CHOICES that matter most

As strong, healthy, decisive individuals, we generally value our autonomy above all. This is a good thing. However, it often is short-sighted to assume that our lives will not change, or that our decisions of the past will apply in all future situations.

There is no easy way to plan for future health care choices. It's a process that involves thinking and talking about complex and sensitive issues. If you follow the news, you have heard about some situations in which choices are left up to others and you might wonder how or why that was allowed to happen. Often there are no warnings of devastating changes in health status; at other times, there is a long illness which may or may not give a person time to consider options and make one's own decisions.

Let me be clear to say that this is not referring to one's last will and testament, finances, property ownership or assets. This is about who will speak for you when you are no longer able to speak for yourself. Who will be your agent, who will work with your healthcare team for your best interest, This is about that inevitable transition that we all will come to – from this life to Life Eternal. The end of life only rarely happens in 'the blink of an eye.'

The death due to ALS of a notable dean of the University of St Thomas is well-documented in the book “We Know How this Ends,” written by Bruce Kramer, with Cathy Wurzer of MPR. There were many decisions about quality of life during his prolonged illness; and he had the courage to write about them for the benefit of others who may face similar situations.

As your parish nurse, I have worked in the settings of healthcare involving many difficult decisions required of patients, their families, their physicians, their other healthcare providers. There are no easy ways to plan for future health care choices; it's a process that involves thinking and talking about complex and sensitive issues. People have the right to have the healthcare team tell them about medical choices, the risks and the benefits of each of the options, in terminology that is understandable and clear. The patient has the right to accept or to decline these choices.

The Advanced Care Planning Guide, of Honoring Choices MN, helps a person share thoughts, feelings, concerns with the healthcare team, family, friends, and spiritual advisors. Consider the health conditions that you may have now, or may likely encounter in the future; and consider the treatment options currently in practice. Whatever your personal decisions are about certain treatments, it's important that you discuss your point of view with the people closest to you. It is also a good idea to put your choices in writing.

It's challenging to think about having to make these decisions, and it's more difficult to make decisions when you don't know what you want because you've never considered what you might want. Additional information and forms to complete are available at www.honoringchoices.org.

THE DOCTOR IS IN . . .

Charles Schultz created the “Peanuts” cartoons of years past, and perhaps you recall the familiar Lucy, sitting curbside, in a type of converted lemonade stand, with a sign overhead, proclaiming “The Doctor is IN” for the purpose of giving advice to the ever-discouraged, ever-confused, ever-anxious Charlie Brown.

I haven't seen any MDs with curbside consultation stands, and one can say that we might wish our MD would be so easily accessible. Let me attempt to describe various types of healthcare delivery systems, and a consumer's guide for discerning which to select among all the choices.

There are many categories of providers of healthcare, and different medical specialties among physicians. There are also various settings in which one might receive health care. In the case of healthy individuals, their health care is usually provided by a family practice physician or a general practice physician. When the patient has chronic conditions that impact overall health, it is common that physicians with specialty designations also participate in care, such as an allergist or an orthopedist. As one's health status involves more than one or two physicians, most often one of them is designated as the primary care physician (PCP); often this is an internal medicine specialist.  WORD TO THE WISE, if your care is not centered within one healthcare provider group exclusively, BE SURE that each physician you visit has a complete list of all your medications and vitamin supplements, as well as your allergy list.  Do not assume that your eye doctor doesn't need to know about your blood pressure medications, for example. When you do see physicians at different locations, ask to sign a release of information form so that the health information from another doctor will be shared with your PCP. This is for your own safety and on-going consistency in care, over time.

Some thoughts on establishing care with a primary care physician for yourself and your family: None of us makes plans to be sick or sustain an injury. No one intends to break a leg—that's why such happenings are called accidents. And accidents can happen at any time, to someone of any age. Often someone goes to the first appointment available at any clinic to find relief for a cold, a rash, or hay fever. If, then, in two weeks the person isn't improved, s/he may go to a different clinic because it's near home or work, and s/he may not report the treatment given before, which results in first-line treatment given a second time---which doesn't work any better than the first time. To the contrary, going to the same provider allows for more in-depth assessment and reconsideration for a change in the approach to treatment.

None of us has any assurance that our health needs will occur during “normal business hours” for a health care clinic. Those accidents and sudden-onset symptoms can be those things that require immediate care.

There are urgent care centers that are located within a larger clinic or hospital; there are other urgent care centers that are 'free-standing' or located within a Target or Walgreen's store, for example. Urgent care services are medically necessary services which are not life-threatening but need some attention within 24 hours. An urgent care center does not typically have anything more than very basic diagnostic equipment, for evaluating basic lab work and uncomplicated x-rays. Examples of some conditions that are treated in urgent care: allergic reactions, rashes, sore throat, sinus infections, pink eye, ear infection, bug bites, sprains, lacerations, migraine, diarrhea, vomiting.

