Talking About Health; Why Health Communication Matters

Happy 80th Birthday to my Dad today! I am so blessed…

June 22, 2013

Today is Dad’s 80th birthday. We live too far apart to be together on many of these big life event days, and this is one of those days where a chat on the telephone just doesn’t quite do it. I am thinking about Dad and there are really so many thoughts but most of all, I just feel blessed to have a dad who shares his spirituality and his passion for nature, which really go hand- in- hand. He shares with me how the Lord has provided for him in immeasurable and unseen ways, and in concrete ways–as when a bike part broke on a ride out in the desert, only to turn the next bend walking his bike and finding in the path, something that would work to patch a repair, making it possible to ride again.

Some of you may know that I dedicated my ‘Talking about health’ book to my dad. And I observed that he always told me, “If it is important to you, then do it.” Along with that advice, he guided me to expect to work hard to do those important things. And he set an example of working hard.

Dad served in the Air Force during the Korean War and the Vietnam War. He was a crew chief on a B-52 bomber. After retirement from the Air Force, he worked for a civilian airport as a facilities and systems maintenance technician. Among my many inherited gifts from him, I love working with my hands in the garden and with wood. I am never afraid to pick up a tool and use it, whether I use it the correct way or not. I have mixed colors of stain to match old woodwork, refinished antique trunks, and repurposed screen doors as art above my fireplace. I know I do these things because Dad’s wood-working skills stir in me.

Dad is not much of one for going to the doctor or for taking medication or having surgery. When he had to have open heart surgery, as I describe in the “Talking about health’ book, he did not let it stop him from being at his grandson’s wedding. He knew before my youngest sister knew that there would be a new granchild in the family–one that he had to heal for so he could take her fishing. And today, at the age of 80, he is enjoying conversations with his five children and looking ahead to a family BBQ tomorrow. Happy Birthday, Dad!

When is reading a mammogram like looking for a polar bear in a snowstorm?

August 9, 2012

When you have dense breast tissue… at least, that is what some physicians say [go here, for more: http://www.womentowomen.com/breasthealth/densebreasttissue-mammograms.aspx ].

It has been 15 years since my annual mammogram led to a callback from the doctor for more x-rays and then a needle biopsy and finally ‘the all clear’ — no sign of cancer pronouncement. But it happened again last week. I got my annual mammogram on my way out of town to go to Atlanta for a visit with my daughter and granddaughter and son-in-law. And the day after I had the screening, I got a message on my home machine to call for a return visit…

Things have changed in the last 15 years, of course. Now, digital mammography makes some things more likely to be seen on the x-ray compared to film. Go here for a comparison: http://www.umm.edu/breastcenter/digital_mammography.htm?gclid=CNbCiKu_27ECFUlnOgodsH4A_A

At any rate, I returned to the imagery center for more x-rays. Here is how the communication went. First, it was nearly impossible to understand the message on my answering machine. My husband and I listened to it a half dozen times. We looked up the phone numbers of the imagery center, and none of them matched what we thought we were hearing. Nonetheless, I wrote what we thought they were saying and tried the number. It rang out to a message saying that it was long distance. Not likely then to be what I needed to call. Next, I tried calling the number using the first 3 numbers that all the numbers online for the imagery center used. And the last 4 numbers we thought the caller was saying that appeared nowhere in the online listing. Success. I got a nurse who checked and said, “When can you come in?” And I made an appointment for the day after I would return from my visit, which was a week after the first mammogram.

I went to the imagery center, this time with my husband coming in. The volunteer greeted me with, “Oh. I am so sorry.” Yikes. Not what you want to hear. She remembered me from the week before because we had a long chat about my height. At any rate, I would venture to say–“so sorry” is not quite the right expression in this situation. Perhaps “sorry you have to come in for more tests” if ‘sorry’ is to be used at all. The expression and her empathy were, however, unsettling.

Once I was in the room with the x-ray technician, I encountered the other end of the spectrum. The communication was reactive rather than proactive regarding what she wanted me to do. “Put your arm up and grab the handle? I did. “No. Turn this way. Face the machine.” Her tone was irritated. Wow. It is 9:30 in the morning. Why is she so grumpy? I am the one getting my boob smashed again.

She sighed. Letting out a clear expression of annoyance, she said. “Stick your bum out.” Who talks like that? “No. Look at me– Like this–” she said as though talking to someone she regarded to be extremely stupid. Finally, she was satisfied.

Time for another image. She turns me a bit and I try to enact what I have learned. I stick my bum out. “No.” she says harshly. “Stand up straight.” My arm began to quiver. Unavoidably uncertain about what I was doing wrong. Several more images and abrupt commands later, we were done.

“Will the radiologist come in here to discuss these with me?”

“No. Wait in the waiting room. I will get you when he is ready for you.”

I asked the volunteer if she would get my husband when I got called to the radiologist meeting. She told me to ask the technician to do it. So, when the technician came to get me, I asked her. And she did. No attitude. Wow!

