Diabetes Foot Care

shutterstock_110360354Patients who have diabetes need to pay extra attention to their foot care to help prevent infections.  I’ve had numerous patients with diabetes need foot or toe amputations that could have been prevented with excellent foot hygiene.  Small scrapes in the skin or ingrown nails can become extremely bad very quickly with diabetes because patients who have diabetes often don’t have as much sensation (due to damage to the nerve endings and blood vessels in your feet).  This can make it difficult to detect sores and once an infection is present it can be very difficult to treat.  I thought I’d put together some tips to help you keep your feet healthy and decrease the risk for infections.

1)      Stop smoking:  If you smoke, this can decrease the blood flowing to your feet and make foot problems worse.

2)     Inspect your feet everyday:  Look for blisters, cuts, cracks or sores.  If you cannot see your feet well then use a mirror or have a family member help you.

3)     Wash your feet everyday:  Use warm (not hot) water – be sure to check the temperature with your hands rather than your feet.

4)     Dry your feet well:  Pat them dry and do not rub the skin on your feet too hard.  Dry between each toe.  If the skin on your feet stays moist, bacteria or fungus can grow and that might lead to a foot infection.

5)     Keep your feet soft:  Use a skin moisturizer such as Aveeno, Dove or Cetaphil on your feet to keep your skin soft and prevent calluses and cracks.  Don’t put the cream between your toes unless you are treating athlete’s foot with a fungal cream.  Make sure to wear socks or traction on your feet after applying the cream so you don’t slip and fall.

6)     Clean under your toenails carefully:  Don’t use sharp objects under your toenails.  Instead use the blunt end of a nail file or other rounded tool to decrease the chance of piercing the skin.

7)     Trim and file your toenails straight across:  This helps prevent ingrown nails.  Use a nail clipper instead of scissors.  Then use an emery board to smooth the edges.  If you need help trimming your nails, schedule an appointment with your medical provider.

8)     Change your socks everyday:  Socks should have a thick cushion and fit loosely around your feet.  Socks without seams are best because seams often rub the feet.  Do not wear stockings, socks, or garters that come up to the thigh or knees unless your medical provider advises you to do so because they can decrease the blood flow to your feet.

9)     Look inside your shoes before putting them on:  Check them every day for gravel, torn linings, or thorns that can cause blisters or sores.

10)  Do not go barefoot:  Don’t wear sandals or shoes with thin soles because these types of shoes are easy to puncture.  They also do not protect your feet from hot pavement or cold weather.

11)  Have your medical provider check your feet during each visit:  If you notice a problem with your feet, see your medical provider right away rather than trying to treat it with a home remedy.  Some home remedies or treatments that you can buy without a prescription (such as corn removers) can be harmful.

12)  Keep your blood sugar down:  Watch what and how you eat, monitor your blood sugar, take your medications and get regular exercise.

When to seek medical help:

A)      If you cannot do proper foot care

B)     If you have a foot sore or ulcer that is not healing after 3 days (including corns, calluses or ingrown nails)

C)     If you have black and blue areas in your toes or feet

D)    If you have peeling skin or blisters between your toes

E)     If you have a fever for more than 24 hours and a foot sore

F)     If you have new numbness or tingling in your feet that does not go away after you move your feet or change positions

G)    If you have unexplained or unusual swelling of your foot or ankle

H)    Anytime you have questions about your feet or concerns it is best to contact your medical provider

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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Tips for Managing your Elderly Parent’s Medication

shutterstock_138204188Many of my clients caring for elderly parents struggle with the fact that their parent has a tough time remembering what medications they are taking and what the purpose is for each medication that they are prescribed. Many seniors are taking multiple medications, with doses sometimes several times throughout the day. The truth is that as we age our memory frequently declines, which can make it challenging to remember all of the details of our daily routines. However, it is critical that patients are taking the proper medications, because their health may be adversely affected.

