Monthly Archives: June 2012

Essential Home Medical Supplies

Most accidents happen in the home, so it’s important to have some supplies around. You may not need—or be able—to have as extensive a collection as a hospital or clinic, but here are some of the basics:

  • Painkillers, ideally regular- rather than extra-strength (easier to avoid accidental overdose). What kind is up to you, but remember they have various side effects and interactions, so read the label or consult your doctor or pharmacist.
  • Alcohol wipes, hydrogen peroxide and soap to clean wounds. Sterile gauze, medical tape and bandages to dress them.
  • Sharp scissors to cut dressings for wounds; EMT scissors are good for cutting without sacrificing safety in an emergency or rushed situation.
  • A digital oral thermometer; other kinds are adequate, but may be less accurate or reliable.
  • Calamine lotion and cortisone for bug bites and antihistamine cream for itching.
  • Tweezers to take slivers and other objects out of the skin.
  • Cold packs for muscle injuries and bruises.
  • Antacids for heartburn.
  • A list of emergency contact numbers, including your doctor’s number, emergency services especially if it’s something other than 9-1-1, and poison control, which is 800-222-1222.
  • Decongestants and cough medicines.
  • Directions to the nearest emergency room. Better yet, the two nearest, if there are several nearby.
  • Dehydration fluids—sports drinks in a pinch—for combating illnesses that feature vomiting or diarrhea.
  • Salicylic acid is good for acne whether or not you have it as a painkiller in the form of aspirin.
  • If there are adult women in your home, you should have something for yeast infections.
  • Antihistamines to treat allergies.
  • Toothpaste, floss, and mouthwash. Keep these on hand so you’re less tempted to skip brushing, and have rub-on painkiller available for gum pain just in case.

This is a general list; you or someone in your home may have specific medical needs that require additional supplies. Your doctor can tell you if there’s anything uncommon that you ought to have around.

The Supreme Court’s Health Care Decision

The Supreme Court today issued its ruling on the Patient Protection and Affordable Care Act. It’s a complex and nuanced opinion (PDF), but ultimately upheld the law’s most important provisions.

Although the law is broad and multifaceted most of the contention—and the suit, officially known as National Federation of Independent Business v. Sebelius—was focused on two elements. The law as passed:

  1. Called on states to expand their Medicaid programs under penalty of being deprived of all Federal funding for Medicaid.
  2. Imposed a requirement, as of January 1st, 2014, for Americans above a certain income level to buy health insurance. There is a carrot and stick approach here, with most employers required to offer insurance and subsidies offered all but the wealthiest Americans to purchase it, and a penalty, called the “shared responsibility payment,” imposed on people who choose to remain uninsured.

The mandate is an important part of the program. The intent of insurance is to pool risk; with other portions of the law preventing higher-risk patients from being denied insurance, lower-risk patients need to be brought in to balance it out. Moreover, uninsured people must be treated at emergency rooms; if they can’t—or won’t—pay for this care, the costs are borne by everyone else.

Under the court’s NFIB ruling:

  • The Medicaid expansion was upheld provided the penalty is only the withholding of funds intended to allow them to carry it out. That is, Federal monies that pay for the expansion of Medicaid can be withheld from states that opt out of expanding the program, but funding for the status quo must be left intact; a state’s Medicaid program cannot be completely defunded even if the state chooses not to expand it so that more people are eligible. Provisions making it more difficult for states to remove people from Medicaid were not effected.
  • The mandate provision, requiring individuals to be insured, was upheld. Although the court rejected the government’s primary argument as to the constitutionality of this provision, it did rule that the penalty payment functions as a tax, and that is something the government is allowed to do.

The ruling does not address whether the law is a good thing. However, it does stand as a declaration that the law does not violate the Constitution. In 2017, states will be able to apply to the Federal government to enact their own programs in place of the ACA, as long as those programs provide the same or greater quality and breadth of coverage at the same or lower cost.

Epilepsy

The seizure disorder epilepsy is actually a group of related conditions resulting from various kinds of brain injury. It is a chronic condition, meaning without treatment it will continue indefinitely. Seizure disorders can be invisible, as in the case of former U.S. Commerce Secretary John Bryson, who resigned last week in the wake of an incident that occurred while he was behind the wheel.

