Health and Disability

Imagine your mother needs to move into a nursing home. It’s going to cost her almost $100,000 a year. Very few people have private insurance to cover this. Your mother will most likely run out her savings until she qualifies for Medicaid.

This is not a rare event. Roughly one in three people now turning 65 will require nursing home care at some point during his or her life. Over three-quarters of long-stay nursing home residents will eventually be covered by Medicaid. Many American voters think Medicaid is only for low-income adults and their children — for people who aren’t “like them.” But Medicaid is not “somebody else’s” insurance. It is insurance for all of our mothers and fathers and, eventually, for ourselves.

The American Health Care Act that passed the House and is now being debated by the Senate would reduce spending on Medicaid by over $800 billion, the largest single reduction in a social insurance program in our nation’s history. The budget released by President Trump last month would up the ante by slashing another $600 billion over 10 years from the program. Whether the Senate adopts cuts of quite this magnitude or not, any legislation that passes the Republican Congress is likely to include the largest cuts to the Medicaid program since its inception.

So, following the lead of the current president of the British Geriatrics Society, the highly literate and entertaining David Oliver – see iti.ms/166DxIC – it is clearly time that we in Ireland developed a profanisaurus of ageing, highlighting the negativity of certain words and phrases, rooted in ageism and indifference to the needs of older people, and avoiding their use.

After “step-down”, there are a host of candidates jostling for a place in the Profanisaurus, starting with the terrible twins of “bed-blockers” and “delayed discharges”. Spawned from the same bedrock of the adversarial patient management system as “step-down”, these phrases imply action or inaction on the part of vulnerable patients and their families that prevent access to healthcare services for others.

First, it is a complete misreading of the challenging nature of the hospital experience. Virtually anyone who can leave to get back to their own home, no matter how humble, will do so as soon as possible.

Second, it is a derogation of the broader duty of medical care above and beyond specific medical and surgical procedures. For example, if Mrs Murphy was continent, mobile and clear in her mind before admission, and is now impaired in all three areas, there are clearly medical and care issues that remain to be addressed through diagnosis, treatment, rehabilitation and support.

Both elderly and children appear to have a higher incidence of cognitive brain problems after even routine surgery. It has been considered that both have delicate blood flow to regions in between the large vessels. These are called watershed regions. It has been postulated that not being able to guarantee perfectly even oxygen during anesthesia to these regions might be causing these problems. But, this mechanism has not been proven. Recent studies with children after surgery show inconsistent findings—one implying a higher incidence of cognitive brain problems.

In the elderly there are no exact studies because of problems performing them, but the percentage of those with mental changes after surgery is great—some considered a reversible delirium and some small regions where a lack of oxygen causes very small microscopic strokes that cannot be seen on MRIs. There is no question that there is a greater amount in the elderly, but the reasons have not been clear. It may not be from loss of oxygen, but rather signals from parts of the body related to inflammation after a physical assault might be altering the brain.

A few simple exercises can help relieve TMJ pain. People should begin by gently massaging the painful area. This can help reduce tension and pain. It also makes it easier to exercise the joint and the muscles that surround it.

Strengthening exercises

Strengthening exercises are best to perform between TMJ flare-ups. During times of intense pain, they can make the pain worse.

Preventing damage in young children is a critical step in managing this disease.....

https://goo.gl/Ymuc65

A drug for cystic fibrosis has improved lung function in children under the age of 12, raising hopes that the life-threatening lung damage caused by the genetic disease can be halted or even reversed.

“It’s a major step forward,” comments Nick Medhurst, head of policy at the UK charity, the Cystic Fibrosis Trust. “What these results show is that it can prevent irreversible damage.”

Since the CFTR gene was discovered in 1989 researchers have tried to develop drugs that directly target the faulty protein it makes in those who have the disease, with some success. Kalydeco helps cells make a correct version of the CFTR protein and has been available since 2012, but it only works for CFTR mutations present in 5 per cent of people with the condition.

