News Room

“I will take better care of my diabetes.” Diabetes is a scary diagnosis because it is about more than just blood sugars. It is a disease that affects your blood vessels, and it can lead to a stroke or heart attack. Other than heart disease, diabetes is a disease that affects the eyes, kidneys, nerves and other small blood vessels. The “complications” of diabetes are really complications of uncontrolled blood sugars.

Once a person has diabetes, he or she has to watch lipids (cholesterol numbers) and blood pressure, as well as blood sugars. Medications, lifestyle and diet all affect diabetes, and managing these are the core of diabetes care. One of the tests that help us see how well diabetes is controlled is the A1C test. It is also called hemoglobin A1c ( HbA1c), or glycated hemoglobin test. The HbA1c test shows the average blood sugar levels for the past two to three months. It measures how much of the hemoglobin (red blood cells) is glycated (coated in sugar).

“Statistically, we know people who attend diabetes self-management training (DSMT) and go to yearly DSMT follow-up education manage their diabetes better,” reports Rhonda Perdelwitz, RN, BSN and Certified Diabetes Educator at Fort Atkinson Hospital. “The American Diabetes Association suggests having an A1c of 7% or less is optimal blood sugar control and you can improve, reduce or eliminate complications of diabetes.”

If your A1c test has not been done for 4 to 6 months, ask your doctor to have this test done. This blood test does not have to be done fasting. If the results are 7.0 or higher, ask your doctor to refer you for diabetes education to the nurse and dietitian.

Diabetes education is covered by some insurance plans. Because each insurance plan is different it is recommended that you call your insurance company and inquire on if diabetes self-management training is a paid benefit. If you have Medicare, diabetes education is a preventative program Medicare covers. Medicare pays for 10 hours of diabetes class education the first year of a new diabetes diagnosis and for 2 hours every year after initial diagnosis. To meet the Medicare requirements for DSMT education the patient must have a referral from the doctor. Go to www.medicare.gov to see what kind of coverage the plan you are on has.

So when you think “I am going to take better care of my Diabetes” it may simply mean asking your doctor for a referral to diabetes education.

Tags: , ,

This is maybe the most common question I get. The answer is far from straight forward and usually a combination of patient-specific factors.

Kidney stones form when, if the urine chemistry is just right, substances combine, crystallize, and then those crystals bind together to form stones.

There are many different types of stones: Calcium Oxalate, Uric Acid, Calcium Phosphate, Magnesium Ammonium Phosphate, and Cystiene stones make up the majority of stone types. About 80-85% of stones are calcium based but it is a common misconception that these calcium-based stones are caused by too much dietary calcium (milk, cheese, yogurt, etc.). Usually it is a problem with the way your body handles the calcium. Abstaining from dietary calcium in these circumstances can do more harm than good.

When looking at ways to prevent stones, I focus on common dietary factors that can increase risk. High sodium intake is probably the biggest contribution to stone risk. Excessive sodium from canned foods, processed meats, restaurants, prepared boxed or frozen meals…all contributes to increased stone risk. I try to get my patients to A) recognize where the sodium in their diet is coming from (rarely just the salt-shaker) and B)keep their sodium intake to <2500mg/day.

Sodium is a big culprit, but chronic dehydration is probably the other most common problem. Stone formers should drink no less than 64oz/day of water, ideally with up to 4oz of lemon juice. Lemon juice is high in citrate which is a potent stone inhibitor. Excessive protein consumption can also lead to a more acidic urine, predisposing to certain types of stones.

If a patient has had more than one stone, or if they are young with a strong family history, I usually recommend blood and 24 hour urine testing for a custom stone prevention workup.

If you or a friend/loved one have lived with recurrent stones and haven’t been evaluated for prevention, give us a call.

Tags: , , ,

I’m sure many readers have seen or heard the commercials featuring law firms that do not have many very nice things to say about “mesh”.

So what is mesh and what should I do about it?

“Mesh” often refers to a web-like sheet of a kind of plastic, polypropylene, that has been used medically for various reasons for many years. This mesh is woven into various shapes and sizes. It is used for large blood vessel reconstruction, hernia repair (umbilical, inguinal, ventral, etc.), incontinence and pelvic organ prolapse.

The controversy surrounding mesh focuses on mesh products that were placed vaginally for pelvic organ prolapse. Prolapse is a condition where the bladder, bowel, or uterus is literally falling out of the vagina, usually causing a prominent bulge. These prolapse-fixing products are often large sheets of oddly-shaped mesh meant to reinforce weakened vaginal tissues. If used properly, they helped many women with their prolapse problems. If used improperly and in the wrong patients, the mesh could erode into structures nearby such as the bladder, the ureter, vagina, or bowel. Usually this requries an additional surgical procedure to remove the mesh. This need for re-operation due to mesh complications led the the Food and Drug Administration (FDA) to issue a “Safety Communication” regarding vaginal mesh for pelvic organ prolapse.

Once again, the mesh “controversy” is regarding mesh used for pelvic organ prolapse. The small pieces of mesh desiged to treat female incontinence are not implicated as problematic and still remain an excellent option for treating stress incontinence. This is a type of incontinence that is often best treated with surgery as no medications are effective. Pelvic exercises (kegels) are often tried first but some women remain bothered by the incontinence and surgery is the next step.

Tags: , , , , ,

Carpal tunnel syndrome (CTS) is a problem that affects the wrist and hand. The carpal tunnel is a narrow space inside the wrist that is surrounded by bone and ligament. This space lets certain tendons and a major nerve pass from the forearm into the hand. With CTS, the tendon sheaths may thicken and enlarge. This reduces the amount of space inside the carpal tunnel. As a result, the median nerve may be compressed.

Tingling and numbness are the most common symptoms of CTS. Some people also have hand pain or even a weakened grip. At first, symptoms may wake you up at night. Later, they may also occur during your daily routines. Your symptoms may become more severe over time.

The most common symptoms for carpal tunnel syndrome include:

  • Weakness when gripping objects with the hand(s)
  • Pain and/or numbness in the hand(s)
  • “Pins and needles” feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers
  • Pain and/or numbness that is worse at night, interrupting sleep

Treatment may include:

  • Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
  • Oral or injected (into the carpal tunnel space) anti-inflammatory medications (to reduce the swelling)
  • Surgery (to relieve compression on the nerves in the carpal tunnel)
  • Changing position of a computer keyboard, or other ergonomic changes

Surgery is not always a recommended course of action. I have been very excited about the feedback we receive from patients regarding the outcomes for carpal tunnel surgery. Not only are most patients achieving relief of numbness, tingling, and pain, but with our rapid mobilization program they are experiencing a quicker return to function with minimal down time. Care is coordinated with a Certified Hand Therapist, and our Hand Care Center is set up to provide easy communication.

Carpal Tunnel release is one of the most common surgical procedures. If you are experiencing any discomfort in your hands or wrists, I would encourage you to talk to your doctor or give us a call.

www.FortHealthCare.com/HandCare

Tags: , , ,