Archive for the ‘Watch Medications’ Category

A Fear Of Sickness Or A Sickness Of Fear?

Posted on September 17th, 2015 by karen

Doctor Transparency

by Kim Keller

Dr. Leana Wen’s interest in bringing transparency to the medical profession began back in 2003, when she was still a medical student.

Leana’s mom, Sandy, had been diagnosed with stage IV breast cancer, which had already spread to her lungs, her bones and her brain. During her third round of chemo, Sandy happened to misplace her address book, so she went online to look up her oncologist’s phone number, and that’s when she discovered that her oncologist was also a highly paid speaker for the drug company that manufactured her prescribed chemo regimen.

Sandy called her daughter in a panic. It made her question her treatment plan. Is the chemo regimen right for me, she wondered? Or is it being prescribed because of my doctor’s financial relationship with this particular drug company?

Leana and her mother weren’t sure what to believe, but the answer was almost secondary. “When it comes to medicine,” Dr. Wen explained, “having that trust is a must, and when that trust is gone, then all that’s left is fear.”

Wen has enjoyed a long and varied career, serving in many capacities, both as a physician and public health official, including, most recently, as the Commissioner of Public Health in Baltimore, MD. And in all her various positions, Wen has discovered that many doctors share that same fear she described above. The absence of trust is by no means restricted to the patient population.

Indeed, there was an incident that left a great impression on Wen during her medical school years. She was caring for a 19-year old boy in a coma, whose body had undergone enormous trauma when he was hit by an SUV. The young man’s parents had immediately flown in from Seattle, traveling some 2,000 miles to be with their son in the hospital. The parents obviously wanted to receive as much information from the medical team as possible. In fact, they asked to be present when the medical team was doing rounds in order to help the parents understand exactly what was happening with their comatose son.

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It’s All About The Meds

Posted on July 22nd, 2015 by karen

Prevent Medication Errors

by Kim Keller

If you were to listen in on some of the conversations I’ve had with my sister Karen during the last 10 years, you might very well hear us talking about medications, and it would probably not be in a positive light.

The disenchantment began with our dad. As a result of having so many doctors contributing to his care, he was saddled with too many meds, some of which were ineffective and even unhealthy. Duplicative prescriptions, improper substances for patients over 65, too many adverse side effects, confusing dosage instructions . . . The list goes on and on.

Then, after Dad passed away, our mom’s health suffered (no surprise there, since she was Dad’s primary caregiver for so long) and the same kind of medication problems started cropping up. The lesson? Be ever vigilant about medication regimens.

Our latest concern is trying to limit the escalation of Mom’s prescription-drug intake. It’s a challenge to find the balance between the meds she really needs and the meds that are being casually prescribed to her.

In general, there are thirteen points we focus on:

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If Only There Was A Second Time Around

Posted on July 9th, 2015 by karen

If Only There Was A Second Time Around

by Kim Keller

As another anniversary of our father’s passing — July 16th, to be exact — approaches, my sister Karen and I find ourselves once again filled with regret for all the lessons learned, far too late in life, about how to help someone you love through serious illness.

Dad’s health issues lingered for quite some time, but during the last year of his life, he deteriorated at a tumultuous pace. It was a painful ordeal, and if it were possible to go back in time, Karen and I would do many things differently.

We would have more actively:

