June 22, 2012

Nutrition and Aging – Some Signs

Yes, I am discussing the topic of nutrition again. With the concerted efforts of the Academy of Nutrition and Dietetic (AND) to become a monopoly in the field of nutrition and force people with degrees in nutrition out of business unless they become certified or licensed under their organization, people will need to learn nutrition on their own. We should not accept the teachings of a monopolistic organization that uses mantras and mandates.

I am hoping our state legislature will continue to protect the nutritionists of our state. It is refreshing to talk to them and know that they will work with you as an individual. They know that in nutrition, “one-size-does-not fit all,” and each person has individual needs depending on age, ability to exercise, and general health. Since I am in the class of elderly, they work with me to attempt to balance my nutritional intake.

For those of us in the elder generation, we need to avoid many of the normal teachings of the AND and learn that many years of whole grains (i.e. high carbohydrate) and low fat have done damage to us. We often need more protein, higher fat content in our food, and less carbohydrates than our younger generations. Even they might do better with fewer carbohydrates.

When I started to look for information, I thought this article in WebMD may have been useful, but it is not as specific or as helpful as I had hoped. The article focuses on anemia and iron deficiency more than anything. It rightly brings up the B vitamins, but fails to point out any specific deficiencies and signs to be aware of if you have any of the vitamin B deficiencies. This is the reason I do not like articles mentioning registered dietitians as they are not getting paid to be informative, therefore it is all generalizations.

We need to be aware of other people on the Internet that also bring in small items about nutrition and those writing about low carbohydrate diets. David Mendosa does like to mention foods that work for him. You should subscribe to his posts. Jenney Ruhl now has a book out titled Diet 101 that I have not been able to read, but hopefully will in the near future.

Other sites that are about nutrition exist, it is just finding them. Yes, here are a few I read, not on a daily basis, but as I can or they have a blog posted.

June 21, 2012

Telemedicine Aids Diabetes Management

The American Association of Clinical Endocrinologists 21st Annual Meeting and Clinical Congress in Philadelphia, PA has had some interesting topics coming out of its sessions. While they are not of an official nature until something shows acceptance or is passed through peer review, some topics are interesting just the same. Telemedicine is an acceptable way to deliver care to endocrinology patients in rural areas, according to a study given at the meeting.

Even with many states passing laws requiring patients to be seen by doctors before being issued prescriptions, this still should not stop this proposal from gaining traction. In a conversation with a friend from a northwestern state, he mentioned that a few doctors were considering and doing this, but another group of doctors is opposing them. He commented that this is very amusing for several reasons. Doctors bickering with doctors, but he found that it was the better doctors that were wanting to do this and the doctors losing patients that were in opposition.

I asked if these were endocrinologists and he said they were from a variety of specialties and primary care. He said that a few were already doing this with success and others were hoping this could be a big help for patients that needed to travel long distances in cutting down their travel. He also stated that another doctor had several patients that needed to travel over long distances and did not have computers, so he was consulting with them on the telephone.

I agree that it is time for doctors to take the initiative and this statement is true. "There is an increased prevalence of diabetes in rural compared with urban areas, which is compounded by the problem of a lack of endocrinologists," said Rabia A. Rehman, MD, an endocrinology fellow at the University of Tennessee Health Science Center in Memphis.

The study took place in Tennessee and the telemedicine unit of the University of Tennessee. There were 66 patients from five rural areas that were referred by their primary care providers. The study lasted two and one-half years.

Patients were interviewed and examined using the video conferencing in the telemedicine studio. A nurse was used at the patient site and assisted the physician in assessing the general condition of the patient. The nurse looked for swelling in the legs and did a thyroid exam. Laboratory tests and management strategies were sent to the patients' primary care physicians for follow-up.

The study author stated that, "We think it may be a little costly to set up the equipment up front. However, in the long-run, this will be cost effective, not only for the patients but for overall healthcare," She continued, "This will save patients from traveling long distances, resulting in timely consultation and leading to better control. Improvement of HbA1c will also result in prevention of the multiple morbidities and complications that result from uncontrolled diabetes."

June 20, 2012

Aggressive Glucose Control May Not Stop Kidney Failure

What is it about adding oral medication on top of oral medication that romances researchers to believe this is the only way to treat type 2 diabetes? In my reading over the last five years, it seems that unless researchers can have a cocktail of oral diabetes medications, the researchers are not interested.

I doubt I will find out, but it is interesting to speculate, especially after this from Yale School of Medicine. Here researchers discovered that aggressive glycemic control may not reduce risk of kidney failure. The researchers found that comparing usual treatment and controlling glucose with higher doses of medication did not improve the chances of preventing kidney failure.

