Sometimes people perceive hospice and palliative care as giving up, but these vital services actually offer life-affirming benefits during challenging times. Let's take a look at how former president Jimmy Carter's decision to opt for hospice care at his Georgia ranch exemplifies a shift in understanding. Rather than enduring more hospital stays and aggressive treatments, Carter prioritized comfort and embraced meaningful moments with his wife of 77 years and indulging in his favorite treat, peanut butter ice cream.
Choosing hospice doesn't mean abandoning medical care but rather focusing on finding comfort in the care you receive. It's about having the freedom to be at home with loved ones, enjoying favorite shows, meals, and the company of pets, instead of being confined to a hospital. It's an opportunity to paint a picture of what you want the end of life to look like and making decisions that align with your values.
To better understand your options, it's important to differentiate between palliative care and hospice. Palliative care aims to provide symptom relief and support for individuals who are seriously ill at any stage, not just at the end of life. It can be combined with curative treatments and offers an extra layer of assistance for patients, families, and the healthcare team. Hospice, on the other hand, focuses on making the dying process more comfortable for individuals with serious illnesses, often those with a prognosis of six months or less to live.
Hospice care can be provided at home or in a hospital-based unit, dedicated facility, or nursing home, depending on the level of support needed. The hospice team ensures patients have necessary equipment, medications, and round-the-clock assistance when required. They adopt a holistic approach, addressing physical, spiritual, emotional, and social pain to support patients as whole individuals.
Research has shown that palliative care can extend life and improve overall well-being. By incorporating palliative care alongside cancer treatment, patients have experienced longer survival times, improved symptom management, and a higher quality of life. However, aggressive medical care near the end of life remains common, often due to a combination of hope for a miracle, fear, and uncertainty. Engaging in discussions about living well and understanding personal values can help individuals make informed decisions that prioritize comfort and quality of life.
One of the greatest benefits of hospice care is the ability to focus on personal priorities. The hospice team works with patients to understand their desires and supports them in achieving their goals, whether it's attending important family milestones or simply enjoying everyday activities. Creating meaningful memories and engaging in conversations that wrap up one's life journey can be profoundly healing.
If you or a loved one has received a prognosis of six months or less to live, considering hospice care is advisable. It's essential to have open conversations with the care team, inquire about enrollment procedures, seek recommendations from others who have experienced hospice care, and reach out to a hospice agency for more information. Assessing your home's layout and equipment needs is also crucial. Remember, embracing hospice care is not a failure but the beginning of a new chapter in life, and there are experienced professionals available to support you through this process.
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E-cigarettes have become a popular topic in the smoking landscape, with debates on their safety and efficacy, especially in comparison to traditional cigarettes. While the prevalence of smoking has decreased significantly in recent decades, cigarette-related issues still contribute to a substantial number of deaths in the United States.
These electronic devices, powered by batteries, produce vapor by heating a liquid that users inhale and exhale—a process commonly known as "vaping." Initially marketed towards the younger demographic, recent advertising campaigns highlight middle-aged, long-time smokers who have transitioned to vaping. The critical question remains: Is vaping a safer alternative, particularly from a cardiovascular standpoint, and can it aid in quitting conventional cigarettes?
Currently, experts offer a tentative "maybe" to both questions. While some acknowledge potential benefits, concerns linger, especially regarding the rising trend of teenage vaping. A CDC survey revealed a significant 78% increase in high school students reporting monthly vaping, reaching 20% in the past year. This troubling statistic underscores worries about a predatory industry enticing young individuals with highly addictive products, as pointed out by Dr. Vaughan Rees, director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health.
Diving into the larger picture, it's essential to recognize that sluggish digestion is just one piece of the puzzle. Older adults, in particular, might find themselves grappling with conditions that can trigger regular indigestion, including gastroesophageal reflux disease (GERD), ulcers, and food sensitivities such as lactose intolerance. Chronic indigestion is also often linked with digestive issues like irritable bowel syndrome (IBS) and functional dyspepsia, both of which entail persistent symptoms without a specific cause.
Fortunately, indigestion usually fades away on its own over time. Over-the-counter aids like antacid pills, liquids, or stomach-soothing medicines such as bismuth subsalicylate (Pepto-Bismol, Kaopectate) can offer relief. Acid blockers like proton-pump inhibitors (e.g., omeprazole or lansoprazole) or H2 blockers (e.g., famotidine) are also potential options for managing heartburn.
Navigating the culinary landscape can also play a role in taming indigestion. Here's how you can make a difference:
- What: Pay attention to what you eat and drink when indigestion strikes, and consider cutting back on or avoiding problematic items like spicy and highly acidic foods, coffee, citrus- or tomato-based beverages, and processed or fatty foods.
