Sunday, April 18, 2010

HEALTH REFORM CHANGING RAPIDLY

As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs
Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.





There is a lot buried in the 2400 pages n the health reform bill passed. Key players are in place  and changes will occur very soon.  Be prepared.

Your comments always appreciated.
Visit www.drneedles.com for more discussion of controversial medical issues.

Sources: Science April 2, 2010
htttp://www.hshsl.umaryland.edu/consumer/sites/minority.html

IS RAW MILK DEADLY OR MANNA FROM HEAVEN

As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs
Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.


IS UNPASTEURIZED MILK SAFE?

Raw milk advocates have been fighting on behalf of the natural food movement saying milk has mystical healing powers and good microbes that can treat everything.  Is it deadly or manna from heaven?    Dairy owners have been selling raw milk over the last 8 years in 28 states.

Recently, in an attempt to get back to nature, a national conference of raw milk advocates in Wisconsin launched a symposium advocating raw milk as a medicine They claim raw milk destroys health giving vitamins, enzymes, and organisms.
The Weston Price Foundation, formed by an Ohio dentist who championed the nutritional benefits of raw milk, championed this viewpoint.

In 1900, clean white milk was used as a medicine to cure chronic diseases it was used.  The lactobacillus in milk helped the bowel and protected its lining.  Raw milk was fed to babies believing it could strengthen their immunity and help digestion.

 Raw milk proponents are concerned about the chemicals and hormones in dairy farming.  They say the heat in pasteurization kills natural proteins and enzymes, and destroys Vitamins C, B6, and B12.   Since the cows, rather than being grass fed, are now confined to pens and fed cottonseed and soybean meals, the cow milk no longer offer immunity. 

Pasteurization began in 1920 when the dairy farms took over distilleries that were bootlegging whiskey. The milk is heated to 161° for 15 seconds to kill pathogens. It is felt that heating also destroys enzymes in the organism important to good health

 There was a lot of filth and pollution in these dairy farms, and people became sick and died from infected milk.  In response, the government ordered that milk be heated for 15 seconds at 71 degrees centigrade to sterilize the milk.  This was called pasteurization.

The FDA insists pasteurization destroys bad bacteria, extends shelf life, and really doesn’t significantly change the nutritional value of milk.  They also claim hundreds of people get sick from salmonella, E coli and other bacteria. 

The Center for Disease control say 1000 people got sick over 7 years (between 1998 and 2005 and 2 people died. The AMA, Center for disease control and prevention, pediatric academy, and FDA all feel raw milk should not be consumed since it can contain pathogens.

 State public health officials claim milk can be dangerous and filled with germs hazardous to children and their immune system.  

Twenty-two states prohibit selling raw milk for humans.  All the other states only allow it within their borders.  The Federal government has let states regulate the raw milk industry. The FDA however prohibits sales across state borders.

It is legal to sell unpasteurized milk in only 10 states, and in another 10 to drink unpasteurized milk. In Maryland “cow sharing agreements” were created to skirt a ban on raw milk sales.   The farmers take care of cows that are leased to them by the consumers.  Some interstate shipments were made in California to be used only as pet food.

Milk can be contaminated with Salmonella, E. coli, and campylobacter, which are carried in unclean manure and dirty milking equipment.

Foods Market Inc. lobbied for a bill to keep raw milk dairies in business, saying they want to let the consumer have a choice.
 
COMMENTARY

Should the FDA spend more time on farming practices that hurt food safety, like confining animals, use of estrogen and antibiotics on animals.  Should raw milk be available?  Europe has not endorsed pasteurization.  Is our milk as tasty as in the past?  Why is the shelf life so short now? Everything is subjective and the battle goes on!

What do you think?  Your comments are always appreciated.
Visit dr needles @ www.drrneedles.com for more discussion of controversial medical topics important to your good health.

Sources:  Weston Price Foundation/Foods Market Inc.
              Raw milk.org/ Real milk.com

Monday, April 12, 2010

A hospital no longer is a place to get well

As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs
Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing



DON’T GO TO A HOSPITAL ALONE

When you go to a hospital, bring a friend. In today’s environment, with severe hospital cuts in personnel and budget constraints, you must constantly be alert and ask questions.   Despite trusting your doctor implicitly, you must realize your care is in the hands of the weakest link of the hospital healthcare team.   Currently this team has difficulty running efficiently.

