ShareThisBy LEE BOWMAN
The small things in health can add up to big things _ big bad things, like the incremental damage of coronary artery disease, or big good things that can save a life or at least improve the odds for recovery.
Here are just a few of the incremental things that are reported in medical journals and government regulatory filings every day that illustrate why it's worth it to sweat the small stuff.
_ Oxygen cold; oxygen warm.
Most everyone's had a brain freeze after trying to inhale too much ice cream or snow cone at once. But is brain freeze a good thing or a bad thing for someone suffering from a brain injury and in a coma or vegetative state?
Theories and medical practice come down on both sides of the freeze-thaw debate, with many surgeons opting to keep patients cool, and others arguing that shivering patients are not a good thing.
When it comes to people who have experienced a loss of oxygen to the brain because of drowning or a stroke, the many instances of long survival after submersion in chilled waters and some recent small studies argue on the cold side.
But in a recent paper published in the Medical Science Monitor, two researchers cite the case of a 53-year-old woman who made fairly dramatic recovery from a coma after being removed from a respirator that had pumped 63-degree oxygen down her windpipe for 31 months.
The patient's daily body-temperature readings had been normal throughout her nursing-home stay, but George Ford of the Institute for the Minimally Conscious in Rye, N.Y., and David Reardon of the Elliot Institute in Springfield, Ill., noted that the chilled air running through her respiratory tract made for hypothermic conditions in her brain.
A month after the tube came out, the woman began showing signs of recovery, responding to simple questions and indicating awareness of her surroundings.
Ford and Reardon did an informal survey of hospitals and nursing homes in metropolitan New York City and found that for patients in a vegetative state, it is normal not to warm up supplemental oxygen delivered via a tube. They argue that perhaps warmer air is warranted, or that at least more research should be done on their theory.
_ One drop or two?
While many eye-drop prescription labels suggest patients use one or two drops _ apparently figuring the chances for a miss are high _ putting in more than one drop is wasteful at best and, at worst, invites an adverse reaction by absorbing the excess into the bloodstream via the tear ducts.
Recent advisories from ophthalmologists consulting with two consumer watchdogs _ The Medical Letter on Drugs and Therapeutics, and Public Citizen's WorstPills.org _ note that the human eye can only hold about 10 microliters of liquid at a time, while a single droplet from an eyedropper can hold 25 to 50 microliters. So, no more than one drop within a five-minute period. If the prescription requires taking more than one drop, do it at five-minute intervals, the experts suggest.
_ Changing catheter styles.
The urinary catheter is one of the least popular aspects of a hospital stay for men. And the devices are often pathways for urinary-tract infections.
But there is an alternative for many men _ an external, or sheath-type, device. A recent study comparing outcomes between patients using the different types of catheter at a Veterans Affairs health center in Seattle found that men using the external, condom-type catheters had an 80 percent lower risk of developing a urinary-tract infection than men using traditional, indwelling catheters.
Ninety percent of men using the external devices reported they were comfortable with them, compared with 58 percent who used the traditional catheter.
Dr. Sanjay Saint, lead author of the study published in the July issue of the Journal of the American Geriatrics Society, noted that about 25 percent of hospitalized male and female patients require a catheter, and that most male patients can use the external devices, as long as the patients are not mentally impaired or have a medical condition, such as a urinary-tract blockage, that mandates use of the internal device.
"The only drawback is that we don't yet have an external device for women that works well," said Saint, who is director of the patient-safety enhancement program and an associate professor of medicine at the University of Michigan Medical School in Ann Arbor.
