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From Peter's Deskby Peter Laverty

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From Peter's Deskby Peter Laverty UMC Health System March 2016 From Peter’s Desk by Peter Laverty There are four types of advance directives that I would like talk about this month. You may execute one, or several, depending on your needs and situation. When you make your advance directives share copies with your doctor, your family, and take copies with you to the hospital. Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses. The laws governing advance directives vary from state to state, so it is important, if you leave Texas you will need to complete and sign advance directives that comply with your state’s law in which you move. Also, advance directives can have different titles in different states. 1. Directive to Physicians and Family or Surrogates often referred to as Living Wills. This directive allows you to specify for the provision, withdrawal or withholding of medical care in the event of a terminal or irreversible condition. • One physician must certify your condition. 2. Medical Power of Attorney • This directive allows you to designate another person as your agent for making health care decisions if you become incompetent. • You do not have to have a terminal or irreversible condition for a medical power of attorney to be used. 3. Out-of-Hospital Do-Not-Resuscitate Order This directive allows competent adults to refuse certain life-sustaining treatments in non-hospital settings where health care professionals are called to assist, including hospital ERs and outpatient settings. • You should carry a photocopy of your written form or wear a designated ID bracelet. • This directive cannot be executed for minors unless a physician states the minor has a terminal or irreversible condition. • Note: The PDF form in English must be properly executed in accordance with the instructions on the opposite side (download Spanish instructions separately) to be considered a valid form by emergency medical services personnel. 4. Declaration of Mental Health Treatment • This directive allows a court to determine when you become incapacitated, and when that declaration becomes effective. • You may opt not to consent to electro-convulsive therapy or to the use of psychoactive drugs. • The declaration expires in three years, unless you are incapacitated at that time. If you do not have an Advance Directive or have not provided one to your provider and you cannot make your own healthcare decisions, Texas law gives decision-making power to other people, usually family members. The person would be chosen from this list in the following order. 1. Your legal guardian 2. Your spouse 3. Your adult children who are available 4. Your parents, or 5. Your nearest living relative. Basic Things You Need to Know Advance directive is a general term that refers to legal documents that allow you to give instructions about your future medical care in the event that you become unable to speak for yourself because of serious illness or incapacity. Each state regulates the use of advance directives differently. A directive to physician is a type of advance directive in which you put in writing your wishes about medical treatment, should you be at the end of your life and unable to communicate. This document may be known by different names in different states, such as health care declaration, living will, medical directive, or living will directive. Regardless of what it is called, its purpose is to guide your family and doctors in deciding how aggressively to use life prolonging medical treatments. You may also appoint a health care surrogate to make medical decisions on your behalf. The person you appoint as your surrogate is authorized to deal with all medical situations, not only end-of-life decisions, when you cannot speak for yourself and lack decisional capacity. Thus, he or she can speak for you if you become temporarily incapacitated -- after an accident, for example -- as well as if you become irreversibly ill. Therefore, you should discuss your wishes with your family, and the person you appoint should be someone you trust to carry out your wishes. Other Things You Need to Know Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person’s condition and determines the underlying conditions, advance directives can be implemented. • One state’s advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state’s own law; and some states do not have an answer to this question. The best solution is if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend a significant amount of time in. • Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one. Continued Page 2 Seniors Are Special is a service of UMC Health System and Texas Tech University Health Sciences Center 602 Indiana Ave • Lubbock, TX 79415 • 806-775-8760 Seniors are Special News – March 2016 2 Warning Signs from Your Gastrointestinal Tract People often ask me what it is like being a doctor. I tell them it is very similar to being a detective like Sherlock Holmes. There is a lot of information to sort through, looking for the right clues and contexts in the story to help us make a diagnosis. Some of the important clues we look for are called “red flags.” These are signs or symptoms of something worrisome, needing further investigation. When these are mentioned by our patients, our ears perk up to evaluate further. Here are some red flags that are most concerning as a gastroenterologist.They are never normal symptoms or signs and should be evaluated by your doctor. Difficulty swallowing Dysphagia, or difficulty swallowing, is never normal. This is when food does not go down smoothly from when you start to eat until it hits your stomach; it either gets stuck or slowly moves. This can be due to any number of reasons: narrowing in the esophagus or food pipe, chronic heartburn or reflux, and ulcers in the esophagus. However, the most concerning reason is a cancer in the esophagus causing blockage. Anyone who has difficulty swallowing, feeling like food gets stuck, or painful swallowing needs an evaluation. Most commonly this entails an EGD or an upper endoscopy to investigate and possibly treat what is going on. Bleeding in stool or vomiting blood Seeing blood either in the stool or vomit is concerning. Ulcers, hemorrhoids, polyps, and cancers can cause bleeding. In my opinion, no matter how small of an amount you see or the assumed cause, blood should be evaluated and mentioned to a physician. There are literally hundreds of patients I have seen who tell me they saw a little bit of blood but blew it off and it ended up being something more sinister. Make sure you get that checked out. Black stools There are very few things that can cause your stools to be black but one of the more concerning is bleeding from the stomach, usually from an ulcer. This should be evaluated to determine the cause and prevent any further damage. Yellow skin or eyes This is a condition called jaundice, and usually occurs when one of the bile ducts in the gallbladder or liver are blocked. This is typically painless, but because of that, many people do not seek treatment. This is a concerning sign for physicians, however, because blockage can occur from a gallstone, stricture, narrowing, or cancer. If you notice your skin or eyes turning yellow, don’t ignore it; make sure you mention it to your physician. Nocturnal bowel movements Having diarrhea is a common problem. More often than not, it can be due to irritable bowel syndrome, which is a safe, though annoying, condition to have. Irritable bowel syndrome, however, usually does NOT cause you to wake up in the middle of the night to have a bowel movement; ulcerative colitis, crohn’s disease, colon cancer, and infectious diarrhea CAN. If you notice this make sure to tell your health-care provider. These are some of the clinical clues we use as physicians to help us determine if some of the symptoms you have are concerning for something bad. Though not a comprehensive list, it does give me some idea of how urgent your symptoms may be. If you notice any of the above occurring, make sure to mention it to your health-care provider. Sameer Islam, MD is a board-certified Gastroenterologist and Hepatologist practicing at Southwest Gastroenterology in Lubbock, Texas. For an appointment feel free to contact his office at (806)-761-0747. You can get more information from his webpage (www.sameerislam.com). Will Your Driver’s License be Enough? Residents of several states (including Texas) may soon need a second form of identification to satisfy the Transportation Security Administration. The Real ID Act of 2005, established federal security standards for government-issued ID. While many state driver licenses met these standards, some including Texas did not. Residents of states with licenses not meeting the Real ID Act standards may need to bring their passport in order to satisfy the TSA, rather than relying on their state driver’s license.
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