 Layoffs of nurses and staff are common these days.  This has resulted in poor patient care.  Services must now provide optimal returns, and hospitals have developed strategic financial and operating plans.  Power, control, and money make it difficult for inter-disciplinary teamwork, and optimal performance.

Doctors are seized by fear their medical reputation will be in jeopardy by poor patient medical care.    Hospital personnel must improve their efficiency, but their pay is based on incentive performances.

 Nonprofit hospitals and healthcare systems are looking for mergers, affiliations, and joint ventures with competing hospitals and large physician entrepreneur groups.  They are now forced to avoid both public and regulatory relations risks and also make big deals to keep financially solvent.

 Healthcare reforms are now in charge of new politicians and regulators.  To find solutions for survival, hospital administrators are twisting the arms of department heads to cut medical costs.  Clinical services are daily evaluated on their reimbursement value to justify their existence. In view of the new political framework, hospitals find it hard to evaluate the economic viability of services they now offer.

The new Obama-Care government is not kind to hospital business as usual. They are constantly shaping health care from a technological, financial, and epidemiological framework.

 New hospital staffs are being formed, from a group of professionals that are interested in promoting and improving fractured care at their hospital, from a collection of independent, employee, and contracted physician groups.  Cultural barriers between these groups, has in the past created inertia.

 SURGERY AFTER 4 PM

 Be aware that a non- emergency procedure that starts after routine business hours has a great risk of complications. Weekend admissions are also death risk factors.  Evening and nighttime hours have shown an increased death risk also in intensive care units.

On weekends compared to weekdays, because of staff fatigue, and part-time medical and nursing staff shortages, your medical risks dramatically increase.  Studies show 46% of harmful events are associated with an operation at that time. (ANNALS OF SURGERY 4.30.08)


   Very few surgeons are available for operations that come from the emergency room, resulting in long waits for emergency and elective general surgery.  (It is estimated that the surgical work force will produce only 145 new surgeons each year for the entire country.)  This is caused by the fact that most doctors now specialize in vascular or thoracic surgery. Having taken medical student loans of $150,000, and working as residents for 40,000 a year for 3 to 7 years before they become board-certified, they find it financially more rewarding than working an unmanageable 80-hour week

This has resulted in a specialist for every part of your anatomy, all-specializing in one organ.  This has resulted in no one doctor in charge to coordinate all of your medical needs.  Doctors have become part of a hospital machine that is cold and uncompassionate.

 As you follow medical developments through the media, you realize you no longer can accept any medical decisions without questioning them.   Many times, you are disappointed because, your doctor has never heard about breakthroughs and certainly is not as excited about your new information as you are.    How willing he is to have a dialogue with you, tells you how willing he will be to successfully treat you medically.

THE WALL BETWEEN YOU AND YOUR DOCTOR

It is normal for your body to heal itself without a doctor.  Hippocrates believed it was better to avoid any treatment that might cause harm or that would interfere with the healing process. Your welfare was always a priority and your state of mind was found important for a successful medical treatment. The art of science and medicine go hand-in-hand, and can’t be divided.

 Are you ready to accept and embrace the realities of Obama care reform?   Will you refuse to adhere to the findings that cheaper drugs work as well as more expensive drugs, or sue doctors who try to do so?

  Doctors believe they are superior to you because of their training, licensure, or prescription drug laws.  What is the doctor to do, when you demand an antibiotic for a cold or your child’s ear infection?  If you demand an MRI for your back pain or knee pain, and your doctor refuses, will you call your lawyer that afternoon?  Ultimately doctors are the only ones responsible to order antibiotics or MRIs. Every decision a doctor now, will makes him subject to the threat of malpractice.

 It’s fine to suddenly have comparative effectiveness research costing billions of dollars, but if the doctor and you don’t abide by those findings, all this money goes down the drain.

 COMMENTARY

 Both doctors and patients are going to have to accept changes.  All of you will need an advocate that will encourage you, the patient, to exercise, eat healthy foods, listen, write stuff down, ask the doctor/nurse questions about things they don’t understand, question rationale for a treatment, understand follow up treatment, tell the doctor if they can’t afford something, or ask the doctor for a more affordable option or alternative.

