Uncategorized » Fall Prevention Clinics Blog

FALLING SIDEWAYS

May 282013

Getting into the spring – summer cleaning, planting, window washing, fertilizing, and mulching amid the ever changing weather is a challenge for anyone. As the activity levels keep us going more and more… burning off those winter calories  … bumps and bruises are bound to happen to many of us.

At this time of year, our M.D.s see plenty of older adults who come in to tell us that they are tipping, swaying and catching themselves one or more times a day as they work on the chores list. They quickly add that they have not fallen to the ground… but more like falling sideways… getting a bruise and a bump in the process.

The Bad News: These people are at the beginning stages of balance loss that will only get worse, and will likely create a serious fall injury if ignored.

The Good News: Over the past dozen years or so, modern geriatric medicine has become good at diagnosing balance issues and keeping people from more serious falls injury. Even Medicare has jumped on the bandwagon of promoting balance and falls prevention. In recent years, Medicare has begun paying for Annual Wellness Visits which can help to determine if a patient is having balance problems… then the physician can refer to a balance specialty practice for more comprehensive diagnostic and treatment services.

Remember… dizziness and balance problems are a symptom, like a fever… telling us that there are health issues that need attention. Like any other health issue, the real trick to prevention is simply recognizing that something is different… and then acting on it.

Keep moving!
Mike
www.FallPreventionClinics.com

AFTER YOUR SURGERY-WHERE SHOULD YOU GO ?

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Apr 302013

Checking into a hospital for some kind of surgery is traumatic enough… then, a day before discharge your doctor recommends going to a skilled nursing facility (we used to call them nursing homes or rehabilitation centers) for two or three weeks of extended treatment…AND … You have until the end of the day to choose where to go!!! Yikes!!!

Where should you go? What are they going to do? Is your doctor going to check on you while you’re there? Double-Yikes!!!!

As you take a few deep breathes and gather some inner strength from your spouse and family… you begin to peruse the “resource list” of skilled nursing facilities that was provided by the hospital case manager. In large towns, the list is often a small font, single spaced and a page or more in length. The “resource list” includes the one or two places you’ve driven by…ten or fifteen that you’ve never heard of… and another twenty that aren’t even in your town.

Now…over the next few hours, you interrogate anyone with a colored uniform of some kind …for their opinion on where you should go for your extended treatment. The most common response is a non-response “…It’s your choice…There are many good places to choose from…!”

You see, hospitals are not supposed to actually recommend outside services. A few years back, hospitals were taken to task by Medicare and medical practice laws called Stark Laws for allowing hospitals or physicians to steer patients to other services providers that they had a financial interest in. Sooooooo, in an effort to avoid legal problems … hospitals stopped recommending…and created “The Resource List”… which, without any background knowledge, is simply a phone book.

Questions that your hospital case manager can answer, include;
1. Which facility has a history of good treatment results for my particular diagnosis? (Some places may be great with joints and fractures, but not so great with respiratory or cardiac care).
2. Which facility does my doctor go to, or has a member of their practice go to?
3. Which facility has the best rating by the State of Illinois? (The state has a ranking system that is available on-line…and your Case Manager can get that information for you.)
Remember, choosing a facility just because it’s close to your home…or attached to your retirement building… doesn’t mean it’s a good medical choice for your needs. Today’s medical world is requiring patients to be more actively involved… but often the patient tools are difficult to find, and harder to understand.

Keep moving!
Mike
www.FallPreventionClinics.com

WHITE COAT CAMOFLAGE

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Apr 042013

A few weeks ago, a 97 year old lady… (we’ll call her Sally)… living at a well-respected retirement community in the western Chicago suburbs, made a brave phone call to complain about medical services she received. Her issue… the hearing aids she purchased 19 months ago don’t work.

A little while after receiving her initial set of aids, Sally called the person who sold her the aids and told him she still wasn’t happy with her hearing, so he came back to her residence and sold her a “stronger” set of aids for an additional $1000. Total cost for the aids: $2700

When we asked why she didn’t call the person back, Sally says,” I don’t trust him.” Was this person who sold you the aids an Audiologist or a Dispenser? Sally responded, “Well, he had a computer…”

A check of Sally’s aids and associated paperwork revealed that the salesperson sold Sally an aid from an unknown manufacturer. A quick trip on Google provided a local phone number of the manufacturer. A call to Starkey, a nationally known repairer of many world-wide hearing aid brands, provided no additional knowledge about the “manufacturer”. We called the Romeoville IL based manufacturer and received a “Hello!” from the other end.

