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

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