Since the results are cloaked behind the veil of money, I am not able to determine what procedures were used and what combinations of medications, if any, were used. The write up about the research hides much information that could be of value. I will say this as I think it could be true also. The research did not reach the conclusion desired so they salvage something and explain the minimum to justify the study.

Since insulin is not mentioned or any other medication by name, it is difficult to give any reliability to this study. My interpretation is that this is again junk science and because the results were not what they wanted, we the patients learn nothing. If they had mentioned the medications by name and really tried to inform us, we may have learned which medications are useless for treating end-stage renal problems. I also have to believe that insulin was not part of the study and only oral medications were considered.

Since before the ACCORD study, stacking oral medications seems to be the only way to do studies. With the exception of Metformin which slows the release of glucose from the liver, oral medications work on the pancreas to produce more insulin and this means a quicker demise of the pancreas because it cannot continue to force out insulin as it is asked to do. Yet, this seems to be the only topic for research.

Therefore, I think it is time that studies are required to have a insulin control group to compare the results of oral medications against to see which gives the most efficient treatment. Then maybe the studies could have more meaning and give people with type 2 diabetes some actual comparisons for determining which treatment to use. Granted, some additional testing would be required of the pancreas before and after the study to determine the amount of insulin the pancreas is capable of producing.

This could also open new analysis for consideration as this is seldom mentioned in any of the current or recent studies. Who knows, we could have many study participants that are producing small amounts of insulin and incapable of more insulin production. This could produce misleading results for any study if these are the people participating in the study produce small amounts of insulin and the people in the control group can produce greater quantities of insulin. The reverse scenario would produce even more inflated results which the study wants. Yet this is something seldom seen even in studies given wide publication and not put behind a wall of money.

If it is the desire to prevent the general public from analyzing the study, then there needs to be a standard criteria published that will let the public know that these procedures were followed. Until this is done, we need to be skeptical of most studies and how much we should rely on their accuracy. Oral diabetes medications have their place and study under different scenarios is needed; however, a group within any study needs to be using insulin for a more accurate comparison.

June 19, 2012

Our Informal Peer-to-Peer Group

Lest you think we talk about nothing but diabetes, you would be wrong. Several are avid NASCAR fans and some of us enjoy photography. A couple of the group are true geeks when it comes to computers and they enjoy solving problems for the rest of us. One of those into photography is an avid bird watcher as is another member that has several binoculars plus one with a built in camera. We do enjoy talking about various topics outside of diabetes.

Diabetes is often our topic of discussion and we have had plenty to research to discuss lately with all of us now on insulin with the exception of Sue who is not on any medications. We all encourage her to do all she can to stay off medications. She is still doing quite well in her efforts and likes the positive feedback she receives from us. She spends some extra money to test more frequently at present while she is learning how different foods affect her blood glucose. Her doctor is supporting her and has been able to convince her medical insurance company to allow her extra test strips for a few months and then they will bring her back down in reimbursed test strips.

Among the ten of us, we see three different diabetes specialists and it has been very interesting to compare notes. Eight of the ten are within ten pounds of ideal weight for their body build (some above and a few below) and only two of us (Max and myself) are overweight. We are working to bring our weight down. Both of us have been approached by our doctors to consider bariatric surgery, but we agree this will not happen and our doctors have stopped pushing the topic. The hospital is pushing the topic and we have told them to stop because for us it was not going to happen.

We have even been approached by others that do not have diabetes wondering how we were resisting. We now give people a card with the applicable URLs on it when they ask about what we plan to do. We tell them it is a personal decision on our part, but they can do as they please; however, we think they should read what the surgeons will not tell them. One surgeon has asked that I stop what I am doing and not answer people’s questions. I politely said, if the person asks, he cannot prevent me from talking about it. I am only a patient and not an employee of the hospital, therefore he cannot do anything to me if another patient asks me questions. I did say that we were not seeking these people out, but they were coming to us with questions.

There are now three of us with neuropathy. One (Jason) is from diabetes and Max and myself from other causes. Nine of the ten of us are on insulin and Ben and Allen are working diligently to keep their weight from creeping up and have been successful to date, by lowering their carbohydrate intake. Ben and Allen are working with Barry to exercise daily and Max and I are taking part, as we are able. Max is struggling now as he had two warts removed from his left foot and his doctor will not allow him to walk except as needed for a few weeks and then with the assistance of a crutch. His doctor is very pleased with the progress of healing.

Allen is now in the upper normal range for both Vitamin B12 and Vitamin D and feeling much better. Ben has not had any more depression problems and like he said, by working diligently he is holding steady with his vision and actually feels it is getting better. He has his next appointment late this month to have his eyes examined again and we are all wishing him well.

