While many medications are safe during pregnancy, there are others that should be stopped prior to conception, as those are known to cause birth defects.
These measures are absolutely critical when evaluating someone who may be sick, because significant abnormalities can indicate major, even life-threatening, illness. Thousands of chemical reactions occurring simultaneously and continuously in the body require a rather narrow range of temperature. As a result, the body does not tolerate wide fluctuations in temperature very well. In fact, severe hypothermia (low body temperature) or hyperthermia (high body temperature) may cause permanent organ damage or death. That’s why the body has such an elaborate thermoregulation system that keeps the body’s temperature close to ideal most of the time. Fever is typically any temperature above 100˚ F. The most common cause of fever is any infection in the body, but there are other causes, including heat stroke or a drug reaction.
Although you can be sick with a normal temperature, body temperature is clearly an important and useful indicator of health. Metabolic rate, infection, and inflammation in the body all influence human health and longevity. So, a falling average body temperature over the last century and a half could reflect important changes and warrant additional research. The bottom line While news that the normal body temperature may be drifting down over time is intriguing, it is not cause for alarm — and it doesn’t mean the definition of fever should change. We’ll need to rely on additional research to tell us how important these findings may be. In the meantime, it’s probably time to abandon the assumption that 98.6˚ is a normal temperature. Something closer to 97.5˚ may be more accurate. Follow me on Twitter @RobShmerling Print The American population is getting older and sicker. More Americans are facing life-threatening illness when approaching end of life.
Palliative care has grown to meet the complex needs of this population. And yet, according to a 2017 article in the journal Palliative Care, many people living with a chronic life-threatening illness either do not receive any palliative care, or receive services only in the last phase of their illness. The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care also addressed this issue, stating that a goal of their recently updated guidelines is “to improve access to quality palliative care for all people with serious illness regardless of setting, diagnosis, prognosis, or age.” There may be many reasons why patients do not access palliative care services. But it’s likely that greater awareness of what palliative care is, and who can benefit from it, may lead to greater adoption of these services.reduslim farmacia prezzo The philosophy of palliative care Palliative care improves the quality of life, comfort, and resilience of seriously ill patients as well as their families. Seriously ill patients are those with life-threatening medical conditions, like cancer, organ failure, or dementia, that negatively impact the patient’s daily life or result in a high level of stress for the caregiver.
Palliative care utilizes an interdisciplinary team of physicians, nurses, social workers, and chaplains to assess and manage the physical, psychological, social, and spiritual stressors associated with serious illness. It can be provided by primary care physicians, specialists like cancer or heart doctors, palliative care specialists, home health agencies, private companies, and health systems. Palliative care can look very different from patient to patient. For a patient with cancer, for example, the palliative care team collaborates with the cancer doctors to manage the pain caused by the cancer, the side effects caused by treatment, and the anxiety and spiritual suffering of having a cancer diagnosis. For a patient with heart failure, the team collaborates with the heart doctors to manage the shortness of breath that makes it hard to walk to the bathroom, the financial stress of being too sick to work, and the social isolation of not engaging in their usual activities. For a patient with dementia, the team collaborates with the primary care doctor to manage the patient’s confusion and agitation while harnessing community resources such as a home health aide or visiting nurse to provide respite and support for the family. This interdisciplinary approach can be provided throughout the course of an illness and across health care settings. It can span hospitals, clinics, long-term care, assisted living, rehabilitation, and correction facilities, as well as homeless shelters. Who can benefit from palliative care? Palliative care is available to all patients with serious illness regardless of age, prognosis, disease stage, or treatment choice. It is ideally provided early and throughout the illness, together with life-prolonging or curative treatments. In other words, patients don’t have to choose between treatment for their illness and palliative care; they can have both.
