Low blood glucose level is a condition when the level of glucose in your blood drops below a certain point. It is also called as hypoglycemia. It may be caused when you eat too little or exercise more than usual or even if you have taken some diabetes medicine. Typically the low values considered as hypoglycemia are fasting glucose levels of 40mg/dL or 2.2mmol/L in women and below 50mg/dL or 2.8mmol/L in men. As high levels of blood glucose prove harmful for the body so do low blood glucose levels too lead to complications. There are several symptoms that need to be treated right away.

Causes of low blood glucose levels

Insulin is a hormone that is produced in the pancreas and helps the cells to absorb glucose from the blood. This glucose is the energy that they require to carry out various activities. Insulin helps keep the glucose levels in control. However, too much insulin in the blood causes hypoglycemic episodes. Similarly even if you skip meals and snacks or even if you do not eat enough meal your glucose levels may go low. Among the non diabetics it may be caused due to reactive hypoglycemia which is the overproduction of insulin by the body. It is a very common cause in overweight people. Low glucose levels may be caused due to a disease of the adrenal glands, weakening of pituitary glands, reduction in liver function; alcohol ingestion and sometime even cancer may be a cause.

Even diabetics may experience hypoglycemia. Low blood glucose levels may often be the result of medicines being taken to manage diabetes. These medicines usually work by taking the sugar out of the blood and providing it to the body’s cells that may make levels in the blood go down. Sometimes, there could be other reasons that may lead to lowering of blood glucose. If you take a hot shower or bath after having an insulin injection, it causes blood flow to increase through the blood vessels in the skin which can lead to quicker absorption of insulin than usual. Another possibility is if you inject the insulin shot into a muscle instead of a fatty layer under the skin. Likewise if you inject in a part of the body that is mostly used in a particular action or sport it may increase the chance of getting hypoglycemia.

Signs and symptoms of low blood glucose level

There can be different symptoms in different people when their blood glucose levels fall. Symptoms seen often may include a feeling of hunger or hunger pains, shaky feeling, and feeling sweaty or cold. Some may experience headaches, irritability, and crankiness. You may also feel drowsy, weak or unsteady and dizzy when walking. Blurring of vision, double vision, confusion, seizures and even losing consciousness may be among the symptoms of low blood glucose level. For diabetics very high glucose levels as well as very low levels of glucose are equally harmful. It is necessary to remember how your body reacts when the levels are low and understand that the levels have gone too low the next time it happens so that you can take steps to counter it.

Diagnosis and control
If you are experiencing the symptoms of low blood glucose levels contact your doctor and if possible get a home blood glucose apparatus or have test done to confirm the status. If the tests show your glucose level below 2.5mmol/L you have hypoglycemia. Test may also be conducted to find out if you have any tumor in the pancreas. If any other causes are detected specific treatment may be taken. When you experience symptoms of hypoglycemia, during exercises or sport try eating complex carbohydrates before you begin exercising or consume carbohydrates like glucose which you may get from sports drinks.

If you are feeling the symptoms of low blood glucose levels contact your doctor and have tests done immediately to prevent future problems.

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Philadelphia is one State that has its own league when it comes to skin care. Skin care Philadelphia is very popular all around, not only within the state but in nearby towns as well. This can be directly attributed to the practitioners in the area, who are all exceptionally good in their profession. There’s a skin care expert who can handle your needs, regardless of how intense they maybe or how simple you think it is. Some of the areas of specialty of skin care Philadelphia include Botox, wrinkles reduction, skin restoration, veins elimination, laser technology, and anti-ageing solutions. Aside from women, these experts also provide their services to male clients.

The advanced medical technology of skin care in Philadelphia is what provides the best service to patients. What’s more, they are able to give a personalized treatment as well. It is a reality that every person has his or her own needs as far as taking care of the skin is concerned. Essentially, it is impossible to provide the same treatments on two patients. This is how personal the service in Philadelphia can really be. It is patterned after your very needs. And that’s also why it works.

Skin care clients will feel so great after the session. This is because you’ll experience your skin’s rebirth right before your eyes. And you’ll surely look very confident in your perfect skin. As such, you’ll have no qualms even if you don’t have anything on. Your skin’s naked beauty is all you need feel gorgeous.

