October 21, 2011

What Type of Patient Are You?

Why am I concerned you ask? Because it is important for you to know how to get the best healthcare possible. If you have read my two blogs on types of patients, here and here, you have a better idea about yourself, and how you deal with your doctor. I hope that I have encouraged you to think and read as each illness or disease has its own problems. There is a lot of good information available for people that want to learn. There is some very poor information on the Internet and people that will take your money and provide no service.

The first resource is my favorite, but you will have to decide for yourself how well you like the information. Trisha Torrey is very good at what she does and she is a patient advocate for patients. Her advice is generally on target and she has a large following.  I have used her blogs and articles for many ideas and like the way they are pulled together. Sometimes the topics are a little too interrelated and requires some sifting to find the answer to what you are researching, but generally, this is not a big problem.

The next two resources on e-patients are interrelated in a way since the first person writes for the second source as well. I have been interested in what they do for about a year, but I have not been actively reading everything until lately. They are leading areas that I am interested in, but have not had the courage to attempt. They are involved in participatory medicine, and have taken on some very active ideas and accomplished many worthy and notable actions.

I was just a passive patient for many years and I realize now how this was not a good thing, and resulted in some of my health problems. Some doctors like patients who just follow orders and will do just about anything to keep you a passive patient. They detest patients that are proactive in their care and some even reject empowered patients.

Either level is acceptable depending on how you perceive your needs. There is nothing wrong with being proactive and at the same time bringing in a patient advocate to assist you. Even many empowered and e-patients do this when they will not be able to speak for themselves. Please reread this about empowered patients. When you get to “The Empowerment Tipping Point”, this is where I feel the e-patient part is at now and will continue to be an influence.

Other organizations are still finding their way and trying to develop an influence in both areas. One group named “WEGO” claims this is “Working … and Health Activism” month, but I have not seen any other groups or organizations following this. In addition, this is only in their newsletter, which finally does have links back to their site. To me this is a poor newsletter, which I can only show you one link to part of it. The entire newsletter cannot be shown as one link.

There are now schools that teach patient advocacy (use “patient advocate” in your search engine. If you are really ambitious, there are foundations that you can join as a patient advocate. I am not a member of either so I cannot speak to which is the better organization. One is here and the second is here.

October 20, 2011

Interventions That Benefit Patients

This is a very interesting collection of studies and maybe the right interventions were chosen for a change unlike the ACCORD and other studies of like ilk. Now we have something that can be comprehended and should be put into practice. Instead of medical interventions of shoving higher doses and more medications at patients, behavioral and educational interventions show more promise for reducing A1c's and doing it without increasing cardiovascular events.

I do wonder how long it will take for those that believe in the ACCORD Study to downgrade this research. To me this is much more practical and provides lasting tools for people to best manage their diabetes. Shoving more medications at them teaches them nothing and gives them no tools to work with in diabetes management.

The press release does leave a lot of unanswered questions and maybe some weakness in their studies, at least they seem to have accomplished the right tasks to get the results needed. And the assumptions of behavioral and educational interventions were properly founded. Unlike the ACCORD Study, that ended early because the wrong assumptions were used and unintended results were the end of the study.

The first study included people with type 1 diabetes while the other two studies apparently confined their study to only poorly managed type 2 patients. All three studies showed that the people receiving individual education showed the greatest improvement in A1c results. All groups showed improvement as a result of the behavioral and educational interventions.

The one failure in all three studies were the differences in ethnic backgrounds and the methodology used in the studies. An improvement over many studies, but definitely a problem for analysis comparing the studies.

I would give the three studies good marks for their studies, but poor marks for not choosing patients with similar backgrounds and financial means. Poor marks for even thinking they could make comparisons between the studies based on the methodology employed so differently.

Another excellent article from another press release about the same studies is written about here by Emilia Klapp, RD, BS. I will repeat – education for people with diabetes is so important. Do not let your doctor avoid this.

October 19, 2011

Some Supplements Create Risk of Death

This was a disturbing piece of news and one that deserves attention. While it has yet to be studied in men, women between the ages of 55 to 69 need to be cautious and possibly talk this over with their doctor. I would suggest all women in the change of life and older should be cautious.

Many supplements are safe, but there are those that pose an increased risk for death in women. These supplements include multivitamins, Vitamin B6, and folic acid. Then there are the following minerals that need attention, iron, magnesium, zinc, and copper.

In a related editorial European researchers stated, "to the growing evidence demonstrating that certain antioxidant supplements, such as vitamin E, vitamin A, and beta-carotene, can be harmful."

"We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population," they add. "Those supplements do not replace or add to the benefits of eating fruits and vegetables and may cause unwanted health consequences."

The authors of the study did state, "Although we cannot rule out benefits of supplements, such as improved quality of life, our study raises a concern regarding their long-term safety,"

This should be taken as meaning you should talk this over with you doctor and be safe in the use of these supplements (vitamins and minerals). Please read the press release here, and what Dr. R Centor says here in his blog.

October 18, 2011

Dangerous Conflicts Between Rx Drugs and Herbal Meds

Many people are using complementary and alternative medical (CAM) treatments such as herbal supplements for chronic pain. This is an area where patients need to use extra caution. Some of the prescription medications and herbal medications can have very serious and potentially harmful side effects. This is a must for older patients as they do not realize how serious these side effects can be.