I believe that helping our patients understand why they take certain medications keeps them involved in their own care and also helps them remember to take them, and typically provide the following recommendations to help patients remember to take their medications:

1. Give the patient an updated list of his/her medications each time they are seen by a medical provider and explain how to take them. In addition, briefly describe what the medication is used for. A short description such as “Blood Pressure” or “Cholesterol” is sufficient so that the patient is able to recall why they are taking it. Make sure this list is in large font and easy to read. Laminating the list makes it more durable. Patients should post this list on the refrigerator or in a location near their medications so that they have it for easy reference. Each time a change is made to one or more of the patient’s medications, a new list is made and given to the patient. If the change is done over the phone – the list should be mailed or emailed to the patient. I routinely give my patients a copy of their updated medication list on a USB device which is carried with them daily. If they go to another medical provider or hospital, they can easily access their updated medication list on their USB drive – it is also available to be stored “in the cloud” – i.e. on a secure website, if they prefer not to carry it with them.

2. Put medicine in a location of the home that your parent visits often. – Next to the coffee maker or water dispenser, or next to the sink in the bathroom are all good places and the bottles serve as visual reminders.

3. Review your parent’s medication bottles at each visit. If you visit the patient at their home or office, look at each bottle and make sure the medication is on the patient’s list and also in the patient’s chart. If this is done at each visit, errors can be avoided, especially if an old or outdated prescription is being used by the patient. At this time, new prescriptions can be issued before the patient runs out of the medication.

4. Pill Boxes and Dispensers are a simple and relatively affordable tool that has proven to work well as it allows you to plan dosage and also track consumption. Most pill boxes can be purchased at a pharmacy and are typically under $5. Some of the higher-end pill boxes also feature built in reminders.

5. Prescription bottle alarms or reminder devices are increasingly available, which can alert them that they are due to take their medicine. Some of these bottle caps glow, and/or give a sound alert reminder. They also have bottle caps which can send a text message to the patient’s phone or an email that can be a great reminder for the tech-savvy patient. One company that produces these prescription bottle caps is: Vitality – and they make GlowCaps. A simple alarm functionality on a cell phone or a calendar meeting reminder also works well.

Vitality GlowCaps from Vitality on Vimeo.

6. There are also a set of new Mobile Applications designed for the iPhone, iPad, and other mobile devices that  help you track and manage medications. A few of the noteworthy ones to check out are: iPills, PillboxPillboxer, and The Pill Phone.

Remembering to take medications appropriately can be challenging, but caregivers can help patients do this with simple tools and a little extra time.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Addressing Wishes for End of Life Care

shutterstock_57012596Last week, I was consulted by a patient who wished to discuss their wishes for end of life care, but did not know how to bring up the subject with their families and care takers. Because this can be a challenging and emotionally filled conversation, often family members are not aware of the wishes of their older loved one.

It is common medical practice to ask elderly or terminally ill patients about their wishes if they were to be taken to the hospital at a time of respiratory distress or cardiac arrest. For a younger patient there is no question that everything would be done, including insertion of an artificial airway to help them breath if needed, to give CPR including chest compressions as well as starting an IV to administer medications. An elderly patient near the end of their life may not wish to have all of these measures taken, and may even resent this treatment if it does not coincide with their wishes. Many patients are not aware that hospitals are required by law to undertake resusitation measures unless the patient has a specific order on file.

Talking with a loved one about difficult issues is not easy, but being proactive and listening to their wishes can save frustrations later and give the elderly loved one the peace of mind that their wishes have been heard. It is also easier for family members to accept these decisions and be the proper advocate for their family in times of crisis after this has been discussed in advance.

Many hospitals can provide their patients and their families with a worksheet that can help plan end of life care. If filled out in advance and posted in a convenient location such as the refrigerator, it can be easily accessed in an emergency at a time when ambulance staff arrives to take the patient to the hospital. State-specific advance directives can be downloaded on the National Hospice and Palliative Care Organization (NHPCO) Web site.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

How Physicians can Enable Longer Independent Living for Seniors

One of the primary goals of my practice is to help my elderly patients continue to live longer, healthier lives in their familiar surroundings and established communities.  Also, one of the most common questions I hear from the families that I care for is “How do I allow my loved one to keep their independence?”