Palliative care not only improves the quality of life of patients and their families, reducing mental and physical distress and discomfort, but also can help patients live longer. The prolonged survival is thought to be due to improved quality of life, appropriate administration of disease-directed treatments, and early referral to hospice for intensive symptom management and stabilization. Palliative care and hospice care: Not one and the same Although the overarching philosophy is similar, palliative and hospice care are distinct services. Hospice care is provided to patients near the end of life, with a high risk of dying in the next six months and who will no longer benefit from or have chosen to forego further disease-related treatment. The focus switches from life-prolonging or curative treatment to comfort care. The interdisciplinary team provides quality medical care to make the patient as comfortable as possible, while supporting loved ones during the dying process and with bereavement support after death. Hospice care can be provided in an individual’s home, assisted living, long-term care, hospice facility, and in hospitals.
Hospice care will neither hasten nor prolong the dying process; instead it will optimize the quality of life for the time remaining. Making the most of palliative care services If you or a loved one is living with serious illness, ask your primary or specialty care doctor for a palliative care referral. If palliative services are not available locally, your doctor may explore your palliative or hospice needs with you directly. Use this discussion and the resulting services as an opportunity to: Assess and manage poorly controlled physical, psychological, social, and spiritual stressors. Understand your illness, its expected trajectory, and treatment options. Explore your hopes, worries, goals, and values; cultural or religious beliefs that impact your care or treatment decisions; treatments you may or may not want; what quality of life means to you. Discuss and document your health care proxy and end of life preferences, including medical interventions you do or do not want. It is never too early to ask how palliative services can help you or your loved one live well. Learn more from the Center to Advance Palliative Care. Related Information: Advance Care Planning Print By: Charlie Schmidt Active surveillance is becoming a widely adopted alternative for some men with prostate cancer.
Instead of having immediate treatment, men on active surveillance are monitored with periodic biopsies, physical exams of the prostate, and prostate-specific antigen (PSA) tests. Treatment begins only when the cancer shows signs of progression. But is it safe to wait until then? A new study adds to growing evidence that the answer is yes, but only for men whose cancers fall into favorable risk categories. The study is based on data gathered at Johns Hopkins Hospital, in Baltimore, Maryland, the site of a long-running active surveillance program. The authors studied nearly 1,300 men who were enrolled in active surveillance between 1995 and 2014. Most of the men had “very low-risk cancer,” meaning that their PSA levels weren’t excessively high at diagnosis and that only small amounts of low-grade cancer had been found in at most 2 cores of a standard 12-core biopsy. The rest were in a “low-risk” category, meaning that low-grade cancer had been detected in no more than 5 cores.
The men averaged 66 years of age at diagnosis. By the time the analysis was finished, 49 of the men had died, but only 2 of them from prostate cancer. The cancer-specific survival rates in both the very low-risk and low-risk categories combined exceeded 99% at both 10- and 15-year follow-ups, and the predominant cause of death by far was heart disease. “These results affirm that men with favorable-risk cancer should be encouraged to consider active surveillance instead of treatment given the low likelihood of harm from their diagnosis,” said Dr. Jonathan I. Epstein, a professor of pathology, urology, and oncology at Johns Hopkins Hospital who led the study. It’s important to point out that prostate cancer can get worse on active surveillance. During this study, 22% of the very low-risk men and 31% of the low-risk men eventually required treatment within 15 years. But by the time treatment was initiated, the men had been on active surveillance for an average of 8.5 years. “Very low-risk men clearly make the best candidates for active surveillance,” Epstein said. “But in the case of low- and even intermediate-risk cancers, advanced age and other health problems can boost eligibility.” Epstein added that some men may feel strongly that they don’t want to live with cancer, which can cause them to opt out of active surveillance in favor of treatment. “We’re trying to come up with strategies to help these men stay the course,” he said. “The study adds important information about the growing practice of active surveillance for certain populations of men,” said Dr.
Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and Editor in Chief of HarvardProstateKnowledge.org. “But we must also consider that we have no evidence of survival benefits from treatment in favorable-risk men either at the time that they’re diagnosed or when cancers progress on active surveillance. The benefits of treatment are hard to prove since favorable-risk prostate cancers typically will not be life-threatening during a man’s expected lifespan.” Print You’ve done it! You’ve taken that last birth control pill, removed your IUD, or stopped using your contraceptive method of choice. You’ve made the decision to try to conceive a pregnancy, and while this is an exciting time in your life, it can also feel overwhelming. There is so much advice around fertility and pregnancy, and sifting through it all just isn’t possible. For many mothers, their goals crystallize around ensuring that their baby is healthy. Evidence-based steps that may prevent birth defects January is Birth Defects Prevention Month, so we want to focus on things you can do to reduce the risk of birth defects. I always encourage my patients to think about the steps they can take to make sure their baby is healthy. Scheduling a preconception visit is a good place to start. At that visit, we can review any medical problems women have, which medications they are taking, and which medications they can continue during pregnancy. While many medications are safe during pregnancy, there are others that should be stopped prior to conception, as those are known to cause birth defects. It is particularly important that women with other medical problems, such as diabetes, attend a preconception counseling visit, as having better control of their diabetes can decrease their risk of birth defects. Get vaccinated It is also important that women are up to date with their vaccinations, including the ones for measles, mumps, and rubella (MMR), influenza, and varicella (chicken pox, which some women may be naturally immune to if they had it as a child).
Rubella exposure and infection can cause birth defects, and rarely chicken pox can develop into a severe infection in some pregnant women, as can the flu, so protecting yourself and your baby by ensuring that you are adequately vaccinated is extremely important. Lifestyle changes can help prevent birth defects, especially taking folic acid daily This preconception visit can also encourage women to maintain a healthy weight and lifestyle. I counsel all of my patients that they will gain weight in pregnancy, and so they should start the pregnancy at a healthy weight. I encourage regular exercise even prior to becoming pregnant, and then continuing that level of activity during pregnancy. Being at a healthy weight prior to conceiving and maintaining a healthy weight throughout pregnancy can help decrease your risk of developing diabetes or elevated blood pressure during pregnancy. Having a body mass index (BMI) of 30 or above can also increase your risk of birth defects, which is why maintaining a healthy weight is also important. All women who are trying to get pregnant should start a daily prenatal vitamin containing at least 400mcg of folic acid, at least one month prior to attempting to conceive. Folic acid helps to decrease the risk of certain birth defects, such as neural tube defects. Another risk factor for neural tube defects is increased core body temperature in a pregnant woman, particularly during the first trimester. I recommend that all of my patients avoid hot tubs, saunas, and hot yoga, and that they treat any fever promptly with acetaminophen (which is safe during pregnancy, unlike ibuprofen). Reduce substances that can increase the risk of birth defects Similarly, it is important to avoid substances that increase the risk for birth defects, such as alcohol, tobacco, drugs, and retinoid medications. There is no safe limit of alcohol use during pregnancy, and while it is known that binge drinking during pregnancy increases the risk of fetal alcohol syndrome, there has been no clear definition of the amount of alcohol intake that is connected to fetal alcohol syndrome. I recommend that my patients abstain from alcohol during their pregnancies.
If you are smoking or using alcohol or other drugs, an ideal time to quit is prior to pregnancy. Planning for a pregnancy can be a powerful motivator to quit unhealthy habits, not just during pregnancy but beyond. There are many resources that can help you quit smoking, including medication and nicotine replacement. There may be clinics that specialize in recovery from drug use for pregnant women in your area; starting the conversation with your doctor will help you better understand how to ensure a safe pregnancy for you and your baby. Doing all you can to ensure a healthy baby Unfortunately, knowing and following these guidelines does not guarantee that your baby will not have a birth defect. Many birth defects are detected by specialized ultrasounds of the fetal anatomy, although some may not be detected until birth.