I am a bit disappointed in the response to the first blog on Type 2 diabetes needing their own organization, but just in the comments. The emails were only from one person and not very friendly.
Outside of the need to have an organization for those of us with Type 2 diabetes, I had hoped to get some more objectives and goals that would give us more ideas. So with that in mind, I will attempt to list a few of them and hope that we can draw some responses.
Besides raising funds for research, finding the proper research venues will be a big priority. There seems to be some areas that are coming to light now that may need more exploration that may lead to keys for managing diabetes. Being more accurate in the diagnosis of diabetes should not be overlooked as the ADA has opted to support the A1c test only.
Something will need to be done for educating the medical profession in being more aggressive in diagnosis, early treatment, and follow up. See this for some hope. Patient education also needs to be strongly promoted. I am not sure how this would be best accomplished, but one suggestion would be on line resources. This could be accomplished by having pamphlets or booklets that every doctor or endocrinologist can hand out when diagnosed.
Sadly in need of education are the insurance companies in preventative medicine and early work for patient education, patient followup, and working with other doctors for overall health. This may include, heart disease prevention, sleep apnea, kidney health, neuropathy, eye health, and many other related areas.
Research will need to be done to find out what other people with diabetes want for support, what education they want and need, and what services would better serve them. I suspect some work will be needed with government agencies, medical groups, and diabetes manufacturers of all types.
Because of the problems specific to women and to men, there should be special education and on line help for each. Education will need to be considered for the younger people now being diagnosed with Type 2 diabetes.
Education programs will need to be developed for hospitals and elder-care facilities. This will develop new standards for how patients with diabetes should be treated, allowed to be self-medicated while in these facilities, and procedures for reducing errors in IV solutions and medications. The attitudes of hospitals does need to be adjusted in many situations.
There has to be more objectives and goals. Help!
October 28, 2010
Which sweeteners are you consuming?
When I started this, I had no idea what I was getting into. The way the sweeteners are looked at and discussed varies more than a person might think. Much depends on site objectives and manufacturer influence. Sugar and sweeteners are generally viewed as a poison by some groups, and should not even be looked at for people with diabetes irregardless of type. So those articles have been ignored as I wanted something that made some sense and might be of interest.
While the glycemic index values may vary from what I have located, generally they are within a few points in the sources checked. A few values could not be found and I used (??) to indicate that. The value can also change when processed differently as in pasteurized and raw honey. The GI values listed are therefore only guides and can vary depending on method of processing.
Various sweeteners Glycemic Index Value
Sugar GI 80
Other calorie containing sweeteners:
all have approximately 15 grams of carbohydrates per teaspoon
Honey, pasteurized GI 75
Raw Honey GI 30
Maple syrup GI 54
Pancake syrup GI (??)
Malt syrup GI 42
Karo syrup GI (??)
Corn sweeteners GI 62
Molasses GI 58
Jellies GI (??)
Jams GI 46
Marmalades GI 55
Agave syrup, nectar GI 15
Brown Rice syrup GI 25
Brown sugar GI 64
Fructose GI 22
Lactose GI 46
Glucose GI 96
Blackstrap Molasses GI 55
Stevia – FOS Blend GI <1
Artificial sweeteners GI <1
Name Brands
Aspartame NutraSweet, Equal
People who have a condition called phenylketonuria should avoid
this sweetener.
Acesulfame K Sunett, Sweet One, Swiss Sweet
Sucralose Splenda
Saccharin Sweet'nLow, Sugartwin
Avoid this sweetener if you are pregnant or breastfeeding
Sugar alcohols - These are neither sugars or alcohols, but pure carbohydrates. Examples of common sugar alcohols are maltitol, sorbitol, isomalt, and xylitol and are called “polyols”. There are other manufactured sugar alcohols, but these occur naturally in plants. This article explains more on sugar alcohols.
The key to non-artificial sweeteners is to use in moderation. Overuse of any sweetener is not good for maintaining tight management of diabetes and for many people will cause weight gain.
The above information is knowledge you should make use of when reading labels. While the GI values will not be listed, these are listed here to hopefully give you ideas when you are looking at labels. This article in WebMD may answer some more questions.
While the glycemic index values may vary from what I have located, generally they are within a few points in the sources checked. A few values could not be found and I used (??) to indicate that. The value can also change when processed differently as in pasteurized and raw honey. The GI values listed are therefore only guides and can vary depending on method of processing.
Various sweeteners Glycemic Index Value
Sugar GI 80
Other calorie containing sweeteners:
all have approximately 15 grams of carbohydrates per teaspoon
Honey, pasteurized GI 75
Raw Honey GI 30
Maple syrup GI 54
Pancake syrup GI (??)
Malt syrup GI 42
Karo syrup GI (??)
Corn sweeteners GI 62
Molasses GI 58
Jellies GI (??)
Jams GI 46
Marmalades GI 55
Agave syrup, nectar GI 15
Brown Rice syrup GI 25
Brown sugar GI 64
Fructose GI 22
Lactose GI 46
Glucose GI 96
Blackstrap Molasses GI 55
Stevia – FOS Blend GI <1
Artificial sweeteners GI <1
Name Brands
Aspartame NutraSweet, Equal
People who have a condition called phenylketonuria should avoid
this sweetener.