I will give the authors of this notice credit for seemingly having the right information and presenting it as facts instead of calling for the Food and Drug Administration to investigate. To get to the heart of their discussion I will list the medications that can have severe side effects when combined with prescription medications that are often involved when someone is having back surgery (orthopaedic surgery).

Examples of popular herbal supplements that are commonly used and can have serious side effects if combined with prescription medications are:

“Feverfew (used for migraine prevention), ginger, cranberry, St. John's Wort and ginseng can interact with the anti-clotting drug warfarin;
Feverfew, ginger, and gingko can interact with aspirin;
Garlic can interfere with anti-clotting medications and the immunosuppressant drug cyclosporine (prevents transplant rejection);
Valerian (used as a sedative) can intensify anesthetics; and
St. John's Wort can interact with immunosuppressive drugs and potentially lead to transplant rejection.”

These herbal products that are marketed for osteoarthritis also can pose serious risks when combined with prescription medications:

“Glucosamine, chondroitin and flavocoxid can affect clotting agents;
Black cohosh can interact with the cancer drug tamoxifen; and
Cat's claw can interact with clotting agents, blood pressure medications and cyclosporine.”

This is why we need to tell our doctors what herbal supplements we are taking. At least the authors are advising surgeons to check this when scheduling patients for skeletal surgery and other procedures that might involve the above list. More of the problem herbal supplements should have been mentioned.

“Most surgery-related side effects can be avoided by stopping the CAM product at least one to two weeks prior to surgery and during the postoperative period while prescription medications such as blood thinners or antibiotics are being used. The problem arises when physicians do not know that a patient is using a CAM product. Herbal supplements can have a negative impact on patients both before and following surgery, and may interact with conventional medicines used to manage chronic conditions."

“Orthopaedic surgeons should have an understanding of the potential side effects of some of the most common CAM products used by their patients, and be able to guide them in suspending use prior to surgery. To help ensure physicians are aware of the products their patients may be using, it is recommended including CAM product-use questions on health/medical assessment forms to encourage patient disclosure.”

Read the article here, and please heed the warning.

October 17, 2011

A Campaign for All of Us

A problem faces all of us, whether we are type 1, type 2, or any other type. How much longer are we going to put up with the Centers for Medicare and Medicaid Services (CMS) setting the limits for how many test strips we can be reimbursed for and that we can use? Yes, we will be taking on a strong arm of the government, but the need is there to do this. We cannot continue to allow them to take away our testing supplies.

Why the CMS? Because they set the limit and private insurance follows their lead. It is time what we notify our senators and congressional representatives to explain to them what is happening. How many test strips do we need? Definitely more than we are currently being allowed.

People with type 1 definitely need more that 4 or 5 test strips per day. Some days when they are going from a high to a low, they go through many test strips. And, if this happens often, where do they get the additional test strips. Many have to buy the extra test strips on their own. People with type 2 on insulin face the same problem.

Those that are also type 2, but on oral medications are allowed a maximum of two test strips per day. People with prediabetes are not allowed any test strips. To become more empowered patients and manage diabetes effectively, we need the limit removed or at least increased to a reasonable number of test strips. This is true after diagnosis, as learning is taking place about what foods can do to our blood glucose levels.

Yes, we also need to rattle some doctors, as they often do not want patients testing at all because they do not wants patients to become depressed when they see the results. Others will not fight for their patients to get them more test strips. This amazes me as doctors are supposed to do no harm. Their attitude is definitely doing harm to their patients.

What these doctors do not realize is that the patients need support and training to manage their diabetes. They do not need to be told not to test when they need to know what their blood glucose levels are to learn how to manage diabetes. Why increase the anxiety level in these patients that the doctors do not want them to succeed in managing their diabetes.

To the patients that have doctors like these, seriously consider finding a doctor that will work with you to help you manage diabetes. Since the doctors cannot hold your hand 24/7, you need one that will give you the tools to use on your own.

It is unfortunate that people do not understand why they need to test. Shortly after diagnosis, people need to understand what the food they are eating is doing to their blood glucose levels. Some are immediately concerned and do not want to eat, but by being able to test their blood glucose levels about one hour after eating. Many are surprised at the increase in blood glucose levels from before eating to approximately one hour after, or up to two hours after eating.

They can see an increase of 60 up to 100 mg/dl (3.3 to 5.6 mmol/L of blood glucose increase. They need to be concerned about the quantity of food consumed as well as the nutritional quality. If your blood glucose happens to be 109 (6.0 mmol/L) before eating, you do not want to see a blood glucose level above 149 (8.3 mmol/L) one hour after eating or a maximum increase of 40 mg/dl (.2.2 mmol/L).

Most people that have managed their blood glucose levels for some time do not want the see an increase above 140 mg/dl (7.8 mmol/L). For the newly diagnosed, they still must work through this trial period and learn what the different foods do to their blood glucose levels.

Even those of us that have managed our blood glucose levels effectively, still need more test strips to assist us in getting through times when we have problems because of illness, stress, or unforeseen circumstances. So it is necessary for all of us to protest the restrictions for test strips CMS is placing upon us.