The last several posts have been about the importance of sleep and the barriers that older adults face. We’ve all seen ads for expensive beds that will miraculously improve sleep. But buying an expensive bed is not the right way to start. It’s also not the correct first step to ask a health care provider for a sleeping pill. A logical, calm, and customized approach is needed. This post is about finding YOUR path to the best sleep possible. Sleep clinics consistently start with a sleep journal Journals examine sleep patterns over a period of […]
Category Archives: Dr. Warren
Are medicines making it hard for me to sleep?
Are medicines making it hard for me to sleep? I was asked this question after my last post. Many people, including seniors, need more and better sleep to feel good and live well. National Sleep Week (March 12-18, 2023) highlighted that sleep is a health issue in a sleepless world. There were 3 points I emphasized in my post about the importance of sleep. Sleep is different from rest. The body and brain do important work that occurs only with sleep, not with rest. Good sleep means more than a recommended number of hours. Quality […]
How did you sleep, Honey?
I say this to my wife almost every morning. It’s my way of showing affection because sleep is very important. We are lucky in three ways: 1) Despite our many ups and downs, we have a good marriage, even better over the years. 2) Our sleep clocks are quite similar and 3) We are good sleepers …. most of the time. Every once in a while, because of life stresses, one of us doesn’t sleep well. The result? We’re tired and maybe a bit grumpy. Eating, sleeping, and bowel movements (E-S-BM) are essential. I call […]
Constipation: Help, I’m stuck
Fecal impaction is when a large amount of poop is stuck inside the rectum. The poop can be soft or hard. Chronic constipation is the most common cause of impaction. Constipation is due to 1) the inability to push stool out 2) the persistent habit of holding bowel movement inside or 3) small stools that pile up. Impaction is often, but not always, uncomfortable. Frail seniors are at higher risk. Sometimes caregivers are surprised to hear that a patient has an impaction. What are signs of impaction? Impaction is likely when a patient feels full […]
Constipation Relief … What’s the Scoop?
Constipation can have an awful impact on quality of life among frail seniors. First of all, it increases urinary tract infections. Then, at its worse, it results in fecal impaction and incontinence. This increases caregiver burden and stress. Ultimately, the person ends up being unable to live at home. What a disaster. That’s why I think it’s so important to avoid constipation. The goal should be a solid, medium-sized, bowel movement with complete evacuation. In addition, at a regular time every day. That’s constipation relief!! Now, what’s the scoop? Step 1: Are medicines causing the […]
Constipation? I Have Two Questions
“There’s Nothing Like a good Bowel Movement” made the point that chronic constipation is all too common and distressing among seniors. In the past, doctors defined constipation as having fewer than 3 bowel movements a week. Anything else was considered “normal”…hmmm…really?? Obviously, the patient was much more uncomfortable than the physician. We now evaluate constipation more broadly, starting with the patient’s perspective. Here are two important questions: Question 1: What bothers the patient the most? Different answers mean different problems. A. It’s very painful to have a bowel movement. Sometimes only small pieces of stool […]
There’s Nothing Like a Good Bowel Movement
There are 3 questions that I always ask my patients. They are about “E, S, B&M”: How well are you eating? How well are you sleeping? How are your bowel movements? These are questions that patients are glad I ask. They show that I care about life’s most basic needs. It’s a doctor’s more specific way of asking “how are you doing?” ESBM are important in childhood, adult life and as people get older. The answers to these questions are “life” vital signs. Just like heart rate or respiratory rate, they give me clues about […]
Medications and Older Adults, the Bottom Line
In the last several videos, Dr. Ariel Green, an Associate Professor at Johns Hopkins University School of Medicine, discussed risks related to medication use among older adults. She has also described problems associated with specific classes of medications. Here are some bottom-line points: Polypharmacy – Too many medicines The greater the number of medications a person takes, the higher the likelihood of problems. This includes side effects, interactions between medicines, and mistakes in taking medicines correctly. Five or more medicines is a rule of thumb that doctors use. More medicines are likely to result in […]
Holidays: Gifting YOURSELF the Right Amount of Connection
Holidays are a time of gift giving. Remember to give yourself an especially important gift: the “just right” amount of connection with others. Caregiving is hard work. Take care of yourself. If you don’t treat yourself well during the Holidays, when will you? Give yourself the gift of connection. I believe that there are five keys to a happy life: 1) having a sense of purpose 2) feeling spirituality 3) doing things that you enjoy 4) taking care of your body AND 5) connecting with other people. Think of these as your daily emotional vitamins. […]
Solving the over medication dilemma
In previous posts, Dr. Green had discussed some of the hazards associated with medication use among older adults. She has also discussed classes of medications that are of concern. In this final post, Dr. Green discusses approaches she has used to deprescribing. Warmest Aloha, [email protected] PS: I say it over and over again: There’s no one more important than the caregiver in the daily life of a frail person.