Acesulfame K Sunett, Sweet One, Swiss Sweet
Sucralose Splenda
Saccharin Sweet'nLow, Sugartwin
Avoid this sweetener if you are pregnant or breastfeeding
Sugar alcohols - These are neither sugars or alcohols, but pure carbohydrates. Examples of common sugar alcohols are maltitol, sorbitol, isomalt, and xylitol and are called “polyols”. There are other manufactured sugar alcohols, but these occur naturally in plants. This article explains more on sugar alcohols.
The key to non-artificial sweeteners is to use in moderation. Overuse of any sweetener is not good for maintaining tight management of diabetes and for many people will cause weight gain.
The above information is knowledge you should make use of when reading labels. While the GI values will not be listed, these are listed here to hopefully give you ideas when you are looking at labels. This article in WebMD may answer some more questions.
October 25, 2010
Hospital Awareness for People with Diabetes
Since the this post, more information keeps coming to light that people with diabetes need to be aware of when entering the hospital. There are some nasty situations that can arise even when the hospital is aware that you have diabetes. The nasty problems are life threatening if the hospital is unaware that you have diabetes.
If you are having an IV(intravenous therapy), please make yourself aware of what will be in the IV. You will want to be sure that dextrose or other sugars are not part of the IV. The IV should be saline, but many are five percent dextrose. For people without diabetes no harm will be done. For people with diabetes, this will play havoc with blood glucose levels (BG) management. Depending on how many you will be given, it could raise your BG to levels higher than manageable immediately, even with insulin, and will require close management for at least 24 hours or more.
So it does not matter whether you are Type 1 or Type 2, be careful of what you are given in your IV's. To assist in maintaining your independence and preventing the inadvertent problems, you should ask your doctor and the hospital administration for release forms to allow you to medicate yourself and to maintain control of your diabetes management. Drives hospitals crazy, but protects them as well as you.
Another area of concern, if you are having any surgeries, will be the medications you will be given (if any), and how they will react with BG levels. There are many medications that can raise BG and you should talk to the surgeons or physicians about your concerns and what medications you may be given.
If enough preparation time, have you doctor find out and discuss the medications you will be given. Be prepared to adjust your insulin needs or oral medications while in the hospital and your doctor can be of great assistance in making adjustments easier to handle. David Mendosa presented the list from Diabetes in Control dot com. This is a very good list to be aware of and use.
If you have surgeries that will involve body part replacements, steroids will probably be involved and this should be known. Steroids will elevate BG levels and for those on insulin, careful watch needs to be done and sometimes extra testing of BG is needed to adjust insulin. Those on oral medications should actually consider using insulin to manage BG levels while on steroids. If staying on oral medications, consult your doctor for dosage and possible addition of other oral medications.
Never be afraid to ask questions and ask for the advice from your doctor or endocrinologist as this assistance may keep you from making some serious mistakes. You may need to schedule another appointment to get this all in, but it will be worth the time and peace of mind for you. If you need to stand your ground, be ready to – it is your health.
This is worth repeating from the previous blog – try to get your medications approved and be prepared to sign any waivers necessary to have them with you. You will still need to guard them carefully. A local legal case brought this home for me. Patient had his medications approved and special warnings put on his chart and records that the medications were to be left with the patient as they were not available in the hospital and patient was allergic to certain comparable medications.
Evening shift nurse thought she knew everything and confiscated his medications and disposed of them in the medical waste. When this was discovered, the patient was suffering from an allergy attack from a substituted medication. When the doctor discovered this and the fact that his medications were gone, at least he had an internal investigation started. Outcome was patient recovered and needed three extra days in hospital at no cost, nurse lost her job, and hospital was out some money in the legal case plus had to replace the destroyed medications.
It is sad that only the bad get the publicity and those that do their jobs do not get the recognition they should. The attitude of the evening shift nurse does happen to be prevalent in more cases than we would like to acknowledge. I am not into speculating what the reasoning for this is; however, hospitals are beginning to slowly realize that with patients who are advocates for themselves, they must listen and facilitate, plus have the nursing staff in full cooperation mode.
The above is all written with the fact that you have knowledge of what is to happen and when. Remember that if you enter the hospital under emergency conditions, then hopefully your spouse, good friend, or other family member can act for you and determine that the above in handled for you. I will mention the limited medical power of attorney again to make sure that those you trust are able to act for you. They must be prepared to act for you and see to your health until you are able to assume that role.
If you are having an IV(intravenous therapy), please make yourself aware of what will be in the IV. You will want to be sure that dextrose or other sugars are not part of the IV. The IV should be saline, but many are five percent dextrose. For people without diabetes no harm will be done. For people with diabetes, this will play havoc with blood glucose levels (BG) management. Depending on how many you will be given, it could raise your BG to levels higher than manageable immediately, even with insulin, and will require close management for at least 24 hours or more.
