Talking About Health; Why Health Communication Matters

Why should you talk about family history and health?

roxannebuggy January 12, 2010

The woman on the horse is a relative that I share a first name with…tho, of course, I never knew her. I wonder what else we might share. Hair color, height, health?

The U.S. Surgeon General advises us to ‘know our family health history.’ The problem is, what to know and how to know it. Since 2004, the Surgeon General has declared Thanksgiving to be National Family History Day [http://www.hhs.gov/familyhistory/] as part of an initiative to get us talking. While we do need to find a time to talk with our family about our health histories, few things seem more doomed to failure than pushing families to talk about poor health at a gathering aimed at celebrating.

First, older adults in our families have many interesting things to tell us about that go on in their lives besides poor health. Many have good health and no reason to focus on poor health. Many want to avoid the stereotype linked to old folks talking about their health and nothing else…even when they do have poor health.

Second, younger adults who need to know about their family health history need to know details that are unlikely to be discussed in such public settings, or if they are discussed, unlikely to be remembered.

Third, it is not particularly helpful to know that there is diabetes or heart disease or cancer in your family if you don’t also know who had the condition, at what age they had the condition, what treatment they used to address the condition, and with what success. Or, knowing what family members have died from should be accompanied by information about the age at time of death.

In this era when we have more awareness of how genes affect health and our reponses to medications and other therapies, we may want to know whether our family members have had any genetic tests. If they have, what ones led to positive results indicating the presence of a particular form of a gene?

Talking about family health history is important but can be difficult if we don’t make time and don’t know what to talk about….

HPV, HIV, HBV…and more

January 8, 2010

I am working on a project designed to understand how college students think about HPV. I have learned that the human papillomavirus — HPV — is confused with HIV by some male college students in this project and that some females confuse it with HBV — the hepatitis B virus…

The media has covered the HPV vaccine and, of course, we have all those direct-to-consumer ads appealing to the ‘I want to be one less’ angle. What isn’t clear in many of these stories and ads is that HPV is transmitted by skin-to-skin contact. That is why genital HPV cannot be guaranteed to be protected by use of a condom during sexual intercourse.

The HPV vaccine is, of course, not designed to prevent HIV. A female who has completed the series of HPV shots likely has about five years of protection from HPV. She is not protected from the human immunodeficiency virus — HIV. Males who mistake the two conditions, HPV and HIV, may wrongly believe that the HPV vaccine protects her and him from HIV and thus feel less inclined to use a condom to prevent HIV. That is a serious mistake.

The incidence of head and neck cancers over the past decade has been found to be related to oral HPV. College males who report engaging in open-mouthed kissing have been found to be more likely to test positive for oral HPV. But this is not the only path for transmitting oral HPV. As with genital HPV, the skin-to-skin contact provides a transmission route.

There is a vaccine for HBV. HBV affects the liver and is transmitted in ways that are similar to HIV, including blood and bodily fluids. It really can be a matter of life and death if we fail to keep straight the differences between these three and our actions to prevent them.

How much “chemo” is too much or too little?

122_0568 January 3, 2010

It doesn’t surprise us to think about needing different dosages of medications…pain relievers, aspirin, and so on. But how often have you heard anyone talk about the dosage for chemotherapy?

My good friend will begin chemotherapy for her colon cancer in a couple of weeks. She was reading a bit online about some of the research related to the treatment. She read that obesity may make it difficult to determine the right dosage for someone’s chemotherapy to be enough to work. Not that she is fat. Quite the opposite. She is a petite woman of average weight. So she wonders if perhaps she needs a lower dose of chemo to work but to avoid some of the toxicity that a so called average dose would have for her. She will ask her oncologist about it.

Another example of important work being done in cancer research studies to help patients get the most out of their treatment. It would be awful to go through chemo and have it not work because you were overweight and didn’t get a high enough dosage…

Another example, too, of how the ‘normal’ dosage is not a one size fits all prescription. A good lesson to keep in mind when we talk about health…our size and the dosage we need.

What’s new for HPV in 2010?

imgp0009 January 2, 2010

Near the end of 2009, the U.S. FDA approved the use of an HPV prevention vaccine for boys. It will be interesting to see how this will be sold in the marketplace. After taking such care to sell a vaccine as a strategy to reduce the incidence of cervical cancer with the slogan, “I want to be one less,” and assuming that even among a public with moderate to low levels of health and science literacy — most know that males do not have a cervix, what will the pitch be to convince parents to vaccinate their sons? It seems unlikely that any ad will focus on selling a vaccine to parents that implies that their sons could be the vectors of disease for girls, as that would turn attention toward sex which the advertisers so carefully avoided in focusing on cervical cancer.

Whatever the pitch, part of our conversation should focus on the vaccine’s efficacy. Clinical studies vary in estimating how many years of protection a vaccine affords, but it seems to be around three years. Some say it may be five years. In either case, there is no revaccination policy at present. As consumers, parents, patients…we need to advocate for a policy.

We need to ask ourselves if and when it is the right time to be vaccinated. We need to understand what HPV is and how it is transmitted. Since the virus is spread in skin to skin contact, a condom may not be enough protection from getting the virus if we come in contact with it during sex. We should talk about that fact with our daughters who may be trying to decide if the use of a condom is the best way to protect themselves from sexually transmitted infections and diseases. And we need to talk with our sons about the fact as well, and remind them that the HPV prevention vaccine does not protect from HIV.

We need to realize that for women, being vaccinated does not mean we do not need to have cervical cancer screenings. Will the advertisers include that in their future messages?

Why does Dr. Oz talk about “gas”?

imgp0014 January 1, 2010

A couple of days ago, I was listening to the Dr. Oz show, and he talked with the audience about ‘gas.’ He described how much gas or flatulence is ‘normal’ and showed the audience a balloon filled with the amount of gas that any one of us on average has in a given day. Dr. Oz described some of the foods linked to forming flatulence. He did a great job of filling some of the void in our understanding about this topic.

But there is more to it than that as anyone who watched could tell from the giggles and embarrassed expressions on audience members’ faces. While we many now understand both that having gas is part of the human experience and that some foods cause more gas than others, we may be struggling with the fact that our doctor told us to start eating a diet that is higher in fiber and doing so has — you guessed it — caused us to have more gas than is normal for us and some discomfort or gas pains as well.

So now the problem is that we are not sure how to tell our doctor about the discomfort. It is after all embarrassing. So do we just give up trying to eat a diet that is higher in fiber? I hope not. A higher fiber diet has a lot of health benefits. So try increasing the fiber in your diet with a little less gusto… perhaps add 1-2 servings of fiber a day rather than 7, and keep track of how that makes you feel. Still a problem? Realize that your doctor may have advice to help with the gas, and no way of knowing you are having discomfort if you don’t disclose the experience. Tell your doctor what you have been eating and what you have experienced and that the gas is not normal for you and is causing discomfort. Normal is, after all, best judged by each one of us when it comes to our own health.