The “manufacturer” stated that he repairs hearing aids in his home… and when we asked about “new” aids… he hesitantly said that they occasionally sell new aids only if the appointment is made for a “home” visit, (probably due to the fact that there is no retail or clinical office for patients to visit).

There are a host of questions regarding the business model and ethics of the “manufacturer” and the salesperson: Were the “new” aids really new, or simply repaired aids sold to an unwitting consumer? If the aids are new, are they FDA approved (as all medical devices must be)? Does the manufacturer know that a salesperson , who does not work for the manufacturer, may be misrepresenting the product and maybe even ripping off seniors in the process?

Bottom line: Sally still has $2700 hearing aids that don’t work for her.

The lesson: An audiologist is a licensed medical professional with a Master’s or Doctorate degree; knowledgeable about, hearing physiology & anatomy, disease, medications and their relationship to hearing. An audiologist is recognized by Medicare as a medical professional.

A dispenser is a person who has taken a class about hearing aids, in as little as 5 days, and is commonly used as a state licensed salesperson. Under current law, each can open a practice that does hearing evaluations and sells hearing aids. In practical application, an average person may not be able to tell the difference between the two…since they may both wear white medical lab coats…use a computer for hearing evaluations…and have other office items that suggest a professional atmosphere.

In truth, a dispenser is often employed by Audiologists or Ear-Nose-Throat M.D.s… so I am not trying to disparage dispensers; but, as always, if there is money to made by selling hearing aids to a growing population of seniors who need them…there are those who care about the sale…and those care about the service they provide. Which do you prefer?

Keep moving!
Mike
www.FallPreventionClinics.com

WHEN DO YOU STOP TAKING YOUR HEART MEDICATIONS?

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Mar 152013

Once you start blood pressure medicine, (or cholesterol, blood thinners, beta blocker meds and many more) you will take it for the rest of your life. Right? Well… Over the years, we have made some basic assumptions regarding some of our medicines….and it turns out that we’re not simply wrong… but we may be doing more harm than good.

In a 3-13-2013 Reuters article titled, Too many drug types are compromising heart health: doctors, Debra Sherman writes:
About 80 million Americans suffer from heart disease, the nation’s No. 1 killer, and most are on multiple drugs. Some cardiologists think prescribing has gotten out of hand.
The criticism was voiced by a number of leading heart doctors who attended the annual scientific sessions of the American College of Cardiology, held on March 9-11 in San Francisco. They said eliminating certain drugs could potentially improve care without compromising treatment. Evidence is growing that some medications are not effective.

‘EAGER TO ADD, RELUCTANT TO TAKE AWAY’

A person who has had a heart attack typically leaves the hospital on a beta-blocker to slow the heart, an ACE inhibitor to reduce blood pressure, clopidogrel and aspirin to thin the blood and prevent clots, and a statin to reduce cholesterol, said Dr. Micah Eimer, a cardiologist with Northwestern Medicine in suburban Chicago.
“That’s a minimum of five medications, and each one has a proven mortality benefit. It’s practically malpractice if you don’t prescribe those,” Eimer said. “But we have no data on when it’s advantageous to take (patients) off.”

Many patients are on many more drugs, according to research by Dr. Harlan Krumholz, a Yale University professor of cardiology and public health. Using Medicare data, he found that heart failure patients, those whose hearts are too weak to pump blood sufficiently, were prescribed an average of 12 drugs; some were on 30.
“We are eager to add medicines and reluctant to take them away,” said Krumholz.

BLOCK THAT BLOCKER?

Beta-blockers are absolutely necessary for some patients, said Dr. Sripal Bangalore, a cardiologist at New York University, but are probably prescribed too widely and for too long a period of time. Examining three distinct patient groups from a data registry of 44,000 patients, he said the drug did not reduce the risk of heart attack, stroke or death after 3.5 years.

Dr. Richard Stein, a professor of medicine at New York University and spokesperson for the AHA, estimated the average patient with heart disease truly needs to take from seven to nine pills each day in order to control the various risk factors, including cholesterol, high blood pressure and diabetes. Beyond that, he said, it makes sense to be restrictive.

