot be influenced by previous information. The disadvantage is that your second opinion doctor may not be able to tell you why his opinion is different without knowing the basis of the first doctor's opinion. A third option is to provide test results, X-rays and other information without the first doctor's written diagnosis and treatment recommendation. Most second opinion doctors prefer knowing the first opinion but they can still provide a good second opinion if they can at least review previous x-rays, test results and medical records. This information is helpful as it often provides clues and baselines to compare to new test results.

Here are some helpful questions that you should ask during the course of a second opinion appointment.
1) Is there any chance the medical problem could have a different diagnosis?                                     
2) Are there any alternative forms of treatment available?                                                                         
3) What are the likely results if you wait or don't have the treatment?                                                        
4) What are the risks associated with the treatment?                                                                                
5) Are there any side effects or residual effects from each treatment option?                                            
6) How is the treatment plan expected to improve your health or quality of life?                                  
7) How long is the recovery period?                                                 
8) If the second opinion differs from the initial one, why? (It is important to understand the reasoning behind a medical opinion.)

It is your right as a patient to be able to have a second opinion.  Also, they may be mandatory for certain conditions or procedures.  In some cases your health insurance plan may reduce or eliminate the benefits paid if a second opinion is not obtained.  Most second opinions are voluntary and are usually paid for by your health plan.

However, always check your policy so you know exactly where you stand.  Always see an expert physician as the benefits of a second opinion include more knowledge, understanding of new treatment options and reassurance and peace of mind that you are making the right decision.  Doctors themselves may seek the help of a more knowledgeable physician when they have a patient with a serious medical problem.

Many patients are still uncomfortable asking their doctors about getting a second opinion as they are afraid of hurting their doctor’s feelings.  A doctor should not be offended if you ask about a second opinion but it really depends on how you bring up the topic.  Start your conversation by stating that you need to gather as much information as possible in order for you to make an educated decision as to what your treatment will be.  Then ask your current doctor to give you the name of a specialist who has a great deal of experience in dealing with your specific type of condition.

What if you begin receiving treatment and then decide that you'd like to get a second opinion? Is it too late? Although it's best to seek a second medical opinion soon after a condition or problem is diagnosed, it's never too late, even after a course of treatment (with the exception of surgery) has begun.  A second opinion can help you better understand your medical condition, answer any outstanding questions, remove any doubts, help you weigh the pros and cons of the recommended treatment options, and help you make an informed, educated decision as to what treatment is best for you.

Because medicine is not an exact science, and many conditions can mimic the symptoms of other conditions, diagnosis can be difficult. As a result, getting a second opinion can be of utmost importance in making certain that the original diagnosis is correct.

If you find yourself on your own and needing to do some research as to whom you might call for a second opinion, you can do so by calling local hospitals, medical centers or medical schools and asking for a referral to a specialist who works at or is affiliated with that facility.

Also, check the American Medical Association’s directory of medical specialists, which is a reference guide that only lists board-certified physicians who have passed certain comprehensive examinations. In addition, before going to see any doctor for a second opinion (especially one you find on your own), check that doctor's background and training. Most state medical boards can supply you with that information and some states have made that information available on the Internet.

While most doctors will want to conduct their own examination (and may order additional tests), in most cases, they will be able to use the data (X-rays, CT scans, blood tests, etc.) that have already been collected to evaluate your condition, verify or disagree with the original diagnosis, and suggest the treatment option they feel is best suited to your condition. To minimize wasted time and resources, make arrangements to hand deliver test results, X-rays, and any other appropriate information, including copies of your medical record, to the second opinion doctor prior to the day of your appointment.

Advocating for Action in a Hospital

Advocating for Action in a Hospital

The most valuable asset for coping with today's medical system is an adult family member, preferably one who is well educated, tactful, feisty, and retired. It's helpful to have someone at your bedside in the hospital to make sure overworked nurses notice if your vital signs are going downhill or to ensure that the right medications are given at the right time. It’s also important to have someone to take notes during doctor visits and ask the questions you forget.

Unfortunately since many of us don't have the perfect family member handy, patient advocates are available for at every hospital. Some advocates have minimal medical training and others are nurses and doctors. Some charge nothing and others thousands of dollars for very complex situations. Some advocates might help save your life and others may complicate patient-doctor communication.

Since this is a relatively new profession it's not entirely clear what an advocate is or how to judge whether you've found a good one. There is currently no regulatory body that oversees or licenses patient advocates. The very idea that patients would need an outsider to lobby for them inside a hospital is not exactly appreciated by many doctors and nurses, who feel passionately that they are already advocates for patients, doing their best to get patients the care they need.

Every hospital is required by law to have staff members hired specifically to be patient advocates, also known as patient representatives. It is their job to focus on the needs of the patient and their families. They will listen to your concerns, respond to a complaint, explain hospital policies and procedures, provide information on community services, provide information on insurance coverage and mediate a dispute between you and the medical team.
Their goal is to resolve conflicts so that the remainder of a patient’s stay can be purely focused on getting well. Look in the hospital directory or ask the receptionist at the Information Desk to give you the name and number.  Hospitals are also required by law to present each patient upon admission a copy of the Patient Bill of Rights, which should provide that contact information.

If you're in the hospital and want more constant monitoring than staff nurses can readily provide, you might consider hiring a private-duty nurse. The nurse can frequently check blood pressure, watch for bleeding and infections, and generally makes sure that you do not become a case of neglect, someone who deteriorated or even died because early signs of problems were not addressed in time.

Hospitals often have registries of private-duty nurses to choose from, and some staff nurses are grateful for this extra help.  Insurers won't pay, but if you can afford it, the cost may be worth the peace of mind and a chance for family members to get some sleep. If a fully trained nurse is more than you need, you can also hire someone to keep an eye on a patient who might be in danger of pulling out tubes or falling out of bed.

Be aware that some physicians might not be so thrilled with this sort of arrangement and may feel that having another person who is not directly involved in patient care actually might complicate the situation and make it more difficult.  The only complication that I can think of is that the hospital staff wouldn’t appreciate being reprimanded if they either willingly or accidentally neglect a patient.  If no one is there to represent the patient’s rights then the staff is basically free to do whatever they feel like doing.  I experienced this recently following a knee replacement when my spouse had to advocate on my behalf for me to be moved to a room two days after the surgery.  If he were not there to speak up for me I might have remained in limbo for the remainder of my stay, which would have definitely been detrimental to my recovery.

What this all comes down to is that you are really lucky if you have a family member or good friend available who can act on your behalf in order to help you get what you need from the medical system. If not, consider hiring a private patient advocate. There's a chance that adding yet another person to the mix may complicate your communication with nurses and doctors. However, it could also help get you the care you need.

Having someone with you in a hospital who is alert and asking questions can help stave off all kinds of potential problems, from mistaken identity to medication mixups to infections. An estimated 100,000 hospital patients die every year in the U.S. because of preventable errors. Many hospitals are under financial pressures to keep nursing staffs lean. A personal advocate can be a valuable resource. It doesn't have to be a relative and it can be more than one person just as long as they know you and are willing to speak up on your behalf.

How To Avoid Being Overcharged

How To Avoid Being Overcharged

Either accidentally or intentionally all of us more than likely have been overcharged or double billed at least once in our lifetime.  Many times this is not obvious and we therefore aren’t even aware that we have been cheated.  However, we may occasionally encounter some instances of outright fraud and in some cases situations like this may be extremely difficult and time comsuming to resolve.

One way to protect yourself is to save all receipts, which is especially important to do if you pay cash.  Check your receipts before you leave a store to make sure that the charges are correct.  Scrutinize your credit card receipts as soon as you receive them for any fraudulant activity.  There may be an occasion where you are double billed from a company or just plain charged for something that you didn’t even purchase.  There are many lawsuits pending against unscrupulous companies who make a practice of doing just this.  They can always claim that they made an honest mistake and offer to rectify the situation if they know you can prove them wrong. 

There are instances of consumers who have switched their cable package to include television, internet service and phone and upon checking their bill discover that not only were they charged the package special price for the three services, they were also charged on another line for the internet service.  Was this an honest mistake?  It’s possible but impossible to know for sure.

I recently had a dispute with my cable company.  I had locked in my cable price for two years less than a year ago.  By doing this I was assured that the price would remain the same for this period of time.  There would be a hefty cancellation fee if I decided to leave them, but I enjoyed their service and decided it would be wise to lock in the price. 

