January 3rd, 2012 by Lucy Hornstein, M.D. in Opinion
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Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?
The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.
I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »
*This blog post was originally published at Musings of a Dinosaur*
December 4th, 2011 by DrWes in News, Opinion
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A sure-to-be controversial article appears in the Chicago Tribune earlier this asking the sensitive question of ‘Health care at any age, any cost?:’
“If you want to save all lives, you’re in trouble,” said Callahan, co-founder of The Hastings Center, a bioethics research institute in New York, and a faculty member at Harvard Medical School, in an interview. “And if you want to save all lives at any cost, you’re really in trouble.”
Callahan and co-author Nuland, a retired professor of surgery at Yale School of Medicine who wrote the best-selling “How We Die,” were both 80 when the article was published.
“We need to stop thinking of medicine as an all-out war against death, because death always wins,” said Callahan.
The article goes on the make some bold demands of doctors: Read more »
*This blog post was originally published at Dr. Wes*
December 3rd, 2011 by PeterWehrwein in Research
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Some medications are well known for being risky, especially for older people. Certain antihistamines, barbiturates, muscle relaxants—take too much of them, or take them with certain other medications, and you can wind up in serious trouble (and possibly in the back of ambulance).
But researchers from the federal Centers for Disease Control and Prevention (CDC) and Emory University reported in this week’s New England Journal of Medicine that those high-risk medications are not the ones that most commonly put older Americans (ages 65 and older) in the hospital.
Warfarin is #1
Instead, they found that warfarin is the most common culprit. Warfarin (the brand-name version is called Coumadin) reduces the blood’s tendency to clot. Many older people take it to lower their risk of getting a stroke.
After warfarin, different Read more »
*This blog post was originally published at Harvard Health Blog*
December 2nd, 2011 by Abigail Shefer, MD, FACP in Announcements, Health Tips
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Getting a flu vaccine is on many “to do” lists in the fall, but for those who still haven’t checked it off their list, it’s not too late to get vaccinated. Many people don’t realize that flu activity usually peaks in the United States in January or February, and flu viruses can circulate as late as May. As long as there’s flu around, it isn’t too late to get vaccinated.
Getting a yearly flu vaccine is the first and most important step in protecting against the flu, and CDC recommends influenza vaccination for everyone age 6 months and older. We urge you and all health care professionals to get vaccinated yourselves and offer flu vaccine at every opportunity to every patient—except infants younger than 6 months and the very few people for whom flu vaccination is contraindicated.
Studies show that your recommendation makes the difference in your patients’ decision to get a flu vaccine. You should continue to emphasize the importance of flu vaccination for your patients. And, if you don’t already do so, consider offering flu vaccines to patients in your own practice, even if yours is a sub-specialty practice and you don’t see yourself as a vaccine provider. Even if you don’t offer flu vaccines, you can still recommend and emphasize the importance of flu vaccination as a way to keep your patients—and their families—protected throughout the season.
As promising as it is sounds that flu vaccination rates are increasing among children and healthcare personnel, Read more »
*This blog post was originally published at Safe Healthcare*
November 27th, 2011 by Howard LeWine, M.D. in Health Tips, Research
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Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones.
Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.
The results are a disappointment for older women and men looking to strengthen their bones without exercising, not to mention to the companies that have sprung up to sell whole-body vibration platforms as an easy way to halt osteoporosis, the age-related loss of bone.
The idea behind whole-body vibration makes sense. Like walking, running, and other weight-bearing physical activities, whole-body vibration Read more »
*This blog post was originally published at Harvard Health Blog*