Skin care Philadelphia treatment clinics establish a healthy working relationship with health parlors and spas. This way, clients are able to go through total skin renewal. More than bringing out your skin’s natural glow, you will also feel totally reinvigorated after a relaxing massage during your cleansing facial session. It’s possible to avail of several services all in one place. Set a consultation today and see how good things can get.

But of all services, Botox is the one mostly offered by skin care Philadelphia clinics. Botox is an anti-aging technique that’s getting the most popularity these days. It is a type of an injection administered on the face to reduce wrinkles and fine lines. Botox can be considered as the body filler that allows your skin to look healthy and plump. It can effectively restore your skin’s youthful beauty – even after a single session. It has been proven that Botox is sure and safe. That’s why a lot of men and women are almost addicted to it.

Aside from Botox, there is also what’s called as facial repairs provided for by skin care Philadelphia centers. Reap the full benefits of undergoing a facelift minus all the pain. It works similarly to the regular facelift procedure. But unlike it, it’s not at all intrusive. Results are usually seen after one session. It’s quite possible to go many years younger in this treatment procedure after only a few hours spent on the derma table. In skin care Philadelphia, you can walk into the clinic looking like 40 years old. But the moment you step out, people would mistake you as only 30 years old.

Modern life is full of hassles, deadlines at work, frustrations, anxiety from school, rowdy children, and demands. Which all of these lead to chronic stress, tension, anxiety, and lack of a good nights sleep. Over time this can and will be a negative affect on your happiness, your relationships, your productivity, your enjoyment of life, and overall towards your health. Many people turn to alcohol and drugs for an instant escape, however, most of the time it only irritates and makes the problem worse.

For many people stress is such a common thing to them that it becomes a way of life to them. Stress isn’t always bad. In small doses, it can help you perform better under pressure and motivate you to do your best. But often when you’re running around like everything is always an emergency, your mind and body are paying the price which means you’re running them down.

In chronic stress the body doesn’t decide between physical and psychological threats. When you’re stressed over an argument with a friend, a traffic jam, a bunch of bills, whatever it may be you’re body starts to react just as strongly as if you were facing a life or death situation. If you have a lot of responsibilities and a bunch of worries, your emergency stress response may be on at all times. Many of the health problems you may be experiencing would be pain of any kind, heart disease, digestive problems, sleep problems, depression, obesity, autoimmune diseases, and skin conditions, such as eczema.

If you’re constantly finding yourself feeling frazzled and overwhelmed, it’s because your nervous system is down and you need to bring it into balance. The neuron is the functional unit of the nervous system. There are 100 billion neurons in each human’s brain alone. There three types of neurons that occur. Sensory neurons typically have a long dendrite and a short axon, which carry’s messages from sensory receptors to the central nervous system. Motor neurons have a long axon and short dendrites which transfers messages from the central nervous system to the muscles. Interneurons are found only in the central nervous system where they connect neuron to neuron. The nervous system observes and controls about every organ system from a series of positive and negative feedback loops.

The nervous system controls about everything in you’re body which when you are stressed it automatically reacts. Anything that puts high demands on you or forces you to adjust can be stressful. This also includes positive events such as getting married, buying a house, going to college, or receiving a promotion. All of these run thro the nervous control system.

A good way from prevent being stressed, calming your anxiety, and feeling more relaxed, is trying RELAXALL. Trying this fast acting herbal supplement will help with symptoms of relieving nervous tension, calm anxiety, and promote sound sleep without causing next day grogginess, by slightly regulating the irritability of the nervous system and decreasing various body pains.

It’s noticed that emotion and belief systems play a part, possibly a big part, in health and illness. Each energy field constantly interacts with the fields or other living beings and with stimuli in the environment. Everything that affects our bodies must first pass through this field. Some of this information is controlled in the field enters our awareness, senses, thoughts, or intuition. A lot of the other information remains hidden, which affects the choices we make and our physiology.

