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Heart Disease

Heart disease affects an estimated 62 million Americans, more than any other illness. Laurie Anderson RN FNP MSN is here to share information and advice on heart disease, its symptoms, treatments, and prevention.

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Tuesday, October 31, 2006

Emergency! Things Your ER Staff Wants You To Know
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Currently at WebMD there is an article called the "7 Pains You Shouldn't Ignore." It's an article that helps people without medical training to recognize the common symptoms of potentially life-threatening illnesses. Patients in the emergency department (ED) where I work often wonder if they have wasted their time (or the medical personnel's) by coming in for something they aren't certain about. Please, never worry about that!

The reason the ED exists is to make certain that you aren't having a medical emergency. If it turns out to be "nothing" then we'll do the happy dance with you. We would much rather that you come in earlier so that real problems can be treated in a timely manner, than to have you stay home while your heart attack or stroke or other serious illness gets worse. The sooner we can start treatment the more likely you are to have a full recovery to your former healthy self.

One word of advice however. It is not the job of the ED staff to diagnose your long-standing health problems. So if you suddenly decide that you 'can't take it anymore' in the middle of the night and come in for the chest pain that has been going on for months, don't expect that you're going to get the million dollar workup right then and there.

We'll make sure that you aren't having a heart attack, and then we'll tell you that we're pretty sure you have a little excess stomach acid. We will give you a prescription to stop acid production in the stomach and tell you to make an appointment with your primary care provider (PCP) for follow-up.

We'll only give you 10 days to 2 weeks worth of medication though, because we want you to see your PCP to make SURE that's the problem. It might be that you actually have a bad stomach ulcer, and you really need a check-up to make sure that it's not bleeding. You'll be sent to your PCP for the follow-up.

This brings me to a point that the ED staff would really like you to know. I don't care how young or old you are, you need to have a PCP in your community.

No health insurance? Then find a community health clinic that takes people without insurance and go there. Yes, hospitals HAVE to provide "free care" to those without insurance, but that doesn't mean that it happens easily. There is a lot of paperwork to fill out, you get good, but not personalized care, and you still get a portion of a very large bill.

Depending on what time of day you come in you also may have to wait HOURS to be seen! Better to call the clinic and get seen on the same day by someone who knows you and pay little to nothing based on an income scale. It will make you feel more like a human being that counts than someone the ED staff treats badly because you don't belong in the ED. I know it shouldn't be that way, but it happens.

We're not a primary care office. So when people decide that that they suddenly need their allergic, sneezing, runny nose treated or that ugly mole removed, or they can't stand the heartburn any longer and they have to drag the kids into the ED in the middle of the night, they should know they're going to get a little attitude from the ED staff. They want you to see your own PCP in the daylight hours for that stuff.

It's not that we don't want to work. I'm telling you, there are plenty of sick people who come to see us every day, and really need to be in the ED. But we want to concentrate on them, and we know you'll get better care in your PCP's office, with less expensive co-pays than you'll have to fork over in the ED (now typically $50.00 or more). We're also worried about the GERMS!

One word that DOES define the ED is germy (it contains a LOT of germs!). EDs and hospitals are full of sick people, so you need to consider whether or not it's worth exposing yourself to them. Ditto for your kids. If at all possible, don't haul the little ones along with you to keep you company in the ED. If you have to, then get someone to come pick them up as soon as you can.

Kids are going to get bored quickly and then they'll want to wander. If you're really sick you don't need to be worrying about what they're doing. If you're not, you'll soon see the wrath and annoyance of a busy ED nurse who is wondering why you had to drag the whole crew in at midnight while we looked at the earache you've had for 10 days.

The ED is a great place to go if you are really sick, including those items on the "7 pains" list. I would also add to that list any fever that you can't control with over the counter medications, and uncontrollable nausea and vomiting. We're here to help you to feel better, including treating life-threatening illnesses and getting you admitted to the hospital if needed.

If there is ever any doubt in your mind about whether or not to visit your local ED, then go. Better safe than sorry, and I promise you that no one will tell you that you should not have come for those 7 painful conditions, a high fever, or not being able to "keep anything down" in your stomach.

