Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease…sounds important huh?  Well it kind of is.  This condition is most commonly found in aging individuals.  Peripheral arterial disease affects the blood vessels that carry blood away from the heart, the arteries.  This disease is caused by hardening of the arteries that usually occurs in the arteries of the legs, it is characterized by an inadequate flow of blood.  Raynaud’s disease or Buerger’s disease are conditions that you may be more familiar with or have possibly heard of, and they are examples of peripheral arterial disease.

The hardening of the arteries occurs gradually, which ultimately results in narrowing of them also.  As the vessels harden, plaques may form on their walls which cause them to be more fragile than normal too.  The gradual stiffening and narrowing of the arteries causes a decreased blood supply to the surrounding tissues.  Plus, the changes of the arteries also make it much more difficult for blood to flow throughout the vessels as it once did.  You will see that your provider will either classify your peripheral arterial disease as inflow or outflow depending upon where it is located.  Also, the severity of peripheral arterial disease may range from mild to severe.  The damage to the tissues will occur and be apparent below where the obstruction is taking place.

We all like to know how likely it is for us to come down with health conditions and being aware of risk factors may provide more of an insight for this.  Following are risk factors in developing peripheral arterial disease.

ü  Increased blood pressure

ü  Increased fat in the blood

ü  Diabetes

ü  Smoking

ü  Obesity

ü  Leading a rather inactive lifestyle

ü  Family history

ü  Advancing age

o   Older adult individuals have a higher incidence of peripheral arterial disease and also a higher mortality rate from complications than younger individuals do.

In addition to all the risk factors you may begin to experience noticeable signs and symptoms that could be indicate peripheral arterial disease is occurring.  The following list describes these possible signs and symptoms.

ü  Burning, cramping, and pain in the legs during exercise or activity.

ü  Numbness or burning pain primarily in the feet when lying in bed.

ü  Pain is relieved by placing legs at rest in a dependent position (allowing legs to hang over side of bed, or always being below heart level).

From the view of a health care professional there may be a decrease or lack of pulses in the feet, loss of hair areas of the lower leg, dry and scaly skin, thick toenails, cool and bluish/purple lower leg, leg will appear pale if it is elevated or appear red if it is below the heart level, and there could be ulcer areas or gangrene of the toes.  Some of the signs will be fairly obvious to health care professionals, but any of them may be apparent depending on the severity of your disease.  Diagnosis and possibly treatment of your disease can occur via several different procedures including an arteriography, exercise tolerance testing, plethysmography, or segmental systolic blood pressure measurements as described below.

ü  Arteriography.  An imaging study of the network of arteries in your legs.  The study involves an arterial injection of contrast medium in order to more clearly visualize the areas of inadequate blood flow on the x-ray image. 

ü  Exercise tolerance testing.  A stress test that is done either on or off of a treadmill.  Your pulse volumes and blood pressures will be checked before and following the start of your symptoms or within 5 minutes of exercise.  Delays in return to normal pressures and pulses will indicate the disease.

ü  Plethysmography.  This is used to determine variations of blood that is passing through an artery.  Blood pressure cuffs will be placed on your arm and leg and attached to a plethysmograph machine to measure variations in peripheral pulses between the arm and leg.  A decrease in pulse pressure of the leg may indicate a possible blockage.

ü  Segmental systolic blood pressure (BP) monitoring.  A Doppler probe is used to take various BP measurements for comparison.  Pressures in the thigh, calf, and ankle will be lower with arterial disease.

This condition can be a nuisance and interfere with how you perform your daily activities, it could interfere with sleeping, and so much more.  Total Home Health has a program that is right for you.  Our professionals completely understand peripheral arterial disease and will implement nursing measures to make you feel as comfortable and independent as possible, while also keeping you safe.  We will encourage you to remain active, however with this disease we will advise you to exercise gradually and increase slowly.  We will advise you to walk until you reach the point of pain, then stop and rest, and then continue to walk a little farther in order to get the most out of what remains of your blood circulation process.  There are a wide array of other tips and tricks Total Home Health professionals will educate you on to make the most out of your condition, while remaining as functional as possible.  Enroll with us today because we always understand, and always put you first!

