Freudenthal Home Health Blog

Freudenthal Home Health salutes family caregivers in the St. Joseph, MO area who are giving wonderful care and help to their senior loved ones each and every day. Our goal with this blog is to give information and resources to help and support St. Joseph, MO area family caregivers.

The Basics of Cholesterol and Coronary Artery Disease

Whether you’ve just been diagnosed with high cholesterol or just want to learn more about cholesterol, we can help you. Cholesterol is a waxy substance. It’s not “bad”: your body needs it to build cells. But too much can be a problem.

chlcad-01.jpg

Coronary artery disease (CAD)occurs when the inside (the lumen) of one or more coronary arteries narrows, limiting the flow of oxygen-rich blood to surrounding heart muscle tissue. Atherosclerosis is the process that causes the artery wall to get thick and stiff. It can lead to complete blockage of the artery, which can cause a heart attack.

chlcad-02.jpg

The disease process begins when LDL (“bad” cholesterol) deposits cholesterol in the artery wall. The body has an immune response to protect itself and sends white blood cells called macrophages to engulf the invading cholesterol in the artery wall. When the macrophages are full of cholesterol, they are called foam cells because of their appearance. As more foam cells collect in the artery wall, a fatty streak develops between the intima and the media. If the process is not stopped, the fatty streak becomes a plaque, which pushes the intima into the lumen, narrowing the blood flow.

chlcad-03.jpg

The plaque develops a fibrous coating on its outer edges. But if cholesterol continues to collect in foam cells inside the plaque, the fibrous outer coating can weaken and eventually rupture. Smaller arteries downstream from the rupture can quickly become blocked. Over time, a clot may develop at the rupture site and completely block the artery.

chlcad-04.jpg

A myocardial infarction (heart attack) occurs when the heart muscle tissue does not receive vital oxygen and nutrients.

chlcad-05.jpg

All Illustrations and explanations © 2017, American Heart Association, Inc.

Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

Cholesterol: 5 Things You Need To Know

Cholesterol seems to be one of those words that’s in everyone’s vocabulary, but many people are still confused about what cholesterol is, and how it affects their health. It also keeps popping up in the media from time to time, partly due to a report from the Dietary Guidelines Advisory Committee, a group of top nutrition researchers who advise the government about what and how Americans should be eating.

28425027_ml.jpg

1. Cholesterol is only found in animal-based foods

There are two types: dietary cholesterol and blood cholesterol. Dietary cholesterol is the cholesterol found in foods, and only foods of animal origin contain it, because animals’ bodies naturally produce this waxy, fat-like substance. So when you eat an animal-based food (think eggs, dairy, meat, seafood) you’re ingesting cholesterol that an animal’s body produced. Plant-based foods do not contain any cholesterol, so if you see a jar of nut butter marked "cholesterol free" know that they didn’t remove the cholesterol—it just wasn’t there to begin with.

2. Cholesterol is essential for your health

Even if you ate zero animal foods, you’d still have cholesterol in your body. That’s because your liver produces cholesterol and it’s needed for several key functions, including the making of hormones, vitamin D, and substances that help you digest food. While cholesterol is vital, it isn’t considered to be an essential nutrient, meaning something you must obtain from foods, like vitamin C or potassium. That’s because your body produces all of the cholesterol it needs.

3. There are “good” and “bad” types of cholesterol in your blood

The two types of blood cholesterol you hear about most often are HDL (the “good” kind; think happy cholesterol) and LDL (the “bad” kind; think lousy cholesterol). HDL and LDL are actually carriers of cholesterol called lipoproteins. HDL is good because it carries cholesterol away from arteries and back to the liver, where it can be removed from your body. LDL—the bad type—has the opposite effect. Too much LDL can lead to a build-up, which clogs and narrows arteries, and creates inflammation. This chain of events can lead to a sudden rupture, which sends a clot into the bloodstream, causing a heart attack and/or stroke.

