This is important information on strokes from Harvard Health Beat

3 Warning Signs of Stroke You know the signs of a stroke. Or do you? You’d probably recognize the classic symptoms, such as sudden weakness on one side of the body or blurred vision, but often the signs are much less obvious. A crushing headache may come on without warning. Your face may feel numb. You may have inexplicable trouble speaking or following what people say. How to tell when someone’s having a stroke Crooked smile. Have the person smile or show his or her teeth. If one side doesn’t move as well as the other or seems to droop, that could be sign of a stroke. Arm drift. Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, they may be having a stroke. Slurred speech. Have the person say, “You can’t teach an old dog new tricks,” or some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of a stroke. Knowing all the warning signs of a stroke may one day save your life and well-being. That’s because the faster you recognize the symptoms, the sooner you can get medical help. And prompt treatment is the key to shielding your brain from a stroke’s damage and sparing you serious disabilities such as paralysis, speech impairment, and dementia. Every 45 seconds, someone in the United States has a stroke. Stroke is the third leading cause of death in the United States and other industrial countries, trailing only heart disease and cancer. In the United States, about 700,000 people have a stroke each year. If you have a stroke, the risk of dying from it increases with age: 88% of deaths from stroke are in people 65 and older. About two-thirds of people who have a stroke have some resulting disability and require rehabilitation. The odds of having a stroke more than double for each decade after age 55. Two-thirds of strokes involve people over 65. Men and women are about equally likely to have a stroke, but women have a greater risk of dying from one. Race is another risk factor. African-Americans, for example, are almost twice as likely to suffer a stroke as are whites. Although you can’t change your age or race, you can take steps to reduce other risk factors for stroke, especially ischemic stroke. The most common risk factors for both ischemic stroke and TIAs (transient ischemic attacks, or "mini strokes") are high blood pressure (hypertension), diabetes, unhealthy cholesterol levels, and obesity. All of these factors affect the health of your blood vessels — increasing the risk not only of stroke, but also of heart disease. That’s why medications and other steps you take to reduce the risk of an ischemic stroke will also benefit your heart. Some types of hemorrhagic strokes are more likely to occur in people with chronic high blood pressure. But other types of hemorrhagic strokes seemingly strike out of the blue. Although abnormal blood vessel conditions such as an aneurysm (a bubble in the blood vessel wall that could rupture) or an arteriovenous malformation (an abnormal tangle of blood vessels) increase the risk, these conditions may only be discovered inadvertently while you are undergoing testing for something else or may not be discovered until a stroke occurs. Fortunately, medicine has made considerable strides in understanding how to treat and prevent strokes. Medical imaging devices now enable medical teams to begin to diagnose a stroke accurately within minutes. Large studies have clarified which medications and other treatments are best for which patients. For those who need rehabilitation, experimental techniques are showing promise in helping patients make better progress than was possible even just a few years ago.

Make the most of your 15 minutes: how to make every second of you doctor’s visit count

So you only have 15 minutes with your doctor. Learn to make the most of every second. Try these techniques and see how much time you save - save for clarification and questions.

If you’ve kept up with your "index card system" you’re one step ahead of the game. You can read from the cards or give them to the doctor - the cards have your list of medical problems and your medications.

Keep the symptom diary and write out the list of symptoms, time of onset and any changes since they began. Practice talking about your symptoms ahead of time. Solicit the help of a spouse or friend to listen to you. Have that person practice looking away from you and looking at you so you experience both methods of exposure and you can get more comfortable talking about embarrassing symptoms to another person.

Remember to just list them with minimal conversational tone. That saves a ton of time.

Bring paper and a pencil so that you can take notes as the doctor asks you questions or says things you’re not sure of. Tell the doctor early on that you may need to interrupt to adequately understand what he’s asking of you or what he’s telling you. If you say this and ask "permission", you’ll get off on the right foot. But keep your notes anyway. While you’re waiting for the doctor, jot things down that you think of as you’re sitting there. After the doctor’s been in there, write down questions. Ask the nurses if you have the opportunity when they come in. Ask the nurses how to approach the doctor with questions if they can’t answer them.