When I received this January’s bill I was upset to see that they had billed me for what would  have been my new rate if I hadn’t locked in the price.  The explanation I was given was that the technician who had recently exchanged my non-functioning DVR for a new one entered the wrong code on the work order and somehow that changed my monthly rate.  I figured that something like this could conceivably happen but changed my mind when the same thing happened to my son who had also locked in his price.  In his case he hadn’t had a technician do any work so when he questioned the amount of the bill they simply told him that they had made a mistake.

Other offenders are medical professionals you pay up front and who are then reimbursed by your health insurance company.  There are occasions when you have to fight to get this money back.  This has happened to me on a few occasions, once recently when a doctor’s office initially refused to refund money that I had paid up front to them.  I had paid the full amount of the bill and my insurance company stated on a claim form a few days later that the copay was actually much less.  The doctor was supposed to refund the difference between what I paid and what the copay was. 

I was told by the billing company to send the paperwork to a specific address, waited awhile only to be told they never received anything.  My insurance company had also resent them everything, which they also refused to acknowledge.  I eventually discovered that it was the billing and not the doctor’s office who was being uncooperative and was finally reimbursed the correct amount.  In order to get paid I had to track down the actual doctor’s office because this was for services rendered while my husband was in the hospital, and all I had to go on initially was the address and phone number of the billing company that generated the bill.

Several years ago I ordered some clothing from a national retailer.  Normally I prefer to try things on prior to purchase but this was something that caught my eye that I had never seen in any store.  Upon receiving the garment I discovered it to be very cheaply made and it didn’t fit properly.  I had no problem contacting the company to get permission to return it with them paying the shipping.  I sent the item back and figured this was the end of it.  However, when I received my credit card bill I noticed that the company had billed me twice for this item even though I had sent it back.  I disputed the charge with my credit card company as I had proof that the item had been returned.  They sided with me and the charges were removed from my account. 

Another problem I recall having was with a well-known internet provider when I decided to switch to their long distance service.  At first the rates were fairly decent but kept rising monthly.  After a while I decided I wanted to switch back to my former carrier and wound up with nothing but aggravation.  I was switched back immediately but was then being charged for both services.  My calls to the internet company fell totally on deaf ears and the only way  I was able to have their charges removed was to file a dispute form with the credit card company.  Even with this that company refused to let go and continued to bill for an additional three months.  Eventually all this was removed from my account but it was a truly aggravating experience.  This is a company that now has lawsuits against them for double billing some consumers for their internet accounts. 

Always be aware of what is going on, keep good records and if you find yourself in a similar situation do everything you can to avoid paying out any more than you have to.  Life is expensive enough without having to pay bogus bills.

Physical Therapy

Physical Therapy

Physical therapy is that dreaded time after surgery or after an injury that is meant to help you recuperate.  In many cases you relearn how to use a limb or how to move a joint, and sometimes you need multiple types of therapy to handle serious injuries.  Often physical therapy can be quite painful, and patients want to learn how long they will have to endure it.

The length of therapy depends on several factors.  The therapist will work with your physician to determine how long the treatments should last.  The doctor should make the therapist aware of any complications that might arise from vigorous therapy as well as the recommended duration.  Talk to your doctor if you have any problems with how long it is taking or the exercises that your therapist has prescribed. 

Everyone heals at a different rate, so you can’t possibly compare yourself to someone else, even if that person has sustained the same injuries.  Your rate of healing will have a large impact on how long physical therapy lasts because you won't be able to complete the program until you've mastered each stage. This also has to do with your pain tolerance and motivation.

Physical therapy isn't just about showing up at the facility a set number of times a week to do your exercises or take your massages. Most therapists will prescribe exercises that need to be completed at home, and this will also effect how long therapy lasts. If you force yourself to set a time for exercises every day and if you continue to push yourself forward safely, you might complete therapy faster.

Obviously, a serious injury will take longer to heal in physical therapy than a mild one. For example, if you've broken bones in addition to tearing ligaments or damaging tendons, you'll probably take longer in therapy than if you hadn't sustained a broken bone. If you have multiple injuries (for example: hip and knee), you'll also be spending more time in therapy because you'll have to work at the pace of both injuries.

If you have a high risk of re-injuring yourself during physical therapy, you'll have to take it slow. For example, my fractured hip in 2006 that eventually required a total hip replacement,  is currently slowing the progress of my total knee replacement rehabilitation. Since my physical therapist is being careful, therapy will more than likely take longer than it would have otherwise. Make sure you know about the risks of re-injury before you start physical therapy.