- How: Opt for smaller servings and eat at a more leisurely pace. Avoid multitasking while eating, as it hinders mindful consumption. Experiment with more frequent, smaller meals throughout the day.
- When: If indigestion tends to haunt your evenings or disturb your sleep, consider having dinner earlier and refraining from eating within two hours of bedtime to prevent overloading your stomach when digestion slows down.
While drugstore remedies can be helpful, they come with some caveats. Magnesium-containing antacids might lead to loose stools, while calcium carbonate (Tums) or aluminum-based antacids could result in constipation. Occasional use is generally fine, but if reliance on these medications surpasses three times per week, it's advisable to consult with your doctor, as it might indicate an underlying digestive issue.
Keep an eye out for red flags like rectal bleeding, black stools, difficulty swallowing, or sudden weight loss, as these could signal more serious problems like inflammation in the digestive tract, ulcers, or gastrointestinal cancers.
If recurrent indigestion is your woe, there's much you can do to alleviate its frequency and intensity without resorting to medication. Consider these lifestyle adjustments:
- Reduce stress: Stress can exacerbate digestive issues through the brain-gut axis. Activities like exercise and meditation can aid in stress management, and in more challenging cases, your doctor might suggest a low-dose antidepressant.
- Address smoking and drinking: Smoking elevates the risk of reflux and digestive cancers, while excessive drinking amplifies the chances of various gastrointestinal diseases. Even occasional drinking can trigger underlying digestive problems.
- Lose excess weight: Overweight individuals, especially those dealing with acid reflux, are more susceptible to indigestion due to increased abdominal pressure. Shedding even a modest amount of weight can have a significant impact on digestion.
So, don't let indigestion ruffle your feathers; tackle it with a multifaceted approach that includes mindful eating, lifestyle adjustments, and, if needed, a chat with your healthcare provider
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Did you know that over 58 million American adults, which is more than one in five, live with mental illnesses like anxiety, depression, or bipolar disorder? Surprisingly, more women than men seek treatment for these challenges.
However, there's a lingering stigma around mental health, making it difficult for those dealing with these issues. Dr. Arthur Barsky from Brigham and Women's Hospital explains that this stigma can affect people's morale and recovery. Feeling labeled and isolated can worsen depression or anxiety, leading to problems like substance abuse or social withdrawal.
The good news is that science is helping break down these old beliefs. Advances like brain imaging show that certain mental disorders cause structural changes in the brain, reducing the stigma around mental health.
For those dealing with mental health challenges, here are some strategies to overcome stigma:
1. Embrace Treatment: Don't let labels stop you from seeking the help you need, whether it's therapy, medication, or both. There are effective treatments available.
2. Separate Yourself from Your Illness: Remember that your condition doesn't define you. Instead of saying "I'm bipolar," say "I have bipolar disorder."
3. Don't Take Comments Personally: People might say the wrong things, but it often says more about them than you. Consider their perspective rather than internalizing their words.
4. Share Your Story: If comfortable, share your experiences to correct misinformation and help others understand better. It might be challenging, but it can be incredibly beneficial.
Additionally, if you're considering therapy, here are some tips to get the most out of it:
1. Choose Your Therapist Wisely: Look for someone who specializes in your specific problem and with whom you feel comfortable.
2. Treat Therapy as Teamwork: It's a collaboration where you lead initially, but over time, your therapist provides guidance.
3. Be Vulnerable: Open up about your experiences and feelings, even if it's uncomfortable.
4. Take Prescribed Medications: If your therapist recommends medication, take it as prescribed. Ask about side effects and work with your clinician to make the best choice.
5. Define Success: Set goals with your therapist to create a framework for progress, understanding that therapy is a process, not a quick fix.
6. Be Patient: Effective therapy takes time, and it's okay if progress is gradual. Be patient with yourself throughout the journey.
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The new drug, called zuranolone (Zurzuvae), works quickly and was officially approved on August 4, 2023. What's even better? It's a short two-week course. Until now, the only other approved medication for postpartum depression was brexanolone (Zulresso), but it needed to be given through a hospital-based IV.
Postpartum depression shares symptoms with other types of depression, such as deep sadness, feeling tired all the time, losing interest in regular activities, and struggling with thinking and memory. In severe cases, women might even have thoughts of hurting themselves or their baby.
The introduction of this pill is not just a medical breakthrough; it's also expected to lessen the stigma around postpartum depression. By offering a more accessible treatment option, it aims to encourage more women to seek the help they need. This is a positive step forward for the well-being of new moms everywhere!
Getting a breast cancer diagnosis can be scary, but things have changed a lot in how we treat it. Unlike the old days when everyone got the same treatment, now it's like having a personalized toolkit to fight the disease.
