Friday, August 18, 2017

HELP- Too Many Pills !

by healthcaredoula.com

Am I Guilty of Polypharmacy?


Do you (or someone you know) have numerous medications that you take?  Do you add supplements, vitamins, and over-the-counter remedies to the prescription medications you take?  In our modern world, we want an instant fix for everything that ails us.  We're not very happy if we spend money to go to the doctor and come away without SOMETHING!  Right?  And that something usually adds up to one more pill to add to the mountain of medications we are already taking at home, thereby creating a polypharmacy situation.  And this can add up to a very serious situation.

Polypharmacy -  What Does That Mean

 

Wikipedia defines polypharmacy as: "the use of four or more medications by a patient, generally adults aged over 65 years...affecting about 40% of older adults living in their own home." 

Wow...40%.  That's a lot of people taking a lot of drugs.  You may be surprised by this fact  but I am not. In fact, I think these statistics fall way short of what is actually true.  I've been a nurse for many years and 10 years of that time I worked in the home health field.  A pile of pills on the table is often there to greet me when I enter a patient's home for the first time.  And when I ask the patient or his caregiver for a current medication list, the conversation usually goes like this:

Me: Can I see a list of your current medications?

Patient:  I don't have one. I don't really need one. 

Me, [with a sweet smile, I promise]:  What?  No med list.  [looking at the pile of pills]  Wow.  How do you know what pills to take and when to take them?

Patient:  Oh, I just know.  In the morning I take a yellow one from that bottle, and a purple capsule from that bottle, and a tiny white one from that bottle.  Then at lunch I take two from this bottle, and another purple one.  I like to take my vitamins and supplements with my lunch so I take one from each of these 6  bottles.  At bedtime...

And the list goes on.  So what do I see as the problem with this?  Ask yourself these questions:

  • Does he know the names of the medications he's taking and what they are for? 
  • What happens if the pharmacy where he gets those medications changes suppliers and the pills change colors? 
  • Does he know if there are possible drug interactions to watch out for, especially when adding supplements and over-the-counter medications? 
  • And, what happens if he gets sick and is unable to let someone know what medications he's been taking?  

Over the course of many visits, I address all of these questions with my patients, their family members and caregivers.  My intent is to hopefully open their eyes to the answers to these questions and help them to understand that polypharmacy is dangerous.

Dangers of Polypharmacy


1.  Not taking medications as ordered

With so many medications to take, it is very easy to get confused and take the wrong pill at the wrong time.  Pharmacies will sometimes change suppliers where they buy medications in large bulk and even though the medication is the same, the color, shape, and markings on the pill are different. When you get used to taking your medication according to color, shape, or size, you may find yourself confused when the these identifying things are changed.  The more pills you take, the more this problem can be multiplied.  

 Let me tell you about a stupid mistake I made one time (and I'm a NURSE!).  

At the time this incident occurred,  I was taking 2 prescription medications in the morning and one at night, along with a huge handful of supplements that I was hoping would keep me healthy and cure my joint pain.  My doctor had recently added a sleeping pill to my prescriptions, since I was having trouble sleeping at night.  I always set my medications up in med planners. Each compartment was jammed packed with colorful pills and capsules. 

My husband and I went on a camping trip with our horses.  Early one morning I grabbed my med planner as I was rushing to go out on a trail ride. I dumped the pile of pills for that day in my hand and swallowed them quickly with a small glass of water.  We saddled up and took off up the mountain. As the day progressed I noticed I was becoming confused and having a hard time remembering where we were and where we were going.  I was dizzy and tired.  We turned around and went back to camp. Once I was back in the camper, I realized that I had taken my P.M. medications instead of the A.M. ones.  That meant that I had accidentally taken my sleeping pill which was mixed in with all those supplements!  I couldn't remember what I had done or where I had gone.  It was only by the grace of God that I got back to camp safely.  Sleeping pills and senior citizens don't mix well!  I'm convinced this medicine error occurred because of the large amount of pills I was taking.  Yes, many of them were supplements, but because there were so many, I wasn't able to easily identify the pills I was supposed to be taking.

2.  Increased Drug interactions = Increased ER visits

I believe drug interactions may may send seniors to the ER  more often than anyone is aware of.  This is a common occurrence in the ER: An ambulance arrives with an elderly patient that is confused, disoriented and having problems speaking and walking.  Many tests are run; results all negative.  After awhile the symptoms that brought the patient to the ER disappear and no real diagnosis is ever made.  No one knows what caused the problem but the symptoms are gone at the end of the day so the  patient is sent home.  And because I have been in so many homes over the years, helping patients with their medications, I know that so many senior citizens take a large amount of medication, mingling prescription medications with over-the-counter remedies.  I always wonder...could this emergency visit to the ER have been because of a drug interaction or the wrong medication taken at the wrong time?

There are many other drug interactions that can occur.  Did you know that taking antibiotics with certain stomach medications can cause the antibiotic to be ineffective?  That taking vitamin K with Coumadin (Warfarin) reverses the blood thinner effect?  That Benadryl (Diphenhydramine) interacts with many drugs, especially in the elderly, causing confusion and balance issues?  And that Diphenhydramine is the basis of most over-the-counter sleep remedies?  These are just a tiny sampling of medication interactions.  There is a long list of them.  These interactions can, and do, result in death.

3.  Overdosing 

To illustrate what I mean by overdosing, I have another true story to tell. The names and places have been changed to maintain confidentiality.