A major factor in deciding how long physical therapy will take is age. A teenager is far more likely to bounce back quickly than a senior citizen. If you're young, you can probably expect to finish your regimen of treatments in a brief period of time, but the probability lessens as you grow older. To make the most of your treatments, concentrate on making progress in movement and flexibility rather than time.

Therapy sessions are most often structured according to many factors. Nature of the injury or therapeutic needs, insurance allowances, and your doctor's prescription are all factors in determining how much physical therapy will be needed. Physical therapy is usually prescribed  anywhere from one to three sessions per week.

Therapy will more than likely be quite difficult. Your therapist should give you a regimen to follow while at home. This practice is common especially if your visits with your physical therapist are around once or twice weekly for about an hour each visit. Exercise regimens can vary depending on individual needs and can be very tiring.

Exercises usually begin with stretches.  These may feel uncomfortable at first but you should never feel more than a gentle pulling. If you ever feel more than that you should stop immediately and get examined by a doctor as soon as possible and follow any advice given. Learning proper form can reduce the chances of injury. If you are ever unsure about doing exercises on your own stick to ones you are confident doing or only work out during your appointments.

Warm up exercises usually follow stretches. These most often consist of a set of repetitive motions with little or no resistance. Following that you may be given exercises with a light amount of resistance. Eventually, the level of resistance will be increased. The amount of weight or tension will be gradually increased by your therapist in small increments over time..

In some cases physical therapy may be required over an extended period of time.  Long-term treatment can be extremely difficult and often involves an inordinate amount of pain. When you have to participate in long-term physical therapy, it is extremely important that you talk to your doctor about your progress. Communicate any of your concerns such as increased pain.  Physical therapy is something that can be tailored to each individual patient, and it isn’t necessary that you progress at a certain pace.  If you feel that you are being pushed too hard, simply ask your therapist if you can slow down. It is also important during long-term physical therapy that your therapist know how things are going with your doctor. When you are prescribed a new medication or receive the results of a test, you should communicate those things to your therapist. This will help him or her to decide on the best course of action during your therapy sessions.

Another problem that patients often have with long-term physical therapy is scheduling conflicts. If you go to school or have a job, it might be difficult to get away for an hour each morning to go to PT. Most clinics will find ways to schedule your appointments  so that you don’t miss school or work and some have evening hours that are usually more convenient for people with jobs.

It is important to check with your insurance company to determine what types of long-term physical therapy are covered under your policy. Some will only let you go to certain clinics while others won't cover certain procedures. Communication between you, your therapist, your doctor and your insurance company is essential.

Enduring a regimen of physical therapy is not an easy task but it is important in helping you recover as much motor function and control as possible. Expect discomfort, especially when dealing with arms and legs. Just don't neglect to inform your therapist when you reach your pain threshold.  The goal is to improve strength and range of motion without further injury.

The Dangers of the Summer Sun

The Dangers Of Summer Sun

The sun provides enjoyment, but over-exposure can damage your skin and your eyes. The harm to your eyes comes from the ultraviolet (UV) light of the sun which can trigger problems such as cataracts, macular degeneration, corneal burns, benign growths, solar retinopathy and eye cancer. 

The best way to protect your eyes is to wear sunglasses with 100% UV protection.  No one color of sunglasses is better than any other in blocking the damaging rays of the sun. The key feature to look for in all sunglasses is that they have 100 % UV protection. Most optical shops have a machine called a photometer that can measure UV transmission, so have your glasses checked. Most brands of sunglasses sold in the United States today have this protection, but some brands may not.

Some people are a lot more vulnerable to sun damage than others. Those who work outdoors, have blue eyes or take certain drugs are especially vulnerable to eye damage from sunlight.  So is anyone who spends time at the beach, or goes sailing or skiing, because the reflective glare of sand, water or snow magnifies sun exposure.

Certain outdoor jobs create the greatest risk. Construction workers, gardeners, truck drivers, park rangers, lifeguards, fishermen, police officers, couriers, farmers, and ski instructors all have increased sun exposure and should wear a hat as well as sunglasses. Certain drugs also increase UV toxicity.  Patients who take drugs containing chlorothiazides, sulfonamides, tetracycline, phenothiazines, psoralens, and allopurinol should be extra cautious about sunlight.

