Cholesterol news...PO Day 243

It's all over the news so you've probably seen this already. But eveyrthing we've been taught and believed about cholesterol and diet is out. For years one of our doctors has loved to say,"If you are eating more than two eggs a week, you are on a high cholesterol diet." And he was including the eggs that hide in so many dishes like cake or bread or so many casseroles. I wouldn't say it changed our eating habits but it did make us feel guilty.

Now medical research is telling us that the cholesterol we eat has very little to nothing to do with the cholesterol in our blood which is where the trouble origininates. I guess what they are saying is that we still should worry about our LDL or HDL but there is nothing we can do about it! That is, short of taking a statin drug if indicated. And cursing our genetic heritage.

So continue to limit beef and pork in your diet and other sources of saturated fats. Exercise has a good effect on cholesterol levels, as does a little wine, just one glass, please. All things in moderation seems to be a good policy since science keeps changing the rules on us!

Insomnia. Drugs...PO Day 242

Ever since I fell and broke my shoulder , July 2013, sleeping has been a terrible problem. Mostly it has been the discomfort and not being able to sleep on that side. I think insomnia is associated with broken shoulders so it's not just me. Even now that I have much less discomfort I still do not sleep well. Now I think it is more habit than pain that keeps me awake.

When friends or acquaintances hear about my sleep trouble many of them suggest over the counter drugs that work for them. But I have resisted and now I am really glad that I have!

According to BBC.com researchers at the University of Washington followed 3,434 senior aged people for eight years. Of particular interest was their use of anticholinergic drugs like Nytol for sleep and antihistamines Benedryl and Piriton.

During the course of the study 23% of the participants developed dementia, Alzheimer's disease mainly. People who took the highest doses of anticholinergic drugs had a higher rate of getting dementia and a 63 percent higher risk for Alzheimer's. The suspect drug was present in antidepressants, sleeping pills, and bladder control drugs and was most likely to cause trouble if taken for more than three years.

This is a terrible situation to be in. The anticholerinergic component that's the problem is in over the counter drugs to treat these medical problems. I don't know if it is in prescription drugs that might treat the conditions but if it is I'd be asking my doctor about it. Is a good night's sleep worth the increase in the risk of developing Alzheimer's? I don't think so.

Trekking poles...PO Day 241

I've been thinking about why I feel like my arm-muscle pain is less.  Of course it has to be mainly the passage of time. Tincture of time, Dear Husband says. But also, I have returned to walking with two hiking sticks or poles. I walk for one hour and, while I am not putting out a lot of energy, swinging even a light weight stick for an hour does a body good. I can certainly feel the effects. While the sharp post surgical pain is better, my arm is somewhat sore in the  good work out feeling one gets from exercising. I'm a believer.

Here's a summary from outdoor gear lab.com of what using trekking poles can do for you:

1. Trekking poles, like ski poles, allow your arms to help propel you forward and upward. Whether walking on flat ground or up steep hills, poles can help to increase your average speed.

2. Poles reduce the impact on your legs, knees, ankles, and feet. This is especially true when going downhill. A 1999 study in The Journal of Sports Medicine found that trekking poles can reduce compressive force on the knees by up to 25 percent.

3. Trekking poles can be used to deflect backcountry nuisances. They can push away thorny blackberries and swipe away spider webs that cross trails-- which can help to make you more comfortable.

4. Walking with poles can help you establish and maintain a consistent rhythm, which can increase your speed. This is especially true on flatter, non-technical terrain. 

5. The extra two points of contact significantly increase your traction on slippery surfaces like mud, snow, and loose rock.

6. Poles help you maintain balance in difficult terrain such as during river crossings, on tree root-strewn trails, and on slippery bog bridges. Staying balanced in turn helps you move more quickly and more easily.

7. Poles can act as a probe to give you more information than you can get with you eyes. Use them to learn more about puddles, melting snow bridges, and quicksand.

8. They can help to defend against attacks from dogs, bears and other wildlife. Swing them overhead to make yourself look bigger or throw them like a spear.

9. Trekking poles help to alleviate some of the weight you carry. For example, if you have a heavy pack on, and you take a short break, leaning on the poles will make you more comfortable.

10. Trekking poles can be used for things other than trekking. They save the weight of bringing dedicated tent poles; pitching a shelter with trekking poles can save up to two pounds. (Trekking poles are also much stronger and more rigid than tent poles, so they're less likely to break in high winds. This help creates safer shelters.) Poles can also double as a medical splint and can serve as ultralight packrafting paddles.

Right again...PO Day 240

I'm trying to be more self aware, pay attention to what is happening as it happens, not wake up one morning and be surprised by changes. That's how it usually is. That's how it was when I was surprised to realize the pain in the bicep part of my operated arm wasn't there anymore.

So, I shouldn't be saying this outloud but I think the pain in the tricep part of my operated arm is lessening. There are a million little things I do now that I have been avoiding for more than a year. I can raise the lever for the bowl of my kitchenaid mixer with my right hand. I can stir the chocolate chips into the stiff cookie dough good enough that there are actually chips in the last five or ten cookies. I can turn the shower lever on and off with my right hand and wash my hair with my right hand. I can iron several items and do it better than before. I can open most jars, but still not the childproof medicine bottles. I can reach the miscreant sock that hides at the back wall of the dryer.

