Wednesday, March 26, 2014

Treatment of severe patients -- Dr. Lapp's lunchtime lecture

In order to fit in everything they wanted to tell us, Dr. Lapp even spoke during the lunch break.  I missed a few minutes at the beginning by going out to get some food.
 
treat the sleep problem first
 
tell the patient that the pain cannot be totally relieved
 
there are only 13 papers on the severely ill
 
Cardiac Output -- Peckerman AmJMedSci 2003; Hurwitz ClinSci (London) 2009
 
Should we treat for mild congestive heart failure?
 
hypovolemia -- rehydrate the blood volume with saline
 
DON'T ATTRIBUTE ALL SYMPTOMS TO CFS/ME/FM -- You may miss something new
 
no medication known to help "tired but wired"
 
He recommends supportive counseling (a "coach"), rarely psychiatry -- help the patient accept and adapt
 
aromatherapy -- orange for alert, lavender for relaxation
 
balneotherapy -- mineral bath
 
prognosis is better for adolescents -- Burgess & Chalder (2011) followed teens, they returned to school full-time (but no gym classes) and gains were maintained at 3 years
 
Hill/Tiersky/Natelson (1999) -- 23 severe patients, 13 remained severely ill over 4 years
 
 
 

No comments: