Getting in and out of the bathtub or shower may be a dangerous task for many older adults. A study suggests a third of adults over age 60 have difficulty climbing in and out of the bathtub or shower, and more than 70 percent of those with shower stalls use unsafe features such as the glass door or towel bar for support.

“For older adults, losing the ability to bathe is associated with having falls, fracturing bones, and even being admitted to a nursing home. It is important that we take steps to help to prevent bathing disability before it occurs,” says researcher Susan L. Murphy, ScD, OTR, an occupational therapist at the University of Michigan Medical School’s division of geriatric medicine.

In the study, published in the Journal of the American Geriatrics Society, researchers videotaped 89 independently bathing adults over 60 as they demonstrated (fully clothed) how they normally get in and out of the shower or tub. The average age was 82 years, and most of the study participants were women.

Researchers examined their movement and noted if the participants had difficulty negotiating the environment or used things like grab bars, towel bars, shower curtains, glass doors, tub seats, or other parts of the tub to assist themselves.

The results showed that a third of the older adults had difficulty getting in or out of the bath. The most common problem was falling or difficulty positioning themselves onto a tub seat or into the bathtub.

About 30 percent of the participants hit the sides of the tub or the bath seat with their legs during the transfer.

Nineteen percent of the participants using a tub used unsafe features, and 70 percent of those with shower stalls used unsafe features.

The biggest problem was using sliding glass doors in shower stalls for stability or balance. More than three-fourths of older adults who had shower stalls used the sliding glass door for assistance.

“This is extremely unsafe because shower doors were not designed to support a person’s weight,” says Murphy. “This problem could be easily remedied by educating older adults not to use the door as a support or possibly replacing it with a shower curtain, which was used only rarely by older adults in this study.”

The second most commonly used unsafe feature was the towel bar, which was used by about half of the participants.

“While bathrooms in senior housing facilities are designed to be safe, we have found that older adults often do not know the difference between a grab bar and a towel bar. They also have unsafe strategies of getting into and out of their shower or tub,” says Murphy. “We think the results from this study demonstrate the need for health care professionals to become involved in helping to prevent bathing disability, instead of just treating people in the hospital after they have had a fall in the bathroom.”

Taking care of yourself when you have gestational diabetes is very much like taking care of yourself when you have other types of diabetes. But it can be a little scary when you’re pregnant and you also have a new condition to take care of. Don’t worry. Many women who’ve had gestational diabetes have gone on to have healthy babies.

Here are the things you’ll need to do:

Follow your meal plan — You will meet with a dietitian or diabetes educator who will help you design a meal plan full of healthy foods for you and your baby. You will be advised to limit sweets, eat often — three small meals and one to three snacks every day, be careful about the carbohydrates you eat – your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snack, and eat lots of whole grain foods, fruits, and vegetables

Get moving — try to be active for at least 30 minutes on most days. If you’re already active, your doctor can help you make an exercise plan for your pregnancy. If you haven’t been active in the past, talk to your doctor. Your doctor can suggest activities, such as swimming or walking, to help keep your blood sugar on track.

Test your blood sugar — Your doctor may ask you to use a small device called a blood glucose meter to check your blood sugar levels. You will be shown how to use the meter to check your blood sugar. Your diabetes team will tell you what your target blood sugar range is, how often you need to check your blood sugar, and what to do if it is not where it should be.

The following chart shows blood sugar targets for most women with gestational diabetes. Talk with your health care team about whether these targets are right for you.

Blood glucose targets for most women with gestational diabetes:

On awakening not above 95 mg/dL
1 hour after a meal not above 140 mg/dL
2 hours after a meal not above 120 mg/dL

Each time you check your blood sugar, write down the results in a record book. Take the book with you when you visit your health care team. If your results are often out of range, your health care team will suggest ways you can reach your targets.

Take your diabetes medicine exactly as your doctor tells you. You may need to take insulin to keep your blood sugar at the right level. If so, your health care team will show you how to give yourself insulin. Insulin will not harm your baby — it cannot move from your bloodstream to your baby’s.

What are the signs of diabetes?

• being very thirsty
• urinating a lot
• feeling very hungry
• feeling very tired
• losing weight without trying
• having sores that are slow to heal
• having dry, itchy skin
• losing feeling in or having tingling in the hands or feet
• having blurry vision
• having more infections than usual

If you have one or more of these signs, see your doctor.

