Health Care and Hospital Emergency Rooms

Hospitals have trauma centers that often double as emergency rooms for critical health and medical needs. Medical staff, including doctors and nurses as well as other critical care personnel, are typically on call 24/7 during their shifts and see all types of major life threatening and urgent healthcare issues. Individuals who use these can often be simply someone who does not have insurance and needs medical attention for any variety of ailments. As well, emergency rooms experience visits by fully insured individuals who may have had a serious accident, injury, or medical need. Emergency rooms are known for life saving treatment.

According to this website: http://www.howstuffworks.com/emergency-room.htm , a visit to the emergency room can be a stressful, scary event. Why is it so scary? First of all, there is the fear of not knowing what is wrong with you. There is the fear of having to visit an unfamiliar place filled with people you have never met. Also, you may have to undergo tests that you do not understand at a pace that discourages questions and comprehension.

According to a report published by HealthSprocket, here are the Top 10 reasons for emergency room diagnoses (2006) for visits:

1. Sprains and strains (6,375,245)
2. Superficial injury, contusion (6,107,869)
3. Other upper respiratory infections (5,285,382)
4. Abdominal pain (4,381,653)
5. Open wounds of extremities (3,697,836)
6. Spondylosis, intervertebral disc disorder, other back problems (3,236,278)
7. Nonspecific chest pain (3,018,660)
8. Headache, including migraine (2,825,233)
9. Open wounds of head, neck, and trunk (2,692,292)
10. Skin and subcutaneous tissue infections (2,610,735)

The information for these medical problems came from a study developed in 2006: HCUPnet. Healthcare Cost and Utilization Project (HCUP), 2006. Agency for Healthcare Research and Quality. Rockville, MD .

According to the Centers for Disease Control (CDC), here are the stats for the last year on record (2010) for emergency room visits:

• Number of visits: 129.8 million
• Number of injury-related visits: 37.9 million
• Number of visits per 100 persons: 42.8
• Percent of visits with patient seen in fewer than 15 minutes: 25.1%
• Percent of visits resulting in hospital admission: 13.3%
• Percent of visits resulting in transfer to a different (psychiatric or other) hospital: 2.1%

Source: National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables, tables 1, 4, 14, 24; and this website: http://www.cdc.gov/nchs/fastats/ervisits.htm .

According to the New York Times, hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising. Urban and suburban areas nationwide have lost a quarter of their capacity over the past twenty years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in non-rural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.

Emergency departments were most likely to have closed if they served large numbers of the poor, were at commercially operated hospitals, were in hospitals with skimpy profit margins or operated in highly competitive markets, the researchers found. Although the study did not examine emergency care at the remaining facilities, the closings take a toll on the quality of care in all emergency rooms according to Dr. Renee Y. Hsia, an assistant professor of emergency medicine at the University of California, San Francisco, and the lead author of the study.

According to the NY Times article, conditions in emergency rooms may be worsened by the new health care law, several experts said. The PPACA will expand eligibility for Medicaid, the government health plan for the poor. “Often beneficiaries turn to emergency rooms for care, because many physicians do not accept Medicaid payments”, said Dr. Sandra M. Schneider, president of the American College of Emergency Physicians. By federal law, emergency rooms are required by law to provide treatment regardless of ability to pay. More information can be found at this site: http://www.nytimes.com/2011/05/18/health/18hospital.html .

Emergency rooms provide a primary life saving option for patients in stress and trauma, whether the reason is due to illness or accident. The medical staff is highly trained to serve under pressure, and for the most part, able to accomplish in the majority of cases care that helps reduce the possibility of someone not recovering from their health care disaster.

Although emergency rooms are not really designed to handle day to day health care situations such as colds, sore throats, and non-life threatening issues. However, for anyone who is not insured, these locations often perform this function due to lack of available treatment options. Certainly, with ObamaCare in place, and due to ramp up starting in 2014, the lack of sufficient urgent care centers are going to suffer significant stress in their own right.

Until next time.

