Monday, January 26, 2015
Please be careful tomorrow. Here in the Fairfield County, Connecticut forecasters are predicting the Blizzard of 2015.
Wednesday, January 21, 2015
About to be discharged from the hospital? Here's 3 things you should know.
The world of health care has made tremendous progress in the last several years in raising the quality and safety of clinical medicine. Despite this, the discharge process (when patients are discharged from hospital) is still fraught with potential pitfalls and opportunities for things to "slip through the net."
If you ask most patients who are discharged — particularly the elderly with multiple medical problems — they will tell you that the process often appears rushed and haphazard, with many things still unclear to them when they exit the hospital. A central problem rests with time itself. For a thorough discharge to occur, the physician needs to spend a lot of time methodically going over all aspects of the hospitalization, working out the appropriate discharge medications and then clarifying the necessary follow-up. This can sometimes take over an hour per patient and in reality this time simply doesn't exist in the busy world of hospital medicine (and doesn't in any health care system or country I'm aware of). Doctors and nurses, therefore, need to focus on the most pertinent points.
Having said that, there are also some things that patients can always do to greatly reduce their chances of post-discharge complications or an abrupt readmission. Here are 3 of them:
1. Don't leave the hospital without feeling comfortable about your medication list and clarifying every single one. During any hospitalization, many home medications can be stopped or changed. Common examples include blood pressure and diabetes medications that will be adjusted in response to fluctuations in these parameters during illness. In addition, there will be new medications prescribed upon discharge. Elderly patients, who form the bulk of hospital admissions, can be on a dozen or more medications, and it is imperative to go over the complete medication list and understand what needs to be taken and what doesn't. It may also be a good idea to have a family member present at this time as well. If this has not been explained thoroughly, be sure to ask the doctor or nurse to confirm before you leave the hospital.
2. Quick follow-up with your primary care doctor. It's always a great idea to quickly follow-up (within 5 to 7 days) with your primary care doctor. Medical studies may have shown mixed results regarding the efficacy of doing this, but it's basic common sense that this would be a useful thing to do after any complicated hospital admission. Let your doctor go over the details of your hospitalization, medication list, and whether you are still in good shape. Potential problems can be nipped in the bud, and any confusion with your medicines can be clarified. Nearly all primary care offices will reserve slots for their patients who've just been discharged from hospital.
3. Monitor yourself like a hawk. Remember that most people who leave the hospital are still in a somewhat fragile state of health. The hospital has done its job in getting you on the path to recovery, but there's still some way to go. If within the first few days, after leaving the hospital you start to go in the wrong direction, don't wait — seek help immediately. Never has the phrase a stitch in time saves nine been more appropriate. Examples include someone with congestive heart failure noticing increased leg swelling, or someone with chronic bronchitis noticing they are more short of breath again. You only have a small window from developing any of these symptoms to going past the point of no return and needing a hospital admission. Get help early on when you need it.
Although the whole discharge process is significantly better than it used to be a few years ago, we still have a lot of work to do. Many patients are still in 50/50 health when they leave the hospital, and there's no way to guarantee a successful outcome. But some basic and common sense rules should always be followed. Physicians often forget that nobody wants to get better and have a successful discharge more than the patient themselves. Education on points such as the above and putting patients in charge of their own care can work wonders in preventing complications and readmissions.
Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being. He blogs at his self-titled site, Suneel Dhand.
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Thursday, January 15, 2015
- From 2001 to 2011, death rates attributable to cardiovascular disease (CVD) declined 30.8% and stroke rate declined by 35%
- CVD still accounted for 31.3% of all deaths and about 25% were <65 years of age.
- About 1 million hospital discharges for heart failure occur yearly, which has not changed.
- There continues to be strong data that that we must continue to prioritize health behaviors (healthy diet pattern, appropriate energy intake, physical activity, and nonsmoking) and health factors (optimal blood lipids, blood pressure, glucose levels) throughout the lifespan
- About 75% of children and 50% of adults have ideal cholesterol levels; about one third of adults or about 80 million people have hypertension (blacks about 45%) and about 10% of adults have diabetes.
