Speak Up! For Your Health!

Communication is key to better health!


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Gone are the days of "Don't question the doctor because the doctor knows best!" Yet, some patients are still stuck in that mind set. It's true that doctors are much more educated than the average person but there is a reason the term "practicing medicine" has been used for so long. Healthcare and medicine are subjects that always keep us learning. There is NO WAY anyone can know it all. Also, what works for one person may not work for another. Medications can affect people in different ways too!

You, the patient, know your body and your symptoms better than anyone and you can explain them better. For your healthcare provider to be able to give you the best care possible he/she must be well informed-not just about the latest technology and drugs but about what's going on with you. Make note of changes you experience, when they started, how long they last, things you may be doing differently from your normal routine and even changes in your environment and lifestyle. All these things, no matter how insignificant they may seem, can be a factor in your current medical situation. By relaying this information to your provider you are allowing for a more thorough assessment of your condition and more options for treatment. Research shows that patients who have good communication with their doctor and take an active role do better, heal quicker and usually stay healthier.

Don't be afraid of 'offending' your provider by asking questions! They are there to take care of you and by a positive interchange of information he/she can do that job much better and your satisfaction will be much higher. If a test is recommended, ask why you need it and what may happen if you don't do it; same with medications. You should ALWAYS know what drug you are taking, why, what it treats, what it is supposed to do and what the side effects and adverse reactions are. If your doctor acts defensive from your questions, tell him/her that you want to be active in your own care and want to understand your treatment. If they still are less than amicable with your shown interest, find another provider that is willing to participate in a 2 way communication with you. Your health is worth it!

http://www.webmd.com/healthy-aging/features/be-your-own-health-advocate

Dilaudid:Frankenstein's Monster of Healthcare

     
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If you've been a nurse for any amount of time in recent years, you know the issues with IV (intravenous) pain medications that is prescribed "as needed" during a patient's hospital stay. There is obviously a need for pain control for those who come to a facility for treatment of acute conditions. Many medications are more appropriate for treating certain ailments than others. Morphine IV is the gold standard for cardiac related chest pain because in addition to controlling pain it helps increase oxygen to the heart decreasing risk for damage. Demerol is better for pain originating from an abdominal source. Of course, alternatives must be made for those who are allergic to 1st choice medications.
http://www.drugs.com/pro/dilaudid-hp.html

Dilaudid (hydromorphone), a derivative of morphine, is a hydrogenated ketone of morphine and considered up to 10x more powerful than morphine. Dilaudid can actually have the opposite effect as morphine when it comes to oxygen levels by depressing the respiratory system. This means that it can cause a person's breathing to slow or even stop if the dose is not tolerated. There is even an HP (high potency) dose, 10mg/ml,  that should only be used for hospice care. Those on Dilaudid are strongly advised to monitor breathing and seek help if it feels like breathing has slowed or become difficult. The problem with this is that the affected person usually becomes groggy and my even fall asleep before realizing that the "sleepy feeling" is due to respiratory distress. In this case, if someone is not there to notice and intervene, the person could actually die from not breathing! It is believed to be a major contributing factor to an ER patient's death in Canada recently.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730090/

Though not as dangerous by pill as by IV, healthcare providers administering this strong opioid for pain control warn their patients to constantly be aware of breathing patterns and notice changes and slowing of that pattern while on this medication. So why, as a nurse working in a hospital, do I see so many more of my patients being prescribed Dilaudid on a regular basis for pain control regardless if it's for acute abdominal or back pain or a run of the mill headache? Giving such a strong medication for a simple headache sounds absurd and overkill I know, but it happens! I have had patients asking for relief from a minor headache with no Tylenol or Ibuprofen but instead had Dilaudid ordered as needed ever 4 hours!

The risk of this powerful drug is not the only issue. It is also highly addictive. Because it has become so popular and so regularly prescribed, we as healthcare professionals are creating 'monsters' when we continually administer this potent IV drug. Many clients of acute care facilities are repeat customers with chronic conditions like Diabetes or COPD and sadly there are many who simply find a reason to be repeatedly admitted for the IV narcotics. Some will even "play the system" well enough to know how to rate their pain on a 1-10 scale and list less strong pain relievers as allergies to get "the good stuff". It is also used and sold as a street drug known as "Dillies" and administered by taking orally, snorting or injecting. The quickest and most intense 'high' is from the injected form.

To the average person this may seem like a joke, exaggeration or something seen only in movies but it has become the reality of our society of today! Drug abuse is a real and serious problem and treating addiction is a business that grosses into the millions of dollars. So, why has it become so frequently used? Why has it become standard practice to automatically add this IV medication to the daily medication list during the majority of hospital admissions? I have heard some physicians say that they order it preemptively to avoid reqests for pain medication. They don't want to be called in the middle of the night or they are too overwhelmed with the already overloaded patient load they have on a daily basis.

I have been an RN for going on 12 years now and have seen the migration of prescribing from morphine to dilaudid and even leaving OTC type pain relievers out of the mix all together. I have also seen the change in the demeanor of the average patient being routinely treated with Dilaudid. This is a major concern to me and should be for others too. Unfortunately, I've even seen and had to treat the most extreme adverse reaction to this medication-respiratory failure!

    
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Just as you would expect to see in a drug addicted person, the anxiety and agitation associated with not getting this drug on a regular basis for someone who has been treated with it for even just a short time resemble that of a street addict. This fact is highly disturbing when you stop to think that this patient that was admitted only a few days ago for pneumonia/abdominal pain/uncontrolled diabetes is now acting highly agitated if not given their "pain shot" on a regular 2 or 4 hour schedule. All pain medication for acute pain is ordered "as needed". This drug seems to quickly create a need in the patient receiving it such as a drug addict.

Side Effects of Dilaudid

• nausea
• vomiting
• constipation (as with all narcotics)
• lightheadedness
• drowsiness
• sweating 

More Serious Symptoms

• agitation
• confusion
• hallucinations
• severe abdominal pain
• difficulty urinating

Symptoms Requiring Immediate Medical Attention

• respiratory distress (especially if given intravenously)
• fainting
• severe dizziness
• seizures
• allergic reaction (rash/itching/swelling especially of the tongue/throat/eyes/face)

http://www.webmd.com/drugs/drug-9130-Dilaudid+Oral.aspx?drugid=9130&drugname=Dilaudid+Oral

Signs and Symptoms of Dilaudid Abuse

• continual drowsiness/dizziness and/or lightheadedness
• trouble emptying bladder
• persistent constipation
• complaints of nausea, vomiting and stomach pain
• shortness of breath
• sleep apnea
• track marks (puncture marks in veins as with any IV drug abuse)
• lack of desire for nutrition, personal hygiene (as acquiring abused drug is more important)

http://www.narconon.org/drug-abuse/dilaudid-signs-symptoms.html

What do we do about this growing problem? The 1st line of defense to any matter of concern is to be well informed. Then, speak up! All vicious cycles need a conscious decision for change in order to be broken. Let's educate ourselves and those around us for a chance at breaking the cycle of addiction not perpetuating it!