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I have been a registered nurse, nurse practitioner and most importantly a patient advocate for over 20 years. I have worked in hospitals, homes and as a private consultant, always teaching patients how to speak up for themselves and to make well informed healthcare decisions that are right for them and help them to avoid all types of Medical Errors. The many things I have seen in healthcare led me write "What Did the Doctor Just Say." In it are all the steps every patient needs to take to remain safe in the healthcare system and avoid medical errors. My personal goal is help to save 100,000 people from the horrors of a medical error and I wrote What Did the Doctor Just Say? to help make that happen.

Wednesday, February 24, 2010

It May Be Depression and Excerpt From What Did the Doctor Just Say?


It may be depression: Up to 80 Percent of Patients are Depressed
According to a University of Colorado study, up to 80 percent of all office visits involve some degree of depression. Many people suffer the effects of depression without ever knowing they have it. Depression can masquerade as chronic fatigue, insomnia, agitation, stomach upsets, constipation, nausea, chest pain, headaches, constant pain, and more. 
            The World Health Organization reports that depression is the leading cause of disability among adults of all ages worldwide. It affects approximately 18.8 million Americans. Patients diagnosed with depression spend, on average, $4,246 per year on medical costs versus $2,371 spent by patients without depression. By 2020, it is projected that depression will be the number two cause of death in the country second only to heart disease.
            Each of us is at risk of becoming depressed at one time or another for any number of reasons. The death of a loved one, loss of a job, prolonged separations, and financial problems can all bring about episodes of this crippling disease.
            When depression is missed, left undiagnosed, and untreated it is reasonable to expect patients and their families will suffer needlessly. Depression is an awful disease for which there is treatment. Left unchecked, however, it can ruin lives and make many medical conditions worse than they need be. 

Conditions That are Worsed by Depression
Heart diseasesRecent studies have shown one-fifth of all patients with heart disease suffer with depression. Depression can come after heart disease or it can be a contributory factor to the development of the disease. Canadian researchers found a significantly higher risk of death from cardiac disease one year after diagnosis in patients who were also depressed. This was true no matter what the level of heart disease – depression was more of a marker for death than the heart disease itself. Have you ever heard of someone dying from a broken heart? Of course you have. Untreated depression actually does kill.

High blood pressure: Depression increases your risk of developing high blood pressure. People who are depressed tend to smoke more, drink more, eat more, to be anxious, and they are ill-tempered and argumentative. When we eat poorly, smoke, drink, and have problems in our relationships we develop high blood pressure. 