- Current cigarette use declined from 24.1% in 1998 to 17.9% in 2013; but about one third of deaths are attributable to smoking and exposure to secondhand smoke.
- In 2013, 15.2% of adolescents reported being inactive during the prior week.
- Only half of American adults met the current aerobic physical activity (PA) guidelines (≥150 minutes of moderate PA or 75 minutes of vigorous PA or an equivalent combination each week), and women and minorities were less likely to meet the guidelines.
- The leading risk factor for death and disability in the United States is suboptimal diet quality. Major contributors were insufficient intakes of fruits, nuts/seeds, whole grains, vegetables, and seafood, as well as excess intakes of sodium.
Tuesday, January 13, 2015
Here are just a few of my favorites from his 64 rules discussed in his book:
- Avoid food products that contain more than 5 ingredients
- Avoid food products with ingredients that a third grader cannot pronounce
- Don't eat anything your great-grandmother would't recognize as food
- Eat only food that will eventually rot
- Stop eating before you are full
- Eat mostly plants
Saturday, January 10, 2015
- Get moving - with regular exercise
- Focus on nutrition - Dash/Mediterranean Diet - mostly plant based and whole grains, make healthy choices and be mindful of portion sizes
- Cut the salt - read food labels and aim for 1500mg sodium or less per day
- Take your medication - if you are superscribed medicine for high blood pressure, take it every day
- Check you blood pressure
- Lose weight - losing just 10 pounds can make a big difference
- Cut back on alcohol - men; not more than 2 drinks/day and women; no more than one.
- Don't smoke - if you smoke, stop!
- De-stress and sleep well
Using weights to target belly fatHealthy men who did 20 minutes of daily weight training had less increase in age-related abdominal fat than men who spent the same amount of time doing aerobic activities, according to a new study by Harvard T.H. Chan School of Public Health (HSPH) researchers and colleagues. Combining weight training and aerobic activity led to the most optimal results. Aerobic exercise by itself was associated with less weight gain compared with weight training.
The study appears online today in Obesity.
"Because aging is associated with sarcopenia, the loss of skeletal muscle mass, relying on body weight alone is insufficient for the study of healthy aging," said lead author Rania Mekary, a researcher in HSPH's Department of Nutrition. "Measuring waist circumference is a better indicator of healthy body composition among older adults. Engaging in resistance training or, ideally, combining it with aerobic exercise, could help older adults lessen abdominal fat while increasing or preserving muscle mass."
Prior studies had been focused on a specific population (e.g., overweight people or type 2 diabetics), were of short duration, and had mixed results. The new study was long-term with a large sample of healthy men with a wide range of body mass indexes (BMI).
Mekary and colleagues studied the physical activity, waist circumference (in centimeters), and body weight of 10,500 healthy U.S. men aged 40 and older participating in the Health Professionals Follow-Up Study between 1996 and 2008. Their analysis included a comparison of changes in participants' activity levels over the 12-year period to see which activities had the most effect on the men's waistlines. Those who increased the amount of time spent weight training by 20 minutes a day had less gain in their waistline (-0.67 cm) compared with men who similarly increased the amount of time they spent on moderate-to-vigorous aerobic exercise (-0.33 cm), and yard work or stair climbing (-0.16 cm). Those who increased their sedentary behaviors, such as TV watching, had a larger gain in their waistline.
"This study underscores the importance of weight training in reducing abdominal obesity, especially among the elderly," said Frank Hu, professor of nutrition and epidemiology at HSPH and senior author of the study. "To maintain a healthy weight and waistline, it is critical to incorporate weight training with aerobic exercise."
Other HSPH authors include Anders Grøntved, Walter Willett, Eric Rimm, and Edward Giovannucci.
The study was supported by National Institutes of Health grants.