Chemotherapy Holiday

In the past, a diagnosis of cancer was considered a death sentence. With the progression of medical technology and cancer research, many cancers are curable and many others are incurable, but survivable. In many, their disease is considered to be stable and not an immediate threat to their lives (progression-free survival). Many may deemed this as having a "chronic" disease as those in this position will likely be on some form of therapy for the rest of their lives. With such long-term treatment possible, a "chemotherapy holiday" may become a necessity in an attempt to balance quality of life and the toxicities of chemotherapy.

A chemotherapy holiday may be defined as  a complete break or a chemotherapy free interval (intermittent therapy). A chemotherapy holiday will more than likely lead to an improvement in the quality of life, a possible reduction or cessation of side effects, and complications, but there is also a risk of relapse or recurrence.Studies have shown that there is no difference in the survival rates in those who take a chemotherapy holiday, but there is an improved quality of life versus those who do not take the chemotherapy holiday.

We must all understand that each situation is unique and the individual must consider their condition, the risks, and the benefits in making a decision regarding a chemotherapy holiday.

NEW YEARS RESOLUTION - SMOKING CESSATION

NEW YEARS RESOLUTION - SMOKING CESSATION

This is the beginning of a new year.  Many will make resolutions to change at least one aspect of their behavior.  Of those who smoke, many will make a New Year's resolution to stop smoking.  No matter what the reason for wanting to quit, many will find and have found quitting tobacco use / smoking to be harder than expected.

 

Tobacco and nicotine use is a form of chemical dependency and according to the CDC nicotine dependence is the most common form of chemical dependence in the United States. Breaking a chemical dependence is difficult and may require several attempts, so don't get discouraged if you are not successful on your first attempt.  Breaking the chemical dependency should not be the only reason to attempt to quit the use of tobacco. The use of nicotine brings with it a myriad of toxins and chemicals, the expose of which can lead to multiple health problems for the users and those around the use (second hand smoke) and the cessation can improve or resolve these health consequences.

According to a report by the CDC, smoking cessation is associated with the following health benefits:

• lowers the risk for lung and other types of cancer.
• reduces the risk for coronary heart disease, stroke, and peripheral vascular disease.
• reduces respiratory symptoms, such as coughing, wheezing, and shortness of breath.
• reduces the risk of developing chronic obstructive pulmonary disease (COPD), one of the leading causes of death in the United States.
• smoking cessation by women during their reproductive years reduces the risk for infertility and women who stop smoking during pregnancy also reduce their risk of having a low birth weight baby.

 

 There are a number of methods available for cessation of tobacco use:

1. "Cold Turkey"
2. Over the Counter Medications
3. Prescription Medications
4. E-cigarettes
5. Counseling
6. Any combination of the above methods

The success rate for tobacco / smoking are continually changing as new cessations methods, cessation mandates (employers, public venues), and a push to become healthier become more common.

Unfilled Prescriptions 2

I visited the topic of Unfilled Prescriptions a few years ago.  It seems that the issues leading to not filling the prescriptions or what is sacrificed in order to fill them have not changed.

According to the report, "Patient Compliance, Disease Management and Consumer Outreach, " 20% of new prescriptions go unfilled, while up to 85% of prescriptions never get refilled.  The leading factor for non-compliance is believed to be a break-down in communication between patients and physicians.  Another contributing factor is the costs of the medication for those with and without medical insurance.

One way to cut down on the costs is to ask if there is a generic equivalent.  Be careful, there are some medications that are not exactly equivalent. Discuss this your medications and this your health care provider.



Karen Rowan, Managing Editor for MyHealthNewsDaily has put together some information regarding this topic as well. You can heck it out as well.

Unfilled Prescriptions

A study done by the Journal of General Internal Medicine shows that a significant number of prescriptions go unfilled. In this study, researchers found that among more than 75,000 Massachusetts patients given drug prescriptions over one year, 22 percent of the prescriptions were never filled. The rate was even higher -- 28 percent -- when the researchers looked only at first-time prescriptions.

Letting prescriptions go unfilled is called "non-adherence." Such "non-adherence," the study found, was common even among patients prescribed drugs for chronic conditions that can have serious health consequences.

The big question is why?  Exactly why many patients did not fill their prescriptions is unclear, but several reasons are possible.

1. The patient does not know why they are taking the medication
2. The patient's condition does not cause any symptoms
3. The patient cannot afford the medication(s)
4. The patient has concern about side effects
5. The patient doesn't want to take any medications

When health problems cause few or no symptoms -- as with high blood pressure or high cholesterol -- people may not see the need for a medication. Although there are many diagnoses that have no symptomotology, your disease is causing damage. When symptoms do occur, it will be more difficult to control and treat.

"If they do not fully understand the reason that they are being prescribed the medication, they may be less likely to take it," lead researcher Dr. Michael A. Fischer, of Brigham and Women's Hospital in Boston, told Reuters Health.  If you don't know why you are taking a medication, ask your doctor. It is our job to educate you about your diagnosis and advise you regarding all treatment options.

Cost could also be an issue, Fischer added -- particularly when people are unsure of why a drug is being prescribed.   All of the patients in the study had health insurance. But even with coverage, people may have high co-payments for medications or may be prescribed a drug not covered by their plan, Fischer and his colleagues note.

No matter what the reason, patients should not hesitate to talk with their physicians regarding their concerns. We especially need to know if you encounter side effects.

What's really scary about this study, though, is that these numbers reflect the behavior of people with health insurance (Massachusetts has a 97 percent insured rate). The numbers are undoubtedly higher among the uninsured.

Check out Trisha Torrey's blog as she takes the patients perspective. She gives the patient's responsibilty regarding prescriptions.