In a study of the human energy field, blood pressure changes heartbeat, galvanic skin responses, and muscle contractions, it’s said that changes occurred in the field before any of the other systems changes. At the middles of all matter is energy, and makes the human body no different. The energy body is a model for the physical body. Emotional energy echo’s with life experiences, personal and professional relationships, and belief systems and these become determined in our cell tissue.

Chronic fatigue is described as the extended lack of physical, intellectual, and emotional energy. Chronic fatigue is not cured through a simple rest or sleep it’s said that a complete change in habit is required to get back on track. The signs of chronic exhaustion are sore throat, pain or weakness in joints and muscles, headaches, restless sleep, problems with concentration and short term memory. The mind can be either a big source of energy or a major waste of it. In order to release the natural energy that is inherent in all of our bodies, you would have to be more familiar to the cycles of nature.

Hormones take part in a serious role in the development and expression of large range of behaviors. There is one part of the influence of hormones on behavior is their potential contribution to the pathophysiology of functional changes in the body which occur in response to injury of psychiatric disorders which describes a broad range of mental and emotional conditions.

The most evaluated endocrine axes, is the hypothalamic-pituitary-adrenal axis. This axis plays a primary role in the response to external and internal stimuli including psychological stressors. Abnormalities in the function of the HPA axis have been described in people experiencing anxiety disorder’s, dissocialize disorders drug use and dependence, mood disorders, eating disorders, personality disorders, sexuality and sexual disorders. These abnormalities are related to changes in the ability of circulating glucocorticoids. It’s been said that there seem to be no cells that lack glucocorticoid receptors and as a consequence, these steroid hormones have a huge part of effects on physiologic systems.

To boost your energy to promote the cellular production of energy, while supporting the normal function of the hypothalamic-pituitary-adrenal axis, is trying EnergyMax. It also plays an immuno-modulating role, thereby boosting energy to combat fatigue and stress, and enhancing intellectual and physical performance. It builds muscular density and increases muscular strength, minimizes sore muscles after physical exertion, and preserves muscle fibers. It also improves concentration and mental alertness.

Have you noticed how many prime time medical shows are doing episodes on next of kin notification issues? Just in the last two months there have been two - “Grey’s Anatomy” on ABC and the new TNT series “HawthoRNe”. Not that they meant to do episodes specifically about that, and as far as one of the series goes, that central theme was completely glossed over, even though a next of kin issue was pivotal to a central character’s survival.

Now I love “Grey’s Anatomy” - always have. And as a television writer myself, (who also happens to run a non profit organization that deals with family safety and patient notification issues), I’m always interested to see how those important themes play out in the drama of an episode. As most fans of the series know, the last two episodes of the season revolved around Izzy fighting for her life following cancer surgery and George O’Malley who, during the first half of the episode, decides to go off and join the Army to treat injured soldiers in Iraq. He then disappeared, as we later found, to say goodbye to his family before heading off to serve his country. In case you’re one of the ten or twenty people in America who didn’t see the episode, I’ll insert a spoiler alert. So if you haven’t seen the episode yet but plan to, skip down a few paragraphs.

A few scenes later an unidentified man is rushed into the emergency department. Hailed a hero, the man was hit by a bus after pushing a woman out of its path. The patient was a mess. He had a massive head injury, was covered in blood, his arm was nearly torn off and before he knew it, had the best residents of Seattle Grace looking down at him with pity. They doubted he would last the night, but they did what they always do and gave it their best. IVs were started, surgery was scheduled and they did a pretty decent job of caring for him.

Except for one thing.

No one, and I mean no one, not even Lexi the patient-loving intern, visibly searched for his ID. Granted the man was run over and dragged by a bus, so finding his ID might have been a challenge, but he was still clearly wearing clothes. The writers could have easily put in a throwaway line to show them doing the right thing, like “I found a driver’s license, but it’s completely saturated with blood” or “this looks like an ID badge, but it’s crushed and completely unreadable. At least they would have not only given a nod to proper trauma procedure, but to the fact that the patient lying close to death was a human being. What if they were about to give him a drug he was deathly allergic to, or that was about to interact with something else he was already taking? What about the fact that this patient had people he loved and who loved him, who needed to know that he might not live through the night?

