I know that nothing is more irritating and embarrassing than having hemorrhoids. Sometimes it is difficult to heal them because you can’t find good advice on it. This may be because you won’t want others to know, or just because everything you have tried up to this point simply doesn’t seems to work. Well, luckily there are some really easy steps you can take for curing internal hemroids and external hemroids. These steps can help reduce the swelling, the itching, and most important of all the uncomfortable feeling that you’ve been enduring so far..

What are hemorrhoids? Internal hemorrhoids are little sacks that develop inside of your anus area and are filled with blood and weak veins. You may have had them now for a while, but only recently become aware that you have them when the pain or itching begins. You need to treat them as soon as you notice they are there, because as time passes some hemorrhoids may burst open during bowel movements and cause spots of blood.

The steps to cure any internal hemroids are fairly simple, but it may take time for your hemorrhoids to actually go away. Even so, they may develop again later in life, though probably not in the same place. To prevent them from returning, add more fiber to your diet and drink plenty of water.

Curing internal hemroids may be as simple as keeping the area clean and as dry as possible until they have enough time to heal. For a start, have a warm bath and soak yourself in it for at least 10 minutes every day. If you can do this several times a day, it will be a lot better. You can add oils or Epsom salt to the water to make it even more healing.

The second step is to use medicated wipes. These wipes don’t have to be specifically designed for hemorrhoids, but it will be better if you use special ones. In either case take care that they do not contain any harsh chemicals in them. Use them after every time you go to the bathroom to keep the area as clean and dry as possible.

Sometimes during the day the itching may become positively unbearable. If this sounds familiar, this next step for curing hemroids may be helpful. Purchase some hemorrhoid cream from your local general store and apply. Its ingredients will help to reduce the discomfort and itching throughout the day.

Curing them also may be as easy as changing your diet. Adding a little fiber to your diet is very helpful to reducing the pressure on the veins that cause hemorrhoids. People who are overweight often have hemorrhoids, but they can go away after you lose some pounds.

If recommended by your doctor, surgery may be the answer to definitely cure internal hemroids but It will be saved as a last resort, but it may be necessary if your situation becomes chronic or severe. Make sure to ask your doctor about other treatment options first.

There are several types of medication errors. When a drug is available in more than one dosage forms, there is the potential for error. For example verapamil is a medication often used to lower blood pressure or to treat cardiac arrhythmias (abnormal heart beats). It is available in many strengths from several manufacturers. The problem arises with the 120mg strength.

There is an immediate release (the tablet releases the drug relatively quickly) and an extended release (the tablet releases the drug slowly over a period of time) tablet of 120 mg verapamil. The extended release (ER) tablet will provide the drug slowly over a 24 hour period but the immediate release tablet provide all the medication at the same time. Once released, a medication has limited time in the body. In this cases about 8 hours. The immediate release tablet must be given every 8 hours to maintain its effectiveness.

The real problem happens when the intended product is the extended release tablet but the prescription is written or phoned in to the pharmacy as verapamil 120mg tablets, take 1 tablet daily instead of verapamil ER 120mg tablets, take 1 tablet daily.

What happens is the patient would get all 120 mg of the verapamil in the first couple hours (essentially an over-dose) and the balance of the day there would not be enough medication in the body to control blood pressure. I have personally seen this error in the pharmacy and in the hospital. The problem is compounded by the fact that the verapamil ER 120mg tablet is often for people who do not need a lot of medication to do the job whereas the verapamil 120 immediate release tablet is for those requiring a large dose (360mg per day). This error could cause severe decreases in blood pressure or dangerous decreases in heart rates.

Another example is Effexor 75 mg and Effexor XR 75 mg. The regular Effexor (venlafaxine) is intended to be given 2 to 3 times daily but the Effexor XR 75mg releases slowly over 24 hours so it should be given only once daily. The problem occurs when the prescription reads Effexor 75 mg once daily instead of Effexor XR 75mg once daily

The order is for the regular product and not the XR. According to the Effexor package insert there is a small increase in the possibility of seizures with the regular over the Effexor XR. Even though this is a small chance it is still a concern and this error can be prevented.

My last example is Wellbutrin (bupropion). This drug comes in three different dosage forms. There is a regular formula for dosing 3 times daily, an SR formula for twice daily dosing and an XL formula for once daily dosing. The presence of 3 different formulas can become confusing as errors can happen as in the examples above plus the potential of the prescriber to mix up the formulas and request an XR product by accident.