The Number of Uninsured Adults Contiues to Rise

Over the last 10 years, the number of uninsured adults in the U.S.--those ages 18 to 64--has steadily increased, and according to 2009 data from the Centers for Disease Control and Prevention, now sits at just over 21 percent. Overall, the number of uninsured people in the U.S. is now 46.3 million--roughly 15 percent of the nation's total population . Children under 18 and seniors 65 and older are more likely to be covered because they are more likely to qualify for government insurance programs, such as Medicaid and Medicare.  Regionally, the Southern and Western portions of the U.S. had the highest percentage of uninsured. Texas had the highest rate of uninsured people at 24.6 percent. At the other end of the spectrum, Massachusetts had the most citizens covered, with only 3.7 percent lacking insurance.(FierceHealthcare)

This is most likely is a symptom of job losses and the inability to afford health insurance as well as lower number of employers offering health insurance. To make things worse, Eighteen governors throughout the nation have ultimately decided against creating temporary high-risk insurance pools for those who are uninsured due to pre-existing conditions. The new health reform law allocates a total $5 billion to the states for the creation of such plans, which would run through Jan. 1, 2014. According to the Washington Post, the states that opted not to administer the risk pools include Alabama, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia and Wyoming. (FierceHealthcare)

Texas, which has the highest rate of uninsured in the nation at 25 percent, is one of 35 states that already operates its own high-risk pool. The good news is that twenty-nine states as well as Washington, D.C., said they would participate in the plan.

Hands-Only CPR

Hands-Only Cardiopulmonary Resuscitation (CPR) or Chest compressions alone are as effective as chest compressions with mouth-to-mouth resuscitation.  According to a studies in Sweden and Washington State the breathing component of CPR is only necessary for those who have respiratory problems, suffer drowning and children. Removing the mouth-to-mouth component of CPR may overcome some of the fears of bystander who are reluctant to initiate CPR because of the fear of infectious disease.

The American Heart Association (AHA) released a statement that states that Hands-Only CPR is a potentially lifesaving option to be used by people not trained in conventional CPR or those who are unsure of their ability to give the combination of chest compressions and mouth-to-mouth breathing it requires.  “Bystanders who witness the sudden collapse of an adult should immediately call 9-1-1 and start what we call Hands-Only CPR. This involves providing high-quality chest compressions by pushing hard and fast in the middle of the victim’s chest, without stopping until emergency medical services (EMS) responders arrive,” said Michael Sayre, M.D., chair of the statement writing committee and associate professor in the Ohio State University Department of Emergency Medicine in Columbus.

Sources state that communities that are using the hands-only approach are already seeing a dramatic increase in survival. AHA statistics show that 310,000 coronary heart disease deaths occur out-of-hospital or in emergency departments each year in the United States. Of those deaths, about 166,200 are due to sudden cardiac arrest (nearly 450 per day). Without immediate, effective CPR from a bystander, a person’s chance of surviving sudden cardiac arrest decreases 7 percent to 10 percent per minute. Unfortunately, on average, less than one-third of out-of-hospital cardiac arrest victims receive bystander CPR, which can double or triple a person’s chance of surviving cardiac arrest. By using Hands-Only CPR, bystanders can still act to improve the odds of survival, whether they are trained in conventional CPR or not, Sayre said.


It is believed that in those who suffer a heart attack, their blood contains several minutes worth of oxygen. Therefore, stopping to provide a breath may reduce blood flow significantly. Continuous blood flow (although not maximally oxygenated) is probably much better in terms of helping to restore spontaneous circulation.

A study conducted at the University of Washington found no statistical significance in the survival rate between those receiving hands-only CPR and those who receive conventional CPR.

The public is still encouraged to obtain conventional CPR training, where they will learn the skills needed to perform Hands-Only CPR, as well as the additional skills needed to care for a wide range of cardiovascular- and respiratory-related medical emergencies, especially for infants and children.

The new statement is intended to increase how often bystander CPR is performed. It emphasizes the importance of “high-quality” chest compressions — deep compressions that allow for full chest recoil, at a rate of about 100 per minute — with minimal interruptions.

Whole Grain in Food

If you walk down any grocery aisle, you will notice that several products tout that they contain or made of X% of whole grain. In 2005, The Center for Nutrition Policy and Promotion, an organization of the U.S. Department of Agriculture, released guidelines recommending 3 ounces (48 grams) of whole grain daily. Manufacturers began adding whole grains to their products, but just because a product contains whole grain does not mean it is a good or healthy food choice.

According to the Department of Agriculture (Inside the Pyramid) any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal, breakfast cereals, tortillas, and grits are examples of grain products.

So what's so great about whole grain? Whole grains contain the entire grain kernel -- the bran (outer layer) which is the main source of fiber, germ where most of the nutrients are found, and endosperm (tissue) where have few nutrients. Examples of whole grains include:

• whole-wheat flour
• bulgur (cracked wheat)
• oatmeal
• whole cornmeal
• brown rice

Grains are divided into 2 subgroups, whole grains, as described above, and refined grains. Refined grains have been milled, a process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Some examples of refined grain products are:

• white flour
• degermed cornmeal
• white bread
• white rice

Most refined grains are enriched. This means certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron are added back after processing. Fiber is not added back to enriched grains. Check the ingredient list on refined grain products to make sure that the word “enriched” is included in the grain name. Some food products are made from mixtures of whole grains and refined grains.

The amount of whole grains placed into foods does not mean a healthier product. If a product contains only a small amount of whole grain, it is likely that the fiber content will be low. Choose products that are low in sugar, sodium and saturated trans-fat.