So it does not matter whether you are Type 1 or Type 2, be careful of what you are given in your IV's. To assist in maintaining your independence and preventing the inadvertent problems, you should ask your doctor and the hospital administration for release forms to allow you to medicate yourself and to maintain control of your diabetes management. Drives hospitals crazy, but protects them as well as you.
Another area of concern, if you are having any surgeries, will be the medications you will be given (if any), and how they will react with BG levels. There are many medications that can raise BG and you should talk to the surgeons or physicians about your concerns and what medications you may be given.
If enough preparation time, have you doctor find out and discuss the medications you will be given. Be prepared to adjust your insulin needs or oral medications while in the hospital and your doctor can be of great assistance in making adjustments easier to handle. David Mendosa presented the list from Diabetes in Control dot com. This is a very good list to be aware of and use.
If you have surgeries that will involve body part replacements, steroids will probably be involved and this should be known. Steroids will elevate BG levels and for those on insulin, careful watch needs to be done and sometimes extra testing of BG is needed to adjust insulin. Those on oral medications should actually consider using insulin to manage BG levels while on steroids. If staying on oral medications, consult your doctor for dosage and possible addition of other oral medications.
Never be afraid to ask questions and ask for the advice from your doctor or endocrinologist as this assistance may keep you from making some serious mistakes. You may need to schedule another appointment to get this all in, but it will be worth the time and peace of mind for you. If you need to stand your ground, be ready to – it is your health.
This is worth repeating from the previous blog – try to get your medications approved and be prepared to sign any waivers necessary to have them with you. You will still need to guard them carefully. A local legal case brought this home for me. Patient had his medications approved and special warnings put on his chart and records that the medications were to be left with the patient as they were not available in the hospital and patient was allergic to certain comparable medications.
Evening shift nurse thought she knew everything and confiscated his medications and disposed of them in the medical waste. When this was discovered, the patient was suffering from an allergy attack from a substituted medication. When the doctor discovered this and the fact that his medications were gone, at least he had an internal investigation started. Outcome was patient recovered and needed three extra days in hospital at no cost, nurse lost her job, and hospital was out some money in the legal case plus had to replace the destroyed medications.
It is sad that only the bad get the publicity and those that do their jobs do not get the recognition they should. The attitude of the evening shift nurse does happen to be prevalent in more cases than we would like to acknowledge. I am not into speculating what the reasoning for this is; however, hospitals are beginning to slowly realize that with patients who are advocates for themselves, they must listen and facilitate, plus have the nursing staff in full cooperation mode.
The above is all written with the fact that you have knowledge of what is to happen and when. Remember that if you enter the hospital under emergency conditions, then hopefully your spouse, good friend, or other family member can act for you and determine that the above in handled for you. I will mention the limited medical power of attorney again to make sure that those you trust are able to act for you. They must be prepared to act for you and see to your health until you are able to assume that role.
October 22, 2010
Diabetic Wound Care of Feet
If this was not so serious, maybe we could all laugh about it, but taking care of foot injuries is very important if you have diabetes and no laughing matter.
Day 1 – stub your toes on the bed as you are hurrying to the bathroom. Nothing shows when you inspect while in lighted bathroom.
Day 2 – large red area on the two toes you banged the prior evening. They are tender, but you put your socks and shoes on and go to work. In the evening, you notice a spot of blood on the sock, so you wash the feet and go to bed.
Day 3 – toes are tender and inflamed, but you go to work anyhow. In the evening, more blood on the sock, again you wash your feet and spray a little antibiotic on the area.
Day 4 – toes are inflamed and very sore, painful when touched and a crust has formed over the bleeding area. You decide to tough it out as tomorrow is Saturday. Evening finds sock soaked in blood and another stain. Wash despite the pain and apply antibiotic and cover. Sleep is difficult as foot is sore now.
Day 5 – wife wants the lawn mowed, so you start, but cannot get far. The pain is too much and when you remove your shoe, the sock is a mixture of blood and more stain. Wife see this and decides to clean the area, apply antibiotic, and cover it. Now she tells you to get the yard mowed as her sister is having a surprise birthday party for her husband at 4 o'clock, and she does not want to be late. You do as told and are able to stay off you feet the rest of the day, but at home, tired and very sore you just fall into bed.
Day 6 – Wife wakes you for church, but you cannot stand on the foot. It is swollen and inflamed. You decide to go to the emergency room. There they clean and disinfect the wound, give you an antibiotic shot and a prescription for more antibiotics, tell you to stay off your feet for a few days. They tell you to see your regular doctor, and tell you not to work for a few days. You forget to tell them you have diabetes, don't see your doctor, and don't fill the prescription.
Day 12 – you wake in the hospital and realize that you are missing your foot. The doctor is telling you that they have saved your life and that the foot and part of the leg was a small sacrifice to be able to save your life.
The above is not a true story, but it could be. If you have diabetes, any small bruise, minor cut or scratch could end up putting you in the above story.
The importance of wound care cannot be emphasized enough, especially the lower part of the legs and feet. Even if your diabetes management is excellent, accidents do happen. For understanding the stages of wounds, burns, and the healing and treatments, see this article by diagnose-me dot com.