Keep moving!
Mike
www.FallPreventionClinics.com

THE OIL & THE SNAKE

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Mar 072013

Last week, I was doing some research on diverticulitis and other digestive diseases. Adorning the page of my customary resources was also an assortment of links claiming to be seen on Dr. Oz or Oprah (or other of the ever-expanding landscape of “help -you-be-better” TV programs). Each of the links proclaimed the “new” research that has produced amazing…even miraculous, health benefits from a tiny mystery berry, breakthrough-extract, ointment or native grain.

When I asked my physician about the never ending stream of miracle cures in our media…he was more tolerant than I expected. He suggested that medical science often takes its cue from what we would otherwise call “home remedies”… and since we have so many cultures, with so many variations of treatment for everything from poisonous bites to headaches… one should keep an open mind.

OK! I get it. Our scientific proofs often lag behind what we often know to be true or false. In the late 19th century, tomatoes were thought to be poisonous. In the 1950s…cigarettes were advertised as a “healthy” habit. In the 1980s…many scientists believed that red dye in foods caused cancer. Whether we are trying to look younger, be regular, live longer and healthier, achieve smoother skin or lose weight with little or no effort… How do we tell the difference between the oil and the snake? (For you younger readers… a man who travelled from town to town selling his cure-all elixir… mostly alcohol… was called a “snake-oil” salesman).
We all suffer from media overdose…I call it Oz-Oprah-fied !

That extract, oil or berry may actually do good things for us (the oil)… but the media sales pitch (the snake)… overwhelms us as we reach for our credit card… hoping we are not being duped. SO… Keeping an open mind… it may be that the amazing berry seen on Dr. Oz will actually have us dropping pounds without changing our other eating habits or exercising… but we should try these things with healthy skepticism.

Keep moving!
Mike
www.FallPreventionClinics.com

CONVENIENTLY SICK

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Jan 222013

Over the past several years, while Washington has been busy telling us the ‘why’s and wherefores’ of U.S. healthcare and its costs … threatening to cut Medicare services, and medical provider pay… while allowing medical insurance rates to skyrocket for everyone… The healthcare industry has been busy learning how to improve their sagging profits by delivering care the way smart retailers deliver clothes, TVs and grocery items. HOW? Offer fast, convenient, competitively priced services in multiple locations with business hours that are aligned with consumer need.

No more calling the doctor after 3 days of coughing through your work day, only to be told that you cannot be worked in until next week at 12 noon… and be prepared to wait! Today’s consumer-patient wants to see their doctor when the symptoms are in play…NOT in a week when the illness is beginning to fade (or a lung falls out!). They also want to avoid missing work if at all possible, since today’s workplace is not always forgiving of that mid-week, mid-afternoon doctor appointment.

The growth of the new healthcare locations… often called “Urgent Care”, “After Hours Care”, “Medi-centers” or the like, may be satellite locations of hospitals or physician groups, or part of the pharmacy areas of major retail stores like Walgreens, CVS, Wal-Mart or Costco. They may also be independently owned franchise operations. Most of them offer physician or nurse practitioner services, and many offer lab work, x-rays, ultra-sounds, etc..

These facilities are set up so patients don’t have to wait any longer than necessary; with walk-in service OR appointments via phone or internet… and they will electronically update your primary care physician with details of the appointment.

Since most of these locations take insurances or self-pay patients, they give the patient who doesn’t need to go through a hospital emergency room a place to get care, without the price tag of an ER visit… which will eventually reduce the emergency room crowds down to the real emergencies.

Keep your eyes peeled for new healthcare locations in your area, and ask your doctor for a recommendation. You never know when that flu bug will bite!

Keep moving!
Mike
www.FallPreventionClinics.com

ACCOUNTABLE HEALTHCARE/ACCOUNTABLE PATIENTS

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Jan 082013

Under the Affordable Care Act, hospitals, skilled care and rehabilitation centers (they used to be called nursing homes!) are looking at reduced Medicare payments for patients that are discharged…and then readmitted within 30 days for the same or related problem.

Generally speaking, the majority of over- age-65 folks are readmitted because of: 1. Medication mismanagement…which means that the patient is not taking their prescription medicines according to the physician instruction…OR 2. Fall Injury…which usually occurs during the at-home recuperation or rehabilitation period, when no skilled personnel are there.

