Director, Emergency Services, Bikur Cholim Hospital
Mail is coming electronically these days. Feel free to
participate.
We are in the era of aggressive diabetes control. No more
urine tests to see how diabetes is doing. Now many insurance
plans cover the machine to check daily glucoses and a new
machine is able to check these without drawing blood. We now
have pancreatic implants to be surgically put under the skin
to give natural insulin, and we have insulin pumps to better
control blood insulin.
We are also redefining what is diabetes and when medication
is necessary. This tight control is important. It reduces the
incidence of blindness, kidney failure and nerve damage which
could lead to amputations. It also is important in the acute
stage. People with heart attacks and stroke do much better if
their glucose is in check. Mothers with diabetes in pregnancy
also have an easier time if there is tight control.
Still one needs to be careful that they do not overdo it. Low
blood sugar can be dangerous. The best bet is to be educated
about the disease.
By the way, buying sugar-free cakes and snacks is useless. In
order to make these palatable, they are spiked with
indigestible sugars that cause gas and, more importantly,
they have loads of fat.
What is a feeding tube?
Often when people get old, they have neurological damage to
the swallowing mechanism or have an incompetent valve and
they may bring up food that may be sucked into the lungs,
causing nasty pneumonias.
A short-term solution is a feeding tube, called a zonde
in Israel and an NG tube in the states. This does not
prevent vomiting but it bypasses the swallowing problem, as
the food goes through this tube in the nose directly down to
the stomach. This tube is uncomfortable to put in and
uncomfortable to leave in.
A gastrostome is a larger tube that is inserted into the
stomach wall directly into the stomach. It is messy. Stomach
acid and contents sometimes back up, and the skin around the
tube is always macerated. But it reduces the problem with
swallowing, although aspiration is still possible.
Ever see someone with a tube in their neck? These people have
either throat cancer — this comes from smoking —
or they have been on a respirator in the past. The respirator
works by blowing oxygen down a tube in someone's throat but
if this is left in too long the throat will close up. A
surgical incision is made in the neck and the tube is then
inserted there, with fewer problems. In order to talk,
though, they must cover this tube. Or, if they have throat
cancer, they may have to talk through a transmitter which
sounds like a radio.
Currently these two tubes are a large question in the courts
as people who need them are often unconscious. However,
gastrostomes do improve quality of life, and we have had a
few gedolim who were able to be stronger as a
result.
Write me in care of the Yated or
jbleibmd@yahoo.com.
A message from GlaxoSmithKline, sponsor of this
column. Zinnat the antibiotic is really all-encompassing,
but with few side effects. It can be taken by those allergic
to penicillin. It is saving people from hospitalizations, and
covers the lungs, urinary tract and tonsils very well. Safe
in pregnancy as well.
