Entries for the ‘Normal Health’ Category

What interesting bit of information did I learn on the Rachael Ray show?

Thursday, September 8th, 2011

September 8, 2011

Imagine my surprise when I was listening to Rachael Ray’s cooking show and one of the guests was a female doctor who talked about a number of important health issues and took some questions from audience members. I was surprised that this guest was on a cooking show. But then I was surprised by some of the information she discussed.

Along the way, she told the audience that they should refrain from sexual intercourse for 24 hours before having a pap smear to screen for cervical cancer.  The reason for doing so is to increase the accuracy of the test results. I always receive written guidelines about preparing for my annual mammogram, including such things as not to wear deodorant or powder or lotion. But I have never received any guidelines about preparing for a pap smear. Not on an appointment reminder card. Not face-to-face with the person checking me in. Not from my doctor. Not in passing in conversation with other women.

I wonder how many dollars we would save if women knew to avoid sexual intercourse for 24 [the recommendation in the attached summary says 48] hours before an appointment for a pap smear and followed this advice. Apparently, sometimes the test result will show something that seems to be a problem but isn’t because a woman has had sexual intercourse.

I looked online and found some guidelines at http://womenshealth.about.com/cs/papsmears/ht/preparepapsmear.htm. I guess I will make it a goal to check whether there are things I should do to prepare for screening tests I have from now on. I suspect if you are like me, getting these things done on the prescribed timetable is hard enough. Too easy to procrastinate. I sure don’t want to have to them again just because I wasn’t prepared properly the first time.

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What’s wrong with these questions?

Saturday, February 12th, 2011

February 12, 2011

“What are you doing in your free time?” “What do you guys eat?” “Do you have a problem eating healthy?” “Why is tanning so important to you?” “Do you have an eating disorder?” “Do you think you have a problem with eating healthy?” “Do you choose white or whole wheat bread?” “How were you raised?” 

Each of these questions has the potential to seem critical. Asking someone what they do with their free time…could be a friendly rapport-building question in the mind of the person asking the question. But it also has a risk related to seeming to imply that there might be a right or a wrong answer. And if that is true, if you ask me the question, I am going to want to appear to be the kind of person who spends my free time doing things that fit my sense of self. I don’t think of myself as “lazy” and so if I tell you that I like to watch “Survivor” or “American Idol”–will it seem like I am lazy?    

And asking me what I eat–when, yesterday, today, over the holidays, when I eat alone, when I am at work? Again, there are so many ways to think about that question and how my answer may say something about me that I don’t want it to say. So, how about if I just say, “It depends,” is that helpful in suggesting how to guide my eating habits?

And what about tanning? I heard that you need some sunlight to get enough vitamin D to help avoid osteoporosis. So why shouldn’t tanning be important to me?

The questions and our answers are likely to be linked to telling us to change our behavior, and we have some instinct about that as well. Most of us like to make smart choices. So a little bit of coaching can go a long way toward helping… But, just telling us “to stop tanning,” or “don’t eat junk food,” or” find more time to exercise…” –well, we’ve heard it all before.  

When we talk about health, it helps to think about the fact that most of want to be liked by others or at least to have a chance to show how what we do matches who we think we are…most of the time.

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How does bad news about our health affect us?

Friday, January 28th, 2011

January 28, 2011

One of the blogs I follow is Belinda Brasley’s, ‘Losing vision, Gaining insight…’ http://losingvisiongaininginsight.wordpress.com/2011/01/27/to-blog-or-not-to-blog/ Her journey with low vision is so parallel with my own that it is at times uncanny…. She puts into words my own experiences, including how she feels about low mobility training, using a cane, and other aids to adapt to losing one’s eyesight. Today, her post addresses how she felt at the news of having lost even more vision after being stable for some period of time. It made me think about how any kind of bad news about our health can drain us emotionally and physically.

In part, we go through a number of stages when dealing with bad news about our health. It takes some time to understand and it can make us angry. We need to grieve about what we have lost. We need to understand what it means for all the other parts of our lives, including relationships and plans we had for the future–work and play. Gilotti, Thompson, and McNeilus wrote about how bad news delivery is perceived in a 2002 article in Social Science and Medicine http://www.ncbi.nlm.nih.gov/pubmed/11999499. In short, it is not a good time for small talk. And it is probably not the best time to go into a lot of information about the situation. As I said, it takes some time… Being ready for all of that information will be an important part of managing the bad news.

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If you are driving or traveling during the holidays, do you know you are at risk to form blood clots?

