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	James L. Holly, M.D.

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Your Life Your Health - How to survive your hospital stay!

James L. Holly,M.D.

August 09, 2007

Your Life Your Health - The Examiner

It may seem unnecessary to define the word "hospital" since everyone knows the nature of a hospital. Hospitals began as charitable institutions for the needy, aged, infirm, or young. The word "hospital" comes from the Latin hospes which refers to either a visitor or the host who receives the visitor. From hospes came the Latin hospitalia, an apartment for strangers or guests, and the medieval Latin hospitale and the Old French hospital. The word crossed the English Channel in the 14th century and in England began a shift in the 15th century to mean a home for the elderly, or infirmed, or a home for the down-and-out. "Hospital" only took on its modern meaning as "an institution where sick or injured are given medical or surgical care" in the 16th century. Other terms related to hospital include hospice, hospitality, hospitable, host, hostel and hotel. The Hôtel-Dieu, a name often given to a hospital in France during the Middle Ages, is "The hotel (of) God." In their beginning, almost all hospitals were run by religious organizations.

Today, hospitals are highly technical, expensive and large organizations which can make a huge difference in your health. In much of what happens in the hospital, you, the patient will be a passive participant, i.e., things are done to you or for you. Yet, while healthcare is increasingly complex and technological, there are several fundamental things you can do to make sure that your hospital stay is positive and beneficial. The first steps you should take in making sure that you receive the maximum benefit from your hospitalization is preparation. Whether your admission is elective or emergent, the same principles apply. Here is what you must do:

Take all the medications which you are currently taking with you to the hospital. Ideally, you should be given a typed list of your medications by your healthcare provider but in the absence of that, you should have a legibly written list and make sure you take the list and the actual medications. You will facilitate your care immensely with this simple step.
Take any legal documents with you which apply to your healthcare such as medical power of attorney or advanced directives.
Take a list of the illnesses with which you are actively dealing and significant past illnesses and surgeries which you have experienced.
Make sure you have a list of the names and contact information of those whom you wish to have access to health information about you. The protection of your privacy requires that the hospital have permission from you or your medical power of attorney before they can release information. It is frustrating for you and for your family if they are unable to get updates over the telephone because proper preparations have not been taken.

The day will come when all of this information will be electronically available in your health data record, but at present it is only available if your physician uses an EMR which is accessible from the hospital. In Beaumont, Southeast Texas Medical Associates, LLP (SETMA) may be the only practice with this capability. Until all practices have that access, you must take responsibility for making sure that all of the necessary information for your care is available.

Once you have arrived at the hospital whether by ambulance or by private transportation, you must take the following steps in order to insure your have a good experience at the hospital. First, you must determine to "keep moving." It is always tempting for us to "go to bed" and stay there when we are not feeling well. And, while you will need rest in order to recover from an illness, your body is dependent upon movement and changing in posture and position in order to stay healthy and/or to regain health. Here are the elements of your care which are dependent upon your remaining mobile:

Your skin - the skin is very sensitive to pressure. Acute pressure such as an injury can damage your skin but so can long-term pressure. Your buttocks were design for sitting comfortably but also require position changes in order to stay healthy. The skin gets thinner as we get older. We also lose the subcutaneous fat in our skin making us more susceptible to skin damage. The blood supply to our skin can also become decrease making our skin breakdown more quickly. If you "mix up" your activity - some sitting, some walking, and some lying down, etc. - you will minimize your hospitalization being complicated with skin lesions.

Your lungs - the natural processes which protect your lungs are compromised when you are laying down all of the time. Clearing secretions and expanding your lungs completely are both diminished when you stay in bed for long periods of time. Postural changes are important to avoid atelectasis (the failure of your lungs to expand completely), or pneumonia (the development of infection in your lungs). Most pulmonary (lung) complications of being in the hospital can be reduced or eliminated by continuing to move.

Your bowels - it is no wonder that bowel regularity often involves an early morning movement of the bowels. When you get up in the morning and start moving around, the natural processes of that activity, of food intact and of gravity, stimulate the bowels to be evacuated. When you eliminate movement and the effects of gravity, you can decrease your elimination. This is not only uncomfortable but can become a significant health hazard.

When James Michener wrote Alaska, the original manuscript was too long. The editors took 250 pages out and entitled it The Journey, and published it as a separate book. The Journey describes the trip from the eastern seaboard to the gold fields in western Alaska. Because the trip could not be completed in one season, the travelers had to build wigwams, or other temporary shelter and "hole up" until the spring thaw made travel possible. Unfortunately some travelers laid down in their shelter and did not get up for weeks and months. Many of them developed "locked bowels" and died as a result. Those who would get up and exercise daily had no such problems. It is unlikely that in a short hospital stay you would have such a problem as this, but it is still important to keep moving.

Your veins - one of the most devastating and preventable complications of a hospital stay is the development of a blood clot in the big veins of the leg. While these blood clots or thrombosis are caused by inflammation in the body, their incidence can be decreased by your remaining active. Muscle contractions caused by walking, changing position, or getting in and out of bed keep the blood flowing properly in all parts of your body.

Your muscles - short term inactivity can cause a significant decrease in muscle strength. One study showed that young men experienced a greater decrease in strength from two weeks of total bed rest than they did in thirty years of aging. Bed rest without activity can contribute to the progressive deterioration of strength, which is experienced by many during their hospitalization.

Your heart - the same study mentioned above showed that two weeks of bed rest cause young men to have a significant decrease in the ability of the heart to extract oxygen from the blood and to use oxygen for the benefit of the body. While short term inactivity will not have the devastating effects as a long-term sedentary lifestyle, the process can begin in the hospital.

Your mental acuity - inactivity will not only cause a short term and ultimately long-term deterioration in your physical capacity, it can and will also cause deterioration in your metal acuity. This differs from the dementia of the elderly and of Alzheimer’s but even those conditions respond positively to physical activity.

To survive the hospital, stay active! There are conditions and procedures which temporarily limit your ability to be active but push yourself to get out of bed, sit in a chair, walk in your room with assistance and/or ask your physician to have physical therapy come help you do these things. It is so simple, yet it is so critical: to survive the hospital - keep moving. The second simple yet major issue which you can impact in surviving the hospital is in eating. Most Americans live to eat, i.e., their life revolves around the social issues of meals and their enjoyment of eating. In the hospital, however, you must eat to live. Obviously, there are conditions which limit or temporarily eliminate your ability to take in nutrition. When those conditions are not present, keep your calorie count and your protein intake up.

The body’s building blocks, those substances which are used by your body both to repair damage and to maintain proper function are the "stuff" of proper nutrition. Nutrition will not cure cancer, no matter what anyone tells you. However, the differences in the outcomes of the treatment of many cancers between those who maintain their weight and those who become malnourished make it clear that nutrition is an important contributor to surviving cancer and the hospital. Your doctor can perform a very simple blood test called a "per-albumin" which is a very sensitive measure of your body’s acute response to your current nutrient-intake status. If you are not getting enough calories or the proper amount of protein, you can receive supplements and when necessary those supplements can be given intravenously.

Within the directions and orders of your physician, make sure your family encourages you to "get up" and "eat up." It is your life and it is your health. And, it is your responsibility to contribute to your success in surviving the hospital.

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