By: Dr. Jonathan WoodWho needs an advance directive? Everyone.What is an advance directive? An advance directive is a document that clarifies your wishes about your own health care, should you be too ill or incapacitated to speak for yourself. Even more important, an advance directive can be used to name someone who knows your wishes (your â€œagentâ€) and will be thereby authorized to make health care decisions for you in such a situation.Arenâ€™t these documents just for old people or chronically ill people? No. Advance directives are for everyone. In fact, much of the legislation surrounding this issue arose due to tragic medical cases involving young, previously healthy patients. Terri Schiavo. Nancy Cruzan. Karen Ann Quinlan. These are familiar names and all cases where national attention was brought to the issue of who should make medical decisions for those patients who are too ill to speak for themselves. These were young people in the prime of life before their illnesses. While these cases all involved dramatic â€œend of lifeâ€ decisions, advance directives are designed to allow your wishes to be followed in any case where you are incapacitated, whether it is life threatening or not. Though we would rather not think about it, any of us could become critically ill or injured at any age. So, truly, all of us need some sort of advance directive.Is this a permanent document? No. An advance directive can be changed or revoked at any time. In fact, it should be updated periodically to be sure it still reflects your wishes. Look at the Maine Attorney Generalâ€™s office website for more information on this point.Isnâ€™t it difficult to anticipate every possible decision that might need to be made? It is not only difficult, it is impossible. While many people choose to outline their choices around a few common decisions regarding life-sustaining treatment (sometimes called a â€œliving willâ€), most also choose to name an â€œagentâ€ to speak for them in all the circumstances that are impossible to anticipate. An agent is sometimes referred to as your â€œpower of attorney for health care.â€ Naming an agent who knows you well and knows your philosophies of life is an extremely important aspect of creating an advance directive. Specifically naming this agent is critical to having medical professionals act in your best interests while you are incapacitated. It also helps your family more easily and compassionately cope with your illness during such unfortunate events, which are often a time of great stress for your loved ones.What if my agent is unable to fulfill that duty? Typically, people name a list of several people who will be asked to step in if their first agent is unable or unwilling to act on their behalf. Considering this possibility can be an important part of creating your advance directive, but is not essential.Where do I find an advance directive form? Any signed statement, witnessed by two other people, will be accepted for naming a health care agent in the State of Maine. However, the best approach is to use an advance directive form created specifically for this purpose. One can be found in your primary care physicianâ€™s office, at any hospital, or at this website. Though the Maine form is long, only Part 1 needs to be filled out in order to name an agent. Part 6 needs to be completed as well, as this is where the signatures are placed (yours and your witnessesâ€™). A notary is not required in Maine. However, to ensure that your advance directive will likely be accepted in other states, it is a good idea to have the signatures notarized, if possible.Advance directives are basic and necessary. With medicineâ€™s increasing capacity to effectively treat critically ill patients, having a health care agent is essential to ensuring that your values, preferences, and wishes will be heard and followed.More information about advance directives can be found at the Maine Hospital Association website.
By- Dr. Joan Marie PellegriniIn today’s complex medical world it is no longer acceptable to be a passive participant in your medical care and to leave all the decision making to the physicians. Patients with complex medical issues may be seeing multiple providers and also may have their care at more than one institution. There are many medical conditions and medications that require a significant amount of patient education. It is for these reasons that many patients now need to be more involved in their care and their medical decisions. Self-advocacy is the ability to recognize, understand, and effectively communicate your needs to other people, including friends, family members, social workers, and medical professionals. Being an advocate for yourself means being actively involved in getting what you want and need.Below is a list of suggestions that I have for being more actively involved in your healthcare. I do not expect that you would need all of these suggestions but rather you select the ones that make sense for your level of medical complexity.-) Write down a list of questions/concerns you may have before your appointment. You may want to do some research before your appointment so that your questions will be more targeted and appropriate.-) Take notes during your visit with the doctor.-) Designate someone who can call on your behalf. You will need to list this person in your record and will need to sign a consent for your providers to discuss your care with this person. This person should also go with you to your appointments so that they can also listen to what is being said. This is particularly important if you have a complex medical issue or if you will be receiving upsetting news.-) Get a folder that has separators or use a journal. In this folder you will keep your medical information. You should have sections for contact information for medical providers, list of diagnoses, imaging results, laboratory results, list of visits and what each visit was for. This folder would also be a good place to keep your advanced directive.-) Write down your diagnoses at each visit and make sure you understand what they are. During your visit is an excellent time to ask your provider what web resources they would recommend for you to gain further knowledge.-) Every time you have a test or something with a result, make sure you obtain a copy. Do not assume that everything is OK if you hear nothing. Before each test is ordered, ask your provider what time frame you should expect to hear the results. Understand what the results mean and what the next step is.-) Ask about your medications. Verify the dose and timing. Verify that you know what each medication is prescribed for. Educate yourself on the side effects and interactions with food or other medications. Much of this can be researched on the web before your appointment so that you can ask specific questions directed at your needs.-) If your condition is complex, it is acceptable to ask your provider if a second opinion might be beneficial. If they agree, they could also make some recommendations.-) If you are having a procedure done, there are a few other questions you should ask:+) what can you do to prepare for the surgery? What can you do before or after surgery to optimize the outcome?+) what are the options available? Is not undergoing a surgery an option?+) what are the risks and how likely are they to happen? If there is a complication, what will happen or what will need to be done?+) has the provider done many of these procedures? For some procedures, there are online resources that will educate patients on national quality initiatives and how to choose a hospital that offers best practice.+) for most procedures, the patient is better served to have the procedure close to home. However, this may not be the case for complex procedures. You will need to balance the risk of being far away from your physicians and support network versus obtaining specialized care that may not be provided close to your home. Your primary care provider can help you with some of this discussion.-) If you are being admitted to the hospital, ask if your advocate can be present during rounds so that all of your questions can be answered and so that you will understand the plan of care. If you do not feel you need someone present, consider taking notes so that you may understand what the goal is for the day and the plan of care. If your care involves multiple specialists, write down their names and specialty so that you may understand what the role is of each member of your team.-) If your provider is referring you to a specialist you should understand what is the question or problem that the specialist should address. If you are seeing multiple specialists you may want a copy of their consult note so that you can keep track of who you are seeing and for what purpose.-) Know your health care plan. Understand what bills you will be responsible for. Ask if there are resources available such a manager for chronic disease, nutrition counseling, reimbursement for gym membership, or other wellness resources.-) Speak up if you do not feel your needs are being met. If you still cannot get satisfactory assistance, ask to speak to a manager. If this do not work, there may be a Patient Relations Representative or Patient Ombudsman who could assist you.