  1. Insisted that our father seek better medical care earlier in his illness. The critical lesson here: sometimes you just have to travel farther for better hospitals and doctors. Dad made his choices based primarily on location, and while we often questioned the quality of his doctors and their related facilities, we weren’t comfortable pushing this point with him, until it was far too late in the game. Given what we now know, we would have kept researching hospitals in the region until we found a teaching hospital with MAGNET status. Teaching hospitals generally attract higher caliber doctors, and a MAGNET designation indicates an impressive level of quality care bestowed upon patients by the nursing staff. Naturally, there are great hospitals that are not teaching facilities, as well as many without MAGNET status, but it’s an excellent place to start.
  2. Focused on how Dad could reduce the amount of medications he was taking. He had lots of specialists, especially as his health unraveled, and each doctor added a new prescription or two. Not enough attention was paid to the possible side effects and adverse interactions caused by combining so many medications. In fact, rather than scrutinizing the burgeoning list of drugs that were being pushed at our father, each new medical issue that cropped up heralded another new prescription. Given what we know now, we would have discussed the medication list with all the various specialists, starting with these five questions: (1) Are any of Dad’s symptoms a possible side effect of another medication? (2) What are the potential side effects of each drug? (3) Is this drug safe and/or effective for someone over 65? (4) Are there any issues to watch out for when this drug interacts with Dad’s other current medications? (5) Is there any harm in changing Dad’s diet and/or exercise regimen rather than prescribing another new medication? And to help us with our own research, we would have used MediGuard.com, which is a great tool for fleshing out medication problems.
  3. Talked with our father about end-of-life issues. Dad already had a living will in place, so we thought we were covered in this important area, but we were wrong. We soon discovered that many common scenarios needing to be fully vetted are not handled by the average living will. For example, do you continue with aggressive treatments when they can’t cure you but can only sustain a bedridden life? Not an easy question to discuss, and we certainly never discussed this as a family, but at a certain point late in the illness, Dad was no longer able to give his input, and continuing treatments no longer held any promise of recovery. We decided to maintain the full-on treatments, but we’ve never been sure this was what Dad wanted. If we’d known back then about the critical importance of a wide-ranging end-of-life discussion, we would have used www.agingwithdignity.com. It’s an important resource that walks you through the fundamental questions that every family needs to consider.
  4. Established ourselves as coordinators for keeping track of all communication between and amongst the various medical personnel and caregivers attending to Dad. Karen and I just didn’t understand, at least not at first, that someone had to pull together all the various pieces of information relating to Dad’s care, from medication mandates and treatment instructions to exercise orders and diet alterations. Counting on the medical teams to coordinate and communicate was not realistic. We eventually learned to keep track of everything and to communicate everything. There was nothing too big or too small. Here are some of our charts and checklists.
  5. Created a support team around us to help us anticipate needs, develop a plan, make better decisions, and clue us in on available resources and tools. Frankly, back then we didn’t even realize we needed a support team, other than our father’s medical attendants. Dad had been sick for so long that we never would have believed we were facing his final year. Without a support team, we spent way too much time being reactive, putting out fires, floundering with decision-making. If we could do it all over again, without the pain and torture that Dad surely experienced, we would’ve reached out to people who had been down this path before. There are many places to start building a team: in-home care agencies, for example. Or local religious organizations, many of which have outreach programs, geriatric care managers, and senior centers. When we finally did build our team, we were relieved and finally confident that we were making sound decisions. We didn’t understand at that point how close we were to the end, but we were at least able to spend our time in a far more important and valuable way: loving our father and enjoying every last minute with him.
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Battling The Healthcare Bureaucracy: A Daughter’s Journal

Posted on April 8th, 2013 by karen

Marianne at Alzheimer's Facility

by Beth Whitman

Mom stayed at home with Dad and me until she was physically unable to stand. The other determining factor in her decline from Alzheimer’s was that she had become overwhelmed with free-floating anxiety, irritability and fear that had been steadily increasing for about six months.

Her level of distress had started to get out of control, and regular anxiety medications, like Lorazepam, had ceased to be effective. But we had found a dosage of the anti-psychotic Haldol that seemed to keep her relaxed and alert and happy, or at least as happy as any normal person could possibly be when they are faced with no longer being able to function as they used to.

Nevertheless, it soon became impossible to care for Mom at home, and Mom knew it. So we initiated the process of moving her to an Alzheimer’s care facility.

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Doctors, Medications And The Progress Of Alzheimer’s: A Daughter’s Journal

Posted on March 5th, 2013 by karen

Marianne & Beth Whitman

by Beth Whitman

“If you or a loved one have concerns about memory loss or other symptoms of Alzheimer’s or dementia, it is important to be evaluated by a physician.”

When I see this statement on so many of the websites that deal with Alzheimer’s, my thought is always the same: “Why? Why is it important to get to a physician if there is no cure?”

Yes, there are pills you can take (if you can remember to take them) that are intended to slow the progress of the disease. But the endpoint is the same, and the pills simply hold you at a certain level of decreased functioning. Improvement is measured only by the temporary absence of decline, which comes along soon enough, that’s a fact. My personal experience has been that doctors have little impact in the treatment of Alzheimer’s, offering only short-time measures at best. I guess that might be helpful in some cases, but certainly not all.

