April 13, 2013

Doctors Can Help Reduce Medications

Reading news articles sometimes is very unnerving.  Not only was I offended by this one, I was irritated and not sure I wanted to blog about something that might have value. The title is really a turn-off and made me think an overly aggressive doctor was the author of the press release. Then I read the second paragraph and when it stated a professor – then I knew that it was one of the academia that has little or no knowledge of the real-world happenings. This is still no excuse, but just another lesson on how the people they write for are belittled and thought of as minds they should be the ones molding for compliance – BS.

This is a Danish study and does have value as very few American doctors even consider this approach. In America, doctors push pills for type 2 diabetes and very few will listen to other alternatives. In Denmark, doctors are more patient oriented and encourage patients to take charge of their health and see what they can do for lifestyle changes to stay off medications.

A doctor in the United States refusing to hand out medication until the patient shows the need is almost unheard of. The doctors here would much rather push medications (notice I used the plural) than allow the patient to prove they can stay off medications with exercise, weight loss, and food habits. Occasionally you find a doctor that will allow this to happen, but very rarely. Many insist on medications and then when the patient demonstrates the ability of managing their diabetes, they are still reluctant to allow them off medications. Some doctors will allow this to happen, but not that many.

I would say that the Danish doctors are to be commended for their actions and maybe a few of these doctors should be allowed to teach in our medical schools on the topic of diabetes management for type 2 diabetes.

This is one time when better heads should prevail and articles not titled by people with little knowledge of the disease they write about. This is the title that I found so offensive - Complications In Diabetes Treatment Can Be Avoided When Patients Cooperate With Their Doctor.” I personally think the title could be improved dramatically and made for people to want to read the article if a title like this was used, “Diabetes Treatment Can Be Improved When Doctors and Patients Share A Common Goal.”

April 12, 2013

Oxygen Treatment May Not Help Foot Ulcers

This was somewhat of a shocker when I received the email mail recently from a reader in Great Britain, and then later finding it in a newsletter. I have been following several news outlets about hyperbaric oxygen therapy for different types of topics, but had not seen this coming. I will admit at first I did not believe it and had to read it several times. I appreciate the reader for having alerted me to this as I may have missed this study otherwise.

Reuters Health reported this and I will attempt to analyze the study for materials not in the press release. The results of this study do call into question results of previous studies, but this study seems to vary and be about foot ulcers only. The prior studies were more centered on wounds and skin problems in areas above the ankle. This is a distinction that may or may not be valid, but still needs to be evaluated. Dr. Stephen Thom, a professor at the Perelman School of Medicine in Philadelphia was very realistic in his analysis and how this needs to be reviewed to see what differences there are.

Please note that HBO (hyperbaric oxygen) and HBOT (hyperbaric oxygen therapy) are usable interchangeably, although HBO may not be as rigorous in its application. This possible variable needs to be explored. The study authors did state that further study is needed to understand the current results and the effects of oxygen treatments. They are also concerned that the people chosen from the National Healing Corporation (NHC) may have had more severe problems although they tried to compensate for that.

Covariates are a continuous control variable that is observed rather than manipulated, but can affect the outcome included age, sex, wound duration at enrollment, wound size at enrollment, Wagner grade, number of wounds on the patient, wound location, history of neuropathy, history of wound recurrence, and history of osteomyelitisor abscess. Osteomyelitis is an infectious, usually painful inflammatory disease of bone that is often of bacterial origin and may result in death of bone tissue.

To minimize bias the researchers used a PS approach. The propensity score (PS) is the conditional probability of assignment to a particular treatment given a vector of observed covariates. This allowed the researchers to achieve balance on observed covariates between treatment groups so that the treatment groups were more comparable. The PS provides a summary value for the potential measured confounders.

The PS represents a summary value of the potential covariates for each patient and is defined, regardless of the actual treatment choice, as the probability that each patient would receive the treatment of interest given the background covariates of that subject. The PS model was used to balance a number of baseline covariates such as age, sex, wound age, wound size, Wagner wound grade = 2, the number of wounds on the patient, history of neuropathy, history of wound recurrence, and history of osteomyelitis or abscess. Importantly, wound age, wound size, and Wagner wound grade = 2 at first visit are highly predictive of the likelihood that a subject will heal and has been used in other PS studies of wound therapies.