Most0f you will accept a doctor’s opinion, if he explains his thinking.   It’s always been easier for him to write down the drug on a piece of paper and run out of the room, then deal with your pesky questions. Our government has painted the doctors as obstacles, seen as enemies to be crushed. Doctors have lost the art of communicating and must get it back fast.

  As we evaluate the new “evidence-based medicine”, that have recently changed medical guidelines, doctors must examine the underlying data, the assumptions, and the motivations, (cost containment) that result in their conclusions.

 The new guidelines do not define the standard of medical care.   The medical profession, collectively, must decide the standards of care, and provide testimony to that in a court of law.
  
Doctors, as well as hospitals, must now be trained into the business of medicine, including the very important skill of coding.   Nurses, on the hospital ward, now sit at computers and translate every medical diagnosis into a five-digit number, with an additional number to explain the type of work done for the patient.   There are inevitable mistakes that lead to non-payment, because of inaccuracies of medical conditions, and some diagnoses not having diagnostic codes. 

 Your treatment now need pre-authorizations, and have innumerable restrictions placed on them, Medicare has placed great paperwork requirements that obstruct good medical care.  Meanwhile, your care is withheld.

 The next time you visit a hospital, check what the nurse and clerks are doing.   They are not helping your loved one, but are filling out all important government paperwork on their computers.

 A hospital no longer is a place to get well.

Visit www.drneedles.com for more information on controversial medical subjects.  Your comments are always appreciated.

Friday, April 9, 2010

NEW END OF LIFE ICU GUIDELINES

As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs
Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.


ICU GUIDELINES CHANGING

New government approved guidelines recommend cutting out tests and treatments.   It is based on “Evidence Based Medicine.” Facts are twisted to show today’s procedures and treatments are not necessary.  Medical personnel and your doctor are being trained in Obama-Care.

 Doctor training involves discussing end-of-life issues, the savings of reimbursement  dollars from labeled “ineffective treatments, and paying more attention to alternative withholdings strategies  to meet family needs, are aimed to show you the medical profession still cares about you, the patient.

Doctors are not required today to provide all life-sustaining measures possible. They must only accomplish treatment goals within the bounds of accepted medical practice. A doctor does not have to write a futile order, like IV nutrition. Even when a treatment might prolong life by giving antibiotics or IDs, the patient has a right to refuse and the doctor has an obligation not to provide this service.

Medicines will be stopped, drying agents will be given, but you will be given good lip and mouth care to leave your thirst. You will be told dehydration improves endorphin release and you will have an improved mood.

You are given enteral nutrition to improve your strength and avoid starving to death. Many people feel that you are weak because you are not eating. They also feel if you do not eat you will die.

The new guidelines want to administer fluids subcutaneously.   They will tell you it eliminates the need for skills to locate a vain, and avoids the risk of infection, clot, bleeding, when IDs are given.   Has anyone seen this treatment to be used in the past?

 Incidentally, no medical technician needs to administer this procedure. A large needle is put in the belly or thigh and 3 quarts of fluid are given every day.  Each quart contains something different. One has more salt, one has less salt, and a third has equal amounts of salt and water.

If you have cancer that can’t be reversed, you are told the causes of the anorexia also cannot be reversed.   Gastrostomy feedings are no longer popular since suddenly they are found to increase the risk for aspiration rather than reduce it. You are told feeding tubes result in increased mortality, and these tubes are associated with infection, swelling, obstruction, and desperation pneumonia.

In summary, the new guidelines show that there is no evidence enteral nutrition will improve the quality of life for survival of your sick family member.

By providing training in discussing the end-of-life issues, the reimbursement dollars of ineffective treatment, will be saved, and spending more attention on alternative withholdings strategies to meet family needs shows they care for you the patient.

Is withdrawing or withholding hydration and nutrition euthanasia?

 It is a decision and action that allows cancer to progress on its natural course. The action is not to seek death and end-of-life? Contrasting, euthanasia actively seeks to end a patient’s life.

The doctor must use the means necessary to accomplish the intent.  Heavy doses of opioids are given for pain, sedatives for sleep, and other treatments controlling symptoms with dosing guidelines to promote death.  Death is not the treatment, since the aim is to relieve the symptoms; it does not intentionally caused death.

Today’s guidelines state that there is no evidence artificial nutrition alone improves functional ability or energy, relieves fatigue, or improves survival, it is a cancer responsible for your anorexia and weight loss.