Diabetes: According to the American Diabetic Association, diabetics suffer from depression at rates three to four times higher than the general population. A 2004 Johns Hopkins study that tracked 11,615 patients without diabetes over six years found that “depressive symptoms” predicted the onset or development of Type II diabetes. The same study found that successfully treating diabetes may be tied to successfully treating depression. Depression causes overeating and cravings for sweet and fatty foods. Depression is also associated with feelings of fatigue and lethargy, which make it very difficult to exercise or even get out of bed. Overeating and little or no exercise are real barriers to successfully controlling diabetes. 
Stroke, Parkinson’s, and Alzheimer’s disease: Up to 160,000 stroke patients annually experience a major depression. Depression rates range from 17-31 percent of patients with Alzheimer’s disease and approximately 50 percent of patients with Parkinson’s disease. Depression seriously affects the patient’s ability to participate in their own recovery. Depressed patients eat too little or too much; sleep too little or too much; refuse to exercise; and have less hope and confidence in the future.
Exhaustion and fatigue: Depression is associated with feelings of exhaustion and fatigue, both of which make living life in general and healing from any medical condition more difficult. When we do not have the energy necessary to interact in relationships, we become isolated, suffer from loneliness, and depression increases.
Stomach problems: Depression can slow down your digestion and cause constipation, reflux, indigestion, and nausea.
Eating disorders: Depression is associated with developing obesity, anorexia, and bulemia.
Chronic pain: Depression plays a part in chronic pain (pain that doesn’t go away). Headaches, back pain, muscle aches, joint pain, and chest pain can all be caused by depression. Untreated depression can lead to a life of agony and pain killers. And, guess what? Pain killers can cause or worsen depression. The combination of pain and pain killers could create a vicious cycle that could lead to harmful addictions. If you are suffering from aches and pains with or without a clear cause, consider depression as a contributing factor.
Immune system: Depression weakens the immune system and can cause you to have more colds and flu and to be more susceptible to other diseases.
Sleep disorders: If you are depressed, you may not be able to fall asleep. You may wake in the middle of the night and be unable to fall back to sleep. You may sleep all the time. Or, you may just want to stay in your bed with the shades drawn and the covers over your head. All of these behaviors can be brought on by depression.
Anger and irriatibility: Depression can express itself as anger, frustration, or by being argumentative. These behaviors make relationships very difficult to maintain. People who have closer social relationship and solid marriages live longer and have happier lives than people who are not in happy relationships. Having depression can shorten your life. 
Suicide: People who suffer depression tend to have repeated episodes and often the episodes worsen. For some, the depression will progress to the point where the person feels so badly that they believe the only viable option is to take their own life. Up to 70 percent of suicide victims were thought to be depressed at the time of the event. 
Depression Assessment Tool
If you have had any of the symptoms listed in the following assessment for more than two weeks, your provider should evaluate you for a diagnosis of depression. In addition to taking the assessment, you may want to read more about depression. It is a problem that is in involved in 80 percent of all primary care visits and is the leading cause of disability in the world.
Depression Assessment
Depression Assessment
Yes
No
Do you have feelings of sadness, isolation, hopelessness, or guilt most of the time?
Are people complaining that you are irritable or in a bad mood?


Do you feel isolated and alone even when people are around?


Have you lost interest in things that used to bring you joy like hobbies, relationships, sex, or work?


Are you sleeping too much or too little?
Are you tired most of the time?


Are you having trouble managing your high blood pressure, diabetes, or stomach ailments?


Do you have unexplained muscle or joint pain, backaches, or headaches?


Are you eating too much or too little?
Do you have a sudden weight gain or loss?


Are you having thoughts of suicide? If so, call your doctor or go to the emergency room and
GET HELP IMMEDIATELY.


            The answer to “what’s causing your problems” may not be in the CAT scan results or the lab test. You may be depressed. Often patients are depressed and providers and patients alike overlook the condition when developing a diagnosis. Yet properly treating depression can make a tremendous difference in the patient’s recovery.
            Avoid the pitfalls of missing a depression diagnosis. If for any reason you are having trouble managing your disorders; you can’t find a clear physical cause for your symptoms; or you have any or all of the symptoms of depression, please be evaluated for depression. If necessary, seek treatment. Depression affects millions of lives and can be a devasting condition. It is not all in your head. It is in your life and your body and help is available. 
Your role as team leader:
·      Complete the depression assessment. If you have had any of the symptoms on the depression assessment for the past two weeks, take this assessment form with you to your provider and have him review it with you.
·      If you feel suicidal, get help immediately. Call your provider or go to the local emergency room.
·      Get treatment if necessary. Treatment could save your relationships, your health, your life, or the life of a loved one.
·      Ask for a referral to a therapist or a psychiatrist. If medication is needed to treat your depression, have an expert manage your medication and seek counseling. Many of the issues that bring about depression are not physical; they are emotional (loss, separation, finacial difficulties, problems with your relationships, and many other things), and you may need help dealing with your issues. You may need a therapist.
  • Don’t be ashamed to say you have depression. Millions of people worldwide are depressed, you are not alone. We are all affected by our emotions and stressful life situations. Don’t be ashamed; rather you should seek help.

Thursday, February 18, 2010

It Heart Healthy Month: Lets Talk About Natural and Conventional Treatments for Coronary Artery Disease

Heart disease is not one disease, it is a category or group of diseases that when treated by natural therapies is considered in many cases reverseable, when treated by traditional medicine heart diseases are considered progressive, chronic and debilitating over time.

