Doctor insights on:
Asthma Patient Education
Can a md. Deny medicare-paid hospice end-stage dementia patient physical therapy if patient's family requests it to maintain movement with new law?
Hmmm . . . : Could there maybe be a disagreement between this physician and your family about what's in the patient's best interests? This is a deep discussion that involves much thought and consideration, and which deserves scheduled time with your relative's doctor to go over treatment plans, prognosis, etc. Maybe such a discussion can resolve these issues? Doctors want to help, not hurt or harm. ...Read moreSee 1 more doctor answer
Don't understand: The question? There are really no teaching plans for altered mental status. You need to figure out the cause and treat it if possible. ...Read more
Mother aged 80 patient copd. Ventilator once. Inhaler asthalin, neubulising asthaline , budecort. Deriphyllyne, prbpm90-100, spo2 is 50 advise.?
All health care DO: All providers, including social workers are required to respect patient confidentiality, just like dentists, physicians, nurses, and pas. In the case of suspected child abuse for example, it is normall legally required for the provider to alert the authorities (child protection services). There are other situations that would require alerting authorities such as elder abuse and death threats. ...Read more
Mother aged 80 patient copd. Ventilator once. Inhaler asthalin, neubulising asthaline and budecort. Deriphyllyne, prbpm90-100, spo2p. Advice?
Difficult situation: COPD at advanced age is difficult. You are probably looking at longterm oxygen which has been showing to decrease mortality in the disease. Make sure your mother's medications are maximized. Also consider physical therapy or pulmonary rehab to help her physically deal with her illness. ...Read more
Palliative care question: good reference guideline for end-stage COPD clinical/functional markers for poor response to CPR, and should recommend DNR?
COPD and DNR: I recommend going to uptodate and review what their recommendations are. This is the best source of good medical information I have found. When you read the sections on these issues you can also click on the reference to see the cited reference. ...Read more
Difficult to answer: I do not think Alupent (metaproterenol) is really available any more. But the problem with Alupent (metaproterenol) and diabetes patients is that it could either exacerbate or mask problems of blood sugar reactions. There is not direct problem with the drug and diabetes to my knowledge. It is an old drug that has really been taken over by albuterol which is given to diabetics without that warning. ...Read more
See explanation: You served on or after september 16, 1940 and •your service-connected disabilities (scd) are rated at least 20% disabling by va and •you need vocational rehabilitation to overcome an employment handicap and • it has been less than 12 years since va notified you of your qualified scd. ...Read moreSee 1 more doctor answer
Yes: You do not need to be a vegetarian to follow a heart healthy diet. That being said, you definitely want to incorporate lots of fresh fruits and vegetables in your nutritional plan. While you may can have some lean meats, non-fat dairy, you will want to minimize saturated and trans fats and emphasize mono and polyunsaturated fats. You will also wants to eat lots of whole grains and some nuts. ...Read moreSee 2 more doctor answers
Geriatrics md: how can nursing home refuse to share care plan with woman's child citing hipaa even before she moves in? Older nonmedical sib has poa.
HIPAA strictly: Demands that medical personnel do not discuss medical care issues with anyone but the person designated by the patient. It appears it is not you. Don't get mad at the nursing home, your beloved government came up with the rule. If they are ever found in contempt, the home is fined and potentially taken out of business. So there's that! ...Read moreSee 3 more doctor answers
Sticky issue: This is a huge question. On one hand, online records can be transmitted quickly when medically needed. This could save a life. On the other hand, this quick transmission can also allow breaches of privacy that are potentially painful, embarrassing, and invasive. Balancing these things is precarious! electronic records seems to be where we're going, so we need safeguards to do it well. ...Read moreSee 1 more doctor answer
CPR: less than 10% of people with cardiac arrest and CPR survive overall. After 10 min of CPR survival is miniscule. Early CPR and defibrillation within less than 4-5min give the best outcomes. Las Vegas casinos with abundant automated defibrillators, trained staff and people watching on monitors have the fastest response and best results. ...Read more
What's the prognosis for frail geriatric esrd patient with 3-weekly hd, uncontrollable BP (> 180/100) and dm (fasting blood sugar >350)?
In ca, if a patient's advanced directive says dnr, but the patient verbally states desire for resuscitation at hospital admission. What will happen?
