A Bit of Common Sense

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

By Mary O’Brien, M.D.

Do you take care of patients?  Are you in a position to teach students or other caregivers?  These days, everyone in healthcare is simmering in a sea of policies, protocols, rules, regulations, and algorithms.  Some of them are reasonable.  A few even make good sense.  Unfortunately, however, many of them are downright dumb.  Often, by the time someone reaches the lofty position of creating assorted rules and policies, she has lost touch with her sector of the real world.  The results are not good.

In recent years I’ve been sidelined with a growing list of autoimmune diseases. I used to joke with audiences that with red hair, green eyes, and see-through skin, I was a walking collection of recessive genes.  It’s not a joke anymore.  Being in constant pain and steadily losing functional ability is not fun.  However, in my new role as “patient,” I have learned a few things that are not taught in most training programs.

In the hope that it might help a few other folks, here’s some of what I’ve learned:

  • Sunshine is our friend.  Over the years, I’ve spent far too little time outdoors.  I was a sickly little kid and a natural-born bookworm.  From the mid-1980s on, I was afraid of “skin damage.”  Swell.  Now I have decent-looking skin but my musculoskeletal system is so badly compromised I struggle to get in or out of a chair.  Please encourage patients to get some fresh air and sunshine on a regular basis — especially if these patients suffer from any chronic illness.  Vitamin D supplements are fine, but they can’t undo the damage of decades of deficiency.
  • Small comforts matter.  The point of health care is to relieve pain and suffering.  Many of our colleagues have apparently forgotten that.  Computers can provide information.  They cannot provide comfort and consolation.  There is a true art to easing another person’s misery, and it usually involves small, simple measures.  “Hugging” a king-size pillow while lying on your side can ease pressure and strain on shoulders, elbows, and knees.  Massaging a nicely-fragranced body butter into hands, arms, legs, and feet before bed can help ease the achiness that accompanies chronic illness.  It’s not a substitute for proper medication, but these measures can provide a few moments of respite.
  • Being squeaky clean feels good.  I was obsessed with hygiene even as a little kid.  But chronic pain and illness can make taking a shower, washing your hair, and brushing your teeth feel like a triathlon.  Nearly anyone who has had the flu can relate.  The most simple measures can make a difference:
    • Change pillow cases every 12–24 hours.  I did this for patients when I was a nurse’s aide 45 years ago.  I do it for myself now.  If feels nice.
    • Step up oral and dental care after meals and before bed.  This feels nice, too.  And, there are discernible medical benefits.
    • Try a shower in the morning and a warm bath at night (as long as it’s safe).  Baby wipes, facial wipes, and dry shampoo are essential for travel and chronic illness.
  • Never wake a sleeping patient for vital signs.  I can hear nursing instructors screaming right now.  However, if a patient is sound asleep, her vital signs are probably fine.  Despite all of our impressive technology and sophisticated medications, we have found nothing more restorative than good, deep sleep.

If policies and protocols eased misery, everyone would feel fine by now.  Sometimes what we need is a bit of common sense.

A Very Long Reception Line

Posted on Posted in Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

He was a bright light shining in the darkness.  Billy Graham changed the lives of hundreds of millions of people.  His message was simple and consistent:  God loves you.  He wasn’t concerned about denomination or fine points of theology even though he knew the Bible about as well as anyone.  He was a bold but humble force for good in the world.

In an age when being snide and snarky is considered “cool,” Billy Graham’s sincerity, honor, and compassion provided a beacon of hope.  Today, few things come more easily than cynicism.  I struggle with it every hour of the day.  But Billy Graham managed to rise above that temptation throughout his long life.  He never worried that someone might ridicule, criticize, or dismiss him because he never worried about himself.  Few people manage to subdue their egos the way Billy Graham did.  His lifelong focus was to share God’s love with as many people as possible.

Living a faith-filled life is very difficult.  Mother Teresa understood that. Pope John Paul II knew it.  Brave souls like these never agonize over focus groups, polls, or surveys.  Political correctness and fence-straddling, psycho-babble have no place in their lives.  They really do answer to a Higher Power.