And then there was the radiologist. I don’t think he could have been nicer or clearer. He put two pictures up on a screen and pointed to a small round dark spot about the size of a pellet for a BB gun. “This is what we’re looking at that’s different,” he said. “All this is your muscle and dense breast tissue.” It all looked like a lot of snow to me but I could see the BB…

“We’re going to do an ultrasound to see what we can learn about that spot.”

“What will the ultrasound tell you?”

He launched into a helpful answer that I will summarize as, ‘if the sound waves go through the mass, it’s a cyst. If they don’t it may be something we need to take a look at.’

The sound waves showed no mass. He spent plenty of time making sure that it did not appear in any direction. And then he announced, “I believe it’s a cyst. I will call this ‘normal’ and you won’t need to return for a year. Unless, of course, you see or notice changes that should be checked. Any questions.”

Hip Hip Hooray…. But I wish someone would give me a satisfaction survey to fill out about the volunteer and x-ray technician. I have a few thoughts about how their communication could be improved.

What we can learn from bald eagles about our health…

March 3, 2012

Last night was the annual dinner of the Juniata Clean Water Partnership group [www.jcwp.org]. The evening’s speaker is a biologist working in the field. He spoke about the comeback of the bald eagles to be removed from the endangered species list. It was fascinating. It sent me on a hunt for children’s books about this topic. I found some but if any of you can recommend such books, please share here. But I digress.

When a species becomes endangered, efforts to save them depend on identifying the cause. Often, it relates to a loss of habitat. For the bald eagle, it turned out to relate to the use of DDT–an effective pesticide that, as is usually the case when we find something to solve one problem, has costs as well as benefits. Here is a summary of science and policy relating to DDT: http://pmep.cce.cornell.edu/profiles/extoxnet/carbaryl-dicrotophos/ddt-ext.html

DDT use was banned from use in the U.S. the same year that I graduated from high school, 1972. Note the caveat relating to use. If we faced a public health emergency, such as an outbreak of malaria, it might be used. Tipping the scales toward benefit over cost.

Those costs? For use as humans–nerve damage and other significant health harms summarized in the link above. For the bald eagle–The shells of the bald eagle’s unborn became so thin that just the act of the parent bird sitting on them caused the shell to crack. Hence, the new generation of eagles was eliminated.

Once the cause was identified, the efforts to bring the bald eagle back and restore their population involved humans climbing large trees to remove young eagles from a nest [nests that average six feet wide and 8-10 feet deep]. If there was only one young eagle in a nest, the bird was left in place. If there were 2 or more, one was carefully removed and taken to another location where bald eagles used to exist. With care and effort to assure that they had habitat to survive, the transplanted birds thrived. In 2007, the bald eagle was removed from the endangered species list. A success.

Let’s hope we aren’t creating conditions in some parts of our planet that will lead to us being the endangered species…

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

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.

What’s new under the sun?

April 20, 2011 GUEST BLOG POST by Caroline Gilson

Over the years, the desire to be tan led to use of tanning beds. Somehow, tanned skin is seen to be sexy and attractive. As many people have continuously begun to be “addicted” to tanning beds, their skin has been put in a dangerous environment.

Tanning beds have a different type of UV rays called UV-B rays. UV-B rays are more harmful to the skin than the sun’s UV rays.

The dangers of tanning beds have caused the need for educational programs to educate the public about the health concerns involving tanning beds. Research studies have been done to find out the best way to communicate about the tanning beds. One study in particular looked at the use of narratives, and statistics. (http://www.springerlink.com.ezaccess.libraries.psu.edu/content/

457nhk7324q63501/fulltext.pdf)

This particular study discovered that both statistics and narratives could be effective in educating individuals about the dangers of tanning beds. Specific stories about real life people seem to grab people’s attention. Statistics about tanning beds on top of narratives help with persuasion and education about tanning beds.

The research has been done and now it is time to effectively educate the public about the risks of tanning beds. Hopefully, through health communication, society will make better health decisions…

How should we talk about tanning?

April 12, 2011 GUEST BLOG POST by Danielle Torrisi

Take a look around any college campus, and you’ll notice at least a handful of tanning salons. Pick up their college’s newspaper and you’ll find ads for tanning salons with gorgeous, tanned women pictured with the slogan “Beautiful Tan Today. Young looking skin tomorrow” and promotional discounts that is sure to catch the eye of any student. The tanning industry portrays tanning as harmless and risk-free. However, research has shown that the incidence of melanoma has continued to rapidly increase since the 1970’s.

A recent study at a southern university surveyed 492 students and results showed that a majority of the participants knew sun exposure increases the risk for skin cancer, but only 29% correctly identified behaviors that reduce this risk.