4. Dietary cholesterol may not impact blood cholesterol as much as previously thought

The old thinking was that consuming dietary cholesterol added to the cholesterol that your body naturally produces, thus raising the amount in your blood. This was perceived to be risky, because too much blood cholesterol has been shown to up the risk of heart disease, the top killer of both men and women. One often-cited statistic is that every 1% increase in total blood cholesterol is tied to a 2% increase in the risk of heart disease.

For many years, the Dietary Guidelines for Americans recommended that dietary cholesterol should be limited to no more than 300 mg per day. To put that in perspective, one egg yolk contains about 185 mg, three ounces of shrimp contains about 130 mg, two ounces of 85% lean ground beef about 60 mg, and one tablespoon of butter about 30 mg. The brand new report eliminated this cap, however, because the committee believes that the research shows no substantial relationship between the consumption of dietary cholesterol and blood cholesterollevels. As such, they concluded, “Cholesterol is not a nutrient of concern for overconsumption.”

5. The new guidelines aren't carte blanche to other animal fats

Nearly every media outlet covered the release of the report from the Dietary Guidelines committee, zeroing in on the omission of cholesterol limits—but that doesn’t mean it’s now healthy to go out and down cheeseburgers and pepperoni pizzas. The committee is still concerned about the relationship between blood cholesterol and saturated fat from foods like cheese.

You may have heard about another recent report, which concluded that a lower intake of saturated fat wasn’t linked to a lower risk of heart disease. That’s true, but it’s not the whole story, because the risk really lies in what you replace the saturated fat-laden foods with. When people curb saturated fat, but eat more carbohydrates, they lower protective levels of “good” HDL cholesterol, and drive up triglycerides (a type of blood fat), a combo that may actually up the risk of heart disease. But numerous studies have shown that replacing foods like butter and cheese with plant-based fats like almond butteravocado, and olive oil can help lower heart disease risk.

The Bottom Line:

The number one message from the new Dietary Guidelines report is that we all need to be eating less sugar and processed foods, and more plants, including vegetablesfruitswhole grainsbeans and lentils. So if you have cholesterol from something like eggs, pair them with other whole, nutrient-rich plant foods, like veggies and avocado, combined with some fruit, black beans, sweet potato, or quinoa. That’s good nutrition.

Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

The dangers of mixing too many medications

Professor David Le Couteur talks to ABC's Catalyst about adverse drug reactions in the elderly.

    SHOW MORE

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Ask the Expert: Over-Medication

    Ask the Expert with Dr. Scott Avery, DO: 
    What you Need to Know About Over-Medication

    Dr. Scott Avery, DO graduated from the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine in 2007. He works in Savannah, MO and specializes in Geriatric Medicine.


    Dr. Scott Avery, DO graduated from the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine in 2007. He works in Savannah, MO and specializes in Geriatric Medicine.

    Question 1: What should a family caregiver know about their loved one's prescriptions/medications?

    They should know what medications they are taking and for what condition.  IN addition they should know who is prescribing the medications.  They should also know that over the counter medications can interfere with prescription medications.  They should always let their phsycian know about any over the counter medicines, supplements or herbs.
     

    Question 2: What is over-medication and are there any definite signs of it?

    [Over-medication] is taking more of a medication than is prescribed.  It can also be two or more medications interacting with each other.  Signs would be a patient acting different than normal i.e., someone is acting groggy after starting a medication.
     

    Question 3: Who is the first person/professional to contact if you are worried about over-medication?

    You should call your physician or your loved one’s physician with any concerns.
     

    Question 4: When should a patient or family caregiver seek a second opinion on medications?

    Anytime there is a concern about a medication you should bring it up with your physician first. If there are still questions after this, then a second opinion would be something to consider seeking.
     

    Question 5: What is your number one prescription medication safety tip?

    This one comes from my nurses. 
    Right medication, right patient, right dose, right route, right time.
    In other words, take only medications that are prescribed for you, take the amount that is prescribed at the correct time. Take it by the right route, i.e. if it says to take orally, swallow the pill or if it says injection, give it by an injection.


