Hospital, Dignity, Reality

[tonyb]

For my money, Atul Gawande has written perhaps the most insightful, non-partisan, least doctrinaire, and practical treatises on the health-care system, and what might be done to improve its outcomes and lower its costs. I found particularly enlightening his comparison of costs and outcomes in places where physicians and other health care providers are mostly employees (of universities and other large institutions) and where they are mostly self-employed.

 

[randooch]

I concur. His articles on the subject are startlingly clearheaded, informative, and direct.

 

[sheeplady]

Yup, I quoted sloppily. 28 weeks has a good chance of survival, but it isn't until 32 weeks that the chances are more or less equal with a fully grown baby.

That wasn't meant as a criticism, just an explanation of what we see here. I was pretty amazed when I started to read those figures. 90% is pretty darned good at 28 weeks- basically 9-11 weeks early. Before modern NICUs, babies born before 32 weeks didn't have a chance.

 

[SHOWSOMECLASS]

Regarding Red Diablo's post. I was talking w/ a friend in his early fourty's who said his Dr. told him he had border line sleep apnea and the problem could be resolved if he lost the extra lbs. he was carrying. If not it would advance as his weight increased and this would require a c-pap unit.
Now he is on the c-pap. My point is he had a choice.

Many folks are on drugs because they go to their Dr. and want a quick fix for what quite frankly are normal problems for aging people.
Myself for example, have problems sleeping. If go to my Dr to get a quick fix. Yes I can get a Rx.
I believe I occasionally have IBS. If I go to my Dr. to get a quick fix. Yes I can get a Rx.
I sometimes have bad headaches. If I go to my Dr to get a quick fix. I can get a Rx.
I regularly have joint pain and muscle stiffness. I can go my Dr and get a anti inflammatory and a a pain killer for that.
Instead I think about my age, job, genetics and realize this is somewhat normal. I am not against medicines. Perhaps at some point in the future I will see the Dr for any and all of these symptoms. For now I will stretch, exercise, apply ice, watch my diet and weight and go to the Dr as a last resort.

Some people have unrealistic expectations about their health. Second they want a quick fix or to feel like they did when they were young. Understood. But I don't believe our grandparents would have visited the Dr. unless their was no other option.

 

[LizzieMaine]

That's certainly the way I was raised, you didn't go to the doctor unless you were flat-on-your-back sick, and a lot of the things that are heavily medicalized today were considered just a normal part of life. I've suffered from violent migraines since I was ten years old, and I've long since given up on going to the doctor about it -- it's just something that happens, and when it does I deal with it with caffeine and aspirin. I know from costly experience that an expensive Big Pharma prescription isn't going to make me feel any better than a bathroom-sink remedy will.

 

[Baron Kurtz]

It's very true that we're probably overly likely to run to the doctor as a first resort for any ache and pain, and that flat-on-your-back-in-pain was the lowest threshold for doctoring when I was growing up.

However, seeing my father literally flat on his back in pain after his first angina attack, having ignored the years of progressively worsening pains in his chest, convinces me that this attitude was taken far too literally in previous generations. A major problem in males of a certain age is a reluctance to go to their doctor, particularly where prostate, testicle or lower digestive tract are involved. We (males) therefore have come along a bit from those old attitudes and are now more likely to visit our doctor, but we have a ways to go …

bk

 

[tonyb]

Indeed.

Delaying a visit to the doctor can indeed be fatal. My biological father's little digestive problem, which he ignored until he no longer could, turned out to be metastatic colon cancer, spread all through his abdomen by the time it was diagnosed. He was a goner a matter of months later, age 27. Same story with my maternal grandmother, who treated herself with over-the-counter hemorrhoid medicine before finally taking herself to the doctor. She was in her early 50s when she croaked.

Me, I see a gastroenterologist regularly. I get scoped.

 

[sheeplady]

I think it's a balance between the two- running off the to the doctor for every little ache and pain versus total avoidance.