Coping With Disasters and Traumatic EventsBy- Dr. David Prescott â€“ Eastern Maine Medical Center Behavioral MedicineCommon Reactions to a Disaster or Traumatic Event: People who experience a disaster or traumatic event directly are often initially in a state of shock. Psychologists view this as a protective reaction that is adaptive in the short term. People often appear detached or numb immediately after a disaster. For people hearing about the disaster through news media, the immediate reaction is often one of fear and anxiety, as such events threaten our sense of safety and often feel beyond our control. What Determines How People React to a Disaster? For everyone, the closer you are to a disaster, the longer it typically takes to recover. People directly affected, particularly those who were injured or saw others injured, are likely to feel the effects the longest. People who were indirectly affected are more likely to feel the effects if they feel closely connected to the event, for example if they knew someone there or have experienced similar trauma at another time in their life. In general, the factors which seem to impact peoplesâ€™ reactions include: â€¢ The degree of intensity and loss. Events that last longer and pose a greater threat, and where loss of life or substantial loss of property is involved, often take longer to resolve.â€¢ A person’s general ability to cope with emotionally challenging situations. Individuals who have handled other difficult, stressful circumstances well may find it easier to cope with the trauma.â€¢ Other stressful events preceding the traumatic experience. Individuals faced with other emotionally challenging situations, such as serious health problems or family-related difficulties, may have more intense reactions to the new stressful event and need more time to recover.Coping Strategies for a Disaster That Are Most Helpfulâ€¢ Share and acknowledge feelings you may experience: Sharing your reactions to a disaster with someone who is supportive is an important way to begin to work through your feelings. â€¢ Reestablish Routines: Disasters disrupt our sense of what is normal. Within reason, it is helpful to most people to reestablish routines that are familiar and help give structure to their day. â€¢ Find active ways to cope with your distress. Watching a disaster from a distance often leads to feelings of helplessness. Psychologists have found that even small active coping strategies can help people feel better. For example, you might participate in a remembrance or volunteer at an organization that helps people in your community. â€ƒCoping Strategies that Do Not Help: â€¢ Avoid reactions that become part of the problem such as drinking or using drugs: Sometimes, progress in coping with a disaster can occur simply by avoiding coping strategies that lead to bigger problems. Excessive drinking or using drugs make the problem worse in the long run.â€¢ Overexposure to Media Reports: While many people desire the most up to date information after a disaster, prolonged watching of news reports may only make things worse. Take a break and try some other type of activity if you find yourself tuning in for extended periods of time. â€¢ Worrying about â€œWhat Ifâ€: It takes time to feel normal again after a disaster. Speculating about the disaster and other problems that might arise is usually not helpful. Realize that feelings of anxiety and sadness are normal, but they do not mean that another disaster is about to occur. Special Tips for Children: Talk with your child. Talking to your children about their worries and concerns is the first step to help them feel safe and begin to cope with the events occurring around them. What you talk about and how you say it does depend on their age, but all children need to be able to know you are there listening to them.â€¢ Find times when they are most likely to talk: such as when riding in the car, before dinner, or at bedtime.â€¢ Listen to their thoughts and point of view: don’t interrupt â€” allow them to express their ideas and understanding before you respond.â€¢ Remind them you are there for them to provide safety, comfort and support. Give them a hug.Keep home a safe place. Children, regardless of age, often find home to be a safe haven when the world around them becomes overwhelming. During times of crisis, it is important to remember that your children may come home seeking the safe feeling they have being there. Help make it a place where your children find the solitude or comfort they need. Plan a night where everyone participates in a favorite family activity.For More Information: American Psychological Association Help Center Click here
Been sneezing a lot lately? That’s not unusual this time of year. TV5 Health Advisor Doctor Erik Steele spoke to Jim Morris on TV5 News at 5 to help us with our spring allergies.
The Searsport Planning Board begins deliberations tonight on a proposed propane tank project.The group “Thanks But No Tank” is against DCP Midstream’s plan to build a 22 million gallon propane tank at Mack Point.Supporters of the project say it will create local jobs and stimulate the local economy.The planning board has held several public hearings and will now determine if DCP’s plan is in compliance with the town’s ordinances and can begin construction.That meeting begins at 6:30 at Union Hall.