Several sunburns experienced as a child will lead to a lifetime risk for skin melanoma. This is also true for tumors in and around the eyes. Though eye cancers are relatively uncommon, basal cell carcinomas are typically found on the more exposed lower eyelid and melanomas of the conjunctiva are becoming more common. Studies have shown that intra-ocular melanomas are more commonly found in people with blue irises and outdoor occupations.

Research has shown that at least twenty five children die each year as a result of being left in hot cars.  A locked car sitting in the summer sun can quickly turn into an oven, with temperatures that can climb from 78 to 100 degrees in just three minutes and to 125 degrees in six to eight minutes. At these temperatures children are a great risk for heatstroke which can lead to a high fever, dehydration, seizures, stroke, and death. To avoid this type of tragedy never leave your kids alone in the car, even for just a few minutes. Always ensure that your child leaves the vehicle when you reach your destination. Many of these tragedies are simply the result of a misunderstanding between parents, in which each one thinks the other brought the child out of the car.

The ultraviolet rays produced by the sun can damage the DNA of skin cells. Toasting your skin often kills off some of the skin cells, forcing other cells to divide to try to replace the ones lost. That combination of cell division and damage can put you at risk for developing cancer. Some people are predisposed to skin cancer and some people put themselves at risk by spending too much time in the sun. Be sure to stay out of the sun when it is the most intense, generally the period between 10:00 am. & 2:00 pm.

A sunburn causes skin damage before significant redness appears. As sunbathers experience little to no pain during the initial stages of sunburn many overexpose their skin without realizing the danger involved. The majority of sun exposure occurs in childhood, so it is very important to start UV protection early in life. Just one blistering sunburn can double your chance of developing skin cancer later in life.

Vacation Health Care Issues

Vacation Health Care Issues

In addition to normal health issues which can occur at any given time, such as the flu, a cold, or even a heart attack, a traveler is also at risk for sport-related injuries. A skier can take a tumble and fracture a leg, a hiker can sprain an ankle, a diver or snorkeler can drown, and a mountain biker could fall and get a concussion.

When you are at home you are generally aware of how to handle such injuries. You know which emergency number to call and know how your hospital operates.  The people involved speak your language, and you are aware of what your insurance will cover.  However, while traveling in a foreign country, chances are you will not be familiar with their health care system and may run into problems as a result.

Health care in many countries is generally  quite good, and hospitals are equally capable of treating injuries as hospitals in the United States are.  Many have Emergency Medical Services which are similar to those in the United States.

However, the traveler can still face a number of difficulties in getting help. First, It is possible that your cell phone, which functions at home, will not operate in a foreign land, rendering it useless if you need to call for help. Secondly, you may not speak the native language, and as a result may not be able to adequately explain where you are and why you need help. You may also face payment issues if your insurance does not cover international health care. However, these problems can all be addressed with some advance planning.

When participating in a  sport, regardless of where you are, you should never do it alone. If you are injured, you might not be able to call for help. Similarly, when traveling internationally, you should never venture off alone, and if you do, always inform someone of your intended itinerary.  If you do travel with someone who has a cell phone which functions internationally, be sure to store the local emergency numbers in the phone and bring it with you.

There is not much you can do to avoid emergency medical problems that may occur while you travel, such as heart attacks or strokes.  However, if you have medical issues like heart disease, high blood pressure, diabetes, kidney problems or others, you should check with your doctor before leaving and take a copy of important medical information along with you. 

For example, if you have heart disease you should bring a copy of your EKG and a list of your medications. You should carry these with you at all times. Your doctor can give you a letter stating you need these medicines in case you are questioned by customs agents.  You should carry the medications (in the bottles they came in from the pharmacy) in your carry-on luggage.

The language barrier is unfortunately a problem with no easy solution. There is no guarantee that those whom you come into contact with will speak your native tongue. In hospitals communication is normally not a problem. If  the doctor doesn’t speak your language there are usually people on the staff who can translate. However, there is no guarantee that this will be the case. The best way to avoid translation issues is to carry a tourism book or dictionary with you where phrases are listed in your language with the native equivalent. This is especially important if you have allergies or existing health problems.

Before departing for your vacation inquire whether or not your insurance covers international health care, and if so what type of treatments. Your regular insurance might not assist you during your journey or pay to get you to a good hospital or back home.  Most travel insurance policies will cover medical expenses and emergency evacuations (with a cap), in addition to other coverage. If you plan for potential problems in advance, you can then feel more secure while traveling.