I admitted 82 year old John Taylor to our home care service. During the admission, he was so frail he could barely walk with help,  He was coughing and wheezing continuously.  When I asked about his medications, his wife directed me to the table, where a large serving tray was piled high with prescriptions and over-the-counter medications.  She did produce a medication list but it only had the names of medications he received from the VA, and did not include dosages or frequency.  She told me he had a list of doctors that he saw- a primary care doctor, neurologist, cardiologist, podiatrist, oncologist, and several different VA doctors.  All of these doctors were prescribing medications for him and were relying on my patient to tell them what medications he was already taking!  They assumed that because he was a college professor, he was capable of understanding his medication regime.

Mr. Taylor was very smart, but he was confused much of the time, because of his medications. None of these doctors were monitoring him for side effects and drug interactions. Several of the medications he was taking were the exact same medication, only prescribed by different doctors and came with different trade names and appearance.  I found that  he was taking double, triple and sometimes quadruple amounts of some of the same medications! He was taking Lasix AND Furosemide, Neurontin AND Gabapentin, along with Carbadopa/Levodopa AND Sinemet!  Each of these drug sets were the same medication, they were just dispensed by different names.  I thought it was a miracle he was still alive!  

It took me over a week to get all of his medications straightened out and get clear orders from his doctors on what medications he was supposed to take.  Over the next month, Mr. Taylor made a gradual recovery.  He still had some severe health issues (cancer, Parkinson's Disease, and heart failure) but he was able to walk, talk and breathe again.  He was able to conduct his business.   He lived an active life for more than 3 years after that initial visit, largely because we were able to get control of his polypharmacy situation and turn it around.

I wonder how many seniors would have such a remarkable health turn-around if they were prescribed less medications and what they did take was more closely monitored  for correct dosage and frequency?

What Can Be Done About Polypharmacy?


1.  Get Help

If you or someone you know is taking a large amount of medications, get help.  Ask your doctor to review ALL of your medications and supplements for side effects and interactions.  Ask your doctor if every pill you take is absolutely necessary or can he begin to wean you off of a few.  
  • Ask a nurse to help you go through your medications to make sure you are taking them correctly.  Ask a friend that is a nurse, she (or he)  may be willing to help. 
  • If you don't know any nurses,  call a home health agency and ask if they can help you.  You may qualify for Medicare to pay for the visit.  If not, it's more than worth the money spent to have a professional come to your home and help get your medications organized.

2.  Stay with one pharmacy

Most pharmacies keep lists of all the medications people take.  If you always use the same pharmacy, they will have a list to compare to.  Pharmacists at smaller, non-chain pharmacies, will often be willing to review your medications and let you know if there are any side effects or potential drug interactions.

If you get some of your medications through a VA pharmacy or through mail order, it is critical that you make any other pharmacy you use aware of this.  Give your main pharmacy a list of your VA or mail-order medications to keep on file.  This is honestly one of the biggest areas of medication errors I've found - patients getting medications from more than one pharmacy.

3. Make sure your Primary Care Provider has an up-to-date and accurate list of your medications.  

Make sure to include all herbs, supplements, and over-the-counter medications.
If you need help making a medication list, click here for a free medication list form.

4.  Question all new medication orders that your doctor wants to prescribe.

Ask him if the new medication has side effects and if it will interact with any other medications you may be taking.  Ask if it is really necessary to add a medication.  Ask if there anything else you can do (such as change in diet, exercise, etc.) that would be beneficial to try first.  


5.  When you see a specialist, make sure you give him a list of EVERY medication that you take.

Don't forget to include all supplement and over-the-counter medication that you are taking.  After your visit to a specialist, if he orders any new medications, add it to your medication list then drop a copy off this updated list of at your Primary Care Provider's office.  Your Primary Care Provider is the one who is supposed to keep track of all medications you are on and coordinate care between themselves and specialist.  


Polypharmacy is not a good place to be.  If this is a problem for you or a loved one, get help.  It just may save our life.

Link to another great Polypharmacy article: Deprescribing Prescription Drugs .

Tuesday, August 15, 2017

Book Review: MOVE WITH BALANCE

Healthy Aging Activities for Brain and Body 

Written by Karen Peterson, a certified educational kinesiologist,  this book benefits people of all ages and abilities. 

As we get older,  the old adage: If you don't use it,  you lose it is true.  Adding these fun-filled movements to your daily schedule will help you use those muscles and keep your brain in shape while you're at it.

I have used this book for years to teach classes at senior citizen centers, independent living facilities and even a local cancer support house.  Everyone loves the activities, young people and seniors alike.  

The author is careful to use the words movements and activities because so many seniors automatically assume they can't participate if the word exercise is mentioned!  

What I think makes this book and the Move With Balance program unique is:

1)  It encourages you  to challenge yourself.  Once the first simple movement is learned, you add cognitive activities, such as reciting a poem or counting backwards from 100 by 3's, while you do the movement.  The movements never grow old or get boring because you continue to add new challenges to each movement as you master it.

2) The book can be used as a manual on 3 different levels: 

  • For individual enrichment - use by yourself each day to improve your balance and memory
  • To teach 1 on 1  - teach movements to a patient or a child or a friend
  • As an instructor  - there are lesson plans and ideas in the back of the book to help instructors teach weekly classes.  If you want to instruct groups, there is a video series that the author has put together to help train you to be a certified Move With Balance teacher.


3) Both the instructor and those being instructed benefit from these movements.  If you are teaching the movements to someone else, you will get equal benefits for yourself!

