Tuesday, June 26, 2012

Alzheimer's Disease and Hospitalization

Picture waking up in an unknown bed with your hands tied down and unfamiliar people around you.  Imagine the desperation that would go through your mind.  Think about the level of stress that would pierce through your entire body.  Then, think about going through this over and over and over again.
Someone with Alzheimer’s Disease experiences this very feeling when they are hospitalized and restrained.  They do not have the cognitive ability to cope with the situation and figure out what it going on.  This is why familiarity is one of the most important components in the care of someone with Alzheimer’s.
As a Geriatrician, I have often told the loved ones of Alzheimer’s patients that hospitals are dangerous places.  This is but one of the reasons.  The other reasons are also quite powerful.  Hospital borne infections, medication errors, unproven treatment modalities.  These are but a few more reasons to keep someone with Alzheimer’s out of the hospital.  
Are there times that hospitalization is required?  There certainly are.  One interesting example is the surgical treatment of a very enlarged prostate.  If the prostate enlargement is so great that a long term catheter is required, the short term risks of hospitalization often outweigh the long term risks of a catheter.  Keep in mind, aside from the inherent increased risk of infection, having a device inserted into ones body when the person will not remember why it’s there can be just as disconcerting as situation we described at the beginning of this article.  
If hospitalization is necessary, how do we approach it?  It is often a good idea to have a familiar person stay with the patient.  Nursing staff must be trained in how to interact with the Alzheimer’s patient.  This means not confronting them with their lack of memory.  It means constant reassurance.  Physical restraints are generally out of the question.  A kind word, a loving touch, often forgotten in the hustle and bustle of the hospital setting, may be enough to soothe the patient.
What are alternatives to the hospital.  Pneumonia, for example, doesn’t always require hospitalization.  Oxygen can be provided in the home.  Antibiotics can be given orally, or intramuscularly.  A loving caregiver, familiar food and surroundings, will make the recovery process easier.  Assisted living or nursing facilities, with staff trained in the care of someone with Alzheimer’s, may actually provide a better and more comfortable surrounding than a hospital.
Now, here’s the kicker.  The approaches that I’ve noted above are usually less costly than the hospital setting.  They are typically fraught with few complications.  Yet, our traditional health care system continues to choose the expensive, less effective approach to caring for our loved ones with Alzheimer’s Disease.  How can we change this?  Through education of health care clinicians.  That will be the topic of my next blog.

Sunday, June 24, 2012

Listening to my body

I always tell my patients to listen to their bodies.  As a physician, I've realized the importance of looking for signs that are right in front of you.  Well, the last four weeks have been a struggle.  After moving to California, I've not only been plagued with tons of life stresses, but with some physical issues.  It started as a mild case of plantar fasciitis, which I babied, then did a 5K.  The afternoon after the 5K, I could hardly walk.  I babied it again, but even my wife noted that I was limping.  I did some swimming and a little biking, worked on massaging my calves.  This helped, but I still had some bad days.  I kept looking forward to doing an olympic tri today, but in the back of my head I knew that I could be pushing my foot too much.  On Friday, I woke up with my foot feeling better than it has recently.  No pain at all.  I went for a walk with my wife, and unfortunately, I could feel some discomfort.  I had a theory that walking was worse than running, so I went out for a run.  Overall, it felt pretty good, but later in the day, the pain came back.  In fact, I was really limping and was truly in a fair amount of pain whenever I put pressure on the foot.  Now, I am not one who really complains about pain, so I needed to listen to this.  Moreover, my left thigh was hurting because I had clearly been favoring the left foot during my run.  Lots of self massage, time in the jacuzzi, and finally some advil and I woke up today with only a little discomfort.  However, I know what I have to do.  I need to rest my foot.  Having just signed up for Ironman Lake Tahoe in September of 2013, I have a long ways to go before my next truly big race.  There is no need to cause any damage right now.  I have a pool to swim in every day.  I have my bike.

The other thing I've realized is that my motivation has also been lacking somewhat.  There's been so much on my mind lately, it's been hard to stay motivated about training.  That said, when I get out and train, it feels good.  That's been a struggle.  I want to spend time with my wife, work on my new website and our new business, and...aren't are retired?  I'm going to need to come up with some priorities, but it's really been hard to find the time to even think about that lately.