Health Care and Aneurysm

One of the most difficult health care issues to diagnose early is an aneurysm. They can be deadly if not caught in time, and often are fatal if they occur in certain circumstances. It is not clear exactly what causes aneurysms, according to the National Institutes for Health (NIH). Some aneurysms are present at birth (congenital). Defects in some of the parts of the artery wall may be responsible. Common locations for aneurysms include:

• The major artery from the heart (the aorta)
• The brain (cerebral aneurysm)
• In the leg behind the knee popliteal artery aneurysm)
• Intestine (mesenteric artery aneurysm)
• An artery in the spleen (splenic artery aneurysm)

High blood pressure, high cholesterol, and cigarette smoking may raise your risk of certain types of aneurysms. High blood pressure is thought to play a role in abdominal aortic aneurysms. Atherosclerotic disease (cholesterol buildup in arteries) may also lead to the formation of some aneurysms. Pregnancy is often linked to the formation and rupture of splenic artery aneurysms. More info can be found at this site: http://www.nlm.nih.gov/medlineplus/ency/article/001122.htm .

According to the Mayo Clinic, with a brain aneurysm, a sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described as the "worst headache" ever experienced. Common signs and symptoms of a ruptured aneurysm include:

• Sudden, extremely severe headache
• Nausea and vomiting
• Stiff neck
• Blurred or double vision
• Sensitivity to light
• Seizure
• A drooping eyelid
• Loss of consciousness
• Confusion

In some cases, according to the Mayo Clinic, an aneurysm may leak a slight amount of blood. This leaking (sentinel bleed) may cause only a sudden, extremely severe headache. A more severe rupture almost always follows leaking. An unruptured brain aneurysm may produce no symptoms, particularly if it's small. However, a large unruptured aneurysm may press on brain tissues and nerves, possibly causing:

• Pain above and behind an eye
• A dilated pupil
• Change in vision or double vision
• Numbness, weakness or paralysis of one side of the face
• A drooping eyelid

A ruptured aneurysm is a medical emergency. In about 30 percent of cases, ruptured brain aneurysms are fatal. Seek immediate medical attention if you develop a sudden, extremely severe headache. If you're with someone who complains of a sudden, severe headache or who loses consciousness or has a seizure, call 911 or your local emergency number. More material about this subject is found here: http://www.mayoclinic.com/health/brain-aneurysm/DS00582/DSECTION=symptoms .

Aneurysms tend to occur in older Caucasian men; women are less at risk. By age 80, over 5% of Caucasian men have developed an aneurysm. People of African descent rarely develop aneurysms. Abdominal aortic aneurysms occur in 4% to 8% of men 65 and older and in 0.5% to 1.5% of women 65 and older. They rarely occur in people under age 55. Unfortunately, 80% to 90% of people who experience a ruptured abdominal aortic aneurysm die from it, according to the pharmacy chain company Duane Reade.

A person's risk of developing an aneurysm may be inherited. Ascending aortic aneurysms and berry aneurysms are especially likely to run in families. The men of an affected family are more likely to develop aneurysms than are the women. Scientists haven't yet identified the responsible genes in humans, though they have identified some in mice.

About half of all people with ascending aortic aneurysms are born with deformations known as Marfan's syndrome. Such people are unusually tall with long extremities. Abraham Lincoln is thought to have had Marfan's syndrome. They also have a weakness in the aortic wall, just where the aorta leaves the top of the heart.

Two other types of aneurysms are mycotic and atherosclerotic aneurysms. Mycotic aneurysms are caused by a bacterial or fungal infection. Almost any such organism can damage the arteries, but the infection must be very deep and severe. The bacteria salmonella and syphilis both seem to have a special liking for arterial walls.

Atherosclerotic aneurysms are linked to the process that causes coronary artery disease, which is the buildup of fatty deposits on the inner wall of the arteries. In reality, the picture's not so clear. Even someone with severe atherosclerosis may not develop an aneurysm if they are not already genetically predisposed.

Risk factors for heart disease, such as high blood pressure, high cholesterol, inactivity, smoking, and obesity, are also risk factors for aneurysms. Severe aneurysms are probably due to a combination of genes and poor cardiovascular health. Occasionally, aneurysms develop where stab or gunshot wounds have perforated an artery. Much more information can be found at their site: http://www.duanereade.com/health/conditionfactsheet/237_1_0_1_0_0/aneurysm.aspx .

According to the Brain Aneurysm Foundation, one of the most frequently asked questions by brain aneurysm survivors is “How long until I get better?” Unfortunately, there is no way to predict the length of time it will take to improve or even how much improvement will actually occur. Recovery for patients who receive treatment for an unruptured aneurysm generally require less rehabilitative therapy and recover more quickly than patients whose aneurysm has ruptured.