4)  The program incorporates movements that help with vision, balance, and strength; which have been proven by an independent study to decrease falls for senior citizens.  

5)  Each movement is accompanied by a picture and a detailed explanation of how the movement should be done, followed by many ways to continue to make the movement more challenging. And just in case the pictures and explanations are not enough, when you buy the book you are given a  password that allows you to go to the on-line teaching site, where you can watch how the movements being done.

6)  The movements can be done to music if you choose - either tunes you have pick out yourself or you can buy the music enrichment accompaniment that was designed to be used with this program.  

7)  These movements can be adapted to use with almost any age and ability.  I've used them with my youngest grandchildren and have taught the movements to seniors of all ages and abilities.  A large portion of the clients I teach are seniors with some level of dementia.  Movements can be adapted for use with those who have Parkinson's, are in wheelchairs or who have had strokes.  

I love this book and have used it until my copy is quite tattered and dog eared.  The book can be bought directly from the Move With Balance web site for $34.95 or from  Amazon.  There is a Kindle edition but...I believe  you need a hard copy to be able to teach it. If you buy this book, I hope you enjoy it as much as I do.  

(Disclaimer - if you buy this book from one of my affiliate links, I will be paid a small amount for each purchase, which in no way changes the amount of money that you pay. If you do buy the book through this blog, then thank you for supporting my work!)

Saturday, August 12, 2017

How to Make a Medication List

It Just May Save Your Life!

[All information that is found on this blog or related social media platforms is meant for educational and informational purposes only.  It is NOT to be taken as medical or legal advice nor is it meant to take the place of any treatment ordered or recommended by your physician or lawyer. ]


Carrying an updated medication list in your wallet or purse might save your life one day.  Including important medical information such as your allergies and diagnoses would certainly help in an emergency situation.  Including the following eight things on your medication list will ensure that your most important medical information is right at your fingertips.

1.  Name and DOB


It seems silly to tell you to put your name on your card...except that people do forget this important step.  I have found medication cards left on the counter after checking a patient in to the clinic but had no idea who to return it to because there was no name on it!

2.  Diagnoses


You may be one of those fortunate few who have no chronic illnesses so you don't need to add this part.  For those with chronic illnesses it would be very beneficial for your doctor to know about them.

3.  Allergies


Print your allergies in bold red so that they stand out above everything else.
  

4.  Current medications- including dosage and frequency


Make sure to include the dosage and how often you take each medication.  If a new medication has been added since your last visit be sure you include the date  that the medication was started. Any antibiotics or medication prescribed through the ER, Walk-In Clinic or another doctor also need to be added to the list. Here's a true story about a patient named Mike(name is changed to protect the patient):

Mike, a 60 year old car mechanic, came to the ER late one Sunday night.  He complained of having an infected cut on his hand. Mike stated that when he first cut his hand at work 5 days ago, he went to a walk-in clinic.  His laceration was cleaned and the clinic doctor gave him a prescription for antibiotics.  Mike reported taking the antibiotics as prescribed but now the area around the wound was red and swollen and the dressing was saturated with a foul smelling drainage. 

I asked Mike what medications he was taking, including the antibiotic.  He replied that he took a lot of medications but he didn't have a list of them.  He also couldn't remember the name of the antibiotic he was currently taking.  He stated, "I'm only here for this infected cut on my hand. I'm sure I just need a different antibiotic.  The one I'm taking now is that large, yellow capsule.  You know the one I mean.  Oh, and I forgot to tell say, I'm allergic to some antibiotic but I'm not sure which one."  

Can you see the many challenges there would be that might keep Mike from receiving the best treatment?  

  • He didn't have a current medication list.
  • He didn't know what antibiotic he was taking.
  • He didn't know what medication he was allergic to.
  • It was a Sunday night, making it impossible to call the walk-in clinic or the pharmacy to find out what antibiotic he was taking and get a list of  the current medications he was taking.
You may think this is only a made-up story and things like this rarely happen, but, unfortunately it is common!  Rarely do people have a current medication list written down.  And if they do have a list, they don't keep in in their purse or wallet for easy access.  


5.  All vitamins and supplements


There are numerous medical studies that have been done that link interactions with different herbs and supplements. Here is a list of 18 herbs that have shown to interact negatively with common medications.  I don't want to imply that taking herbs or supplements is bad!  I use and believe in taking herbs and supplements.  But adding them to your medications list may help your doctor find any interactions that might occur.

6.  Emergency contact number 


List one or 2 people that can be reached in case of emergency and would have your best interests at heart.

7.  Primary Care Provider and phone number


You can also add any specialists that you may see.

8.  Your Pharmacy name and number


Having your pharmacy name and number is helpful to have on your list.  You may need to call them for refills or to ask questions.  And if you are seeing a new doctor, they will ask what pharmacy you use.  I've noticed that doctors are getting away from writing prescriptions and instead, fax or call them directly to your pharmacy.

I hope you will take this information and create your own medication list and keep it updated and in your purse or wallet.  There are also applications for your smart phone where you can keep your medication list.  (I keep both a hard copy in my purse AND use a phone app- just in case my phone gets lost).  You can also click here for a blank medication form that includes all the above categories if you don't want to make your own.  Make a copy, fill in the blanks, and you're done!

HINT: Copy the template on a bright color paper that will stand out in your purse or wallet, thereby making it easier to find. I like to use neon yellow!


More articles about  healthcare:




Wednesday, August 9, 2017

What Is a DNR?


Don't get Advanced Directives confused with a DNR.


