Your Medical Mind – Book Review. Best for Patients or Doctors?

I looked forward to reading Dr. Jerome Groopman’s new book, Your Medical Mind: How to Decide What Is Right for You
, co-authored with Dr. Pamela Hartzband.  His previous work, How Doctors Think
, shaped my thinking as a practicing primary care doctor on the importance of language and the potential pitfalls we make in reaching decisions.  I always recommend my medical students read that book.

Unfortunately, his latest work fell quite short of my expectations.  In it, the authors try to understand and create a framework on how patients reach decisions about their medical care.   In the end, this was a book about human psychology wrapped in the doctor patient relationship.  Nothing particularly earth shattering here.

The real question I had is who is responsible for helping patients avoid these cognitive and psychological errors?  Patients or doctors?

They note how the mindset of patients can be divided into the following categories – “believers and doubters; maximalists and minimalists; a naturalism orientation or a technology orientation.”  Specifically, some patients want maximal treatment and others believe “less is more”.  To avoid cognitive traps, the authors recommend that data be viewed in both positive and negative forms.  Telling a patient that a therapy has side effects for 10 percent of patients is very different than saying 90 percent of patients have no side effects.

Other tips to good decision-making included minimizing emotion before deciding, bringing a friend or family member to an appointment to provide additional eyes and ears, and also getting second opinions.  Finding a doctor who provides “shared medical decision making” might also decrease the chance of making a choice only to regret it later.  In the book, many patients moved beyond decision paralysis upon hearing a story of another patient with a similar illness and predicament.  Specifically, patients realized that instead of focusing on the negative, like the side effects, focusing on the positives and the ability to adapt made all the difference.  There is both power and potential pitfall in hearing other patient’s stories, which may be anecdotal.

Dr. Groopman and Dr. Hartzband noted that patient decision making and autonomy vary depending on circumstance.  Sometimes patients want full control.  Other times they wish to cede it to physicians, hence the reason many want to find the “best” physician.  Surrogates, who act on behalf of patients when incapacitated, are ideally supposed to use “substituted judgment” and choose treatment based on what the patient would have wanted.  Like patients, however, surrogates too will change their mind or relinquish or reclaim autonomy depending on the situation.  As a result, sometimes doctors use the principles of “beneficence”, the principle that physicians should act in the patient’s best interest, and “nonmaleficence”, to do no harm.

Physicians can also unwittingly bias a patient’s decision by recommending a “best” treatment and downplaying others, which could be a better match for the patient’s preference.  Although there is a movement in health care to provide treatment which is evidence based, the authors conjecture that this focus would result in doctors recommending treatment not in preference of a patient.  These seems rather ludicrous as already many current guidelines are not being followed.

The authors conclude that patients are best served if they find doctors who do not superimpose their preferences while at the same time don’t simply rubberstamp what you want.  “A doctor who facilitates but also may challenge your decision process sometimes gives you more.”

Completely agree. Perhaps this book is best suited for doctors.  While the book may be an enlightening read for patients, there isn’t necessarily an easy practical framework which will help them make the right decisions.
 

Cholesterol Measurements May Be Made Easier

(HealthDay News) — Methods to gauge blood cholesterol to determine vascular disease risk can be simplified, researchers in England say.

Their method measures levels of either total or high-density lipoprotein (HDL, or “good” cholesterol) in the blood or apolipoproteins (proteins that help transport cholesterol), without the need to have patients fast and without regard to another form of blood fat called triglycerides.

“Expert opinion is divided” on which combination of measurements is ideal in gauging cardiovascular risk, explained John Danesh, of the Emerging Risk Factors Collaboration Coordinating Centre at the University of Cambridge, and colleagues.

In order to examine the association between major blood fats and apolipoproteins and coronary heart disease and ischemic stroke, the researchers analyzed data on more than 300,000 people without initial vascular disease who took part in 68 long-term studies.