Survival rates have gone up, with only 5% of women at an average risk of dying within five years after a breast cancer diagnosis, down from 14% in the 1990s. Dr. Harold Burstein from the Dana-Farber Cancer Institute explains, We may not always know why someone gets breast cancer, but the good news is that outcomes are improving.
Instead of using a one-size-fits-all approach, scientists can now categorize breast tumors based on cell type. This allows for tailor-made combinations of treatments. Surgery is still common, but chemotherapy might be smaller or skipped. New drugs like immunotherapy and targeted therapies are giving doctors more options.
Breast cancer comes in different types, like ER-positive or HER2-positive. Knowing this helps doctors choose the best treatments. Thanks to research in the last decade, tests can now identify gene mutations, predict tumor growth, and help customize treatments.
For ER-positive, HER2-negative breast cancer, the use of chemotherapy has become more selective. Powerful tools allow doctors to decide if a patient really needs it. Medications like CDK4/6 inhibitors are also used for high-risk cases.
HER2-positive breast cancer, a more aggressive type, has seen progress with targeted therapies like Herceptin. A new approach pairs chemotherapy with proteins for better results with fewer side effects.
Triple-negative breast cancer, a fast-growing type, is challenging, but new drugs and immunotherapy are showing promise. Even more promising is the future use of liquid biopsies, blood tests that can guide treatment based on circulating tumor DNA.
Dr. Burstein is optimistic about the coming years, mentioning new technologies like liquid biopsies. For metastatic breast cancer, which isn't curable yet, patients are living longer with new treatments improving their lives.
Inflammatory breast cancer (IBC) is rare but dangerous. Unlike other types, it doesn't always show a lump. Symptoms develop rapidly, and early signs are often mistaken for less serious issues. Dr. Filipa Lynce advises not to ignore changes in the breast, even without a lump. If symptoms persist, seeking medical attention is crucial.
Finally, for women diagnosed with breast cancer, a multidisciplinary care team is essential. Collaboration among specialists and communication with your healthcare team are key to better outcomes. Don't hesitate to ask questions and be an active part of your treatment plan.
Seasonal affective disorder can be treated and managed with the use of light therapy and medicines.
The winter season brings chilly days and cozy vibes, but for some, it also ushers in a condition known as Seasonal Affective Disorder (SAD). SAD is a form of depression that kicks in during late fall and winter, easing off with the arrival of spring. While the exact cause remains a mystery, researchers believe a lack of sunlight plays a pivotal role.
Dr. Richard Schwartz, an associate professor of psychiatry at Harvard-affiliated McLean Hospital, emphasizes the significance of recognizing SAD as a serious condition. He notes, "People should not ignore the signs of SAD and should seek treatment if they appear, as left alone, SAD can escalate to serious health issues."
Sunlight and Your Mood
Sunlight exposure has a profound impact on our brains. It stimulates the hypothalamus, a brain region housing our internal sleep-wake clock. Insufficient light disrupts this clock, leading to an overproduction of the sleep hormone melatonin and a decrease in serotonin, the feel-good brain chemical. This chemical imbalance can result in feelings of low energy, lethargy, and depression.
SAD comes with other telltale signs, including diminished sexual desire, an inclination to overeat (especially comfort foods), and sleep disturbances. It also correlates with cognitive challenges like difficulties in concentration and memory. Dr. Schwartz adds, "As you become more lethargic from SAD, you are also less likely to exercise or socialize."
Several factors heighten the risk of SAD, such as a family history of SAD or depression and geographic location. People residing in northern states, where daylight diminishes significantly in fall and winter, are more prone to SAD than those in the south.
Childbirth, a timeless and sometimes unpredictable journey, has been an integral part of human experience. In the United States, where rates of avoidable complications and maternal deaths are surprisingly high, the demand for doulas is on the rise. Natalia Richey, interim chief midwife at Massachusetts General Hospital, notes an increasing interest in additional care during pregnancy and birth.
But what does a birth doula do? Unlike midwives or doctors, professional doulas offer emotional and physical support to women throughout pregnancy and the birthing process.
Here's a glimpse into doula care if you're considering it.
Doulas vs. Midwives
While midwives and doulas share some responsibilities, a crucial distinction exists: midwives provide medical care, whereas doulas focus on emotional and physical support. Midwives, like certified nurse-midwives, are trained nurses responsible for maintaining the physical health of both mother and baby during childbirth. On the other hand, doulas don't perform medical tasks; they specialize in helping laboring women stay comfortable and calm, employing various techniques like suggesting comfort measures and optimal positions.