By the end of the episode, they were doing everything they could to save this patient. He was stable but still very critical. For the second or third time the man tried to talk, to no avail. Meredith leaned in, and the patient grabbed her hand. He started drawing on it with one of his only good fingers. Zero, zero and a seven. 007. George. He instantly went from being a John Doe to a much-loved friend. In that moment, Meredith’s eyes and scream told the whole story. It was the difference between taking care of someone you know, with his or her needs in mind - even if the only way you “know” them is by reading their medical history and talking with their family - and someone who is just another person or worse just another patient. They took incredibly good care of George even when they didn’t know who he was, but from our own experiences with my grandma’s hospitalization, when the hospital didn’t bother to call us for several days to tell us that she’d been admitted and was becoming more critical by the minute, the step of looking for identification and trying to locate a patient’s identity and next of kin, is just too vital to be glossed over like this. “Grey’s Anatomy” had the perfect opportunity to show how it should be done, and missed it. They usually do a terrific job, but this one decision was disappointing.

Now over on TNT’s new series “HawthoRNe”, they did a different twist on a next of kin issue. Nurse Hawthorne’s patient is alone and his wife isn’t yet on scene. He has a brain injury that will require surgery and is altered - meaning that he doesn’t really know what’s going on around him. While Hawthorne is treating him, he mistakes her for his wife and confesses that he has been having an affair. The man’s injuries intensify - he’ll need surgery - but of course he has a DNR. Hawthorne wants to make sure that her patient has the opportunity to see his wife before surgery to provide closure to both of them in case he doesn’t make it. The man codes. Now with a DNR, she’s supposed to stand aside, respect his decision and not resuscitate him. But his wife is going to be there any moment. Hawthorne is thinking about this patient as a human being and realizes how important closure could be to both her patient and his wife. The doctors standing around her keep telling her that he’s too far gone and just to let nature take its course. But she risks her career and her reputation, by grabbing the paddles herself and shocking him back to life, much to the chagrin of the doctors. The patient is able to talk to his wife and he survives his surgery. Why? Because a nurse treated a patient who on paper wasn’t mentally competent and who had chosen not to be resuscitated, as a human being who had a history, people who loved him and in this case, extenuating circumstances that could alter the rest of his wife’s life. A difficult issue was raised and handled in a way that was respectful to the patient, his family and the medical profession.

The one thing that the producers of medical shows need to realize is that a lot of health care professionals out there are watching. Not that anyone takes their cue on how to provide patient care from a television series. But it wouldn’t hurt to get the basics right like showing the search for an unidentified patient’s ID. Not only would we as viewers feel like everything that could be done for the patient, had been done, but it would serve as a reminder to all those health care professionals out there, of how important it is to quickly identify a patient to be able to treat him with his specific needs in mind, and not just as a body.

And who knows? That two second scene of Meredith or Lexi searching for an ID that’s completely torn apart and unreadable, would have intensified the drama even more, because they’d have us all asking “who is this person and how in the world are they ever going to discover his identity?”

Thanks producers for all the excellent work you do on incredibly difficult subjects week after week. All we ask is that you look after the basics too

Sedation is often required for a number of procedures to reduce patient anxiety, improve cooperation and ensure immobilization when necessary. Sedative drugs can be given orally, rectally, sublingually, as an inhalation or an aerosol, or by or subcutaneous injection. However, intravenous administration provides the most reliable sedation. In routine practice, intravenous drugs are given in small bolus doses and titrated to effect.

Opioids are commonly used in conjunction with sedative drugs to provide anesthesia. Previous studies have shown that opioids reduce the clinical requirements of sedatives needed to provide adequate anesthesia.

These are commonly administered to patients with advanced cancer. However, it is often assumed that the use of these drugs inevitably results in shortening of life. Ethically, this outcome is excused by reference to the doctrine of double effect.

Many neurophysiologists severely restrict the use of opioids and sedative drugs during deep brain stimulation procedures due to the concern for depression of cellular firing frequencies used to map the brain for placement of the stimulator leads. Often spinal opioids were used to achieve prolonged pain relief in patients with chronic back pain, without altering cellular firing critical for brain mapping

When used properly, narcotics and sedative drugs sedate and relieve pain, but should not lead to a respiratory compromise. As a result, circumstances should be under control when competent staff is present.

It is widely accepted that the antihistamines have found their greatest therapeutic potential in the treatment and management of various allergic disorders, including seasonal and perennial rhinitis, urticaria and dermatologic conditions. However, the most problematic aspect of their use is sedation, which can severely compromise the safe performance of cognitive and psychomotor tasks of everyday living. The associated increase in accident risk is important when deciding which antihistamine should be prescribed to ambulant patients with allergies and dermatologic disorders.

It has also been demonstrated that ketamine possesses analgesic properties in a subanesthcloses. Sma-dose ketamine in combination with sedative drugs has been used for sedation and analgesia with less toxicity than either drug alone. Small-dose ketamine in combination with sedative drugs has increasingly been used for and analgesia in local anesthesia.

Delirium occurs in 35% to 80% of critically ill hospitalized patients. Little is known however, of delirium prevention and treatment in the critical care setting. Trials emphasizing early mobilization suggest that this no pharmacologic approach is associated with improved outcome as well as “delirium days”. Reduction of opiate analgesics and sedatives may improve subsyndromal delirium rates. All critical care caregivers should rigorously screen for alcohol abuse, apply alcohol withdrawal scales in alcoholic patients,

Studies of the effect of sedatives on normal and leukemic bone marrow cells, in vitro, and in the case of phenobarbital, on subjects suffering from overdose, showed that chlorpromazine, phenobarbital, and benzopiperidine decreased bone marrow proliferation only at toxic doses whereas propranolol and fluanisone were effective at nontoxic doses.

In the course of the study of the effects of some sedative oriental medicines on neurotransmission and antioxidative, it was noted that the extract of Euphoria longan, Zizyphus jujuba, Thuja orientalis, Polygala tenuifolia, Acorus gramineus, Cyperus rotundus, Poria cocos, Uncaria rhynchophylla, and Albizzia julibrissin, have been used as sedative drugs in Korean folk medicine.

Sedative drugs are one option when autistic or mentally disabled childre behavioural disorders

that place them or other people in physical danger.Among the classic neuroleptics, haloperidol

is the drug with the best-documented efficacy and safety.

Recent studies on the abuse in older people highlight the use of epidemiol, screening techniques, brief intervention, and treatment issues show that this is common in older people, and frequently goes undiagnosed. Although alcohol abuse is most common, abuse of narcotic and sedative drugs also occurs. Older adults are particularly susceptible to adverse medical outcomes from substance abuse, and recent studies show that brief interventions by primary care providers can have a major impact on the health and well being of this category of personnel.

Since the late 19th century, doctors and patients have taken one-pill-fit-all model for grant. Many patients blindly trust their doctors and swallow all prescription medicines. Unfortunately, drug side effect is a leading cause of death today. There is a saying that a great doctor kills more people than a great general.

Now we should know the bottom-lines of prescription medicines:

1. Most prescription medicines are effective for fewer than half of the patients. In fact, your doctor does

not know whether this drug works for you or not.

2. Side effects can be worse than the illnesses. More than 100,000 Americans die from drug side effects each year (Business Week September 5, 2005).

3. Most blockbuster drugs are prescribed too broadly and doses are too high.

A CEO of a big drug company admitted that from a strategic standpoint of meeting the needs of our customers, the current blockbuster drug model doesn’t work. A study reported that nearly all of the prescribed cough medications for acute bronchitis are of little help.

A patient has used 18 prescription drugs for a decade, and figured out that she was being poisoned by the drugs for 10 years. Finally she has her life back by taking tiny amount of three drugs and using homeopathic remedies together. So, you should know that your health is your responsibility. Listen to your body and feel what is good for you. After taking a drug, you feel better without high side effects, and then it is a right medicine. Otherwise, you should find alternatives. Doctors are advisers only, and it is very necessary to get second opinions and try alternatives.

