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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.

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