Tag: physician

How do Physicians Treat Congestive Heart Failure?

Congestive heart failure is precisely what it sounds like; it is a failure of the heart to properly function, and its effects on the body can be devastating. Physicians do their best to treat the symptoms and give the patient the best prognosis possible; however, no true cure for congestive heart failure currently exists.

Heart failure occurs when the heart is unable to properly pump blood throughout the body; as a result, rather than distributing nutrients and oxygen to the tissues and then excreting the excess fluid into the urine the blood pools. This results in either a systemic or localized edema as fluid builds up in the veins and organs, causing swelling of the extremities as well as the organs themselves (this fluid accumulation is responsible for an excessive amount of stress on the heart as fluid accumulates in the pleural cavity as well as the dyspnea, or difficulty breathing, often symptomatic of heart failure). The swelling and lack of oxygen and nutrients will result in permanent damage to the organs if left untreated, providing a very poor prognosis for the patient.

The first stage of treatment generally consists of the administration of extra oxygen to attempt to return the oxygen levels in the tissues to normal. Once oxygen has been administered and a pulse oximeter reveals blood oxygen levels to be acceptable the focus will shift to attempting to treat the fluid build-up in the body. Diuretics will be administered to assist the excess fluid on its path out of the body via the urinary tract, and nitrates are administered to cause the vessels to dilate, allowing blood to flow more freely without the heart having to work quite as hard. Treatment with diuretics is often accompanied by supplemental potassium, as the body will excrete potassium in the urine and long term hypokalemia may result in muscle weakness or paralysis, as well as an increased risk of fatal cardiac arrhythmia.

Patients will often be sent home from the hospital with diuretics, as well as a medication known as an ACE inhibitor (an angiotensin-converting enzyme inhibitor) which prevents the body from creating angiotensin, a substance which raises blood pressure and causes the blood vessels to constrict. An angiotensin II receptor blocker may also be administered if the patient continues to produce angiotensin. Patients may also be treated with vasodilators other than ACE inhibitors, particularly if they have responded poorly to treatments with ACE inhibitors in the past. Nitroglycerin is a common example of this type of medication.

Digitalis, or Digoxin, may be prescribed to strengthen the force of the heart’s contractions, aiding it to push blood throughout the body. Treatment with a beta blocker is also beneficial in cases of heart failure, preventing the heart from beating more rapidly in an attempt to compensate for the poor movement of the blood in the body and placing more stress on the weakened muscle.

Blood thinners are used to prevent the formation of clots in the body that may be caused by the decreased movement of the blood in the vessels. Coumadin and heparin are the most commonly prescribed blood thinners in use today; however, due to an increased risk of bleeding patients taking these medications should undergo coagulation testing regularly.

Lifestyle changes are just as important as medications in the long term treatment of heart failure. Patients should consult with their doctor to establish an appropriate (low sodium) diet and exercise program, and should do at least some moderate exercise daily. Equally important is taking sufficient time to rest every day. The heart pumps more easily when the body is at rest, which is vital to an already overstressed muscle. The nicotine from cigarettes causes an increase in heart rate, blood pressure, and the tendency for clumping in the blood vessels; patients with heart failure should abstain from smoking. Flu or pneumonia can be very difficult for hearts that are failing as they attempt to compensate for the lack of oxygen in the bloodstream being carried to the organs. It is very important that patients receive an annual influenza vaccine, as well as a dose of the pneumococcal vaccine, which will protect them from the pneumococcal bacteria that cause over eighty percent of cases of bacterial pneumonia. Wearing non-constrictive clothing will assist in preventing blood clots and facilitating blood flow to the extremeties, and in cases of extremely warm or extremely cold temperatures it is important that the patient take all precautions necessary to keep the body at an appropriate temperature..

Researchers are still seeking to find a cure for congestive heart failure; however, until that day comes it is extremely important that patients suffering from heart failure follow the treatment plan outlined by their physician. With careful attention to maintaining their condition, the prognosis associated with heart failure increases dramatically.

How CHF Patients can Take Advantage of Translational Research?

In nature every action spawns a separate and equal reaction. In the field of medicine, the reaction may not always be equal to the action. The performance of a particular treatment in the lab on test animals may not be the same as would be seen in a human subject; this is where the field of translational research comes in.

Translational research takes research from the laboratory to the patient’s bedside. This can be done in several forms. In its earliest stages a treatment will undergo controlled clinical trials with a voluntary group of test subjects. If these small, controlled tests meet the acceptable range of success the treatment is then taken to research hospitals such as St. Jude’s or Children’s Hospital of Boston. Here patients are given the opportunity to experience new methods of control and treatment of a disease with the understanding that it is still considered highly experimental; however, for many these treatments represent a chance for a cure that previously as out of reach for them as the moon.

Congestive heart failure is, at the moment, an incurable event, occurring when for whatever reason the cells of the heart muscle are destroyed and the heart can no longer adequately pump blood throughout the body. Once the cells in the heart tissue are non-functional the body is unable to replace them, making it impossible for the heart to regain full heart function on its own. The current mortality rate is high, and over fifty percent of patients with congestive heart failure will die within five years of being diagnosed. There are many treatment options currently being considered for congestive heart failure, however, and a number of new technologies being tested daily. For example, Montefiore Medical Center in New York City is currently doing clinical trials on a drug known as Lovosimendan, a calcium sensitizer that does not trigger cardiac arrhythmia, and research into the possibility of using stem cells to regrow cardiac tissue is ongoing.

