Discovery Health - John Whyte, M.D.

The Power of Video

Your knee has been throbbing for months. You’ve tried a brace, soaking in a tub and even cortisone shots. But nothing seems to bring down the swelling. Golf and tennis are now totally out of the question.

The doctor suggests arthroscopic surgery. It sounds scary. Heck, you’re not even sure you can pronounce it. The next few minutes are a blur as the doctor tosses around words like anesthesia, incisions and debridement. Now your head hurts almost as much as the knee. You give the doctor that quizzical look he’s seen a dozen times before. But he’s got patients lined up in the waiting room so he places a brochure in your hand and tells you to think about.

Guess what? There may a better way!

Imagine instead that the doctor flips open his laptop, taps a few keys and shows you a video of the procedure. Now it doesn’t seem so terrifying. That night, at home, you log on to the Internet, watch it again and even find a few articles that explain what to expect during recovery.

Just as technology is improving the way we deliver medicine—the less-invasive arthroscopic surgery is a great example—technology can also be an invaluable tool in educating patients. Several authoritative studies have found that better-informed patients tend to experience less anxiety about surgery or other treatments and, as a result, tend to recover faster and with fewer complications.

Video is a good option if the physician is not the next Great Communicator or if a patient has trouble making sense of written materials. Even doctors who are skilled at translating medical mumbo jumbo into laymen’s English will find videos a useful tool. And the popularity of television shows such as “House” and “Mystery Diagnosis” are evidence that there’s an appetite for well-produced medical programming.

The research also tells us that consumers are increasingly turning to the Internet for information. More than one-third of all adults in the United States say they watch video online at least once a week and 60 percent of consumers who use the Internet for health information say it improves their conversations with physicians.

But not all websites are created equal, especially when it comes to medicine. At Discovery, we partner with some of the top experts in the field to present unbiased, reliable information. The videos are part of a new trend what many are describing as “Medutainment” – a rich blend of medicine and entertainment.

On the Discovery Health website, for instance, we offer short video clips from the Cleveland Clinic on a range of health topics. Doctors and patients can go to the site (http://health.discovery.com/news/cleveland-clinic-clips.html) for the latest evidence on vitamins, the debate over radiation exposure and CT scan and the value of folic acid for women of childbearing age. These timely segments are a great way to make sense of the avalanche of medical journal findings being released nearly every day.

Through Discovery Hospital, providers have the ability to integrate video into their own websites. One of the most popular is our video library on parenting with the “Great Expectations” series outlining tips for before, during and after the big day. The video archives cover common chronic conditions such as diabetes and asthma, as well as tackling more complex illnesses such as depression and heart disease.

We’ve also found that using tools such as video and the Internet helps even smaller hospitals demonstrate their high-tech savvy. After St. Thomas Health in Tennessee won top rankings for its cardiac care, the hospital began posting videos on the popular site You Tube touting their accomplishments.

“St. Thomas is obviously the best to go to for heart treatment here in Nashville,” says one woman interviewed on the 30-second spot. Others, such as Stanford University Medical Center, have produced mini-documentaries of 30 or 60 minutes exploring issues such as alternative medicine, end-of-life care and “Body Image after Breast Cancer.”

For the physician or hospital squeezed for time and money, online video libraries are an excellent way to supplement what you can offer consumers. And although these kinds of videos cannot clear your arteries or make that bum knee new again, but they can help make patients feel better.

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Care-Givers Need Care Too

May is the month we pay tribute to mom – and often treat her with a bouquet of flowers. This Mother’s Day, you may want to consider giving mom a break, especially if she is one of the millions of women who are caregivers.

We all know men who pitch in with care-giving duties. But research indicates that 75 percent of caregivers in the United States are female – and many of these women are holding down jobs outside the home, while tending to the needs of children and an older relative. Thank goodness they do. Their volunteer, unpaid caregiving is valued at between $148 billion and $188 billion a year, according to the Family Caregiver Alliance. That’s a lot of help!

Women also live longer than men in our country, which means many will need care after a lifetime of providing it to others. In future columns, I’ll offer some concrete advice on how to decide if your loved one needs assistance and what types of caregiving are available. But today, in honor of all those hard-working moms I’d like to draw attention to an equally important, less-noticed concern: the health of the caregivers.