Migraine Headaches

Headaches are a common occurrence and can affect individuals of all ages at any time.  Having a headache sure can be a nuisance, especially when you have a full day of work, school, or something fun planned.  It’s no fun to have to go through the day and not be at your full potential because your head hurts.  Most of the time we can take over-the-counter medication and our headache will go away, but sometimes having a headache may be a bigger concern. 

Headaches can be short-term or long-term, temporary of life-threatening.  Generally they are associated with other conditions too, such as colds, allergies, and stress or muscle tension.  Described as follows, medical professionals also categorize headaches as either primary or secondary.

·      Primary.  These headaches have no organic cause that can be directly identified.  Migraines, tension-like headaches, and cluster headaches are included in this category.  If you or a loved one experience this type, they can be managed in the primary care setting.

·      Secondary.  These headaches do have an organic cause, meaning they are caused by either a tumor or aneurysm.  Secondary headaches warrant further investigation and will require more in-depth medical treatment.

Our focus is going to be on headaches that are more likely to be experienced by you or your loved ones which include migraine headaches.  Following are several triggers that could result in either a migraine or cluster headache, these include:

ü  Alcohol use or having environmental allergies

ü  Intense odors, being in bright lights, or overuse of certain medications

ü  Being tired, sleep deprivation, being depressed

ü  Being under emotional or physical stress, having anxiety

ü  Menstrual cycles and/or use of oral birth control may also trigger headaches

ü  Foods consumed with tyramine, nitrites, MSG, or milk products

First of all we’ll discuss migraine headaches.  If you or your loved one experience a migraine headache, you will most likely complain of symptoms such as nausea and vomiting, stress and anxiety, pain that is often behind one eye or ear on one side of the body, sensitivity to light, and/or sensitivity to sounds.  Upon your visit to your provider related to your headaches they will take into consideration any immediate family history and your health history to determine any apparent headache patterns.  Also, your provider may inquire if you have noticed any changes in your daily functioning within the past 72 hours, such as having more difficulty completing tasks because of your headaches. 

A migraine headache can occur with an aura, without an aura, or it may be atypical.  Any indication of an aura will also be discussed between you and your provider to gain a better insight about your experience.  An aura is an event that triggers your headache.  The aura event is almost the exact same each and every time and you begin to easily recognize when a headache is going to begin.  There are 4 stages your body goes through when you experience a migraine with an aura, if this pertains to your specific case your provider or professional with Total Home Health will go over the stages thoroughly with you.

A migraine without an aura is a little simpler.  If you experience a migraine without an aura you will notice the following signs and symptoms:

ü  Pain is aggravated if you engage in physical activity.

ü  The pain occurs in an area on one side of your body and will be pulsating.

ü  You may be sensitive to sounds, lights, and/or have nausea and vomiting.

ü  Headache will persist for 4 to 72 hours

ü  Headache often occurs early in morning or during stress

In comparison, an atypical migraine will cause you to experience a headache that lasts for over 72 hours and it is one that does not fit any other criteria.  If you are older with a new onset of headaches, or if headaches are beginning to noticeably affect your thinking abilities, imaging studies of your head will be completed to try to determine the extent of your problem.

Total Home Health has a program that is right for you and all your migraine needs.  When in your presence, our nursing professionals will take all measures that we feel will help keep you more comfortable and decrease the duration and intensity of your headache.  When you experience a migraine we will do our best to create a cool, dark, quiet environment in your home to increase your comfort and decrease your headache intensity.  We will help you to maintain a slightly upright position instead of lying flat, which will also help decrease pain.  We will also teach you how to administer medications and its side effects as ordered per your physician.  Total Home Health professionals will not only be your nurse, but we will be your friend and teacher.  We will educate you on how to best prevent future headaches so that you can continue to function as independently as possible in your home…enroll today!