[All information that is found on this blog or related social media platforms is meant for educational and informational purposes only. It is NOT to be taken as medical or legal advice nor is it meant to take the place of any treatment ordered or recommended by your physician or lawyer.] 


Do you have an Advanced Directives or a DNR?   That question is asked every time someone is admitted to the hospital. Yet most people have no idea what those words mean.  Or worse yet, they THINK they have a DNR  order but upon further investigation, find that what they really have is an Advanced Directive. In fact, in my 35+ years as a nurse, I believe only 3 patients ever responded with a “yes”  when asked if they had a DNR order and were actually able to show me the signed documents.  Advanced directives and DNRs are confusing to many people.  In this article, I'll define these terms, explain the difference between the two, and share who should have a DNR.  At the end, I would love to hear some of your thoughts, opinions, and experiences with DNR orders and how have they have affected you. 


Definitions


1. DNR stands for DO NOT RESUSCITATE.  Resuscitation is what happens when a person quits breathing or their heart stops – someone steps in to breathe for them and pump on their chest to stimulate their heart to beat.  Another name for resuscitation is CPR, which stands for Cardio
Pulmonary Resuscitation.  So another way to say DNR is “DO NOT PERFORM CPR” or “DO NOT BREATHE FOR ME OR PUMP ON MY CHEST if I quit breathing or my heart stops.” 

A DNR is both a legal document and a doctor's order, signed by both you and your doctor.  A person having a medical POA (Power of Attorney) for someone CAN sign this document, along with the doctor,  if the patient were unable to do so.  Medical personnel, including EMTs and nurses, are bound to follow this order when it is produced.

2.  An Advanced directive is a written plan for your future healthcare and an expression of your wishes if you are no longer able to make healthcare choices for yourself.  Advanced directives spell out for your family, doctors, and healthcare team, what your wishes are regarding end-of-life decisions and plans.  It is a legal document but NOT a doctor's order, therefore medical personnel (including EMT's and nurses) are not bound to follow it.

An Advanced Directive (may also be referred to as a Living Will, Health Care Directive, or Advanced Health Care Directive) is also a legal document, but only needs to be signed by you and a witness.  Your doctor's signature is not  needed on this document.  A medical POA cannot make and sign an Advanced Directive for you. The very nature of an Advanced Directive is that you make your own wishes known in advance. That is why it is called an Advanced Directive.  

(Look for a future article discussing Advanced Directives in more detail.)

IMPORTANT: ALWAYS CHECK YOUR STATE FOR LAWS GOVERNING ADVANCED DIRECTIVES AND DNR ORDERS. LAWS GOVERNING THESE DOCUMENTS VARY FROM STATE TO STATE.


Here are some examples of things that MAY be covered in an Advanced Directive:


1.  Do you want to be put on a respirator (ventilator) if you were to quit breathing?

2.  If you are unable to eat, do you want to be fed through a tube placed in your stomach?

3.  If you are detertermined by medical tests to be brain dead or if your doctors conclude that there is        no hope for your recovery, do you want to remain on a respirator or have CPR (Cardio-pulmonary      resuscitation) performed if your heart were to stop?

4. Do you want to be an organ donor?

5. Preplanned funeral arrangements.


What is the difference between a DNR and an Advanced Directive?


A DNR may be PART of an advanced directive, but it is NOT the advanced directive.  I have found that often, when a patient tells me yes, they do have a DNR order, that what they really have is an advanced directive that does NOT include a DNR.  One reason an Advanced Directive may not include  a DNR is because the person may want to be resuscitated if his heart stops or he quits breathing, whatever the circumstances.   

A person's Advanced Directive may use the following terminology:  
"In the event that I am found to be brain dead or have been determined by my doctors to have no hope of recovery, I do not want CPR performed."  To the NON medical person, this sounds like a DNR.  It is not.  This only covers what to do AFTER someone has been found to be brain dead or AFTER a decision has been reached about any hope for recovery.They may have already received  CPR.  Let's see if I can clarify this by the following examples:
  
Example #1, the patient has an advanced directive that includes a DNR.  
Example #2- the patient does not have an advanced directive OR a DNR. 
Example #3- the patient has a DNR but not an advanced directive.

#1.  Joe has a car accident and quits breathing at the scene of the accident.  The EMS (emergency medical system) team arrives and performs CPR.  When he arrives at the hospital, he is found to have a serious head injury and is placed on a ventilator.  Tests show that he is brain dead and the only thing keeping him alive is the ventilator.  His family arrives and tells the doctor that Joe has an Advanced Directive that specifically states that if he is found to be brain dead, he did NOT want any further CPR and did not want to remain on a ventilator.  They have a copy of his Advanced Directives signed by himself and a witness.  The ventilator is removed and Joe's heart stops.  CPR is not performed, per his wishes that were declared in advance of the accident.

#2.  Mary has a car accident and quits breathing at the scene of the accident.   EMS arrives and performs CPR.  She is transported to the hospital and placed on a ventilator because she is unable to breath on her own. Numerous tests are performed and the doctors determine that she is brain dead and has no hope of recovery.  Her family arrives and the doctors explain her prognosis. The family has no idea what to do.  Mary never discussed what she would want done in the event of something like this happening to her.  She is transferred to the ICU on a ventilator and many weeks go by while the family comes to terms with her condition and tries to come to a consensus of what they should do.