I suffered from severe back pain from about 14 years of age until I was about 28- the pain was so bad I couldn't sleep most nights and I had no idea how I could make it through to old age. I didn't go to the doctor because I was told that they'd only want to medicate or operate. If I went to a chiropractor, they could mess me up. And after all, I was getting older, and wasn't pain part of the deal? Finally, it got so bad that I couldn't stand it, and I went to an OD after a lot of research.

I wept for a half an hour in my car following my first adjustment- I have rarely cried that hard in my life. I didn't know that it didn't have to hurt to stand up straight. I also regained almost 2 inches of height. If I had waited another 10 years, my body probably would've stayed that way and I would've needed to be medicated and/or surgery.

Now, if I don't feel right, I go to the doctor. I always ask if there is anything I can do to avoid medication or surgery to treat it. If they say no, I do my own research and get a second opinion. I'm lucky to be pretty healthy, but I'll be damned if I'm going to suffer needlessly and make a problem worse.

 

[Bluebird Marsha]

I've been fortunate in my life (so far). I recently had my Very First Surgery (there ought to be a picture book for adults on the subject ). It was minor surgery, and I can't say enough about how good my doctor and the hospital were. One lesson I learned as a single person - be very careful about the friend you ask to accompany you, I ended up having to stay in the hospital for quite a few hours longer than anticipated (it was minor surgery), and I and the staff told my friend she could go back to work, and we'd call when we needed her. The ding bat didn't keep her phone handy. Lucky I didn't have a real problem!

I will say that one thing that shocked me is how easy it is to "doctor shop" in order to get medications you don't/shouldn't have. Just before she died, my step-grandmother was admitted to the hospital, and when the staff put her on the appropriate level of pain medications, she reacted like the drug addict she was. They were horrified when my dad brought in the bucket of prescriptions she took. In an another case of medical personnel being sane, humane people, they decided that it wasn't the time to try and fix her addiction problem- they just increased her "pain" medication to a level that worked for her. I can't help but believe that she hastened her own death through her behavior. But it was equally sad that there are doctors who are willing to give a person anything they ask for.

 

[SHOWSOMECLASS]

We recognize w/ the progress of medicine and Rx. Our longevity and quality of life has benefited. But technology and modernization has made people feel unqualified to know what is serious and what is clinical evidence of aging. In the past people were uneducated and endured pain and symptoms we now recognize as red flags or abnormal symptoms that should be diagnosed. The modern contrast is people who are unwilling to make life changes to improve their health or want to feel pain or symptom free and take multiple Rx.
My mother in law takes two Rx. to compensate for the other Rx. side affects. We won't go down that road.
My observation is, a great number are not self reliant and run to the Dr. to fix everything.

 

[tonyb]

I recommend a quick read titled "You're Only Old Once," by some obscure fellow named Theodor Geisel.

 

[sheeplady]

I will say that one thing that shocked me is how easy it is to "doctor shop" in order to get medications you don't/shouldn't have. Just before she died, my step-grandmother was admitted to the hospital, and when the staff put her on the appropriate level of pain medications, she reacted like the drug addict she was. They were horrified when my dad brought in the bucket of prescriptions she took. In an another case of medical personnel being sane, humane people, they decided that it wasn't the time to try and fix her addiction problem- they just increased her "pain" medication to a level that worked for her. I can't help but believe that she hastened her own death through her behavior. But it was equally sad that there are doctors who are willing to give a person anything they ask for.

I have an aunt who does this- she has scripts from multiple doctors at multiple pharmacies. She also gets scripts for her father (my grandfather) for pain medication and takes it. In some cases, she has stolen medication my grandfather needed after surgery from him (as opposed to getting scripts in his name he doesn't know about). However, because there is no universal tracking mechanism and her doctors get paid no matter what (and I doubt her doctors are at all ethical- just like many people in a lot of professions), there's no way to stop it. My grandfather even had the cops into the house and the they noticed she had narcotics in her bedroom with different names on them than hers, but nothing could be done about it and my aunt then accused my grandfather of having dementia.

The sad thing is that because of limited resources, she gets medicine that harms her while others can't get it from their insurance when they need it because she is hogging the resources.

 

[SHOWSOMECLASS]

"Winning" an argument is way too often considered a worthy end in and of itself, no matter how illusory that "victory" truly is.