Doula Training and Licensing
It's important to note that doula training lacks standardized rules. Certification from over 100 independent organizations is common, although no formal licensing is required. While private insurers often don't cover doula care, some employers, like Walmart, assist in covering costs. As of February 2023, ten states and the District of Columbia offer Medicaid coverage for doula services.
Impact on Birth Outcomes
A 2023 analysis spanning 22 years and 16 studies found that doula support correlated with improved birth outcomes, including fewer C-sections, premature deliveries, and shorter labor. Emotional support from doulas was associated with reduced anxiety and stress in mothers, with notable improvements in breastfeeding success, especially among low-income women.
Collaboration with Doulas
Agreements regarding care may vary, but typically, doulas meet with expectant individuals throughout pregnancy to discuss birth goals and build rapport. Doulas, akin to obstetricians, are available 24/7 to support clients during labor. This constant support, especially for those with limited resources, can be invaluable.
Doula and OB/GYN Collaboration
Collaboration between doulas and OB/GYN teams is generally seamless. Whether a hospital arranges for a doula or if hired privately, coordination ensures everyone sticks to their roles. Doulas suggest nonpharmacological ways to ease pain, respecting boundaries when medical intervention is necessary.
Questions to Ask When Considering a Doula
Interested in working with a doula? Natalia Richey suggests asking yourself questions like:
- What are my hopes and goals for the childbirth process?
- How do I envision my support team during delivery?
- Do I have friends or family members who have used doulas, and what were their impressions?
When contacting a doula, inquire about their training, the number of births attended, how they can assist during pregnancy and labor, and their approach to collaboration with your partner, spouse, and the medical team.
Take the time to meet with any doula you're considering and make sure they're a good fit, advises Richey. "Because this is someone who will be there during one of the most vulnerable times of your life. Having someone there who doesn't make you feel safe and comfortable can affect birth in a major way.
Oh, and if you've been rocking nail polish for ages without a break, your nails might rebel with some dry, white spots. It's like they're saying, "Hey, let us breathe!" There's also a chance a sneaky fungal infection is behind the scenes, leaving a white film on your nails. Sometimes, more serious stuff like low iron, kidney issues, or liver scarring can play a part in turning your nails half or mostly white.
If you're scratching your head because none of these seem to fit, it's cool to chat with your doctor about it. Waiting for the spots to vanish on their own might take a while – like six months or more – because, you know, nails take their sweet time to grow out.
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Prevention of Diabetes and Four Ways to Lower Your Risk
1. Adopt a healthy diet
2. Participation in physical activity
3. Maintaining a healthy weight
Finding relief for the discomfort of atopic dermatitis, a common form of eczema, can be a daily challenge. This skin condition, characterized by inflammation and itching, can disrupt sleep, social activities, and various aspects of daily life.
If simple remedies like gentle cleansing and regular moisturizing don't offer relief, your healthcare provider might suggest a prescription cream for your skin. A recent study has narrowed down the most effective options for managing atopic dermatitis.
The study, evaluating over 200 trials involving more than 43,000 people with atopic dermatitis, sheds light on the effectiveness of various prescription creams and ointments. These treatments fall into five categories, including topical corticosteroids, Janus kinase inhibitors, PDE4 inhibitors, calcineurin inhibitors, and other topicals like antibiotics and prescription moisturizers.
The research aimed to identify medications that significantly improved patients' quality of life, reduced severity, itch, sleep disturbances, or flare-ups, caused fewer serious side effects, and were discontinued the least due to adverse effects.
The standout winners in the study were two calcineurin inhibitors, namely pimecrolimus (Elidel) and tacrolimus (Protopic), along with moderate-potency topical corticosteroids like fluocinolone acetonide (Synalar cream 0.025%) and triamcinolone acetonide (Kenalog cream/ointment 0.1%).
Pimecrolimus excelled in six of seven outcomes, proving effective at reducing sleep disturbances and eczema flares. High-dose tacrolimus (0.1%) demonstrated improvement in five outcomes, particularly reducing itch and flare-ups. Moderate-potency steroids, a larger group, were effective in four to six of the seven outcomes, excelling at alleviating eczema itch, flares, and serious side effects.
The study also revealed a surprising finding: using a topical cream twice daily wasn't significantly more effective than using it once daily. While the traditional advice is twice daily, once a day could be more convenient without compromising effectiveness.
On the flip side, the study identified topical antibiotics as among the less effective treatments for eczema.
While the study involved a substantial number of participants, individual responses may vary. Factors like age, affected skin areas, eczema severity, and potential side effects should be considered when determining a treatment plan.
The bottom line? If your current treatment works well without serious side effects, stick with it. However, if your regimen isn't delivering the desired results, consult your healthcare provider or dermatologist to explore alternative prescription creams or ointments.