    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Geriatric Pharmacology: Polypharmacy

    In this 3rd of 4 videos, Dr. Smith discusses management of a patient taking many medications. How to control or treat the side effects of medications which result in the addition of more medications. 
     

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    The Pharmacist Who Says No to Drugs

    Armon B. Neel Jr. shows patients — and their doctors — the way to better health with fewer medications

    PHOTO BY MARC ASNIN/REDUX Armon B. Neel Jr., a certified geriatric pharmacist, evaluates the medications older people take or are given on doctors’ orders.

    PHOTO BY MARC ASNIN/REDUX

    Armon B. Neel Jr., a certified geriatric pharmacist, evaluates the medications older people take or are given on doctors’ orders.

    Editor’s note: Every year, 38 million older Americans experience serious — often life-threatening — complications from the medicines they take. And the problem seems to be getting worse, not better.

    The number of Americans treated in hospitals for medication-related problems surged from 1.2 million in 2004 to 1.9 million in 2008, and more than half of those hospitalized were 65 and older. A recent study estimated that roughly 1 in 7 Americans 65 and older is taking at least one potentially inappropriate medication.

    Neel hasn’t worked behind a prescription counter since the early 1970s, when he gave up dispensing drugs for a career that would often put him on a collision course with the doctors who prescribe them.

    For nearly 50 years, Armon B. Neel Jr., a certified geriatric pharmacist, has been caring for older patients, often in nursing homes, to evaluate the medications they are taking or being given on doctors’ orders. 

    The following article about Neel — who is now 72 and absolutely not retired — first appeared in the September 2004 issue of AARP Bulletin. We have updated the profile and are republishing it here because too many older adults continue to be overmedicated, at great personal and financial cost. Neel is now writing an advice column for AARP.org. 

    Ruby Gifford, 86, has come to see Armon B. Neel Jr. out of fear and perhaps even desperation. Gifford (her name has been changed in this story to protect her privacy) hasn’t been feeling well lately, and the list of symptoms that have prompted her to come to Neel’s office in Griffin, Ga., might well mark her as a hypochondriac in the eyes of many doctors.

    The problems run from dizzy spells and falls to osteoarthritis and back pain, from uncontrolled high blood pressure and erratic pulse rates to anxiety and depression. Then there are the skin rashes, hives and other allergic symptoms that seem to have come out of nowhere. Gifford’s 60-year-old daughter has brought her to the Wednesday morning appointment, and the two wait anxiously in Neel’s conference room, where he meets with patients. 

    Neel isn’t a doctor. He’s a pharmacist whose specialty is determining whether people are taking the right medications — and in the right doses — for what ails them. Neel hasn’t worked behind a prescription counter since the early 1970s, when he gave up dispensing drugs for a career that would often put him on a collision course with the doctors who prescribe them.

    Neel asks to see the blood pressure log Gifford has been keeping for the past couple of weeks at his request, along with all the medications she’s been taking. The woman reaches down, produces a plastic bag that’s bulging with prescription drugs, and places it on the table. Then comes another plastic bag, this one full of over-the-counter medications.

    Too Many Drugs, Too Many Falls

    Neel quizzes Gifford about the prescription drugs, one by one. He asks Gifford about Ultracet, a pain medication that she’s taking. "I never have headaches," she explains. "My aches are all from falls."

    "Tell me about the falls," Neel says. "Tell me how long it was after taking this pill that it happened."

    Neel gently guides Gifford through the entire inventory. He explains that Aldactone, the blood pressure medication she’s been taking, isn’t the drug of choice in her case and may in fact be responsible for some of her other health problems. As he looks through Gifford’s records, he sees that her doctor, in attempts to control her hypertension, has tried four different ACE inhibitors, two beta-blockers and two alpha-blockers. Nothing has worked, and Gifford has had allergic reactions to all of them. Neel seems stupefied.

    "There wasn’t a need to go to the second one after the first one did you harm," he says. "They’re in the same family. You need a calcium channel blocker instead."