Consider bringing a tape recorder- ask the doctor if you can record the encounter so that you don’t have to worry about misinterpreting what he said. Explain that you want your spouse to know what went on and "what the doctor said". You can even make a joke of it with him because I’m sure he’s heard many times before that the patient has problems remembering enough to satisfy the spouse.

Write, write, write. If you have chronic problems, you should get a stenographer’s pad and label that as your doctor pad. Use it to record your symptoms and take it with you to put your notes in. This way it’s always available for reference and you don’t have to worry about small pieces of paper and worrying about losing them.

Stop worrying about whether you’re saying the right thing or not or whether you’re answering questions correctly. Just say what comes to mind. There is no answer the doctor is looking for - he wants to hear what’s going on with you.

Don’t worry about whether the doctor looks at your or seems friendly. This will distract you from the purposes of your visit - to relay your symptoms accurately and succinctly and to receive information back. That should be your only focus.

Focusing on these two purposes will help you make the most of your time - those precious 15 minutes will seem a lot longer.

Hope this helps!

What on earth do I mean by that? What is perception? All I know is that perception is reality. How many times have we heard that? And how often do we think of that when we’re in the medical environment? Probably not as often as we should…..

I was having lunch with a good friend and his wife (whom I’ve gotten to know fairly well in the past 2 years). She told me about her encounter with a new doctor recently for a sinus infection. She was adamant when she simply stated "I know enough about what’s going on in my body that by the time I go to the doctor, I just want them to give me the drugs I need." My internal reaction to that was very disconcerting. I understood what she was saying but my doctor-instinct was horrified - I know I’m telling alot about myself

I wanted to explain to her that sometimes she might not know exactly what was wrong with her because "after all, you’re not medical" but i restrained my tongue for once, knowing that what she believed was, in fact, reality to her - and therefore, she probably did know what she needed.

I recalled a very sad case where a mother did not want to take her twin daughters home from the ER because they did not seem "better" to her after their asthma treatment. The ER doctor (not me, thank goodness) told her that the girls were not wheezing so they "must" be better. So, reluctantly mom took them home. The outcome was not good - one of the girls ended up dying. I tell this not to be morbid but to emphasize to patients that they really do know their bodies better than anyone (and to remind the physicians to listen to the patients and pay attention). I learned such a valuable lesson that night, nearly 28 years ago - and I think that’s what held my tongue in abeyance with my friend’s wife.

The point is that doctors and patients have different perspectives and therefore the perception of each is most likely 180 degrees apart. Each of us has to ask for clarification or offer it if we want to be understood by the other - and if we’re not understood, we’re in deep trouble.

Doctors - throw away your judgments and open up your ears AND your minds.

Patients - stick up for yourself and make sure your doctor hears you and where you’re coming from. And then make sure you understand what he’s saying.

Perception really is reality

Til next time…..

Terrie

This is cool. My article got published on MySeniors.com . It was also in HealthNewsDigest.com

Your Doctor Said What?

Make the Most of Your 15 Minutes

By: Dr. Terrie Wurzbacher DO 

Doctor-Patient Communication What your doctor does (and doesn’t) need to know

     Ok, you’ve got your appointment scheduled. You’ve kept your symptom diary. Now what? What is it your doctor needs to know – and conversely, what is it he doesn’t need to know? After all, you’ve only got those infamous 10 minutes to get everything accomplished – tell your problem, be examined, get a diagnosis, and ask your questions.

    What does the doctor need to know? Just about everything – but not in the conversational manner you’re used to. What’s your predominant problem and how long have you been experiencing it. Have you had this before – sometime in the past perhaps? If so, what was your diagnosis (if you went to have it checked)?    

    In addition, you should list the associated problems – pain, weight loss, nausea, vomiting, urinary symptoms, loss of appetite, cough, fever, chills, headaches, etc. It’s important to make sure you separate the two issues.

    What’s the character of the symptoms? Are they intermittent? Or constant? Are there periods of time when you don’t have any symptoms and feel pretty good?

    Have there been any changes in severity or location? Changes can indicate a lot about what’s going on.

    Why did you decide to come see the doctor now? Was it that it became intolerable? Was it that you finally realized it wasn’t going to go away?

    Remind the doctor about your past medical problems and your current ones. Take your index card and read off of it to him. Often times, your current symptoms may be related to your other problems or to their treatment.