During the follow-up periods of the studies, there were almost 8,900 nonfatal heart attacks, more than 3,900 coronary heart disease deaths, over 2,500 ischemic strokes, 513 hemorrhagic strokes and more than 2,500 unclassified strokes, the study authors noted. Read more…

What is Chemotherapy and What Impact

dangers of chemotherapy
If at some places in the body cells of growth are excessive, there will be a lump or tumor. These tumors have a benign or malignant. A malignant tumor is called cancer. Malignant tumors have distinctive properties, which can spread to other parts of the body to develop into new tumors. The spread is called metastases. Cancer has different characteristics. There is growing rapidly, there is growing not too fast.

The main function of chemotherapy drugs is to recognize and destroy cancer cells in the body. There are approximately 130 types of cancer diseases, which affect the condition of our body in various ways and require different handling. But all have the same type of cancer, which is composed of cells that divide rapidly and uncontrollably.

Chemotherapy is usually given before or after surgery. The goal is to eradicate all cancer cells through the roots, up to a location that is not affordable scalpel. At the very least to control the cancer cells spread more widely in order not to miss another. In the case of primary cancer treatment is through:
• Surgery or Surgery
Chemotherapy or by giving drugs
• The use of beam radiotherapy or radiation

Chemotherapy benefits, among others, are as follows:

1. Treatment

Some types of cancer can be cured completely with one type of chemotherapy or
some types of chemotherapy.

2. Control

Chemotherapy there that aim to inhibit cancer development in order not to
grow large or spread to other tissues.

3. Reduce Symptoms

If kemotarapi can not eliminate the cancer, the chemotherapy is given
aims to relieve symptoms in patients, such as relief of
pain and give a better feeling and reduce the size of the cancer in the area
was attacked.

Chemotherapy can be administered by infusion, direct injection (in muscles, subcutaneous, body cavity) and how to drink (tablets / capsules).

Chemotherapy also has side effects that greatly feared. There are people who did not feel any side effects of chemotherapy. Some women experience mild side effects. But there is also the pain of it. There is-no or severity of side effects of chemotherapy depend on many things, among other types of chemotherapy drugs, the condition of your body, your mental condition, and so on. Chemotherapy Side effects occur because chemotherapy drugs are very powerful, and not only kill cancer cells, but also attack healthy cells, especially cells that divide rapidly. Therefore the side effects of chemotherapy appear on parts of the body cells divide rapidly. Side effects can arise when treatment is being carried out or some time after treatment. Side effects that may arise are, among others:

1. Limp

Common side effects arise. Onset can be sudden or slow. Indirect
disappear with rest, sometimes continue until the end of treatment.

2. Nausea and Vomiting

There are several chemotherapy drugs are more make nausea and vomiting. In addition there
some people are very prone to nausea and vomiting. This can be prevented by
anti-nausea drugs given before, during, or after chemotherapy treatment. Nausea
vomiting may last a short or long.

3. Indigestion

Some types of chemotherapy drugs affect diarrhea. There’s even a diarrhea accompanied
severe dehydration should be treated. Constipation can sometimes occur.
If diarrhea: subtract fiber foods, cereals, fruits and vegetables. Drinking a lot to
replace lost fluids.
When hard CHAPTER: multiply fiber foods, moderate exercise if possible

4. Sprue

Some chemotherapy drugs cause oral diseases such as thick or infection.
Conditions of a healthy mouth is essential in chemotherapy

5. Hair Loss
Hair loss is temporary, usually occurs two or three weeks after
chemotherapy begins. Can also cause hair breakage near the scalp. Can
occur after several weeks of therapy. Hair can grow back after chemotherapy is completed.

6. Muscle and Nerve

Some chemotherapy drugs cause tingling and numbness in fingers or toes
and weakness in leg muscles. Some muscle pain can occur.