Most Common Type of Mental Health ProblemBy- Dr. David PrescottMore than 40 million Americans have Anxiety Disorders: Nearly 18% of American adults experience some type of clinical anxiety disorder. This makes anxiety disorders one of the most common types of mental health problems. Learning the different types of anxiety disorders is an important step in overcoming them and reducing the negative impact of anxiety on your life. Normal Anxiety vs. Anxiety Disorders: It is entirely normal for people to experience anxiety. In fact, many of us perform better (for example at work, school, athletics) when we are mildly anxious. The line between normal anxiety and an anxiety disorder has to do with the intensity of anxiety, the frequency of periods of extreme anxiety, and how much anxiety interferes with your daily activities. When anxiety becomes intense, frequent, and prevents you from completing your work, family commitments, or daily tasks, it may be time to seek help. Types of Anxiety Disorders: Social Phobia: Social phobia (most common type of anxiety disorder) is a strong fear of being judged by others and of being embarrassed. People with social phobia are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store, or they might be afraid to eat or drink in front of other people, or use a public restroom. Most people who have social phobia know that they shouldn’t be as afraid as they are, but they can’t control their fear.Panic Disorder: Panic disorder involves sudden, intense and unprovoked feelings of terror and dread. People who suffer from this disorder generally develop strong fears about when and where their next panic attack will occur, and they often restrict their activities as a result. The most common age of onset for panic disorder is in the early twenties. Generalized Anxiety Disorder (GAD): People with GAD are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks. Often, people with GAD will visit their doctor for problems like headaches or difficulty falling asleep. Obsessive-Compulsive Disorder: True obsessive-compulsive disorder (OCD) occurs less frequently than other types of anxiety disorders, impacting about 1% of the adult population. People with OCD feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. Examples of common compulsions include washing hands or cleaning house excessively for fear of germs, or checking work repeatedly for errors.Post-Traumatic Stress Disorder: Someone who suffers severe physical or emotional trauma such as from a natural disaster or serious accident or crime may experience post-traumatic stress disorder. Thoughts, feelings and behavior patterns become seriously affected by reminders of the event, sometimes months or even years after the traumatic experience. Unfortunately, many new cases of post-traumatic stress disorder have occurred in people who served in combat situations. The current prevalence of PTSD is estimated to be around 7.7% of the population. Treatment for Anxiety Disorders:Treatments for anxiety disorders include counseling, or psychotherapy, and for some people medications. Counseling techniques for anxiety disorders are highly effective, and typically involve changing anxiety provoking thought patterns, or learning to encounter a feared situation in a state of increased relaxation. Medications for anxiety disorders may include specific medications to reduce physiological anxiety, or for some people antidepressant medications. Antidepressant medications often take a few weeks before they have their full benefit. For any type of treatment, people may contact a licensed psychologist or other mental health professional, or talk with their primary care physician. FOR MORE INFORMATIONAmerican Psychological Association: www.apa.org/helpcenter National Institute of Mental Health: http://www.nimh.nih.gov/
HAND WASHINGAmy Movius MDThe influenza season was rough this year, filling Maine hospitals to capacity. Warnings about new “superbugs” are in the media nationally and abroad. Several schools across the country (including our neighbor Vermont) have temporarily shut down because of rampant stomach flu, which is making the rounds locally as well. How do you keep yourself healthy?? Wash your hands!Hand Washing is the single most important thing you can do to prevent illness. Most of us use our hands constantly. Infection (germs) can be transferred to our hands by everything we touch. This infection can then be transferred into our bodies by touching our eyes or nose or mouth. Of course, if you already have an infection you can likewise spread it to everything you touch. These germs can then be picked up by others and so the infection goes around and around. It is estimated hand washing with soap could prevent 1 out of 3 cases of childhood diarrhea and 1 out of 6 cases of childhood respiratory infection worldwide (2,3).People tend to think they are more conscientious about hand washing than they really are. One study found that, even though over 90% of adults reported always washing their hands after using a public restroom, only about 4 out of 5 were actually doing it. In middle and high schools, less than 60% of girls and 50% of boys were observed to clean their hands after using school restrooms. People routinely admit to less hand washing after using their home bathrooms. Hand washing can dry and chap the skin. If skin irritation becomes a problem, pick a mild soap and moisturize after each washing. Sometimes there is no washing facility nearby. Keeping waterless soap or sanitizer (at least 60% alcohol) available is an alternative in this circumstance.Below is a list for when and how you should wash your hands – and gently remind others to do so if needed.Before: Eating After: Using the bathroom (or diaper changing) Blowing nose/coughing/sneezing Touching animals Touching pet food/treats Touching garbage Outdoor activitiesBefore and After: Preparing or serving food Taking care of a cut or wound Visiting/caring for anyone who’s sick How: Use any type of soap and warm running water Wash all of your hands: front and back, fingers, nails, wrists Wash for at least 20 seconds, or two rounds of “happy birthday” Rinse well and pat hands dry with a clean towel Use paper towels to turn faucets and door handles in public bathrooms1. www.cdc.gov/handwashing/ – Cached2. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008 Jan 23:(1):CD004265.3. Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health. 2011 Jan:8(1):97-104. >
MARCH IS COLORECTAL CANCER SCREENING MONTHBy: Dr. Joan PellegriniColorectal cancer (CRC) is the second most common cause of cancer (excluding skin cancers) and cancer deaths in Maine. The good news is that it may be somewhat preventable. Over the last 20 years there has been a national effort to increase the number of people being screened for this disease. Also over the last 20 years there has been a decline in the death rate from CRC. It is felt that this is partly due to more people being screened for CRC. Screening allows precancerous polyps to be found and removed before they develop into cancer. CRC starts from a small precancerous polyp which can be removed at the time of colonoscopy. If this polyp is not removed, then it becomes a cancer. Even if it is cancerous, it is better to remove it when it is still small because the procedure can be easier and there is less chance of spread to other organs. Once CRC has spread outside of the colon then chemotherapy and radiation may be needed and this makes the treatment more complicated. If CRC is found in an early stage the survival is about 75% over 5 years. The 5 year survival is much less if CRC is not found until it has already spread to other organs or lymph nodes.Screening includes a physical exam, blood work, a digital rectal exam and imaging of the colon. It is recommended that screening including a colonoscopy start at age 50 years (for those without a family history). Unfortunately, only about half of the people who should be screened are screened. In Maine there are several obstacles to being screened: no primary care provider, no insurance, fear of the test and the results, denial, ignorance of the seriousness of CRC, embarrassment, lack of time, difficulty traveling to location for colonoscopy. The CDC (Centers for Disease Control and Prevention) recognizes that it can help with some of these obstacles. Maine CDC has funding for the CRC screening program to defray the costs of colonoscopy for someone without insurance or someone whose insurance may not cover the costs of a screening colonoscopy. For more information:
Why CPR is so important?By- Dr. Anthony NgEach year in the United States, roughly 360,000 people of all ages suffer non-traumatic sudden cardiac arrest with nine out of ten victims dying. Sudden cardiac arrest is the leading cause of death among adults over the age of 40 in the United States and other countries. According to the American Heart Association, about 88% of sudden cardiac event occurs in the home. The number of sudden cardiac arrest deaths does not take into account other individuals who die from cardiac arrest as a result of variety of injuries or illness, including electrical shock, heart attacks or drowning. One often thinks that in all these instances, the more rapid first responders arrive to help, the higher the survival rate. However, the most important predictor of survival is whether or not cardio-pulmonary resuscitation, or CPR, is performed on the individual with cardiac arrest. Effective bystander CPR can double or triple survival rate. Sadly, the American Heart Association noted that 70 percent of Americans may feel helpless to act during a cardiac emergency because they either do not know how to administer CPR.CPR is a manual procedure that ensures the heart is still pumping and the lungs are putting oxygen into the blood in the event that the heart stops. This procedure ensures that the heart and brain are not deprived of oxygen. Who should take CPR? Often, many assume that only health care workers or emergency personnel take CPR. However, many more in the community can benefit from learning CPR. Most certainly individuals who are caring for someone with a medical condition should be taking CPR classes. Additionally, individuals who interact with the public on a regular basis should take CPR. Both adults and teenagers can take the class. CPR is taught by the American Heart Association and the American Red Cross through various agencies, including hospitals, schools and community agencies. It is often free to low cost. It is half to full day depending of the class. CPR class also teaches one to use Automated External Defibrillators or AED’s. AED is a portable electronic device that diagnoses cardiac rhythm disturbances in a person with cardiac arrest and is able to treat the person with electrical therapy, allowing the heart to return to its regular rhythm. AED’s are now available in many public places. However, it should only be used by someone trained to use it safely and effectively.CPR teaches not only immediate intervention for adults with cardiac arrest, but it also teaches someone to perform child and infant CPR. Additionally CPR classes teach one how to deal with choking in both adults and children. In 2009, almost 1,100 children under 14 died from unintentional choking and in 2010, close to 17,000 children were treated in emergency rooms for unintentional choking. Some of these children suffer long term sequelae from the choking. This is why it is so important that adults, such as parents, teachers, and child care workers take the class. CPR certification is often good from one to several years depending on the course. As most individuals may not need to use CPR between certification, it is important that individuals take refresher class. While one hopes never having the need to use CPR, knowing how to do CPR effectively is probably one of the most effective public health interventions. With increase number of the public knowing this skill, many lives can be saved. American Heart Associationhttp://www.heart.org/HEARTORG/CPRAndECC/CommunityCPRandFirstAid/Community-CPR-First-Aid_UCM_001123_SubHomePage.jspAmerican Red Crosshttp://www.redcross.org/take-a-class
Teaching Our Children and OurselvesBy- Dr. David PrescottIn tonight’s State of the Union address, the President will reportedly talk about our national struggle to cope with gun violence. Given the wide range of viewpoints, debates concerning the best strategies for reducing violence will likely continue for weeks and months. Watching and hearing about violent events is troubling for most people. Psychologists have helped identify strategies for coping with violent events in the short term, as well as strategies for the longer term issue of raising our children to deal with anger and frustration in non-violent ways. Not surprisingly, adult behavior and role modeling play a large role in how children learn to deal with these issues. The Short Term: Coping with Violence or Exposure to ViolenceWhether people are directly impacted by a violent event, or witness violence through news and other mass media, working through the feelings takes time. Any one of the following strategies can help people cope more effectively: Â· Honor Your Feelings: Remember that it is common to have a range of emotions after a traumatic incident. You may experience intense stress similar to the effects of a physical injury. For example, you may feel exhausted, sore or off balance.Â· Strive for balance. When a tragedy occurs, it’s easy to become overwhelmed and have a negative or pessimistic outlook. Balance that viewpoint by reminding yourself of people and events which are meaningful and comforting, even encouraging. Striving for balance empowers you and allows for a healthier perspective on yourself and the world around you.Â· Turn it off and take a break. You may want to keep informed, but try to limit the amount of news you take in whether it’s from the Internet, television, newspapers or magazines. While getting the news informs you, being overexposed to it can actually increase your stress. The images can be very powerful in reawakening your feeling of distress. Â· Help others or do something productive. Locate resources in your community on ways that you can help people who have been affected by this incident, or have other needs. Helping someone else often has the benefit of making you feel better.The Long Term: Teaching Gentleness To Our ChildrenHow can parents help to teach their children to behave in a compassionate caring manner? Social scientific research suggests that even at young ages, children have the capacity to empathize with the feelings of others, and to help others in need. Part of raising children who don’t use violence to cope with anger or frustration is nurturing these tendencies. Here are some strategies that parents and other adults can use to help teach children to act with compassion: Â· Lead By Example: What most inspires a child to grow up caring about others is the caring that the child receives. That nurturing is itself a perfect role model for children. Experts point out that when children feel they have a secure base at home, they’re more likely to venture out and pay attention to others.Â· Choose Books that Illustrate Compassion and Caring: Particularly for young children, books that illustrate compassion and caring help children learn about these behaviors. For older children, make sure that the books promote realistic characters who deal with everyday struggles in a caring manner. Â· Limit television and movies which promote violence: Research from the National Institute of Mental Health found that children tend to imitate behavior they see on television. For this reason, you may want to limit their viewing of violent programs and encourage them to watch shows that promote ideas about caring and helping.For More Information: American Psychological Association www.apa.org/helpcenter