Can you imagine living the rest of your life with a constant ringing in your ears? If you currently have no hearing problems of any kind, it may difficult for you to imagine such a life. Unfortunately for millions of others, this situation is a sad reality that they have to deal with. These people are desperate for news of a medical breakthrough that can effectively cure ringing ears, otherwise known as tinnitus. Currently, there is no known cure for the condition, but there are several treatment options that help prevent or minimize the distracting sound.

Although it is called ringing ears, the sound associated with tinnitus is not limited to constant ringing. You may also experience a humming, swishing, or buzzing sound, or any other unusual sound that seems to originate from inside your ears for that matter. While the condition is very seldom a cause for serious concern, it can be very annoying. You should also take the necessary steps to have your tinnitus evaluated properly, considering the possibility – no matter how remote – that the condition is a sign of a more serious health problem such as a brain tumor.

It is very unfortunate that there is no known method to cure ringing ears because millions of individuals, children and adults alike, have to cope with the annoying condition everyday and are struggling to lead normal lives. It would make these people very happy indeed if a cure for tinnitus were to be identified anytime soon. A bit of good news is that there are ways to reduce the intensity of the condition and lessen the volume of the noise that it involves.

Careful removal of excess ear wax is one of the most effective ways to lessen the intensity of tinnitus because this condition is often brought about by wax irritating the eardrums. The excess wax, or whatever foreign object that enters the ear, irritates the eardrums or blocks the inner ear, it prevents external sound from entering and results in tinnitus. If you are already suffering from ringing ears then it is best to have a physician remove the excess wax for you. Removing it yourself using an ear swab could push the wax deeper into the ear and make matters worse. While wax removal is technically not expected to totally cure ringing ears, it is very advisable and is in fact a practice of good hygiene.

Some people also turn to cochlear implants to address the problem of tinnitus. These implants are normally performed to make people hear the sounds around them more easily. When you are more able to hear the sounds around you, you will be less likely to notice the sounds that are coming from inside your ears, thereby making it easier to live with tinnitus. As with wax removal, cochlear implants are not meant to cure ringing ears but it can definitely make your life a lot more pleasant.

Although a cure has not yet been found for this condition, medical experts and researchers are continuing the search for effective techniques and treatments to help sufferers cope with tinnitus. Right now the most effective treatment is said to be the identification and treatment of the underlying cause of ringing ears. Hopefully, with continued research, a permanent cure will soon be found.

I had a young couple come to the pharmacy the other day. The man looked miserable - with itchy, puffy, watery eyes, stuffy nose and a horrible cough. His girlfriend came to the pharmacy and said, “My boyfriend is sick and has been a baby about it and snoring at night! What can I give him?”

All of his symptoms were caused by histamines (which are released when we have a cold or allergies). Histamine can also cause hives (itchy, red, raised bumpy rash). So, we treat them by taking an ANTIhistamine. The antihistamine neutralizes some or all of the histamines so that our symptoms are lessened. Antihistamines come in many forms -oral, topical, nasal spray and eye drops.

These oral antihistamines can help with cold/allergy symptoms and hives…

The following are available OTC:

1. Benadryl (diphenhydramine) -Best for rashes and to take at bedtime if the patient can’t sleep due to cold/allergy symptoms (it will help symptoms and cause drowsiness).

2. Dimetapp allergy (brompheniramine)

3. Chlor-Trimeton (chlorpheniramine)

4. Tavist (clemastine) The above antihistamines work well but can cause a lot of sedation for most people (although some young kids may become hyperactive). It has been estimated that up to 90% of the Benadryl sold is used as a sleeping aid.

Helpful hint: Diphenhydramine (the active ingredient in Benadryl) is used in most OTC sleeping pills and can be used to treat motion sickness.

5. Claritin and Alavert (loratadine)

6. Zyrtec (cetirizine) The two above do not usually cause drowsiness. They are available in generics, combo products with pseudophedrine (decongestants) and come in formulations for kids 2 years old to adult.

The following antihistamines are available with a prescription…

7. Xyzal (levocetirizine) -Great for rashes and itchy skin due to allergies. It often causes drowsiness.

8. Allegra (fexofenadine) -Option for those that an OTC antihistamines does not work or causes too much drowsiness. It is available in a generic!

