HEALTH INFORMATION
Understanding Your Lab
Diet
Vomiting & Diarrhea
Calcium & Vitamin D
Hemoglobin A1C
Target Lab Values For Diabetics
Laboratory tests should always be evaluated by a medical professional in the context of the patient's condition, treatment and history. However, to assist you in understanding, here is a brief explanation of some of the laboratory tests commonly ordered:
Glucose - Sugar
BUN/Creatinine - Kidney Tests
Sodium, Potassium, Chloride, Carbon Dioxide, Calcium - Minerals
SGOT, SGPT - Enzymes related to liver, heart
CPK or CK - Muscle enzyme
TSH - Thyroid Function
Cholesterol, Triglyceride - Two different fats in the blood
LDL Cholesterol - "Bad" Cholesterol
HDL Cholesterol - "Good" Cholesterol
Hemoglobin A1C - Diabetic Control
PSA - Prostate Cancer
Uric Acid - Elevation may cause gout
WBC - Cells involved in the body's reponse to infection
RBC, Hemoglobin, Hematocrit - Anemia
Hemoglobin A1C is used to evaluate overall diabetic control. Hemoglobin A1C is a fraction of the hemoglobin molecule. The higher the blood sugar level in the 4-6 weeks prior to the test, the higher the hemoglobin A1C level. The normal range may vary depending on the technology used. The normal range is 4-6 or 4.5-5.7. The national diabetic goal is under 7, but the lower the better. With a normal hemoglobin A1C there is a lower chance of diabetic complications. These complications include kidney disease, heart disease, nerve disease, eye disease and amputations.
Calcium & Vitamin D are important to prevent osteoporosis. Adequate intake of calcium and Vitamin D is important on a daily basis. The best dietary source of calcium and Vitamin D is skim milk. However, it would be necessary to drink 4-5 full glasses a day. Women should have 1200-1500mg of calcium and 600-800 units of Vitamin D daily. Men should have 1000-1200mg of calcium and 1000 units of Vitamin D daily. Supplements can be used; one is not better than another. The patient's tolerance and preference should dictate which supplement to take. Some patients cannot take supplements, for example, patients who form certain kidney stones.
TARGET LAB VALUES FOR PEOPLE WITH DIABETES:
Blood sugar before meals: 70-110 mg/dl
Blood sugar 2 hours after the start of a meal 70-140 mg/dl
Hemoglobin A1C - The national goal is 7% or less; Ideal is 6.5% or less
Reference: American College of Endocrinology and American Association of Diabetes Educators
BLOOD CHOLESTEROL:
LDL - 70-80 mg/dl
HDL - greater than 45 mg/dl for men; greater than 55 mg/dl for women
Triclycerides - less than 150 mg/dl
Reference: American Diabetes Association
TARGET BLOOD PRESSURE LEVELS FOR PEOPLE WITH DIABETES:
The lower the blood pressure, the better. However, the blood pressure should be:
Less than 130 mm Hg systolic
Less then 80 mm Hg diastolic
Reference: American Diabetes Association
Weight loss invoves a good diet: fresh fruits & vegetables, whole grain breads & cereals, skim milk, beans, fish, & poultry. Red meats are OK on occasion (trimmed of fat, not overly marbled & not hamburger meat). Meats should be grilled, baked or broiled; not fried. Sauces should be lemon or tomato based, not cream based. Avoid cheese, ice cream, cakes, pies, cookies & candies. Calories overall should be restricted. Avoid alcohol. Regular exercise is called for 1 hour per day or aerobic exercise (brisk walking, running, bicycling, swimming, exercylce, treadmill, skiing, rowing machine, stepper, cardioglide or elliptical).
The danger with vomiting and/or diarrhea is dehydration. Dehydration can be a serious medical condition. Push fluids (water, ginger ale, sodas, etc.); usually clear liquids are best because they are easier for your body to process. If you are losing more fluids through vomiting and/or diarrhea than you can drink, then you need to go to the nearest emergency room as intraveous fluids may be necessary.
Care of Diabetic Foot
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DO NOT SMOKE
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Inspect the feet dialy for cuts, blisters & scratches. The use of a mirror can aid in seeing the bottom of the feet. Always check between the toes for skin breakdowns.
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Wash feet daily with mild soap. Don't scrub. Dry carefully, especially between the toes.
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Avoid extreme temperatures. Test water with hand or elbow before bathing.
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If your feet feel cold at night, wear socks or booties. Do not apply hot water bottles or heating pads. Do not soak feet in hot water.
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Do not walk barefooted. This includes getting up at night to go to the bathroom.
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Do not use chemical agents for the removal of corns and calluses. Do not use corn plasters. Do not use strong antiseptic solutions on your feet. use an emery board or pumice stone to plane down calluses.
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Do not use adhesive tape on the feet.
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Inspect the inside of shoes for foreign objects, nail points, torn linings and rough areas.
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Inspect each time they are put on to be sure no foreign objects are in the shoes.
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If your vision is impaired, have a family member inspect your feet daily; trim nails and buff down calluses.
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Do not soak feet.