Then there are those that think nutrition is the end-all for people with diabetes and go to extremes to promote it as the only way of managing diabetes and try to scare those who don't manage diabetes with nutrition as poor candidates for wounds and other problems as they don't practice good glycemic control. Yes, nutrition is important, but exercise is also important and taking your medications if you cannot control diabetes with exercise and nutrition.
Then when we get past those that only have one line of thinking, we can get down to those that care and offer sound advice and directions for taking care of ourselves. Even if I often do not like WebMD, they have done an excellent job of outlining the problems and treatment of wounds for people with diabetes.
The article has a ten point checklist that make a lot of sense.
Check you feet daily.
Pay attention to your skin.
Moisturize your feet.
Wear proper footwear
Inspect your shoes every day
Chose the right socks
Wash your feet daily
Smooth away calluses
Keep toenails clipped and even
Manage your diabetes
They put a lot under manage your diabetes – monitoring blood glucose levels, blood pressure, and cholesterol levels. At least they went on to say a person with diabetes should eat healthy, exercise regularly, taking medications the doctor prescribed, not smoking, and having regular medical checkups. Too many writers stop at just manage your diabetes.
I also like that WebMD also covers burns as part of taking care of yourself. There are many parts to wound care and burns can certainly happen. Please read this carefully even if it is not all about your feet.
Two other sites worth reading are: Site 1 and Site 2.
Please take the extra time to inspect your feet and legs daily and treat every minor injury immediately. This could save a toe, a foot, and even your leg by taking care of minor bruise, cut, or ingrown toenail early. If the healing does not start promptly, get to the doctor for quick medical care. This should be done for good care and proper antibiotics or other treatments.
You should have regular appointments with a podiatrist to check your feet to prevent problems from starting. Even for regular food care this should be done. For injuries see your regular doctor promptly.
Day 1 – stub your toes on the bed as you are hurrying to the bathroom. Nothing shows when you inspect while in lighted bathroom.
Day 2 – large red area on the two toes you banged the prior evening. They are tender, but you put your socks and shoes on and go to work. In the evening, you notice a spot of blood on the sock, so you wash the feet and go to bed.
Day 3 – toes are tender and inflamed, but you go to work anyhow. In the evening, more blood on the sock, again you wash your feet and spray a little antibiotic on the area.
Day 4 – toes are inflamed and very sore, painful when touched and a crust has formed over the bleeding area. You decide to tough it out as tomorrow is Saturday. Evening finds sock soaked in blood and another stain. Wash despite the pain and apply antibiotic and cover. Sleep is difficult as foot is sore now.
Day 5 – wife wants the lawn mowed, so you start, but cannot get far. The pain is too much and when you remove your shoe, the sock is a mixture of blood and more stain. Wife see this and decides to clean the area, apply antibiotic, and cover it. Now she tells you to get the yard mowed as her sister is having a surprise birthday party for her husband at 4 o'clock, and she does not want to be late. You do as told and are able to stay off you feet the rest of the day, but at home, tired and very sore you just fall into bed.
Day 6 – Wife wakes you for church, but you cannot stand on the foot. It is swollen and inflamed. You decide to go to the emergency room. There they clean and disinfect the wound, give you an antibiotic shot and a prescription for more antibiotics, tell you to stay off your feet for a few days. They tell you to see your regular doctor, and tell you not to work for a few days. You forget to tell them you have diabetes, don't see your doctor, and don't fill the prescription.
Day 12 – you wake in the hospital and realize that you are missing your foot. The doctor is telling you that they have saved your life and that the foot and part of the leg was a small sacrifice to be able to save your life.
The above is not a true story, but it could be. If you have diabetes, any small bruise, minor cut or scratch could end up putting you in the above story.
The importance of wound care cannot be emphasized enough, especially the lower part of the legs and feet. Even if your diabetes management is excellent, accidents do happen. For understanding the stages of wounds, burns, and the healing and treatments, see this article by diagnose-me dot com.
Then there are those that think nutrition is the end-all for people with diabetes and go to extremes to promote it as the only way of managing diabetes and try to scare those who don't manage diabetes with nutrition as poor candidates for wounds and other problems as they don't practice good glycemic control. Yes, nutrition is important, but exercise is also important and taking your medications if you cannot control diabetes with exercise and nutrition.
Then when we get past those that only have one line of thinking, we can get down to those that care and offer sound advice and directions for taking care of ourselves. Even if I often do not like WebMD, they have done an excellent job of outlining the problems and treatment of wounds for people with diabetes.
The article has a ten point checklist that make a lot of sense.
Check you feet daily.
Pay attention to your skin.
Moisturize your feet.
Wear proper footwear
Inspect your shoes every day
Chose the right socks
Wash your feet daily
Smooth away calluses
Keep toenails clipped and even
Manage your diabetes
They put a lot under manage your diabetes – monitoring blood glucose levels, blood pressure, and cholesterol levels. At least they went on to say a person with diabetes should eat healthy, exercise regularly, taking medications the doctor prescribed, not smoking, and having regular medical checkups. Too many writers stop at just manage your diabetes.
