Facilitating Story-telling Leads to Patient Growth | Sarah Monahan, RN, QMHA | LinkedIn

Facilitating Story-telling Leads to Patient Growth | Sarah Monahan, RN, QMHA | LinkedIn.

I came across this article in linkedin.  It’s an interesting idea because when a physician uses the term “challenging patient” (s)he is likely referring to one of two kinds of patients. One kind is one with a lot of health problems, some of which interfere with the treatment of others (or perhaps just a couple complicated health issues).  However it is often used to refer to patients who are hard to reach/not very compliant/have poor insight to how their behavior affects their health.

Many times I ask myself how did the latter kind of patient get to where they are.  I haven’t yet used this with any of my patients, but it does seem like an interesting way to help patients.

Sugar: Madness Over a Macronutrient – MPR

Sugar: Madness Over a Macronutrient – MPR.

This article is interesting to me for a few reasons. One is that the current fad of calling refined sugar ‘evil’ (as well the fad of considering high fructose corn syrup as even worse than Satan) is something that has come and gone. This is something that the article does point out repeatedly.

The other is that, as with  many things dietary and lifestyle related, perhaps caution with somethings is warranted but that for many things (like sugar), a moderate approach is better.  It’s perhaps wiser to avoid refined sugar as much as possible (no two liter bottles of regular soda, have candy only occasionally, etc), but not get upset if one does have a can of soda or a piece of candy on occasion. If having something with a lot of refined sugar once in a while helps someone eat in a healthy manner, it’s better than going overboard with too much refined sugar. A can of soda or a piece of cake isn’t going to undo one month, or one week for that matter, of eating a healthy diet.

I would no more suggest that people don’t exercise because they might get injured than I’d say cut out sugar entirely. Better you do both (exercise and have sugar) moderately. That way if you do have something “bad” for you then won’t beat yourself over the head when you do so.

Talking with your doctor.

Since I’m coming up on my second anniversary here on wordpress (I joined in late December 2012 and first published this post in January of 2013), I thought I’d reblog it

doctorgladstone

As this is my first blog post I’d like to start of by saying a few of things. One is thank you for visiting my blog. The other is that I won’t be responding to specific questions on this blog, except perhaps in a relatively generic way. In other words, talk with your primary care physician before you act on anything you read in this blog. For that matter, it’s probably a good idea no matter where you get your medical information from. Lastly, I have yet to decide on a schedule for posting. I don’t know whether it will be once a week, once a month, something in between or even less frequently.

And now to the subject of today: suggestions for talking with your doctor and getting the most out of your visits.

As a practicing physician there are times when I think my patients and I speak…

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An aspirin a day….

For this post I thought I would write about staying healthy, but in a slightly different manner than I’ve done in previous blogs. In older blogs I’ve written about screening, vaccinations, etc.  In this one I thought I’d talk about using a medication to stay healthy, and in this case talk about aspirin.

Aspirin has been around for more than 100 years, and perhaps is a bit under appreciated since it is an over the counter medication (meaning one can buy it without a prescription). It is also something that is derived from a natural product. Willow bark had been used to treat fevers  and it was eventually found that salicylic acid was the active ingredient. Salicylic acid was then derived from this. I won’t go into the chemistry of this (I figure if you’re a bit of science nerd like I am you probably already know, and if not I don’t want to bore you).

Most people probably think of it as a pain killer or a headache medication.  It is much more than that. Aspirin plays an important role in treatment of patients who’ve had heart attacks – it helps treatment and also helps decrease the death rate from heart attacks. It is used in primary prevention heart disease as well. In the past high dose aspirin was used in the treatment of Rheumatoid Arthritis. It’s use in this latter population (at least for treatment of Rheumatoid Arthritis) has been eclipsed by other medications. However it still should be used to treat/prevent heart disease in this group of patients.

Use of aspirin in ischemic stroke patients is advised as well.

Though less studied at this point, aspirin use to prevent recurrent deep venous thrombosis, is a consideration (this is after someone has been treated with coumadin for an acceptable length of time).   A link to a review on this subject can be found here: http://www.ncbi.nlm.nih.gov/pubmed/24745726

There is some evidence linking aspirin intake to a decreased chance of developing colon cancer. At the moment there is not enough evidence to routinely suggest people take aspirin solely to prevent colon cancer. There is also some evidence that it only helps prevent colon cancer in certain groups of people – those that have a particular form of a particular gene. The only recommendation is for aspirin to help reduce the risk of heart disease.

