Category Archives: Patient Care

Give A Heart On Valentine’s Day

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Today, 19 people will die who could have been saved. It isn’t yet known who they are, but they are among the more than 120,000 people awaiting organ transplants in the United States. Some of them are children. A small number are infants under one year old. One person will have die waiting for a transplant for every four patients who get transplants. These people will die because there are ten times as many people waiting for organs as there are willing donors, including living donors for some organs, and not all of those donors can donate to every, or even any, would-be recipient.

Organ transplants are necessary. In fact, because they are so difficult—they require not only an exact match, but anti-rejection drugs that suppress immune response to the transplanted organ isn’t rejected for the remainder of the recipients life—transplants are only performed when the recipient has a good chance with a transplant but essentially no chance without one. These people need donors who agree to allow their kidneys, pancreas, liver, lungs, heart, and intestines to be removed posthumously and given to someone who needs it, if it is useable, or for a part of any of these organs except the heart to be removed from a living donor and transplanted into a patient in need.

People who volunteer to donate organs are given the same treatment as other patients when they themselves are hospitalized. There’s no rush to declare them dead to use their organs. In fact, their organs require more extensive testing, to determine what is useable and how it can best be used. This testing is paid for by the recipients insurance, or by charitable organizations. These are also the sources of funding for living tissue donors; no expenses are born by the donors or their families. Modern donated organ and tissue recovery techniques mean it’s even possible for someone to have an open-casket funeral after donated tissue is removed. No one is too old or too sick to donate tissue; even people with illnesses affecting some organs are generally able to donate the rest. In most states, enlisting as a donor is done though the department of motor vehicles. but any health care facility should have information on how to volunteer.

Detecting And Preventing Dementia

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Dementia is notoriously difficult to see before it happens. Risk factors can be determined, such as family history, prediabetic conditions or diabetes, heavy drinking, smoking, and high cholesterol, but the actual condition has no symptoms until significant damage has already occurred. Detection is complicated by the fact that even the early symptoms of cognitive decline are often taken as ordinary signs of aging. However, researchers are learning ways to recognize dementia early on, and possibly reverse or treat the damage. It seems the depression and irritability associated with dementia often appear before the more obvious signs, such as memory loss, begin to show themselves.

Dementia isn’t just memory loss and confusion, though those are the most visible manifestations of the condition. It is commonly thought that dementia patients respond to cognitive difficulties with depression, irritability, and anger. While that is partly responsible, those responses are also part of the same changes in brain structures that are responsible for dementia in the first place; they are direct symptoms as well as a response to symptoms. Now it has been discovered hat they are among the earliest symptoms, and that sudden irritability or sudden depression are indications that screening for dementia may be in order.

When signs of dementia are spotted early, it may still be possible for doctors to take steps to address the problem and also for people to take preventative measures to minimize further damage. Alzheimer’s disease, a form of dementia, has been called "type 3 diabetes" in reference to the overlap in risk and causative factors between the two conditions, and losing weight, stopping smoking, eating a healthier diet, and reducing alcohol can all keep dementia at bay. Mental activities, such as crossword puzzles, can also help, as can maintaining an active social life. Learning new things can provide intellectual exercise that helps keep cognition strong.

One study has found evidence that eating walnuts might have some beneficial effects on cognition and stave off the onset of Alzheimer’s. Regardless of other risk factors, study subjects of all ages who had eaten walnuts performed better on cognitive tests than those who had not. The connection is unknown, the study does not prove that walnuts prevent dementia, and no clear mechanism has been found, but walnut consumption is linked to cognitive protection.

Precision Medicine Initiative

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The Information Age is bringing a number of benefits to humanity that were undreamt of, even unimaginable in decades past. One of thee advances ins "e;precision medicine,"e; which means taking into account each individual patient’s medical and personal history, lifestyle, even genetic heritage to find the treatment that will work best for his or her specific situation. To do this requires gathering and cross-referencing data about each patient, as well as research to determine the myriad ways all these factors interact and intersect.

Precision medicine is in some ways a return to medicine’s roots. Medieval medical practice consisted of analyzing not just the patient’s symptoms, but the whole person, including habits and living environment. Although with the rise of industrialization, modern science, and the professional approach, this was derided as superstitious and inefficient, it turns out the problem was merely poor tools and lack of accurate information. The nostrums of old didn’t really work, but the principle was more or less sound—looking at individual factors is actually more efficient than a one-size-fits-all treatment approach that is only truly effective for a subset of the population.