I also like that WebMD also covers burns as part of taking care of yourself. There are many parts to wound care and burns can certainly happen. Please read this carefully even if it is not all about your feet.
Two other sites worth reading are: Site 1 and Site 2.
Please take the extra time to inspect your feet and legs daily and treat every minor injury immediately. This could save a toe, a foot, and even your leg by taking care of minor bruise, cut, or ingrown toenail early. If the healing does not start promptly, get to the doctor for quick medical care. This should be done for good care and proper antibiotics or other treatments.
You should have regular appointments with a podiatrist to check your feet to prevent problems from starting. Even for regular food care this should be done. For injuries see your regular doctor promptly.
October 19, 2010
Sleep apnea and hospitalization Part 2
This part provides some issues you need to be aware of for treatment of sleep apnea in a hospital or out-patient setting whether for a surgical or other treatment. This is information I wished I have made myself aware of for past procedures. I will be ready for any future procedures.
Oral appliance users will need to consult with their prescriber for procedures to follow, but much of the following may apply. Just substitute oral appliance when CPAP is discussed.
When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices. When reading about obstructive sleep apnea (OSA) please use the terms mild or moderate sleep apnea if applicable.
For all sleep apnea patients, knowledge is important to get proper care and treatment in the hospital or out-patient area. If at all possible - DO NOT LEAVE YOUR EQUIPMENT AT HOME. This is important in so many ways as sleep apnea therapy is as important in the hospital as it is at home.
If you do not inform your physicians or surgeon of your need for sleep apnea therapy
during and after medical procedures, this can create problems in healing and delay recovery time leading to longer hospital stays. Do not assume that the physicians and nurses will know how to manage your OSA. If they are not aware, they will not be prepared to care for OSA.
Please ask if you may use your own CPAP equipment. This will be when you will find out what the hospital policy says and you should talk to your doctor as well as your surgeon and the anesthesiologist if you are having surgery to confirm the hospital's policy. If they say no, then ask if they have a form called “Permission and Release for use of Outside Medical Equipment/Appliance for Patient Treatment” so that you may use your own equipment. At this time also ask if they will need a letter from your doctor or a consultation with your sleep doctor.
The only way you should accept the hospital's equipment is if clear that it has the same or better benefits as you equipment. If they cannot meet these requirements, you should be able to use your own equipment for your own well being and comfort. Always make every attempt to use your own mask to control leaks and for comfort.
If they allow your equipment, ask if they need to inspect the equipment to see that it is functioning correctly and does not pose any hazards. Ask when they want to inspect the equipment as you do not want to do this too far in advance.
Important - Label your equipment, CPAP carrying case, mask, and CPAP machine. When you are admitted, labels identifying you, and for your chart are printed. Be sure to ask for enough extras to label your equipment.
Again important, if supplemental oxygen is required, your mask may have ports for attaching an oxygen line. If your mask does not have oxygen ports, contact you equipment provider or the manufacturer to find out if an oxygen port adapter is available for your mask. Most of the time the hospital may have an adapter that will work with your mask.
If you are having surgery and will have a breathing tube inserted into your windpipe, your CPAP will not be required. After the tube is removed, you should be put on the CPAP machine. If you are not intubated, then remind the hospital staff that the CPAP need to be used.
Show your family and/or friends who will be visiting as well as the doctor and shift nurses how to use your equipment. Let them know and reinforce with them that if you are sedated or sleeping, your CPAP needs to be operating.
Normally while you are in what is termed pre-operation stage and being prepared by the nurse, your surgeon and anesthesiologist will stop by to discuss concerns and surgical plans. Do not forget to remind them that your CPAP needs to be in use at all times (if not intubated), and that they need to check your oxygen saturation and to monitor your heart rate.
Be ready if there are exceptions to any of the above when applied to your upper airway surgical procedures and if this should be cleared with the treating physicians and discussed with your sleep physician.
Good luck.
Oral appliance users will need to consult with their prescriber for procedures to follow, but much of the following may apply. Just substitute oral appliance when CPAP is discussed.
When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices. When reading about obstructive sleep apnea (OSA) please use the terms mild or moderate sleep apnea if applicable.
For all sleep apnea patients, knowledge is important to get proper care and treatment in the hospital or out-patient area. If at all possible - DO NOT LEAVE YOUR EQUIPMENT AT HOME. This is important in so many ways as sleep apnea therapy is as important in the hospital as it is at home.
If you do not inform your physicians or surgeon of your need for sleep apnea therapy
during and after medical procedures, this can create problems in healing and delay recovery time leading to longer hospital stays. Do not assume that the physicians and nurses will know how to manage your OSA. If they are not aware, they will not be prepared to care for OSA.
Please ask if you may use your own CPAP equipment. This will be when you will find out what the hospital policy says and you should talk to your doctor as well as your surgeon and the anesthesiologist if you are having surgery to confirm the hospital's policy. If they say no, then ask if they have a form called “Permission and Release for use of Outside Medical Equipment/Appliance for Patient Treatment” so that you may use your own equipment. At this time also ask if they will need a letter from your doctor or a consultation with your sleep doctor.
