24
July
2008
Senior citizens tend to have the most need for health care, and the demand on Medicare is increasing. The 35 million elderly folks will increase to 71 million by 2030. That is 20% of the US population.
However, each year the rich US government officials try to slash Medicare benefits to patients and payment to health care providers. Right now you pay more at the gas pump to fill your car than Medicare pays your doctor for a 15 minute visit. Hmmm, maybe I should start selling gas at the office? My nurses can fill your tank while I treat your congestive heart failure.
I didn’t realize George W. Bush is only 62. I thought he was 108. (Isn’t it interesting how presidency makes men old? Bill Clinton went from a hip saxophone player to Father Time during his presidency.) But on July 15, 2008, almost-Medicare-eligible Bush vetoed the legislation to stop a 10.6% cut in payments to doctors. Hello! I don’t see him cutting fuel prices (or his own salary).
drjohnhong 
senior citizen, insurance 
Comments (0) » |
28
May
2008
Alzheimer’s Disease is the #1 type of dementia in the elderly – about 60-80% of cases. About 4 million Americans. Occurs between ages 40-90, is progressive, and causes memory loss, global cognitive dysfunction, personality changes, and loss of independence due to poor executive functioning. It comes on slowly, usually starting with short-term memory loss.
drjohnhong neurological, senior citizen Comments (0) » |
28
November
2007
Fecal Incontinence: #2 cause of nursing home placement. Adult diapers in 1988 $400 million in USA. This means an adult accidentally poops at least once a month. Minor fecal incontinence is while passing gas (flatulence/farting) some stool comes our, or a person has loose stools (like in diarrhea) and it comes out accidentally. Major fecal incontinence means feces comes out unwillingly.
Who knows how many people have fecal incontinence because most people are too embarrassed to admit to it. It is estimated to affect 11-15% of community-dwelling adults (like nursing homes, assisted living)
Risk factors: age, obesity, COPD, IBS, urinary incontinence, colectomy, mentation. Men and women have the same prevalence, but women are 2x more likely to admit to it.
People with brain injury often have fecal incontinence. After childbirth, trauma to the anal sphincter or pudendal nerve can cause fecal incontinence for years. Surgeries such as for hemorrhoids & anal fistulas can lead to fecal incontinence. Rectal prolapse is risk.
Diabetics with autonomic neuropathy, bacterial overgrowth syndrome, and reduced sphincter pressure can have fecal incontinence. History of radiation therapy can lead to proctitis. Ulcerative proctitis as well.
Some cannot sense stool in the rectum: diabetics, MS, dementia, spinal cord injuries.
With fecal impactions, liquid stool can seep around the hard stool and out the anus in elderly.
Continence relies on many factors. The bottom line is when stool stretches the rectum, the person should sense this. To poop or not poop is based on relaxing or not relaxing the external anal sphincter muscles.
Work up: history and physical examination by doctor. Endoscopy is often needed. Anorectal manometry measures the function of the anus and rectum which can give valuable information. Pudendal nerve terminal latency test, endorectal ultrasound, defecography, and EMG can be done.
Treatment: Medical therapy, biofeedback, and surgery. Depends on the underlying causes.
drjohnhong senior citizen, GI Comments (0) » |
30
May
2007
Parkinson’s Disease
Parkinson’s Disease is a progressive degenerative disease that destroys a part of the brain, in particular the midbrain’s basal ganglia, and it helps to control movement. Millions of people have it now. Rare before the age of 40, 1% over the age of 65, and 2.5% of people over the age of 80. Parkinson’s Disease that causes dementia affects about 0.2- 0.5% of people over the age of 65. Parkinson’s Disease peaks between 70-79 years of age and is twice a common in men compared to women.
Cause of Parkinson’s Disease: we aren’t sure. It might be genetic. Perhaps exposures are associated with Parkinson’s Disease, such as pesticides and heavy metals (mercury, zinc, iron, manganese). The basal ganglia release dopamine, a chemical to help control movement in the body. In Parkinson’s Disease, there is a lack of dopamine release from the basal ganglia to the key movement center of the brain.
Symptoms: Falling down, change in walking, worsening of handwriting, slowing down in movement, resting tremor that goes away with movement. Fatigue, dementia, even psychosis. Drop in blood pressure, incontinence, erective dysfunction, slow GI system can occur with worsening Parkinson’s Disease
Signs: 1) A resting tremor. Pill rolling tremor is seen so the thumb and index finger look like they are rolling a small marble. 2) Rigidity. On exam, while extending the arm it looks like a cogwheel movement – an unsmooth mechanical motion. 3) Akinesia, meaning lack of movement. Even the face is blank, called a masked face. 4) Gait disturbance, so turning around can call a fall. Shuffling the feet occurs.
Other diseases that can be mistaken as Parkinson’s Disease include a stroke to the basal ganglia, progressive supranuclear palsy, and multiple system atropy. Some medicines cause Parkinson-like symptoms. These drugs block dopamine receptors of the brain. Antipsychotics are big ones doing this. Metoclopramide (Reglan) for GI motility can cause this.
Treatment: no cure unfortunately. Medications don’t slow down this progressive disease. But researchers are working on drugs to slow it down.
For symptom treatment, levodopa (such as Sinemet) is used to replete the lack of dopamine in the brain. MAO B inhibitor, such as selegiline, is used – and you hear all the pharmaceutical commercials say, “Don’t use our drug if you take an MAOi.” Dopamine receptor agonists include Mirapex, Requip, Parlodel, and Permax. Also anticholinergics can be helpful in Parkinson’s Disease, such as amantadine and Cogentin. COMT inhibitors (Tasmar, Comtan) are used to assist levodopa drugs, because levodopa tends to “wear off” between dosings and after 5 years usually aren’t as effective as once before. In postmenopausal women, estrogen might be helpful – but then there is increased risk of heart attack, blood clot, and breast cancer.
Unfortunately all these medicines have side effects, like fatigue, nausea, headaches.
Surgical procedures are still being investigated.
It is vital to see a neurologist and discuss all your options with him/her.
drjohnhong neurological, senior citizen Comments (0) » |
Podcast Video [2:29m]: Play Now | Play in Popup | Download | Embeddable Player | Hits (147)
Email it
