There are times during a hospital stay when the care team may ask a patient (or family member on behalf of the patient) to consider having a special feeding tube, or PEG, placed to prevent medical complications, such as dehydration, malnutrition or aspiration pneumonia. (more…)
The thyroid gland got its name from the Greek word for “shield,” due to its physical appearance in the neck. In many ways, it acts like a shield by protecting our bodies from losing functional balance. The thyroid gland produces and releases thyroid hormone, which is crucial in regulating overall metabolism (the physical and chemical processes in the body that convert or use energy). Digestion, weight, temperature regulation and reproduction all are affected by the thyroid gland.
The thyroid gland works like a thermostat via its connection with the brain. If there is not enough thyroid hormone in the blood stream, the brain will stimulate the thyroid gland to produce and release more. Blood tests are an easy way to detect both the level of thyroid hormone circulating in the blood — generally free thyroxine (T4) — and the stimulating signal from the brain (TSH, or thyroid stimulating hormone). The most common thyroid problems involve abnormal production of thyroid hormone.
Hypothyroidism is the term used to describe an underactive thyroid.
Symptoms include:
• Fatigue
• Feeling colder than usual
• Changes in skin and hair
• Weight gain
A common cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune disorder in which cells in the body prevent the thyroid from producing and releasing enough thyroid hormone. Other causes include surgical removal of the thyroid gland for thyroid cancer; treatment of hyperthyroidism (an overactive thyroid gland) with radioactive iodine; or being born with an underactive thyroid gland.
The treatment for hypothyroidism is to replace thyroid hormone in the form of a pill taken once a day, preferably by itself and on an empty stomach so that it is fully absorbed. The dose is easily adjusted based on blood tests.
Hyperthyroidism describes an overactive thyroid gland.
Symptoms include:
• Increased sweating
• Heart palpitations
• Increased anxiety
• Diarrhea
• Weight loss
A number of conditions can cause hyperthyroidism. Opposite to hypothyroidism, cells in the blood stream called antibodies make the thyroid gland secrete an excessive amount of thyroid hormone.
The two most common treatments for hyperthyroidism are radioactive iodine and medication. Radioactive iodine works by destroying part of the thyroid gland to restore a normal level of thyroid hormone in the body; however, it is possible that hypothyroidism may then develop. Radioactive iodine has the benefit of generally being a more permanent treatment, although medications used to treat hyperthyroidism can be very effective in certain people, too. Just as in hypothyroidism, blood tests should be done routinely to monitor treatment.
Thyroid cancer can develop and, in the majority of cases, is curable by surgical removal of the thyroid gland by an experienced surgeon. Radioactive iodine may be used after surgery to destroy any small remaining cancer cells. An endocrinologist should be directly involved in monitoring care.
Extremes of thyroid function can certainly have an impact on your quality of life; the beauty is that with the correct diagnosis and management, these conditions can be greatly improved!
To find an excellent doctor who is right for you, please call our Physician Referral Service at 866.804.1007.
Winter in New York City often means unpleasant weather, like snow and freezing rain—common culprits of slippery sidewalks, streets and stairs. Snow also can block visibility of curbs, curb cuts, sidewalk cracks and other elements that may affect how you walk about.
Falling on an outstretched hand is the most common way people fracture their wrists. During poor weather, one of the best things you can do to prevent a wrist fracture is to follow the fall prevention tips below:
• In anticipation of poor weather, stock up on household staples ahead of time.
• If poor weather has already begun, order food and household items to be delivered to you.
• Travel outside during daytime hours. More light means increased visibility and increased pedestrian presence.
• Wear sensible footwear. Don appropriate shoes, such as boots, with good support and tread. Avoid heels and open-toed shoes.
• Use handrails and ramps whenever possible. This is especially important for people who have difficulty navigating stairs during the best of weather.
• Take well-travelled streets. Walking on heavily travelled streets is safer, because traffic will have decreased snow accumulation, and if you do fall, an increased pedestrian presence means there will be other people around to assist you and call for help.
Phineas Gage was an American railroad construction foreman in the 1800s who is remembered for his survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain’s frontal lobe. After that, his personality and behavior were so profoundly affected that friends saw him as “no longer Gage.”
Gage had suffered a traumatic brain injury, or TBI—the same type of injury experienced lately by several well-known individuals, including Sen. Gabby Gifford and Junior Seau. While there are two types of brain injury—TBI and acquired brain injury—what we hear about in the media mostly involves TBI, an often-puzzling condition. The Brain Injury Association of America defines it as an alteration in brain function, or other evidence of brain pathology, caused by an external force. According to the Centers for Disease Control and Prevention, the causes of brain injury are falls (35.2%), motor vehicle crashes (17.3%), struck by/against events (16.5%), assault (10%) and unknown (21%).
There are many different types of TBI: diffuse axonal injury, concussion, contusion, coup-contracoup and penetrating injury, to name a few. Depending on the type of injury and its location on the brain, the outcome—including the behavior of the injured individual—varies. Brain injury can affect people of any age or gender.