Study after study tells us that the people delivering care often don’t take care of themselves. Caregivers are less likely to eat a balanced diet, exercise, visit their own doctor and even fill their own prescriptions. In some cases, financial pressures cause caregivers to cut back on essentials. But more often, they are simply too busy and too tired to focus on themselves.

It’s easy to understand why: Suddenly you are responsible for the financial, physical and emotional well-being of your loved one. Caregivers are at increased risk for injuries from lifting patients. I also see caregivers whose immune systems are weakened, making them more susceptible to illness. People who are caring for a family member tend to have higher hospitalization rates and slower healing rates.

They are also more prone to suffer emotional problems such as depression. Caregivers may experience frustration that they have lost the vibrant, fulfilling life they once had with a spouse. Others may feel guilty that they remain healthy, while their loved one is suffering. It is common for many caregivers to have trouble concentrating at work, to abuse alcohol or drugs or withdraw from social activities. It may sound obvious, but you can’t take care of a loved one if you aren’t healthy yourself.

Whether you are a caregiver yourself, a friend of one or a relative, be on the lookout for signs of caregiver stress. These can include fatigue or difficulty sleeping, musculoskeletal injuries, chronic pain, a short temper or weight fluctuations. Some of the most important steps to take are also the simplest: Get plenty of rest,

eat properly and exercise, even if it is just a walk around the block or making a few extra trips up and down the stairs at home.

For many of us, our faith or support groups play a critical role in assisting caregivers. AARP and groups such as the Alzheimer’s Association have informative websites and local chapters. Check them out.

Most importantly, caregivers need breaks. Play a round of golf, go to the movies, visit a spa or just find a quiet place to meditate. Be sure other family members and friends are pitching in, even if it’s just for an hour. Adult day care and respite care are other options. And don’t forget to laugh. A good chuckle now and then—even just finding amusement in life’s daily hassles—is some of the best medicine around.

So before you order another bunch of flowers, consider giving Mom a caregiving break.

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Visit the Discovery Health Stress Management Center for more help.

Tough Pill to Swallow

Modern medicines can be wonderful therapies -- if you remember to take them and take them properly. That may sound simple, but I've noticed that following a medication routine can be one of the great challenges for patient and physician alike.

Research suggests that half of all patients do not take their medicine properly. Missed doses, known as non-compliance or non-adherence, can worsen an underlying medical condition, lead to other health problems, or even prompt premature death. Skipping blood pressure medicine can lead to a heart attack; missed doses of glaucoma medication can speed blindness; intermittent or inaccurate insulin doses can result in diabetic emergencies. It's also a huge waste of money to buy pills and not take them.

There are myriad reasons for medication non-adherence.

It can be hard enough to remember to take a certain pill at a certain time of day for a certain length of time. Now imagine folks who have to take several pills a day -- and maybe some are prescribed for once a day and others are three times daily. It can get very confusing.

Some patients have poor eyesight and misread labels; others can't afford the medicine. For some, the act of taking a pill is an unwelcome reminder of being ill.

Many of us stop taking medicine when we start feeling better. This is especially true -- and especially risky -- for patients with high cholesterol or high blood pressure. Just because your blood pressure comes down doesn't mean it's a good idea to stop taking the medicine. That can lead to the heart attack or stroke the medication was intended to prevent.

Another reason for skipping doses is the side effects that patients attribute to a new medication. The drug mayor may not be the reason. The best approach is to it with your doctor, who can help determine if the drug is causing the problem, and if so, how to mitigate the side effects.

Ultimately, it's up to the patient to follow a drug regimen. But doctors must do their part too -- when they first prescribe a medication and throughout treatment. Research indicates that too often a physician does not clearly explain the reason for prescribing a particular therapy or dosage, let alone provide guidance on how to take it.

Doctors should follow up with patients, making sure prescriptions are refilled and the patient is comfortable with the regimen. Printed instructions or even a reminder phone call from a nurse are worthwhile.

Some tips for patients:

• Most important, check with your doctor if you are confused or want to make a change.
• Understand the purpose of each drug, the correct dose and possible side effects.
• Create a calendar to record when each medicine is taken.
• Post reminders on the refrigerator or medicine cabinet.
• Integrate medications into daily routines, perhaps with a certain meal or television program every day.