Billy Graham gave spiritual counsel to 12 presidents regardless of their political party or religious affiliation.  He didn’t need to play games, massage egos, or create clever sound bites.  He said what he meant and he meant what he said. He had a clear understanding of right and wrong, and he wasn’t embarrassed by it.

Status had no claim on him. He lived a simple, scandal-free life.  For decades he showed as much attention and kindness to orphans in huts as he did to heads of state in palaces.

Finally, Billy Graham gave us all a noble example of how to endure the ravages of illness and old age with grace and dignity.  As we have seen with other saintly individuals, his patience, courage, and good humor endured until the very end. Protracted illness, pain, and suffering could not conquer the Spirit that worked within him.

I’ve heard it said that when you die, all the souls you’ve helped along the way are there in heaven to greet you.  In Billy Graham’s case, it must have been a very long reception line.

Vitamins & Minerals: What Does The Body Need?

Posted on Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Nutrition, Seminars

By Annell St. Charles, Ph.D., R.D., L.D.N.

In 1912, Casimir Funk, a Polish biochemist, isolated a concentrate from rice polishings that cured polyneuritis in pigeons.  He called the substance a “vital amine” or “vitamine” because it appeared to be vital for life.  There was widespread interest in eradicating several prevalent diseases at the time, and, in an article published in 1912, Funk postulated the existence of four substances:  one that prevented beriberi (“antiberiberi”), one that prevented scurvy (“antiscorbutic”), one that prevented pellagra (“antipellagric”), and one that prevented rickets (“antirachitic”).  Funk was one of several researchers in the early 20th century investigating these and other substances and their connection to health.

Epidemiologists, physicians, physiologists, and chemists all worked on this puzzle through the mid-20th century; the work was slow and onerous and plagued by many setbacks and contradictions.  Chemists were the ones ultimately able to identify and isolate the substances we call vitamins, leading to the development of synthetic forms that are available for wide consumption.  The proposed benefits and risks of vitamins and vitamin supplementation continue to be hot topics today.

The vitamins needed by the body for growth and normal development are:

  • Vitamin A
  • B Vitamins (vitamin B6, vitamin B12, folate, and others)
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Vitamin K

Vitamins are divided into two groups:

  • Water-soluble are easily absorbed by the gut and stored only minimally. These include Vitamin C, thiamin, riboflavin,niacin, biotin, pantothenic acid, B6, folic acid, B12, and others.
  • Fat-soluble are stored in body tissues and excess accumulation can be toxic.  Vitamins A, D, E, and K are fat-soluble vitamins.

Macrominerals & Trace Elements

These essential inorganic elements are categorized by abundance:

  • Macro-minerals are present in the body over 100 mg:  calcium, phosphorus, magnesium, potassium, sodium, chloride, and sulfur.
  • Trace elements are present in microgram or low-milligram amounts:  iron, zinc, iodine, selenium, copper, manganese, fluoride, chromium, molybdenum, silicon, nickel, boron, arsenic, tin, and vanadium.

After The Storm

Posted on Posted in Brain Science, Elder Care, Homestudy, Psychology

By Mary O’Brien, M.D

A week of frightening forecasts.  Days of hectic, worried preparations.  Hours of terrifying wind and torrential rain.  Now nearly seven million Floridians are without power.  They, along with millions of other people, will begin the long process of recovery.  Despite their exhaustion and stress, they will follow in the footsteps of so many Texans and help one another.  People in Florida are not strangers to disasters.  They know how to re-build.

And who, among the rest of us, does not know someone in Texas or Florida?  Nearly every individual I know has family members, friends, colleagues, or acquaintances in one of these disaster-ravaged areas.  We are all interconnected whether we realize it or not.  Those of us in health care who are well-acquainted with suffering have an opportunity to set a good example for others.  Whatever each of us can do to help, now would be a good time.