Online Diagnosis

Online Diagnosis

Because of the Internet, people have access to information anytime and anywhere.  They tend to have confidence in the things they find on the Internet. Therefore, when symptoms arise, many check online before seeing a doctor, and if they do consult with a physician many still tend to take the Internet’s advice over the doctor’s. While researching on the Internet for references is practiced even by doctors, patients should always keep in mind that doctors do not take the Internet as a tool to diagnose an illness and neither should you.

This medium is filled with websites about health and medicine. Some have good advice, recent news and links to more detailed information. It is therefore not surprising that many people have resorted to self-diagnosing their conditions online. Although knowledge is always useful, it might not always be accurate, and as a result may put you in danger.

If you already have either a suspected or confirmed diagnosis, the best source of advice (in addition to a trained medical practitioner) is from an online support group. There are support groups and forums for virtually every known illness and these are very helpful in discussing symptoms, medications and their side effects. The knowledge you gain at these websites may also help you to better understand your condition and make you aware of many different treatment options that you can then discuss with your physician. Slightly Creaky provides links to over 2,000 supports groups.

To do research at one of these sites, you generally would look at your major symptoms, then read each condition and compare whether other listed symptoms are also present. You will then end up with a list of possibilities, but rarely will there be just one obvious condition. The problem here is that diseases mimic each other, and this can only be ruled out by an examination and subsequent testing by an actual physician.

These medical websites are run on fairly simple databases, matching symptoms and conditions. They are good in getting a short list of possible conditions but should not be relied upon to narrow this list down to just one particular disease. It is even possible to have all the listed symptoms of a condition, as well as an additional problem that would rule out that particular diagnosis. Such analysis is not yet available online, and this is where the knowledge and experience of your physician is necessary.

You can get information at these sites about what type of testing is necessary for each potential disease on your list such as specific blood tests, physical tests or perhaps an X-ray or MRI scan, among others.  Write down all your findings and then seek your doctor’s opinion.  Since your doctor is aware of your medical history he will quickly be able to eliminate many of the most unlikely diagnoses and therefore concentrate on testing for what is most likely the problem.  Since a website can’t do such complex analysis, it is crucial that you be examined by your doctor. 

People who rely totally on the Internet run two risks when they try to diagnose and treat themselves. They might miss something subtle or important about their problem thereby causing them to misdiagnose themselves with possible disastrous results.  They might treat themselves incorrectly possibly doing harm, whereas a closer professional examination might very well uncover a different underlying condition.  Even for those who are confidant that the online diagnosis is correct. A doctor is needed to advise on the correct dosage of any medication as self-medicating can cause serious problems. Only a licensed doctor can write a prescription for medications or testing, or admit a patent to a hospital.

Access to medical information does not ensure that one will fully understand everything, let alone take the right actions without considering many other variables that doctors would consider before making a diagnosis. Without a doubt, when it comes to health, a doctor should always be consulted.

Companion Animals

Companion Animals

Dogs, cats, and other animals can be great stress relievers. Petting a purring cat, throwing a ball for your dog to retrieve, or going for a ride on your favorite horse can make you feel calm and peaceful. Pets can be of great comfort to those who have stressful lives.  Coming home and finding a loyal pet waiting for you is reassuring and allows you to unwind in the company of a totally nonjudgmental friend.

Unlike people, with whom our interactions may be quite complex and unpredictable, animals provide a constant source of comfort and need for attention. They bring out our nurturing instinct and also make us feel safe and unconditionally accepted. We can just be ourselves around our pets without any worry of being rejected.

Have you ever wondered why  some doctors and dentists  waiting rooms contain a fish tank?  It is designed to calm people down and help them to relax prior to a procedure that they may be apprehensive about.  Research has shown that patients’ blood pressure has a tendency to decline under these conditions. Stroking a dog, watching a kitten play, or observing fish in their own little world can be an antidote to a foul mood or a frustrating day.

Animals are usually quite predictable and constant in their reaction to their owner.  People like this response in their pets because it is totally different from what they experience in their dealings with people in everyday life.  People can be very unpredictable and downright nasty.  Dealing with people is one of the most stressful things that a person can face.  Having a pet can help to defuse stress.  People get great satisfaction and fulfillment from taking care of a pet and having to feed, groom and taking care of a pet brings out the nurturing instinct in most people. (PDF file)

Active pets can motivate a person to exercise which is also good for relieving stress levels and health in general.  Watching fish swim helps people take their mind off stressful situations.  On the other hand, keeping a pet can also add to stress so it is advisable that you know what you are getting into before getting one.  Some are pretty self sufficient while others may require a great deal of care.  You must also take your living arrangements into consideration.  For instance if you live in a small apartment it wouldn’t be wise to get a large dog.