    Next, Neel zeroes in on Mobic, the NSAID (nonsteroidal anti-inflammatory drug that Gifford’s doctor has prescribed for her osteoarthritis). "There are certain drugs you just don’t give old people," he explains, and NSAIDs are among them. It turns out that the doctor has ordered yet another NSAID, in the form of Voltaren eye drops. "There’s a newer product that’s better than this," Neel says.

    Gifford seems relieved but at the same time disturbed. "I don’t want to go back to this doctor," she says. "She never checked anything before she gave it to me."

    Neel promises to put everything in a written report by the end of the week. "Some of these things," he says, pointing to all the medications spread out on the table, "we might just chuck in the trash can."

    Neel hits the road later in the day to make his way to two nursing homes in rural Georgia, where he will review the charts of dozens of residents and carry on his long-running crusade against the overmedication of geriatric residents in long-term care facilities.

    Neel does this two or three days a week, nearly every week, and has been doing it since 1968, when he decided to focus exclusively on clinical consulting. He’s one of a few thousand consultant pharmacists nationwide who specialize in identifying, resolving and preventing medication-related problems that affect, and afflict, older people.

    The way Neel sees it, pharmacists are often a patient’s last line of defense in a nation of doctors who, more often than not, don’t know much about the drugs they are prescribing and the geriatric population they are treating.

    "You see so many cookie-cutter approaches to taking care of old people," Neel says. "Almost 100 percent of the people I see as outpatients are overmedicated, because the ones I see are the ones who are having problems. If I go into a long-term care environment, it’s about 80 percent."

    Typically, medication levels in nursing homes can be cut in half or better. "If I can get the drug therapy management correct," Neel says, "there are fewer hospital stays, fewer hospital admissions, lower labor costs involved in care and a better quality of life for residents."

    A Rebel With a Cause

    Neel is a rebel with a cause — namely, advancing the idea that pharmacists must serve and protect the people who take the medications they dispense. "I get paid by the patient," he says, "not the doc."

    The way Neel sees it, pharmacists are often a patient’s last line of defense in a nation of doctors who, more often than not, don’t know much about the drugs they are prescribing and the geriatric population they are treating.

    The renegade streak goes way back. In 1963, for instance, just two years out of pharmacy school, Neel opened an apothecary shop in Griffin that, just like a doctor’s office, had a carpeted reception room and a separate consultation room. He also set up prenatal counseling programs as well as hypertension and diabetes clinics. Neel thought the new approach would earn praise; instead it drew ridicule from many of his peers.

    In the late 1960s, Neel, at the request of a friend, started doing some clinical consulting in nursing homes, and what he saw both shocked and transformed him.

    "Here was a brand-new population of people, and nobody had any earthly idea how to take care of them," he recalls. "Back then you’d see Mellaril [a powerful antipsychotic drug] brought in by the truckload. They used it as a chemical restraint. Nursing homes back then didn’t have a lot of help, so the best help they had was to drug the patients. I knew it wasn’t humane, and I fought it from day one."

    On Wednesday night Neel is driving to a mom-and-pop motel in rural Georgia that he has stayed in many times. It’s not far from a county-owned nursing home Neel counts among his institutional clients.

    The next morning at 9, Neel is stationed at a small desk near the nursing director’s office. He has brought along a notebook computer, portable printer and a supply of blank forms and printed materials. He knows just about everyone, it seems, by name.

    An Epidemic of Overmedication

    The doctor who serves as the nursing home’s medical director doesn’t seem to care for Neel’s approach to medication reviews — a task mandated by federal law that’s often seen as rubber-stamp work. The doctor doesn’t talk to Neel, choosing to deal with him mostly through the nursing staff.

    Throughout the day Neel will type his medication-related suggestions on a form of his own design (printed on a pink paper so as to stand out in the patient’s medical records) that directs the patient’s physician to check a box that says "Accept" or "Reject" before signing and dating it.

