Monday, February 27, 2017

OOPS! EXERCISE CONFESSIONS AND...

Friday, pains were so strong (plus a migraine flare-up) that I had to go back to my morning stretch routine.

So, even tho I haven't needed to soak the eyelids in the morning, obviously I still need to do all the stretches I used to do during eye-care time. (Which, of course was also brew coffee time.)

PS The migraine images were a dead give-away that I had spent way too much time on Twitter.

And, no surprise (especially after a walk yesterday) I was just about  pain-free this morning.

Meanwhile, back at the allergies-- the area around the market and Starbucks was not a good place for that walk around 5pm - way too much car exhaust from the dinner crowd. Finding a time outside free from pollen and exhaust fumes is tricky.  And imperative!

Bottom line:  my all-body, PT approved stretches are a minimum - No exhaust fumes and pollen in here. So No excuse.

Okay, the other confessions:

The podiatrist is too polite to say my feet would hurt less if I lost weight.  I confess I gained back 4 or 5 pounds that I had lost after pre-diabetic diagnosis.  (Gee, they mean it when they say it's easier to lost than to keep it off.)  So grocery shopping is modified til I get that scales needle back toward the left.

And finally, my posture stinks.  And our postural muscles do burn calories, but only when we flex them.

Tuesday, February 21, 2017

HOW LONG MUST I TAKE BISPHOSPHONATES, OR?


This week, a tweet led me to a brief item from Mayo Clinic: 


Mayo Clinic

"Most people don't receive any additional fracture-prevention benefit after they have been taking intravenous bisphosphonates for more than three years or oral bisphosphonates for more than five years."

The item went on to indicate that we might want to stop bisphosphanates at that point, but with a qualifier that later, if our bones scanned as fragile, our physician might restart the medicine then.

For some reason, that item suddenly pulled me back to a study I saved a few years ago when I briefly considered bisphosphonates.  (For several reasons, I can't take them.)   

Before I went on to Prolia, I had accumulated a big file on bisphosphonates, and the following was in red in my BONES file: It's got good news and for some, bad news:

NEJM Catlyst:
Consequences of poor compliance with bisphosphonates.
Conclusions:

" Reductions in fracture risk and overall health costs can be detected in individuals achieving as little as 60% to 40% compliance with bisphosphonates. However, as many as 34% of patients in the first year of therapy and 52% by the third year will not reach even the minimal compliance levels required to receive benefits."
Published by Elsevier Inc.

So apparently, it's not just for how long, it's also how often (as in taking them on schedule.)

Why would someone pay for some of the pills or have some of the shots, then stop or delay too long?  
Are the side effects so miserable?  Is the cost so high?  Do some women just have so many demands on their time from job, family, money or distance that they can't continue?



Friday, February 10, 2017

WHEN TO STOP YOUR ANTIBIOTICS - BIG NEWS Don't miss this


Back in December, I had several stresses at once, including ongoing blepharitis.  Antibiotics I took months earlier had not helped.  My primary doctor offered an alternate antibiotic to start at once.

Got side effects as unpleasant as the disease.  The leaflet said to stop the meds if side effects got worse, but   I didn't stop.  Finally, close to the last dose, the night before my mammo aptmt. my eyes were badly blurring. Worried about driving to mammo the next morning, I left a msg for doctor, and I stopped taking the RX. 

That may have been my first time ever.  All my life we all heard warnings,

 DON'T STOP until all medicine is gone

Yes, everybody said that we should be sure we'd wiped out those little critters; If any were alive, we'd
stay sick or get sicker.

Then, Twitter led me to this:

"Why your doctor’s advice to take all your antibiotics may be wrong"


The old 'take all of it" warning started when penicillin was new;  we had a new "gun,' why not use it to the max.  After all, we don't want any bugs left that might make us sick all over again.

Why are there rumblings now in the medical community, more than whispers that the old "TAKE IT ALL" advice might be dangerous?

The answer: One word we weren't worried about when penicillin came out... now makes change imperative:


                                                RESISTANCE 

Bugs evolve when exposed to an enemy; they can emerge stronger. 

So if we don't need the drug any more, why give the bugs more fuel for their evolving?

Avoiding resistance makes changing medicine instructions critical.

Then I learned this position is not new.

Turns our Dr. Luis Rice of Brown U Alpert medical school has talked openly in recent years about the danger of giving bugs extra time with the enemy medicine.  . But this is no longer one man's theory.

The WHO in a meeting next month will consider changing antibiotic directions to patients and their doctors.  They already have drawn up a report in response to our fight to prevent resistant bugs evolving into something we will no longer be powerless against.

 We are, it seems at the threshold of a world full of immune, uncontrollable bugs.