Pressure Ulcer

Pressure ulcers may also be known as “bed sores.”  Either way, an unpleasant sight should enter your mind.  These areas can occur in a person of any age, but most generally they occur in the elderly on bony prominences if they remain in one position for an extended period of time.  This is why in most hospitals and long-term care facilities there is usually a protocol for turning and repositioning patients every 1 to 2 hours to maintain the integrity of the skin and keep the blood flowing adequately.

Pressure ulcers are caused by increased pressure against areas of the skin that results in limitations of the blood flow to that specific area and to the nearby tissues.  Friction and shear are also contributory factors to the development of pressure ulcers.   Friction and shear can cause a compromised skin area when a patient is pulled up in bed or turned and repositioned.  Or, if the head of the bed is elevated and the patient gradually moves down the skin may be pulled gradually in opposite directions.  If correct technique is not used when assisting someone to turn or reposition, the skin could tear when it is dragged across a surface.  Pressure ulcers fall into one of four categories and are staged according to the characteristics of the wound itself as follows, including:

·        Stage I.  Skin is intact, but appears red, and does not briefly lighten (blanch) when touched.  Area may be tender, painful, firm, soft, warm or cool in comparison with the skin around it.

·        Stage II.  Outer layer of skin and part of the underlying layer is damaged or lost.  Wound area may be shallow, or look like a fluid-filled or ruptured blister.

·        Stage III.  Ulcer is a deep, crater-like wound.  Skin loss usually exposes fat and in the bottom of the wound you may notice some yellowish dead tissue.

·        Stage IV.  At this stage, there will be a large loss of tissue.  The wound may even expose muscle, bone or tendons.  There will still be yellowish dead tissue in the bottom of the wound, and it could also appear dark and crusty.  Damage often extends beyond the primary wound below layers of healthy skin in this stage.

Your provider and a professional who is specially trained in wound treatment will decide which category your pressure ulcer falls into.  A pressure ulcer may also be considered unstageable if its surface is covered with yellow, brown, black or dead tissue.  When the wound is covered with all this different tissue, it is not possible to see how deep it actually is.  You will see that your wound treatment is frequently adjusted in order to keep up with the progression or worsening of the pressure ulcer itself.  The wound treatment professional assigned to your specific case will make frequent visits to you in order to assess your wound and keep up with its course in order to provide the best treatment to see that it resolves as quickly as possible.

Common sites of pressure areas include those areas which are bony prominences such as the tailbone or buttocks, shoulder blades, elbows, back of skull, heels, hips, ankles, skin behind the knees, rims of ears.  Of course the affected area will depend on which position the individual spends the greatest length of time in.  Risk factors of developing a pressure ulcer include increased age, inability to feel pain or discomfort, weight loss, skin that is too moist or too dry, incontinence, having a condition that affects blood flow, smoking, decreased level of alertness, and muscle spasms. 

Total Home Health has a program that is right for you and your specific needs related to your pressure ulcer.  Our professionals will work in conjunction with other providers to ensure that you receive the best and most up-to-date treatment available to provide the best outcomes for your pressure ulcer.  Your safety and overall health is our priorities and we want to make you feel like one of our own.  You, as the client will be involved in your care as much as possible, and our Total Home Health professionals will do our best to see that you understand all aspects of your treatment process.  A trusting relationship and great communication makes all the difference to provide more successful outcomes of treatment.  We guarantee with Total Home Health you will see this first hand…let’s start our journey today!

Stroke

Hearing the word “stroke” probably brings a hundred things to mind, and usually most of them aren’t too pleasant.  That is basically the truth though because generally the outcomes of a stroke are both unpleasant and definitely unwelcomed.  If you or your loved one has experienced a stroke in your lifetime, you probably already understand.  However, for those out there who need a little more insight related to what a stroke actually is…please continue reading.