In order to keep their revenues up and patient readmissions down, the hospitals, skilled care and rehabilitation centers are working to improve their interactions with patients, before AND after discharge.

Plopping a patient in a wheelchair and delivering them to the curbside with a folder or bag full of pre-printed advertising, discharge instructions, and other non-specific information… is giving way to more personalized dialogue with private case managers who are charged with physician and patient follow-up in order to monitor progress and recommend interventions that may be needed.

These efforts are being implemented in various flavors across the country… and will undoubtedly be a work-in-progress for the foreseeable future. As Medicare and our medical facilities work to provide ever-improving patient care while containing and reducing costs… the patient also has a bigger role in their health. Here are a few things that ALL patients should do in order to get well and stay well:
1. Always have a spouse, family or friend on hand when speaking with physicians, social workers and case managers… since we commonly only remember half of what is said, two sets of ears is a good idea!
2. Before discharge from a hospital or other skilled facility, ask your social worker or case manager to write down what your next appointments and care steps are.
3. If you are to have home health, ask your social worker or case manager to set up meetings with representatives from more than one home health agency…BEFORE you are discharged!
4. Always ask questions! The more you know about your condition(s) and treatment, the more likely that you will have a good outcome… and avoid a relapse.

Keep moving!
Mike
www.FallPreventionClinics.com

THE HOLIDAY VOYEUR

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Dec 212012

O.K. …maybe voyeur isn’t quite the right word… you can be the judge.

Holidays are the perfect time when friends and families get together with some frequency. It is also the perfect time to “watch and take note” of how everyone is doing. You know what I mean…it’s the short observations that you make to your spouse AFTER everyone is headed home. Like, “Boy, Uncle Jim seems to be losing a little weight since he started walking.” OR “Aunt Linda seemed a little down…do you think she’s feeling alright?” OR “Dad looked pretty good, but Mom seemed to be hovering over him more than usual.”

If you are in your late 40s to early 50s I hope you get to spend time with your parents over the holidays. When you’re together, please try to take notice of their physical and emotional being. You’ll want to note how they maneuver around the dining room table and chairs… how easy is it for them to get up off the chair?… does their movement show signs of instability?… Do they seem to be extra cautious when moving around?… Do they seem like they are present but not really participating like usual.

If your folks are in their 60s and 70s, you may notice the increasing number of missteps; or they seem startled as they turn around and nearly bump into someone… and it is happening more often; and then there is the number of times they scold themselves OR their spouse for not paying attention.

If they are in their late 70s and 80s… you’ll want to note whether they seem somewhat disconnected from the rest of the group. Do they pick a chair and stay there for the whole time? Do they express a fear of falling?
As a holiday voyeur, your observations can give you some insight into the health and well-being of those closest to you… and might also provide the basis for good dialogue.

Falls injury is the number 1 cause of injury and death for those over aged 70…and the number 1 cause of injury for people aged 65 and above. The subtle signs of instability are there so we can take action for a better, longer life.
Keep moving!

Mike
www.FallPreventionClinics.com

Older Adults-Caregivers & Mesothelioma

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Nov 292012

Caring for an Elderly Mesothelioma Patient by Tim Povtak

Mesothelioma is a rare cancer that is difficult to diagnose and even tougher to treat effectively, requiring a specialist who understands its intricacies. It is caused almost exclusively by exposure to asbestos, which was used extensively throughout America in the 20th century. Although the use of asbestos has been dramatically curtailed in recent decades, the lengthy latency period (20 to 50 years) between exposure and diagnosis is one reason the average age of a mesothelioma patient is 60-plus years old.

Surgery, chemotherapy and radiation – a multi-faceted approach – have proven to be the most effective tools in fighting mesothelioma, but they can be taxing on both patient and caregiver. For patients undergoing these taxing treatments, the risk of falling can add yet another layer of worry and complexity to the care.

While there is no cure for mesothelioma, and recent advances in therapy provide some hope, all too often an accurate diagnosis doesn’t occur until after the cancer has spread, thereby limiting the treatment options.
Like many cancers, mesothelioma is a disease that often effects more than just the victim, taking a physical and emotional toll on loved ones serving as caregivers. Caring for an elderly patient with mesothelioma can be a daunting task, requiring a commitment that, at times, might seem overwhelming.