Technology -- some quite simple and others more sophisticated -- can also help. One of the most common and most successful tools is the pill box with separate compartments for each day of the week.

The federal Agency for Healthcare Research and Quality has developed an easy-to-use pill card that keeps track of what drugs are taken and when. It has colorful, common-sense symbols such as a rising sun for morning meds and a bag of sugar for diabetes checks. This link includes step-by-step instructions. http://www.ahrq.gov/qual/pillcard/pillcard.htm Family and friends might consider setting up cards for loved ones who aren't comfortable with a computer.

More elaborate devices are also on the market today, including pill boxes that sound an alarm when it's time to take the medicine and cell phone programs that flash reminders.

And some pharmaceutical companies are working on combination therapies that would enable patients to take a single pill for a host of maladies. That sure would make life easier!

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Understanding Your Prescription

Diabetes: An Energy Imbalance

Our world is out of energy balance. I'm not talking about all the electricity and gasoline we use. I'm thinking of another kind of energy. Worldwide, rates of obesity are rising as we take in more calories than we need and don't spend enough energy to work those calories off.

One result of that energy imbalance is diabetes. The most common kind of diabetes, type 2, is caused by a combination of genetics and lifestyle. More than 246 million people around the world now have this dangerous disease. Diabetes puts you at risk of heart attack, stroke, nerve damage, kidney disease, and more.

To draw attention to the dangerous consequences of diabetes, the United Nations has designated November 14 as World Diabetes Day. It's a way to get governments, big companies, and non-profit organizations to take notice and to provide help to people who can't afford diabetes care. It's also a reminder to the rest of us: if your body's out of energy balance, it's time to think about making some changes. A healthy diet and exercise can reduce your risk of developing diabetes.

Not that changing your lifestyle is easy! Here in the U.S., when we think about losing weight and getting in shape, we think of strict diets and long hours at the gym. But that's not for everyone. In honor of World Diabetes Day, I've been searching the globe for other ways to get in shape.

If you lived in Brazil, your favorite exercise might be dancing. Samba's still hot in Brazil, the social scene often centers around music, and people of all ages take part. Check your neighborhood for a dance class and learn to move to a tropical beat.

If you lived in The Netherlands, there's a good chance you'd commute to work by bicycle. In Amsterdam, much of the rush hour traffic is on two wheels. Too far to bike to work? Consider your bike instead of your car for short trips after work or on weekends.

If you were Italian, you might have grown up playing soccer in the park, when you weren't cheering for your team on TV. People say soccer is like a national religion in Italy! To find a local soccer league or classes, try your city's parks and recreation department or check the web.

In Austria, you might spend the winter on skis. Alpine skiing is hugely popular in Austria, where over 60% of the country is covered by mountains. Can't afford skiing? Hiking is another way to get in shape while enjoying the great outdoors.

Even if you hate to exercise, somewhere in the world there's a sport for you. On November 14, how about observing World Diabetes Day by getting started with an activity you'll enjoy?

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Spinal Cord Injury

It’s Sunday – so like most people, I’m watching football! Have you been following the story of Kevin Everett, the Buffalo Bills football player who was injured on September 9?  Everett dislocated a vertebra in his neck during a tackle and needed emergency surgery to try to prevent paralysis.  His doctor gave him a five to ten percent chance of recovery. 

You may not be out there tackling professional football players, but that's not how most of these injuries happen.  Car accidents cause a little over a third of spinal cord injuries, followed by falls, violence, and recreational sports, especially diving.  Most spinal cord injuries happen to young adults, although as the population ages the average age of injury is going up.  People over 60 make up about 12% of new spinal cord injuries.  Males outnumber females approximately 5 to 1.

Everett was lucky: he's now in physical rehab and as of late October, doctors said he had a good chance of walking again.  But not everyone who suffers a spinal cord injury is so fortunate.  In light of what Everett 's gone through and what the other 11,000 victims of spinal cord injury in the U.S. each year face, I want to offer some pointers on spinal cord safety. 

