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Monday, June 3, 2013

Pressure Ulcer Prevention

A pressure ulcer, sometimes called a "bed sore", is an injury to your skin that is caused by pressure. Sitting or lying in one position without moving puts pressure on your skin and slows down blood flow. When blood flow slows down, skin and tissue can die and result in a pressure ulcer.

An easy way to remember pressure ulcer prevention is:
1. Take special care of your skin
Keep your skin hydrated with mosturizers, especially after a bath or shower.
Skin should be washed with warm water. Avoid hot water. Use gentle cleansers to minimize dryness.
Avoid aggressice massage or massaging over bony areas such as hips.
Replace soaps with skin cleansing products

2. Keep turning and repositioning
When sitting:
Adjust your weight every 15 minutes
Use a chair cushion while sitting

When lying:
Turn from your back to either side every 2 hours or less.
Keep the head of the bed as low as possible while in bed.
Use pillows or wedges to help take pressure off a certain area, especially your heels
Talk to your healthcare professional about getting a special mattress or overlay.
3. Keep your skin clean and dry and pay special attention to incontinence
If you are incontinenet, make sure your skin is protected from urine and feces
Clean skin well at each time of soiling
Apply a protective cream to your skin to prevent urine or feces from irritating it.
Use underpads or briefs that are absorbent and provide a quick drying surface for skin.

4. Eat healthy foods and drink prenty of water. Optimize nutrition. Nutrition is very important in preventing pressure ulcers.

Friday, May 31, 2013

How to Enjoy the Last Few Months of Your Life Rule # 1: Forgive yourself!


Patients and family members often face feeling of guilt during the last few months of life. This feeling could include anything from guilt over previous encounters with loved ones to guilt over treatment options.

Forgiving yourself is a skill so few of us have the ability to accomplish. 

In the New Testament, Jesus speaks of the importance of forgiving or showing mercy towards others. Jesus repeatedly spoke of forgiveness, “Be merciful, just as your Father is merciful.” Luke 6:36 (NIV) “Do not judge, and you will not be judged. Do not condemn, and you will not be condemned. Forgive, and you will be forgiven.” Luke 6:37 (NIV) Jesus asked for God's forgiveness of those who crucified him. "And Jesus said, 'Father, forgive them, for they know not what they do.'" Luke 23: 34 (ESV)
Self forgiveness is extremely powerful and can help patients and their loved one to enjoy the last few months of life.


Here are 10 ways to forgive yourself
1. Accept your emotions
2. Let go of other people's expectations for you.
3. Stop punishing yourself
4. Practice self acceptance.
5. Love yourself and give yourself permission to heal.
6. Laugh more; it'll give you more freedom to stop taking it all so seriously.
7. Enjoy positive experiences consciously and don't seek to downgrade them.
8. Be grateful for what you do have – great relationships, a home, a family, an education, abilities, interests, hobbies, pets, health, etc. Look for the good in your life.
9. Be self-compassionate. Shift your thoughts to more fulfilling, value-focused things when negative reproaches arise.
10 Apologize if others have been involved and you have not already done so, or you have not done so genuinely. Only do this when you have changed your negative outlook and if doing so will not harm that person.



It's perfectly fine to say: "I am not proud of what I've done (or how I've devalued myself) but I'm moving on for the sake of my health, my well-being, and those around me." Affirming this is healthy and allows you to break the cycle of self-harm you've fallen into because you openly acknowledge what was wrong and the intention to set it right from now on.


If you’re trying to heal, learn to forgive. Forgive others without resentment and most importantly, forgive yourself. We all screw up but then we all breathe and cry and hurt, too. We’re all human.



Sunday, May 19, 2013

When should palliative team be involved in your care?


48 year old male got admitted to our hospital for stage 4 gastric cancer. He was previously followed in another facility. However, he was told that his choices were limited and hospice program was introduced.  He did not like the idea of withdrawing care and as such he came to our hospital for exploring other options.

End of life issues are difficult subjects for patients, family members and physicians.

Objectives:
1. When should palliative team be involved in your care?
2. How to improve communication with patients who want "everything"


1. When should palliative team be involved in your care?
  • Declining ability to complete activities of daily living
  • Weight loss
  • Multiple hospitalizations
  • Patient, family or physician uncertainty regarding goals of care
  • DNR order conflicts
  • Use of tube feeding or TPN in cognitively impaired or seriously ill patients
  • Patient or family psychological or spiritual distress
  • Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g., dementia)
  • Two or more ICU admissions within the same hospitalization
  • Prolonged or difficult ventilator withdrawal
  • Metastatic cancer
  • Anoxic encephalopathy
  • Consideration of patient transfer to a long-term ventilator facility
  • Family distress impairing surrogate decision making

2. How to improve communication with patients who want "everything"
  • Family Meeting: where and who should be there
  • Pain Control
  • Risk and benefits of chemotherapy and radiation therapy - Should financial burden be part of decision making
  • Is hospice a happy ending
  • How to interpret studies on new chemotherapeutic medications.
  • What are risks and harms of hospice; Does hospice facilitate Death?
  • Do you screen for depression before hospice agreement? Do family members ever regret the decision of hospice?

Monday, February 11, 2013

Top 10 best Treatment of Osteoarthritis

Top 10 best Treatment of Osteoarthritis
1- Weight Loss: Even a reduction of 5% in body weight reduces pain and improve disability
2- Obtaining X-ray of the joint improves the certainty of the diagnosis
3. MRI should not be performed
4. Exercise is essential - Especially the water exercises
5. Acetaminophen (tylenol) is the best initial treatment; NSAIDs may be better tolerated in some patients but NSAIDs have more side effects.
6. Duloxetine may benefit patients with osteoarthritis who are depressed.
7. Joint injections at best offer only 1-2 weeks of pain relief
8. Hyaluronic acid provide only small pain relief.
9. Glucosamine or topical capsaicin are useless.
10. Surgery is reserved for severe disease.

Sunday, January 6, 2013

Female Sexual Dysfunction

http://pinterest.com/amashhadian/female-sexual-dysfunction/
Estimates suggest that as many as 43% of women complain of at least one sexual problem. 


Diagnosis of Female Sexual Dysfunction
1. Hypoactive sexual desire—the persistent or recurrent lack of sexual thoughts and/or receptivity to sexual activity, which causes personal distress. Hypoactive sexual desire may result from endocrine failure or may be associated with psychological or emotional disorders.

2. Sexual arousal disorder—the persistent or recurrent inability to attain or maintain sexual excitement, which causes personal distress. 

3. Orgasmic disorder—the persistent or recurrent loss of orgasmic potential after sufficient sexual stimulation and arousal, which causes personal distresz

4. Sexual pain disorder—persistent or recurrent genital pain associated with noncoital sexual stimulation, which causes personal distress. 


Treatment of Female Sexual Dysfunction:
1. Clitoral stimulation rather than coital intromission may be more beneficial.

2. The use of topical lubricants may address complaints of dyspareunia and dryness.

3. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire.

4. Contributing medications such as antidepressants may need to be altered, including the use of medications with less impact on sexual function, dose reduction, medication switching, or drug holidays.

5. Estrogen replacement in the form of local cream is the preferred method, as it avoids systemic side effects.

6. The widespread use of exogenous androgens is not supported by the literature except in select circumstances (premature ovarian failure or menopausal states) and in secondary arousal disorders.

7. In patients with arousal and orgasmic difficulties, the option of using a clitoral vacuum device may be explored. This handheld battery-operated device has a small soft plastic cup that applies a vacuum over the stimulated clitoris. This causes increased cavernosal blood flow, engorgement, and vaginal lubrication.