By- Dr. Jonathan WoodThis month, the American Academy of Pediatrics* published its first Practice Guideline on the management of newly diagnosed Type 2 diabetes mellitus (T2DM) in children and adolescents. This comes in the wake of increasing prevalence of Type 2 diabetes in children, a phenomenon attributed to the epidemic of childhood obesity in North America.This publication is intended for professionals caring for children with this disease. But, as is usual in the US, the public wants to know about such publications and hopes to understand their significance. This requires (1) knowing the definitions of some key terms and (2) understanding the benefits and limitations of publications such as Practice Guidelines. Neither of these tasks is simple.Two important definitions:1. Diabetes Mellitus (DM): The word “diabetes” is derived from both Latin and Greek and essentially means to “pass through.” This alludes to the prominent of symptom seen in all forms of DM: increased urination. The word “mellitus” is derived from Latin and essentially means, “honey sweet.” Again, this comes from the fact that high blood glucose (sugar) results in high urine glucose. If tasted, which early diagnosticians did, the urine would be sweet.Confusion comes when people equate all forms of “diabetes”. There are three distinct, different diseases:Type 1 DM – previously known as “juvenile onset DM” (a misnomer, because it is not strictly age dependent) or “insulin-dependent DM” (also a misnomer given that other forms can come to require treatment with insulin). Type 1 DM (T1DM) typically does occur in children and adolescents. And it involves the loss of the pancreatic cells that produce insulin: hence T1DM always requires insulin shots. Type II DM – previously known as “adult onset DM” or “non-insulin-dependent DM,” both misnomers for the same reasons noted above. The main problem in T2DM is insulin resistance, meaning the body does not respond to insulin properly. This often is a complication of obesity and the exact mechanisms are not known. Hence, typically the first approach is to modify behaviors and use medicines that directly reduce blood sugar independent of the insulin mechanism. Sometimes, in T2DM, there is a relative lack of insulin later in the disease and extra insulin (shots) is used in the treatment.Note: at diagnosis, it is sometime difficult to distinguish between Type I and Type II DM. It will become clear quite quickly, but sometimes the final label needs to wait and during this time there can be overlap of treatment types.Gestational DM – a transient form diabetes seen in some pregnancies. It is similar to T2DM in that is involves insulin resistance, but it is typically transient and resolves after the pregnancy. That said, it is dangerous to both mother and baby, so it should be treated. Woman who have gestational DM have a higher than usual incidence of developing T2DM later in life.2. Practice Guideline: A practice guideline is just that: a guideline. Â· It is not a set of rules, nor is it a standard which all must follow. A professional society or group of experts in the field typically puts it together.Â· The guideline attempts to pull together all the evidence on the chosen subject. The evidence is then “graded” on its quality and validity. If there is no evidence, then “expert opinion” is often invoked.Â· The best guidelines detail specific questions or issues to “answer”. They then issue a statement based on the graded evidence. Typically, the statements “for” or “against” the issue in question are also given levels of strength. (e.g. strong recommendation, recommendation, option, no recommendation)Potential Problems:Â· When practice guidelines are seen as dictums, rules that must be followed.Â· When practitioners (or patients) fail to appreciate the strength of the recommendation or the grading of the evidence that led to this recommendation. This is particularly important in pediatric practice guidelines, because the volume and quality of evidence is frequently lacking in pediatrics. (but that is a topic for another WABI pieceâ€¦) Â· When a guideline is applied to a disease (or a patient) for which the guideline does not fit. Although this seems like an unlikely circumstance, it happens frequently and it can lead to a poor outcome.What is the point? What about the AAP’s T2DM Practice Guideline?The AAP’s Practice Guideline has all the qualities you would want in a guideline, as outlined above. Â· Most importantly, it raises awareness of the true increase in T2DM among youth in the US. Â· It has an excellent section on definitions to help avoid confusion like those outlined above. Â· It explains the evidence grading system and subsequent recommendation strategy. Â· It identifies six (6) clear issues and offers clear “action statements”: two Strong Recommendations and four Options.The strongest recommendations are centered on making the diagnosis of T2DM accurately and starting treatment promptly. In the most dramatic presentations, treatment may include insulin, despite my definitions above. But usually the treatment of T2DM stresses lifestyle modification (nutrition and physical activity) and initiating oral medicines to control glucose levels.The AAP’s new Practice Guideline on Type II Diabetes Mellitus is a good one. Patients and practitioners alike will benefit from the teaching it offeres and its judicious application to this increasingly prevalent disease.* This guideline was published with support from the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics.
By- Anthony Ng, MDDomestic abuse is a public health crisis that has recently gained more attention. In a report from the US Preventative Services Task Force (USPSTF), published in the recent Annals of Internal Medicine, it recommended that all women of childbearing age be screened for abuse, and women who screen positive should be provided or referred to intervention services. A survey from CDC in 2011 which interviewed about 16500 adults in 2010 showed 1 in 3 women was a victim of domestic violence. It is suspected that this number may actually on the low side as there may be widespread under-reporting of abuse. Last year, domestic violence accounted for almost half of all homicide cases in the state of Maine. Domestic abuse comes in many forms. They may include not only physical abuse, but also sexual and emotional abuses, intimidation, stalking and even economic deprivation. Additionally, while this report focused on women of childbearing age, it is important to recognize that domestic violence also known as spousal abuse or intimate partner violence (ITF) can occur in any person including males. Domestic abuse is often under-reported. Reasons may include victims minimizing the abuse. There may be stigma to being identified as a victim of domestic abuse. Such abuses can occur in all walks of life. Some victims may fear reporting domestic abuse may lead to more abuse and violence or perhaps abandonment from the abusers. Some victims may actually blame themselves for the abuse, thinking it is their fault for the abuse. There may also be under-detection and screening for domestic abuse. Lastly, there may not be enough resources in communities, such as shelters for victims, to address the issue of domestic abuse even when such abuses are identified. Domestic abuse is not limited to women. Males are also at risk of domestic abuse. However the data in this group remains sparse. It is widely under-reported with stigma likely being a major reason. There are some identifiable risk factors for abuse. They include individuals with physical or emotional disabilities being victims, young age, substance abuse, marital conflict and instability, economic and work stress. Domestic abuse can lead to significant physical and emotional concerns. Victims of domestic abuse can lead to increased risk of physical injuries and illnesses. It can also lead to depression, anxiety, post traumatic stress disorder and substance abuse. To intervene in domestic