Wagner Grading System for Diabetic Foot Infections is the following:
- 0 - Intact Skin
- 1 - Superficial ulcer of skin or subcutaneous tissue
- 2 - Ulcers extend into tendon, bone, or capsule
- 3 - Deep ulcer with osteomyelitis, or abscess
- 4 - Gangrene of toes or forefoot
- 5 - Midfoot or hindfoot gangrene
This study does point out how important it is to have our feet examined on a regular basis to head off problems before they get to this stage. I hope that this study is not reflective of other problems we may encounter with hyperbaric oxygen therapy in the future. I will be looking for more studies to see if there are further problems, or if it is the foot ulcers that are the problem.

For a past blog on hyperbaric oxygen therapy, read my blog here. 

April 11, 2013

HFCS Does Not Increase Liver Fat

This is one study that we must question. The doctor doing this study is heavily influenced by his position since, “He is an advisor to the food and beverage industry and has received unrestricted educational grants from the Corn Refiners Association.”
Since high fructose corn syrup is a product of industries represented by the Corn Refiners Association, we know that this study is quite likely biased and may well be rigged in results.

Rigged, yes, in a study only lasting 10 weeks, we must question the validity of the findings. This is not a length that would give other than the findings reported. A study lasting for one year or more would have given more trustworthy results, but would have done more harm to the participants.

Therefore, I can only say this is another junk science study and done by a person heavily indebted to the Corn Refiners Association. This is another of those studies that should have never made it into print. The study was done by James Rippe, MD, professor of biomedical sciences at the University of Central Florida and a paid consultant for the Corn Refiners Association.

April 10, 2013

Fructose May Affect Hunger Cues

More research on high fructose corn syrup (HFCS) keeps coming. Some of these are becoming more difficult for the corn refiners and corn producers to refute and even their experts are more careful in what they say. This is because they don't want to be caught in a misstatement and most are recycling old arguments to divert attention from more and more studies showing the damage caused by HFCS. Even if we want them to give up and admit defeat, they will not and will continue to recycle old arguments.

This study is more scientific in nature even though not a lengthy study since measurements were done in recording reactions in the hypothalamus, which helps to control appetite. The participants were not told which type of sugar solution they were given, fructose or glucose. Blood samples were also taken to check hormone levels that control feelings of hunger and fullness. The study participants were asked how satisfied they felt.

In as quickly as 15 minutes, people showed changes in brain flow and activity. After the glucose drink, the body seemed to recognize and respond to the extra calories with increases in glucose and insulin. This blunted the hunger and brain activity slowed in the hypothalamus. However, after the fructose drink, the hypothalamus activity stayed active with little increase in insulin. The study participants reported they felt hungrier. Other hormones known to regulate hunger, such as ghrelin and leptin were unchanged after either drink.

Of course, James Rippe, MD, professor of biomedical sciences at the University of Central Florida and a paid consultant for the Corn Refiners Association, the group that represents manufacturers of high-fructose corn syrup says, “When consumed together, as they almost always are, balance each other out and would likely have no effect on hypothalamic blood flow. Any suggestion that this artificial experiment has implications for human nutrition or obesity is unwarranted speculation.”

At least the authors of the study made no such statements and only alluded to the possibility that fructose may affect hunger cues. Even Rachel Begun, RD, a spokeswoman for the American Academy of Nutrition and Dietetics just stated that we need to try to limit added sugars in all forms. She was not involved in the study.

April 9, 2013

Caregiving to a Parent or Loved One – Part 3

Part 3 of 3 parts

Why is it that caregivers don't feel that they can take care of themselves? Yes, they feel that this is a luxury while caring for others, but stop and think about it. If you burn yourself out, you will have nothing left to give to those that need it!  Harsh, not even,  I have seen people that were caring for a parent or spouse that did not take time for themselves. One ended up in the emergency room because he hadn't taken care of his needs and was hospitalized, his wife died the same day. His family was left to take care of the funeral. The other killed herself with exhaustion and her parent who was near death, lived for six more years.