Back to my body and my foot.  Yesterday, I was hobbling around like an old man.  My father in law, 87 years young and status post a recent knee injection for his arthritis, was walking much better than I was!  Plus, I was really hurting.  OK, no race today.  And, time to give this foot a rest for at least a couple of weeks.  I'll try to spend as much time in the pool as possible.  But I also think that some mental rest would be good as well.  It feels right coming up with this plan.  Listen to my body:)

Thursday, June 21, 2012

Training, in life

Since my last post a couple of weeks ago, I mentioned my plantar fasciitis.  It continues to nag me, but life has really been the nag for the past two weeks.  Construction on our new home, personal life challenges, dealing with a start up business, dealing with issues from my old business, it seems like I'm busier now than I was when I was "working".  I have realized one thing.  When I was working full time, my wife dealt with a lot of these things.  She dealt with contractors.  She dealt with our rental properties.  She dealt with the bills.  She dealt with the kids.  I "just" went to work.  Granted, I was a workaholic and took work home with me every night.  Granted, work was often far more stressful than I let on.  It's certainly all relative.  My plantar fasciitis seemed better for a couple of days, then got worse again.  I wonder how much is my body just rebelling right now?  My training has slacked off big time, I blame it on not having any time (which is partially true), but in reality, I'm just not feeling it at the moment.  The fact that my heal hurts with most every step doesn't help, but I can still swim and bike.  I've signed up for an olympic distance tri this weekend, and may not know if I'm doing it until Sunday morning.  Part of me just wants to do it for fun.  Part of me is worried about worsening my foot.  Part of me is just tired.  Could I make my foot worse?  Possibly, but in reality, if my heal acts up too much on the run, I could just pull the plug on the race and have gotten in a good swim and bike workout.  Well, maybe life isn't quite like racing.  I can't really pull the plug on life.  I've got to finish.

Waiting for the Supreme Court

We will soon be hearing what the Supreme Court has to say about the Affordable Care Act.  Does it matter as much as everyone thinks?  I have to say that I'm so tired of hearing both sides talk about the Act as if it's either the solution to the health care crisis or the end of civilization as we know it.  It's neither!  And the worst part of all of this is that we're all spending our time fighting, rather than finding solutions.  How can we have life, liberty and the pursuit of happiness without adequate health care?  I just moved from Colorado to California and I will have to reapply for health insurance (with the same insurance company, no less!).  Of course, I have to buy automobile insurance, but that isn't an infringement on my personal liberty (I know, it's a state requirement, not a federal one.  State governments can tell me to buy broccoli, but the feds can't)?  There are a bunch of items in the Affordable Care Act that are truly a waste of everyone's time and money, but because an intern in a Senator's office was interested in it, it got put in the bill.  The Republicans came up with many of the core elements of the Act, but now that the democrats support it, they're against it.  Most people that are against the Act can't even tell you what's in it or what it does.  There is no rationing of health care in the act.  There are no death panels.  At the same time, there is really no part of the Act that effectively puts free market forces back into healthcare.  The health care market is presently a free market for insurance companies to make as much money as they want.  It's also set up for specialists and medical device makers and pharmaceutical companies to spend our hard earned dollars on treatments that have not been shown to be beneficial.  We are in the 21st century of snake oil and don't even know it.  So, what are we really waiting for?  The entire legal battle over the Affordable Care Act has been nothing more than another way to kick the health care can down the road.  Neither party is truly interested in solving this problem.  They're only interested in getting reelected. Maybe it's time to throw them all out!

Monday, June 4, 2012

Is the Juice Worth the Squeeze?