    Likewise use your other index card – the one with your medicines listed on it.

    Tell him if you’ve had any other problems that you’ve seen another doctor for. Have your medicines changed? Have you run out of your medications? If so, when? If you’ve stopped your meds because of your symptoms, tell him when you stopped them.

    Have you been taking any herbal medications or other naturopathic remedies?

    What’s changed in your daily living or activities or abilities? Do you get out of breath faster, are you unable to walk up your stairs or go for your usual walk since you got sick?

    What doesn’t your doctor need to know? He doesn’t need to know all the details that go along with you telling your story. This is not a good way to describe your problems “I felt worse than when cousin Charles died” or “It started 3 weeks ago on a Friday and then that whole weekend we were at a high school reunion – you know my 30th – it wasn’t bothering me as much except when I went to bed. The long car ride made me more carsick than usual though. When we went to dinner with the Sullivans I wasn’t able to eat as much but I really didn’t have any bowel problems.”

    Eliminate the natural conversational patterns to get more out of the time you have with the doctor. Short and to the point makes it easier for him to hear the pertinent points.

    The doctor doesn’t need to know what you think the diagnosis is – unless you’ve had this same condition/symptoms diagnosed by a physician before. If you try to convince the doctor it’s something, then you may mislead him or lead him down the wrong path.

    Give your doctor your story in bullet points and don’t elaborate unless asked. Practice and write things down and you’ll do great!

Managing Stress in a Workplace Full of Risks

Pharmacy work can be highly stressful, and pharmacists who are under extreme stress are at risk for more errors, said Henry Cobb, PhD, MD, BS, CDM, Clinical Associate Professor, University of Georgia College of Pharmacy, Athens, Georgia.^[11] Pharmacists need to identify their own personal stress triggers and anticipate their responses to stress. He presented 5 questions that could be used for such self-analysis:

• How do you know whether stress is a problem for you?
• What is causing most of your stress?
• Is your supervisor aware of the problem?
• How do you deal with stress?
• What can you do to reduce the impact of stress?

Cobb described 3 ways that most workers deal with stress on the job. The active-cognitive person draws on past experience, taking one thing at a time. He or she considers several alternatives, looking for the positive side, and is able to step back and be objective. The active-behavioral person finds out more about the situation and takes positive action. He or she may talk with a friend or spouse, exercise more, or talk with a professional in order to find a solution. The person who practices avoidance keeps feelings to himself or herself, prepares for the worst, takes out frustrations on others, and eats or smokes more to reduce tension.

Identifying the phases of stress can be helpful. Phase 1, or the warning phase, includes vague anxiety, depression, and apathy. Phase 2, or mild stress, includes sleep disturbances, muscle aches, and irritability. Entrenched stress, or phase 3, includes alcohol abuse, depression, ulcers, withdrawal, and marital discord. Phase 4, or severe stress, includes asthma, heart problems, severe depression, violence (or suicide), paranoia, and uncontrolled anger. It is important to note that professional help is needed for phases 3 and 4.

To reduce stress on the job, Cobb presented this list of quick strategies:

1. Discontinue caffeine;
2. Engage in regular exercise (30 minutes 3 times weekly);
3. Practice relaxation-breathing exercises (20 minutes 2 times weekly);
4. Get adequate sleep (try going to bed 30 minutes earlier than usual);
5. Nurture your leisure time, engage in hobbies;
6. Set realistic expectations and avoid perfection;
7. Reframe your outlook to be optimistic, not pessimistic;
8. Eat right;
9. Maintain a sense of humor;
10. Talk and vent;
11. Write down your thoughts;
12. Avoid unhealthy habits (such as alcohol);
13. Set limits (learn to say "no"); and
14. Get help from a professional.

In some cases, however, a person who is in a job that does not match his or her personality and preferences may need to switch to another role or job, Cobb added. That may be a much better stress-reduction technique than any other.

What a great creation by Geoff Smith - he made all these jingles and the voice over too.

Thanks Geoff!

Has anyone in your family (like maybe your mom) ever said "hey, watch your tone of voice"?

And maybe you have no idea of what you did or said wrong but your mom "heard" something negative in your voice.