Tuesday, December 21st, 2010

December 20, 2010

119_1944a3Tens of thousands of us develop blood clots each year. Sometimes, they start as a pain in your thigh. Often, the cause is too little movement for too long a period of time. Hence, the need to take breaks and walk around if you are traveling in a car. Get up and move about on the plane or train or bus. Stretch your toes forward from your ankles when you are sitting and then pull your toes back. Repeat half a dozen times.

Stay hydrated. Drink water and not alcohol. For more advice about traveling and blood clots, visit  http://www.mdtravelhealth.com/illness/deep_vein_thrombosis.html.

AND, talk to your family about this. Ask, “has anyone had a blood clot?” Your family history may predict greater than average risk. All of us need to avoid cramped spaces and long periods of not moving around. Some of us may have a family history that suggests we should be tested for genetic contributors to clotting. You won’t know if you don’t…ask.

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Does drinking diet soda cause osteoporosis?

Tuesday, October 12th, 2010

October 11, 2010

As I observe in the chapter, ‘What are my risk factors?’, we have a lot of competing goals in life that put being healthy in competition with other things going on.  I was attending a conference and met a graduate student who was on crutches. I asked her what happened. She said that she had a fractured pelvis and it was blamed on osteoporosis. She told me that her osteoporosis was caused by drinking too many diet sodas. I decided that I would find a research review article about osteoporosis to share with my undergraduate health message design class. I did. And it reported that the evidence is inconclusive about a link between diet soda and osteoporosis. There was a collective sigh of relief from my students about that statement. Until I asked them, “How would we draw a conclusive link between drinking diet soda and osteoporosis? Why isn’t the research finding considered to be conclusive?”

And so, we launched into another discussion about self-report data and relationships based on having a condition versus  not having the condition. “How much diet soda do you drink each day?” I asked. Some were able to answer, while others said, “It depends…” “On what?” I asked. “How hot it is outdoors.” “How much money I have.” “…you know.”

“I do.” imgp1303I know that we often build  an understanding about health conditions based on asking people questions. As a form of communication, asking people health questions is both an art and a science. How do we ask a question in a way that someone can give us an accurate and complete answer? If asked about how  much diet soda you drink on an average each day, how do you decide to respond if you only drink diet soda when it is hot? Do you say, “none,” because it is winter? Do you respond “less than one a day” because you divide it out and even though you may drink a six-pack a day in the summer, summer is only really two months long…so it seems to average out to…less than one a day?

Trying to answer a question about how much diet soda has been consumed for a survey that may later be used to relate to participant responses about whether they had been diagnosed with osteoporosis or not may give some evidence to support a relationship. But the evidence is not…strong. If there are enough survey participants to consider all those who consume large quantities of diet soda and divide them into two groups–those with osteoporosis and those without osteoporosis, one might find that there are significantly more with the condition than without… This provides another kind of evidence.

If we think about what bones are made from…and we take diet soda and soak a bone in it…either or both may also provide some evidence that drinking large quantities of diet soda weakens one’s bones and contributes to osteoporosis. But we are not going to have a medical research study in which we give a randomly selected group large quantities of diet soda in order to see if their bones become weak… So, yes, this story of a student whose doctor was willing to tell her, “Stop drinking a six-pack or more of diet soda a day. In fact, stop drinking diet soda–period–and maybe we can prevent more bone deterioration,” imgp13045suggests that her doctor used the evidence of a patient before him to guide a recommendation that the published medical research says was based on inconclusive data… And I say, “Let’s be truthful about what we mean when we talk about the data and the evidence. Let’s be willing to consider the ethical boundaries of research studies. Let’s realize that ‘inconclusive data’ sometimes means that a clinical trial, the gold standard of medical research, is not appropriate and so, there will never be “conclusive data”…

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What does the “food pyramid” tell us about health communication and ‘old science’, ‘new science’, ‘conflicting science’, and no science’?

Monday, May 3rd, 2010

143_07811May 3, 2010

I cannot recall the first time I heard about the ‘food pyramid’ but it was decades ago.  The United States Department of Agriculture [USDA] online site at http://www.mypyramid.gov/ provides an overview of the research in this area. Right under the image of the pyramid on the homepage, the follow sentence is bolded: “One size doesn’t fit all.” Over to the left of the pyramid, the heading, ‘Specific Audiences,’ includes ‘Preschoolers’, ‘Kids’, ‘Pregnant & Breastfeeding’, and ‘General Population’–giving us a sense of groups whose needs vary. Skimming through some of the information, it doesn’t take long to affirm one of the points that I make in my book, Talking about health

When communicating about health, sometimes there is no science to guide prevention guidelines, diagnosis, or treatment. A quick review of the history of the food pyramid shows that even before vitamins and minerals had been discovered, the USDA provided dietary guidelines–the first time appearing in 1894. The first food pyramid was published in the 1960s. The goal is to help us know how to talk about food and nutrition without having to be an expert. So food is divided into groups and we gain a sense of how much of each group adds up to a more versus less healthy diet.

