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You could look it up, but not feasibly in the middle of a consultation in which Mrs B has already moved on to talk about her knee pain ( time pressure bias, knowledge access bias).
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You are aware that adding spironolactone is often used as an add-on drug for heart failure but you don’t know the precise trial evidence ( ignorance bias). You may also be worried about what might happen if you decide not to follow the SpR’s instruction and the patient gets worse ( risk aversion bias). So right away you are in a trap and your easiest way out is to do what you are told ( obedience bias) and what the patient expects ( expectation bias). So Mrs B comes to see you and tells you that the clinic doctor said she should start some new pills to help her breathing. Today her creatinine was 189, K 4.8, Na 131.” The letter has been copied to the community heart failure nurse. Could you please start her on spironolactone 25mg daily and monitor her electrolytes in two weeks. She has just been to the cardiology clinic and the SpR has written to say that “Mrs B reports worsening dyspnoea on exertion. She is already taking furosemide, carvedilol, and losartan (she could not tolerate her ACEI due to cough). Let’s say that your patient is an 80 year old woman with diabetes, angina, and arthritis and breathlessness which has been attributed to heart failure because her LVEF is 32%. This pressed several buttons for me and I found myself writing a rather long case example: Andrew Spooner, an experienced GP and RCGP Council member, suggested that we use the example of spironolactone as add-on treatment for heart failure to debate the key issues. It is far more complex than just using evidence synthesis and decision aids, though these can be valuable in their context.
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Since I retired from full time general practice five years ago, it’s something I have thought a lot about. But there are participants from all over the world too, and from other medical or non-medical disciplines.Ī lot of recent discussion has centred on how we actually share decisions with patients. The group is now a standing body within the Royal College of General Practitioners and most of its members are working GPs. Coller spoke about sleep apnea during a special video premiere Healthy Life Talk.The liveliest e-mail streams I have ever encountered are the ones which are currently coming out of the Overdiagnosis Group, set up by Margaret McCartney last year.
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Talk to your doctor about how to better control allergies.ĭr. Nasal allergies cause the tissues in your airways to swell.
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Sleeping on your side helps keep the throat open.” “If you wake up on your back, roll to your side.
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“Try to stay off your back while sleeping,” Dr.
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Smoking can increase swelling in your upper airway, making snoring and apnea worse. Both can decrease muscle tone in the back of your throat, which can disrupt air flow. Limit alcohol and avoid sleeping pills.A recent study also showed that CPAP therapy increases the ability to be active during the day. Exercise is beneficial to your overall health and wellness, as well as makes you feel more tired so you sleep better. Losing as little as 20 pounds can make a significant difference in sleep quality. According to the National Heart, Lung, and Blood Institute, about half of people who have OSA are overweight. Dry and/or sore throat when you’re not sick caused by repeated gasping, choking or blocked airflow during sleep.Īlong with using a continuous positive airway pressure (CPAP) machine, a common treatment option for OSA, these tips can also help those living with sleep apnea: Waking up to sweaty sheets and pajamas on a regular basis. OSA makes it hard to get enough restorative sleep. Morning headaches located at the front and sides of your head that often last for several hours.
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Feeling sleepy or falling asleep while reading, watching TV or even when driving. In addition to loud snoring, other less obvious signs of OSA include: Without treatment, OSA raises the risk of potentially life-threatening conditions like high blood pressure, heart disease and stroke.” “When breathing stops, the person wakes up, usually with a loud snort or gasping sound, and breathing then continues. Dale Coller, board-certified specialist in critical care, pulmonary and sleep medicine at Holland Hospital Pulmonary & Sleep Medicine. “When people with OSA are asleep, their throat narrows, causing decreased oxygen intake,” said Dr. Their loud snoring doesn’t just make them groggy the next day it often awakens and frustrates their partners. People who have obstructive sleep apnea (OSA) experience repeated breathing pauses during sleep.