Most recent is right: An advanced directive is just a statement of someone's wishes in the event of a serious illness. Wishes can change. The most recent and clear statement of intent is the one that counts. But it can't be some relative interpreting the patient's intent for them. The reason you need advanced directives is if the situation arises where a dnr is needed, the patient is usually too out of it to change it. ...Read moreSee 1 more doctor answer
Depends.....: Although there can be long, symptom-free intervals, asthma is an incurable disease so there are no "former asthma patients". Cats can contribute to asthma exacerbations in a patient with asthma and a cat allergy. An allergist can determine if an asthmatic is allergic to cats and, if so, can recommend treatments. ...Read more
Yes: Asthma is an inflammatory airway disease that occasionally causes reversible obstruction of the airway. Immediate relief is necessary for reversal of obstruction but anti-inflammatory agents are used to control inflammation of the airway. Key to control of asthma is control of inflammation to prevent airway remodeling hence need for chronic polypharmacy / immnuotherapy. ...Read more
Depends : Bronchoscopy is an useful tool to answer some clinical questions . In the context of asthma it is useful to answer questions such as difficult to control asthma , unexplained and difficult to control cough . These are some of the indications. In highly selected patients bronchial thermoplasty ( via a bronchoscope ) is a procedure that is offered to aid in control of very severe persistent asthma. ...Read moreSee 2 more doctor answers
Won't hurt: There have been many non-traditional treatments proposed for asthma. This includes yoga, accupuncture, chiropractic manipulation, etc. These are in general unproven and controversial, primarily because there have not been good scientific studies to show benefit compared to placebo. I think yoga is excellent and perhaps the calming and centering nature of yoga can help a person feel better. ...Read more
Does asthma affect my body weight? Or is it impossible for asthma patients to gain weight? If possible, what would be a recommended diet for us?
It depends: on more information and examining particular patient. Generally propofol is safe in a well controlled asthmatics, yet anesthesia plan is formulated by anesthesiologist after careful consideration of past medical and surgical history, current medications, allergies and the nature of the procedure, as well as patient's physical status. Consult your doctor or consider "virtual" appt on HealthTap ...Read moreSee 1 more doctor answer
Avoid allergens: 1.Avoidance one should avoid things to which you are allergic. Also avoid irritants like cigarette smoke and air pollution. 2. Medication medications control inflammation and symptoms, but do not cure. It is important to take medications regularly. 3. Immunotherapy for environmental allergies, allergy shots are effective. New research shows oral desensitization effective for food anaphylaxis. ...Read moreSee 2 more doctor answers
What are the causes of breathing insufficiency? Patient age 44. No bp, no diabetic and asthma problems....
Needs evaluation.: Your doctor can perform the initial evaluation to determine your problem. If the answer is not clear, a pulmonary (lung) specialist might ultimately provide the answer. ...Read more
Can patients with vocal chord dysfunction get some relief from asthma inhalers, particularly blue rescue inhalers?
How are asthma & bronchiectasis similar & different? Can one be misdiagnosed as the other? How do you know that patient has one and not the other?
Different: Asthma is manifested by airway inflammation leading to bronchial narrowing and spasm. It may produce sputum if the inflammation is not controlled. Bronchiectasis is from loss of lung tissue beyond a small bronchial tube leading to a blind pouch at the end and collection of mucus. With nothing to expel the mucus, it often gets infected. (ba by lung function, bronchiectasis by hrct or bronchoscopy. ...Read more
Is it true with patients that have asthma excercise improves asthma and makes the lungs stronger to where your asthma is not as bad, or is that false?
Exercise helps: Exercise will help those with asthma in the fact that when the body is well conditioned the lungs do not have to work as hard to meet the body's oxygen demands. However, exercise does not control the airway inflammation associated with asthma and if your physician recommends a daily controller medication you should continue this even if you start exercising. Exercise can induce bronchospasm. ...Read moreSee 1 more doctor answer
Beta-blockers: They are beta-blockers and may cause bronchial constriction which exacerbates asthma and copd. We treat asthma with beta-agonists (albuterol etc) which are exactly the opposite. That being said, metoprolol in particular is a selective drug and many asthmatics/copd-ers are able to take it if needed for heart disease without any ill effects. Talk to your doctor. ...Read moreSee 1 more doctor answer
Triggers: A majority of asthma is secondary to allergies. An allergist can test you and determine your triggers. They can help you avoid your allergens, get you on a good treatment plan and if you are a candidate for it, can suggest desensitizing you to your allergens to improve your asthma and allergies. ...Read moreSee 1 more doctor answer
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