For a patient to take advantage of these options they should discuss the possibility of being a subject for clinical testing with their physician to see if they would be a good candidate, then allow the physician to make a recommendation on a course of action from there. It may be suggested that the patient contact a research facility, or the physician may suggest their name for a clinical trial they know is occurring soon. If the patient lives in an area with a research hospital nearby, chances are there will be an opportunity for them to benefit from the hospital’s policy on translational research.

It should be understood that translational research is precisely what it sounds like; research. Scientists and doctors are often still learning about the treatment and its effect on the human body, and there is always a possibility that it will be unsuccessful or carry with it many hazardous side effects. These courses of treatments are unknowns to physician and researcher alike. For patients who have run out of options, however, even the possibility of a negative effect cannot stifle what the opportunity to be part of a translational research project provides: hope.

How Can Continuing Medical Education Credits Be Obtained?

While physicians spend many, many years in school prior to receiving their MD, it is impossible for them to learn everything there is to know. The medical field is simply too vast, and it is constantly in motion; therefore, it is important that every physician complete continuing medical education.

Continuing medical education (CME) allows a physician to stay abreast of new discoveries, treatments, and other advancements in their chosen field. What worked thirty years ago is not usually the method of choice for today’s physicians, and clinicians who do not complete these continuing education credits may often be placing their patients at risk because of a lack of knowledge of treatments that have been deemed ineffective or hazardous. Unfortunately, often when a physician is wrong it is the patient‘s life that pays the price.

Due to this, every physician is required to complete a minimum number of CME credits every year; however, they are certainly not required to stop once that number is met. This does not necessarily mean returning to school, although this is certainly an option; however, for most physicians caring for their patients leaves them little time for the heavy workload of a secondary education institution. Many other more convenient options are available to them.

Across the nation hundreds of thousands of medical conventions, symposiums, workshops and conferences are available to healthcare professionals, covering topics from new surgical techniques to treat collapsed heart valves to the use of stem cells to treat congestive heart failure; all cutting edge technology not yet taught in the classroom. These often take place over the course of a weekend, often last more than one day and are held in various locations, so physicians from any location in the country may attend at their discretion.

In many rural areas there is only one doctor available, often with no one to see to their patients when they are unavailable. These are the physicians who are still on call twenty four hours a day, make their own hospital rounds and see patients from birth to death for everything from a toothache to a heart attack. Needless to say they are often unable to get away from their practice to attend weekend workshops. Another option is available for them so they can continue to provide their patients with around the clock care. The internet has opened up a whole new world to the field of continuing education. Many organizations, such as the American Medical Association (AMA) and the American Association for Continuing Medical Education (AACME) offer resources online for healthcare workers to complete their continuing medical education credits. Here clinicians will have the opportunity to complete coursework online, view online conferences and use the teleweb to attend lectures and symposiums.

These CME resources may be found free of charge or for a small fee per credit hour, depending on the situation; however, this is infinitely less expensive (and time consuming) than returning to a college or university, and offer greater benefits because attendees are able to stay apprised of new research and untried methods that are not taught to students.

It is true that no one ever stops learning, and this is especially true in the medical field. Continuing medical education allows clinicians to stay on top of their field and provide the best, most advanced care options available to their patients.

My Lasik Vision Story

I am putting this story on the web to encourage those who are interested in a Lasik vision procedure, but have read so many horror stories that they are getting ever more reluctant. I had to get off of the Internet to get enough courage to even go down to a nearby Lasik center to have them talk about my individual case. I am glad I went, and the people were very kind, professional, and encouraging.

Let me begin with why I was even interested in Lasik. I have worn glasses for thirty years, ever since I was a very little girl. I have very weak eyes, and needed to wear my glasses from the moment I woke up until I went to bed. I have a special spot where they are kept, and a number of backup pairs of glasses so that I never have to go without them. I also have had some dry eye problems for the last few years, which is often a reason that Lasik doctors do not recommend the Lasik procedure for some people.

When I got to talk to the Lasik physician, he was encouraging but realistic. He stated that one of my eyes would be a good candidate for total vision correction, but the other eye would likely see only some (though possibly major) improvement. He stated that about one of his Lasik procedures per month are with clients with the same level of poor vision of my worst eye.

I would also like to encourage those people with some problems to go ahead and visit their local Lasik center to talk to the professionals there. As I mentioned earlier, I have had some occasional problems with dry eyes. I also have pupils that dilate easily. Both of these can be reasons to be dissuaded from Lasik, but in neither case were my problems significant enough for the doctor to consider me not a good Lasik client. Do go and discuss your individual case.

I cannot say that the information I was given made me totally relaxed about the whole procedure. I did talk myself into and out of the Lasik procedure several times during the weeks before it was done. The only thing I was a little bit surprised about was that I did not lose sleep over it, and that I actually showed up at the Lasik center to get the procedure done!

I was given a mild sedative (as well as numbing eye drops) and the Lasik procedure went without a hitch. Though I did feel a mild pressure during the time on my eyeball, my hands were the things that hurt after the Lasik operation was over (I must have had them clenched the whole time!). I was so grateful to my physician who said things like “I’m using the laser for 20 seconds, 5 seconds to go, procedure done for this eye. Very successful.” In this way I was reassured that the Lasik operation was going quickly and according to plan.

I followed all my Lasik physician’s instructions to the letter after the procedure, and I am so happy with the results! I could see much better even directly after the operation was over, and things have continued to improve. I personally do not have any of the problems that are often mentioned as effects, such as halos around lights, etc. I would strongly encourage anyone to be brave enough to go down to your Lasik center and at least talk about the Lasik procedure with a knowledgeable professional.