Think of the modern day "whatever". I’m really getting so I hate this word - and as a result of disliking it so much, I’ve been practicing different ways to say it so that it’s NOT so passive aggressive.

In the doctor’s office you’re probably not happy, you’re cold, sick (or you most likely wouldn’t be there), tired, feeling vulnerable with your butt hanging out, etc etc…so, you’re ready for a fight and you’re ready to hear things the "wrong" way perhaps.

And the doctor maybe hasn’t been having the best of days either  (or perhaps is just trying to act and sound professional). So, the doc comes in, says "hi" but looks distracted and you’re automatically on the defensive.

If he (or she) then says "what’s going on with you", depending on how warm sounding the tone is, you might respond in different ways. But guess what, your response then leads to a similar response from the doctor etc etc etc…

Someone has to break the chain.

Listen in on my discussion of this topic:

Terrie

More from About.com

Should You Change Doctors?

"C" if your needs are being met.

A doctor-patient relationship is a lifelong relationship for someone with chronic arthritis.

Since the illness is chronic, and without a cure, regular appointments are scheduled with your doctor to diagnose and problem-solve. It’s a process and a journey you take together with your doctor.  It is imperative that your needs are being met. Consider these 6 C’s: 

Communication 

It is clear that if you and your doctor are going to problem-solve and work towards achieving quality of life for you within the framework of your chronic illness, you must be able to communicate with each other. 

You must trust you will be heard, trust that his/her decisions are sound, and trust your options will be fully explained to you.  

Cost

 The financial impact of chronic illness can approach exhorbitant, so cost needs to be a factor. 

Another post from About.com

Top 10 Reasons to Fire Your Doctor

I found an article the other day that discussed use of the ER for non-emergency conditions. I thought it would be a good discussion topic so here it is:

Overuse of Emergency Departments Among Insured Californians

October 2006

One of the key challenges facing emergency departments (EDs) nationwide is a marked increase in use, driven primarily by insured patients who do not have true emergencies. With the troubling trend in California of emergency room closures, it is important to examine the factors that lead to inappropriate emergency room use.

A recent Harris Interactive Inc. survey found that nearly half of recent ED patients felt their problems could have been handled by a physician’s office visit, had one been available, rather than using the ED.

CHCF commissioned Harris Interactive to conduct two sets of surveys, one of emergency room patients and one of primary care physicians and ED physicians. The patient survey found four key factors that drive increased ED use by insured patients who are not critically ill:

• Lack of access to medical care outside the ED (e.g., same-day appointments with a primary care physician, or evening and weekend appointments);
• Lack of advice on how to handle sudden medical problems;
• Lack of alternatives to the ED (e.g., nurse advice lines or urgent care clinics); and
• Positive attitudes about the ED as a site of care.

The lack of options for Medi-Cal patients, who have even more trouble with access to primary care than privately insured patients, is especially severe. The study also noted that patients with chronic conditions made more ED visits, suggesting that their primary care providers may need to improve their methods of chronic disease management.

This issue brief summarizes the key findings of the survey, recommends strategies to increase alternatives to ED use, and calls for streamlined ED processes, as well as improved communication between physicians and patients.
 
Overuse of Emergency Departments Among Insured Californians - CHCF.org  –  http://www.chcf.org/topics/hospitals/index.cfm?itemID=126089

The one good thing from this (remember, I’m an ER doc) is the last bullet - that people had positive attitudes about the ED as a site of care. They may complain about the wait they have to get the care and to complete the care, but it’s apparent that people do think that ED physicians and staff are on the cutting edge. That’s a very important point but not a good reason to use the ED.

Not only is it bad for you when the EDs are so crowded but it’s bad for everyone coming in. Fortunately the ED staff is used to getting the story quickly and barking off orders for this bed or that bed and they all get done. But this is NOT a good way to get personalized care. I hope that physicians look at this brief and say to themselves that they need to look at the services they offer. As I talk about in "Your Doctor Said What?", we have to get sick on the doctor’s schedule and I can tell you from expeirence on both sides of the fence (as a doctor and perhaps, more importantly, as a patient, that rarely occurs. The Urgent care clinics have been a great boost there but a greater review of the situation is needed.

Terrie