To Our Friends And Colleagues In Texas

Posted on Posted in Elder Care, Psychology
credit CNN

How do you cope with a year’s worth of rain in a few hours? It’s like anything else in life: Until you’ve been through it yourself, you don’t know. Some of us scattered across the country have vivid memories of Superstorm Sandy or hurricanes like Andrew, Hugo, or Katrina. I remember all too well what Hurricane Floyd, in the late 1990’s, did to my house in coastal North Carolina. Water poured into my kitchen and living room, ruining my furniture and morale. I was on call at the time. At one point, all I could do was cry. That was a result of 22 inches of rain in 24 hours. How anyone copes with 50 inches of rain is beyond my comprehension.

The days, weeks, and months ahead of you will be brutal. At some point, nearly everyone will feel overwhelmed with exhaustion, anguish, anger, and frustration. Many of you will wear yourselves out while helping others. That’s what good people do in a crisis.

Throughout the U.S. and Canada, there are many good people who frequent INR (Institute for Natural Resources) and Biomed seminars. Perhaps it will give you a miniscule measure of comfort to know that you are in our thoughts and hearts and prayers. Across the country, the number of people in schools, businesses, religious groups, and civic organizations contributing to relief efforts is growing. One day all of this will be behind you. Until then, may you all be blessed with the safety of your loved ones, compassion for one another, and Texas-sized resolve.

Diet and Alzheimer’s Disease

Posted on Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

What weighs a mere four pounds and has a workload that demands 20 percent of all the oxygen inhaled?  Answer:  the human brain.

As technology opens the door to the unique metabolic functions of the brain, scientists are investigating the nutrients required to keep mentally sharp over the decades.

With dementia rising at an alarming rate — along with obesity, diabetes, heart disease, and other ailments — let’s eat with purpose, using sound, nutrition-related science applicable to the brain and the rest of the body.

Starting with the belief that what we eat plays a significant role in determining who gets dementia, Martha Clare Morris, Ph.D. and colleagues developed the MIND Diet as an intervention against the most common cause of neurodegeneration:  Alzheimer’s disease.

The work of Morris and her colleagues is based on research completed at Rush Medical University in Chicago, Illinois.  The term “MIND” is an acronym for Mediterranean-DASH Intervention for Neurodegenerative Delay.

The DASH diet plan is based on research sponsored by the U.S. National Institutes of Health.  The plan was developed to lower blood pressure without the use of medication.

The Mediterranean and DASH diets are models of healthy eating for the body.  The Morris team chose foods that improve brain function significantly and also added to overall body wellness.

Adherence to the MIND diet may lower the risk of Alzheimer’s disease by as much as 53%, offering more protection for the brain than any other dietary regimen.

The MIND cuisine lists 10 brain-healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine).  The plan limits consumption of five brain-unhealthy food groups (red meats, butter/stick margarine, cheese, pastries/sweets, and fried or fast food).

The plan suggests a minimum of three servings of whole grains, a salad, and one other vegetable every day — along with a glass of wine.  For snacks, add a variety of nuts.  Berries are the only fruits recommended.

Specifically, blueberries are noted as the powerful protectors of the brain.  Strawberries are a second choice for good cognitive function.

Use Google and enter the term “MIND Diet” for daily guidelines and recipes of a cuisine designed to maximize brain function while providing healthy foods for the rest of the body as well.


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

 

Influenza

Posted on Posted in Continuing Education, Elder Care, Homestudy, Nutrition, Seminars, Webinars

By Raj Hullon, M.D., J.D.

The flu is a contagious infection that affects the nose, throat, and lungs.  Onset is more abrupt compared to the common cold.  Symptoms can range from mild to severe, even leading to life-threatening complications.  Nausea, vomiting, and diarrhea are more common in children than in adults.  Other flu symptoms include:

  • fever (usually high).
  • extreme fatigue.
  • dry cough.
  • sore throat.
  • nasal congestion or runny nose.
  • muscle aches.
  • impaired sense of taste and smell.
  • loss of appetite.

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 people are hospitalized for treatment of flu-related complications.  Approximately 36,000 deaths a year result from flu-related causes in the United States (cdc.gov).