The only advice I can give is to call on others and locate service agencies, even hospice to help if this is necessary. To be able effectively to continue to be a caregiver, you must take care of yourself. You may not be able completely to avoid stress, but you should be able to reduce it. The following steps may help to minimize the stress pressure:

Stay Connected: Here I am not talking about the person you are caring for or even your immediate family. They are important, but will not give you the stress release you need. If you have a caregiver group where you live, investigate this before you become too busy to do so. Do not forget friends that you have and that you may have shut out as you have become busier with caregiving. Even a walk around the neighborhood can keep you in touch with your neighbors and walking will help relieve some stress. Sometimes is necessary to think outside the family or the box if you must.

Accept Help: Many caregivers pass on this and have only themselves to blame when they are overstressed. Many friends and people known to you or your loved one may sincerely make an offer of help, but because you haven't thought about it, you don't accept the help. Always think about what they could do or how they could help. Rather than dismiss them, say you have not thought about it, but you will and ask when it would be best to contact them. Then do think about it and if they are able, they may be able to sit with your parent or loved one while you take a two or three hour break. If special meals are not a requirement, maybe a cooked dish would prevent you from cooking a meal or two. They will appreciate being able to help and may help you relax. Never forget community resources which may give you a much-needed time to rejuvenate.

Find Time Alone: This is important for your well-being! If you are the sole caregiver, an hour or two way from duties may relieve stress and give you the needed break that will help your health and revitalize you. This may be the time to go for a brisk walk, or go to a nearby park and just sit and watch others. This also may help you avoid burnout.

Maintain a Hobby: This will depend on you and what hobbies you already have or maybe willing to start. Let you imagination run with this one. This link provides a few that may be possible, depending on the season and the type of care your parent or loved one requires. Some may provide the stress relief you need and others may add to the stress, but this can depend on you. I knew one caregiver of a spouse that used her photography hobby to do an inventory of the house and then the area of the neighborhood. Her children were later very happy with the results.

Stay Informed: I like the suggestion the article provides, but also stay informed about what the news is, the local weather, and what others are doing. One caregiver of a parent used letters to pass the latest news on the condition of the parent and then had letters to read to her parent about other family members.

Researching on the internet may yield unsettling information and if you are not aware of it, sometime very questionable information. Use this to converse with the parent's doctor and let them know you want accurate information. This will provide information about what to expect and how fast something may progress.

Stay Spiritually Grounded: I don't care what studies may say, if you are religious or spiritual, stay grounded. Reading the religious teaching of your faith may relieve stress and assist you in accepting the status of your parent or loved one.

Take Care of Yourself: I have stressed this before and I hope it is getting through to you. As a caretaker, you have to take care of yourself, if you want to take care of others. You are no good to them if you lose your health in the process. I will not cover them, but this link may give you additional ideas for self-care. If you experience persistent feelings of fatigue, resentment, or burnout, don’t be afraid to talk to a professional and get some extra support for yourself and your loved one.

April 8, 2013

Caregiving to a Parent or Loved One – Part 2

Part 2 of 3 parts

In this part, I will be discussing some of the other aspects of caregiving. If you are the caregiver, there are some things you need to realize to prevent your becoming a casualty of doing your best in giving care. Some of the pressures you need to be aware that caregivers may face.

Fear or Uncertainty: These are not uncommon and can paralyze your actions. As a caregiver for a parent or loved one, you will have concerns about their future and this can cause fear of the unknown. If this is a child of yours, uncertainty can be a real part of what causes you anxiety.

Shift in Roles: When caring for an elderly parent, this is where roles you have grown up knowing are now reversed and this can become very difficult for both parties. The parent can be embarrassed for depending on a child of theirs and the caregiver now. As the caregiver, you are anxious about their health, well-being, and how vulnerable the parent is now. If it is a spouse, this can create unforeseen complications and exact an emotional toll on both parties.

Financial Pressure: If there is not adequate health insurance, doctor bills and other treatment fees can become burdensome, leaving less energy left for work. Caregivers often find themselves facing financial pressures as well.

Isolation: Don't do this. Do not shut yourself off from others, especially friends and others that want to be there for you and your loved one. Find someone to spell you so that you can take time for yourself. If you are caring for a parent, schedule an evening meal out with your spouse or a friend. There are people or agencies that can stay with your friend or loved one while you have time away. With cell phones and telephones, there is no reason that if something happens, contact can't be made. Learn other ways to relieve the stress of the moment, even if doing nothing more than getting exercise, which brings up the next issue.