Wow Tony, that was a beautiful although poignant post. Three quarters of the people I work w/ fit this personality type. That is why Type A's are in my profession. Yet it becomes a challenge to deal w/ them on a day to day basis. Especially if they are in leadership positions. If you know what I mean.

 

[countryclubjoe]

Hi Folks

Great discussion. I am closer to 60 YO then 50 yo. The nurse's and doctors at the hospital seemed astonished when I informed them that I was on no medications.
TIA
Best regards
CCJ

 

[Baron Kurtz]

I was amazed by how over-drugged and over-prescribed many of my US peers (at the time 21-30-year-olds) were. It was seen as just "how it was" to take pills every morning, for whatever ailment (real, or supposed).

As an example of how it all goes wrong, a known side effect of many SSRIs is to raise blood pressure in a small number of a patient cohort (normally 2-5%, depending on the particular drug). A postdoctoral sceintist in my lab in Indiana was a bit of a hyperchondriac and so would use those blood pressure machines (25 cents for a blood pressure reading) whenever he saw one. he was a bit overweight so was worried his blood pressure seemed a bit low. Went to his family doctor who confirmed it was a bit low … And wrote a prescription for Prozac! Hmmm, let me wonder which drug company's books that particular doctor is on? But really, prescribing a mood-altering (and potentially suicide-inducing) drug to overcome blood pressure issues? Where do these guys learn medicine?

As an aside, I should note that in 5 years of medical school, one of my undergraduate buddies never bought lunch, dinner, stationery or textbooks. All of these were provided by the friendly drug company reps who surround and groom the medical students in the UK. It was apparently never ending, the hassle from these guys (just doing my job!!). As another aside, we were talking about evidence, and numbers, earlier. Here's the kind of evidence that pops up in the literature. Beware the unreliable narrator! I wonder who funded this study? To distill: They say that a drug produced by a particular company increases blood pressure less in this study than reported in another study for a drug produced by another company. Note: these numbers are not directly comparable. This is dodgy statistics being used to try to prove better efficacy of a particular drug. I'm willing to bet at least one of the authors (if indeed they actually took part and the paper is not ghost written) is in the pay of the company that makes the "better" drug. This situation is rife in the literature.

Blood pressure changes during short-term fluoxetine treatment.
J Clin Psychopharmacol. 1999 Feb;19(1):9-14.
Recent reports of sustained hypertension in some patients receiving venlafaxine have rekindled concerns about antidepressant-induced hypertension. This study examined sitting and standing systolic and diastolic blood pressure, pulse rate, and rate of sustained hypertension in 796 depressed patients (mean +/- SD age, 40 +/- 11 years) taking fluoxetine 20 mg daily for up to 12 weeks. A modest reduction in sitting and standing systolic (p < 0.001) and diastolic (p < 0.001) blood pressure measures were observed in the entire patient sample. Patients with pretreatment diastolic blood pressure < 60 mmHg (N = 32) showed a modest increase in mean diastolic blood pressure (p < 0.001), whereas patients with pretreatment diastolic blood pressure > or = 90 mmHg and < or = 95 mmHg (N = 57) had a modest reduction in mean diastolic blood pressure (p < 0.001). Patients with preexisting, stable cardiovascular disease (including hypertension) (N = 35) showed no significant blood pressure change (p = not significant). Of the patients receiving fluoxetine, 1.7% had sustained hypertension for > or = 3 consecutive clinic visits-a rate significantly lower than that previously reported with venlafaxine (4.8%) (chi2 = 13.3, p < 0.001) and similar to that previously seen with placebo (2.1%). In conclusion, these data demonstrate a low rate of sustained hypertension (1.7%) during short-term fluoxetine treatment.

 

[Red Diabla]

I will say that one thing that shocked me is how easy it is to "doctor shop" in order to get medications you don't/shouldn't have.

I was just reading this article from the LA Times about prescription deaths. Sad and fascinating how easily it can happen.

 

[jamespowers]

I was amazed by how over-drugged and over-prescribed many of my US peers (at the time 21-30-year-olds) were. It was seen as just "how it was" to take pills every morning, for whatever ailment (real, or supposed).