 We know that large doses of opioids to relieve pain also result in respiratory arrest. These large doses are permitted as appropriate, if the intent and doses given are titrated to the patient’s needs.  (Who defines needs?).

 COMMUNICATING THE BAD NEWS

 The guidelines encourage doctors to follow a six-step protocol, called SPIKES.   If a treatment has no chance of achieving an intended benefit, it need not be offered (the example given is: like CPR on a body with a head severed).   Doctors are told patients want to discuss treatment decisions even if the benefits are zero. Talking about this builds trust and doctors must sharpen their persuasive skills when they discussed withholding treatment.

 The first discussion is about general goals of care. The doctor is to discuss specific treatment preferences in light of whether they will help achieve the overall goal (who defines the goal). 

An end-of-life nurse specialist, a part of the healthcare team, will continue the discussion and prevent some conflicts within the team. They will spend additional time talking to the patient and family. The team will give emotional support to both family and patients.

 Despite all this discussion, the doctors still must write the medical order and assume full responsibility for its accuracy.
Doctors find it hard to discuss withholding artificial feeding and hydration. They have not been trained to do so. Food and water were symbols of caring. Withholding hydration was always seen as neglect by the family the patient, and all caregivers.

 The doctor must get familiar with the new policies and statutes their hospital is establishing.  Many doctors presume their hospital had a specific policy on hydration, reflecting state and federal laws.   Doctors must now be reminded that no state requires artificial nutrition and hydration when a cancer patient cannot eat.  Most states leave those decisions to the doctor and his patient.  So it’s legally safe to withhold hydration.

 A doctor must ask the patient and family what they understand.   He must make sense to them about the patient’s eating, drinking, and disease patterns.   If a family member says: “ Mom would get better if she ate”, the doctor must review why mom is weak. When the family went to hydrate their loved one, the doctor must explain how normal dying occurs.

 The selling continues by doctors saying:
 “Can we review our overall goals for your care?
 Let me tell you what I understand you want as we plan your care.”

 The doctor must talk about the general medical condition and if the patient has advanced cancer, let the family understand the overall situation. They will be told the expected course of the cancer, and told everything that is meaningful to them is not reversible.   Finally specific life sustaining treatment preferences are discussed.

 A well-meaning doctor might say: “do you want us to do everything? “ A misleading question like this must be avoided. Everything is too broad, and misinterpreted, especially when the family believes everything has not in fact been done.

 The family must see that improved energy and strength will not occur with artificial fluids, and above all will not accomplish the hospital’s medical goals.  The family must understand that the goals for artificial nutrition are appropriate.

 Specific treatment preferences must be discussed in a language the family will understand. Perhaps a translator is necessary who is trained in the skills.   Information must be given small doses daily. The decisions made must be reinforced.   The team must check for reactions, ask the family for questions, and clarify misunderstandings. In other words, diplomacy is the rule of the day.

 It is quite confusing to ask families to decide about specific treatment preferences.  Doctors must not state that all possible therapies will be offered, but the can choose some medical items from a menu, as in a restaurant.

 Contemporary medical care requires, a fundamental ethical principle called “informed consent.”   Patients deserve a clear, complete understanding of all therapies proposed for them. Some want to know all the details, and others prefer to do nothing.

The doctor must be prepared to simplify the aspects of hydration that conforms to the principle of informed consent including: the problems of the treatments, what’s involved in the treatment, what happens if the patient decides not to have the treatment, the benefits of the treatment, and the burdens created by the treatment.   The patient is then given a patient’ family education handout during these sessions.

 What if the family of the patient says: “ don’t want mom to starve to death, dehydration is a miserable way to die, and we can’t just let her die”.   The family must be reminded these are goals for the family and not goals for the patient.    The family may believe there loved one’s lack of appetite and oral intake of fluids is causing the patient’s level of disability.

 The programmed doctor must answer: “Cancer is taking all your mom’s strength and her heart is so weak. This is what causes her to lose her appetite and feel so tired. I understand why you think that, but mom is dying of cancer, not starvation”. The family must know that a dry mouth will not improve with intravenous fluids, but will be more likely helped with oral lubricants and lemon swabs.