There will be a better chance for recovery if the survivor and his or her family maintain hope, even if that means the recovery process will take a long period of time. A famous rehabilitation pioneer, George Prigatano, Ph.D., frequently tells his patients “If the brain is alive, it can learn.” If you are an aneurysm survivor or you are a caretaker, you need to remember these inspiring and assuring words. The brain can learn new skills for a lifetime. For survivors, there are many challenges to face in the road to recovery: physical challenges, emotional challenges, depression, and dealing with potential deficits. Much more information can be found at this website: http://www.bafound.org .

Aneurysms are extremely serious health events. If you feel that you may be experiencing one or know someone who is, seek immediate medical attention. Better to be cautious than not.

Until next time.

Health Care and Financial Wellness

How is your financial wellness? Are you living paycheck to paycheck as most Americans, or have you been fortunate as a steward of your resources to stash some cash for the rainy days? Do you have enough stored away for a few raindrops, or are you prepared like Noah to last through the flood and until the waters recede? That would be a very long time, and require a good portfolio of financial stability.

The evidence is piling up: Chronic stress is linked to chronic medical issues. More than 200 medical research studies have documented the connection between stress and costly mental and physical diseases, according to Lynn Gresham, former senior editor of Employee Benefit News. The growing awareness of the link between high stress and poor health is prompting employers to take a more holistic approach to employee wellness, addressing workers’ financial health as well as physical health. This is because a primary cause of employee stress is concern about personal finances.

Ms. Gresham writes that money, the economy, and jobs are the top three causes of stress for Americans, according to the American Psychological Association. Although economic signs are improving, the average employee is still struggling to meet financial obligations and make ends meet. A survey conducted for Allstate in February of this year shows:

• Four in 10 Americans still live paycheck to paycheck.
• 8% don’t have enough money for everyday essentials.
• Half describe their financial situation as “fair” or “poor.”
• 47% say they are not saving as much as they should be.

None of this is surprising, given Americans’ debt level, according to Lynn Gresham. The Federal Reserve reported in March that the average credit card debt is $7,122, and among households with other debt, it jumps to a distressing $15,266. The average mortgage debt is $149,667, and the average student loan debt is $32,559.

As stated in the PwC 2012 Employee Financial Wellness Survey, “Despite recent improvements in the economy, the hangover effect from the recession and slow economic growth continues to erode employees’ retirement confidence and overall financial wellness. Cash flow and debt management issues continue to top employees’ financial concerns.” And they don’t leave their problems at home; one-third of employees polled by PwC said they spend time at work thinking about or dealing with money issues.

In fact, 35% reported spending one to two hours per week distracted by personal finances, and 29% spent three to four hours per week. The result, of course, is lower productivity and a diminished work environment. Money worries also increase turnover. A report from Financial Literary partners estimated that 40% of turnover is due to financial stress as employees job-switch to earn more short-term income, according to the report.

According to Met Life, here are the factors influencing financial wellness:

--Personal characteristics: includes both personality factors and societal status (for example, age or
marital status).
--Financial literacy: working knowledge of financial concepts and tools to make the most
advantageous financial decisions.
--Financial behavior: refers to financial actions, for example, financial planning, saving and investment.
--Financial situation: refers to objective wealth, such as home ownership, salary, benefits and
accumulated wealth.
-- Financial stressors: financial events such as losing a home, personal bankruptcy or job loss.

According to the Foundation for Financial Wellness, here is why it matters: In today’s economy, as more and more people worry about their personal finances, organizations are seeing the degree to which employees who are “financially unwell” are negatively impacting the bottom line. Studies are showing that personal financial distress can result in lost productivity, absenteeism and even health issues. Conversely, employees who enjoy peace of mind regarding their personal finances are more inclined to be happy, productive associates who transfer the quality of their employment experience into everything they do.

Even in a good economy, individual financial wellness is important. For employers, the well-being of employees is a critical component to success. Today, the financial distress employees experience is yet one more way a bad economy impacts business. When workplace outcomes can be improved, everyone benefits. More information about financial wellness can be found at this website: http://www.foundationforfinancialwellness.org/ .