The most important tool for preventing spinal cord injury is your own common sense.  Don't try to balance on a ladder that isn't sturdy, and don't ignore the label showing the highest safe step.  Behind the wheel, drive defensively.  Stay off the road if you've been drinking and don't ride with a driver who's been using alcohol.  When you're swimming, don't dive in if you aren't certain of the depth.  The American Association of Neurological Surgeons recommends at least 9 feet; diving boards require even deeper water. 

You also need to know your limits.  Older adults, who may be at higher risk of fracture due to thinning bones, should consider staying off ladders altogether.  If you're out of shape, don't push beyond what's comfortable in a backyard football game, at the gym, or in any other activity: weak muscles interfere with balance and control, putting you at risk of injury.  Consider your vision and your reflexes before driving at night or in bad weather. 

If a spinal injury does happen, you can learn from the Buffalo Bills. 

Everett 's trainers didn't try move him after he fell.  Moving a spinal cord injury victim can cause further damage.  Unless there's a reason like fire, falling debris, or the need to perform CPR, leave the person as they are until the experts arrive.  The Bills got medical help on the scene right away.  As with any major injury, every minute counts.  Don't wait: call 911 immediately.

Remember, even with the best treatment, spinal cord injuries often cause permanent disability.  Keep prevention in mind, use good sense, and stay safe!

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More about Spinal Cord Injury

Pet Perks!

Maybe you've heard of therapy dogs. These pets and their owners visit people in hospitals and nursing homes, offering gentle companionship and bringing cheer. A visit from a therapy dog can "do your heart good." But did you know that owning a dog or cat really can be good for your heart?

For one thing, having a pet can keep you active. If you go for a brisk walk with your dog instead of just letting him out the back door to do his business, you can count that toward your daily exercise requirement. Get in two fifteen-minute walks each day (fast enough to elevate your heart rate but not to make you feel out of breath) and you've met the American Heart Association's goal for aerobic exercise to reduce the risk of heart disease and other chronic illnesses. Some cats will enjoy a good walk, too. Yes, that’s right – some cats…not all cats! If yours is an indoor cat, spend some time playing. Dangle a ball of yarn for your cat to bat around, and keep yourself moving to keep the game exciting—and to sneak in some exercise.

Owning a pet may have direct benefits for your heart, too. The evidence isn't definitive, but a few small studies suggest that pets can help control blood pressure. For example, researchers at the State University of New York at Buffalo looked at how pet ownership affects stress reactions in people with high blood pressure. They recruited 48 volunteers who had high blood pressure, were willing to take medication, and wanted to own a dog or cat. Half the people got the pet they wanted right away, and half were asked to wait. The results, published in the medical journal Hypertension, confirmed that the medicine lowered overall blood pressure for everyone. But when the pet owners were given stressful tasks, their blood pressure rose less than in the volunteers who didn't have pets.

Owning a pet may even increase your chances of surviving a heart attack. Doctors studying heart patients found that people who owned dogs were more likely to be alive one year after a heart attack than people who didn't. This may have to do with the love and support a pet can offer.

It looks like man's best friend continues to earn the title, and our feline companions are great assets as well. Take your dog for a walk, chase a toy mouse with your cat, and let them know you appreciate all they do!

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Furry Friends Can Aid Your Health

Huggable Healthcare Workers

Staying Young Center

The Ins and Outs of Being Hospitalized: Preparing as Best You Can

Being hospitalized can be a difficult experience. A lot happens in a short amount of time: tests, procedures, medications, and people…many people. I recently met with Dr. Matt Press, a resident physician at the Hospital of the University of Pennsylvania, to discuss this topic. Here are 5 tips we came up with to help you—and your family—navigate the ins and outs of being admitted to the hospital.

1. Bring a buddy

It’s a good idea to have a "buddy" (such as a family member or close friend) with you as often as possible while you’re in the hospital. While you’re focused on getting better, your buddy is there as an extra set of eyes and ears. Your buddy is your advocate, which means he or she can talk things over with you and be a source of support.

2. Be alert and aware

Ask a lot of questions and pay close attention to the answers. You should be told what tests you are having and why, what medications you are being given, and what the overall plan is for your care.

3. Keep a paper and pen by your bed

If questions come to mind and the medical team has already made its morning rounds, you can jot them down to ask the next time. Just as important is to write down the answers. This will help you keep track of your care, including medications and tests.