7. Effect On Blood

Some types of chemotherapy drugs can affect the bone marrow is working
manufacturers of blood cells, so blood cell count decreased. The most common is
decrease in white blood cells (leokosit). Decrease in blood cells occurs in every chemotherapy and
Blood tests will be carried out before the next chemotherapy to ensure the number of cells
blood had returned to normal. Decrease in blood cell counts can lead to

8. The skin can become dry and discolored

More sensitive to the sun.
Nails grow more slowly and there is a transverse white line.

9. Hormone Production

lowered sexual appetite and fertility.

Some dietary supplement products claim to reduce the side effects of chemotherapy as well as to rebuild your body’s condition. You can use it, but please check with an expert, and certainly with your doctor as well.
Today, with the increasingly widespread use of herbal medicines (which increasingly accepted among medical), many clinics which claim to be giving a free herbal chemotherapy side effects. If you intend to use it, make sure that you handle in the clinic is a medical doctor. At least you should consult with a physician who cared for you, and do laboratory tests regularly to monitor the results.

Hopefully Helpful

Today is National Family Meal Day

Most of the families nowadays rarely have dinner together. Busy work schedules seem to be the primary reasons. That’s why the National Center on Addiction and Substance abuse designated September 26, 2011 as the National Family Meal Day with its theme A Day to Eat Dinner with Your Children. The said organization believed that by having meals with the family together, parents-children relationship will be strengthened. And this   saves them from addiction or substance abuse.

So go home early and spend your dinner with your family today!

Medicines Cardiovascular Support

Medicines Cardiovascular Support
1. Epineprin (adrenaline)
Very useful to overcome cardiac arrest in VT / VF without a pulse and because it has the effect asistole vasokontriktor.
Epineprin given at a dose of 1 mg in a bolus and then rinsed with NaCl ± 10-20 ml, 3-5 minutes of administration can be repeated. If IV not available to diberiakn melaului epineprin ETT with a dose of 2-2, 5 mg.
2. Atropine (SA)
SA serves to increase the frequency of pulse and increase blood pressure is recommended in asistole and PEA (HR: 60x/menit) with a dose of 1 mg can be repeated 3-5 minutes until maximum dose of 3 mg. melaluui given IV bolus and then rinsed with D5% or NaCl 0.9% ± 10-20 ml.

3. Norepineprin
Vasoconstriction and inotropic drug is strong. Norepineprin improve renal blood flow and urine output. Norepineprin can be effective in the management of patients with severe hypotension (systolic blood pressure <70 mmHg)
The initial dose is 0.5 to 1 μ norepineprin / ml was titrated until the visible effect
4. Adenosine
Adenosine can inhibit the activity of the SA node and AV, recommended indications:
4.1 Tachycardia SA or AV node reentry
4.2 SVT unstable during the preparation cardioversion
Preparation of 6 mg rapid IV bolus (1-3 seconds) bebarengan with 0.9% NaCl bolus of 20cc. If no change in cadence subs 1-2 minutes to give back 12 mg rapid bolus.
5. Amiodarone (Cordaron)
Amiodarone can cause vasodilation and hypotension that gift should be a slow infusion. The use of amiodarone is the treatment of life-threatening ventricular arrhythmias.
Provision of amiodarone of 150 mg for 10 minutes, followed by 1 mg per minute for 6 hours and 0.5 mg per minute subs 18 hours
6. Lidocain

Making A Personal Trainer Westmont IL Selection

By Tammie Caldwell

Consumers are now becoming much more focused and interested in reaching personal fitness goals.Most people find that attempting to actually reach their specific goals can be reliant on the skills and guidance from a trained professional in an attempt to minimize the effects of poor training and dietary plans. When making a personal trainer Westmont IL choice people are able to feel much more confident in their fitness endeavors.

Personal trainers are appropriated with the credentials and experience needed for ensuring people reach their fitness goals. Consumers are mostly interested in these professionals when trying to be healthier but are unaware of how to make sure their goals are reached in a viable manner. The decisions made from the various professionals are usually performed with a great deal of caution.