That’s why in the 2015 State of the Union Address, President Barack Obama announced government support for research into this new approach, saying:

I want the country that eliminated polio and mapped the human genome to lead a new era of medicine—one that delivers the right treatment at the right time. In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes—and to give all of us access to the personalized information we need to keep ourselves and our families healthier.

In the future, precision medicine could mean stem cell treatments from a patient’s own cells, used to build replacement organs that won’t be rejected. It may mean drugs that don’t merely fight illness but harness the body’s own defenses, thereby reducing side effects. In the speech, Obama alluded to a cystic fibrosis treatment developed by a company in Boston. The researchers worked out a way to create drugs specific to particular genetic mutations of those that cause the disease, rather than the scattershot approach that would otherwise be needed. This means better and more effective treatment, and a similar approach is being investigated for other conditions

Cervical Cancer And HPV

New findings show that one dose of the HPV vaccine may do the trick.

Nearly every person who develops cervical cancer did so as a result of contracting one of around 15 types of human papillomavirus, or HPV, a sexually transmitted disease. There are actually more than 150 types of HPV, though most of them are not associated with cancer; a substantial portion of sexually active people have one form or another of the infection, but because most strains cause no symptoms, the exact percentage is hard to determine.

Both HPV and cervical cancer in its early stages are generally asymptomatic—the strains of HPV that cause genital warts are different from those that cause cancer. That is why it is important to be screened for HPV for someone who is sexually active regularly. A test called a Pap smear, after a shortening of the name of the doctor who developed it, Georgios Papanikolaou, is used to look for signs of cancer in the cervical canal, the exit and entrance of the uterus.

Cervical cancer strikes more than 10,000 women each year. It is very rare for someone to get it except as a result of HPV infection. While a high partner count makes transmission of the virus more likely, anyone who is sexually active can acquire HPV. Not every HPV infection, even with the high-risk strains, leads to cancer. Things like smoking and smoking, stress, poor overall health, and other sexually transmitted infections such as chlamydia can make it more likely that cancer will develop.

Nonetheless, HPV prevention, quixotic a task as that is, can help reduce the incidence of cervical cancer. Many of the risk factors for HPV appear to be behaviors that are related to having more than one sexual partner—either resulting from decision, facilitating it, or simply the behaviors of someone likely to make it—and it is more likely that their contribution of these factors to getting HPV is mediated by that. Regardless, condom use provides a degree of protection, but it is imperfect because the virus can be transmitted by contact between areas of skin not covered.

The HPV vaccine is becoming more popular. It is available for children and teenagers—since HPV can be transmitted during a person’s first sexual encounter, it is recommended that people be vaccinated before they become sexually active, but the vaccine is effective through age 26 in women and 21 in men. The vaccine provides protection against the three HPV strains that cause more than three quarters of all cervical cancers, and experts say vaccination programs could cut cervical cancer deaths by as much as two-thirds.

Infectious Conjunctivitis

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The inner surface of the eyelid consists of a thin membrane called the conjunctiva. It is one of the places tears are produced, though not to the same extent as in the tear ducts; these tears serve as a lubricant to reduce friction between the eye and eyelid. This layer also helps protect the eye from dust and microorganisms. Despite its usefulness, the conjunctiva is almost never noticed by people until an infection or an allergic reaction causes the inflammation that results in the redness, itching, burning, and sensitivity to light characteristic of conjunctivitis, or pinkeye.

Conjunctivitis can be caused by a viral or bacterial infection, chemical exposure, irritants such as sand or stray eyelashes, or an allergic reaction. Rubbing the eyes makes any form of pinkeye worse, but especially when a chemical or other irritant, or an allergy, is the cause. Bacterial conjunctivitis is possibly the most recognizable form, causing a greenish-yellow discharge that is responsible for a "stuck shut" feeling. Sometimes, pinkeye due to bacterial infection can be associated with a sexually transmitted disease, although this accounts for a very small percentage of eye infections. Bacterial conjunctivitis, left untreated, can cause long-term damage to eye health.

Both the bacterial and viral forms of pinkeye are highly contagious. Someone who has pinkeye should be aware of that and try to take precautions to avoid infecting others, if only out of courtesy. For everyone else, prevention an play a big role in avoiding the disease. Rubbing the eyes can cause or worsen any eye irritation already present, whatever the cause, as well as bringing any microbes on the hands into contact with the eye. Regular hand-washing, such as after cooking using the restroom, or coming in from outside—particularly after using public transit—can also make a significant difference.

Once someone has pinkeye, it is likely to go away on its own faster than most treatments are likely to be effective, particularly it there is no bacterial infection. However, people who have or who have recently had a bout of pinkeye should not wear contact lenses until it is completely cleared up. Eye drops can provide some relief and mitigate irritation.