Often, what we know in any area relating to health is based on ‘old science’ that we learned in school several years or even decades ago–forgetting the simple fact that times change. New knowledge is generated everyday. If asked, we know this truth. The trick is to apply it when we are communicating about health. ‘New science’ may support the ‘old science’ or build on its core idea. ‘New science’ may also conflict with ‘old science’ creating doubt and indecision. It is helpful when talking about health to consider the ‘age’ of the science we are using and also the characteristics of the people the science is based on. As suggested by the latest food pyramid, when science takes into account the ‘age’ of and audience, the food pyramid looks slightly different for different groups…

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What is Dr. Besser telling us when he says, “There is no ‘evidence’ that herbs work for a cold”?

Tuesday, March 30th, 2010

143_0779March 30, 2010

Spring is in the air and hopefully, you are not suffering from a spring cold. Or allergies. This morning on, “Good Morning America,” Dr. Besser talked about health information and social media–offering cautions about ‘advice’ that might appear on Facebook or other outlets, or health information sent via tweets.

After offering the general advice to be careful about what we believe, he focused on an example relating to the use of an herb to fight a cold. He made the statement I used in the title for this post: “There is no evidence that herbs work for a cold.” O.K. What’s wrong with that statement?

From a health communication perspective, this kind of comment is made often. If Dr. Besser or another source of the comment is someone we trust and believe to be an expert, we may accept the comment without further thought. We are usually not expert in health. Not surprisingly, we look to experts in health to guide our understanding.

But here is the problem I have with such statements. They do nothing to help us become more competent in making decisions for ourselves about health information. Dr. Besser could explain that there is no evidence and also explain what he means by evidence. For him, evidence = scientific data. Those numbers are usually the result of carefully conducted clinical trials. Those carefully conducted clinical trials cost — well a lot of money. And relatively few dollars are spent on research to study complementary and alternative medical practices–such as the use of herbs to fight colds.

The traditional approaches to health in the U.S. are prescription and over-the-counter drugs, and surgery, and the use of medical devices–many device relate to surgery and others that boost some of our ability to manage our own health. There are many expensive funded studies to evaluate the effects of these approaches. Based on the results, evidence is published and then disseminated to guide our doctors’ knowledge and our care.

We should realize that the research by pharmaceutical companies sometimes looks at herbs and works to understand how they might work to help or harm human health. Finding that an herb works may lead the drug company to produce synthetic versions of  the herb and conduct research to see how they work. After all, we and our doctors do not live in the era of Dr. Quinn, Medicine Woman and cannot go into nearby woods to pick herbs to make teas or other potions to heal us. Medicine generally needs products that can be sold in mass quantities.

So, what does a lack of evidence mean when it comes to Dr. Besser’s statement? It means that no scientific clinical trials have shown the use of the ‘natural’ herb to be effective in reducing the effects of a cold.

Dr. Besser’s statment is not considering that your friend, your neighbor, or a thousand friends and neighbors on a social media site have used the herb and tell their stories about how it worked for them. It is not addressing the fact that we often trust the stories of others as ‘evidence.’ But it is not the same kind of evidence as science would provide. That is something he did not say. From a health communication perspective, we want to know this to help us better understand health information.    

He also did not say whether the herb being promoted for a cold is one that drug companies may have or may be studying in some form. From a health communication perspective, we also want to know this to help us better understand health information…

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Do we want doctors to tell us if we have advanced cancer?

Thursday, February 18th, 2010

117_1755February 18, 2010

In 2002, Hisako Kakai published an article in the journal, Health Communication, about preferences for disclosure of a cancer diagnosis. Dr. Kakai indicates that in Japan, a direct communication style is usually preferred when it comes to disclosing one’s personal diagnosis of cancer. In other words, people want to be told they  have cancer. However, an indirect communication style with no disclosure, or an ambiguous disclosure to the patient was preferred for a family member. The article raises many interesting communication and ethical issues.   

A serious diagnosis raises the question, ‘how do we deal with uncertainty?’ Communication plays a big role. It points to the reality that we often are not good with dealing with uncertainty. We frame uncertainty as ‘bad’ and let uncertainty overtake everything good that might be going on in our lives. This relates to how we communicate about a serious health condition. It also relates to how we communicate about the economy, about security, and about an endless number of issues that equal being — human.

The message communicated often to us is, ‘work hard and it will pay off’ — with payoff crossing a spectrum from health, relationships, and wealth. The message, ‘life is uncertain. Work hard at your relationships and school and work, and take satisfaction in the fact that you worked hard’ — is communicated less often, if at all. And it shows up in our inability to deal with uncertainty, our obsession with …reducing the uncertainty.    