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For dry feet, use a very thin coat of lubrication oil such as baby oil. Apply this after bathing and drying the feet. Do not put the oil or cream between the toes. Consult your physician for detailed instructions.
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Wear properly fitting stockings. Do not wear mended stockings. Avoid stockings with seams. Change stockings daily.
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Do not wear garters.
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Shoes should be comfortable at the time of purchase. Do not depend on them to stretch out. Shoes should be made of leather. Running shoes may be worn after checking with your physician. If there are deformities, special shoes may be necessary. The toe box must be big enough. Buy shoes in the afternoon when feet are the largest due to the swelling. Break in shoes slowly, wear them one hour the first day and increase one hour per day.
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Change shoes frequently, every 4-5 hours. Remove shoes at coffee breaks if possible.
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Do not wear shoes without stockings.
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Do not wear sandals with thongs between the toes.
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In winter-time take special precautions. Wear wool socks and protective foot gear, such as fleeced lined boots.
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Cut nails straight across, do not cut or file into the corners. File even with the end of the toe. Do not file shorter than the end of the toe.
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Do not cut corns or calluses. Follow special instructions from your physician.
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Avoid crossing your legs; this causes pressure on the nerves and blood vessels.
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Walk slowly and in short steps.
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Avoid crowded spaces where feet may be stepped on or stubbed.
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Loosen bedding at the bottom of the bed to avoid pressure on feet.
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See your physician regularly and be sure that your feet are examined at each visit.
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Notify your physician at once should you develop a blister or sore on your feet.
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Be sure that anyone caring for your feet knows that you are a diabetic. This includes the shoe salesman.
Pink Eye
Back Exercises
Pink eye is usually a self-limited viral infection. Pink eye is VERY infectious. Symptoms include: redness, itching, discharge & discomfort. Treament involves treating the symptoms with cool compresses and eye drops that wash the eye. These eye drops are available without prescriptions and usually contain saline or methylcellulose. Do not touch the tip of the eye dropper to the affected eye or the discharge. Do not touch the contaminated eye or used compress to the other eye. If you touch the discharge or the affected eye, immediately wash your hands thoroughly. Hand washing is critial to preventing the spread of Pink Eye to the other eye or to others. If there is severe pain or decreased vision, you should be seen in an emergency medical facility or an eye doctor's office.
BACK PAIN:
Common Characteristics:
Back pain, which afflicts four out of five Americans at one time or another, is second only to headache as a common disorder characterized by pain. Pain in the spine may accompany an injury or occur spontaneously; for the overwhelming majority of sufferers, the pain originates in the lower back, or lumbar region.
Recent studies indicate that fewer than 15% of cases of lower back pain are traceable to structural defects, such as ruptured discs, arthritis, or tumors. In most cases, the disability arises from weakness of the muscles surrounding the spine or abnormal positions or posture. Therefore, the most important element of treament for back pain involves strengthening and protecting supporting muscules and maintaining correct posture. With a doctor's evaluation and guildance, well-informed and motivated patients can carry out most of the treatment themselves.
How the Conditon Originates:
The spinal column is made up of 33 bone segments, or vertebrae, held together with touch bands of tissue called ligaments. Nerve roots pass through openings between the vertebrae. Thus, a severe wrench of the back or a failure of muscular support may result in the painful "pinching" of a nerve. The sciatic nerve, which extends from the lumbar area into the buttocks, legs and toes, is particularly vulnerable to such pressure. (The condition know as sciatica is a frequent companion to lower back pain and is associated witha ruptured or herniated disc.) Pain is also generated when muscles go into spasm. While such a spasm may occur as a protective reflex, it intensifies discomfort by cutting off circulation and setting up an inflammatory response. Stress of any kind (physical or psychological) may cause spasms in underexercised, mis-used muscles.
Basic Causes:
Recurrent back pain leading to the deterioration of the muscles supporting the spine can usually be traced to a specific condition. These include (alone or in combination) a sedentary lifestyle, obesity, poor posture and general lack of muscular tone. The type of exercise undertaken by usually sedentary people often fails to strenghten muscules supporting the lower back. Indeed, such popular weekend sports as tennis, golf and skiing may actually promote back problems.
Treating the Pain:
Typically, acute lower back pain comes on suddenly and without apparent reason. Symptoms of sciatic nerve involvement (twinges, numbness, burning, weakness) may also be present. In such cases, bed rest, hot baths and use of a painkiller usually provides relief. A short course of muscle relaxants may also be recommended. If sagging abdominal muscles need support, use of a girdle is helpful.
In about 90% of all cases, lower back pain subsides within 2 months. However, if the circumstances that caused it are not altered, it is likely to persist or recur.
Preventing a Recurrence:
As soon as possible after the acute pain subsides, exercises should be undertaken to strengthen muscles in the back and abdomen. A long-term weight-reducing plan may be advised. Yoga, meditation and breathing exercises may help reduce tension and stress.
If your daily routine involves many hours of standing, check your posture in profile. Your chest should be raised, buttocks tucked in and stomach flat. Sedentary workers should have a chair with armrests, support for the lower back, a moveable upper section and an adjustment for seat height so that the upper legs and thighs are supported and the feet can rest comfortably on the floor. When picking things up, bend at the knees only. If the object is heavy, hold it close to the body and tighten the abdominal muscles. Sports involving sudden body movements should be avoided in favor of walking, jogging, cycling, and swimming.