Consumers in Westmont, IL that are considering this form of professional assistance have all kinds of competitors to work through. Most people are unaware of how to make sure their choices will actually be performed in a simplified and comprehensive manner from such a competitive industry. The best choices are made when numerous ideas are thoroughly weighed in.

Consumer rating posts are often the most preliminary sources of information that are considered in this effort. Reviews are offered from people that are specifically aware of what professionals have to offer as they have been utilized by others that are willing to share their insights. Concentrating on the providers that have received the largest number of great reviews is often useful in avoiding major complications with effective guidance.

People are also often interested in seeing if their gym has any effective professionals available to them. Many fitness centers are appropriated with plenty of professionals that are thoroughly skilled in offering the guidance they need for reaching their goals. Many facilities offer specialty prices for their members which can help save a great deal of money in the end.

The areas of focus that are maintained by various trainers can also be a major concern when narrowing down the options. Most professionals are unique in regard to the kinds of training they are able to provide which are based on their experience and specific types of certification which can impact their ability to guide their clients effectively. This information is readily made available through marketing programs in most instances and can play a major role in narrowing down the options.

Personality can also be a major concern among consumers that are worried about making a great choice. The demeanor and personality of the professional in question is often essential to clients that wish to feel comfortable throughout the sessions which can be difficult when the professional is unpleasant or not a personality match. This is usually an assessment that is easily performed in person and can play a pivotal role in narrowing down the options.

Consumers are also specifically worried about prices when making their professional decisions. Fee structures are often based on each session that is offered which can become difficult to pay for and is an added expense on an already limited budget. The lowest cost professionals that are also the most effective in helping consumers reach their goals offer the type of value that most people are interested in.

Alzheimer’s Disease and Dementia Symptoms—Does Light Therapy Help?

onditions in America is the development of Alzheimer’s disease symptoms, also called dementia, or senile dementia. Most common symptoms of elderly people with dementia are a decrease in mental function (cognitive decline or persistent confusion), change in mood (usually depression), altered behaviors (which are frequently aggressive), reduced memory (usually for recent events or people) and/or sleep disturbances. Importantly, several FDA-approved medications are recommended and prescribed for this condition, and they have a small but definite effect on reducing the progression of Alzheimer-type symptoms. These medications include Aricept (denepezil) and Namenda (memantine).
However, many physicians believe that some of these symptoms may be related to changes in the natural time clock of the brain that changes mood, behavior, and sleeping patterns, a clock called the “circadian pacemaker.” This time-keeping system is sensitive to outside light. For this reason, many people from Northern latitudes (for example Alaska, Canada, and Northern states) have a condition called light deprivation, often with severe depression, and these individuals improve after undergoing light therapy.

An important study was recently published by Dr. Rixt Riemersma-Van Der Lek and co-workers from the Netherlands Institute for Neuroscience (JAMA, Volume 299, page 2642, 2008). These authors treated 189 elderly patients in group care facilities between 1999 and 2004 with either whole day bright light exposure, evening melatonin, the combination, or just inactive placebos. They treated patients for an average of 15 months (some patients for up to 3.5 years).

The results were very impressive! The natural history of dementia with progressive reduction in mental functioning was improved with daylight exposure by 5%. Mental deterioration was reduced by 5% on exposure to whole day bright light. Also, light reduced depression by 19%. The patients had a 53% improvement in functional activity according to nurses if they were exposed to light. Melatonin increased sleep duration by 6%, but also increased depression, but not if patients also were exposed to light in addition to the melatonin. The combined treatment of light and melatonin reduced aggressive behaviors by 9% and increased sleep efficiency by 3.5%.

These studies have very important conclusions for all of us. We will either suffer ourselves from dementia as we grow older, or we may currently be caring for family and/or friends who are suffering from early or advanced dementia. At one time or another, it affects all families and people!

The more we know about the symptoms of dementia, the standard treatments of this problem, and the supportive measures that can benefit such individuals, the more that each of us can recognize people who should be tested, and the better we are able to help them get the best care from their doctors.