There are many drugs with the potential for this type of error.

In addition to the possibility of errors with these extended release products, there is no standards for the use of a suffix on drug names. Suffixes CD, CR, ER, LA, SR, XL, XR do not have a standard definition describing the dosage form or the release characteristics of the product.

There are steps you can take to protect yourself from these types of errors.

• Ask the doctor about the medication prescribed, if it is extended release, how often to take it, and what it is to be used for.
• Make sure you can read the prescription and it agrees with what the doctor told you.
• Be aware if your medication is available in more than one dosage form and verify you are receiving the correct one.
• Check the bottle from the pharmacy to verify it is the same as what the doctor wrote.
• Always question any changes in the size, shape or color of the medication you receive.

For a free special report on medication errors you can visit PharmerDon.com

The Announcement That Started It All

Last year, the Centers for Medicare and Medicaid Services announced that it will stop reimbursing hospitals for treating eight reasonably preventable conditions - including pressure ulcers - in October 2008. That simple announcement has put hospitals across America into a state of anxiety and with good reason. Up until now, the majority of hospitals focus on the treatment of pressure ulcers and the extreme pain and life-threatening infections that follow, rather than preventing them.

Which is understandable, since the number of hospital patients who develop pressure sores has risen by 63% over the last 10 years and nearly 60,000 deaths occur annually from hospital-acquired pressure sores.

But that’s not the only toll. According to the Agency for Healthcare Research and Quality, the average stay for patients admitted to the hospital for treatment of hospital-acquired pressure sores was 13 days, with an average cost of $37,500 dollars per stay.

Unless hospitals can afford to continue simply treating pressure sores as they occur without Medicare to subsidize their costs, something must be done. Pressure sores can initially develop when the blood supply to a patient’s skin is cut off for more than two or three hours, or is aggravated by constant pressure on the skin and tissues.

When a patient is immobile or has difficulty moving after surgery or procedures, even the slightest friction burns created by bed sheets, wheelchairs or other surfaces can quickly turn into pressure ulcers. One problem, is that pressure ulcers can initially be hard to identify, sometimes looking like nothing more than a pink or red spot on hard to see areas like skin folds or bony protrusions.

And when they do occur, complications such as bone, blood, and skin infections, can quickly develop. Not only do patients suffer; but so do hospitals - treating pressure sores often costs more financially and in personnel hours than the measures that could have prevented them. That doesn’t even take into account the cost of litigation hospitals and care facilities can face, for putting their patients at risk when pressure ulcers develop.

So what can we do? We need to put proactive medicine to work by transforming our basic pressure sore protocols into pressure ulcer prevention programs.

I know what you’re going to say. Your facility already has a program in place to identify patients who are at risk to develop pressure ulcers. Maybe you even have a wound management professional to treat patients and instruct your staff on proper procedures. But as hospitals across the country have seen, if pressure ulcers are still occurring, following basic protocols may not be the answer.

For example, Thibodaux Regional Medical Center in Louisiana already had a better than average pressure ulcer rate. But when their quality improvement data detected an increase in the ulcer rate in late 2003, they decided to launch a Six Sigma project to address the issues. After examining the data, they were surprised at the outcome. First they determined that the tools they had been using to analyze their care were unreliable. Second, some preventative measures they relied upon, like using a specific type of patient bed, wasn’t having as much of a positive effect of patient outcomes as small improvements had.

For example, the way smaller tasks were performed on the nursing floor. The recommended changes that came out of the project included simple shifts in procedure including reorganization of wound care products on nursing units and creating task lists for CNAs.

Additional solutions included:

• Posting a turning schedule in patient rooms to identify need and document results of Q2H turning of patient.
• Unit educators to address skin issues during annual competency testing
• Reporting on patient skin issues during shift changes

The result? A sixty percent reduction in the overall nosocomial pressure ulcer rate, with an annual cost avoidance of about $300,000. The best way to create and implement a new pressure ulcer prevention program is to model the successful programs instituted by other hospitals, and recreate that success in your own facility.

That’s why our organization has created a databank of information on pressure ulcers, causes, treatments, successful prevention programs, six sigma projects and even products other facilities and patients have found helpful. It’s a great place to start.

So how does your facility rate? Can your patient’s pressure ulcer rate be improved? Now is the best time to find out. With a little analysis, research and a good deal of planning and implementation, you’ll be ready and able to give your patients the best skin care available. And that is what good medicine is all about!