The diversity of epilepsy means a diversity of causes. Things that can lead to the types of brain injuries that produce seizures include:

  • Congenital brain defects or neonatal brain injury
  • Head trauma
  • Meningitis and other infections
  • Long-term cocaine or amphetamine use
  • Stroke
  • Brain tumors

There are three main types of seizure. They are absence, or petit mal, characterized by a brief period of staring typically no longer than 15 seconds; partial seizures, which only affect some functions and rarely result in loss of consciousness; and the prototypical generalized tonic-clonic, or grand mal, seizure, the one people are perhaps most familiar with. A grand mal seizure involves muscle rigidity and contractions and loss of consciousness or alertness. It is frequently presaged by a seizure aura, sensory changes or hallucinations immediately before the person seizes. Afterward the person often experiences some or all of sleepiness, memory loss, headache, confusion, or brief confusion.

Epileptic seizures can happen at any age, but if epilepsy is present they usually start before age 20. Congenital epilepsy can run in families. There are a variety of tests for epilepsy in someone who is not currently seizing, including an EEG to track the brain’s electrical activity and an MRI scan to look for lesions in the brain.

If you had a seizure—or think you may have had one while alone—contact a medical professional. It is important that you find out whether you are epileptic so that you can be properly treated.

Some Medical Terms You Should Know

Here are some commonly used medical terms, and what they mean. Save this so when you see your doctor, you know what he or she is talking about:

ANEMIA
Having an insufficient number of red blood cells, which carry oxygen around the body. There are several conditions that can cause this.
AUSCULTATION
Listening to bodily processes as a diagnostic technique. Diagnosticians listen to various things including heartbeat, respiration, and digestion/
AUTOIMMUNITY
A reaction by the body against its own organs that ought to e directed against foreign bodies such as bacteria. Most people have a small amount of harmless autoimmunity, but it sometimes goes overboard and causes illness.
BIOPSY
Harmlessly cutting out tissue to put it under a microscope to look for signs of cancer or other illness. Biopsies can be performed on any tissue but is frequently done with bone marrow, muscles, and skin.
CARDIAC
Something having to do with the heart, and its function of pumping blood throughout the body.
CHEMOTHERAPY
Anticancer drugs that bind with cancer cells to destroy them. This can have side effects but it is often effective.
ENDOCRINE SYSTEM
The hormones, by which many bodily functions are regulated, and the network of organs that produce them and glands that distribute them.
IMMUNE SYSTEM
The system that detects and attacks intruders such as viruses and bacteria.
INFLAMMATION
Swelling and warmth, often causing pain; external inflammation will be red. Inflammation is usually a result of infection or injury.
LEUKOCYTE
A white blood cell, part of the immune system. White blood cells help the body fight infection.
SLEEP APNEA
A condition in which the patient stops breathing in his or her sleep several times a night. It prevents the patient from getting truly restful sleep, and leads to fatigue, memory loss, depression and irritability. Sleep apnea can increase risk of heart attack or stroke.
SPHENOPALATINEGANGLIONEURALGIA
An ice-cream headache.

Look for more terms in future posts.

Our Friend the Stethoscope

The stethoscope is perhaps the most familiar symbol of the medical profession. It serves an important practical function as well: it’s designed to enable doctors to listen to a patient’s body as it functions, so they can hear anything that might be off.

The first stethoscope was developed in 1816 by a French pediatrician named René Laënnec, a tapered wooden tube resembling a contemporary hearing aid. The first flexible stethoscope appears to have been created less than 15 years later. The next improvement, in 1851, was the addition of a second earpiece by the Irish physician Arthur Leared.

The stethoscope has not significantly changed its design since that time. George Cammann, who made some refinements facilitating the commercial production of the instrument, also wrote about its diagnostic use. The only real change was the division of the listening part on two sides, for the heart and the lungs.

There are two major types of stethoscope:

  • Acoustic stethoscopes use a hollow tube filled with air to transmit sound. The sensitive listening end vibrates with the patient’s heartbeat or respiration, which vibrates the air in the tube. The earpiece is connected to the other end of the air column, and so the wearer is able to hear the patient’s breathing and heart that way. Although they can be very quiet, an amplification system was developed around the close of the 20th century.
  • Electronic stethoscopes use a microphone to pick up the sounds and convert them into electrical signals. These signals can be heard by medical personnel, transmitted wirelessly to a receiver, recorded, or even loaded onto a computer and analyzed. These analytic tools make diagnosis easier and surer, but the equipment is more complicated.

The “ear trumpet” variety of stethoscope is still in use. It is how fetal heartbeat can be heard. It’s also called a pinard, having been introduced to obstetrics by a French doctor named Adolphe Pinard.