Mesothelioma is rare (an estimated 3,000 Americans are diagnosed annually) and is often misdiagnosed by medical professionals and misunderstood by caregivers. Here are a few tips for caregivers to use:
- Educate yourself. Learn everything you can about the disease, about treatment plans, and symptoms and what to expect. It can help reduce the anxiety and frustration.
- Keep records. Mark down everything that happens and document every change in health and behavior of the patient, both the positive and negative. It can help eliminate confusion.
- Accept help. When friends or family members offer to help, accept it willingly. Caregiving for a mesothelioma patient is not a one-person job. It’s too big. Home-care services also can be helpful.
- Stay Healthy. Caregivers often put so much into their role that they neglect taking care of themselves, mentally and physically, which only adds to the problem. Take time away and find ways to reduce stress.
- Find a support group. Find others who are dealing with the same issues as you are.

“You have to make choices in fighting this disease. Fear will destroy you,” said caregiver Geri Lepore, who cared for husband Gene Lepore until he died in 2010. She shared her story with Asbestos.com. “It wasn’t ‘I have cancer.’ It was ‘we have cancer.’ It invaded our home, our family. But we never ran from it. We gave it our best.”

Tim Povtak writes about veterans and survivors of asbestos-related diseases for The Mesothelioma Center. For more information please contact Mesothelioma Center 189 South Orange Avenue suite 1600 Orlando, FL 32801 800-615-2270 or visit www.asbestos.com .

Keep moving,

Mike
www.FallPreventionClinics.com

FROM POINT A TO POINT B: A TALE OF TWO CITIES

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Nov 132012

In July, we took a trip to a beautiful lake about two hours north of Toronto Canada. My wife, sister-in-law and I were part of a family reunion retreat that was 10 months in the making. The drive is not particularly difficult…in fact…there are really only three changes in road names to our Canadian crossing; followed by one road change after that. Total road time without breaks is only about 13 hours…so I thought the trip would be easy. Point A…Naperville, IL Point B…Bracebridge, Ontario… Done!

It turns out that the real challenge was designing a travel arrangement that we three could agree on. For my part, I wanted to get up and drive straight through, allowing only sufficient time for potty and quick meal stops. My wife wanted to leave about noon, stopping just over the border so we stay overnight with a cousin we haven’t seen for many months… see some of the local colour (you have put a “u” in when in Canada) …and resume the trip after a leisurely breakfast with aforementioned cousin. My sister-in-Law was inclined to have no timeline at all…moving when the mood was right (which coincidentally was just about 2 minutes after my left eyelid began twitching as I paced like a caged tiger).

How in the world can getting from point A to point B have so many variations?

In a journey that many of see as simply a departure and an arrival… a senior who has fallen and has poor balance, often changes their view of the journey with every step. Simply getting from the kitchen table to the living room chair may be viewed as a road wrought with danger, fatigue, and worry. Their path may even include many quick stops… touching the wall or furniture along the way… like a hidden safety rope, reinforcing the balance that the mission requires.

Many times, seniors who fear a fall will simply stay put…having meals brought to them on a tray-table and opting for walkers and caregivers to assist with getting to and from the bathroom. For those seniors…the short distance between two points can feel like a hundred miles when they have no confidence in their capability to navigate.

As with most cases of balance, research shows us that even seniors of an advanced age can improve their balance and their quality of life. With some encouragement, a strategic plan that includes a talk with their doctor, and some daily activity that promotes balance… a senior can begin to enjoy their travels again. All they need is a place to start…

Keep moving!
Mike
www.FallPreventionClinics.com

Older Entries

Fall Prevention Clinics Blog

FALLING SIDEWAYS

AFTER YOUR SURGERY-WHERE SHOULD YOU GO ?

WHITE COAT CAMOFLAGE

WHEN DO YOU STOP TAKING YOUR HEART MEDICATIONS?

THE OIL & THE SNAKE

CONVENIENTLY SICK

ACCOUNTABLE HEALTHCARE/ACCOUNTABLE PATIENTS

THE HOLIDAY VOYEUR

Older Adults-Caregivers & Mesothelioma

FROM POINT A TO POINT B: A TALE OF TWO CITIES

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