Less than 46% of the participants were able to identify signs of melanoma, and less than 10% were able to identify the primary area of the body for melanoma. Approximately half of the participants strongly believed that a tan improves one’s appearance, and only half thought that sun safe behaviors are necessary. It is very troubling to learn that they think their appearance outweighs their health.

College students need to be informed about the dangers of using tanning beds in hopes of changing attitudes and behaviors. It all starts with the media and advertisements need to show a more natural appearing skin. “As long as marketers portray being tan as healthy, attractive and sexy, young women will continue to believe that a tan is desirable, regardless of the risks” (Spradlin et al).

It needs to be understood that there is no such thing as a healthy tan. “In fact, UVA rays which are used in tanning beds can go all the way through the skin’s protective epidermis to the dermis, where blood vessels and nerves are found. Because of this, UVA rays may damage a person’s immune system, making it harder to fight off diseases and leading to illnesses like melanoma, the most serious (and deadly) type of skin cancer” (Tanning). This needs to be reinforced in student’s minds in order to see a behavior and attitude change.

To view this article go to: Citation: Spradlin, Kimberly, Martha Bass, William Hyman, and Rosanne Keathley. (2010). Skin Cancer: Knowledge, Behaviors, and Attitudes of College Students. Southern Medical Journal. 103, 999-1003.

Why is belly fat bad for your health?

March 17, 2011

I guess we would have to be living under a rock not to have heard health messages about belly fat. What I remember hearing the most is something like, “Belly fat is bad for you.” or “You want to concentrate on that belly fat.” And what I really got out of the messages had to do more with how we look–that belly fat is not attractive–than how it relates to health. I had seen a number of programs addressing how to get rid of belly fat [ http://www.meandjorge.com/] but never really made a connection with why in terms of health. Until the other day…

I can’t even say what program was on as I was making a meal but I heard them say that belly fat is especially harmful for our health because it is fat that works it way between and around our organs. That it literally does harm by wrapping our kidneys, liver, and intestines in fat… that was a rather horrifying image. The program went on to say that one cannot have belly fat liposuctioned away…because it is wrapping and twisting its way through our insides. The fat that can be liposuctioned away is just beneath the skin… [see this for a discussion, http://blog.healia.com/00488/belly-fat-damages-blood-vessels-could-cause-cardiovascular-problems]

To me, this is an example of one of those messages that needs to be clearer. I especially think that men are being shown as at risk for having belly fat…but the emphasis is too often placed on how the men look and not on what is really happening inside their bodies when the pounds add up around their middles…

What didn’t Oprah know about drug use and sperm quality and women’s health that Pam Grier told her?

February 3, 2011

Wild horses… well, not exactly. More like tame pets… A few images from our fall camping trip to Assateague…where ‘wild’ horses live on the beach, walking among the campers and even sharing our water and facilities…

And then, there was Oprah’s show today… [http://www.oprah.com/oprahshow/The-Original-Foxy-Brown/4]

Pam Grier talked about her life–today and during the period of time when she had starring roles in such shows as Foxy Brown. She also talked about relationships she has had, including with Richard Pryor.

As the Oprah show revealed, “After a gynecologist visit, Pam says she discovered Richard’s vices were affecting her too. She writes candidly about the experience with the hope of informing women who may be at risk. “There was an epidemic of a lot of people doing cocaine,” she says. “And it accumulated in the body and often in the prostate gland. It would come out during your sexual activity and [end up] inside a woman.”

Pam’s doctor cautioned her about the dangers of having unprotected sex with Richard. “[The cocaine] could harm the woman’s internal organs,” she says. “So I had to tell Richard, ‘You’re going to have to wear a raincoat—a condom.’ And he had an issue with that, and I said, ‘Well, it’s my life. You have to understand.’ So I chose me.”

Oprah said, “I did not know that–” in response to the revelation about the drugs ending up inside the woman… We have discussed such matters before http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=295&action=edit

We can’t talk about ‘women’s reproductive health without talking about men’s reproductive health… and we can’t talk about men’s health without talking about women’s health…

How does bad news about our health affect us?

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.

How do we talk about pain?

January 18, 2011

Have you ever been asked, ‘On a scale of 1 to 10, where 10 is the most, how bad is your pain?’ I’ve been asked that question. I have heard others be asked that question. I have even seen it in prime time shows. Is it just me, or is that a hard question to answer?

I took a quick look online to see what kind of research there might be about ‘taling about pain.’ I found very little published research. There is research about pediatric pain and getting kids to use pictures of faces to tell about their pain. Then I found an article about developing a measure of neuropathic pain [http://www.meduniwien.ac.at/phd-iai/fileadmin/ISMED/Literaturhinweise/Bennett_LANSS_Pain_2001_92.pdf]. It has the kind of things that I would imagine being more helpful both for making treatment recommendations and to help a patient be able to answer. It asks whether the pain feels like pin pricks, for example. A doctor takes all of the patient’s answers to add up for a total pain score. This seems to be a good way to talk about pain when working to manage it…