Listening as a diagnostic method takes some practice, but it is the fastest, lowest-tech method of finding heart murmurs, irregular heartbeat, and respiratory difficulties.

The Right Way To Fight Obesity

Although experts say obesity rates are leveling off, it still affects one-third of all adults. Many people have put forth ideas to fight the obesity epidemic—some good, some bad. In the latter category, for example, is New York City Mayor Michael Bloomberg’s proposal to ban the sale of drinks larger than 16 ounces, which is unlikely to be consistently applied and which some experts say will have little if any effect. In the former category is a plan supported by the American Medical Association to give kids and teens annual instruction in healthy eating and healthy living.

The AMA elected to support moves to create special classes in first through 12th grades that focus on obesity. In these classes, students would be taught about what causes obesity and how to prevent it. Lessons will also focus on the consequences, including that being overweight puts people at significantly higher risk of heart disease and type 2 diabetes. The resolution notes that a weight loss of as little as five pounds can make a huge difference in someone’s health and longevity.

As in so many areas, the importance of education cannot be understated. Most people tend to make good decisions if they have the tools and knowledge available to them. Children who know how and why to eat right grow up into adults who eat right. Students who learn how to avoid obesity grow into adults who learn to avoid obesity. And the benefits may come sooner than that if the kids influence adults in their families to make better choices for their health.

The AMA meeting also addressed the issue of a soda tax. While the group refused to endorse a tax there was support for the idea of using the proceeds from a soda tax that may be enacted to fund programs to fight obesity.

There was some concern that such a tax would fall disproportionately on the poorest consumers. Sales taxes in general are costlier for poorer households, and a soda tax would be no exception. Furthermore, it is debatable whether there’s a straightforward relationship between drinking soda and obesity, or between sin taxes and consumption. However, using such a tax specifically to fight obesity is an important step towards dealing with the problem.

Living With Sickle Cell

Although there are medical treatments available for sickle-cell anemia, doctors also recommend lifestyle changes to help sufferers better manage the condition. There are precautions you can and should take to keep yourself healthy and minimize crises.

Many of these are common-sense tips for everybody, but they are particularly relevant if you have sickle cell:

  • Be sure you get folic acid. Folic acid is a B vitamin that is a vital part of the making of red blood cells. By taking supplements and eating fruits, vegetables, and whole grains—important sources of folic acid—you can boost your red blood cell replacement rate.
  • Drink lots of water. Staying hydrated helps lower your risk of sickle-cell crisis. Keep water with you, especially on hot or dry days or if you’re getting a lot of exercise.
  • Be sure to get enough sleep. Tell your doctor if you snore or have any other signs of sleep apnea, which can interfere with restful sleep and leave you tired and vulnerable to sickle-cell anemia complications.
  • Stay away from temperature extremes, including swimming in cold water. Both extreme hot and extreme cold can trigger crisis pain.
  • Avoid medications such as the decongestant pseudoephedrine that constrict blood vessels, making it even harder for misshapen cells to get through.
  • Be alert at high altitudes or while flying. The thinner air means there’s less oxygen available, so be prepared to have supplemental oxygen.
  • Exercise regularly, but without overdoing it. Stay fit, but don’t overexert yourself and risk triggering a crisis.

Your doctor can help you develop a strategy to reduce the intensity and frequency of sickle-cell crises. With proper treatment, you can live a happy life with sickle-cell anemia.

Treating Sickle Cell

Newborns are routinely tested for sickle-cell anemia. If you think your child might be at risk—if you and your partner are both carriers, if at least one of you has the condition, or if one or both of you don’t know—you might want to consider having the testing done even earlier; genetic testing in utero can detect sickle-cell anemia as early as the tenth week of pregnancy. Early diagnosis is absolutely essential for your child to receive possibly life-saving treatment, so it’s best to be prepared.

The most widely used test, which is generally administered as part of ordinary screening of new-born infants, is called hemoglobin electrophoresis. It uses the electrical charge of red blood cells to look for abnormalities.

Treatments are available to help manage crises and deal with potential complications. In childhood, doctors frequently administer oral antibiotics to help fight pneumonia and similar infections. These conditions can be particularly dangerous, and even fatal, in infants with sickle cell.

Infancy and childhood, before the blood vessels have fully grown, is the most dangerous time. However, sickle cell requires lifelong medical care. Sickle-cell patients need plenty of folic acid, a B vitamin, to stimulate production of red blood cells.