I can finally do these things mostly without pain. There is some discomfort still if I actually reach behind my back but even that is improving,

I am adroit again...capable, able. Or french for right handed.  And no longer gauche...awkward, uncoordinated. Or french for a leftie. Not even ambidextrous, which is pretty much how I have been functioning for the recent months. In french, ambidextre.

What a shame left handed ness has carried such a stigma through the past. Thank goodness left handed children are no longer punished for using the left hand to write or throw or eat. And isn't it amazing that so many of our modern day presidents have been lefties....Truman, Ford, Bush (HW), probably Reagan, Clinton, and Obama. I've read that left handed people who have to function in a right handed world grow up to be more flexible and creative. I'm hoping that my spell as a leftie made me grow a little intellectually. Physically, I am still shrinking.

Sunday night TV...PO Day 239

It's Sunday night at 9:00 PM and I am not thinking about reverse total shoulder arthroplasty surgery. I am one of the 120 million people worldwide who is glued to PBS television during the "season" to watch Downton Abbey, the period series set in the early decades of the twentieth century. Renowned for its attention to detail, the series follows the titled family and their staff through love, marriage, death, births, the Titanic, WWI, economic crashes, successes, rebellion and upheaval. I read that the director is so dedicated to authenticity that there is a ban on soft drinks and associated containers after a soda can showed up on a mantle in a publicity photo.

So that's why I can't get over the Mrs. Patmore predicament.

In Season 1 episode 7 Lord Grantham sent Mrs. Patmore off to London to have cataract surgery. It was successful and she returned to Downton Abbey to cook another day. Things came out so well that she doesn't even wear reading glasses, let alone glasses for distance. While that might be possible today, it just wasn't the way it worked in that era. Where is the ophthalmic consultant on set? Where are the letters to the writers demanding accuracy?

In the first half of the 20th century cataract surgery was done, that's true. The cloudy lens (the cataract) was removed and light and color flooded into the eye again. But without the lens the image was totally unfocused, completely blurred. Hence, those coke bottle bottom glasses-think Claude Monet or George Burns. The next advance post WWII was contact lenses which were cosmetically and functionally a huge improvement. It wasn't until the late 1970's- early 1980s intraocular implants came along, putting the lens inside the eye rather than outside. But in the post WWI era, cataract
glasses were the only choice.

So, where are Mrs. Patnore's glasses? Good heavens, she's not even wearing a pince nez.

Okay, I admit it, I am a bit obsessed.

Who has more injuries?...PO Day 238

Who would you think had more injuries, Nursing assistant staff or construction workers?  I would have guessed construction workers but I would have been wrong.

NPR, National Public Radio, reported that nursing staff suffered more musculoskeletal injuries due, mostly, to the strain of lifting patients. Nursing staff experienced injury more than police, correctional officers, truckers and repair workers. When compared by injuries per 10,000 full time employees, nurses and orderlies suffer musculoskeletal injury at about TRIPLE the rate of construction workers! In 2010 the healthcare industry reported 600,000 workplace injuries. That was more than any other occupation. It cost the system $3.1 billion in 2011.

The problem originates with trying to move the patient. Techniques for doing it go back decades. There is just no good way to do it and protect the nurse's back. Extra manpower, or should I say nurse power, helps but is not always available. A cooperative patient is a plus but that is not always possible. When I was brought to a room from the ER after being treated for a collapsed lung I was limp as a wet noodle. I had to be moved from the gurney to the bed. I wanted to help but could not even lift an arm. Fortunately the attending nurse called for help and three other nurses appeared. Each  grasped the side of the sheet on which I lay, pulled it taunt, and half lifted-half slid me from gurney to bed. It took seconds and was unbelievably efficient. But I wonder how well it would work with a patient who weighted, say, 300 pounds.

The VA is working to install special equipment to lift patients, as has Baptist Health Systm in Florida. They report lifting injuries have been reduced by 80%. But such change is expensive and slow to be
put in place. In the meantime, hospitals are focusing on encouraging nursing staff to be physically fit.

I'm not sure being physically fit protects one from the physical stresses that result in back injuries. In the short run calling for help and getting it is a good idea. Long term, the mechanical patirnt lift mechanism is the answer.

Lung cancer screening...PO Day 237

As usual, I am off topic. But this seemed important.

CMS, Centers for Medicare and Medicaid Services (I had been wondering what CMS stood for), has announced they will begin covering lung cancer screening. This is in spite of the negative recommendation by the panel that reviews such matters.

Screening will be with a low dose cat scan which is excellent since cat scans can be heavy on the radiation. Screening will be available for patients between 55 and 77 years of age. Patients will be eligible for a scan once a year, much in the same way mammograms are covered. Persons who are current smokers, those who have quit in the past fifteen years or those who smoked a pack a day for thirty years will be covered. A prescription from your doctor will be required.

Lung cancer is the third most common form of cancer and the leading cause of cancer deaths in the US. It has surpassed breast cancer as the leading cause of cancer death in women in the western world. Proponents say screening could prevent up to 20 percent of  deaths from lung cancer, comparable to mammogram and colonoscopy screening.

Supposedly this is an expensive test, running in the $300 range. But it seems that for everything else medicare approves a much lesser amount so it will be interesting to see what the fee actually turns out to be.