Diabetes & Low Blood Sugar; Nurses' Week; Adult Immunizations; Proper Med Lists.

Welcome back!  This blog will re-iterate & expand upon the topics discussed in the May 11, 2012 broadcast of Let's Talk Medical with Doctor Gigi.  Feel free to listen to the corresponding broadcast via www.SkipShow.com where you can find the podcast version.


Diabetes & Low Blood Sugar:

Most of us know that diabetes is a disease in which a person has a disregulation of glucose (= sugar)metabolism, resulting in the person having a high glucose.  Diabetes can lead to many bad things, including heart disease, strokes, neuropathy, poor healing, frequent infections, kidney failure, & even blindness, so anyone with the disease obviously wants to have good diabetic control.  This means that you would like to have your glucose be between 80-150.  If your sugar is often higher than this, you have a higher risk of getting these ill effects, but what happens if you get your sugars too low?

A glucose below 60 is too low, and doctors really worry if it gets below 40.  This is due to the fact that the brain needs sugar, so if your glucose gets too low, the brain actually dies.  Symptoms of hypoglycemia (= low blood sugar) include feeling anxious, confused, cold, sweaty, shaky, & agitated.  If you experience these episodes of low sugar, you can quickly correct the problem by eating sugar, so you should carry glucose pills (which you can purchase at a pharmacy) or packets of sugar (like you get in a coffee shop).  In the absence of these, you can try juice or soda... as long as they are NOT sugar-free versions.

Though we aim to control glucose to decrease the harmful effects of diabetes, we must realize that too low of a glucose can actually be more harmful than a high glucose.  When your glucose gets below 40 (or perhaps even 60), you can suffer brain damage & even death within several HOURS.  On the other hand, a high sugar (more than 150) will take YEARS to cause enough damage to result in brain damage or death.  So work with your physician to get good control of your diabetes, but don't try to have such tight control that you bottom-out & have low glucose as that will likely cause you more harm than good!


Nurses' Week:

We recently celebrated Nurses' Week.  This celebration begins on May 6th & ends on May 12th... which is the birthday of Florence Nightengale, who is the founder of modern nursing.  Though being a nurse often involves doing tasks which are less than glamorous, it is in my opinion the closest thing to being a mother.  Nurses care for us when we can't care for ourselves, & they do so without judgement or malice. Though they often make us do things we don't want to do, they do it for our benefit.  They are the quiet support that hold our hands & care for our dignity & emotions, as much as they care for our physical health.  They do more for us than we know, & during this week, we celebrate those nurses, past, present, & future who give so unselfishly of themselves to care for us!  And though they might not love us like our mothers do, the service they give us is done so with love in their hearts!


Adult Immunizations:

Though we are aware that children need immunizations, we often forget that adults also need certain immunizations.  Perhaps because schools mandate proof of immunizations, most children get their shots.  On the other hand, no one insures adults get their shots, so consider the following & discuss with your doctor to be sure you keep up-to-date.

There are generally 4 adult immunizations:  Td or TdaP (tetanus & diphtheria without or with whooping cough), Pneumovax, Flu, & Zostavax (shingles).

Td stands for tetanus & diphtheria, & everyone should get one every 10 years, unless they have had a problem with previous Td shots.  This shot protects us from getting tetanus, which is also called lock-jaw.  Though we mostly think we are prone to tetanus when we get a rusty nail injury, any open wound can be a source of tetanus.  Thus, even a clean wound predisposes us to tetanus, so it behooves us to keep current with this shot!  Unfortunately, if you have Medicare benefits, Medicare will only pay for the Td shot if you have an open wound.

TdaP is the tetanus & diphtheria shot with whooping cough as well.  Whooping cough does not usually harm adults, but it can kill or permanently injure children.  Most kids get DPT shots which include whooping cough, but not every child will make proper immunity, so we still want to immunize adults to decrease the risk of an adult getting the disease & spreading it to a susceptible child.  So adults have the choice of Td or TdaP... & those who have frequent exposure to children should opt for the TdaP.

Pneumovax is a vaccine to protect you from getting Strep. pneumonia... which is a bacteria that often causes sinusitis, ear infections, pharyngitis, bronchitis, & pneumonia.  It is recommended that anyone who is prone to these respiratory illnesses (such as those with asthma, emphysema, or even chronic allergies) should get a Pneumovax shot every 5 years.  Everyone older than 65 should get this shot.  Medicare will pay for only one shot after the age of 65, unless you have high risks for respiratory infections as noted above, though I recommend all of my patients over 65 continue to get this vaccine every 5 years, even if they have to pay cash for it.

Flu shots are given every fall in an effort to protect the population from influenza.  As the shot changes every year, it is given to virtually everybody every year.  Again, those who are highest risk of respiratory disease should get this shot annually, but it likely is a good idea for everyone to get one.

Zostavax is the vaccination which helps decrease the risk of getting shingles, which is also known as Herpes Zoster.  When a person gets Chicken Pox, the virus causes infection & then goes dormant in the body.  If it re-awakens many years later, it causes shingles... which is heralded by a classic painful, blistery, red rash which involves only one side of the body.  Anybody older than 50 can get a Zostavax, but unfortunately it is expensive, costing $250-$300 or more.  Because of this expense, many wait to get this vaccine when they have Medicare coverage, as Medicare Part D will usually pay for it.  Oddly enough though, it is covered as a pharmacy benefit, so most physicians cannot bill for it so they do not give it.  Instead, it is recommended that you go to a pharmacy with an in-house walk-in clinic... such as CVS or Walgreens... where the doctor or nurse can get the vaccine from the pharmacy, administer it, & then bill your pharmacy insurance.  If you wonder why you can't just pick up a vial of this stuff from the pharmacy then bring it to your doctor to be administered, it is because it must be given to the patient within 30 minutes after being removed from the freezer.


Proper Medication List:

Just a note to make you aware that as a physician I would love for my patients to keep a list of their medications.  I have noticed however that they do not record the meds as I would like, so here's a few helpful hints.

The list should include the name of the medication, preferably the generic & name-brand if you know... as different doctors will use different names.  Also, include the strenghth of each pill AND how many you take & when you take them.  This seems straightforward enough, but patients sometimes try to help me by writing the total dose they take in a day... yet I need to know the way the prescriptions are written.  For example, if a patient takes Pravachol 40 mg 2 pills with supper, this is how I want it recorded.  If the patient writes Pravachol 80 mg per day (their total daily dose), I will likely write the prescription for an 80 mg pill which is more expensive than 2 of the 40 mg pills.  Also, if the patient calls to ask a question about the "2 pills" he takes at night, there will be a disconnect in our communication if my records indicate he is taking one pill at night for his cholesterol problem.  Be accurate & be honest when you write your list, as it will help protect you from medication errors in the long-run.

An example of how this can make management difficult, I recall a recent situation at a local hospital. One of my patients was being treated for an infection but also had some chronic pain.  Unfortunately he also had a swallowing problem, so swallowing pills was difficult for him.  I ordered MS Contin 30 mg one pill 2 times per day, so I was confused & agitated when the patient complained repeatedly about having to take 6 pills every morning & 6 pills every night.  I checked the computer & could not find where he had 6 pills of any type ordered, so I spoke with the nurse who checked her records.  Her records showed that the pharmacy did not have the 30 mg pills, so they had switched to six of the 5 mg pills for each of the 2 doses.  Though there would usually be no problem with this substitution, it certainly was a problem for my patient with swallowing problems!  And worse yet, it was a problem for all of us because the records did not show me an accurate med list, so this impaired my ability to properly care for my patient! 


Until next time, you can catch us on the radio... WTAN 1340-AM on Fridays 1:00-1:45 PM in the Tampa/St. Petersburg, FL area, or on the web... www.SkipShow.com where you can listen live or to the podcasts.  We are always happy to answer your questions, so keep them coming... (727)-441-3000 or tollfree (866)-TAN-1340 or DoctorGigi@SkipShow.com.  And if you find this blog educational & worthwhile, please become a "follower" & please consider sharing the link with your Facebook & Twitter friends!  By the way, I will soon have a central website for the podcasts & this blog, so stay tuned for the opening of www.DoctorGigi.com.

Here's to our health!

Doctor Gigi