A stroke occurs when the blood supply to a part, or parts, of your brain is interrupted or drastically reduced.  This reduction of blood flow is noted in the important tissues of the brain, meaning these tissues are deprived of the nutrients they need to function, ultimately resulting in death of brain cells.  Depending on which brain cells die, relies on the severity of the stroke and how your body will be directly affected.  For a more simple view, the trucks in your blood vessels that transport all the adequate nutrients and other supplies either get stuck at a red light for too long or completely break down.  Whatever the culprit, the end result has a good chance of being compromising to the body and to the normal level of functioning the individual once knew.

A stroke is considered a medical emergency.  At the first inclination of not feeling right you should immediately seek medical attention.  Prompt treatment is very crucial when it comes to dealing with the blood flow to such vital organs.  If the problem is caught early, that could mean brain damage could be minimized and other complications would virtually be non-existent.  However, prompt treatment does not always occur in real life situations, so other treatment measures will be implemented depending on the extent of the damage from the stroke.  The good news in all this is that strokes can be treated and prevented even more these days with modern, high-tech medicine.

Following are signs and symptoms that you should be aware of for yourself or your loved one if you think a stroke may be happening.  If possible you should take note when the first signs of a stroke began, because the length of time you have been experiencing them may provide a specific route for your treatment decisions.  These signs and symptoms include:

-  Confusion.  This may be noticed by others and you may find yourself slurring your words, or you may even have difficulty understanding what someone else is saying.

-  Sudden weakness, numbness, or paralysis may be apparent in your face, arm, or leg.  This will usually be one-sided, or felt more so on one side of the body.  If you think this is happening, raise both arms over your head at the same time and if one arm begins to fall without your control, you may be having a stroke.  Also, you may notice that if you smile one side of your mouth may droop instead.

-  Sudden blurred or black-out vision may occur in one or both eyes.  Or, you may find yourself seeing double.

 -  Individuals may say, “I am having the worst headache of my life.”  Generally with a stroke, a sudden and severe headache will accompany it.  This headache may also bring about vomiting, dizziness, or changes in your level of consciousness.

-  You may stumble, experience dizziness with a sudden onset, have a loss of balance, or have a loss of coordination.

Signs and symptoms of a stroke will be unique depending upon the individual involved.  It seems as if we all would rather wait sometimes to see if our symptoms will go away just to avoid visiting the doctor’s office.  However, it is a good point to become familiar with the major signs as listed above because the quicker you get help, the lesser the damage to your body.  The signs and symptoms of a stroke should be taken very seriously.  Head to the emergency room and do not delay if you feel you or your loved one is having a stroke, it is better to be safe than sorry.

Some risk factors for a stroke can be modified by you, and some cannot.  Risk factors for a stroke include: being overweight, physical inactivity, heavy alcohol use, use of illegal substances, high blood pressure, smoking, high cholesterol, diabetes, heart disease, family history of strokes, being over age 55, African-american race, and males are at a greater risk than females.  Complications that arise from having a stroke depend upon what type of stroke is experienced, its severity, and the health condition of the individual that was involved.  These may include: paralysis on one side of the body, difficulty swallowing or talking, memory loss, difficulty thinking, emotional problems, pain, sensitivity to temperature changes and various changes in self-care abilities. 

If you ever suspect any signs and symptoms of a stroke at all, you should immediately seek emergency care.  Timing plays a huge role in the treatment choices that are made if a stroke has occurred.  The treatment option with the best chance of reversing stroke symptoms and definitely putting a stop to any further damage should take place within 3 hours of the onset of your symptoms.  Total Home Health has a program that is right for you or your loved one who has been affected by a stroke.  We understand the severity and how this can affect your life and the lives of those around you.  Our staff will provide you with the best care possible in order to allow you to function at your highest abilities and feel good while doing it.  Our empathetic and highly skilled professionals will be alert to your way of life and will intervene if even the slightest change occurs so that you get all the prompt treatment you deserve.  Never hesitate to approach us at Total Home Health with any questions or concerns, your optimal health is our passion and we’ll make sure you know it!