Medical Cannabis

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As an increasing number of people have legal access to marijuana—rather, to cannabis, as it is generally referred to in medical contexts—for medical purposes, debate over these changes in the law continues. Medical experts and ethicists continue to discuss what good it might do, what harm it might do, and whether the good outweighs the harm. Some of this debate is misinformed, on both sides, but it is necessary, as with any treatment, to balance the potential benefits with an awareness of the possible downside.

Though the long-term effects of cannabis are not well studied, some fears about cannabis are misplaced. Though there are people who make a habit of using marijuana, cannabis is not habit-forming on a chemical level the way some painkillers are. In fact, a recent study found that in states that have legalized cannabis for medical purposes, deaths from opioid painkillers, which can be addictive, are 25 percent lower than in states that have not. Although only 60 percent of deaths from these medications are in people with prescriptions, prescribing cannabis instead can lead to an overall reduction in the amount of these drugs in circulation.

Cannabis has a long history as a medical treatment. More than 3,000 years ago, cannabis was used to alleviate headaches, prevent nausea, treat gastrointestinal disorders, relieve constipation, ease labor pains, and stop nosebleeds. The substances tetrahydrocannabinol and cannabidol have properties that are medically useful in certain situations. and in 1990 researchers found sites in the body that specifically respond to these substances. Now it is used to treat stomach cramps, to help chemotherapy patients deal with nausea, to help people who have conditions or are undergoing treatments that affect the appetite avoid malnourishment, and to treat muscle spasticity, and research is ongoing into other possible benefits.

For example, recent studies suggest marijuana may have some use in treating epilepsy. Patients with severe forms of the seizure disorder have shown significant reductions in symptoms—in particular, a greatly reduced frequency of seizures—from using cannabis. The reduction seems to be primarily due to cannabidiol rather than the psychoactive component, THC, though both substances have anti-convulsant effects.

B12 In The Body

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Vitamin B12, or cobalamin, is an important nutrient. It is an essential nutrient, meaning in this case not that it is necessary for good health—though it is—but it is not produced in the body, and must be consumed in food or supplements. Vitamin B12 is needed to produce red blood cells and effects the functioning of the brain and nervous system. It is also used to treat cyanide poisoning, to essentially suck the cyanide out of the bloodstream so it can be passed harmlessly.

It is also, unsurprisingly, used to treat B12 deficiency. B12 deficiency is rare, because most people consume more than they need and the body stores the excess—as much as five years’ worth—primarily in the liver. Certain medical conditions or treatments can diminish the body’s ability to absorb or use B12, however, and this can lead to symptoms such as fatigue, depression, and impaired memory. More severe deficiency can result in irreversible damage to the brain and nervous system, leading to dementia.

Dietary sources of vitamin B12 include in fish and shellfish, meat, eggs, and dairy products. Vitamin B12 is often added to livestock feed in the United States, so farmed meat generally has particularly high levels. Vegans, who don’t eat eggs or dairy, often need to take supplements, which are typically made from a synthetic form called cyanocobalamin. This molecule does not occur in natural sources but is easily converted by the body into the natural forms of the vitamin. Vegetarians who do eat eggs and dairy products may still need supplements, because vegetarian diets often feature a lot of soy, which can impair B12 absorption.

Scientists have recently found signs of a previously unknown role for vitamin B12. In conjunction with the compound taurine—known from energy drinks, but actually an important nutrient in its own right, with important roles in the functioning of the cardiovascular and central nervous systems—B12 helps regulate the creation of new bone tissue.

This means doctors may be able to add osteoporosis to cyanide poisoning and vitamin B12 deficiency on the list of conditions treated with B12. While it can stop or even reverse cognitive decline resulting from B12 deficiency, there is no indication B12 can improve cognitive function in healthy people.

New Year’s Resolution: Get More Exercise

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When people think of broken New Year’s resolutions, ones that may not have even lasted a month, one of the first things that often comes to mind is "this year, I’m going to get more exercise." Gyms often waive their initiation fees for the first two weeks of January, or the entire month, to draw in eager new exercisers—and more than make it back when people who joined in the first wave of enthusiasm continue the membership without actually ever going. Resolutions often fail, but exercise seems to be particularly—or perhaps just publicly—difficult for people to stick to.

So why do people who are initially determined not to go to the gym end up not doing so? One part of it is that exercise is boring. People generally understand that actually putting in the work to exercise is needed to see results, but when they are looking at it prospectively people tend to overestimate their determination to go to the gym, overestimate their self-discipline, and underestimate the tedium of actually exercising. In particular, what is called "impact bias," a feature of how the mind works, causes people to overestimate how strongly and for how long they will maintain the future intention to go to the gym on a regular basis. When it comes to feel like a chore, people are motivated to dodge it.

