12 March 2011

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) has a number of uses. The one that has my attention is the use for diabetic wound healing. And I have seen it work – no, not on me, but on another fellow that had not been managing his diabetes, but when given the facts of diabetes and his wound decided that management was worth the effort.

The therapy involves breathing pure oxygen in a pressurized room or a pressurized chamber. It is used to treat decompression sickness, serious infections, and wounds that won't heal from diabetes or radiation injury just to name some of the uses.

What is really difficult to understand is that in this country the Undersea and Hyperbaric Medical Society (UHMS) lists approvals for reimbursement for certain diagnoses in hospital and clinics. These are reimbursement decisions based on cost of medical treatments verses HBOT at the hospital charge of $1800.00 per 90 minute HBOT treatment. And this probably does not include the attending physician fee and several other fees.

Medicare does recognize HBOT as a reimbursable treatment for 14 UHMS “approved” conditions. Medicare seems to reimburse between $108 and $250 in private clinics and over $1000 in hospitals. This is a great difference in ranges and seems discriminatory.

There seems to be quite a difference in procedures around the country and whether is is a chamber or pressurized room there is also a difference in some procedures. Safety is always emphasized and very strictly adhered to so that if you are going to be using one, be sure of the instructions of what is to be worn and what not to carry in with you. Also do not use certain cremes or lotions that can be flammable. Hopefully, you will ask for the restrictions beforehand to avoid being denied HBOT treatments.

There are several good sources of reading and I will include three of them. Article one is from the Mayo Clinic and can be found here. Article two is from Sechrist Industries, Inc. and is here. The third article is from the Wikipedia site here.

11 March 2011

Prescriptions – Source for Many Errors - P2

The March 2011 issue of Good Housekeeping decided to do an article under Good Health titled Rx for Trouble, subtitled – How to be sure the prescription your doctor orders is the drug your get. This is the second part and about errors in the hospital setting.

The Good Housekeeping article also did an excellent task of describing many of the errors that happen in the hospital setting, but they did miss a few important problems. I will refer you to previous blogs for these discussions. Blog 1 is about drug abuse in the ICU setting when patient is discharged. Blog 2 is for what to do when entering the hospital under various conditions. Blog 2 is important for many reasons.

If you think you have problems with lab coat syndrome, most people really have brain failure when being admitted into a hospital. This is why a prepared list of medications is important to give to admissions. Forgetting even one can have serious complications if a new drug is introduced and even this can be deadly. They suggest downloading “My medicine list” from safemedication.com, filling it out and printing copies for different needs and one for your wallet.

The article talked about an Australian study showing that hospital nurses were interrupted 53 percent of the time when they were dispensing drugs. This is when errors in medications were made – like incorrect dosages, incorrect amounts of injections, or even the wrong medication increased 12 percent with each interruption.  Just make sure that they check your ID before they administer a medication.

If you are in the hospital, make sure that your doctor knows about it. This is doubly important upon discharge. Often the list of medications is just handed to you with a group of prescriptions attached and you are not given any explanation. Some may be very important for you to continue until a set time after discharge. Other medications may be what they think you need.

Check the medications checklist against your list and ask questions before you are released. If they put you off, do what you have to do to talk to your primary doctor and discuss the list and what you have been taking. I had to create a scene to get the hospital doctor back to explain what the medications were for and any potential combination bad effects. When he just told me that I was to forget about what I was on prior and all that I needed was on the list.

Needless to say, I was not going on oral diabetes medications from insulin and definitely not the ones I knew the FDA was investigating. I had to ask for the correct spelling of the doctors name and then he asked me why. I said for the lawsuit for prescribing medicines about to be taken off the market and and for totally ignoring my medication list and the fact that I get my medications from the VA pharmacy.

He left in a huff and I walked out without signing the paper they wanted me to sign. I contacted my doctor and talked to him about the medications from the hospital and he agreed that I did not need to change. There was one that he wanted to look up and he would get back to me about even filling the prescription. About three hours later, he called me at home to say not to fill that as is would create very severe complications with the medications I was taking.

This is why I want to emphasize how important this is and why. Never, and I repeat never assume that the doctor always knows best or that they think of everything. Ask questions and then check with your primary doctor.

10 March 2011

Prescriptions – Source for Many Errors - P1

Is this worth a repeat? When I blogged about prescriptions back in November 2010, I had wondered how long before the subject would show up in other sources. The March 2011 issue of Good Housekeeping decided to do an article under Good Health titled Rx for Trouble, subtitled – How to be sure the prescription your doctor orders is the drug your get.

Because I feel this is so important, I will refer you to the blog I wrote above in Nov 2010. The Good Housekeeping article also raised many points and I won't begrudge them their sensationalizing this topic because of the importance. I feel they did a good article and although it is impossible to completely check the facts they used, I would say this is an above average article for them.

They are not pointing out particular pharmacies, but do state that 20 percent of prescriptions have errors according to a 2009 study done by Auburn University. In hospitals the error rate for medications is only 18 percent, which I find a little difficult to believe. I would have thought it would have been much higher from the studies I have been reading, but since I cannot locate the article, I will accept the 18 percent for now.

The article stated that the biggest error was the incorrect transfer of doctors' instructions onto the drug label. They cited alarming omissions like “take before dinner” on a diabetes drug that could cause blood sugar spiking after a meal. Also mentioned was failing to counsel patients about risk drug combinations.