The only way you should accept the hospital's equipment is if clear that it has the same or better benefits as you equipment. If they cannot meet these requirements, you should be able to use your own equipment for your own well being and comfort. Always make every attempt to use your own mask to control leaks and for comfort.
If they allow your equipment, ask if they need to inspect the equipment to see that it is functioning correctly and does not pose any hazards. Ask when they want to inspect the equipment as you do not want to do this too far in advance.
Important - Label your equipment, CPAP carrying case, mask, and CPAP machine. When you are admitted, labels identifying you, and for your chart are printed. Be sure to ask for enough extras to label your equipment.
Again important, if supplemental oxygen is required, your mask may have ports for attaching an oxygen line. If your mask does not have oxygen ports, contact you equipment provider or the manufacturer to find out if an oxygen port adapter is available for your mask. Most of the time the hospital may have an adapter that will work with your mask.
If you are having surgery and will have a breathing tube inserted into your windpipe, your CPAP will not be required. After the tube is removed, you should be put on the CPAP machine. If you are not intubated, then remind the hospital staff that the CPAP need to be used.
Show your family and/or friends who will be visiting as well as the doctor and shift nurses how to use your equipment. Let them know and reinforce with them that if you are sedated or sleeping, your CPAP needs to be operating.
Normally while you are in what is termed pre-operation stage and being prepared by the nurse, your surgeon and anesthesiologist will stop by to discuss concerns and surgical plans. Do not forget to remind them that your CPAP needs to be in use at all times (if not intubated), and that they need to check your oxygen saturation and to monitor your heart rate.
Be ready if there are exceptions to any of the above when applied to your upper airway surgical procedures and if this should be cleared with the treating physicians and discussed with your sleep physician.
Good luck.
October 16, 2010
Sleep Apnea and Hospitalization Part 1
If you have sleep apnea and use a positive airway pressure machine, are you aware of what to do when if you are admitted to a hospital, or if you have an outpatient surgical procedure where you will be put under? I admit I was not! So it was with great interest that I read the article here from the American Sleep Apnea Association (ASAA).
Not included as part of the above link are the procedures for those who use oral appliances. This is the reason for making sure the dentist that prescribed your oral appliance is included in the following discussion.
When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices.
The ASAA makes several recommendations for us as patients to accomplish prior to being admitted and what to do once we are admitted. I am concerned that this is aimed only a those of us with obstructive sleep apnea (OSA). So I will mention that this might will be considered by those with mild to moderate sleep apnea. It would be wise to consult with your doctor or dentist in charge of your sleep apnea to have their input in resolving any sleep apnea issues while undergoing medical procedures.
Know you patient rights to be properly treated for OSA and mild to moderate sleep apnea during all surgical procedures whether in a hospital setting or in an outpatient surgical center. This includes any same-day procedure that requires sedation or anesthesia, including but not limited to a colonoscopy or an angiogram.
You will need to determine whether you will be able to use your own CPAP equipment that is set to your prescribed pressure or whether the hospital or facility will supply an identical mask and/or identical or better equipment. You will also need to know whether you will be allowed to have humidification if you use this and whether there are any contraindications for its use. You will need to consult with your oral appliance prescriber for how to handle oral appliances.
To supplement the above, you, as the patient are required to notify your physicians and other caregivers that you have sleep apnea and what pressure the equipment must be set at. You will need to describe the therapy required and provide the contact information for your doctor or dentist so that they can provide the diagnosis information and prescribed pressure or equipment use.
Be prepared to provide your own clean mask and, if needed, your own CPAP machine. Be ready to label your equipment with your name and required identifying information. If possible meet with the surgeon and anesthesiologist to inform them that you have sleep apnea and require therapy.
Important! Make sure that your family, and if necessary friends, know that you are a sleep apnea patient and that they know you require the equipment. They should also know the parts of the equipment and how it is used for your sleep apnea treatment. Lastly, you should make sure that you have the information as part of your medical alert jewelry and on your wallet emergency information card so that medical emergency personnel will be able to take proper action for you.
Watch for Part 2
Not included as part of the above link are the procedures for those who use oral appliances. This is the reason for making sure the dentist that prescribed your oral appliance is included in the following discussion.
When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices.
The ASAA makes several recommendations for us as patients to accomplish prior to being admitted and what to do once we are admitted. I am concerned that this is aimed only a those of us with obstructive sleep apnea (OSA). So I will mention that this might will be considered by those with mild to moderate sleep apnea. It would be wise to consult with your doctor or dentist in charge of your sleep apnea to have their input in resolving any sleep apnea issues while undergoing medical procedures.
Know you patient rights to be properly treated for OSA and mild to moderate sleep apnea during all surgical procedures whether in a hospital setting or in an outpatient surgical center. This includes any same-day procedure that requires sedation or anesthesia, including but not limited to a colonoscopy or an angiogram.