4. Know the people…the many people

You will meet many people over the course of your hospitalization, and it’s helpful to have some idea of who’s who. In general, there are doctors, nurses, and support staff. The doctors are typically divided into a primary team (which is based on what your medical condition is) and consulting teams (which may be asked by the primary team to help with a specific aspect of your care). Each of these teams may have different doctors, and—if you’re at a teaching hospital—these doctors may be at different stages of training. Remember that the "attending" is the leader of the team and has the most experience. Nurses give medications and frequently assess how you’re doing. The support staff includes nursing assistants, pharmacists, social workers, physical therapists, and others who are trained to perform specific tests (such as x-rays).

5. Bring comforts from home

With its thin mattresses, cold temperatures, and noisy hallways, the hospital can be uncomfortable. Add to that the stress of being sick…and being hospitalized can make you downright homesick. To help, bring a pillow, a book or magazine, and a toothbrush. These items from home will start you off on your way to a speedy recovery!

Have you ever been admitted to the hospital? Share with us the strategies you used to help deal with the experience.

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Communicate More Effectively With Your Health Care Professionals

Communication Breakdown With Your Health Care Professionals

Surgical Inpatient Unit

Heart Disease: Guessing the Risk

If you knew you had a 25% chance of having a heart attack in the next ten years, wouldn’t you do something about it? And if you knew your risk was less than 1%, wouldn’t you feel good?

For people who don’t have any signs of heart disease, guessing the risk might seem impossible. There’s no crystal ball to show who will or won’t develop heart disease. But we do have a way to estimate who’s at higher risk. It’s called the Framingham Risk Tool, and you can find it online at Discovery Health.

This calculator is based on a huge study of the population in Framingham, Massachusetts, where researchers have been tracking residents’ health since 1948. To use it, you’ll need to know your blood pressure and your cholesterol level, including your high density (HDL) cholesterol. (The calculator only works for people who don’t have diabetes or signs of heart disease, because those things independently raise your heart attack risk.) The calculator gives you a starting point, a number you can use to open up a discussion with your doctor. He or she will also want to know your family history of heart disease, your ethnic background, how much you exercise, how much you weigh, and how much alcohol you drink. These are all things that can influence your risk.

Once you’ve got your number, what do you do about it? Young, healthy people will usually have a risk of less than 1%. If that’s you, it’s likely that you need to focus on eating a healthy diet and getting plenty of exercise to protect your heart.

But what if it’s higher? When you have that conversation with your doctor, he or she will recommend ways to decrease your heart attack risk. Here are some of the things you can do:

• If you smoke, quit. Smoking a pack a day increases the risk of a heart attack by six times for women and three times for men.
• Treat high blood pressure. A normal blood pressure is below 120/80. It’s considered “high” if it’s 140/90 or above. Diet and exercise can help keep blood pressure down. Some people need medication, too.
• Control your cholesterol. A healthy cholesterol level is below 200mg/dL. Your LDL number (the “bad” cholesterol) should be under 130, and your HDL number (the “good” cholesterol) should be above 40. People who already have signs of heart disease need even lower LDL.
• Consider a daily aspirin. In people at elevated risk of a heart attack, aspirin can reduce that risk by about one third. If your ten-year risk is 6% or above, ask your doctor about taking a daily aspirin. Too often, patients don’t think aspirin is important since it is available over-the-counter, rather than prescription. It is one of the most effective therapies to treat heart disease as well as to prevent it, so ask your doctor if you should be on it.

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Printable Worksheet for Men

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The tool: http://discoveryhealthcme.discovery.com/aspirin/reference/resources/framingham.html

Flu Shot Season

Find out if you—and your family—should get it this year

It’s Fall! Time for football, apple-picking, and—for millions of Americans—a flu shot. According to the Centers for Disease Control (CDC), about 36,000 people in the US die each year from "the flu"—also called "influenza" by doctors—which is a respiratory illness caused by influenza viruses. So should you get a flu shot—the vaccine intended to prevent the infection—before the leaves change this season?

First, it helps to understand a bit more about influenza. The symptoms of influenza vary but typically include a combination of common cold-like symptoms (dry cough, sore throat, runny nose) and the sudden onset of fever, headache, extreme fatigue, and muscle aches. People with influenza are contagious even before they start to feel sick and can spread the infection just by coughing or sneezing near others.