By combining Kalydeco with another drug called lumacaftor to create a single medicine called Orkambi, clinicians have since targeted the most common CFTR mutation and extended treatment options to half of all people with cystic fibrosis. Orkambi has been approved in the US, EU and other countries, and has been shown to reduce the number of lung infections people with cystic fibrosis get. However it is not available on the NHS in the UK, because the body NICE – which assesses the cost-effectiveness of drugs – has deemed the benefits of Orkambi to be too low for its high cost. Treatment costs £104,000 a year.

But new results from a phase III clinical trial suggest that the drug can stop the otherwise inexorable damage to the lungs that people with cystic fibrosis experience throughout their lives. The results also show that the drug can be beneficial for young children. At present, Orkambi is only approved in the EU for people over the age of 12.

“We’ve shown that even in younger patients who have relatively mild disease, Orkambi led to improvements in lung function,” says Felix Ratjen, of the Hospital for Sick Children at the University of Toronto, in Canada.

This is an interesting model for managing complex pharmacy need. Does anybody know of a Michigan program like this?.....

https://goo.gl/dmrvj4

The law addresses how pharmacy technicians can accommodate the new workflow. “As we place pharmacists in positions to provide more care, we have to maximize the role of our pharmacy technicians and get them more involved in the provision of the care as part of the pharmacy team,” said Micah Cost, PharmD, MS, executive director of the Tennessee Pharmacists Association.

This is a great site about chronic pain.....

https://goo.gl/TQeHU6 

In this episode, we tell you about an internet-based research tool named PubMed.gov. It can help you quickly get your hands on straight-from-the-lab findings and conclusions published by the world’s leading experts in every medical field. Those published papers are often packed with important insights that can help shape your health-care decisions and make you a savvier patient.

We let you know how well PubMed.gov works based on three criteria:

• Is it effective?

• Is it easy to use?

• Is it inexpensive?

Hyperfunctional voice disorders (HVDs) are hard to describe but easy to hear. People with the condition produce a grab-bag of forms of unusual voice behaviors that make them more difficult to follow. Nodules on the vocal cords may trigger the condition, but it may linger after the nodules are removed by surgery. Voice exercises or other treatments sometimes work and sometimes do not.

And although HVDs are the most common class of voice disorders, afflicting about 3% of the U.S. population, their causes are not well understood. Doctors typically attribute the condition to emotional stress that affects the performance of muscles involved in speech.

A study by researchers at Boston University College of Health & Rehabilitation Sciences: Sargent College, however, suggests that a neurological problem affecting those muscles also can be to blame.

“We show the first evidence that some HVDs may be due to a motor control disorder, in which patients improperly process what they hear,” says Cara Stepp, an assistant professor of speech, language and hearing sciences at Sargent College. “This is a very small study, but it’s important because no one previously showed a neurological cause for this condition.”

“Calling this condition ‘hyperfunctional’ suggests that it is something that you should just be able to stop doing, but that’s clearly not true,” says Stepp, the lead author on a paper about the research in the Journal of Speech, Language, and Hearing Research.

In some cases, she notes, people can regain their normal voices after rigorous massages or other treatments, but these successes are often followed by a relapse of the condition.

The reconciliation of these two so-called opposites is that low-calorie intake and very low weight aren't the same things. As anyone who is in their 60s or 70s and trying to lose weight can tell you....

https://goo.gl/rj1cOm 

People who are underweight in middle-age – or even on the low side of normal weight – run a significantly higher risk of dementia as they get older, according to new research that contradicts current thinking.

The results of the large study, involving health records from 2 million people in the UK, have surprised the authors and other experts. It has been wrongly claimed that obese people have a higher risk of dementia, say the authors from the London School of Hygiene and Tropical Medicine. In fact, the numbers appear to show that increased weight is protective.

At highest risk, says the study, are middle-aged people with a BMI [body mass index] lower than 20 – which includes many in the “normal weight” category, since underweight is usually classified as lower than a BMI of 18.5.

These people have a 34% higher chance of dementia as they age than those with a BMI of 20 to just below 25, which this study classes as healthy weight. The heavier people become, the more their risk declines. Very obese people, with a BMI over 40, were 29% less likely to get dementia 15 years later than those in the normal weight category.