abuse, the approach needs to be from multiple avenues. First, there needs to be greater education to communities of the extent of the problem of domestic abuse. It is a major health problem that needs early recognition so that intervention can be effective. Identifying the risk factors and stress that can cause and worsen domestic abuse would be paramount. For example, if a couple is experiencing marital stress or stress from economic hardships, counseling early on may prevent domestic abuse. Better screening is needed, especially by primary care physicians. According to the recent USPTSF guidelines, primary care physicians are strongly encouraged to screen closely for signs of domestic abuse. This may include asking for stress at home and further questioning about psychological distress, as well as repeated physical injuries. For victims of domestic abuse, there are some shelters that are available. In the Bangor area, Spruce Run is a shelter for victims of domestic abuse and violence. In some instances, law enforcement may also need to be involved to protect the victims.Domestic abuse is a major health problem in Maine and the United States. It can lead to a rippling of other health and mental health problems if not treated. Greater awareness and early interventions can help both the abuser and the victim. So, don’t be surprised if your doctor starts to ask more questions about the presence of domestic abuse. Resources:Spruce Run Tel: 1-800-863-9909Website: http://www.sprucerun.net/Maine Department of Health and Human ServicesTel: 1-866-834-4357 (HELP)Center for Disease Control on Intimate Partner ViolenceWebsite: http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.htmlMaine Office of Attorney GeneralWebsite: http://www.maine.gov/ag/children_families/domestic_violence.htmlMaine Coalition to End Domestic ViolenceWebsite: http://mcedv.org/
Health Watch â€“ January 22, 2013Dr. David Prescott â€“ Eastern Maine Medical Center Behavioral MedicineHow Many People Are Able to Stick with New Habits? It has been exactly three weeks since the start of the New Year. For many of us, the New Year means taking a moment to reflect on those things we would like to change in 2013. But wait a moment! How are those resolutions coming along? If you are having trouble developing a new positive habit, you are not alone. Surveys suggest that about 60% of people who set a personal goal to make a positive change in their life have given up 6 months later. So, take a bit of comfort that making lifestyle changes doesnâ€™t happen automatically. How long is the list of things you would like to change about yourself?: Psychologists have found that one common problem with resolutions to make our lives better is that our list is too long. Changing one habit or incorporating one new thing into each day presents a big enough challenge. Trying to change many things at once can lead to frustration and giving up. If you resolved to make yourself a better or healthier person, did you focus on one small, but achievable step? Increasing Your Odds of Success: These 5 strategies can help make a new habit or routine a permanent part of your life: 1. Change one behavior at a time. Unhealthy behaviors develop over the course of time, so replacing unhealthy behaviors with healthy ones requires time. Many people run into problems when they try to change too much too fast. To improve your success, focus on one goal or change at a time. As new healthy behaviors become a habit, try to add another goal that works toward the overall change youâ€™re striving for.2. Start small. After youâ€™ve identified realistic short-term and long-term goals, break down your goals into small, manageable steps. It may sound overly simple, but change leads to more change. If you would like to eat healthier, consider as a goal for the week replacing dessert with a healthier option, like fruit or yogurt. At the end of the week, youâ€™ll feel successful knowing you met your goal.3. Make a plan that will stick. Your plan is a map that will guide you on this journey of change. You can even think of it as an adventure. When making your plan, be specific. Want to exercise more? Detail the time of day when you can take walks and how long youâ€™ll walk. Write everything down, and ask yourself if youâ€™re confident that these activities and goals are realistic for you. If not, start with smaller steps. Post your plan where youâ€™ll most often see it as a reminder. Donâ€™t underestimate the impact of simply putting your plan on a piece of paper where you see it several times a day. 4. Involve a buddy. Whether it be a friend, co-worker or family member, someone else on your journey will keep you motivated and accountable. Perhaps it can be someone who will go to the gym with you or someone who is also trying to stop smoking. Talk about what you are doing. Consider joining a support group. Having someone with whom to share your struggles and successes makes the work easier and the mission less intimidating.5. Ask for support. Accepting help from those who care about you and will listen strengthens your resilience and commitment. If you feel overwhelmed or unable to meet your goals on your own, consider seeking help from a psychologist. Psychologists are uniquely trained to understand the connection between the mind and body, as well as the factors that promote behavior change. Asking for help doesnâ€™t mean a lifetime of therapy: even just a few sessions can help you examine and set attainable goals or address the emotional issues that may be getting in your way.Thanks to the American Psychological Association for help with this feature. For more information, go to www.apa.org/helpcenter.Or visit Acadia Hospitalâ€™s website at www.acadiahospital.org.
One terrible day last week, four snowmobilers plunged into Rangeley Lake. The body of just one of them has been found. TV5 Health Advisor Dr. Amy Movius joined Jim Morris on TV5 News at 5 with advice to help keep snow sledding safe.
The holidays are an exciting and memorable time for everyone. The following tips may help keep you and your family safe while enjoying this special season.Christmas TreesFor many households, putting up a Christmas tree is a major event. When picking a precut tree, choose one with branches than bend (not break) and with needles that do not easily pull off. These indicate that it is fresher. The trunk of a fresh tree will have a sticky trunk butt and cutting a little more of the trunk off will exposes fresher wood which will absorb water better. Be sure to keep the tree stand full of water. Otherwise, even the freshest tree will dry out quickly.Keep Christmas trees away from any heat source – this includes fireplaces, radiators, wood stoves or portable heaters.If you use an artificial tree, make sure it is labeled â€œfire resistantâ€.DecorationsLIGHTS are the star of holiday decorations. Check all of your lights, even if brand new. All the bulbs should be in working order and there should be no loose sockets/cracked areas/other defects. Outdoor lights should be certified for this use. Metal and lights do not mix! This means no lights should be used on metal Christmas trees and no metal should be used to hang lights, such as staples or nails. There are noncombustible hooks or insulated staples available just for safely hanging decorative lights. Although coming home to twinkling lights seems charming, it is not safe to leave them on in an empty house, so please turn off all decorative lights when you are not homeLIGHTED CANDLES are also traditional for many but should be carefully kept away from any trees or other greenery. Candle holders must be non-flammable and only placed on secure surfaces where they will not be knocked over. ORNAMENTS should also be flame resistant or non-combustible. Ornaments that are small, sharp, breakable, or have removable parts should be well out of the reach of children. The same is true of ornaments that look like candy or other treats.WrappingFor