The doctor will be programmed to say:” I wish things were different”, acknowledge the situation, and then become silent.  He then will turn the emotional support to other friendly members of the healthcare team.   Since emotions are challenging, other better-trained members of the healthcare team will assist.

 A well-articulated and understood plan will be established. It may be simply, will be discussed again at the next visit, or the team will convene a family meeting to discuss the proposed treatment plan.   Discussion will include social work, a chaplain intervention, notifying a key family member from out of town to come in preparation for opium death, and organizing the nursing staff for the end of life protocols.

 If the doctor is forced to give a time limited trial of artificial nutrition and hydration, he must set a measure of success: We will see if mom feels stronger or can resume eating for the next two weeks. “ Just tolerating the feeding is not a good endpoint.

 The plan must be documented and spread around, to the healthcare team, so the entire team can work in an organized fashion.   The doctor, after writing the appropriate orders, must document the discussion in the medical records, and talk about the plan to the health care end-of-life team.

 Families change their goals and treatment priorities periodically.   After being presented with a situation and information, the family must know that the plan can change at any time. How to change it is not discussed.

COMMENTARY

Your mom may feel very lonely as she fights for her life in an intensive care unit.  She may be curled up in a blanket, the hospital blinds remain closed, and she sees herself at the edge of the world.   Today, many people have few friends, are very lonely, cut off from their family, few friends, and the real world outside of the hospital.

A hospital filled with doctors, nurses, and healthcare professionals, does not help relieve the loneliness of dying. Friends do not visit because they can’t handle their friends suffering.  They are not alone, but they feel alone—it’s not like dying in your own bed at home.

Loneliness contributes to weakened immune system and a lack of desire to fight for life. We humans have evolved to depend on each other.   Since we do not connect with others, we are more likely to die without support.   Our desire to fight loneliness is as strong as our need to eat, drink, and relieve pain.  We all seek companionship and fear being ostracized—a hospital ICU does not provide this.

We all seek support in whatever way possible. A hospital is cold when one is alone.  Few Americans today die at home with their family around them.  Now with the hospital no longer providing medical help, it makes more sense to die at home among your compassionate family.

We are all going to die, but our culture dreads death.  We all seek the latest new treatment that might add months to our lives.  After all, if it is something new, why not try it.  Maybe it will help, just maybe! Now the guidelines remind us:  there is no hope.

Most of us now must consider shifting our primary attention to compassion and palliation of pain, rather than dreaming about medical intervention.  After all, Medicare says: “we all must die sooner or later! “

This is a good way to ration health care.  New are government approved guidelines recommend cutting out tests and treatments.  It is based on “Evidence Based Medicine.” Facts are twisted to show today’s procedures and treatments are not necessary.  If you are on the wrong side of the “evidence”, too bad1 by saying:  “Yearly screenings are not necessary, your insurance will not have to pay for them,” now that Obama- care is implemented.

What do you think?  Your comments are always appreciated.
Visit www.drneedles.com for more comments on medical controversial issues.


SOURCES
 EPEC™-O: Education in Palliative and End-of-life Care for Oncology (Module 11: Withdrawing Nutrition, Hydration Copyright The EPEC™ Project, Chicago, Ill, 2005).  
 (The EPEC™ Project, receives major funding from the National Cancer Institute, and the Lance Armstrong Foundation).

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Washington, DC: US Government Printing Office; 1983. 

DOCTORS TRAIN TO BE SALESMEN OF DEATH

As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs
Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.



NEW END OF LIFE FEDERAL GUIDELINES

Doctors   are now trained to implement new proposed federal guidelines developed for end-of-life care.   In their medical training, doctors were taught to save life at all costs as they swore to uphold the Hippocratic oath they took when they became doctors.  They must now develop skills to revoke legal and ethical issues that guided them in the past.

Doctors are today challenged to deal with end of life proposed medical treatments issues that center on withholding and withdrawing medical interventions.   Doctors, and their assistants are all being taught the skills necessary to negotiate with you, discuss with you, and implement decisions to withdraw life-sustaining treatments from you that are financially costly.

 For centuries, all doctors implemented medical care and provided continuity of care in their practices.   The doctor is now responsible to ensure that, despite lack of medical knowledge, his patient’s wishes are documented and supported by his medical orders.   A patient’s advance directive must now be translated into treating his present medical conditions, as defined by our federal government.