Seasonal flu refers to any of the combinations of influenza viruses that circulate throughout the world each year.  The flu season in the United States can begin as early as October and run through March.  The Center for Disease Control (CDC) tracks circulating flu viruses and related disease activity all year and, between October and May, provides weekly influenza updates at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.   Pandemic flu refers to a global outbreak of flu that can overwhelm the health care system.  The cause is most likely a strain of influenza virus that is new or that has not circulated recently enough for large portions of affected populations to have built up gradual immunity to it.  Therefore, healthy individuals are at risk for complications following infection during a pandemic flu outbreak.  Seasonal flu, however, usually leads to fewer complications in healthy adults.  During the 1918 pandemic, for example, the estimated deaths from the disease and disease-related complications reached 20 to 40 million individuals globally. Fortunately, pandemic flu outbreaks are rare.  There were only three pandemic outbreaks in the 20th century while seasonal flu is annual and peaks in January or February.

Arthritis and Diet

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

older-black-woman-rubbing-her-hands-arthritisThere are more than 100 different types of arthritis, and, therefore, no single diet will work for every person with arthritis.  However, studies have found that green tea, green leafy vegetables, dried plums, and kiwi fruit are all vitamin-rich and have powerful antioxidant properties.  Diets which include large quantities of fruits and cruciferous vegetables have been shown to have a beneficial effect on preventing the development of rheumatoid arthritis.  In addition, it is clear that carrying extra weight can put significant stress on the joints, and even a small reduction in weight can have an effect on the severity of arthritis symptoms.  Studies have shown that losing weight can significantly ameliorate the effects of osteoarthritis.  Significant weight gain prior to age 35 — as well as excessive alcohol consumption — has been linked to the development of gout.

Other contributing factors are certain foods and nutritional supplements (vitamins, minerals, and omega-3 fatty acids) which may play a role in preventing and reducing symptoms in some types of arthritis, such as gout, osteoporosis, osteoarthritis, rheumatoid arthritis (RA), and reactive arthritis.  Fish oil, particularly when ingested in conjunction with a diet low in arachidonic acid, reduces inflammation in some patients with rheumatoid arthritis.   Regular intake of fish has been shown to have a beneficial effect.  Consumption of excessive dietary fat, however, appears to exacerbate arthritis symptoms.

WEIGHT LOSS AND THE ARTHRITIS PATIENT

Weight loss for overweight arthritis patients is very important for several reasons.  First, as mentioned previously, loss of even a few pounds can significantly reduce stress on weight-bearing joints.   Research demonstrates that exercise and combined weight loss — as well as exercise regimens — result in decreased pain and disability and increased performance levels in patients with osteoarthritis.  Biomechanical data suggest that exercise in combination with diet may also result in improved gait when compared with exercise alone. Secondly, patients of all ages who have arthritis are much healthier, have an improved sense of well-being, and are less likely to suffer arthritis-related depression when they follow a nutritious, well-balanced diet.  The Arthritis Foundation recommends following a balanced diet that includes plenty of fruit, vegetables, and whole-grain products, while limiting consumption of sugar, salt, and saturated fat (i.e., a diet low in fat, high in fiber, and low in sugar).

By Mary O’Brien, MD

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Neck Pain: An Introduction

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

Rear view of a young man holding her neck in pain, isolated on white background, monochrome photo with red as a symbol for the hardening

By Raj Hullon, MD

Almost everyone has experienced neck pain of some sort during his or her lifetime — and for good reason.  One of the most common causes of such pain is poor posture.  Simple activities such as reading, especially in bed — or sleeping on a pillow that may either be too low or too high — can cause neck pain.  Other activities that can cause neck pain include bending over a desk for hours, maintaining poor posture while watching TV, and positioning a computer monitor either too high or too low.  The key is always to maintain the neck as close to a neutral position as possible.

The best medical care, however, begins with a crucial question:  What is the most serious problem this could be?  Neck pain can be referred from multiple anatomical structures as a result of developmental processes in the embryonic stage.  Serious cardiovascular, neurologic, infectious, or neoplastic etiologies must be considered before attention is focused on common musculoskeletal disorders.