Pet therapy is widely used in nursing homes, prisons, hospitals, and schools to reduce loneliness, anger, depression, and stress. It has been found that cardiac patient survival rates were higher for those who owned pets, and that elderly people with pets made fewer visits to the doctor's office. Significant decreases in resting heart rate and blood pressure, as well as mood changes, have also been observed when people played with their pets. The presence of an animal provides entertainment to those watching it. Even people who don't like animals often enjoy watching their antics and reactions. Especially in long-term care facilities, it seems everyone is entertained by animal visits in some way. Also, pets can be a great conversation starter and can assist in helping you make new friends. 

When contemplating pet ownership make sure that owning and caring for your new addition won't cause you more stress in the long run. You should first ask yourself if you have suitable living space and if you will be able to properly care for your new friend. Always put the pet's best interests ahead of your reasons for wanting a companion.  it is important that the pet you have selected fit your temperament, living space and lifestyle. 

Choosing the Right Doctor

 
The Importance Of Choosing The Right Doctor

Healthcare has traditionally relied on the personal relationship between a patient and a doctor, freely chosen by the patient to provide needed medical services.  Patient standards of care can vary considerably from doctor to doctor. 

Yesterday’s ability to diagnose and treat was primitive compared to today’s sophisticated testing and treatments.  Therefore it is extremely vital that you find a doctor who has kept up with medical advances so that you can expect the best possible care irregardless of the situation.  Blood tests, scans, and X rays all improve the accuracy of the diagnosis. 

However, all these tools have had the effect of distancing the doctor from the patient, and thereby placing less importance on their interacting with each other.   Since medical care is about our life and death we need physicians who can address our fears and ignorance.

Health care in the United States has been eroded in the past decade by managed care. The effect has been to somewhat destroy the old-fashioned doctor-patient relationship. Health maintenance organizations and other managed care plans generally reimburse physicians at such low rates per visit that doctors schedule shorter and shorter office visits in order to be able to see more patients. The result of this is poorer patient care as many doctors do not bother to take the time to address their patients’ sometimes multiple problems. 

You have a right as a patient to expect your doctor to be knowledgeable and technically skilled. In addition, you also have a right to expect caring and compassion from this professional. A competent physician without compassion is overwhelming to a patient who is already feeling uncertain and vulnerable. 

In the past my family has had the misfortune to have used doctors who were too quick to operate and in some cases prescribe medications that were not good for the patient’s well being.  In a couple of instances these medications could have been deadly.  I wonder if these physicians had taken any time at all to review the medical history beforehand. 

In preparation for your office visit you should think through and then write down what problems you are experiencing.  That way you will be less likely to leave anything out.  Be sure to list all symptoms, their severity and when they first occurred.

Many people are afraid of offending their doctor by saying that they want to seek a second opinion before they undertake a new treatment. This should not be at all a concern to you. If your doctor is offended, that in itself may tell you something that you need to know. Doctors today should encourage second opinions as everyone gains confidence upon hearing that another has made the same decision.

Convey your wishes clearly, indicating whether you are someone who likes to have all the facts or just the facts needed to make decisions regarding any necessary treatment. Be organized and prepared to discuss your problems, keep good records, ask all the questions you are concerned about, and make it clear that good communication, including attention to your emotional well-being, is essential to getting the care you want.

Important references:

U.S Dept. of Health and Human Services
National Institute On Aging
Consumer Reports Health Organization
About.Com- Arthritis

The Good and the Bad of
                Online Medical Forums

Online Medical Forums

If you are experiencing health problems, the internet is filled with websites about health and medicine. Some have good advice, recent medical breakthroughs and links to more detailed information.

(See the over 2,500 Slightly Creaky Medical Support Groups.)

As a result, many people have resorted to self-diagnosing their conditions online. Although knowledge is always useful there are some things to be aware of before concluding that you have a specific ailment.

(SC Online Diagnisis Group links)

If you already have either a suspected or confirmed diagnosis you may decide to seek advice from an online support group. There are support groups and forums for virtually every known illness and from these you can obtain personal information about symptoms, medications and their side effects. The knowledge that you receive at these websites may help you to better understand your specific condition and possibly even lead you to suspect that a tentative diagnosis may need to be looked at more closely. 