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Our Best Medication Safety Tips

Posted on January 24th, 2013 by kim

by Kim Keller

Karen and I have been on Medication High Alert lately. As I’ve recently reported, our mom has been in the hospital for the last few weeks, and at this writing, she’s moved on into the rehab program at the same facility.

We feel fortunate that Mom is receiving such wonderful care, but we remain vigilant nonetheless. Our experience has taught us that you can never pay too much attention to the dispensing of medications, especially in a hospital.

So, in the spirit of prudence and foresight, we decided to share with you all our best medication advisements. Take a look:

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Overmedication – An All Too Common Problem

Posted on May 14th, 2012 by kim

too many pills

by Kim Keller

“Overmedication of the elderly is an all too common problem, a public health crisis that compromises the well-being of growing numbers of older adults.  Many take fistfuls of prescription and over-the-counter medications on a regular basis, risking serious and sometimes fatal side effects and drug interactions.”

So states science and nutrition writer Jane Brody in the April 16 edition of The New York Times, in an articled entitled “Too Many Pills for Aging Patients.” This is a topic that’s near and dear to my heart.  My own parents have suffered greatly from medication side effects, such as debilitating nausea, shortness of breath and sleeplessness, and their adverse reactions have included severely impaired cognitive ability, aggressive behavior and acute anxiety.  (The difference between a side effect and an adverse reaction is that the former is expected and the latter is not.)  Far too often the drugs produced more turmoil than healing.  And then the cycle intensifies when more drugs are added to counter the unpleasant side effects.  In fact, the situation with my dad was so serious that drug-safety awareness became one of the driving forces in the creation of In Care of Dad.

Sadly, my parents’ struggles are all too common.  In Brody’s article, she shares a story about her 92-year-old aunt who was hospitalized and nearly died because of a series of medication complications.  Her aunt’s extended hospital care, Brody points out, ended up costing Medicare a significant amount of money.

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Our Favorite Tools: A Celebratory Retrospective

Posted on January 23rd, 2012 by kim

Green Tool Box Photo by Sue Schultz

by Kim Keller

Today In Care of Dad publishes its 101st blog!

It’s quite a milestone for us.  To celebrate this landmark occasion, we’re taking a look back at some of the most useful tools and resources we’ve written about here at In Care of Dad, items that have helped many people — just like you and me and my sister — to care for our aging parents.

Here are some of our favorite finds:

CaringBridge.org — This wonderful service helps friends and families sharing a health crisis by offering space and access to any group, extended or otherwise, that wants to stay abreast of a loved one’s health status.  But more than that, Caringbridge helps families arrange their websites with the following format features:  1) journal entries to keep everyone up-to-date; 2) photo uploads to provide a visual component; and 3) a private message center where family and friends can deliver words of encouragement and support.  This service is easy to use and completely free!

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Sometimes No Treatment Is The Best Treatment

Posted on January 19th, 2012 by kim

hysterectomy cartoon

by Kim Keller

Did you ever wonder if all of the tests, treatments and medications that doctors order are really necessary?  Karen and I started wondering about this during our dad’s illness, and we became even more convinced it was true when our mom had a stroke a few years ago.

Naturally my curiosity was piqued when I noticed the cover story in a Newsweek from a few months ago (August 14, 2011), entitled “One Word That Will Save Your Life: No!”  Research by the author, Sharon Begley, brings to light the fact that many low-risk patients with light symptoms at best, some with no symptoms at all, suffer more harm than good from various types of tests, procedures and medications.

“There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” says Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and the editor of the American Medical Associations’s Archives of Internal Medicine.  “Less is more,” she explains.

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Making Sure Medications Are Taken Properly

Posted on November 29th, 2011 by kim

by Kim Keller

Almost half of the people in America don’t take their medications properly, according to Stephen B. Hanauer, MD, a professor of medicine and clinical pharmacology at the University of Chicago, and a frequent contributor to the web on medication issues.  Dr. Hanauer offers these ten reasons why:

  1. They don’t understand why they should take this medication when they feel fine.
  2. They simply forget.
  3. The medication ran out and they didn’t refill it.
  4. They have too many pills to take.
  5. They only take medication when they feel a flare-up is imminent.
  6. They aren’t sure of the dosage instructions.
  7. They don’t like the way the medication makes them feel.
  8. The medication reminds them that they have a disease.
  9. They don’t understand why they need the medication.
  10. They don’t understand how the medication is affecting their body.
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