But always consider this question early in the day if you aren't feeling well: "What will I feel like 6 or 8 hours from now if this progresses?" If the answer causes you to be concerned, then you should call your PCP's office and ask for a call back from the provider.

If he or she advises coming to the ED, please come. But wouldn't it be better to get some advice from someone who knows you well, and can help you decide the best approach to your problem? It may be that with that kind of advice you can be saved a trip to the germy, overcrowded emergency department.

Related Topics: Watch Video Timely Hospital Care With Computerized Bed Board, Men Delay ER Trips to Watch Sports

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Posted by: Laurie Anderson, RNP at 2:42 PM

Thursday, October 05, 2006

Can't Read Food Labels? You're Not Alone
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A friend and I were just talking about food labels. Don't they drive you CRAZY? I hate it when I'm half-way through a bag/bottle/package of something that I think is 100 calories, and for some reason I look at the label a second time. Closer than the first time I glanced at it, right before I ripped it open and began to chow down...

Hmmm... There are HOW MANY servings in this bag/bottle/package??? What the heck? There are 2.5 servings in here? Does anyone out there actually have 1 and a 1/2 friends they share a snack with? If you do, will you please drop me a line (and a picture) telling me about that friend? Because I want to see that!

As reported in the November issue of the American Journal of Preventive Medicine, dietary information presented in food labels may be "well beyond" individual's ability to understand, especially those with lower math skills.

In a study from June 2004 to April 2005, 200 primary-care patients (average age 43, 72% women) from a wide socioeconomic range, filled out a Nutrition Label Survey. The survey was designed with input from registered dietitians, primary care physicians, and authorities in health literacy and numeracy.

At first glance most patients (89%) felt the food labels were a snap. Yet on average, only 69% of them answered food-label questions correctly. And broken down, even that figure turned out to be misleading.

First the participants completed standardized math and reading tests; 68% of these individuals had some college education and 75% of them had at least a high school education.

Among these participants' results, 77% had at least 9th grade reading skills, but only 37% had 9th grade math skills. The results of the food label reading portion of this study reflected this math deficiency. For example, slightly less than 1/3 of the patients (32%) could calculate the number of grams of carbohydrate (67.5) consumed from a 20-ounce bottle of soda that contained 2.5 servings (total carbohydrates per serving = 27 grams).

Only 60% of patients could determine the number of carbohydrates consumed if they ate half a bagel, when the serving size was a whole bagel. In a summary of the nutrition questionnaire errors, the researchers said there were 970 errors in the subjects' responses to the first 12 items on the questionnaire. Frequent errors included misapplication of the serving size (325 errors), confusion due to extraneous material on the food label (369 errors), and incorrect calculation (276 errors).

Those individuals who did the best on the questionnaire tended to have a higher income and educational level, and to score better on the standardized tests for reading and math ability.

According to the researchers, the FDA is considering changes to food labels, with the aim of improving comprehension. In the meantime the researchers strongly recommend that individuals who need to understand food labels in order to self-manage chronic illnesses such as diabetes and high blood pressure be referred to a registered dietitian for assistance. These health care professionals have the time, resources and training to assist patients to understand food labels.

If you feel that you have difficulty reading food labels and would like to improve your own understanding, ask your primary care provider to refer you to a clinical dietitian for assistance. It is usually paid for by insurance, as long as there is a documented reason, such as high blood pressure (hypertension), diabetes, high cholesterol levels, a need for weight loss or other documented concern.

Laurie

Primary source: American Journal of Preventive Medicine
Source reference:
Rothman, RL, et al, "Patient Understanding of Food Labels: The Role of Literacy and Numeracy," American Journal of Preventive Medicine 2006; 31 (5): doi: 10.1016/j.amepre.2006.07.025



Related Topics: WebMD Video: Decode Labels and get Supermarket Savvy, Learn to Decipher "Nutrition Facts"

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Posted by: Laurie Anderson, RNP at 12:03 AM

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