Aspirin, like any other medication, has its downside as well. It can cause stomach ulcers. If the ulcers are large enough they can cause a lot of bleeding. It should not be used in children, except in rare circumstances and even then only then under the guidance of a pediatrician or other health care provider who provides a lot of treatment to children (EG pediatric rheumatologists, family practice physicians, etc).

Should doctors be environmentalists/advocates for the environment?

One thing that sometimes crosses my mind is whether physicians and other health care workers should also be environmentalists. After all the environment does play a role in people’s health. Contaminated water lead to outbreaks of water born diseases (John Snow, a London physician in the mid 1800’s is credited [at least in part] for ending a Cholera outbreak  by convince authorities to block use of a water pump at the center of the outbreak).  The cholera outbreak following the earthquake in Haiti several years ago is another example. Polluted air leads to increased respiratory disease.

Though in the U.S. and other developed nations with functioning governments, the chances of contaminating water with sewage is low. The one exception could be when severe weather overloads the septic systems in an area. However even in the Northeast U.S. where I live, beaches are monitored for coliform bacteria (this is a generic term for bacteria that live in our guts) and closed when the counts are too high.

Air quality effects health of populations – there were reduced hospitalizations in parts of Ireland after there were bans placed on burning coal.  When lead was taken out of gas (well, actually prevented from being put in gasoline…), blood levels of lead dropped. It’s a neurotoxin and high blood levels can affect brain development in children (hence the ban of lead in paint in the U.S.), and function in adults. For water, it’s not just bacterial contamination/pollution that is important. Chemical pollution can also affect health. Toxins can build up in the food chain – this is part of the reason why it’s suggested that pregnant women limit their intake of certain fish, for example. Mercury builds up in fish at the top of the food chain, such as in Tuna, and can adversely affect people neurologically and adversely affect developing brains. Studies continue to show an association between air pollution and respiratory  deaths.

Given the number of of medications that are derived in whole or part from the plant and animal world (aspirin, reserpine, taxol, digoxin, penicillin, streptomycin, are all plant and fungal products), an argument could be made that making sure plant and animal species don’t become extinct because it might affect future drug discovery. Before you say “but wait,….” think of this: heparin is derived from the linings of Pigs. ACE inhibitors were discovered through research on snake venom. There are some newer medications for Type 2 Diabetes which are derived/grew out of research on saliva from a lizard known as the Gila monster.

 

Men’s Health

My previous post was about women’s health. In this post I am going to review a couple of aspects of Men’s health. Most of the things men should be doing are things  people of both genders should be doing to stay healthy: stop smoking, exercising, eating a healthy diet, maintaining a healthy weight (or loosing weight if overweight).  Staying up to date with immunizations, such as yearly flu vaccination, is also important. Getting screened yearly for hypertension is important. Skin cancer screening is also important, though this might only need to be done every 2 years depending on whether you have any suspicious moles or lesions, prior history, you and your dermatologist’s comfort levels for yearly vs every other year screening. Cholesterol screening at appropriate intervals is important (a healthy male in his 20’s with no risk factors for heart disease only needs his cholesterol checked every 5 years or so. Older men and those with risk factors require monitoring more frequently and perhaps yearly if risk factors are present or if on treatment to lower cholesterol). I won’t get into more details about screening or other issues covered already in other posts.

Perhaps the biggest controversy in mens health is prostate cancer screening. The U.S. Preventive Services Task Force actually recommends against routine screening for prostate cancer in healthy men of all ages. Even the American Urological association recommends against screening for prostate under the age of 64 and in men with life expectancy of less than 10 years. For screening, a conversation with your primary care doctor is warranted before getting the test. The main reason it is controversial is that one runs the risk of finding a prostate cancer which is indolent (slow growing), non aggressive that one is likely to die with than of – meaning one is likely to die of some other disease before the prostate cancer becomes a problem. At this time we don’t have enough information to know what low grade/early prostate tumors are going to become aggressive and turn into problems. One therefor runs the risk of over treating something that would not be a problem.

Occasionally I’ve had patients ask for testosterone levels and had to talk to patients about testosterone replacement. Testosterone levels are not something  routinely checked unless there is a clinical reason (if there is loss of libido, erectile dysfunction, and so forth, then it’s worth getting). Testosterone replacement has been associated with an increased risk of heart disease so replacement benefits needs to be worth the increased risk.

Although I probably run the risk of repeating myself by saying this, but reducing the risk of heart disease, lung cancer, colorectal cancer by exercising, watching what one eats and getting appropriate screening applies to men’s health as well.