9. Clarinex (desloratadine) -It does not come in a generic and hasn’t really been proven to help more than the generic OTC Claritin.

If you have questions about how to treat other symptoms from allergies/cold, come check out this other article.

Although all the drugs are antihistamines they work differently for each person. You may need to try out a few to see which one works for you.

Oral antihistamines are also used to treat acid reflux, motion sickness and dizziness…but that is a story for a different time.

We’ve all seen patients who were far beyond the reach of medical treatment suddenly defy the odds and recover. We’ve also seen patients who were well on the road to recovery, take a turn for the worse for seemingly no reason at all. No matter what the technology or how terrific we are at our jobs, sometimes medicine just isn’t enough.

Case in point, a few years ago, my Grandma, in her mid-sixties at the time, had a moderate CVA. No matter what her doctors did for her, she wasn’t regaining consciousness, defying explanation. My mom and I were living and working in Los Angeles and Grandma was two thousand miles away in Chicago. When the doctor called to tell us about the stroke, he not only said that Grandma might not live through the night, but that she might not last the few hours it would take us to fly to her side. Mom and I both felt very strongly that we had to talk to her for what might be the last time, before we got on the plane. Hearing our voices and knowing that someone was with her, had always made a huge difference in any difficulty she faced. So Mom got the head nurse on the phone and asked if she could get a phone to Grandma. Asking quickly turned to pleading - we needed to tell Grandma to hold on and that we were coming. The nurse basically dismissed the notion - what possible good could THAT do It took a while, but Mom finally convinced the nurse to put a phone up to Grandma’s ear. We were able to tell her how much we loved her, that she was going to be fine and that we were on our way. By the time the nurse came back on the phone, she was speechless. Evidently the moment Grandma heard our voices her eyelids began to flutter. Her vitals stabilized, her eyes opened for the first time since she’d been in the hospital and she looked straight up at the nurse and then around the room looking for us. Two weeks later, she was out of the hospital and on her way to rehab.

That’s the miracle of communication.

Whether it’s a family member, a friend or just a familiar face, patients need to have the people they love surrounding them, when they’re ill, in pain, or afraid. As caregivers, it’s part of the job to realize that patients might be too ill or physically unable to initiate the contact they so desperately need, on their own.

I wish that were the end of the story. A few years later, Grandma who had recovered fully, badly injured her leg and her jaw after falling in the bathroom at home. She was unable to speak but was in stable condition, when admitted to a different hospital. She was supposed to have gone on vacation so we hadn’t expected to hear from her and had no idea she was in the hospital. A few days later she began spiraling into critical condition. By the time the hospital called us, she was in the ICU, unconscious and critical. While I was on one phone trying to get a flight, my mom was on the other phone with the doctor who happened to be standing right outside Grandma’s room. She begged him and then the nursing staff, to get a phone into her, so she could talk to her, for what looked like it would be the last time.

But at this hospital, the doctor and the nurses refused. While the doctor was on the phone with mom, Grandma, who had been unconscious just a few minutes before, unexpectedly opened her eyes and began to look around. The doctor told Mom what happened and took this as a sign that she her condition was turning around. Even so, Mom still pleaded with him to get a phone to Grandma. He told her there was no way to get a phone to an ICU patient. “We’ll try and figure something out in the morning,” he said, hanging up the phone. But Grandma didn’t have until morning. She died just a few hours later, before we could get to her and we lost our chance to tell her we loved her - our chance to say goodbye.

Looking back on that time reminds me of that scripture, “without a vision, the people perish”. Some people, even while facing serious illness or death are so self-motivated that just the possibility of dying makes them muster every ounce of strength they have, to fight it. But most people aren’t that way. Most people need to use the strength of others - the people they love - to provide the strength they cannot find.

Patients need connection. They need vision - the vision to “see” themselves getting through the darkness and fear that they’re facing. They need help “seeing” the next day or the next week. Seeing themselves strong and well again. And without that strength and that support they so desperately need from the people they love, there is no vision. And without that vision, they perish.

Simply put, at that moment, Grandma needed us. She needed to hear our voices that night and the very people who were there to be her advocates and to help her make that connection happen, didn’t do it. And that night, Grandma perished, without knowing that we were right there at the other end of that phone and on our way to be with her.