Little Time Alone: Caregivers can certainly feel isolated, but there are times when you need a little time alone. Some are capable of rejuvenating during this time and others just want the time alone to cry and relieve stress this way. On the other side, it is also possible to feel confused by having little time alone when also feeling isolated. Caregivers have both feelings, and then be very careful as this can sometime cause stress to multiply.

Demands of Constant Care: When a parent or loved one causes a situation where you are caring for them 24/7, this “always on duty” feeling can cause a heavy toll on you as a caregiver. This type of situation can happen at any time and this is one reason to have others you can call on to allow you to get away from this. This is a reason for not waiting for this to happen and bringing people in early to acquaint them and your parent or loved one with each other. Remember, your own health is important and needs repair from time to time.

Guilt: Having this feeling is not a sign of disloyalty, although when felt with caregiver burnout may be hard to dismiss. Often guilt can be part of frustration, but needs to be separated as the feeling of guilt should not be.

Interference by other family members: This creates an overabundance of stress and because you have been selected by the parent or loved one, creates family animosity and ill will among other family members. I have seen this in other families and wondered how the caregiver was able to survive. One caregiver just walked away and said enough is enough. Another caregiver had been wise and had papers allowing her to be the only family member involved. This played out in the courts and the family was split permanently because of a meddling member. Jealousy was a large player in this family even though the parent had clearly stated what her wishes were and the caregiver was doing what needed to be accomplished.

This is only some of the “stressors” that caregivers can feel. Hopefully, this list will give you ideas and relievers that will assist you when, and if, you become a caregiver. Remember that as a caregiver, it is important that you make self-care a priority.

April 7, 2013

Caregiving to a Parent or Loved One – Part 1

Part 1 of 3 parts

Depending on whether you are on the receiving end or the one giving the care, there are many issues that are in play and it can be trying on both sides. Another factor that many people forget about when talking about caregiving is the degree to which the parent or loved one is disabled. I wish I could have had something like this available to me when I was battling giving care to my first wife over ten years ago. I was fortunate that when it started, she took it on herself to call in a couple of social agencies and eventually hospice. It did not relieve the pressure and stress I was feeling, but it did take a lot of the burden off.

The following blogs are some of the ideas and steps you need to consider and keep in mind if you are put in the situation of caregiver. This series includes this blog and two others. Here are a few of the issues you need to consider:

1. Consider a Medical Power of Attorney. Why other writers always leave this to later in the discussion, I do not understand. This is the most necessary and most important part of caring for a loved one or close relative and needs to be accomplished before it is needed. If your loved one was considerate during this time, and you are the person trusted to take care of them, then get the papers drawn up now rather than after the fact, when you may need to go before a judge to put it in force. Then sometimes other relatives may decide that they are more responsible and oppose the wishes of the parent, or loved one. While your loved one is in their right mind and can clearly show this, this is the time to sign legal documents, not after the person is already near death or incapable of signing legal documents.

In some states, other documents may be required, so check this out. Most times a medical power of attorney is sufficient to allow a trusted family member make financial decisions while a loved one is under medical care. This is no longer in effect when the loved one becomes capable of managing their affairs or the medical treatment has ended. Often a power of attorney is drawn up at the same time and can be very specific in purpose and powers. It is important to discuss this with a loved one before they are receiving medical care because both forms need to be notarized. If the parent or loved one wants special provisions in either the medical power of attorney or the general power of attorney, it is best to have the family lawyer draw up these papers early enough to prevent hostile or untrusted relatives from finding a way to contest these.

I was twice fortunate because my wife knew what her mother's plan was. Since she will still able, she called the attorney and had the papers drawn which would prevent her mother from stepping in and dictating her care. When my parents were at this point in their lives, my father was very clear in stating that my sister would have the responsibility, and my brother and I could be called upon if necessary.

2. Know when to ask for help. No, I am not talking about the person needing the caregiving. I am talking about you as the caregiver. Forget about family pride and bringing strangers into your parent's or your home. There is no need to stress yourself out and do damage to your health when there are agencies available that can give you assistance and guidance and in a sense take some of the burden off of you. Not asking for the right help from your doctor or your parents' doctors is not the way to be the best caregiver.