I like photography, but lately I have been busy with other activities and have not had time to participate with the rest. I have also been busy driving my wife to her appointments with the doctors and surgery for her injured shoulder, rotator cuff and torn tendons. Therefore, my projects have been taking a back seat as well. I would not do otherwise, but it is starting to wear on both of us. She needs assistance with her clothes, and her hair. I admit I do not do well in handling her hair and putting it up in a ponytail. For some this is easy, but for some reason I am not as coordinated as I need to be, and my fingers are too large.

Brenda will be busy this summer with her grandchildren. Her daughter and husband will be taking a second honeymoon. Like she said, they have earned it and she will be happy to have the two children for that time. Several of the group have volunteered to assist on the weekends, but she assured us she would ask only if needed. She did say that we would be invited for a Saturday afternoon.

Two of the group will be in Alaska for much of the summer. One has a relative living in Juneau, and they are planning to travel to some areas. We have asked for pictures. They said we may have to wait until they return.

Most of the rest will be here, except for day trips to see some of the nearby sites and be a tourist for part of a day. To everyone, in the northern hemisphere at least, have a great summer!

June 18, 2012

Nursing Shortages – Oh Really?

Nursing shortage seems like another myth. In some areas of the USA, this is true. In other areas, there is an honest shortage, but it may not last long. What are some of the factors affecting the field of nursing? There are some obvious answers and some almost obscure answers.

Two of the most telling answers are one; older nurses are not retiring because of the economy and may well have a spouse without a job. The second and more frightening answer is hospitals are just not replacing nurses as they leave. Why you might ask? The reduction in profits is largely to blame and increases in hospital administrator salaries are adding to this pressure.

Although many hospitals have positions for nurse aids, more hospitals are adding them in place of nurses. This will increase the workload for remaining nurses, but the hospitals are striving to keep profits increasing. How are the hospitals determining this? They have people patrolling the floors of the hospitals, counting patients, watching nurse activities and other variables. These people report to the administration about their observations.

This may sound cruel, but many nurses have brought this on themselves by their actions or maybe I should say lack of doing their duties. I have been in a few hospitals and actually seen this and wondered how the hospital could make money with the nurses sitting around the nursing station. In one visit to a friend, the five hours I was there they sat and never made rounds. Call buzzers would go off and still they did not move. They would send an aid to check and only leave the nurse's station if it was something urgent. The patient I was visiting needed a shot every four hours, but while I was visiting, no shots were given.

Even a trip to the nurse station did not get a shot. In this case, I called the doctor and explained what had happened. The doctor said he would be there in a few minutes and he was. He came in an entrance away from the nurse's station and came directly to the room. He checked the chart and asked how long I had been there. Next, he headed to the dispensary to get the medication for the shot and the syringe. He asked why his patient had not been given a shot on time. The answer was it was not listed on the patient file. He came to the room, gave the shot, and then went back to the station with the patients chart in his hand.

I don't know more as visiting hours were over and the nurses were checking every room and making sure all visitors were leaving. The whole time I had been there, no rounds had been made by the nurses, but the aids had come and gone rather regularly. From what I observed, the five nurses had a gab fest the whole time and I don't think four had gone anywhere except to use the ladies' room and one to the cafeteria to bring back food for all.

In another hospital, I knew there were very few patients on that level, but the nurses were constantly checking rooms and I very seldom heard a call bell (or buzzer) sounding. About every 15 to 20 minutes, a nurse would be in to check on my wife, checking pulse and blood pressure and moistening her lips with water on a cloth. When shift time came, one of the day nurses stayed and two others reported in plus a couple of aids. Even they were making rounds and checking on the few patients. A very clear contrast when compared to my visit to a friend.

From the second article, this seems to be the case I have described above and varies from hospital to hospital. Some nurses are extremely busy and at some hospitals, it is difficult to see nurses at work. Even patients are complaining at these hospitals. Although this is seldom talked about, hospitals that have strong unions are where the most complaints originate. Others say it depends on the strength of the director of nursing. And, it may be a combination of these.

Either way there are several scenarios that may play out in the next few years. I disagree with the scenarios discussed in this blog, but he may be right as he is an insider and I am a patient. I suspect there will not be an oversupply of nurses because many will leave for employment that is more lucrative. Hospitals will work diligently to reduce the nursing staff and replace many with nurse aids to reduce labor costs and at the same time bring in pharmacists to administer medications and manage inhouse pharmacies. Unions will be either forced out or greatly weakened all as a means of increasing profits.