The Douglass Report October 2013

October 2013 PDF

Into the hospital... and out of your mind!

You might not be nuts when you go into the hospital... but there’s a good chance you will be by the time they’re done with you.

Every single day, healthy seniors are transformed into raging lunatics, battling the demons of delirium——a frightening condition where you quite literally go out of your mind.

New numbers show that a third of all hospitalized seniors, half of seniors given anesthesia during surgery and as much as 80 percent of all seniors in intensive care units battle some form of this living nightmare.

Delirium has different symptoms in different people, but it’s often marked by hallucinations, delusions, paranoia, voices in your head and just plain nutty behavior.

In some cases, that behavior could turn violent and you could find yourself strapped to your hospital bed so you don’t hurt the nurses. That, of course, only makes it worse——making some of the most paranoid delusions seem even more real.

Some seniors refuse food——in some cases because they believe it’s poisoned. (They may have a point. Have you tasted any hospital food lately?)

And along with losing your mind, you could also lose your memory——so much so that it could actually look like sudden-onset dementia.

Some docs will even tell your family that’s just what’s happened——because most of them have no clue as to what’s really going on. One recent study finds that hospital doctors either miss or misdiagnose delirium a stunning 76 percent of the time.

Most of them assume they’re dealing with a rotten patient packing an attitude problem. And in most cases, they’ll sew you up and send you home——or, in the ultimate indignity, to a nursing home——and not even care for a moment that you’re drooling and can’t remember your own name.

And when you’re in that state, you’re not exactly in a position to help yourself.

That’s why the time to act is now, when you’re home and have all your wits about you. And you can start by knowing the risks and how to treat them——starting with my...


#1) Anesthesia: Some 45 percent of all seniors given anesthesia during surgery suffer from at least some form of delirium afterward——and most doctors will blame their age.

But that’s not the real problem here. No, the real problem is that anesthesiologists are absolutely clueless when it comes to knocking seniors out.

Seniors are supposed to get lower doses than other adults. For the drug propofol, for example, they’re supposed to get half the dose given to younger adults——but one recent study found they’re often given MORE than other adults and a median of 75 percent more than what they should be given.

No wonder they’re going nuts!

Along with increasing the risk of delirium, too much anesthesia can lead to dangerous drops in blood pressure and postoperative cognitive dysfunction——a dementia-like condition that could last for weeks or even months.

And in some tragic cases, too much anesthesia can lead to death. (Just ask Michael Jackson; propofol was one of the drugs that did him in.)

THE CURE: Time alone will usually do the trick. As the anesthesia wears off, in most cases your mind will come back. (Or most of it, anyway.) Some nasal oxygen will help as well.

That’s why it’s critical to have a sit-down with your anesthesiologist BEFORE the surgery, let him know your concerns and make sure he understands the proper dose for a senior.

Tell him you want the lowest possible dose for the shortest period of time.

#2) Medication: Seniors are often given drugs in the hospital they don’t normally take at home. And they’re often given a cocktail of drugs that could drive even a young and healthy person out of his gourd.

Some drugs are worse than others.

For example, seniors in hospitals are often pumped full of Benadryl to deal with everything from allergic reactions to a stuffy nose (blame all the germy recycled air). But Benadryl——aka diphenhydramine——can increase the risk of delirium by 70 percent in hospitalized seniors, according to a Yale University study. Benadryl is an excellent sedative if not overdone. The problem is it too often is.

Other antihistamines, sleeping pills, anticholinergic drugs, antidepressants, painkillers (especially narcotic painkillers), central nervous system depressants and lidocaine can all cause or contribute to delirium.

THE CURE: Your doc needs to find the drug causing the problem and remove it——and he can start by getting rid of anything that’s new that you don’t absolutely need.

More importantly, he needs to understand what the cure ISN’T——because many docs try to “cure” the delirium by adding even more drugs to the mix.

And that’s a recipe for tragedy——because these drugs can actually make the condition worse. The drug rivastigmine, for example, can actually add two full days to a battle with delirium, according to one major study.

#3) Complications:  Many hospitals have a different definition of success from the rest of us. When the decisions are left up to some less-than-scrupulous hospital bureaucrats instead of the doctors it doesn’t matter if the operation has left you looking——and feeling——as though you’ve just been hit by a truck,  if you’re still breathing you’re a success.

What does the patient really want? They want to go home but the doctor, not the patient or hospital, must make that decision. And all too often that's not the case. As a result, many seniors suffer from complications——sometimes very serious ones——that go undiagnosed, and many of them can lead to delirium.

One common complication is hypoxia, or low oxygen. Another is hypercapnia, or too much carbon dioxide. Both conditions can drive you into delirium. Anemia, infections, a minor stroke, electrolyte imbalances and thyroid problems are all common after surgery, all often undetected and all could lead to delirium.

Heart failure, kidney failure and liver failure can also lead to delirium——but if you suffer from any of those, delirium will be the least of your concerns.

I emphasize that good hospitals, meaning free enterprise hospitals, seldom make these mistakes. Yes I know a majority of people cannot afford luxury, high quality care. I can’t afford a private jet either. Life can be cruel. I have traveled the world and without exception, government medicine is inferior to private medicine. An example: Finland has medicine as good as it gets but the government medicine is less than optimal.

THE CURE: The reason these conditions often go undiagnosed and undetected is that hospitals rarely test for them, even in cases of delirium. The key here is a doctor with the intuition to know when something’s wrong——and the smarts to find out what it is.

Now, it’s one thing to KNOW all these causes and cures now. It’s quite another to be able to DO SOMETHING about it later——because if you’re in the throes of delirium, you’re not going to know what’s going on. And it’s not like anyone’s going to listen to the crazy person chained to his bed.

That’s why it’s critical that the entire family knows about the risks, the causes and the cures——so if delirium strikes after your surgery or ED procedure, they can get help.

This is important in all three steps, but it’s especially important in #3——because in some cases, simply telling the hospital that something is wrong may not be enough to get you the attention you need.

In fact, your family may need to fight, fuss and raise a stink until someone in a white coat takes it seriously.

It’s not just your sanity that’s on the line here. If your delirium is being caused by heart, kidney or liver failure, your very life is on the line.

So ask your loved ones to come and keep watch over you——and to be prepared to pull out the boxing gloves if they have to.