    The medical director rejects, almost without exception, Neel’s suggestions. He evidently takes umbrage at being second-guessed by a pharmacist — something, Neel says, that’s not at all unusual. Neel finds the lack of engagement troubling.

    "He’s here once a month," Neel says. "Maybe five minutes per patient. That’s all a medical director is required to do."

    Neel begins working his way through a tall stack of blue loose-leaf binders that contain patient charts and other medical records. Today he’s reviewing the charts of residents who are taking nine or more prescription medications simultaneously.

    It’s important on at least two counts that Neel — or someone like him — review the medications these people are receiving.

    First is safety. The risks of adverse effects expand exponentially with the number of medications "onboard," partly because they indicate the presence of numerous diseases or other medical problems and provide an opportunity for both drug-disease and drug-drug interactions.

    Second is cost. "The rule of thumb," Neel says, "is $100 a drug."

    That’s per patient, per month. Thus the cost of having someone on, say, 15 different medications — many of which may be unnecessary or even harmful — is $1,500 a month, or $18,000 a year.

    [Editor’s note: Neel today points out that the figure has doubled in the seven years between 2004 and 2011 — to $200 a day and $36,000 a year.]

    Getting Up Close and Personal

    First up today is the chart for a 68-year-old man who is on many drugs, including Nitrofurantoin, an antibacterial that’s prescribed for urinary tract infections. Neel enters the man’s age, weight, height and information from his blood work into a calculator programmed with certain formulas he uses over and over. Neel explains that toxic levels of the drug will build up in the man’s system because his kidneys aren’t as efficient as they used to be.

    Why would a doctor prescribe it? "Because," Neel says, "it works in young people."

    The next chart is for an 89-year-old woman who’s on 13 different prescription medications, including Zantac, which raises an immediate flag for Neel. There are no blood chemistry tests in her charts, but Neel quickly computes her probable renal clearance at 32.5 cubic centimeters a minute. "This tells me right off the bat she shouldn’t be taking it," he says. 

    He then types his suggestion to the doctor: "Zantac dose too high/could lead to hepatic shutdown ... resulting in serious patient adverse events."

    Neel opens the next chart, that of an 82-year-old woman who’s on 17 different medications, including, for type 2 diabetes, a prescription drug called metformin.

    He’s dumbfounded at first, then angry. He reads the suggestion slip he typed out six weeks earlier: "Patients with serum creatinine clearance less than 60cc-m use of metformin is contraindicated and places the patient at high risk for lactic acidosis, which is fatal in most cases."

    In a little while, Neel joins the staff for lunch in the cafeteria and spends much of the time soaking up details about residents that may prove useful in his work. On the way back from lunch Neel stops to visit with them in their rooms or in the hallway.

    Neel rises early the next morning to drive to another nursing home about 20 miles south. There, too, he has a combative relationship with the facility’s medical director.

    “I Gave Him His Life Back”

    As soon as Neel arrives at the facility, he searches out a 73-year-old resident who’s lived in the nursing home for five years. The man, who has advanced Parkinson’s disease, brightens instantly.

    One problem, as Neel sees it, is that few of the 300 or so doctors who treat patients in the facilities he visits have a special interest in geriatrics. How many do? "Maybe two," he says.

    When Neel first looked at his chart, the man was on 20 milligrams of the antipsychotic medication Zyprexa, a daily dose that by any measure is therapeutic overload; he’s down to 2.5 milligrams a day, and soon, Neel says, he may be off the drug entirely.

    The man’s old symptoms — nonstop yelling, tongue-thrusting, pill-rolling (a Parkinsonian tremor that takes the form of a continuous back-and-forth motion of the thumb and fingers) — have all disappeared, and now he sometimes comes to sit quietly next to Neel as he works.

    The physician overseeing the man’s treatment told Neel and the nurses that he would never be able to walk again. But walk he now does — and walk and walk. He visits other residents in their rooms and likes to sit near the main nursing station — the hub of activity. "I gave him his life back," Neel says matter-of-factly.