That’s why experts recommend starting slowly and building up. Many people start out intending to go every day, in order to see results as soon as possible, in the hopes of developing a habit, and in an effort to remind themselves how serious they are about this. Unfortunately, an intense workout every day is likely to backfire. For a beginner, this can quickly become overwhelming, and seem like an impossible task. It also becomes tiresome sooner, as opposed to a once or twice a week gym night or morning being something to look forward to and savor the anticipation of. Four or five workouts a day may be possible in the long run—though every day is probably a bit excessive for most people—but it’s too much right from the outset.

New Year’s Resolution: Stress Less

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After the busyness and pressure of the holiday season, it’s not surprising many people are determined to conquer stress when the time to make New Year’s resolutions rolls around. It’s a good idea regardless. Stress can contribute to heart disease, by increasing the heart-rate and raising blood pressure. It worsens asthma symptoms, and the children of a stressed person have a higher risk of developing asthma in the first place—to say nothing of the fact that stressed-out people are likely to be heavier smokers and create an environment with secondhand smoke. It leads to obesity, again both directly and indirectly through association with poor eating habits.

However, managing stress presents some obstacles. A certain amount of stress is fundamentally external, meaning it comes from other people whose actions the person experiencing stress cannot control. However, there are things that can be done to reduce the impact. Smiling more can help. Just as being happy makes people smile, smiling has been shown to make people happier, and less stressed. More broadly, keeping an optimistic outlook on life trying to can help make someone more mellow and chill. Spending time with friends, and building a friend network generally, can help mitigate stress by reducing feeling of isolation. Cutting back on caffeine can have a calming effect as well.

Sometimes, people make New Year’s resolutions that are not themselves about stress, but that can support stress reduction, whether or not that is an intended outcome. Some people may decide that this will be the year they meditate more, or do yoga, or even simply carve out time for themselves. All of these things are good for relaxing and reducing stress levels. Exercise is another common resolution with a calming effect on people. A good workout burns off adrenaline and gives a person the opportunity to get out aggressions. Spending less money, another common resolution, can lessen or eliminate a major cause of stress.

Other resolutions can hurt the cause. Things like eating better, quitting smoking, or cutting back or giving up alcohol all mean lower stress levels in the long run, but trying to do these things simultaneously with reducing stress is a recipe for disaster. Smoking, drinking, and eating comfort foods—which are not always especially healthy—are all helpful in momentary, temporary destressing, and the last two in particular may actually be helpful as temporary coping methods while building a long-term strategy that is healthier.

New Year’s Resolution: Quit Drinking

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The New Year is a time of new beginnings. One of the most common new beginnings for people is resoling to quit drinking. Not necessarily people who have a drinking problem, but anyone who fears they might develop one in the future, who dimly senses one on the horizon, or just someone worried about the health effects of too much alcohol consumption even in people who are not addicted and who have control over that consumption—indeed, for some the point of the resolution is to demonstrate that control.

None of these are bad reasons. In fact, someone who does have a drinking problem, and who recognizes that, and is ready to quit, shouldn’t be waiting until the New Year to do so. That, indeed, is one of the problems faced by people who do make New Year’s resolutions to stop drinking alcohol: they risk losing the motivation when the day actually comes, particularly with Champagne typically being so central to the previous night’s revelry. Conversely, they may feel pressure, if only from themselves, to stop before they are actually ready to.

Part of the problem with giving up alcohol, particularly on one’s own, is that it doesn’t always feel good, even when the newly abstinent person recognizes on an intellectual level that they are doing the right thing. The immediate if temporary unhappiness may seem realer than the abstract reality that alcohol is causing problems or has the potential to cause problems. Similarly, while for many people, drinking may be negatively affecting their relationships with friends, family, and partners, what they see in the moment is only that a number of their social relationships involved alcohol, or interaction happened in bars, which can be an obstacle to quitting.

That’s why it’s important for someone who is trying to quit to look for ways to stay on track. Avoiding temptation is one of the most obvious—not keeping alcohol at home or at the office, and avoiding recreational activities in bars or other places whee alcohol is part of the environment, even if that means skipping a season of sports or a few months of pub trivia. Exercise and healthy eating—frequent resolutions themselves—can help with this one. The number one tip for sticking with all resolutions is this: it shouldn’t be all-or-nothing, one slip ends the whole thing. Acknowledge, it, try not to do it again, and move on.