Individuals who suffer brain injuries will begin acute rehabilitation as early as possible. In acute rehabilitation, a team of health professionals with experience and training in brain injury work with the patient to regain as many activities of daily living as possible. The team includes a physiatrist (doctor who specializes in physical medicine and rehabilitation), rehabilitation nurse, physical therapist, occupational therapist, speech therapist, social worker and nutritionist. Activities of daily living include dressing, eating, toileting, walking, speaking and more.
Preventing TBI has become a public health priority. The American Association of Neurological Surgeons offers the following guidelines:
* Buy and use helmets or protective head gear for such sports as baseball, cycling, skiing and more;
* Wear a seatbelt when you drive or ride in a car;
* Do not drink alcohol and drive;
* Do not dive in water less than 12 feet deep or in an above-ground pool;
* Remove hazards at home that can contribute to falls, like scatter rugs, electrical cords, etc.; and
* Maintain safety in the bathroom for the elderly.
Finally, if you or your loved one suffers a TBI, community support is available through your local hospital, Brain Injury Association of America and even in online communities.
References
Brain Injury Association of America (2012).
American Association of Neurological Surgeons (2012).
To find a great doctor who is right for you, please call the Physician Referral Service at 1 (866) 804-1007 Monday through Friday, 9 am to 5 pm.
Diabetes is a disease that affects all ages. But as people get older it’s particularly difficult to deal with—especially because diabetics are more likely to develop dementia.
In an 11-year study of more than 1,000 people, 27% of those with diabetes developed dementia, compared to 20% of people with normal blood sugar levels. Diabetes and Alzheimer’s disease (an advanced form of dementia) are connected in ways that still aren’t completely understood. It’s thought that diabetes contributes to vascular disease, disrupting the flow of oxygen to the brain.
In the last 50 years, the number of people diagnosed has risen from 1.5 million to around 26 million, and it’s estimated that 60 million have prediabetes. So the prevalence of dementia could increase as the U.S. population ages. However, taking steps to control diabetes now may help reduce the risk of Alzheimer’s later. And that’s important because the treatment for dementia is very limited.
Reducing the risk of dementia is actually quite simple—it’s all about managing diabetes in the best possible way. Here are some steps that can help:
* Follow physician recommendations for monitoring blood glucose, cholesterol level and blood pressure.
* Eat healthy foods, including fruits and vegetables, lean meats, whole grains, and low-fat milk and cheese.
* Exercise at least 30 minutes most days of the week.
* Maintain a healthy weight. Losing weight can seriously reduce the negative effects of diabetes. Just 10 to 15 pounds can make a difference.
* Take a doctor-approved multivitamin to help fill nutrient gaps in the diet.
* Take medications on schedule. There are reminder alarms with a vibration feature for people who have trouble hearing. For people who have trouble opening small pill containers, there are larger, easy-to-open pill containers available. Some include magnifiers for reading medicine labels. And for people with vision problems, there are blood glucose meters that “talk.”
* Keep an updated list of medications and record important information about each one.
Diabetics can significantly reduce the risk of dementia by consistently managing their disease.
For more information and help on managing the disease and caring for elderly diabetics, visit www.friedmandiabetesinstitute.com.
Some forgetfulness, or a little memory loss, in people middle-aged and older, is actually normal and not a cause for concern. There are natural aging processes that explain minor lapses in memory, more popularly called “senior moments.”
As we age, our ability to divide our attention among two or more activities starts to diminish slightly—it may be harder to do “two things at once”! The holiday season is an especially busy and hectic time, full of many tasks that we feel we have to accomplish before the festivities begin. We may find it more efficient to do one thing at a time, from start to finish, as typical interruptions may lead us to forget momentarily what we were doing or saying.
After about 55 years of age, both our physical and mental responses naturally start to slow down. Humans have millions of impressions, recollections, words, dates and other items stored in our memory bank. Withdrawing information—such as remembering appointments, errands to run, people’s names and phone numbers—might take a little longer as we get older, so it’s always a good idea to mark a calendar and write things down. The more we have on our mind, the more we should use simple reminders such as “to-do” lists, wrist-watch or cell-phone alarms, and pill boxes sorted by day of week.
So, while the occasional forgetting where we placed our car keys or the pen we were just writing with is typical of normal aging, there are other memory changes that are not normal. Benign senescent forgetfulness is a disorder characterized by continual repetition of accounts of events, questions and requests; generally, the person’s short-term memory loss does not worsen or interfere with everyday life. Dementia is a far more serious and progressive decline in mental functions, including not remembering your name and address, how to dress yourself or balance your checkbook, and clearly requires an evaluation by a physician.
For more information on normal and abnormal behavior as we age, please visit http://www.merckmanuals.com/professional/geriatrics.html or the Beth Israel Senior Health web site at http://www.wehealny.org/services/bi_seniorhealth/index.html.