Medical conditions that  can make living at home difficult include problems remembering to take medications, issues with mobility such as recent hip fractures, as well as complicated medical problems such as congestive heart failure, out of control diabetes and severe COPD.  Oftentimes the elderly patient’s family lives far away, even in another state so helping your elderly parent be sure that they are getting the proper care that they need also often challenging.

I believe that having a primary care provider who coordinates all of the medical care that your elderly family member needs is most important.  I find it extremely rewarding to help my patients navigate the often confusing healthcare system.

Several tools help me assist my patients at home:

1)  Prescription Bottle Caps which have a timer to help patients remember to take their medicine.

2)  Medical record on key ring that is updated at each visit.

3)  Print Medications and summary of visit for each patient at each visit as patients may forget what you tell them during the encounter.

4)  Make patients caregivers/family aware of any changes in patient’s care

5)  In-home care providers can be very helpful when needed

6)  Involve the patient in the decision making as much as possible

7)  Be careful about any medications that may cause drowsiness or falls

8.   Work with specialists and coordinate patient care with all upcoming appointments written down on their calendar

9)  A home visit will allow you to assess the patients environment and get them home equipment which will help keep them independent.  Some examples are:     Shower Chair, Raised toilet seats, bathtub/shower grab bars, Bed rails, Hospital type bed that can be adjusted to prop the patient up or an Over Bed Table.

One of the most fulfilling parts of my career is helping elderly patients retain their independence, and stay at home for as long as they can.  I enjoy working with family members to help make this possible.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Nine Tips for Accessible Travel by Your Elderly Parents

by Candy B. Harrington

Are your elderly parents reluctant to travel because they just don’t get around like they used to? Well they’re not alone. According to the 2002 US Census, nearly 23 million people had difficulty standing for an hour, while 21 million people had difficulty walking up a flight of 10 stairs.

But that doesn’t mean globetrotting is out of the question for senior citizens; in fact, with a little advance planning your parents can still enjoy travel. Here are a few tips to share with them, before they make their next trip.

• Even if you can walk, reserve an airport wheelchair if you tire easily. Some airports are huge and you could easily put on several miles while in transit, and arrive at your destination exhausted.

• You are not required to remove your shoes at the airport security checkpoint if you are physically unable to do so. Just tell the TSA agent that you can’t do it, and they will hand wand you and swab your shoes for explosive residue.

• Tell the gate agent that you would like to pre-board the aircraft. This means that you will board before the rest of the passengers. Pre-boarding allows you to take things at your own pace, and gives you a little extra time to get settled in your seat.

• If you need wheelchair-accessible transportation from the airport to your hotel, choose a hotel that has a free airport shuttle. Under the Americans with Disabilities Act, if the hotel provides free transfers, they must also provide free accessible transfers, even if they have to contract out the service.

• Cruises are a great accessible travel choice, but new cruise ships are huge and it can be very tiring to walk from one end to the other. If fatigue is a factor, rent an electric scooter and have it delivered directly to your stateroom. Check with the cruise line for their approved vendors.

• If you drive to the cruise departure port, remember that parking is free at all Florida cruise ship piers for cruise passengers who have permanent accessibility modifications installed on their vehicles.

• If you tire easily, be sure and request a hotel room near the elevator. For safety’s sake, it’s also advisable to ask for a ground floor room whenever possible.

• Remember, in Europe the first floor is not at street level, so if you want a room at street level, ask for a room on the ground floor. Many small European hotels only have stairway access to the first floor, and if they have an elevator it’s usually very small.

• Don’t forget to pack your accessible parking placard with you whenever you travel. It’s good everywhere in the US (except for New York City), Canada and Europe.

Finally, encourage your parents to do extensive pre-trip research, and expand their horizons. There really are a lot of accessible travel offerings out there and the internet is a great place to find updated access information.

Candy Harrington is the editor of Emerging Horizons and the author of Barrier-Free Travel; A Nuts and Bolt Guide for Wheelers and Slow Walkers. She blogs regularly about accessible travel issues atwww.BarrierFreeTravels.com.

See Related Accessible Travel Articles
For tips and information about finding and booking an accessible hotel room, read Finding an Accessible Room Beyond ADA Compliance.

If you’d prefer to rent a house instead, read In Search of an Accessible Vacation Home.