But, it will be tough to wipe out the generations-old  warning so firmly lodged in our heads.  (Also, the author is brave enough to mention  that drug companies won't help speed change to find out how they can sell fewer pills!)

Before we turn the whole dosing thing upside down, the article discusses many individual situations where continuing a medicine longer has already proven the best course of action.

Dr. Lorri Hicks of the CDC summed up both sides of the situation by e-mail.  The CDC advice site had been sticking to the old warning, But now when we look at "CDC Get Smart About Antibiotics"  one bit of advice has a new ending:


  • "Never skip doses or stop taking an antibiotic early, even if you no longer feel sick, unless your healthcare professional tells you to do so."
I like very much their advice to talk to my MD about bug "resistance".  The time to do that is probably soon, before a new Rx is needed.  And, Heaven forbid, before I have to go to a bossy hospital where someone sees the OLD directions on pills I no longer even take.

Bottom line for me, I'm going to start by resisting refills on antibiotics that already proved they don't work for me.

https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/

Wednesday, January 25, 2017

Population Based Payment - for medical care Midnight Special


Twitter today led me to an article from Harvard Medical School News   "Alternative payment model boosts quality of care for low-income patients."

Population-based payment is a new concept for me, and so is the name BCBS of Massachusetts uses "Alternative Quality Contract (AQC).  But the program itself is not new.  Lump-sum payments to healthcare providers are intended to assure us of getting all the way to "well."

But detractors have seen possible problems down the line, and this article intends to show us that the criticism may be exaggerated.

I found the article easy to read.  And I think we may all need some good $ news about getting care in the future.

I just Googled Harvard News raising quality, and the title popped up right away.


Thursday, January 19, 2017

START SMALL AND LIVE Coffee Break


You probably know I loved my PT in Texas.  The most important thing I learned is still what my mechanic used to say:

We're not 29 any more

Even if you are 29, I still suggest caution with most moves. Extra caution with new moves.

That said, I'm a fan of Mayo Clinic, often go there first for health questions.  But regretfully must say, the balance exercises I got today in email are not, not for beginners.  

My PTs and one podiatrist insisted:  anything like standing on one foot, and maybe leaning from side to side, even stepping left to right/right to left quickly...First, do it all at a counter so you can grab on instantly if balance isn't ballerina-perfect.  

(For those of us who are really impatient, you can do those at-the-counter things while you're waiting in the doctor's treatment/consult room in front of the mirror.)

 Trust me.   

If you're still impatient, say "balance" to your MD and maybe you'll get more PT from somebody good.  Someone like the super coach who took away my fear of going down stairs.

I wish you health.


Wednesday, January 4, 2017

A HOSPITAL NAVIGATOR - MORE THAN WHERE'S THE ICU

Twitter led me to the STAT news article: 


 In a Byzantine health system, navigators help at-risk patients find their way

Interesting article with many good stories of extreme help some navigators may provide, and times they seem to go beyond business as usual.  Also a bit about widely varied training for this position (the training part was a little uncomfortable for me since I've had a social worker or two who only seemed to be working on hours for their senior year college internship.)

This field can have many different definitions, and the navigators may have wide functions.  Headlines don't always tell it all:  I haven't interviewed the local navigator, but she did introduce herself at the lumpectomy surgeon's office and invite us to some educational lunch meetings for breast cancer patients and perhaps some 'survivors' still in treatment or with issues like lymph problems after surgery.

I loved the stories about navigators helping patients with little or no English.  However, facile English speaker patients are mentioned.  We who speak English can be permanently lost in giant hospitals with lousy signage if any.

ONe danger of the system was mentioned, and it's a va.lid  one:  patients, because of the wide varieyty of navigator duties may (easily) gget the ideea that the navigator is a medical professional (often not so.)  

Even our own doctor may be unaware of our hospital's navigator, if there is one, or the navigator's duties or expertise.

I suggest, if you ask for a navigator, be clear on what you want.  If one approaches you, or the hospital sends one, we can ask politely "Is she a cancer nurse?  What will she plan to do for me?"

As I read the article, I learned a lot of things the navigators sometimes do.  

Any way, it's a good read.  And worth knowing about - Even a friend may sometime ask us about them.  

PS  My wonderful NP Carol Hennessey was a perfect navigator for me when she helped me plot which doctor visit first, second, third.  And since I still use the great cream she prescribed. 

Wednesday, December 21, 2016

WHAT HAPPENS IN A WAR WHEN A DOCTOR MUST SAVE THOSE WHO HATE HIM?



Sunrise Rounds brought another forgotten medical issue for this season: Please read it and tell one person about this courageous doctor and what his country has given him to fear.

Is anyone here willing to protect his family while he is protecting members of our families?

http://sunriserounds.com/an-american-muslim-physician-goes-to-war/

I wish you, doctors, and your loved ones in the service HEALTH