They wisely advised that patients should ask their doctor about any instructions when they give you the prescription(s). This should also be the responsibility of the doctor to insure they give out instructions. Many patients are at fault for going to too many pharmacies to have prescriptions filled, thereby creating problems for drug combination risks that a pharmacist may not be aware of.

Their next advice I have been aware of for years. Try not to have refills done in the first seven days of the month. Why? Because this is the time that many people receive their government assistance checks and get their prescriptions filled. This causes a overload for the pharmacists and prescription errors jump at the beginning of the month.

Here is a checklist as a reminder.
  • If the drug is new to you, have the pharmacist explain the instructions. 
  • If this is a refill, make sure that the medication instructions have remained the same. 
  • Also check the color and size to be assured that the medication has not been changed. 
  • If the prescription is new get it filled then, otherwise if it is a refill, try to wait until the first seven days have passed to have it refilled, or refill before the end of the month. 
  • If something does not look right, do not be afraid the ask questions. 
  • Remember, mistakes do happen and the pharmacist is willing to correct them.
Next, the second half of the Good Housekeeping article – errors in the hospital.

09 March 2011

Privacy of EMRs or EHRs Is of Major Concern

This is a common concern for both the patients and doctors. Your electric medical records (EMRs) or electronic health records (EHRs) depending on who is writing about them are the topic of an interview with Eric Liederman, MD, MPH, director of medical informatics for Kaiser Permanente HealthConnect, in Sacramento, California, and associate clinical professor of internal medicine at the University of California, Davis.

He refers to (ERs) electronic records and the challenges and strategies for dealing with them in a presentation titled - Protecting Privacy Without Harming Patients. He says access to ERs can't be monitored, but that access to a patient's data is recorded. Consistent and proactive surveillance of ERs activity, in addition to investigation of issues discovered can be a very strong deterrent to patient privacy.

What he failed to mention in the interview and others seem to forget is a system in place requiring anyone working with patient records to be informed of the consequences of talking about what may have been seen, even accidentally, to a third party may result in immediate dismissal. I have to wonder at times what is happening in one of my doctor's office as there is quite frequently a different person as receptionist or nurse and the previous person is not even in the office. I have never inquired, so I don't know if rotation is the practice or if someone has moved on.

What is of concern is achieving a balance in restrictions and access. The ERs need to be accessible quickly, especially in emergencies, but at the same time there needs to be restrictions in place to limit who has access. That is the reason for having an audit trail, surveillance, and on-going investigations of any complaints.

It is a shame in our society that people feel the need to have the latest in gossip to spread about people and feel that medical records will provide this gossip. One of our local hospitals has a large problem with this, yet seems to be doing nothing to stop a few nosy people who always are spreading the latest gossip after certain people have been in the hospital.

Read the interview here.

08 March 2011

Websites About the New Healthcare Law

If you do not follow Dr. Bill Quick and his blog at Health Central dot com, and if you are interested, I urge you to read it. He is the first blogger about diabetes that I am aware of, that has pulled together the websites for information on the healthcare law that we will need to be informed about. Whether you bookmark his blog here, or the individual sites, they will provide you with valuable information about questions you may have in the future.

At first cursory look, and reading Dr. Quick's blog, the content is presented without an agenda and is factually presented. I very much like Dr. Quick's final statement in this blog (quote) I'd like to offer my personal thanks to the organizations involved for the effort that went into setting up HealthCareandYou.org. I hope that it continues to be updated, and that word spreads that the website exists, and that people read it as well as the biased comments of politicians and newspaper editorialists. (unquote).

I am sure in the month and years ahead, we will be bombarded with many half-truths, lies, and misinformation that we will be happy to have these to refer to for clarification. We already know that the media (all forms) and politicians will pick parts of this (the good and bad) to emphasize what is on their agenda and supports them.

I know that I will be using many of the links in the months ahead so that you can affirm what I am writing about (am maybe avoid my sometime agendas) which can creep in even if I had not intended. All bloggers have agendas, whether they will admit it or not. I do want mine to be education, but I know that I let other issues come to the fore on occasion for my own reasons.

07 March 2011

Dairy Product Consumption – Less Diabetes Risk

After reading several articles on dairy foods being good for you, I do have to wonder if there is an agenda in the study. The article reports that a natural substance in dairy products apparently helps protect against diabetes.

A study of over 3700 people found that higher levels of trans-palmitoleic acid was linked to a reduced risk of type 2 diabetes. Trans-palmitoleic acid is present in milk, cheese, yogurt, and butter. Trans-palmitoleic acid cannot be made by the body. This is the first study to state this and they are asking for more studies to prove the function of trans-palmitoleic acid.

The researchers advise not changing your diet to include more dairy products because if these are consumed in excess to reduce the risk of diabetes, this will contribute to weight gain and possible insulin resistance. They continue to recommend that people, with or without diabetes, should eat a nutritionally balanced diet, low in fat, salt, and sugar.

The researchers are consistent in their mantra of low fat, which has been proven to be false in several recent studies. Of course, they say more research is needed to see if these trans-palmitoleic acids can be a useful tool in preventing Type 2 diabetes. The study did track the health of the participants over a 20 year period and this is where the result of the higher levels of trans-palmitoleic acid were determined to be beneficial.

Read the articles here, here, and here. Another blog is here.