Some of the types of heart disease are; genetic heart disease, coronary artery disease, heart failure, valvular disease and conduction or electrical disorders.  In todays post I will be talking specifically about Coronary Artery Disease or CAD also know as having high cholesterol, blocked or hardening of the the arteries. Coronary Artery Disease is a major type of heart disease as it takes in excess of 400,000 lives per year. In this video you will see an animation of CAD that make the disease process very easy to understand.


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Coronary Artery Disease occurs when the elastic smooth lining inside the cornary arteries becomes hard, stiff, cracked and swollen allowing cholesterol plaques to attach to the damaged vessel linings and clog them. 

When the vessels have plaques, which can be a big as a very large pimple, its hard for blood to get through and carry oxygen to the heart. When the heart doesn't get enough oxygen from the blood it starts to scream at you. You call that screaming chest pain. When you have CAD you might have one or two plaques or an entire vessel might be clogged and unable to pass blood through to the heart.  

The signs and symptoms of CAD are angina which is pain and or a heaviness in the chest, that may or may not radiate to the jaw and down the left arm. These symptoms could be accompanied by shortness of breath, dizziness and lightheadedness and the inability to do what you used to be able to do like walk up and down a flight of stairs. Any and all of these symptom warrant a trip to the doctor for further investigation.

Here are some of the questions you need to ask your provider about cholesterol medication and the treatment of CAD. If you do not have insurance you will want to go to the emergency room to be checked out immediately if you have the signs and symptoms of angina or a heart attack. While you are there ask to speak with the social worker and discuss charity care, payment plans or other programs your state may have to cover the cost of your care. 

Its important that you are aware of these options and you do not delay seeking help for these symptoms because if the CAD is severe enough it can and will lead to a heart attack, stroke, disabilty and possibly death.

Again if you don't have insurance and you want to monitor your cholesterol levels you can get blood cholestrol screenings for free. These screenings are offered by churches, at health fairs, county, city and state health departments and other organizations. You may also want to contact the American Heart Association, CVS or  Walgreens all which offer free cholesterol screenings.  

Management of CAD disease includes you taking control of your diet, exercise and stress reduction. If you want to be proactive in reversing already diagnosed CAD I highly recommend you at least look at the videos of Dr. Dean Ornish. He is a Harvard Professor who had a heart attack and has since devoted his life to the natural reversal of CAD with great success. You will find his book Reversing Heart Disease by clicking the "diet" link and many videos of him on U-Tube.

Reducing stress is important because stress brings about the release of hormones and other chemicals that cause inflammation and damage to the the lining of the blood vessels. Now remember it is only when blood vessels are damaged that the cholesterol plaques can adhere to them. Having healthy blood vessels is a key and essential component of  preventing cholestrol plaques and managing your stress is an essential part of that process.    

As always I suggest; meditation (see my earlier post on that topic), listening to relaxing music, avoiding stimulating music is a good idea too, yoga is faboulous for relaxation as is exercise. Exercise helps to flush blood through the vessels and to wash away plaque formation in addition to reducing the levels of stress hormones that irritate the blood vessels. Another important benefit of exercise is that it decreases the bad cholestrol (LDL and triglyceride) and increases the (good cholesterol-HDL)

Much of our stress is related to our current relationships and our past emotional hurts.
If you need help with these issues, you may want to journal about your problems, talk to a trusted friend and or seek a therapist to help you deal with and overcome toxic emotions.  

You may find it interesting that when predicting survival from a heart attack the patients level of depression and stress are bigger determinants of survival that is the severity of the heart attack itself, you can quite literally die of a broken heart.

