Archive for February, 2011

THE ELDERLY

Sunday, February 20th, 2011

On his show many years ago, Art Linkletter was interviewing children, and they came up with the following answers to a question he posed: “You can’t play with toys anymore…the government pays for everything…you don’t go to work…you wrinkle and shrink.” The question was “What does it mean to grow old?” The responses of the children contain many of the stereotypes our society attributes to the elderly. They also show that this negative picture develops from a very early age. There is a stigma to growing old. The notion is that for the elderly there is no play or fun, no money, no usefulness, and no attractiveness.
It is important to recognize that in considering the elderly, we all really are talking about ourselves. It is inevitable: we will all age; we will all become the elderly. A participant at a recent geriatric conference reported being asked by a friend, “Give me the inside scoop… what can I do to keep from getting older?” The response the person received was simple: “Die now!” There is no other way to avoid aging. So, for those not themselves among the elderly, in thinking about the older person, imagine yourself years in the future, because many of the circumstances will probably be the same.
Of the approximately 240 million people in the United States, 29 million are over age 65. This is the group arbitrarily defined as the elderly, or aged. Each day, 3000 die and 4000 reach their 65th birthday, so there is a net gain of 1000. By the year 1990, it is estimated that over 35 million persons will be over age 65; this will represent a larger percentage of the population than ever before. Consequently, the problems of the elderly, including alcoholism, that will be discussed are going to become a growing concern for our society.
Coping styles. Despite the inevitability of aging and despite the inevitability of physical problems arising as the years pass, there is an important thing to keep in mind. It has been said many times and in many different ways that you are as young as you want to be. This is only possible, however, if the person has some strengths going for him. The best predictor of the future, specifically how someone will handle growing old, is how the individual has handled the previous years. Individuals who have demonstrated flexibility as they have gone through life will adapt best to the inevitable stresses that come with getting older. These are the people who will be able to feel young, regardless of the number of birthdays they have celebrated.
Interestingly, as people get older, they become less similar and more individual. The only thing that remains alike for this group is the problems they face. There is a reason for this. Everyone going through life relies most heavily on the coping styles that seem to have served them well previously. With years and years of living, gradually individuals narrow down their responses. What looks, at first glance, like an egocentricity or eccentricity of old age is more likely a life-long behavior that has become one of the person’s exclusive methods for dealing with stress. An example illustrating this point arose in the case of an elderly surgical patient for whom psychiatric consultation was requested. This man had a constant smile. In response to any question or statement by the nurse or doctors, he smiled, which was often felt to be wholly inappropriate. The treatment staff requested help in comprehending the patient’s behavior. In the process of the psychiatric consultation, it became quite understandable. Friends, neighbors, and family of the man consistently described him as “good ole Joe, who always had a friendly word and a smile for everyone, the nicest man you’d ever want to meet.” Now under the most fearful of situations, with many cognitive processes depleted, he was instinctively using his faithful, basic coping style. Very similarly, the person who goes through life with a pessimistic streak may become angry and sad in old age. People who have been fearful under stress may be timid and withdrawn in old age. On the other hand, people who have been very organized and always reliant on a definite schedule may try to handle everything by making lists in old age. What is true in each case is that the person has settled into a style that was present and successful in earlier life.
Main stresses. In working with the elderly, in order to understand what is evolving in an individual case, it is imperative for helping professionals to consider every possible piece of information. Integration of data from the social, medical, and emotional realm is essential for understanding what makes the elderly person tick in order to make an intelligent treatment plan. Four areas of stress should be considered in dealing with the elderly: stresses that arise from social factors; psychological factors; biological or physical problems; and, unfortunately, iatrogenic stresses due to the helping professions as they serve (or inadequately serve) the elderly.
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ASTHMA DEVICES: NEBULIZERS

Friday, February 11th, 2011

Nebulizers are made from plastic and come with either a face mask or a mouthpiece. They function simply and effectively.
The liquid solutions used in the nebulizer are mixed with a diluter (unless specifically stated in instructions or by your doctor). Your doctor will prescribe the amount of medication and diluter. Ventolin, Atrovent, Bricanyl, Pumicort, and Intal solutions are available in single-dose plastic vials. The solution is placed in the nebulizer chamber and compressed air from the pump creates a fine mist which penetrates the airways. (Nebulizers can also be driven by an oxygen cylinder.) The mist is then inhaled through the mask or mouthpiece.
Nebulizer therapy is the most effective method of medication for an acute asthma attack. The mist from the nebulizer penetrates quickly and easily through the bronchial trees and into the lungs.
NEBULIZER USERS
•Children and adults who have difficulty using aerosol sprays;
•People in geographically isolated areas where rapid access to medical assistance is not possible;
•Those patients with severe chronic airway obstructions which are unresponsive to high doses of aerosol inhalants and spacers.
MEDICATIONS FOR USE IN NEBULIZERS
•Bronchodilators, for opening up the airways and helping clear obstructive mucus (including Atrovent, Alupent, Respolin, Ventolin, Bricanyl and Berotec);
•Preventive medication, such as Intal and Pulmicort;
•Some antibiotics.
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NON-ANATOMIC CONDITIONS MASQUERADING AS ALLERGIC RHINITIS

Sunday, February 6th, 2011

This group of illnesses includes those disorders that are not due either to allergic causes or to some abnormality of the anatomy of the nose.

Atrophic Rhinitis
More common in women for reasons that are not clear, this is a disorder in which the lining of the nose becomes chronically inflamed and thinned and large numbers of scabs accumulate on the lining membrane of the nose. Patients with this problem are most bothered by two symptoms: a characteristic sensation of nasal congestion in spite of a wide-open nasal passageway, and a foul odor, called ozena, that comes from the nose. Ozena is caused by a bacterial infection of the lining of the nose.
Atrophic rhinitis is uncomfortable to have and difficult to treat. The cause of atrophic rhinitis is not known, although a causative role for bacteria, chemical fumes, cigarette smoke, and viral agents all have been suggested.

Cold Air Rhinitis
You’ve probably walked down a cold, windy street and experienced mild nasal congestion, runny nose, and occasional sneezing. This is such a common experience that most of us consider it to be normal. However, some people experience severe nasal symptoms on exposure to cold air. In these people, mast cells release the same mediators that they would if the person had been exposed to something to which they were allergic, causing these people to experience symptoms very similar to severe allergic rhinitis. However, this is not an allergy because cold is not an allergen and no IgE antibodies are involved.

Eosinophilic Non-allergic Rhinitis (E-NAR) Syndromes
When a physician makes a smear of your nasal mucus to examine under a microscope, he or she is looking to see what type(s) of cells are present as a means of differentiating one form of rhinitis from another. The eosinophil, a red-staining cell easily seen in nasal smears, is one cell doctors always look for. Although common in each of the three types of allergic rhinitis and frequently called “allergy cells,” they also appear in the nasal mucus of a group of non-allergic rhinitis syndromes called the eosinophilic non-allergic rhinitis syndromes (E-NAR syndromes).
The symptoms of E-NAR syndromes are no different from those of the other forms of non-allergic rhinitis, and can include nasal congestion, runny nose, and sneezing. These syndromes are likely to be seen in patients who also happen to suffer from asthma, chronic sinus infections, nasal polyps, or have severe reactions to aspirin.
While only your doctor can distinguish the subtleties between one form of eosinophilic rhinitis from another, you should be aware that these forms of nasal dysfunction exist and can be identified by a nasal smear. It is also important that you and your doctor know that a nasal smear full of eosinophils does not always mean that you are allergic, a misconception held by many physicians and patients.
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