For most patients, influenza is a self-limited illness—meaning the symptoms will go away in less than a week’s time. But for some, the infection can have serious consequences, such as pneumonia. These are the people who really need the influenza vaccine. If you fall into one of the following categories, then YOU should get a flu shot this season:

• adults 50 years of age or older
• children aged 6 months until their 5^th birthday
• pregnant women
• people who live in nursing homes or other long term care facilities
• people of any age with chronic medical conditions (including heart or lung conditions, asthma, diabetes, kidney disease, or HIV infection)
• people who live with or work with anyone who meets the above criteria OR with children less than 6 months old (who are too young to be vaccinated)

(source: CDC)

• Some people should NOT receive the influenza vaccine without first talking with a physician. They are:
• people who have a severe allergy to chicken eggs
• people who have had a severe reaction to the influenza vaccine in the past
• people who developed Guillain-Barre syndrome (a neurologic condition) within 6 weeks of receiving the flu vaccine previously
• children less than 6 months old
• people with a moderate to severe illness with fever, who should wait until their symptoms improve before getting the influenza vaccine

(source: CDC)

The influenza vaccine comes in two forms: injection and nasal-spray. The nasal-spray vaccine is only for individuals aged 2-49 years who are not pregnant and who are otherwise healthy.

You might ask, "If I had a flu shot last year, do I need it again this year?" The answer is, Yes! The vaccine is required yearly because the viruses that cause influenza can change slightly and because your body’s ability to fight the infection declines over the course of the year.

The influenza vaccine is the best way to prevent influenza this season if you or your family members are in one of the categories we discussed. And, for everyone, don’t forget a year-round infection-fighting strategy: wash your hands!

You can find out more information about influenza and the influenza vaccine at http://www.cdc.gov/flu/

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Colds and Flu Center

Ultimate Flu Guide

About Diabetes

Over 20 million people in the United States have diabetes.

One of the most important things you can do to decrease your risk of complications is to get your blood sugar under control.  Improved glucose control can help save your eyesight, your kidneys, and even your life.  But what exactly does “improved glucose control” mean?  How do you know when you’re doing it right?

One of the most important tests in diabetes care is the “hemoglobin A1C.”  This test tells how well you’ve been doing at controlling your diabetes over the past three months.  When blood sugar is high it causes changes in hemoglobin, a molecule that carries oxygen in your blood.  The new form of hemoglobin is called hemoglobin A1C.  The more hemoglobin A1C you have, the higher the number—and high numbers mean your blood sugar is out of control.  The American Diabetes Association says a safe A1C number in diabetes is 7.0.  People without diabetes usually have an A1C number less than 6. 

How do you get that number down?  You have to monitor your blood sugar daily.  If your blood sugars are pretty good but your A1C is still too high, you may need to check your postprandial glucose level.  That’s a fancy way of saying that you should check your blood sugar one to two hours after the start of a meal.  The reasons are convincing.  Not only does that postprandial glucose level contribute a lot to your A1C, it’s been shown that high blood glucose levels following meals is a risk factor for death!

If you check your levels after you eat, you will see firsthand the effects that different foods have on your blood sugar.  Maybe you’ll see that your blood sugar tends to be high after breakfast or that a large bowl of pasta may not be the best choice for lunch.  If you know this from checking your postprandial glucose level, you will be able to make better food choices in an effort to fix it.  Further, if you keep a log of your levels, you will be able to aid your doctor in adjusting your medication schedule.  The American Diabetes Association recommends aiming for a postprandial glucose level less than 180 mg/dl.

If your doctor hasn’t mentioned postprandial blood glucose monitoring, it may be because he or she doesn’t know the importance of it.  Information in medicine changes quickly and it can be difficult to keep up.  The next time you visit your doctor, ask about postprandial glucose monitoring. It is, without question, another way that you can help keep your diabetes in optimal control. 

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Diabetes Health Center

Nutrition Advice from Discovery Health Experts

Unfortunately, many of them will develop serious complications of the disease.  Diabetes is a major cause of heart attacks, blindness, and limb amputation.  If you have diabetes, are you doing all you can to prevent these from happening to you?