According to financial guru, Dave Ramsey, here is how both employers and employees benefit with a financial wellness plan at work:

Company Benefits:

• Increased participation in benefits programs
• Decreased loan and hardship requests from retirement plans
• Increased employee satisfaction and retention
• Decreased garnishments and payroll advancements

Team Member Benefits:

• Better income management
• Increased savings
• Reduced debt and stress
• Improved investing, retirement planning, and college savings
• Stronger marriages

Dave Ramsey’s website has a huge amount of resources about financial wellness: http://www.daveramsey.com/home/ .

Financial wellness is a critically important topic, and unfortunately most Americans are financially sick as they often don’t adopt steps to prevent problems related to their financial well being. Next to physical, spiritual, emotional, and mental health, financial health should be a top priority. Unfortunately, bad financial health leads to problems in these other areas over time. Do yourself a favor, and investigate ways to improve your financial wellness. Your family, and your wallet, will thank you.

Until next time.

Health Care and Swimmer's Ear

During the warmer months of the year, the popular activity with many people is to go swimming. In addition to being a fun way to relax, you can get lots of exercise and great physical stamina from participating in this great water sport. But sometimes, you can experience problems with a common infection in the ear, especially during the summer, called Swimmer’s Ear—an inflammation, irritation, or infection of the outer ear and ear canal. The medical term for swimmer's ear is otitis externa.

Occurring commonly in the outer ear canal, which runs from your eardrum to the outside of your head, swimmer’s ear is often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth, according to the Mayo Clinic. Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer's ear by damaging the thin layer of skin lining your ear canal.

Swimmer's ear symptoms are usually mild at first, but they may get worse if your infection isn't treated or spreads, according to the Mayo Clinic, at this site: http://www.mayoclinic.com/health/swimmers-ear/DS00473 . Doctors often classify swimmer's ear according to mild, moderate, and advanced stages of progression.

1. Mild signs and symptoms:

• Itching in your ear canal
• Slight redness inside your ear
• Mild discomfort that's made worse by pulling on your outer ear (pinna, or auricle) or pushing on the little "bump" (tragus) in front of your ear
• Some drainage of clear, odorless fluid

2. Moderate progression:

• More intense itching
• Increasing pain
• More extensive redness in your ear
• Excessive fluid drainage
• Discharge of pus
• Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
• Decreased or muffled hearing

3. Advanced progression :

• Severe pain that may radiate to your face, neck or side of your head
• Complete blockage of your ear canal
• Redness or swelling of your outer ear
• Swelling in the lymph nodes in your neck
• Fever

According to the National Institutes for Health (NIH), ear drops containing antibiotics are usually given, usually for 10 to 14 days. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Your doctor or nurse can show you how to do this. Other treatments may include:

• Antibiotics taken by mouth if you have a middle ear infection or infection that spreads beyond the ear
• Corticosteroids to reduce itching and inflammation
• Pain medication, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• Vinegar (acetic acid) ear drops

People with chronic swimmer's ear may need long-term or repeated treatments to avoid complications. Placing something warm against the ears may reduce pain. More details can be found at this website: http://www.nlm.nih.gov/medlineplus/ency/article/000622.htm .

According to the American Academy of Otolaryngology, other factors that may contribute to swimmer’s ear include:

• Contact with excessive bacteria that may be present in hot tubs or polluted water
• Excessive cleaning of the ear canal with cotton swabs or anything else
• Contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.)
• Damage to the skin of the ear canal following water irrigation to remove wax
• A cut in the skin of the ear canal
• Other skin conditions affecting the ear canal, such as eczema or seborrhea

If left untreated, complications resulting from swimmer’s ear may include:

--Hearing loss. When the infection clears up, hearing usually returns to normal.
--Recurring ear infections (chronic otitis externa). Without treatment, infection can continue.
--Bone and cartilage damage (malignant otitis externa). Ear infections when not treated can spread to the base of your skull, brain, or cranial nerves. Diabetics and older adults are at higher risk for such dangerous complications. To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent or severe infections. More info can be found at their site: http://www.entnet.org/HealthInformation/swimmersEar.cfm .

Swimmer’s ear is treatable. Other than being irritating and problematic in its initial stages, it can be properly diagnosed by your doctor and easily resolved. Just don’t delay taking action on any infection of any kind. Remember, your hearing is a vitally important function of life. Don’t abuse it.

Until next time.