So, today I've been hobbling around.  I'm a little embarrassed by that fact, as my wife seems to feel sorry for me.  But it's my fault.  I was determined to do a 5K yesterday despite struggling this past week with some plantar fasciitis.  I was doing a lot better, and didn't really have any pain in the foot yesterday morning.  Last night and today are a different story.  Ahh, but back to the race.  It's a local 5K/10K in Westlake Village supporting an organization called Senior Concerns, which provides service for seniors in the area.  I chose to do the 5K, because I only wanted to suffer for about 21-22 minutes.  In fact, I really wanted to see how hard and how fast I could go.  It was about 65 degrees, but it was humid out.  I ran the course for my warm up, going pretty easy, with four forty-five second efforts fast towards the end.  I sweated a ton and decided that I wasn't going to wear a hat, as all it seemed to be doing was keeping the heat in.  I seeded myself at the front, which was good, as it turned out that over 650 people were doing the 5K (about 250 men, and over 400 women).  I was actually a little hemmed in at the beginning, but quickly made my way out, letting all the young people do their 100-200 yard sprints.  I really focused in on keeping a fast pace and breathing every 3rd step.  One thing was odd today, it almost felt easier to run fast than it did to do my slower warmup!  I didn't wear any electronics, so was just going by feel.  Through the first mile, only a few people passed me, and I found myself passing the folks who went out too fast.  The effort started to get harder, but unlike some of my past 5K's, I didn't feel like I was slowing down as I started the second mile.  In fact, when I got to the turnaround, I was still feeling fairly solid, though it was definitely getting harder!  I passed a few more people and by the time I got to the 2nd mile marker, I realized that my breathing had started to pick up and was just now getting closer to every 2nd step.  I passed a couple of more people and then noticed that I was keeping pace with the woman in front of me.  There was a guy behind me, I pushed a little, he stayed with me, I was starting to hurt, but I knew that I was getting to a slight downhill just before turning to the uphill finish.  The guy behind me passed me, and I didn't feel like I had another gear.  As I turned the corner to the uphill finish, I felt like I was giving it all I had, but didn't really have a "kick".  I did see the clock as I approached the finish line, and knew that I was going to be right around 21 minutes.  I glanced back and there wasn't anyone close.  My finish time was 21:06.  This was my fastest 5K in the past few years.  It was probably the best I could have done.  I always over analyze races, and my over analysis of this one would suggest that maybe, just maybe, I had 20-30 seconds in me.  However, I can't really be sure.  I feel like I slowed a bit over the last mile, but I think I really nailed the pace/effort over the first two miles.  Afterwards, I ate and drank and then went to look at the results.  Lo and behold, I was first in my age group!  Of note, there were two 55+ guys who beat me:).  That said, I was still about 24th amongst the men, and only 4 women beat me.  It was a very solid result.  I waited for the awards ceremony, this may have been the first time I'd ever received a 1st place AG award in a running race.  Standing around was probably not good for my plantar fasciitis, which reared its head later in the day.  This morning, I hobbled around and have been hobbling a lot.  But, I do have that medal!  I guess the Juice is Worth the Squeeze after all.

Saturday, June 2, 2012

California Dreamin'

This may end up being a perfect day.  I woke up early, as usual, had some breakfast and went to Home Depot to get some pieces of wood for a step for our jacuzzi (didn't work in the end).  Drove out to Newbury Park to pick up my bib for tomorrow's 5K and then headed to Westlake to meet up with Larry from the tri club for a tempo workout.  It was a group workout, but just the two of us showed.  It was a little cool, and a little humid, but it quickly warmed up and the humidity did lead to a lot of sweating.  I warmed up for about 10 minutes before Larry arrived, then we did a warm up ride out to the starting point for our 4x5mile tempo intervals.  The ride is along a long country road, not too many cars, and we even get to pass by Tom Selleck's house!  Larry and I are probably fairly even on the bike, although I had my aero helmet on and he didn't.  The first interval started nicely, I really tried not to go out too hard and let the effort come to me.  It did, and we were against a headwind with some rollers along the way.  I maintained a solid cadence and pushed fairly hard, leaving something in the tank for the next three intervals.  Took a short break to get our breath back and did the 5 mile return.  Most of this was with a tailwind, but I still managed to push my effort quite solidly.  The third interval was the one I'd been waiting for.  I got up to speed and then held a hard effort that got me nauseated about a mile from the end, but I really worked to hold on to the effort at the end.  Stopped briefly to talk with a couple of 70-80 year old guys who were out riding and were impressed with our bikes.  We were impressed with their engines!  I hope that I'm riding when I'm 80!  The last interval was quite solid, probably not quite as hard as the third one, but definitely pushing into the red zone a bit.  Cool down ride back and we were done with what turned out to be about an hour and 45 minutes of cycling.  Drove back to my daughter's house, they're out of town, so I mowed their lawn (hand mower!).  I managed to break a sprinkler head.  Cleaned up around their yard.  All in all, about an hour's worth of yard work, the mowing was intense.  Got home and spent time in the pool with my wife and daughter.  These days when I'm in the pool I'll swim, do drills (one armed swimming, sculling, kicking), swam some with a band around my ankles.  Hopped into our new jacuzzi and then showered and am writing this blog.  Frozen yogurt is up next, then we're going to see a friend's young daughter in the musical Annie, she has the lead!  My plantar fasciitis is improving by the day, hope all will be ok with the 5K tomorrow.