However, you cannot believe everything that you see discussed on these forums.  In some cases people who have had treatments or surgeries go badly do nothing but vent their frustrations on these sites.  Every person is different and what might work for one might be dangerous for another. 

I experienced this firsthand two years ago after being told that I would need a total hip replacement.  After signing on to a joint replacement forum I was bombarded with a huge amount of negative feedback.  There were some satisfied patients, but for the most part people had had pretty awful, life ruining, results from this surgery.  As a result I was petrified of undergoing this procedure and only had it because no other options were available.

Most people will attempt to search for all the possible conditions that may have certain symptoms. Some medical websites are better than others and it really boils down to a personal choice in how the information is presented.

Generally you would look at the key symptoms, then read each condition and compare whether other listed symptoms are also present or not. One will then end up with a list but rarely will there be just one obvious disease. The problem here is that medical websites do not show which symptoms are the most important.  Also there can be so many variables involved that it would be virtually impossible to nail down anything specific.

These medical websites are run on fairly simple databases matching symptoms and conditions. They are good in getting a list of possible conditions but they should not be relied upon to hone this list down to just one major suspect. It is even possible to have all the listed symptoms of a particular condition but also to have one very important extra condition that would rule out that particular diagnosis. That kind of analysis is not available online and this is where the knowledge and experience of a medical professional is invaluable.

Knowing your medical history and personal symptoms, your doctor will quickly eliminate many of the most unlikely ailments. At this point it might happen that there are still a small number of possible conditions left. The doctor should at this point consider testing for the most likely one.

It is good to be informed but where a website may be good at listing potential illnesses it is not so good at discarding those for which some vital symptom is lacking. This is where a doctor's experience is crucial.

The Dangers Of Online Diagnosis
Web Helpful But Doc Is Best

Vitamins

Vitamin Consumption

With the increasing popularity of vitamins and nutritional supplements, it is necessary to be aware of your options, particularly from a safety point of view.  These products are intended to make you healthier, but they can be anything but healthy if you overdo it. Taken to excess, you actually can overdose on vitamins and other food supplements.

Fortified foods and supplements are very popular these days. They are hyped to be ideal for both busy and health conscious consumers. A vitamin pill or a liquid multivitamin seems the ideal solution to compensate for a missed meal. For dieters, ads imply that you can limit your calories while still getting all the nutrients you need.  Is this really the case?

As with most substances, it is the amount consumed that is the key. Almost anything is toxic if consumed in excess, including salt, alcohol and even water or oxygen. Provided that supplements are taken in the amounts recommended on the pack by the manufacturer, and the recommended doses are not exceeded by combining too many different supplements, then it is highly unlikely that supplements will cause toxicity. Supplements are little regulated if at all. You can pick any one of them up at your neighborhood grocery store.

As our bodies age, they become less efficient at absorbing some of the nutrients from our diet making it important to ensure that the right quantities of necessary vitamins and minerals are consumed. For example, as we get older our bodies are less able to absorb iron but Vitamin C can help increase absorption, as can multivitamins in liquid form. On the other hand, we are also more prone to toxicity as even water-soluble vitamins are not excreted as much because of our less efficient kidneys. Due to individual sensitivities, if any unexpected symptoms appear while taking a particular supplement, medical advice should be sought.

If you suspect that you're taking too much of a vitamin or mineral, don't stop completely. Nutrition experts suggest cutting back to about half of your current dosage. Your body has adjusted itself to handle a massive dose, so if you stop altogether, it could trigger a deficiency.

If you're thinking about increasing the dosage of some nutrients or are just curious about your present vitamin regimen, consult your doctor or a registered dietitian. This is especially important if you have an illness such as diabetes or high blood pressure, since large doses of some supplements can interfere with the function of some medications.

Many people are anxious over whether their families should be given extra vitamin pills. Much depends on the circumstances under which they live. When people are healthy and strong, extra vitamins are not required. However they are valuable when a person is recovering from a severe illness or injury. Many people can get all the vitamins they require by consuming a decent diet, along with enough rest, sunshine and exercise.

Suggested links for more information:

Fitness Tips
Vitamins & Minerals
Multivitamins & Minerals
Benefits Of Vitamins and Mineral Food Supplements
The Med Guru

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