Ulcerative colitis is a superficial inflammation of the large intestine, not caused by bacteria, which results in ulceration and bleeding. The patient typically experiences alternating periods with no or few symptoms, and periods with frequent stomach pains and diarrhoea that is mixed with pus, blood, and mucus.

The exact cause of ulcerative colitis is unknown. Hereditary, infectious and immunological factors have been proposed as possible causes.

The symptoms of ulcerative colitis can vary considerably. The disease is characterized by periods with diarrhoea, mixed with pus, blood, and mucus, which alternate with periods of few or no symptoms. When the colitis is active, the patient often has mild stomach pains, and sometimes a fever. The symptoms vary according to the extent of the disease. A quarter of patients only have the disease in the rectum, which means that the symptoms are fairly mild. In one third of patients, the disease also affects the lower part of the large intestine. In the remaining patients, ulcerative colitis affects all of the large intestine.

Flare-ups cannot be prevented, but the severity and extent of the attacks can be reduced. It is important that affected people follow preventive treatments carefully, watch out for symptoms, and consult their doctor if there is blood in their stool.

Diagnosis:
Stool specimens are collected for cultivation and microscopy to exclude infection caused by bacteria and parasites. The diagnosis is confirmed by means of an endoscopy in the large intestine and the rectum. Small tissue samples from the mucosa are usually obtained during the procedure, which can in many cases confirm the diagnosis. An endoscopic examination of the entire intestine (colonoscopy), or a barium enema X-ray examination can help determine the extent of the disease. Blood samples can help determine the severity of the inflammation, and show whether the patient suffers from anaemia (low haemoglobin count).

In rare cases, life-threatening bleeding, perforation of the intestine, and inflammation of the abdominal cavity may occur. Malnutrition and inflammation of joints, eyes, and skin. The risk of colon cancer and rectal cancer begins to rise after 10 years of ulcerative colitis.

When the disease is active, it is often treated with tablets. When the disease is in remission, the treatment often continues in order to suppress the inflammation. Medical treatment is usually sufficient. If the disease cannot be controlled by medical treatment, it can be cured by surgical removal of the large intestine. In having the removal of the large intestine you may be required to use a pouch or bag.

Which medicines can be used?

Corticosteroids to reduce inflammation. Enemas and suppositories are used for mild to moderate symptoms in the rectum. Tablets are used for moderate to severe symptoms and more extensive disease. Hospital admission and injections of corticosteorids are required for very severe symptoms and extensive disease.

Aminosalicylates, as tablets, enemas or suppositories. These are anti-inflammatory medicines for the treatment of mild to moderate symptoms. They can also be used continuously to prevent attacks.

Immunosuppressants, such as azathioprine (eg Imuran) are used for very severe symptoms that cannot be controlled by corticosteroids (unlicensed indication).

Eczema is an inflammatory skin response. It is chronic and has flare-ups and remissions. It is not contagious. Some eczema may run in families with a history of allergies. There are various types of eczema: some caused by allergies or irritating chemicals, others the result of other medical conditions such as varicose veins. In the early states the condition is characterized by dry, red, itchy skin. An acute attack may produce crusty scales or blisters.

About 10% of Americans suffer from atopic eczema. In 70% of the sufferers the condition runs in the family. Symptoms may clear up after a week or two or may persist for years, resulting in a chronic condition. Treatment may also vary from person to person.

One of the most useful tools for a healthcare provider is to have a great deal of information about the symptoms and general habits of the child. Consider keeping a symptom diary of daily habits and routines for a two week period prior to a medical appointment. You should take care to note when your child voids during the day and night, when accidents occur (time of day or night), the amount of urine voided, drinking patterns (does your child drink a lot of fluids in the later afternoon/evening? Does your child get up to drink something during the night?), what your child drinks (sugary fluids, caffeinated, etc.), when constipation occurs, if fecal soiling occurs, the nature of the urinary stream (is the urinary stream is strong and constant? Is there continuous dribbling?), if there are recurrent infections, and the number of wet versus dry nights. Any and all of this information can help a healthcare provider determine the cause of the problem and the appropriate treatment.

At the time of the appointment, you should be prepared to supply such information as well as questions related to medical history, medication, and family medical history. In addition to helping you find options to help cure bedwetting it is also important that you see a healthcare provider to rule out any other more serious problems that may cause bed wetting as a side effect.

