May 31, 2016
There are times patients might ask their doctors for medications and tests that might not be necessary and that could cause harm, according to Dr. Ray Brignac, a family medicine physician who practices at University Medical Center-Northport, which is operated by the College. During a lecture that was part of the College’s Mini Medical School program with The University of Alabama’s OLLI program, Brignac said doctors and patients need to talk and to use evidence-based recommendations to make the best care decisions possible. “You need to put as much research into your medical decisions as you do buying a car or a washing machine,” he said. “There’s a lot of information out there. Try to go where the evidence is.” A national campaign called Choosing Wisely advocates just that. The campaign encourages doctors and patients to have conversations informed by evidence-based recommendations that facilitate good decisions about appropriate care based on a patient’s individual situation, and to avoid unnecessary medical tests, treatments and procedures. “The Choosing Wisely campaign gives us good tools to be better informed and wiser,” said Brignac, who titled his lecture “Choosing Wisely in Geriatrics.” OLLI, short for Osher Lifelong Learning Institute, is a member-led program educational program catering to those aged 50 years and older. The College’s Mini Medical School lecture series through OLLI provides an opportunity for OLLI members and community learners to explore trends in medicine and health and to receive important information about issues and advances in medicine and research. Brignac presented on May 3, and Dr. Catherine Ikard, a physician at University Medical Center and UMC-Northport, presented on May 10. Choosing Wisely in Geriatrics Brignac said older people often have more medical conditions and, as a result, take more medications than younger people. While medications have benefits, they also carry risks. “Is it always wrong to take medications? No. But you need to exercise caution,” he said. He noted that sleeping pills help with insomnia, which affects many people over the age of 60, but studies show increased falls by those taking sleeping pills. Antibiotics do not cure colds and have risks, including diarrhea and damage to nerves and tendons. Nutritional supplements have the potential to react with other medications. Narcotics are not always the best way to treat chronic pain and non-drug interventions like exercise and physical therapy are sometimes more effective. Non-steroidal anti-inflammatory medications like Aleve and Ibuprofen are safe but can sometimes cause gastrointestinal bleeding and increased risk of heart attack or stroke, and while acetaminophen, found in Tylenol, is a good medication, if taken in excess can damage the liver. Medications for heartburn and acid reflux can carry higher risk of osteoporosis, but sometimes avoiding certain foods and sleeping with the head of the bed raised can help. “It’s not that you shouldn’t ever take these drugs, but you need to be aware of the risks,” Brignac said. “It’s always good to questions medications – are there alternatives, lower doses?” Many older patients have low back pain and often ask for X-rays or MRIs, Brignac said. He recommends patients wait a month before tests because most back pain clears up in that time. “If you jump right into testing, you can create needless anxiety, or you might wind up under the surgeon’s knife unnecessarily.” Brignac joined University Medical Center-Northport last year after a 34-year practice at Selma Medical Associates in Selma, Ala. In addition to family medicine, Brignac also has an interest in geriatrics and nursing home patients and is working to build a “hands-on” nursing home practice in Northport and Tuscaloosa. Recognizing, Treating and Preventing Strokes If you suspect someone you know is having a stroke, the most important information that can be relayed to the EMT or physician treating that person is the last known well time, said Dr. Catherine Ikard. This will determine the course of treatment. Ikard, assistant professor in Psychiatry and Behavioral Medicine and Internal Medicine, spoke about the causes, symptoms and treatments of strokes at a lecture she presented as part of the College’s Mini Medical School with The University of Alabama’s OLLI program. OLLI, short for Osher Lifelong Learning Institute, is a member-led educational program catering to those aged 50 years or older. The College’s Mini Medical School lecture series through OLLI provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures by CCHS faculty offer important information about issues and advances in medicine and research. One of the best ways to identify if someone might be having a stroke is to ask the person to smile. If the smile is lopsided or there is drooping, the person might be having a stroke, Ikard said. If a stroke is caused by a blood clot, a medication called a tissue plasminogen activator, or tPA, may be given within four and a half hours of the last-known well time, said Ikard. After four and a half hours, or if the patient cannot receive a tPA for medical reasons, endovascular therapy can be used, which involves the use of a stent retriever that a doctor routes through a catheter to the blocked artery and removes the clot, Ikard said. “If you suspect a stroke, call 911,” Ikard said. “If it is a stroke, every 30 minute delay could lead to a 10 percent relative reduction in recovery.”