Dietary measures to decrease cholesterol and heal blood vessel linings include a diet that is high in fiber. Fiber helps to pull cholesterol out of the linings of the vessels. Omega 3 and Omega 6 fatty acids oils help to heal the lining of the blood vessels. This is important because when the blood vessels are healthy and are free from swelling and disease they will not allow the cholesterol to stick to them. Therefore having a diet that is high in Omega 3, & Omega 6, fiber will help to prevent and reverse CAD. As will decreasing the amount of saturated or animal fats you you take in.

Another treatment for high cholesterol that has been shown to have just as much success as statin drugs without the side effects is Red Yeast Rice, in fact the Red Yeast Plant is where cholesterol drugs were orginally derived from.

One more thing is the diet category. Reducing your sugar intake could help to reduce your cholesterol levels. You see sugar makes the body work very hard for little pay off (nutrition) and that causes a good deal of metabolic (all work and no payoff leaves the body fatigued and stressed out), and the by products of sugar breakdown are harmful to the lining of the blood vessels. In short sugar produces a lot of stress and damages the lining of the blood vessels and that is not a good thing. So it's a good idea to reduce your sugar intake when thinking of treating or preventing CAD.

I hope this post was helpful, if you would like to find out more about your options for the treatment of heart disease this is a link to the American Heart Association which will explain your traditional treatment options.

Please click the links in this post to find out more about each of the topics highlighted and let me know if you have any question or comments about this post. You can post your comments here or share them with me and your friends on facebook or any other of your favorite blogging sites.

Take care and I hope you will look forward to my next post in which I'll talk about other holistic ways to take control of your health and your healthcare the same way I do in my book What the Doctor Just Say?

http://www.hsph.harvard.edu/nutritionsource/questions/omega-3/index.html
http://www.webmd.com/fitness-exercise/news/20000823/exercise-cholesterol-reduction
http://my.clevelandclinic.org/heart/disorders/cad/cadsymptoms.aspx
http://altmedicine.about.com/od/herbsupplementguide/a/redyeastrice.htm
http://www.americanheart.org/presenter.jhtml?identifier=1200000

Wednesday, February 10, 2010

My Neighbor Died Last Week Because of A Medical Error

My 50 year old neighbor a slightly over weight African American male
with a history of high blood pressure and high cholesterol went to the
doctor complaining of chest pain and shortness of breath. Classic signs
and symptoms of a heart attack, right?

Well the doctor gave him a Nitroglycerin tablet, to help his heart get more
blood and oxygen.  When that didn't work after one tablet ( it would have
been acceptable for her to try up to 3 tablets) to relieve his pain she gave
him an asthma inhaler to help open up his airways.

The problem with inhalers in this case is that they make the heart work harder
and can bring on arrythmias and even a  heart attack in someone suffering with
 a heart problem.

The Dr. told him to go home rest and to go for an EKG on Tuesday
(four days later).  Just and FYI if you have chest pain and shortness
of breath you need an EKG NOW!!!

Well instead of going for an EKG on Tuesday he was buried on Tuesday.
He died later that day from a heart attack, something that could have been
prevented with proper diagnosis and treatment.

This terrible turn of events left his family without a husband, father, brother,
uncle and friend and it left  me with a question.  And that question is this...,
what would it take for people to use the techniques in What Did the Doctor Just Say?
that could have saved his life.

Had he or his loved ones questioned the doctors diagnosis of a breathing
disorder and doubled checked her on a symptom checker to ensure she was
treating the right symptoms. Had he insisted on an EKG.  Had he gotten a
second opinion from and ER doc, he might well be alive today.

Im not blaming him or his family for his end.  Im really wondering what would
inspire those who are not motivated to take an active role in their healthcare to
 do so? To not only buy the book, but to use it to use prepare to go to the doctor
and to make sure they get the best treatment after the visit.

Please post your ideas, comments and suggestions as this is a matter of life and
death and I need your input, we all do.

If you have a story of medical error you would like to tell please post it here as a
comment.  If you would like help with your treatment decision making process,
you can email your questions and your stories to
Lynn@WhatDidtheDoctorJustSay.com, and I will respond in a timely fashion.

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