many people, especially children, the most exciting part of the season is opening presents. While the wrapping paper is being ripped off, someone needs to remain vigilant and keep track of the discarded paper, bags, bows and ribbons as they can become fire, choking and suffocation hazards. It is important to never burn wrapping paper, bows or ribbons in fireplaces: they can ignite suddenly and burn intensely.Especially for ChildrenVisiting friends and relatives or having visitors can be the most meaningful part of the holidays. It may also require some extra planning to keep small children safe. Other homes may not be childproofed, and though it can be socially awkward, asking your hosts to temporarily adjust their homes during the visit is essential. Likewise, visitors may themselves need to be â€œchildproofedâ€! Attention to how personal belongings are handled, such as purses and luggage â€“ which may contain medication or choking hazards â€“ is a must. Monitoring and directing visitor behavior with food and drink is necessary also. Another potentially touchy subject is the gifts your children may receive from well-meaning loved ones. All toys given should be age appropriate. If not, you will need to remove it from your childâ€™s possession. No items with an electrical cord are appropriate for children under 10. Also, no items with strings or cords are appropriate for infants or young toddlers. Swallowing button batteries and magnets can be deadly. Besides being found in some toys, button batteries are also found in items ranging from musical greeting cards to hearing aids. All of us at EMMC want you have the most wonderful holiday season possible! Hopefully, these safety tips will help you enjoy the seasonal festivities with confidence and peace of mind. For more details visit the American Academy of Pediatrics Website 2012 Holiday Safety Tips. Referenceaap.org 2012 Holiday Safety Tips
By- Dr. Anthony NgEmergency rooms are great community resources to help provide medical care to anyone in crisis. However, emergency rooms have now become a crisis in itself as many emergency rooms around the country are inundated with patients. There are a variety of reasons to why emergency rooms are getting busier. They may include a lack of community health resources for people to get care in a timely manner or there are insufficient inpatient beds for patients who need hospitalization, just to name a few. As a result of emergency rooms getting busy, people are waiting longer to be seen. Some people even leave the emergency room before they are actually seen due to the long wait. For some others, they don’t even bother going to emergency room at all when they are really sick because of concerns of long wait in the emergency room, as well as to how they will pay for the visit. As chaotic and stressful an emergency room visit may be, there will be times when a visit to the emergency room is necessary. However, there are few things one can do to make the visit less stressful so that one can get the care they need. The most important time to prepare for any emergency room visit is actually before the emergency happens, especially for individuals with illnesses. If one has an illness, whether it is an acute or chronic condition, one should discuss with the health providers to what conditions would necessitate a visit to the emergency room and what can be handled by contacting the health care provider directly. An alternative to emergency room is walk in center or urgent care centers which many hospitals offer for less emergent medical concerns. One should ensure that they have enough medications for their medical condition. A trip to the emergency room is not necessary to obtain medication refills. These can be obtained by contacting your regular health providers ahead of you running out of the medication. Also, before you go to the emergency room, you should prepare an updated list of contact information of your regular health providers, emergency contacts, allergies, past and current medical conditions and current medications that can be easily produced for the emergency room provider. This will help ensure they are fully aware of your current health status. You can also keep a copy of this information in your wallet or purse so it is readily available. You should also check with your health insurance carrier to your financial responsibilities such as copayment for emergency room visits. Often many patients learned too late after an emergency room visit that their insurance plan did not fully cover the visit and they incur additional stress trying to figure out how to pay for their visit. Understanding what happens to you when you visit an emergency room can help lessen some of the stress of a visit. While you are in the emergency room, you may be asked multiple questions by different staff members. While the questions may seem redundant and frustrating to you, the questions are meant to get as accurate information as possible about your emergent health needs so you can get the best help. This information also is important to help the emergency room staff determine the priority of patients to be seen. As there are limited resources in the emergency room, sometimes health providers there must see the sickest first. For example, someone with a heart attack or a major trauma will require more emergent response than someone with a less severe medical condition. This is why sometimes one may experience that another patient who arrived after you may be seen before you. Lastly, it is important that you allow communication between the emergency room health provider and your regular health provider to ensure good coordination of your care, not only at the time of the emergency room visit but also in regards to your follow up care with your regular health provider. A visit to the emergency room can be extremely stressful to a person. With some important steps that you can take and some awareness, you can help lessen the stress and your experience to ensure that you get the best health care during your emergency room visit.
Coping With Anniversaries of Traumatic EventsHealthy Living â€“ December 4, 2012Dr. David Prescott â€“ Eastern Maine Medical Center Behavioral MedicineWhy are Anniversaries of Traumatic Events so Difficult? Living through a difficult time takes energy and hard work. Most people wish that once they make it through a difficult time it will be behind them forever. Unfortunately, people who experience the loss of a loved one, extreme personal hardship, or a traumatic event often relive parts of that experience on anniversaries of the event. This can be especially upsetting when the anniversary occurs during the traditional holiday season. Common Reactions on Anniversaries of Traumatic Events Anniversaries of traumatic events may be associated with a variety of difficult memories and feelings. Common experiences on an anniversary include: â€¢ Extreme anxiety or apprehension as the anniversary approaches. â€¢ Repeated memories of the event, or a renewed clearity of memories that had begun to fade. â€¢ General feeling of sadness or depression. â€¢ Sensitivity to reminders of the event. â€¢ Difficulty sleeping or having dreams about the event. â€¢ Impaired concentration or trouble focusing. â€¢ Unexpected outbursts of anger or irritabilityDifficult Events that Occur around the Holidays: For some people, the traditional holiday season is also the anniversary of a personal loss or traumatic event. This can lead to feeling left out or detached from others who do not share your experience. In most cases, it is important to honor your true feelings at the moment, and avoid trying to pretend that you feel upbeat or joyous. Over time, unhappy anniversaries tend to fade in their intensity. Most psychologists agree that grieving and sadness are part of healing, and that if allowed to take its course, recovery from a traumatic event occurs in most people over time. Strategies for Coping with Anniversaries of Traumatic Eventsâ€¢ Recognize and acknowledge feelings you may experience. Understand that your feelings are part of the recovery process.