Advance Medical Directives
These are legal documents made by you and allow your surrogate to be your decision maker when you become incapacitated.  That person can accept, reject, or withdraw medical procedure and life support on your behalf.   If you don’t have this directive, the court can appoint a guardian to make medical decisions for you.

DNR 
A part of the directive is DNR, (do not resuscitate), passed in 1991 into federal law.   It instructs removing any life saving resuscitation or procedures to restart your breathing or your heart.   This is now an option offered by hospitals, and must be placed in your chart once signed.
The purpose of the DNR was to avoid suffering from a terminal illness or any condition that is medically irreversible.  Once on the chart, the hospital personnel are forbidden to use CPR and other reviving measures on your behalf.

You can revoke the DNR document anytime you communicate your desire by removing your medallion or bracelet that indicates your DNR status.   Some states will keep a registry of all people who have DNR orders.

These forms can be requested from a doctor, you can write down your wish, or some computer software for legal documents can prepare the form.   The doctor must be told your wishes and he must explain to you what happens when you sign a DNR order. The doctor must sign the DNR order before providers can honor the order.   A doctor who does not carry out your DNR order, for whatever reason, must be removed from your case.

THE QUINLAN CASE
 In 1976, artificial nutrition was withdrawn from Quinlan assuming she was in a persistent vegetative state.   Seven years later, a commission to study medical ethics found no medical treatments are obligatory, including artificial nutrition and hydration.   In 1990, the Cruzan case, said artificial hydration and nutrition are the same as all other life-sustaining treatments.   States differed in what requirements were necessary if a patient lacked decision-making capacity; some require clear and convincing evidence, while others allowed substitute decision-makers.

THE ROLE OF HOSPITALS
 Hospitals have always developed institutional policies drafted by their ethics committees, to protect your rights and interests. Other risk management committees also protect the hospital from the legal challenges of withholding and withdrawing nutrition and hydration if you lack decision-making capacity.

 The general response was,” when in doubt, choose the treatment that will prolong life”.   To bypass this goal of life at all costs, written plans of care are now being specifically written to accomplish the new goals of end of life policies.

Emergency units are required to provide resuscitation and life-prolonging treatments unless you have a DNR order in place.   Since only doctors can write orders, the doctor is being bypassed by making it the responsibility of an entire healthcare team to ensure that your wishes are followed.

Most patients enter intensive care units without attention to issues of life-sustaining treatments.   Most of them were given invasive medical treatments against their wishes, and many of them survived.

 These new guidelines require that if you are transferred to an acute care setting, your medical care orders must be completed and an appropriate end of life treatment plans must be in effect. Seventy five percent of patients transferred from nursing homes to a hospital acute care unit, do not have advanced directive orders. This will change soon.   Currently medical care orders may not transfer across settings from nursing home, ambulance, or acute care hospital. Changing this will eliminate a great deal of expensive care on your behalf.

WHAT LIFE-SAVING TREATMENTS WOULD BE ELIMINATED?
 They include: cardiopulmonary resuscitation, elective intubation and mechanical ventilation, surgery, dialysis, blood transfusions or administration of blood products, artificial nutrition and hydration, diagnostic tests, antibiotics, other medications and treatments, and future hospital or intensive care unit admissions.   A DNR directive would eliminate all of these treatments.

YOUR DOCTOR, NOW A SALESMAN
 Your doctor or his surrogate will now discuss specific treatments with you and your families and tell you whether these treatments will achieve the overall goals.  Your family will be asked whether you prefer an invasive intervention or an alternative noninvasive intervention. The doctor will get an idea of your priorities as you make treatment decisions.  How you answer about antibiotic decisions and surgery decisions will indicate to him how successful he will be in selling you a “noninvasive decisions”.

SOCIETY VIEWS ON PROLONGING LIFE
 Very few nonwhite patients have DNR orders. Asian cultures oblige children to take care of their parents in gratitude for the parents taking care of them. Withholding life-support is seen as unfaithfulness.    Even if you do not want life support, the family is expected to do everything possible to prolong your life and keep honor in the family.

Different cultures see suffering in different ways.   Obama care sees the withholding of life measures at the end-of-life as a very compassionate act that prevents you from needless suffering.  Many others, however, see pain and suffering as redemptive, to be endured as a test of faith rather than to be avoided.  Many religions feel that only God knows when it’s time to die.  This affects how they feel about life sustaining therapies.

