Delirium

Delirium is a situation in which a person presents with severe confusion and disorientation, often rather quickly after some kind of change in their situation such as trauma or hospitalization.

And it’s very common, especially among hospitalized people, and as always, especially among the aged, in whom it’s often mistaken – particularly by those doctors who don’t know the delirious person in a healthy state - to be a sign of the onset of dementia.

And unfortunately, it’s often mistreated as well.

In fact, a recent study concluded that the drug most commonly used to treat delirium is no better than placebo.

Bottom line, then: if you are elderly, or if you are a caregiver for an elderly person who gets hospitalized, make sure you know as much about delirium as you can.

And if you live in the Lower Mainland, the good news is that as part of their Dialogue on Aging, with which I am associated (I’m going to be the MC for the talk on October 16 about the importance of exercise), on September 4, the Tapestry Foundation is presenting a talk entitled: Dodging Delirium: Recognition, Prevention and Treatment.

If you’re around, and if you’re interested in this issue, make sure that you register for this event at tapestryfoundation.ca.

Trust me, you’re going to be very glad you did.

More proof of the power of immunization

Immunize a person against a particular bug, you protect her against that condition.

Immunize enough people against that bug, you end up protecting a huge community, much larger than the one that simple includes those who were immunized.

That’s the beauty and power of “herd immunity”.

And as more proof of that power, a study just published in the Journal of the American Medical Association found that since the introduction of a widely-used vaccine in infants against a virus called rotavirus, which causes severe, even life-threatening diarrhea particularly in infants, the number of hospitalizations and deaths from rotavirus has not only plummeted among infants, as you’d expect, but the number of hospitalizations has also plummeted in toddlers, older kids, teens, young adults, and even older adults, none of whom had been vaccinated against rotavirus.

In other words, herd immunity is at work to protect a whole bunch of people who have no idea they’re even being protected.

Vaccines work.

And they have huge benefits for the community at large.

Cancer diagnosis and screening: Part 3

As my son keeps telling me every time I ask him to do something he thinks I should have learned to do myself by now (which is, of course, anything to do with a computer or a cellphone), “WE are what we repeatedly do,” meaning (I think) that if you’re a lazy boomer with tech-smart kids and you’ve always relied on your kids to help you out of some tech mishap, you are not suddenly going to start solving your tech problems on your own but rather you are going to go back to the well – your kids – every time they allow to ring em on their cellphones.

Anyway, I thought of that citation as an appropriate way of introducing this piece of frustrating medical news, namely that despite universal new guidelines to stop testing women so often for cervical cancer, according to a recent survey of doctors’ practices published in the American Journal of Preventive Medicine, lots of American doctors are still subjecting their female patients to yearly Pap smears, even women into their 70s and 80’s, in whom there is absolutely any proof at all that Pap smears will prevent any deaths from cervical cancer.

So why are doctors doing this test way more often than is recommended by guidelines?

Well, the easy answer, of course, is that it pays to do it and undoubtedly in the US that does play a role in why doctors seem to order so many more tests and perform so many more procedures than Canadian doctors do.

But in this report, the biggest culprit (my word) for this over-use of Pap smears was not money but rather the “fear” that many doctors expressed that 1) if they stopped doing annual Pap smears, women would stop coming in for annual check-ups (someone should tell those doctors that most health authorities don’t recommend annual check-ups any more either), and 2) that they have no real choice in the matter because so many women still demand annual cervical cancer testing because, “Well, what’s the harm, eh?”.  

So for those women (and others), here’s a quote in the editorial that accompanied this survey: “Screening for cervical cancer and other cancers such as breast and prostate has clear potential for harms as well as benefits and must be carefully weighed before a rational decision about screening can be made.”

Cancer Diagnosis and screening: Part 2

Brief follow-up comment to yesterday’s post about psychological costs in a diagnosis of cancer.

And that comment concerns my frequent carping about the hazards in over-testing, especially testing for cancer.

This psychological cost – that once you’ve heard the word cancer linked to your name, you’re likely to suffer some kind of long-term if not permanent psychological scar from that possibility – is one of the strongest reasons to thoroughly inform yourself about the cancer screening tests you choose to get because all cancer screening tests have a large false positive rate, meaning that lots of people are told they may have a certain cancer – particularly breast and prostate = on the basis of a screening test, which turns out to be a false alarm on further testing.

But that false positive still leaves a psychological scar, which may be worth risking, or maybe not, depending on the kind of person you think yourself to be. 

Cancer diagnosis and screening

A cancer diagnosis is forever, alas, by which I mean that once you’ve been told that you have cancer, you are never going to be totally free of the concern that it may recur.

And nor is your partner.

That’s according to an excellent recent study from the UK published in the journal, the Lancet Oncology, in which researchers looked at 43 studies including over 50,000 patients who had all been diagnosed with a range of different cancers.

The good news is that although a diagnosis of cancer frequently resulted in a bout of depression shortly following the diagnosis, depression tended to dissipate within 2 years.

In a lot of cases, however, depression was replaced (displaced?) with significant anxiety, and that increased level of anxiety lasted a long time for a lot of people, many years in fact because even after 15 or 20 years of being cancer-free, there is always the worry, it seems, that the cancer can still recur.

There was no particular cancer that was more likely to produce anxiety than others meaning that even those cancers with a good prognosis can result in chronic recurring levels of anxiety.

The interesting thing in this study, though, is that often spouses of cancer patients end up with an even higher level of long-term anxiety than the cancer patients themselves.  (This study was not geared to measuring anxiety in kids of cancer patients, but one can only assume that that’s a real problem for a lot of families, as well).

Not surprisingly, I think, women tend to have a tougher time with this post-cancer anxiety than men do so that even in the case of prostate cancers, apparently it was more often the female partner who developed anxiety later on instead of the prostate cancer patient himself, although that may be only on the surface, I think, since as most of us will acknowledge, lots of men are programmed to say they are not worried – even to researchers, maybe especially to researchers – when they are in fact consumed with anxiety.

Anyway, thee take-away message here is pretty obvious: being diagnosed with cancer has clear and obvious significant short-term costs.

But even when those costs have been adequately dealt with, there’s still a crucial legacy of potentially damaging long-term consequences, and the more vigilant a cancer patient is – and their family members – for such problems, and the sooner those problems are acknowledged, the better the overall long-term prognosis because cancer is never just a physical problem.