Chronic Disabling Pain:
When diagnostic tests determine.........
Driving
Sleep Hygiene
SHOULD I BE DRIVING?
Driving a car symbolizes independence in our society, especially in Texas. However, there may come a time when it is too dangerous for you and others to drive. Here are some questions to ask yourself:
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Do I have difficulty reading the road signs?
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Do I frequently get lost while driving?
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Do family members tell me I am a bad driver or that I should stop driving?
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Do I think that everyone drives too fast? Am I frequently the slowest car? Do people honk and gesture at me frequently?
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Do I have full range of motion in my neck, shoulders and wrists?
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Have I had any traffic violations? Close-call accidents in the last 6 months? Year?
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Is my hearing significantly impaired? Can I hear a car horn when my windows are closed?
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How strong is my grip?
Talk to your family and friends about alternative transportation methods - family, friends, bus and cab. Remember, this is a public health issue. Driving is dangerous and stressful for the healthy and strong person and requires many skills. Don't put yourself and others at risk unnecessarily.
FALLING ASLEEP:
If you can't get to sleep, rather than trying harder and harder to fall asleep, try getting out of bed and doing something else. If you have not fallen asleep after 20-30 minutes, get out of bed. It is best to move to another room and return to bed only when sleepy.
If you have trouble getting to sleep, establish a routine for an hour or so each night before bedtime, such as reading, taking a warm shower or bath, or resting quietly.
Avoid too much mental stimulation during the hour or so prior to bedtime. Read a light novel or watch a relaxing TV program; do not finish office work or discuss family finances with your spouse.
STRESS:
Almost everyone experiences an occasional night of lost or disturbed sleep. It is a natural, perhaps adaptive, response to acute stress.
NAPS:
If you are having trouble falling asleep at night, avoid naps in the early afternoon or early evening. However, a regular afternoon nap may be beneficial to some people even if it shortens night-time sleep.
GETTING UP:
No matter how poorly you have slept the night before, always set your alarm to arise at the same time each morning. This strengthens the circadian cycle, and leads to more regular bedtimes and better sleep quality.
EXERCISE:
Regular exercise can be an effective aid to sleep. It releases energy and mental tensions. However, it is better not to exercise strenuously just before bedtime.
NOISES:
Occasional loud noises from aircraft, streets, or highways disturb sleep even in people who do not awaken and who cannot remember the noise in the morning. These sleep disturbances can reduce restful sleep. People who sleep near excessive noise should try heavy curtains in their bedrooms, a fan or other white noise in the bedroom, or ear plugs to protect the amount of restful sleep they get.
HUNGER:
Hunger may disturb sleep. A light snack, especially warm milk, seems to help people get to sleep. Beware, however, that bedtime snacks may predispose to acid reflux while asleep.
FOOD:
Various foods stimulate the body and disturb sleep. Avoid coffee, tea, chocolate and cola drinks near bedtime. Avoid late heavy meals.
SLEEP PATTERNS:
Everyone has a unique sleeping pattern. Some adults need 10 hours per night while others need only 5 hours per night. Many people function best with approximately 8 hours of sleep. Your requirement for sleep is unique. What is effective for your husband, your wife or your friends may not be for you. If you need only 5 hours of sleep per night, do not worry about it or try to force longer sleeping hours. Instead, learn to use your extra waking hours for something you would like to do or get done.
QUANTITY & QUALITY:
Sleep needs change. The amount and quality of sleep needed varies in the course of each person's life. The infant may require 16 hours of sleep each day, and an elderly person may sleep 3 to 4 hours at night, with frequent naps during the day. Changes in the length and depth of sleep are a normal part of life. Within limits, the quality of our sleep is more important than quantity. Many patients at the end of life may sleep most of the day.
SYMPTOM OF A MEDICAL PROBLEM:
Sleeping problems may signal a medical condition such as anxiety, depression and other disorders. It is important to get a proper diagnosis and treatment of the underlying cause of a chronic sleep disturbance.
PREGNANCY:
Excessive sleepiness in the first 3 months of pregnancy is normal. Don't worry about it. Pregnant women also tend to sleep about 2 more hours at night.
MEDICATIONS & ALCOHOL:
An occasional sleeping pill may be of some benefit, but chronic (nightly) use of sleeping pills may actually hinder good sleep. Natural sleep is the best sleep.
Sleeping medications should be used with caution and only upon the advice of a physician by the elderly, pregnant women and people with respiratory disease, kidney disease or liver impairment.
If your doctor prescribes a sleep medicine, ask for clear directions and information about the particular drug you are to take. Some sleeping pills have a prolonged effect, and can impair your coordination and driving skills the following day.
Sleep medication should only be used for the short-term management of a sleep complaint. Do not self-medicate or increase the dosage yourself. If you feel that your medication is losing its effect, report this to your doctor.
Although alcohol may help to induce sleep, the chronic use of larger quantities of alcohol causes disturbed sleep and dependency.