 Most religions teach that when death is inevitable and not caused by the absence of hydration or nutrition, withholding these treatments would be appropriate.   Most religions however teach that, as found in the Hippocratic oath, human beings must do all in their power to prolong life.

TO FEED YOU OR NOT TO FEED YOU
 Most family members are troubled if they’re sick member is not eating.  It has always been considered ordinary care to provide oral nutrition if you want to eat. This included bringing food to your mouth even if you are too weak to do so. You are given assistance, and special attention was given to the consistency and smell of the food to make it appetizing.

Your doctor will now tell you that this is an emotional and spiritual issue, not a biological medical care issue.   When a family member is given a feeding tube, you will be told it only sets you up for a later disappointment.

The current guidelines propose that decreasing your caloric intake, increasing your metabolic rate, and helping you get vitamin and nutritional deficiencies are all good treatments.   These new findings contradict popular wisdom by doctors that provision of nutrients improves quality of life and survival.   The new approach is to tell you withholding treatment is guided by “current medical evidence”. Today it is considered unethical and even illegal to force you to eat if you do not wish to do so.   If you taken no calories, you soon develop ketosis, as fats and proteins are metabolized to give you an energy source.

If you cannot eat, and you appear hungry, nutrition by intravenous methods was used.    This maintained your electrolyte and fluid balance while you are temporarily unable to drink adequately.  

COMMENTARY
The federal government is building institutions to reduce the cost of healthcare. Goodness of different treatments are being compared is a so-called Medicare innovation Center and a Medicare oversight board that sets payment rates.

All of us knew the disasters of managed care 20 years ago.  These new agencies are already being accused of rationing Medicare.   Donald Berwick, a physician who now runs Medicare, will tell you that we all want the best possible care.  He will tell you that unnecessary care causes a lot of pain and even death.  Berwick made his fame by campaigning against medical errors.

These agencies are now seeking to tell you what treatments work and what ones do not work.   They will tell you that the data is incomplete or unavailable. Over half of treatments lack clear evidence of effectiveness, and therefore should not be available.

 You will be given information about potential benefits and risks to invasive care.   They are hoping you are not willing to accept the risks and side effects that may come with treatment. They will encourage you to leave an intensive care unit and enter a hospice.

RELATED POST:   ICU GUIDELINES CHANGING

The new health-care bill requires that Medicare and its agencies help hospitals and doctors give patients more programmed information.   Under the pretense of giving you more control and more choices, they hope you will choose the treatments that they advocate.
 What do you think?  Your comments are always appreciated.
Visit www.drneedles.com for more discussion of controversial medical issues.

Sources
 EPEC™-O: Education in Palliative and End-of-life Care for Oncology. The EPEC™ Project, Chicago, Ill, 2005).  
 (The EPEC™ Project, receives major funding from the National Cancer Institute, and the Lance Armstrong Foundation.)

Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Washington, DC: US Government Printing Office; 1983.


Monday, April 5, 2010

Welcome to Dr. Needle's medical blogs

As a medical physician for over 51 years, I strive to give you the best medical information on controversial medical subjects, and help your read betwwen the lines. You must come to your own conclusions. I have no ties to any organization, pharmaceutical, or lobby group. As an practicing medical acupuncturist since 1982, I find western medicine and medical acupuncture are very complimentary. This results in astounding healing in pain management, addictions to cigarettes and food, and a host of other maladies. Visit drneedles is blogging" at the end of each blog for a complete alphabetical list of all my blogs
Visit http://www.americanacupuncture.com/ for more detailed information on mind, body, and spirit healing.
LACK OF STOMACH ACID CAUSES MOST GERD

GERD  has become a household word.   It is the most common digestive disorder in America, affecting 20% of us at least once a week.   More than 60 million prescriptions for Gerd were filled in 2004, and over $13 billion was spent on acid stopping medications in 2006.

 This incidence may be underestimated because of over-the-counter antacids that permit us to self medicate, without reporting our problem to a doctor.

 Once food lands in your stomach, a ring of muscles at the bottom of the esophagus should prevent the food and acid from moving backwards.  If it doesn’t close well, acid can leak back into the esophagus, causing heartburn.