#3.  Fred has a car accident and quits breathing at the scene.  When EMS arrives, no CPR is performed because Fred's wife is also on the scene, and is able to produced a document, signed by Fred and his doctor, that states he did NOT want CPR performed for any reason. (Maybe Fred had a terminal illness or maybe he had  religious reasons for making this choice.  It doesn't really matter what the reason, if there is a signed DNR order that can be physically produced at the time, no CPR need be performed.)


As you can see, there are endless possibilities and endless emergency situations that could be discussed and how a DNR order pertains to each one. 


Who needs a DNR?


Any person who does not want CPR performed if he quits breathing or his heart stops beating needs to have a DNR order signed by themselves and their doctor.

If you have a medical POA (power of attorney) for someone, it is up to you and the person's doctor to make a decision on whether CPR should be performed if they were to quit breathing or their heart stops. An example of this can be taken from my own experience: My dad became very ill with liver disease. His illness advanced rapidly and he became comatose. Everything medically possible was done for him but it became obvious that unless the Lord intervened, he would not live. My dad never discussed with me what his wishes were if he were not able to make decisions for himself. I was left to have to make those decisions for him. A situation most of us never want to be in. Eventually I signed a DNR order, after the doctor admitted that nothing else could be done for my father, When his heart stopped, no CPR was performed.


Some things to keep in mind:


1.  An Advanced Directive is NOT a DNR

2.  A DNR is a legal document, signed by both the patient (or his Medical Power of Attorney) stating that CPR is NOT to be performed if the  patient quits breathing or if his heart stops beating.

3.  A DNR order signed in the hospital does NOT transfer to the home.  A new form must be signed    and dated by all parties, AND posted clearly in the home (usually the refrigerator). A spouse or family member saying, "He has a DNR" cannot be accepted by EMS or any other medical personnel.  A hard copy of the document has to be presented.

4.  A DNR order that is correctly dated and signed by all parties CAN be taken to the hospital and shown on admission.  It is likely that a new form for that hospital will need to be signed also but having a signed form in hand can make that process much easier.

5.  In most hospitals, a new DNR form must be signed with each hospital admission.

6.  It is a good idea if you have a DNR order and/or an Advanced Directive, that you make that known to your family members.  Let them know where you have filed a copy of the Advanced Directive. Post the DNR order on your refrigerator and tell your family and friends that it is there.

7.  A DNR order does NOT mean that comfort measures would be withheld from you. You would still receive treatment  for medical illnesses or accidents, such as getting a UTI or breaking your leg.  A DNR order only covers withholding CPR if your heart quits or you stop breathing! 

8.  A DNR order can be revoked by the patient at any time, so if you change your mind after signing one, tear it up and let your family and doctor know that you changed your mind.


It is my goal for the reader to be able to clearly see the difference between a DNR and an Advanced Directive and to understand the importance of each document.  If you want to create an Advanced Directive, check out this site. It gives further information on Advanced Directives and offers, free of charge, the correct documents that are required for your state. If you would like to have a DNR form, click here.  This site answers many more questions about DNR orders and has a blank DNR order form that can be filled out and signed by both the patient and the doctor.





Monday, August 7, 2017

Senior Health: How to Choose a Primary Care Provider

5 Tips to help find the primary care provider that is right for you.


[All information that is found on this blog or related social media platforms is meant for educational and informational purposes only. It is NOT to be taken as medical or legal advice nor is it meant to take the place of any treatment ordered or recommended by your physician or lawyer.] 


We are all faced with choosing a primary care provider at some time in our lives.  The doctor we have seen for years may retire or we may move. Whatever the reason, choosing your next doctor is not always easy.  The following are some tips in that will help make that choice a little easier.

1.  Establish care with a primary care doctor before you get sick.

I don't know if it's like this everywhere, but it takes a long time to get a first-time appointment with a doctor where I live.  A standard waiting time is often two months or more.  So you can see, if you wait until you are sick or need refills on your medications, it will be too late to be able to choose wisely.  

If you are a senior, and you plan on moving to a new city or state, establishing care before hand is essential, especially if you have ongoing medical issues.  You can ask your current doctor for help in making sure you are prepared with enough medicine and  prescriptions until you have established care at your new location.

2.  Get recommendations from your friends and family.

This seems like such an obvious thing to do - start with recommendations from friends and family. But I have found that many people take whatever doctor they can find that will see them once they are already sick.  Then they stick with that doctor, even if they don't like him or her, because they don't know that they have the right to change doctors if they are not satisfied with the care they receive.  

 If you know any nurses...ask them for recommendations.  Nurses often have experience working with a variety of doctors and will share their opinions of how those doctors treat their patients and if they treat their nurses well.  Of course, being a nurse I'm a little opinionated about this.  I believe if a doctor doesn't treat his nurses well, he doesn't really understand our healthcare system and would not have true compassion for his patients. It would not be ethical for a nurse at the hospital or at a doctor's office to share their opinions with you, so don't ask them.  And even if you have a friend that is a nurse, be aware that she (or he) may be unwilling to voice an opinion about local doctors (they may feel it is unprofessional to do so).  Most friends and family members will be more than happy to share their opinions with you, as will complete strangers.

Friends, family,  nurses, and even strangers will all have opinions based on their experience with individual doctors.  And their opinions are just that...opinions.  They may have valid reasons for liking or not liking a certain doctor.  Keep in mind that all doctors have to have a doctorate level of education, have on-the- job training (called internships and residencies), and have to have passed rigorous testing.  But that doesn't make all doctors equal.  We all want a doctor who is knowledgeable and skilled but if you can't talk to a doctor because their bedside manner stinks, then keep looking. Communication is a huge part of your healthcare.  It's possible that other people can give you a place to begin your search, but don't stop there.