The good news is, the same thing that happened to us, doesn’t have to happen at your facility. With just a few simple steps designed to help communication-impaired patients, you can not only make a huge difference in their lives, you might even save them.

With just a few simple steps designed to help communication-impaired patients, you can make a huge difference in their lives.

Assessing Your Patient’s Ability To Communicate

The next time you’re caring for a patient with compromised communication ability, take a moment to see your patient’s surroundings from her perspective. If your patient’s family and friends are not at the hospital with her or can’t come often, are there tools you can provide your patient that will facilitate communication with the outside world

Mobility Limitations

If your patient can speak, is the telephone close enough to her for her to use

Does she need help dialing Is she able to see well enough to read a number off a piece of paper or out of her address book

If your patient is unable to hold a telephone, would she benefit from a speakerphone or a cell phone

Hearing/Speech Limitations

If your patient can’t speak, ask her to indicate if she would like to have someone called for her, and task a patient representative or volunteer to hold the phone up to her ear and facilitate their communication.

If your patient is deaf, make sure that your facility has TTY telephones to connect with family members. If your patient is blind, make sure that she has Braille writers or other devices to help her communicate.

Take a moment to call the department in your facility that deals with hearing or vision-impaired patients. They may have more tools or ideas that can bridge difficulties and enhance communication.

Another idea for patients who can’t speak, is patient Internet access. If your hospital has it available, it can be a real lifesaver, allowing a patient to type an email, a text message or to supervise while a message is typed for them. If your facility doesn’t have Internet access for patients, either you or another team member can use a smart phone or cell phone to send an email or text a message for them, facilitating emergency communication with a loved one.

For patients who have a temporary physically impairment, like a broken jaw, encourage them to use patient Internet access or their cell or smart phones (if allowed) to email, text and keep in touch with family or children who might not be able to visit in person.

If you work with seriously ill pediatric or adult patients who need to communicate updates about their patient to a whole team of family and friends, there is a terrific service called Care Pages. It was created by a family with a seriously ill child and no time to constantly email everyone who wanted to know how the child was doing.

Critical Care/End of Life

Since many hospitals still don’t have a means of patient communication in the ICU, you may have to get a bit more creative for patients in critical care units.

There are now low emission wireless phones, like those manufactured by Spectralink, which can be used safely in critical care units. Wireless web pads also work well, or if those aren’t available, you can always order an extension phone, like those used in regular patient rooms and keep it at the nurses’ station. When it’s needed, it can be plugged into a phone jack in a patient’s room.

And don’t forget that technology is making huge strides in facilitating patient communication. As unusual as it sounds, surgeons are now using Twitter to keep families apprised of patient’s progress during surgery, while families who are apart during emergencies, are using Facebook and MySpace to keep each other up to date. You can use that same technology to help a critically ill or dying patient communicate with family members who might not make it to the hospital in time to be with them.

How With your smart phone!

Most smart phones have the ability to record video, audio and take photos, all of which can be sent or received via email right from the phone. Let’s say you have a patient who might not make it through the night. His family is about to board a plane, but won’t arrive for three or four hours. Even if you aren’t allowed to turn your personal cell phone on to receive calls in the ICU, the family can record a video or audio message on their own phone and email it to you, so you can play it for the patient - something you can do without the phone actually being on. Or they can email you a photo of themselves to show to the patient or an email that your patient can read for himself.

You can do the same thing at your end. Let’s say that your patient is alert and oriented now, but you both realize that he might not live. By using your smart or cell phone with video or audio recording capability, he can record a final message to a loved one, that can later be emailed to the family. I don’t think I have to tell anyone, how much that bit of video can mean to a family.

Or let’s say that your patient is a John Doe or that she was a part of a mass casualty and even though you’re relatively positive you have the right name with the right person, the family member is still in transit. You can snap a quick photo and email it to the family, hastening the identification.

Communication isn’t just a patient’s right - for many it can be their only link to the outside world, or a life-renewing source of strength and love. Combine that with outstanding medical care and watch the miracles flow.