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Keep a visit to the ER out of your holiday plans

Tradition dominates all kinds of holiday experiences, and it's the same in hospital emergency departments at this time of year. Physicians say they generally see the same seasonal collection of illnesses and injuries. But they also say that many of these holiday-busters could be avoided with a little extra care.

Prescription for disaster

Topping the list are people who travel without their medicines, or who get so caught up in the holiday whirl that they fail to take their usual doses.

"Forget something like a blood thinner and they have heart attacks," says Dr. Charles Sand, an emergency medicine physician at St. Joseph's Hospital in Tampa. "All they have to do is miss a couple days and you end up spending your vacation in the hospital."

At particular risk: anyone with high blood pressure or diabetes, and heart patients with stents.

"They figure missing one dose isn't going to hurt. Well, it can kill you if you are on aspirin or Plavix, for example, and you have stents. You gotta keep those open," Sand says of the tiny mesh tubes that hold open blocked blood vessels.

It's also common for travelers to stop taking medications that lead to frequent bathroom stops. "Patients who have heart disease or heart failure, who are on a diuretic, stop taking their medicine because they can't go far without a bathroom break. They will come in with shortness of breath and chest pain," says Dr. Kelly O'Keefe, an emergency medicine physician at Tampa General Hospital. "We can count on seeing those patients every year."

Dietary splurges like nuts, chips, ham, salami and other holiday treats tend to be loaded with sodium, which can make being off a diuretic even worse. "The salt causes patients to retain fluid so they develop those symptoms," O'Keefe says.

Rx: If you forget your drugs, call your doctor or home pharmacy and explain the problem so they can call in an emergency prescription to a nearby drugstore. Make sticking to your regular regimen a priority — try posting reminder notes to yourself. And go easy on the dietary indulgences.

High hazards

Falls from ladders also keep emergency departments busy at this time of year. Whether it's to get one more box of decorations out of the attic, string one more set of lights on the house or take advantage of time off to catch up on maintenance projects around the house, "all it takes is one misstep," says Sand, and you're off to the hospital.

John Reidy knows that all too well. The 78-year-old, who divides his time between homes in Massachusetts and Tampa, decided to tackle an insulation job in his Carrollwood attic on Dec. 16. On one trip down his old wooden ladder, Reidy lost his footing and the ladder toppled; he fell about 4 feet and was caught under the arms by a couple of 2 by 4s. To get down, he aimed for a pile of insulation on the ground, thinking it would break his fall. Instead, Reidy broke a couple of ribs, cracked his pelvis, fractured his skull, injured his shoulder and has been hospitalized since, in terrible pain.

"It was one of those things,'' he said. "I figured I'd do this job myself in a day or two and I got into real trouble.''

Sand, who took care of Reidy in the emergency department at St. Joseph's, says he hears the same story every year.

People who don't normally spend much time on ladders don't realize they're not as agile as they used to be. "And they don't take precautions or have the right backup support, like someone holding the ladder," Sand said.

Rx: Reidy's best advice: Hire a pro to do your repair work. But if you must get up on a ladder, be sure it's a strong one, and get a spotter.

Holidays on the rocks

Drinking and driving accidents nationwide will send hundreds to hospitals and take dozens of lives. Binge drinking — defined as five drinks over about two hours for men, and four drinks for women — can be deadly if you never leave the house. "If you're prone to stroke, and many people don't know if they are until it's too late, studies show just one alcoholic binge can be a trigger," Sand says.

Alcohol, plus holiday stress, can lead to another type of ER visit, notes O'Keefe. He says it's not uncommon for friendly get-togethers to turn into dangerous fights, resolved with guns and knives. "It's the worst," he says. "Usually the result of too much alcohol and too much time in between visits."

Rx: Never drink and drive, and take away the car keys of anybody who appears impaired. As for the family drama, Dr. Francisco Fernandez, chairman of the department of psychiatry and neurosciences at USF Health, advises that you limit your exposure to people who create stress. And be prepared. "For example, if a relative always criticizes your appearance or another always makes rude jokes, don't expect them to change their habits,'' he said.

It's been too long

Another cause of holiday hospitalizations: When family members visit aging relatives for the first time in a year or more, they may not be prepared for how they have declined. "They are shocked to see such a change in their loved one, and their instinct is to rush to the emergency department,'' O'Keefe said. "But it hasn't happened overnight. It's usually just a general dwindling of their health.''

Rx: Before you assume the worst, talk to your relative's nurse, advises Cheryl Harrell, a Tampa licensed clinical social worker who specializes in long-term care. You also can speak to the nursing supervisor, the doctor, the nursing home administrator — and bring in another physician for a second opinion. "When you take a frail elderly person to the emergency room it's traumatic and very disruptive to their lives,'' she said. "If the situation is not life-threatening, go through the chain of command. But do what is best for the elder."

. Gathering the gang?

The holidays are a great time to collect information about your family medical history. Websites, including www.mayoclinic.com, have guides to help you know what kinds of questions to ask — and how to ask them.

Keep a visit to the ER out of your holiday plans 12/22/10 [Last modified: Wednesday, December 22, 2010 6:22pm]
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