3. Do a Google search.  

That's right.  Do your homework!  You will be amazed what you can find out about a doctor before you make an appointment.  Just type their full name into your search engine and see what comes up. If you don't have any names but have certain requirements, you can google those instead.  For example, when I googled  "Primary care doctors specializing in geriatrics in Fort Smith, Arkansas", I got the following results: 

Primary Care Doctors - Fort Smith, AR | DocSpot

www.docspot.com/d/AR/fort-smith/primary-care.html

181 primary care doctors near Fort SmithAR -- 37 have pictures and 73 have patient ratings. ...Specializes in General Internal Medicine, General Pediatrics.

Geriatric Medicine Doctors near Fort Smith, AR - Senior Care Doctor

https://www.healthgrades.com/geriatric-medicine-directory/ar-arkansas/fort-smith

Find and research local Geriatric Medicine Specialists in Fort SmithAR including ratings, contact information, and more.
I actually got a ton of results but I picked out these two links from the many that popped up.  These sites show pictures of all the primary care doctors in my area,  plus they give a summary of each doctors training, any sub-specialties they may have, and what hospitals they are on staff for.  What I particularly liked was there were star ratings available and I was able to read the  different experiences patients had with each doctor.  

Once you have a list of a few doctors you may be interested in, you can google that particular doctor. There is an abundance of information to be found on the internet.  I still prefer personal recommendations but I like to follow those up with a google search!


4. Check with your insurance company.

Always check with your insurance company before making an appointment to see a new doctor.  In these days of managed care, most insurance companies have a network of doctors that they will pay for.  You will need to choose a doctor within that network.  In fact, you may be able to narrow down a list of doctors from the very start by asking your insurance company for a list of primary care doctors that are in-network in your area.  

Medicare affiliated insurance companies keep a listing of all  the doctors that they work with, as do most insurance companies.  A word of caution here: always call the number on the back of your card BEFORE showing up for the appointment.  Doctors have the option to change Medicare insurance company affiliation at any time. If you see a doctor that is not on the CURRENT list, you run the risk of having to pay for the entire visit out of your own pocket. Here's a true story that happened to a friend of mine (names are changed to protect the guilty!):

Gina took her father-in-law to an appointment with a primary care doctor, Dr. Sam Smith.  Her father-in-law had been seeing Dr. Smith for over a year and this appointment was a follow up visit for treatments he had been receiving.

Imagine her surprise when a week later she received a bill from Dr. Smith showing that her father-in-law, who was on a fixed income, owed  $225!  They had already paid the copay of $15 at the time of the appointment and that was supposed to be all they would need to pay.  When Gina called the insurance company to find out what the problem was, she was told that Dr. Smith was no longer in their network, therefore her father-in-law was responsible for the entire bill!

(Personally, if this had happened to me, I would have held the doctor's office responsible for not telling me when I checked in that my doctor was no longer affiliated with my insurance company and would have insisted they drop the charges, but...that's just  me!)

Be aware that if you move, you have to re-sign up with a Medicare carrier in your new location. Medicare insurance is confusing to many people.  Even after taking insurance classes and becoming an insurance agent, it can still be confusing to me!  Few people really understand their Medicare policy.  And most don't realize that their Medicare policy does not move with them.  It won't cross state lines and often doesn't even cross county lines.  Your Medicare policy will cover you after moving for a certain amount of time, usually 60 days, until you find  another Medicare carrier. Each carrier is managed and operated locally, including Humana, Blue Cross, and United, just to name a few of the more well known Medicare insurance companies.  The company you are signed up with may have an office in the area where you are moving to but...they are DIFFERENT in every state and may be different in each county.  You must have a Medicare insurance policy with a LOCAL company, once you have established a new residence.  So if you live in Texas and have a Humana Medicare policy, and you move to Oklahoma, you will need to sign up with a local company.  You may still choose to have Humana but the benefits will be different and will be managed by the Oklahoma office.  Trust me on this one!  Along with being a nurse, I am also a licensed insurance agent specializing in Medicare insurance.

What if you're moving mom or dad closer to you to so that you can help in their care? (Be looking for a future article on "What to Do BEFORE Moving Mom.")  When moving a parent to live closer to you, check to see what Medicare carrier they have.  They will have an insurance card that designates what insurance carrier they are using. Then find a local independent insurance agent to talk to. Explain that you are helping your family member move and ask them to help you with some suggestions for signing up with a local insurance company.  Let them know what Medicare insurance they currently have. If you go to an independent agent, they will be able to help you find the most cost effective Medicare plan in that area.  The agent can't sign a new client up until they actually move but it helps tremendously to have things prepared in advance so that when the move occurs, the information is available to choose from. 

5.  Look for any sub specialties the primary care doctor has.

PCPs may have subspecialties.  These might include such specialties as: geriatrics, pediatrics, internal medicine, etc. I once worked with a doctor who was a primary care provider but she was also board certified in pediatrics and internal medicine.   So what does that mean for you?

Primary care doctors have general training in all fields, but being board certified in other specialties besides primary care/family practice means that they have extra training in that area. Extra training is always good.  😊

Often a board-certified geriatric doctor will be willing to act as your primary care doctor, but beware...you may find yourself paying  "specialist" fees or copays when you see them.