Treatment Options

A variety of options are available to end bedwetting. Effective treatment for bed wetting has also been show to greatly improve the self-esteem of the child. Treatment options may vary based on the severity of the problem, the age of the child, the impact on the family. Both pharmacological and behavioral treatment options exist. To better combat the problem a combination of treatments may be used if necessary.

The most important aspect of all treatment options is the child’s involvement in treatment and motivation to dedicate the time and energy necessary. For this reason, some younger children may not be motivated and ready for treatment. This should be considered and if necessary treatment postponed until the child is ready.
It is also important for parents to be motivated and supportive of the child.

Behavioral Treatments Include:

Withholding Fluids: Limiting a child’s intake of fluids in the late afternoon and evening before bedtime, thereby causing a decreased amount of urine at night, may be a helpful first step to reduce wet nights.

Urotherapy : This behavioral treatment option implements a regular schedule of voiding during the day with voiding occurring every 2-3 hours.

Wakening: This treatment option involves the parent either randomly waking the child during the night or at schedule times once the child is asleep in order to urinate. If choosing this option, it is very important that the child be fully awake and aware. Otherwise the process encourages urinating while sleeping. This option also requires a high level of parental involvement to wake the child in the middle of the night and put them back to bed.

Reward System: While the child cannot control nocturnal enuresis, this option involves positive reinforcement of behavior the child can control, such as voiding before bed and at regular times during the day, as well as helping clean sheets and strip the bed. Rewards in some cases have consisted of sticker charts for positive behavior with a prize when a certain number of stickers have been won. Punishments for wet nights or rewards for dry nights are NOT appropriate as the child has no control over these.

In any case, until they are able to overcome this it is best to use underpads in bed in order to keep the urine from getting to the mattress.

Foods rich in cocoa appear to reduce blood pressure but drinking green and black tea may not, according to an analysis of previously published research in the Archives of Internal Medicine, published by the American Medical Association.

The drop in blood pressure among participants who consumed cocoa products for at least two weeks was in the same range as achieved by someone taking drugs commonly prescribed to control high blood pressure.

Both cocoa and tea contain polyphenols, a class of chemicals known to help prevent cardiovascular disease that are present in most fruits and vegetables. But cocoa has a different type than tea — procyanids — that appear to be more active.

Treats such as dark chocolate might be substituted for other high-calorie desserts, based on the study’s findings, but “we believe that any dietary advice must account for the high sugar, fat and calorie intake with most cocoa products.

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Adapted from the American Journal of Obstetrics and Gynecology 1996

The change from the recumbent position to standing produces acute hemodynamic changes that are exaggerated during pregnancy. The result is that in the third trimester, standing can produce a decrease in blood pressure and cardiac output, followed by increases in maternal heart rate and systemic vascular resistance. To compensate for the positional change, chemical compounds derived from the amino acid tyrosine, catecholamines, are released to increase vascular resistance and normalize blood pressure and heart rate. Graduated compression stockings have been shown to reverse these effects.

The authors conclude that the use of support stockings during pregnancy is associated with favorable cardiovascular effects. They point out that support stockings may be useful clinically to reduce contractions that occur in pregnant women on standing. Thus, use of compression stockings during pregnancy appears to promote beneficial hormonal, mechanical and cardiovascular effects.

The flow of blood leaving your legs is rather sluggish when you’re stuck motionless in a seat during air travel. It tends to encourage an accumulation of fluid in your feet (gravitational edema). Ordinarily, the muscles of the leg, and particularly the calf, act as pumps to encourage the main veins in the leg to empty upwards. Just walking does most of the work in this respect.

To minimize the problem during air travel, it is suggested that you keep your feet moving, constantly stretch and flex your calf muscles, get up and walk about the airplane every half an hour or so.

An additional option would be to wear support stockings for the duration of the flight. It is best to use an above-knee stocking that has been measured to fit properly. There are a few folk who should not use support stockings. They tend to be older people with poor arterial blood supply to the legs.

If, however, you are getting swollen legs in your everyday life, then that is something you need to discuss with your own doctor so that it can be investigated further. I hope this helps.

The National Associate for Continence (NAFC) has prepared this Bladder and Bowel Control Diagnostic Tool to help you determine and understand the type of incontinence your symptoms indicate. This web tool is not meant to substitute a diagnosis from a qualified healthcare provider and is not provided by Disposable Medical Express.