Blood transfusions can also help maintain proper red blood cell levels. However, too many transfusions can lead to iron overload, a buildup of excess iron that can lead to diabetes, organ damage, sexual dysfunction, heart failure and increased pain. If you receive blood transfusions to help manage your sickle cell disease, ask your doctor for a simple blood test called a serum ferritin test, used to determine the level of iron in the body.

A cancer drug called hydroxyurea, taken daily, can reduce the frequency of sickle-cell crisis. It stimulates the production in adult patients of a type of hemoglobin normally found in newborns that actively resists sickling.

The possibility of a cure exists in the form of bone marrow transplants. Stem cells from the donor replace the patients bone marrow and manufacture healthy blood cells. However, the procedure is risky, the recovery time is long, and the donor has to be a good genetic match for the recipient, so transplantation is only recommended in severe cases.

Gene therapy and nitric oxide to keep blood cells from forming clumps are being investigated as potential treatments or cures. Although research is promising, no firm conclusions have been reached.

Sickle Cell: What to Look For

Sickle-cell is a form of anemia, meaning that there are not enough red blood cells to properly carry needed oxygen around the body. This results in a variety of symptoms, which typically start to appear around four months.

These symptoms can vary in severity, intensity, and frequency from person to person. While some sufferers have only mild symptoms, in other cases, they can be excruciating or debilitating. They will almost always cause quite a bit of distress to young children with the illness.

The earliest symptom is called hand-foot syndrome. When the oddly shaped cells block a child’s small blood vessels, this causes pain and swelling, most commonly in the extremities. It is usually accompanied by fever. This is often the first visible sign of sickle cell, appearing in infants who are not yet manifesting the disease in any other way.

As with other types of anemia, sickle-cell patients tend to be pale and tired, and get winded easily. Anemia can seriously impact a person’s energy level. In addition, the unusually accelerated breakdown of red blood cells can cause jaundice, or a yellowing of eyes and skin.

The red blood cell shortage can also cause developmental problems. Though cognitive ability is generally unaffected, children with sickle-cell disorder grow more slowly and reach puberty later than others.

Most people with sickle-cell anemia report pain that occurs randomly and unpredictably throughout the body. In severe cases, someone can have more than 15 of these episodes, called crises, in a year, and a sickle-cell crisis can last anywhere from a few hours to a few weeks. This is the main symptom of the illness, and can require hospital care if the pain is severe or goes on especially long.

In the long term, sickle-cell patients are more prone to infections. The malformed cells damage the spleen so it can’t respond to infectious bacteria in the bloodstream. Infants and small children are particularly vulnerable; physicians often administer preventative antibiotics to infants known to have sickle-cell anemia. Children with sickle-cell are often prone to stroke, because their smaller blood vessels are particularly liable to be blocked by accumulations of sickled red blood cells.

Although symptoms are often clear in the early months of life, sickle-cell disease is particularly dangerous in those months, so it’s important to be on the alert. If possible, you and your partner should be tested before you have children. If your child is at risk, he or she should be tested soon after birth so that immediate preventative measures can be taken.

World Sickle-Cell Day

Today is World Sickle Cell Awareness Day. In 2008, the United Nations recognized sickle cell anemia as a global public health problem. The ongoing efforts to fight the disease remain important.

The United Nations passed a resolution that addressed sickle cell in a number of ways, including:

Recognizing that sickle-cell anaemia is one of the world’s foremost genetic diseases, that it has severe physical, psychological and social consequences for those affected and their families, and that in its homozygote form it is one of the most lethal genetic diseases,

Aware of the need for greater international cooperation, including through partnerships, to facilitate access to education, management, surveillance and treatment for sickle-cell anaemia,

Recognizing that proper management of sickle-cell anaemia will contribute to an appreciable decrease in mortality from malaria and in the risk of HIV infection

Since then, the body has been working with the World Health Organization to fight sickle cell. WHO has made a commitment to:

  • Recognize that sickle cell disease is a major health issue.
  • Increase awareness of the world community regarding sickle cell disease.
  • Eliminate harmful and wrong prejudices associated with sickle cell disease.
  • Urge member countries where sickle cell disease is a public health problem to establish health programs at the national level and operate specialized centers for sickle cell disease and facilitate access to treatment.
  • Promote satisfactory access to medical services to people affected with sickle cell disease.
  • Provide technical support to all countries to prevent and manage sickle cell disease.
  • Promote and help research to improve the lives of people affected with sickle cell disease.

This week, we’re going to explore the various facets of this condition: what it does, what it means, and how doctors are treating it, and what the future holds for that.