I hope these tips will be helpful to you whenever you find yourself in need of choosing another primary care doctor.  I'm  including a link to another fantastic healthcare blog, called the Frugal Nurse, written by a nurse committed to helping people save money on their healthcare. Click here  to see her article "Choosing Wisely, 5 Questions to Ask Your Doctor."

If you have any other helpful hints when choosing a healthcare provider, please let us know in the comment section below.





Saturday, August 5, 2017

Product Review: Jigglin George

What is the Jigglin George?

All information that is found on this blog or related social media platforms is meant for educational and informational purposes only. It is NOT to be taken as medical or legal advice nor is it meant to take the place of any treatment ordered or recommended by your physician or lawyer. 

The Jigglin George is also called the New Life Bed Exerciser.  It is a device that generates passive, side-to-side movement of your feet and lower legs, which then vibrate up the legs and through the spine. The machine is made to be used while lying down on your back, either on the floor or on your bed.  It is portable and similar in size and weight to my portable sewing machine.


How does it work?

As seen on the picture, there are indentions where the ankles are placed.  There is a hand controller that allows you to set the intensity of the movements and the length of time you want it to last.  The Exerciser can be used on the floor or on the bed.  I prefer to use ours while lying on the bed but my husband prefers using it on the living room floor while watching T.V.

Click HERE  to watch the machine in use and to get full explanation of how it works.

Benefits of using the Jigglin George

The official Jigglin George site (see below) claims that this machine will help with all of the following conditions:

1. arthritis
2. circulation
3. diabetes
4. fibromyalgia
5. knee/back/ neck/shoulder pain
6. Restless Leg Syndrome
7. stress.

While I can not make all those claims from personal experience, it makes sense to me that the gentle, side-to-side movements could be helpful in all of those conditions.  If you have any of these issues, or have any other medical conditions, I recommend that you check with your physician if you are planning to purchase or use this machine, just to be on the safe side.

The medical part of my brain makes me wonder if it would be beneficial to someone with lymphedema; so if there are any of you reading this who have medical training (or maybe have lymphedema and have used this machine), I'd love to hear from you in the comments below.

Personal experience with the Jigglin George

When I've had a stressful day, I can spend 20 minutes lying down and letting this machine gently "shake out" all the knots in my tense muscles.  I play soft, relaxing music while I'm lying there.  After a session my muscles feel like I've had a massage, my legs feel as if I've had a brisk 30 minute walk, and I can feel the blood pumping through my calves!

My husband  has a history of chronic low back pain and has had back surgery in the past.  He has never wanted to get hooked on pain pills.  When we first saw and tried  the Jigglin George in Branson years ago, we were delighted to find an alternative treatment for his pain.  He was willing to give it a try and here he is, years later, still using it.   Regular use has drastically cut his need to go to a chiropractor.

Where can you buy a Jigglin George?

New:  

Go to Jigglin George Website to get info straight from the company.  New models at the time of this writing are selling for $399.99.

Used:     

At the time of this writing,  eBay has many models ranging in price from $29.99 to  $99.97.  Some even offer free shipping.

There is a plastic,heavy duty platform that comes with the newer models and I would check to make sure the platform was sold along with the used models. If not, go to the website and contact the company to see if they will sell you one separately.  Our model didn't come with this platform.  When we were in Branson this past year, we went by the Jigglin George Store and were able to purchase one.  It's not an absolutely necessary addition. We were able to use our machine for years without it but we did only use it on the floor.  The platform allows the machine to be used on the bed and not lose some of the movement/vibration into the mattress.


We've had our Jigglin George New Life Exerciser for 4 years and we feel like it was a good investment.  It is a high quality, well made machine.  We both still use it and it is still in great condition. And it is made in the USA, which makes us really happy!


Wednesday, August 2, 2017

How to Improve Your Healthcare

 5 Things Doctors Wished Their Patients Would Do


All information that is found on this blog or related social media platforms is meant for educational and informational purposes only.  It is NOT to be taken as medical or legal advice nor is it meant to take the place of any treatment ordered or recommended by your physician or lawyer. 


Are you tired of feeling out of the loop where your health care is concerned?  Do you come away from doctor appointments feeling frustrated that your doctor didn't listen?  Communication between you and your doctor is crucial to receiving the correct  diagnosis and the best care.  Choosing a primary care provider that is right for you would solve part of the problem.  For now, let's look at some things you can do to improve communication with your doctor.  After working with multiple doctors over the years, I've been able to compile the following list of  things that every doctor wishes their patients would do:

1.    Bring an up-to-date medication list to every appointment.

As a nurse with experience in multiple areas of patient care, I found it RARE for any patient to arrive at the emergency room or an appointment with a current medication list! Even in this era where computers keep track of everything, bringing a current  medication list with you is important.  How else will the doctor be able to assess for side effects or adverse interactions with medications you are currently taking and any he may want to prescribe?  And you never know when there may be a glitch in the computer, making your records inaccessible or if the last nurse checking you in got your medications listed incorrectly.  

Click  here  for a downloadable blank medication list that you can fill out and carry in your purse or wallet.  While you're there, make a copy for your spouse and each of your children!

HINT: Print the medication list on colored paper so that it stands out in your purse or wallet.  This will make it easier to find!  I like to use neon yellow - it stands out from all the other papers in my purse and it's easy to see the words printed on it.


2.   Limit the issues you want to address with your doctor to one or two chief complaints per visit.  

It's tempting to list every possible medical issue that you are experiencing each time you have an appointment or go to the ER.  I know. I know.  I get it.  I want to get my money's worth out of every appointment, too.  And I hate to waste money on future office visits if I could possibly combine everything into one visit.