Should the goal in communicating be to reduce uncertainty? When it comes to our health, that may not always be the best aim. If we can learn to manage the uncertainty of a diagnosis, we may be better able to live our lifes as someone living with cancer or heart disease or diabetes. If we make the diagnosis a more integral part of our being and identity, we may communicate in ways that define us to others as being disabled rather than living with a disability, diabetic rather than managing life while living with diabetes, and so on.  

Even more surprising, when we focus on managing our uncertainty as a part of life, we may even discover that there are times when we communicate to increase uncertainty. Instead of being certain that our future, our health, our well-being are uncertain and that is a bad thing, we can use uncertainty as a way to promote hope. In our own research, Ben Cairns and I found that this was particularly important for people who have newly experienced spinal cord injuries and their family members. ‘Will she walk again? Will he be able to do things for himself? Can she sit up on her own? Can he feed himself?’ Not knowing offers people living with the injury and their families and friends the hope that they might do these things again. 

Communicating to increase uncertainty about a diagnosis thus gives some time to adapt to a diagnosis. And that may be the best and more ethical way to communicate about an advanced cancer diagnosis as well. Not telling so that a patient does not know a true diagnosis may seem to offer a way to manage a serious diagnosis and thus to reduce uncertainty. Telling and acknowledging that the diagnosis is serious, even very serious, but that predicting exactly when the end-of-life will happen is uncertain may give some time to adapt to the diagnosis and some hope that important things that have not been said can be…

…a lesson in Dr. Maureen Keeley’s award-winning book, Final Conversations that has been shown to be so important for those who know that they are dying and the loved ones they will leave behind.

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Why should we keep track of our use of vitamins and other supplements and who should we tell?

Thursday, February 11th, 2010
February 11, 2010

 

119_1917aTaking vitamins is the number one way that U.S. citizens ‘complement’ the formal health care they receive. This is a finding that has been consistent for some years and the 2005 Institute of Medicine Report about use of complementary and alternative medicine [ http://www.iom.edu/Reports/2005/Complementary-and-Alternative-Medicine-in-the-United-States.aspx] considers this reality as well.

Many debates about using vitamins, minerals, and other supplements — including garlic or herbs or cinnamon or ginger — focus on getting us to eat ‘healthy’ rather than depending on vitamins to make up for a diet that may be lacking. Other debates focus on the cost of ‘unproven’ therapies.

Whatever the debate, keeping track of use increases our ability to report use to our doctors. Talking to our doctors about use may make the difference between a therapy working or not. Many prescribed medications have been found to interact with different vitamins and other supplements, spices, and/or herbs. Sometimes, we need more or less of a medication based on use. So keep track and talk about use to avoid harmful effects.     

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What is race-based medicine?

Sunday, January 31st, 2010

Winter afternoonJanuary 31, 2010

Medical research has shown that there are some patterns linked to racial group categorization in how some medicines work. Some medicine may metabolize faster or slower for some racial groups–in general. Lower does of some medicne may be required for treatment of members of some racial groups–in general. Similar patterns have been observed when comparing how men and women respond to some medications or therapies–in general.

What’s wrong with talking about race-based medicine? 

First, stereotypes emerge from communicating about any group as if every member of the group behaves and responds in the same way to anything. Not everyone in the group will respond as suggested.

Second, it may seem to suggest that others who are not members of the racial group are less at risk for a condition. If we are a member of a different group, we may distance ourself from feeling at risk for the condition and socially distance ourselves from those who are at risk. This may happen because communicating the medical research that finds members of a particular group seem likely to respond in a particular way may seem to suggest that anyone not mentioned is not at risk. If, for example, efforts are made to commmunicate about a particular group’s response to treatment for heart disease becomes the focus of advertisements aimed at selling the treatment to members of the group, the unintended message may be, ‘They aren’t talking about me so I have less risk for heart disease.’ When communicating about therapies for men, for example, women may have long assumed that they were not a risk for heart disease, and that, of course is not true.

Third, communicating about race-based medicine may unintentionally contribute to the formation of stereotypes. As shorthand, classifying someone as a member of a group reduces our uncertainty about how we expect he or she will ‘be.’ As a result of such communication, we may, for example, form views that all members of a particular racial group are at risk for a particular health condition.     

Finally, stereotypes of others and our own feelings of social distance from them often forms the foundation for stigma…our feelings of stigma about people and conditions, and our behavior toward those we consider to be members of a stigmatized group.

In sum, communicating about race-based medicine must be done with care to achieve valuable health outcomes and to limit harmful social outcomes.

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