As an example of how it all goes wrong, a known side effect of many SSRIs is to raise blood pressure in a small number of a patient cohort (normally 2-5%, depending on the particular drug). A postdoctoral sceintist in my lab in Indiana was a bit of a hyperchondriac and so would use those blood pressure machines (25 cents for a blood pressure reading) whenever he saw one. he was a bit overweight so was worried his blood pressure seemed a bit low. Went to his family doctor who confirmed it was a bit low … And wrote a prescription for Prozac! Hmmm, let me wonder which drug company's books that particular doctor is on? But really, prescribing a mood-altering (and potentially suicide-inducing) drug to overcome blood pressure issues? Where do these guys learn medicine?

As an aside, I should note that in 5 years of medical school, one of my undergraduate buddies never bought lunch, dinner, stationery or textbooks. All of these were provided by the friendly drug company reps who surround and groom the medical students in the UK. It was apparently never ending, the hassle from these guys (just doing my job!!). As another aside, we were talking about evidence, and numbers, earlier. Here's the kind of evidence that pops up in the literature. Beware the unreliable narrator! I wonder who funded this study? To distill: They say that a drug produced by a particular company increases blood pressure less in this study than reported in another study for a drug produced by another company. Note: these numbers are not directly comparable. This is dodgy statistics being used to try to prove better efficacy of a particular drug. I'm willing to bet at least one of the authors (if indeed they actually took part and the paper is not ghost written) is in the pay of the company that makes the "better" drug. This situation is rife in the literature.

Blood pressure changes during short-term fluoxetine treatment.
J Clin Psychopharmacol. 1999 Feb;19(1):9-14.
Recent reports of sustained hypertension in some patients receiving venlafaxine have rekindled concerns about antidepressant-induced hypertension. This study examined sitting and standing systolic and diastolic blood pressure, pulse rate, and rate of sustained hypertension in 796 depressed patients (mean +/- SD age, 40 +/- 11 years) taking fluoxetine 20 mg daily for up to 12 weeks. A modest reduction in sitting and standing systolic (p < 0.001) and diastolic (p < 0.001) blood pressure measures were observed in the entire patient sample. Patients with pretreatment diastolic blood pressure < 60 mmHg (N = 32) showed a modest increase in mean diastolic blood pressure (p < 0.001), whereas patients with pretreatment diastolic blood pressure > or = 90 mmHg and < or = 95 mmHg (N = 57) had a modest reduction in mean diastolic blood pressure (p < 0.001). Patients with preexisting, stable cardiovascular disease (including hypertension) (N = 35) showed no significant blood pressure change (p = not significant). Of the patients receiving fluoxetine, 1.7% had sustained hypertension for > or = 3 consecutive clinic visits-a rate significantly lower than that previously reported with venlafaxine (4.8%) (chi2 = 13.3, p < 0.001) and similar to that previously seen with placebo (2.1%). In conclusion, these data demonstrate a low rate of sustained hypertension (1.7%) during short-term fluoxetine treatment.

Yes indeed. In other words, the less medication you can get by with the better.
You need one drug for the original problem like hypertension. The you need another drug for the side effects of that drug and another drug for the side effects of that drug and on and on. lol lol

 

[sheeplady]

What is really disturbing to me is that while many drugs treat the problem on the surface, they don't seem to prolong life or prevent serious issues. For instance, I've read a little of the research on statins. While it appears that statins do lower cholesterol, they don't actually lower the incidents of heart attacks (according to what I've read, which is really limited). But still they are prescribed to people who are borderline of needing them as far as cholesterol levels (mildly high cholesterol). And they aren't exactly cheap meds and they do have some serious side effects as far as quality of life for some people.

 

[Baron Kurtz]

Tat sounds about right. Take a drug to prevent cholesterol formation, but keep stuffing one's face with saturated fats and other unhealthiness, one is still going to have problems …

 

[jamespowers]

Tat sounds about right. Take a drug to prevent cholesterol formation, but keep stuffing one's face with saturated fats and other unhealthiness, one is still going to have problems …

Yes. They are treating the symptoms and not the cause of the problem.