But there is a limited amount of time the doctor has on his schedule for you. It's important that he be able to focus on a plan of care for one body "system" at a time.  By this I mean: If you are having problems with your blood pressure, don't come with a "shopping list" of medical issues.  I've had patients come to the ER for a broken arm, but since they were having to see a doctor,  they wanted the ER doctor to address the wart on their finger, the rash they'd had for 6 months, and their constipation issues.  Many people don't realize that doctors form a plan of care each time they see a patient.    They do a physical assessment and look at medications, medical history, symptoms and chief complaint.  Asking them to address multiple, non connected issues is like asking your spouse to water the lawn, cut the grass, weed eat, plant some flowers, and trim the bushes all in 15 minutes!

3.  Come prepared to give an accurate history of the medical problems that you are having. 

I have found it helpful to write down the details. Make a list that includes what the main problem is, what symptoms you are having, and when these symptoms began.
During the appointment, resist the urge to get sidetracked from these  main issues.  Keep in mind that the doctor is on a schedule.  You have been allotted a certain amount of time (usually 15 minutes or less!). The more concise you can be, the better opportunity you have to get all of your story told and questions answered.

4.    Give symptoms, not your diagnosis.

In todays high tech world anytime people experience symptoms of any kind, they look on the internet to see if they can diagnosis their problem.  And I have to admit...I have often done the same. It's okay to look up your symptoms (although sometimes it will cause you needless worry!) - just don't go to your appointment and tell the doctor what you have diagnosed.  Let him do his job.  After all, he has spent at least 8 years in school and has had many more years of internship and  medical training.  He (or she) is much better qualified to put the symptoms, exam and lab work together to arrive at a diagnosis.  

Years ago I had this conversation with a patient in the ER:

Me: "What brings you to the ER today?"

Patient: " I have the flu."

Me: "What are your symptoms?"

Patient: "I just told you, I have the flu."

Me: "But what symptoms are you having?  What makes you think you have the flu?"

Patient: "I've been throwing up.  I looked it up on the internet and it said that I probably have the flu."

After many questions I was finally able to find out that he only vomited after eating, he had no fever, and his symptoms seemed to be related to his eating.   Maybe he had ulcers or food allergies or something else going on in his belly.  I was pretty sure he didn't have the flu but I didn't tell him that.  It's the doctor's job to do the diagnosing, not the patient's or the nurse's job!

Here are some examples of symptoms:  nausea, vomiting, fever, pain, redness, swelling.
And these are examples of a diagnosis:  flu, ulcers, sprain, broken, cancer.

I'd like to share a story with you that clearly demonstrates what could happen if an accurate history and reporting of symptoms does not occur. This is a true story that happened 20 years ago.

I arrived home at midnight after working the evening shift at the hospital to find Dale, my husband already in bed.  He was tossing and turning, which is highly unusual for him.  When I asked what was wrong, he said, “My back hurts.”  Not feeling very sympathetic at the time (after all, my back AND feet hurt after my long shift at the rehab hospital!), I told him to go take some Advil and I went to sleep. His tossing and turning woke me up an hour later.  Again he said his back hurt.  I was trying to go back to sleep when I heard these next words, “And it feels like a tight band is squeezing around my chest.” To any medical person, those are ominous words and denote something much more than just back pain. I finally managed to get the whole story from him –he had pain in his upper back that radiated up to his neck, there was a squeezing pressure around his chest, and he felt weak.  Those are all signs that should send you straight to the ER! 
When we arrived in the ER, the nurse asked him what his chief complaint was and again he said, “My back hurts.”  I wanted to scream.  In fact I probably did!  My husband is not a person who ever complains of pain nor will he volunteer the details of any symptoms  he may be having.  In fact, he even JOKED around with the nurse, acting like nothing was wrong.  To make a long story short, he was in the middle of having a heart attack.  If I had not been with him to press him to tell the whole story, he would have sat out in the ER waiting room with his “back pain” until he keeled over from the heart attack!


5.  Tell the Truth!

Most patients lie to their doctor.  I could even say ALL patients lie.  They may lie by leaving out important details or by stretching the truth.  Or even just bold faced lie!  We lie about taking our medication as ordered. We lie about symptoms. And we especially lie when asked questions about drinking, drugs, food and alcohol intake and our sexual activities.

Yes, it's true and doctors are very well aware of it!  They are even taught  in medical school to expect for patients to lie to them.  Their job would be so much easier if we all just told the truth when asked certain questions.  Often patients lie because they are embarrassed or because they feel that the doctor or nursing staff will be judgmental. In actuality, doctors and nurses have heard so many truly strange and bizarre things from their patients over the years that there are few things that surprise them. Their job is to gather the facts, not judge or condemn you.  Telling the truth, the whole truth and nothing but the truth will enable your doctor to get the whole picture.  It's easier to tell the whole truth to a doctor that you're comfortable with, so if you feel that your doctor or his staff are judgmental, find another doctor.  Your life may be in their hands some day and you want to trust that they have your back. (Read  article Senior Health: How to Choose a Primary Care Doctor

A doctor once told me that 90 percent of an accurate diagnosis comes from taking an accurate history and only 10 percent of the diagnosis comes from the physical exam and lab work.  For your next appointment or emergency room visit, be sure to arrive with an up-to-date medication list, limit yourself to one chief complaint, give an accurate history, share all of your symptoms clearly and tell the truth. You'll be glad you did.  And so will your doctor!  




  

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