â€¢ Find healthy ways to cope with your distress. Share memories and feelings with someone you trust or just spend time with friends and family. Activities that allow your mind to focus on something other than these memories are a good coping strategy for some people. Contemplative activities like reading, thinking or just taking a walk are also a good approach. â€¢ Avoid reactions that become part of the problem such as drinking or using drugs. Sometimes, progress in healing from a traumatic event can occur simply by avoiding coping strategies that lead to bigger problems. Excessive drinking or using drugs usually make the problem worse in the long run. â€¢ Engage in an activity that honors lost loved ones. You may want to plant a tree in their memory, make a donation to their favorite charity, participate in activities your loved one would have enjoyed or share happy memories with others. Consider volunteering: you may find that helping others actually helps you. â€¢ Use your support system. Reach out to friends and family. Donâ€™t isolate yourself. For More Information: American Psychological Association Help Center (www.apa.org/helpcenter)
By- Dr. Joan Marie PellegriniBecause I am a surgeon, I often have to talk to my patients about managing pain both before and after surgery. As such, I discuss using over the counter (OTC) pain medications with my patients. Many of my patients are confused about how to use the medications and what are the side effects. I also find that many of them think that Tylenol and Motrin are the same. Acetaminophen: This is also known by its trade name as Tylenol. It is sold as just acetaminophen but can also be found in many other OTC medications such as cold/flu remedies and arthritis medications. It is commonly combined with a narcotic as a prescription medication (such as Percocet, Vicodin, etc). It is extremely important to know if your medication has acetaminophen in it and how much is in it because of the risk of taking too much. The maximum dose is 4000 mg a day. The usual dose for an adult is 325-650 mg every 4 hours. Taking too much can lead to severe liver damage. It is not known exactly how this medication works to reduce pain and fever. It can be safely combined with anti-inflammatories and narcotics. It does not usually affect kidney function nor does it cause hypertension often. Also, it does not cause bleeding and is safe to use if you are on blood thinners.Ibuprofen: This is often known by the trade name Motrin. It is an anti-inflammatory and is in the class of medications known as NSAIDs (non-steroidal anti-inflammatory drugs). Other medications in this class are aspirin, Naprosyn (also known as Aleve), and meloxicam (prescription only). Like acetaminophen, there are many different brands of the same medication in the pharmacy and therefore it is important to read the ingredients to know what is in the medication. NSAIDs can cause hypertension, fluid retention, and bleeding disorders. They also can affect the kidney and should not be used in people with kidney disease or on blood thinners. Long-term high dose use of NSAIDs can damage the liver. Ibuprofen has a maximal adult dose of 2400 mg a day. Almost all OTC ibuprofen tablets come as 200 mg. Therefore, the maximum dose is 2 pills (400 mg) every 4 hours, 3 pills (600 mg) every 6 hours, or 4 pills (800 mg) every 8 hours. The prescription strength of 800 mg is just one pill that acts the same as taking 4 pills of the OTC brand. Since aspirin, ibuprofen, and Naprosyn are in the same class these medications should not be combined.If the patient is healthy and on no medications, then a combination of acetaminophen and ibuprofen may be quite effective for pain control. When you talk to your doctor about your pain medication, make sure you write down exactly what you are taking. Also make sure you write down whether you can take acetaminophen or ibuprofen or both and how much your doctor recommends. Neither of these medications causes the side effects that are common with narcotics such as constipation, sleepiness, respiratory depression, or addiction.
By- Dr. David PrescottLack of Willpower is the Number One Barrier to Positive Health Behavior Change: Many people can identify changes in their behavior which would improve their health or mental health. For example, getting support from others rather than staying isolated can help reduce depression. Improving poor eating habits can lower cholesterol or improve your diabetes. Reducing excessive alcohol use will result in better overall health. However, the number one barrier cited by Americans to making positive behavior change is lack of self-discipline. Self-discipline is not entirely pre-determined at birth. By focusing on certain key factors, you can improve your own willpower and self-discipline. The Marshmallow Experiment: Delay of Gratification Really Does Pay Off: Researchers at Columbia University wanted to study how early children can begin to delay gratification, which is a key component of self-discipline. They offered 4-year olds a treat (a single marshmallow) immediately, or told them that if they could wait a few minutes, they would get more than one marshmallow. But more importantly, they kept track of these 4-year olds until they were teenagers. Those teenagers who had been most able to delay gratification had, on average, higher SAT scores, better ability to handle stress, and better ability to plan. Research Supports the Idea that Willpower Wears Down: As people try to change unhealthy behaviors, they often report that the make an initial change, for example not smoking, but that over time stress wears them down. Psychology research actually suggests that this is true! One key to maintaining a healthy behavior is to try to strengthen your willpower. Tips for Building Up Your Willpower: Â· Avoid temptations. In the marshmallow study described above, children who stared at the treat were less likely to resist it than those who closed their eyes, turned away or distracted themselves. “Out of sight, out of mind” works when you’re studying, too. When you need to focus, turn off your phone, sign out of email and eliminate any other distractions from your environment.Â· Make a plan. Having a plan in place may help you resist temptations without having to draw on your willpower, research www.tandfonline.com/doi/abs/10.1080/01443410.2010.506003 suggests. Decide ahead of time how you will react to situations that are likely to foil your resolve. If you need to spend the weekend studying, for example, you might tell yourself, “If someone invites me out, I’ll suggest a Sunday night outing as a reward for studying.”Â· Think you can. How you think about willpower itself is also important. In one study pss.sagepub.com/content/21/11/1686 , researchers found that people who think willpower is a limited resource are more likely to have willpower problems than those who don’t think of it as easily exhausted.Â· Fuel your willpower. Your brain runs on glucose, or blood sugar. But exerting self-control can leave brain cells consuming glucose at a fast pace. Feeding your brain may help restore your willpower, research www.ncbi.nlm.nih.gov/pubmed/17279852 suggests. Eating regular meals can keep your blood-sugar levels on an even keel and may help refuel your run-down willpower.Â· Focus on one goal at a time. The evidence suggests that making a list of New Year’s resolutions isn’t a great idea. That’s because having your willpower become depleted in one realm may reduce willpower in other realms. Instead of trying to adopt better study habits, exercise more and quit smoking all at the same time, take your goals one by one. Once a good habit becomes routine, you no longer need to draw as much on your willpower to maintain it.FOR MORE INFORMATION: American Psychological Association: www.apa.org/helpcenter