It's important to keep an Emergency Department free of 'busy work' that should have gone to urgent care, so that the Emergency Department can focus on true emergencies. Statistics show that about 30% of cases in the Emergency Department could have been successfully treated in urgent care. So how do you decide? Here are some more guidelines for situations that should go directly to ER:  chest pain or other heart attack symptoms – call 911; multiple broken bones, or bones protruding through the skin; head injuries with or without multiple trauma, loss of consciousness, severe headache, sudden vision loss; overdose; suicide attempt; severe bleeding; poisoning.

A word about 911 and ambulance transportation:  Especially with symptoms of heart attack or stroke, do NOT drive the person to the hospital in your own car!  I cannot emphasize this enough.  The reason for this is that the ambulance has supplemental oxygen which immediately begins treatment for these potentially serious conditions; in addition, the ambulance will place a heart monitor on the person and that information will be transmitted to the destination emergency facility so diagnosis begins enroute by the staff in the ER.  Also, the ambulance has emergency medications that may save the life of the patient before arriving at the ER. Similarly, with these symptoms as well as possible fractures, the ambulance personnel also know which ER is most quickly available without delay, i.e. shortest “wait time.”

It is important to pay attention to, and comply with, your home-going instructions from urgent care, emergency care, or hospitalization. Most often you will be instructed to follow up with your personal physician. If you don't have one, this is the motivation to schedule an appointment at the clinic of your choice to establish care. The reason for this follow up is that there frequently can be complications of your condition which would have been symptomatic within that period of time, generally one-to-two weeks.

There is one additional healthcare provider to keep in mind. The larger orthopedic (bone) specialty clinics in the Twin Cities metro area have their own Urgent Care facilities fully staffed with x-ray and MRI capabilities, and with physicians to provide diagnosis and treatment on-site. Hennepin County Medical Center (HCMC) has their Fast Track Ortho Clinic for acute injuries and/or fractures. That department is open Monday through Thursday from 1 p.m.- 8 p.m., and Friday from 1 p.m. - 5 p.m. After those hours of service, HCMC Emergency Department will assess and treat orthopedic injuries. Twin Cities Orthopedics has several clinics in the metro area including Edina; their Urgent Care facility hours are 8 a.m- 8 p.m. Walk ins are welcome. TRIA, an orthopedic specialty clinic, also has urgent care services 8 a.m.-8 p.m. Walk-ins welcome there, as well. It is this writer's recommendation that an injury with suspected fracture be evaluated and treated at one of the orthopedic specialty urgent care facilities; it saves a lot of time, and frequently avoids a secondary referral.

Charlie Brown, his friend Lucy, and the 'Peanuts' gang, together with your parish nurse,

“The Doctor is IN.”

WATER, WATER, and MORE WATER!

If you were expecting some inspired words about Noah and The Flood, I am sorry that is not the topic for this time. Psalm 42:1 leads into my thoughts somewhat more directly: “As the deer pants for flowing streams . . . “

In the midst of summer, with heat and humidity creating “heat advisory” status, it is important to pay attention to the amount of water that we drink in any given day. Hydration is important because the body is comprised mostly of water. The proper balance between water and the chemistry of our blood (mainly sodium and potassium) determines how all systems of our bodies function. Adequate hydration is key in regulating body temperature, heart function, blood pressure, removing waste, proper function of nerves and muscles, and in maintaining a healthy metabolism.

If we wait until we feel thirsty before drinking a glass of water, we're already dehydrated. Thirst is not the best indicator of hydration status. It is recommended that a person maintain the habit of being proactive in health maintenance or improvement by beginning each day with 16 ounces of water immediately upon arising. . . and then continuing to drink water throughout the day up to 64 ounces, ideally. The primary benefit is that water helps the body combat heat, aids digestion, aids the effectiveness of prescription drugs, jump-starts kidney and bowel function, and enhances heart, blood vessel, nerve, and muscle function. Think of it this way: WATER is cheap medicine.

Signs and symptoms of dehydration include:

  • loss of appetite
  • fatigue
  • flushed, reddened skin in the face
  • dizziness, light-headedness
  • dark-colored urine
  • dry cough

While water is the prime fluid to support body function, the chemistry of the blood is supported by other foods and beverages that provide sources of sodium and potassium. Think of a tall glass of lemonade, made from fresh-squeezed lemons with a few lemon slices in the glass. Sports drinks, fruit juice, soft drinks also supply some sodium and potassium, but be mindful of the nutritional contents on the labels. Alcoholic and caffeinated beverages are not recommended for optimal hydration because they actually pull more water out of the body than they add to it.

In addition to water and other beverages, foods that supply potassium that is key to the body's health, moreso in hot weather, include bananas, canteloupe, strawberries, potatoes, chard, spinach, and lentils. To make water-drinking more appealing, try adding sliced lemons and limes to a pitcher of water, or a few slices of cucumber, or perhaps whole strawberries and a mint leaf. 

TO YOUR HEALTH!