You will need to determine whether you will be able to use your own CPAP equipment that is set to your prescribed pressure or whether the hospital or facility will supply an identical mask and/or identical or better equipment. You will also need to know whether you will be allowed to have humidification if you use this and whether there are any contraindications for its use. You will need to consult with your oral appliance prescriber for how to handle oral appliances.
To supplement the above, you, as the patient are required to notify your physicians and other caregivers that you have sleep apnea and what pressure the equipment must be set at. You will need to describe the therapy required and provide the contact information for your doctor or dentist so that they can provide the diagnosis information and prescribed pressure or equipment use.
Be prepared to provide your own clean mask and, if needed, your own CPAP machine. Be ready to label your equipment with your name and required identifying information. If possible meet with the surgeon and anesthesiologist to inform them that you have sleep apnea and require therapy.
Important! Make sure that your family, and if necessary friends, know that you are a sleep apnea patient and that they know you require the equipment. They should also know the parts of the equipment and how it is used for your sleep apnea treatment. Lastly, you should make sure that you have the information as part of your medical alert jewelry and on your wallet emergency information card so that medical emergency personnel will be able to take proper action for you.
Watch for Part 2
October 13, 2010
More on Sleep Apnea
Sleep apnea is not a simple problem. There are problems that I have not covered and there is not one size fits all solution.
I have been covering obstructive sleep apnea (OSA) from mild, moderate, to severe.
OSA is the most common type of sleep apnea. It happens when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring). Snoring is one of the symptoms of sleep apnea, but does not always mean that your have sleep apnea. (Don't let your non-snoring spouse see this).
Now I must add - central sleep apnea and mixed (complex) sleep apnea. Central sleep apnea, while much less common, is still serious. It involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. This is what makes it so serious – it is more difficult to diagnose.
Complex sleep apnea (some use the term of mixed sleep apnea) is a combination of OSA and central sleep apnea. Be sure to read this about sleep apnea.
Unlike OSA, in which you can't breathe normally because of upper airway obstruction, central sleep apnea results when your brain doesn't send the signals to the muscles that control your breathing. Central sleep apnea is less common, accounting for less than five percent of sleep apneas.
Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude also may cause central sleep apnea. Other medical conditions also cause central sleep apnea. Life-threatening problems with the brain stem is also a cause. Read this for more on other medical problems.
Treatment can include CPAP or oral appliances, but often requires oxygen being supplemented. Your physician may preform a physical exam in addition to a sleep study. Other test that may be included are lung function studies and a MRI.
Central sleep apnea patients should avoid the use of any sedative medications Some types of central sleep apnea can be treated with drugs that will stimulate breathing. If it is due to heart failure, the goal will be to treat the heart failure itself. Other symptoms may include apnea due to neurological condition. The symptoms depend on the cause of the disease and what parts of the nervous is affected, but may include difficulty in swallowing, voice changes, and weakness or numbness throughout the body.
I have been covering obstructive sleep apnea (OSA) from mild, moderate, to severe.
OSA is the most common type of sleep apnea. It happens when the soft tissue in the back of your throat relaxes during sleep, causing a blockage of the airway (as well as loud snoring). Snoring is one of the symptoms of sleep apnea, but does not always mean that your have sleep apnea. (Don't let your non-snoring spouse see this).
Now I must add - central sleep apnea and mixed (complex) sleep apnea. Central sleep apnea, while much less common, is still serious. It involves the central nervous system, rather than an airway obstruction. It occurs when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. This is what makes it so serious – it is more difficult to diagnose.
Complex sleep apnea (some use the term of mixed sleep apnea) is a combination of OSA and central sleep apnea. Be sure to read this about sleep apnea.
Unlike OSA, in which you can't breathe normally because of upper airway obstruction, central sleep apnea results when your brain doesn't send the signals to the muscles that control your breathing. Central sleep apnea is less common, accounting for less than five percent of sleep apneas.
Central sleep apnea may occur as a result of other conditions, such as heart failure and stroke. Sleeping at a high altitude also may cause central sleep apnea. Other medical conditions also cause central sleep apnea. Life-threatening problems with the brain stem is also a cause. Read this for more on other medical problems.
Treatment can include CPAP or oral appliances, but often requires oxygen being supplemented. Your physician may preform a physical exam in addition to a sleep study. Other test that may be included are lung function studies and a MRI.
Central sleep apnea patients should avoid the use of any sedative medications Some types of central sleep apnea can be treated with drugs that will stimulate breathing. If it is due to heart failure, the goal will be to treat the heart failure itself. Other symptoms may include apnea due to neurological condition. The symptoms depend on the cause of the disease and what parts of the nervous is affected, but may include difficulty in swallowing, voice changes, and weakness or numbness throughout the body.
October 10, 2010
Identifying Sleep Apnea – Part 2
Who can have sleep apnea? Anyone at any age can suffer from sleep apnea, whether they are young children to the elderly. Risk factors become important in both obstructive and central sleep apnea.
The risk factors for obstructive sleep apnea include being overweight, a male, over the age of 65, black, Hispanic or a Pacific Islander, being related to someone who has sleep apnea, and a smoker. Other factors would be having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids. You must also include other medical factors that cause nasal congestion and blockage.
