Dear Dr. Roach: My question is about medical bracelets and necklaces. I’ve never seen any recommendations as to what conditions would warrant wearing one or what the inscription should say. When are they either necessary or beneficial?
D.A.M.
Medical ID tags can be useful. They serve to alert medical personnel of potentially important medical conditions when someone is not capable of providing that information, whether due to temporary incapacity (such as being unconscious in a motor vehicle accident) or permanent disability (such as intellectual disability). In my opinion, the most appropriate use of these tags is when there is a potentially life-threatening medical condition that would not be obvious to emergency medical personnel. Some examples of these would include anaphylactic reaction to medications or latex; the presence of an illness that can cause temporary disability (epilepsy, diabetes, Addison’s disease); and medical conditions that might affect use of some common treatments, such as bleeding disorders, organ transplant status and medical implants (such as implantable defibrillators). Personal and contact information is a natural set of complementary information to have on a medical tag.
Some newer tags include electronic information, but this is in its infancy. These include the use of near-field technology to let emergency personnel read the information (if they also have the technology); phone numbers the emergency personnel can call to get more information; and QR codes to allow emergency personnel with a smartphone to go to a webpage with more detailed information. Most smartphones also have the ability to store information that can be read in an emergency, even by someone without the person’s phone password. I recommend taking advantage of this feature.
Many of the ID tags I see have information that is not likely to be helpful. Listing chronic conditions such as high blood pressure or high cholesterol is not necessary.
Finally, one of the biggest benefits of a medical ID tag is a little peace of mind.
Dear Dr. Roach: My adult son with Type 2 diabetes was recently diagnosed with diabetic gastroparesis. He was put on metoclopramide, hoping to control the intense, constant nausea and abdominal pain. What causes this condition? Is there a cure? What specialist should he see?
G.R.
Diabetic gastroparesis, also called diabetic enteropathy or diabetic autonomic neuropathy, involves nerve damage to the nerves of the stomach and intestines. It seems to be more common in people with Type 1
diabetes.
Longstanding, poorly controlled diabetes predisposes a person to all kinds of nerve damage. Most people are aware of the fact that people with diabetes can develop numbness in the feet, but other nerves can be affected. When neuropathy affects the gastrointestinal organs, it can cause many different specific symptoms.
One of these is gastroparesis, from the Greek roots meaning “paralysis of the stomach.” The nerves do not send the stimulus for the stomach to contract, so food sits in the distended stomach, causing nausea and an uncomfortable abdominal fullness, even pain. Some people will lose weight because they are unable to absorb enough food (this is NOT how you want to lose weight in diabetes).
Metoclopramide is not a good long-term treatment for gastroparesis (or anything else). It can cause a potentially permanent movement disorder in a significant number of people who take it. Those who do use it long term need careful monitoring. Newer medications, surgery and electrical pacing of the stomach are potential new treatments that an expert can talk with your son about. Some gastroenterologists subspecialize in this condition.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