    One problem, as Neel sees it, is that few of the 300 or so doctors who treat patients in the facilities he visits have a special interest in geriatrics. How many do?

    "Maybe two," he says. "They’re not up-to-date with the physiology of the geriatric patient as it relates to the chemistry of the drug. That’s the easiest way to put it."

    Neel reviews a few more patient charts, producing more small pink suggestion slips, each numbered sequentially, as he goes.

    At another nursing home, where Neel has known the medical director for more than 30 years, the success of a collaborative approach is clear. 

    "If I write up a suggestion to paint the nose blue," Neel jokes, "when I go back the next time, the nose is blue." 

    The cost per patient for drugs at this nursing home is down to about $14 a day, the lowest in Georgia.

    Neel will be back in Griffin before suppertime, where he’ll finish the written report that he promised Ruby Gifford before leaving for a weeklong vacation with his wife, children and grandchildren. He doesn’t yet know that Gifford’s physician will be angered by her decision to seek out his help and will refuse even to read Neel’s 17-page report.

    So Armon Neel soon will help Gifford find a new doctor. He isn’t one to pass the buck.

    "I’ve always gotten along well with old people," he says. "They’ve always been special to me."

    A mischievous smile breaks. "And I really like ’em now, ’cause I’m one of ’em."

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Doctors 'De-Prescribing' for Over-Medicated Patients

    More patients are taking five or more prescription medications at once, putting them at risk for side effects and drug interactions. Amid concern about the potential harm of taking too many drugs, more doctors are de-prescribing, and getting patients off prescriptions that are no longer necessary. WSJ’s Laura Landro explains on Lunch Break with Tanya Rivero.

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Service Highlight: Housekeeping

    Housekeeping makes you feel great about your home again. Have you noticed you are having trouble keeping your home as clean as you would like? If so, allow our housekeeping service to help you feel great about your home again.

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Home Solutions for Aging in Place

    Home improvement expert Danny Lipford showcases innovative home features for aging homeowners.

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Service Highlight: Medication Management

    Medication management brings peace of mind knowing you are taking your medications as prescribed.

    Are you having trouble keeping track of your meds? Or are you forgetting to take your meds? If so, our medication management services bring you peace of mind knowing that you are taking your medications as prescribed.

    Here's how it works: A certified staff member will make short visits (estimated 10 to 20 minutes in length) to your home to setup, manage, and if needed, administer your medications.

    If administering your meds for you, visits can be made to your home multiple times per day if needed. If only setting up and managing your meds for you,  a visit maybe once a week or once every couple of weeks may work well for you.  Your plan of care is fully customizable and can be changed as needed.

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Technology for Aging in Place

    Dr. Jeffrey Kaye, director of the Oregon Center for Aging and Technology, talks about testing technologies that record and track real-time changes in older adults’ health status and activities. Video courtesy of Oregon Health and Science University (OHSU).

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Service Highlight: Personal Care/Companionship

    Do you have certain daily activities that you feel could be easier with a little help?

    If, so let our personal care/companionship services allow you to live in your own home independently while we become your caregiver, companion, personal hygienist, chef, chauffeur or any other role that needs to be filled. Call (816) 676-8050 today.

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    How More Americans Are 'Aging in Place'

    The average American over the age of 65 will need roughly three years of long-term care, on average, according to government estimates. To get that care in a nursing home costs about $72,000 per year. But from D.C. to Massachusetts, Minnesota to California, Americans are devising innovative plans to help more people save money and stay in their homes longer. Here are a few examples. Learn More: http://zurl.co/qpz4o

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!

    Aging In Place: Where do you begin?

    As advances in medicine and personal care advance, more Americans are living longer lives, but yet we put off thinking about how to live these lives at home. From cleaning the house to folding the laundry, Freudenthal Home Health is your source for answering all the questions posed in the video below. Click here or call 816-676-8050 and let us help you age in place.

    Sign up below and we will occasionally email you a digest of our blog posts. Thanks!