Instead of pushing yourself and possibly other family members to exhaustion, learn to rely on others as well. If you are new to caregiving, learn that there can be aids like installing toilet lifts in the bathroom, trapeze bars above the bed, or even medical devices that may aid in caregiving. Talk to the parent's physician to find out what will work and ask what community agencies are available to provide assistance. Better to have assistance early and make yourself more valuable to your loved one. Some agencies' services are covered under Medicaid, Medicare, or maybe even private insurance policies. A little time spent early checking this out will prevent problems when you need the help.

3. Don’t take things personally. Remember that some individuals, who are ill, disabled, and elderly, may say things they don't mean. Try to forgive and forget, but do realize that this could be as a result of pain or a medication. Please be aware of a sudden personality change and report this to their physician immediately. A personality change may mean a medical problem, or a bad reaction to a medication or combination of medications. To be sure, always consider all possibilities.

4. Understand memory loss doesn’t equal crazy. Caregivers need to be careful here as they often make this mistake when is reality; the caregiver may be off balance. Memory loss or forgetting something happens to all of us at different times and for different reasons. Some of the reasons include a medication, disability, old age, and stress. In general, the medical condition of a parent or loved one may make memory loss very noticeable so you need to be alert for them. How you handle this, can affect how they feel about themselves, and could affect your future relationship with them.

Some of the suggestions I find valuable is a voice-activated recorder, a small notebook and some pens for making lists of things whey want to remember or want to accomplish. If they do use these, never ignore what the list says and be willing to assist them like filling in names when incomplete or phone numbers they have forgotten. Be prepared to listen when the parent or loved one repeats things and don't become exasperated at them for repeating something several times.

Finally, there could be a medical reason that needs to be addressed if they suddenly have become ‘foggy brained.’ If this happens, speak with their physician as soon as possible to investigate the cause.

Learn to listen first and act second. Some people just want another person to listen to their problem. This can be hard for people who have “take charge” personalities and want to protect their family from outsiders. Never act or do something for a parent or loved one unless they ask you to take action. Even then, you may hesitate and think about the proper way to handle the situation. I had an aunt that wanted to see an old friend one more time, but her sister was the caregiver and would not do this because she disliked the person. I stopped by on my way to see another aunt (my mother only had sisters), and this aunt asked me to stop by and ask her friend if she would come visit her. The caregiver aunt followed me outside and asked me not to do this and was very insistent.

Since I was going to be in the same town to visit my other aunt, I decided to talk this over with her. This was wise on my part, as my aunt knew what had transpired between the two several years earlier and said I had better take her friend to see her, as she was sure that her sister wanted to patch up the relationship before it was too late. My aunt even suggested we go immediately and see if her sister's friend could travel that day. She was and my aunt said she was coming along to stop her sister from preventing this. When we arrived, there was a scene and my one aunt was very angry with me. The aunt that had come with me tried to make peace, but this was not possible that day. The friend did get to see her and was very happy that we had made it possible and my aunt passed two days later.

On the return trip to take them both back home, my aunt's friend said she appreciated seeing her friend and repairing their friendship. She then handed me some money and I said no. She said this was from my aunt and she did not want to explain that I had refused. So in one day I had made one aunt very happy and another one very unhappy, and for the right reasons. Even my aunt whom I was planning to see was happy that I had helped when needed. It is sometimes difficult to know what is best and checking things out is often the best way to handle things. At the funeral a few days later, the daughter of my deceased aunt thanked me and said how happy her mother was the last day. Even my angry aunt admitted that I had done the right thing as she had seen how happy it had made her sister.

In conclusion, as a caregiver, learn how to make things pleasant for the parent or loved one while not losing your place in the day-to-day activity. Rely on others to assist you and make the best use of the different service agencies available. They often can make your load a lot lighter and your time as a caregiver more fulfilling. Learn about ways to assist your loved one while they are under medical care, such as using a Medical Power of Attorney. Finally, try to forge a better relationship by being a good listener and trying to understand that memory loss doesn’t always equal dementia; it may just be a by-product of a medical condition or medication.