Chronic neck pain is prevalent in Western societies, with about 15 percent of women and 10 percent of men suffering from it at any given time.  People with physically demanding jobs requiring neck flexion and awkward lifting are at high risk of developing chronic neck pain.  It is also common among health care professionals, particularly affecting nurses who are constantly involved in handling tasks that involve reaching, lifting, and pulling.  Dental professionals who work long hours bending over their patients also suffer from neck pain because of postural demands.

The pain is often muscular or ligamentous in origin and is usually self-limited although the pain can be persistent.  Pain is transmitted through nerve endings in the various ligaments and muscles of the neck, vertebral joints, and the outer layer of the intervertebral discs.  When these structures are irritated, strained, or inflamed, pain is felt in the back of the neck, may spread toward the shoulders, and is commonly felt between the shoulder blades.

The natural healing processes result in improvement in almost all cases.  In fact, the pain from serious neck injuries such as fractures, dislocations, and most cervical spine surgeries often resolves after a few weeks or months.  There is usually little if any correlation between neck pain and the degenerative changes that are commonly seen on X-rays.

Neck strain or sprain is the most common type of injury to motor vehicle occupants treated in U.S. hospital emergency departments.  Whiplash injuries can be serious in certain situations.  Severe damage to the spinal cord can be fatal.

Sports and athletics are also common sources of injury to the neck region and should be a particular concern for the younger adult population.

Another common offender is carrying unbalanced loads, such as a heavy briefcase, luggage, or a shopping bag. A careful history is often required to identify such factors as playing a role in neck and shoulder pain.

 

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About Systemic Lupus Erythematosus (SLE)

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

bhmkclteeodsgq5wrqwaSystemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage to the heart, lungs, kidneys, joints, skin, brain, and blood vessels.   It is characterized by flare-ups, and symptoms, ranging from mild to severe, including extreme fatigue, chest pain, anemia, swelling in legs and near the eyes, painful joints, fever, skin rashes, hair loss, and kidney problems.

At least 1.5 million Americans suffer from lupus.  The ratio of female to male is 9:1 according to the Lupus Foundation of America.   African-American women are far more likely to be affected than are Caucasian women.   Recent research points to a strong genetic role, but environmental and hormonal factors seem to be involved in lupus as well.

Diagnosis can be difficult and may be delayed because the onset of symptoms is hard for patients to pinpoint and because the wide variety of symptoms overlap with many other conditions.  To diagnose lupus, the clinician takes a careful history, performs a physical exam, and orders anti-nuclear antibodies and other laboratory tests.

Although lupus can be life-threatening, some 80 to 90 percent of sufferers can expect to live a normal lifespan if they are carefully monitored and treated.

Management of lupus is directed at preventing flare-ups, treating symptoms, and preventing or slowing damage to organs.  According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the principal medications include:

  • NSAIDs to reduce inflammation.
  • Anti-malarials such as hydroxychloroquine (Plaquenil®) to prevent flare-ups.
  • Corticosteroids such as prednisone (Deltasone®), hydrocortisone, methylprednisolone (Medrol®), and dexamethasone (Decadron®, Hexadrol®) to reduce inflammation.
  • Immunosuppressive agents such as cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) to inhibit an overactive immune system.  Belimumab (Benlysta®) is a B-lymphocyte stimulator protein inhibitor that was approved by FDA 2011 for patients with lupus who are receiving other standard therapies.  It may reduce the number of abnormal B cells thought to be a problem in lupus.
  • Methotrexate (Folex®, Mexate®, Rheumatrex®), a disease-modifying antirheumatic drug, may be used to help control the disease in some patients.

Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin, which may be useful for controlling lupus when other treatments haven’t worked.

A variety of self-care and complementary approaches can be useful, including exercise, diet, the avoidance of sun exposure, and skin protection.  Patients are advised to recognize early signs of a flare-up and get immediate medical attention.

Findings from prospective human studies have strengthened the evidence of a connection between lupus and vitamin D status.  There is evidence that increased vitamin D levels (via supplementation) may help reduce inflammation.  A reasonable dose would be 2000 IU of vitamin D3 on a daily basis.  Vitamin D levels are easily checked.

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