 We are told that obesity, cigarettes, alcohol, and hiatus hernia can all increase our chances of Gerd.  Asthma bronchodilators, seasickness medication, high blood pressure beta-blockers, Parkinsonism’s dopamine drugs, insomnia sedatives, and antidepressants, all make Gerd worse.

You may feel a burning pain in your chest under your breastbone and feel food is trapped behind your sternum.  The pain is worse at night, relieved by antacids, and results in nausea after eating.   A chronic cough, wheezing, hiccups, hoarseness, change in your voice, and sore throat, can also be symptoms.

 To prevent heartburn, your doctor recommends you stop alcohol, carbonated pops, caffeine, chocolates, fatty foods, regular fat dairy products, peppermint, spearmint, and of course spicy foods.

 You are told to avoid bending after eating, quit wearing a tight belt, avoid eating three hours before bedtime, start eating smaller meals, lose some weight, reducing your stress, and sleep with your head raised about 6 inches.

  You start taking antacids after your meals, but this does not relieve the pain for very long.   Then you upgrade your meds, and start taking over the counter  drugs and prescription drugs as Prilosec, Nexium, and Prevacid, Zantac, and Axid.   This helps, but once you quit taking the medications, your symptoms get worse.   Since these drugs are now available over-the-counter, you also have no warnings about the dangers of these drugs.

 Your doctor then suggests looking down into your stomach with a thin tube with a camera on it to identify the cause and check your swallowing tube for damage.   You are told you have inflammation of your esophagus, and if things keep getting worse you may need an operation to narrow a possible hernia of your diaphragm, a biopsy will be taken, and the upper portion of your stomach will be wrapped around the weakness of your lower esophagus.   You are told, if your symptoms continue, you could get Barrett’s disease, which leads to cancer, (both are very rare).

 You follow your doctor’s recommendations, and find the medications cause your mouth to be dry, you have some hair loss, diarrhea, trouble sleeping, and are gaining weight.  Your iron supplements are blocked by the medications.   If you have allergies to foods, dyes, or preservatives, things can get worse. Other serious side effects can occur as: hallucinations, depression, and occasionally yelling of the weight of your eyes.

 You take antacids to cover the problem of neutralizing your stomach acids but this is  only a temporary fix.  Most of you will take Prilosec, Prevacid, or Nexium to relieve your symptoms.   The powerful acid suppressors lead to atrophic gastritis (an absence of stomach acid).   You read that these drugs can cause gastrin hormone to be released, which is linked to cancer.

Most drug ads suggest you have too much stomach acid. On the contrary, stomach acids decline with age and 30% of people over 60  have little or no acid secretions.  When you have Gerd and heartburn, you almost always have very low acidity.

STOMACH ACID IS IMPORTANT

Stomach acid is there for a reason.  It is essential to absorb nutrients (protein, carbohydrate, fat, minerals, vitamins) and protects you against infections,  including H. pylori, which is the primary cause of gastric and duodenal ulcers.

Gastric acid consists of HCl, and reduces your stomach contents to a pH of 1 to 2.   The acid is secreted at the top of the stomach by parietal cells. This acid acts as a barrier against bacteria to prevent infections, and it’s important for the digestion of food.

 The acid   breaks down protein in the stomach and also helps calcium and iron to be absorbed.   A lack of calcium results in hip fractures.  This acid environment also destroys most organisms, and hence infections of the bowel are prevented.

 To maintain a normal level of stomach acids,  natural herbs as gentian and dandelion can help by releasing digestive juices.  Slices of apple have been known to relieve Gerd.   Herbs as grapefruit seed extract, garlic, oregano oil, and peppermint oil all help if there is bacterial overgrowth.   Probiotics, glutamine, and ginger tea also work.

Capsules of Betadine Hydrochloride containing pepsin and plain Betadine Hydrochloride capsules are also available.  Check with your doctor before taking them. 

COMMENTARY

Drug companies are not interested in curing you because that’s not profitable. It’s much more lucrative to sell drugs that you have to take the rest of your lives to promote lifestyle changes that would cure the problem.

Its important to remove the cause of disease rather than just treat the symptoms.  Stomach acid is important for the absorption of protein, carbohydrates, fat, minerals, and vitamins:  the acid also protects you against infection, especially H. pylori.

What do you think? 
Visit www.drneedles.com for more information on controversial medical subjects.

Labels