The risk factors for central sleep apnea can have many factors, but is most common in males and people over the age of 65. Central sleep apnea is often caused by serious illnesses like heart disease, stroke, neurological disease, and spinal or brain stem injury.
When diagnosed with sleep apnea, there are some things that you can do to lessen the problems with mild to moderate OSA. Lifestyle modifications are the biggest area to improve the condition. These include losing weight, quit smoking, avoid alcohol, sleeping pills, sedatives, avoid caffeine, heavy meals before going to bed, and maintaining regular sleep hours.
When going to bed, learn to sleep on your side as this will help keep your tongue from relaxing and obstructing your airway. Prevent yourself from rolling onto your back by having something at your back that is rigid enough to stop you. Some people are able to elevate their head with a foam wedge or by using a cervical pillow. If you have nasal problems, use a nasal dilator, saline spray, or breathing strips.
Many people do not use some aids that should be done. Throat exercises can be successful in reducing the severity of sleep apnea by strengthening the muscles in the airway making them less likely to collapse.
Some of the exercises you can try (I found the first the most helpful but try them for yourself) include pressing the tongue flat against the floor of mouth and brush top and sides with toothbrush. Repeat brushing movement 5 times, 3 times a day.
I found this very difficult - press length of tongue to roof of mouth and hold for 3 minutes a day. The next exercise is place finger into one side of mouth. Hold finger against cheek while pulling cheek muscle in at same time. Repeat 10 times then rest and alternate sides. Repeat sequence 3 times.
I have not tried this one - purse lips as if to kiss. Hold lips tightly together and move them up and to the right the up and to the left 10 times. Repeat sequence 3 times.
If nothing more this will strengthen your lungs, but it seems to help. Place lips on a balloon to inflate. Take a deep breath through your nose then blow out through your mouth to inflate balloon as much as possible. Repeat 5 times without removing balloon from mouth.
One exercise that also helped me is holding both hands together at the back and forming a V, take the thumbs and massage the jaw area starting at the back near the jaw hinge and pulling the thumbs forward in the soft area under the jaw. Start at the outside and work toward the center. Just use care not to depress the arteries at the side of the neck, stick to the underside of the jaw.
What ever you do, find out what works for you and give it a consistent trial and a chance to work. Even though I have severe obstructive, the most aid I have received is by sleeping on my side and using a strong back support to prevent me from turning on onto my back. I still use my VPAP machine to get the restful sleep I need.
The risk factors for obstructive sleep apnea include being overweight, a male, over the age of 65, black, Hispanic or a Pacific Islander, being related to someone who has sleep apnea, and a smoker. Other factors would be having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids. You must also include other medical factors that cause nasal congestion and blockage.
The risk factors for central sleep apnea can have many factors, but is most common in males and people over the age of 65. Central sleep apnea is often caused by serious illnesses like heart disease, stroke, neurological disease, and spinal or brain stem injury.
When diagnosed with sleep apnea, there are some things that you can do to lessen the problems with mild to moderate OSA. Lifestyle modifications are the biggest area to improve the condition. These include losing weight, quit smoking, avoid alcohol, sleeping pills, sedatives, avoid caffeine, heavy meals before going to bed, and maintaining regular sleep hours.
When going to bed, learn to sleep on your side as this will help keep your tongue from relaxing and obstructing your airway. Prevent yourself from rolling onto your back by having something at your back that is rigid enough to stop you. Some people are able to elevate their head with a foam wedge or by using a cervical pillow. If you have nasal problems, use a nasal dilator, saline spray, or breathing strips.
Many people do not use some aids that should be done. Throat exercises can be successful in reducing the severity of sleep apnea by strengthening the muscles in the airway making them less likely to collapse.
Some of the exercises you can try (I found the first the most helpful but try them for yourself) include pressing the tongue flat against the floor of mouth and brush top and sides with toothbrush. Repeat brushing movement 5 times, 3 times a day.
I found this very difficult - press length of tongue to roof of mouth and hold for 3 minutes a day. The next exercise is place finger into one side of mouth. Hold finger against cheek while pulling cheek muscle in at same time. Repeat 10 times then rest and alternate sides. Repeat sequence 3 times.
I have not tried this one - purse lips as if to kiss. Hold lips tightly together and move them up and to the right the up and to the left 10 times. Repeat sequence 3 times.
If nothing more this will strengthen your lungs, but it seems to help. Place lips on a balloon to inflate. Take a deep breath through your nose then blow out through your mouth to inflate balloon as much as possible. Repeat 5 times without removing balloon from mouth.
One exercise that also helped me is holding both hands together at the back and forming a V, take the thumbs and massage the jaw area starting at the back near the jaw hinge and pulling the thumbs forward in the soft area under the jaw. Start at the outside and work toward the center. Just use care not to depress the arteries at the side of the neck, stick to the underside of the jaw.
What ever you do, find out what works for you and give it a consistent trial and a chance to work. Even though I have severe obstructive, the most aid I have received is by sleeping on my side and using a strong back support to prevent me from turning on onto my back. I still use my VPAP machine to get the restful sleep I need.
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