Therefore, we should learn from this important article that exposure to light and use of mild treatment with melatonin can be highly beneficial. We should suggest that caregivers discuss these findings with physicians who are caring for those individuals. Also, when choosing a chronic care facility for patients with dementia or Alzheimer’s disease, reviewing daylight exposure activities with the staff is important to make certain that these patients are afforded the benefits of daylight exposure. Continuing care of these individuals can result in improved relationships with family and friends, if the severity of symptoms and progression of symptoms are minimized.

Diabetes Test Diagnose With Blood

When a body produces higher levels of sugar within the bloodstream it is known as the disease diabetes. When someone has this disease, the body loses its ability to breakdown excess sugars by itself. In order to breakdown extra sugar you need to add insulin at regular intervals. The body will also require a diet specially constructed for someone with diabetes. If you think you may have diabetes, or it runs in your family, get a diabetes test done. The best test is a blood workup.

When doctors first suspect that someone has diabetes, they do diabetes tests to make certain. One of these tests is a glucose test. This is one of the first steps in the actual determination of diabetes being present. Besides this diabetes test doctors will also check for standard symptoms, medical history and a physical exam.

Sometimes the tests are not conclusive. Such as in the cases of someone who is extremely ill (illnesses cause your blood sugar to rise) as well as certain medications. Some medications that you take can raise your blood sugar levels to the point where it could show as though you are diabetic.

A killer migraine

Basilar-Type Migraine (BTM) is an uncommon type of complicated migraine with symptoms that result from dysfunction of the lower part of the brain. In serious cases, it can lead to stroke, coma, or even death.

Who’s at risk?
Early research suggested that BTM was most common in adolescent females. More recent statistical analysis has shown that BTM affects all age groups and both male and female. However, BTM, like other forms of migraine, is more common in females. The are approximately three times as many female sufferers as male.

Symptoms
The symptoms of BTM is usually occur suddenly and can be associated with inability to speak properly, ringing in he ears, and vomiting. This called the aura phase, where sufferers experience perceptual disturbances. This phase usually last for an hour and can be frightening due to the dizziness and loss of control.

Other symptoms:
-Double vision
-Loss of balance
-Vomiting
-Diarrhea
-Loss of consciousness
-Intense headache pain
-Slurred speech
-Temporary loss of vision.

What cause and triggers BTM?
Previously, it was thought that BTM started in the basilar artery (one of the arteries supplying the brain with blood). Now, researchers are looking more at neural cases (the chemicals sending messages throughout the brain) but like other migraines, the specifics of what is taking place are still somewhat of a mystery.

Cheese and wine are common food triggers, as well as food additives such as nitrites (mainly found in processed meats). It can be helpful to keep a food dairy and note the foods you eat to identity triggers.

Treatment option
Unfortunately, rare disease do not always receive much interest and research and BTM is a rare disease. Treatment is similar treatment to other migranes.

Medications include beta-blockers , anti-epileptics, calciums channels blockers, anti-depressants, pr over-the counter drugs such as acetaminophen (paracetamol)

Advice for sufferers
1-Lie down in a dark, quiet room during the aura phase. You can also try placing a cold damp cloth over your forehead to soothe the throbbing head pain.
2-Avoid or limit your alcohol intake as BTM can be worsened by consumption of alcohol.
3-Cigarette use or oral contraception alongside BTM can put you at an increased risk for stroke so it’s good idea to stop both if you are a sufferer.

How can you be treated?
1-Biofeedback is one of the alternative treatments suggested for BTM. It measures internal processes in the body to allow you to actively heal yourself. Evidence is still largely sketchy but it may be worth trying if you’re looking for help.
2-Always seek medical advice. Doctors are concerned about BTM because symptoms are the same as serious conditions. There is also concern that those with BTM may be at increased risk of stroke. Frequent and intense basilar migraines may require consultation with a neurologist.
However, BTM is rare, and even if you get the symptoms, don’t panic. But make sure you see a doctor immediately to make sure you’re keeping you risk as low as possible.

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