Thursday, April 23, 2009

Do You Live Your Life in Bullets?

You’ve seen bullet formatting - they show up everywhere; those little abbreviated lines creating a quick and easily skimmed list of the most important highlights of information. But are we living our lives in this abbreviated form as well? Are we losing the ability to stop and smell the roses?

We tend to live our lives in the fast lane, squeezing as much in a day as we can. We power walk, power lunch, have power meetings, and power our way through the day until we collapse and have to power nap before moving on to the next item on our busy agenda.

My blogs recently have revolved around the recession and how it has affected our general mental health. With these added stressors of layoffs, rising prices, and dwindling opportunities it is more important than ever to protect the mental health of ourselves and our loved ones.
This is often hard to do when we feel the need to push ourselves even harder to beat out the next round of layoffs or take on that second job to keep the house out of foreclosure. Patience flies out the window. When we speed up our own personal production, we tend to get frustrated by those who are still running at normal speed.

Here are a few warning signs of living life in bullet format:

You find yourself getting short with coworkers who take their time in getting to the point

You grumble as you speed around people in the “slow lane” of hallways just as you do on the roadways as you calculate which would be faster, the elevator or the stairs

Everyone but you is working in slow motion

You are moving at such a fast pace that quality work takes a back seat to just getting the job done so that you can move on to the next four or five jobs on your list

You begin to lose the ability to successfully multitask and prioritize, and feel the need to speed up even more to compensate

You take this sped-up version of yourself home to your family and expect them to bullet their time with you as well

You find it hard to unwind and let go of the hyper speed you have achieved

You forget to smile

Your caffeine consumption skyrockets; at the end of the day you always feel you need one more drink

What can you do if too many of these examples describe you? A friend or loved one shouting, “slow down” seems too simple a fix, but it may be just that simple. Slowing down won’t fix the amount of work you have to do and it won’t pay the mortgage. But it could save your life.
We all know behavioral and physical health are linked. Unhappy, over-stressed people tend to live shorter lives than their counterparts. So in the midst of the hyper-fast, bulleted life you lead, don’t forget to schedule time for you.

Ways to rewrite the bullets of your life:

Take time to notice those around you. Are you wearing that same pinched look of stress you see in others? Relax your face and try on a smile. Compliment that person and watch as they startle out of hyper speed.

Schedule time for meditation. You don’t need a special place or special equipment to get started. Just close your eyes and breathe deeply and evenly for 2 minutes. Concentrate on how far you can expand your lungs, and how slowly you can inhale and exhale. Steal a few of these moments for yourself throughout the day. If you prefer guided instructions, check out Soft Belly Meditation, a free four minute guided breathing relaxation meditation exercise available over the internet.

Pause for a moment to appreciate the little things in your life: You may find the little things are really what’s important to you! BE in the moment. Stop and just do one thing at a time!

After work, take the time to reconnect with the special people in your life. Say “Hi” to your neighbor across the backyard fence. Reconnect with the lost art of the long-winded yarn Grandpa’s across the country made famous. And above all, take time to smell the roses while they are still in bloom.

Thursday, April 16, 2009

Finding Quality Mental Health Treatment: Voodoo Science

The Wall Street Journal posted an article reporting that primary care physicians have difficulty getting mental health services for patients. One blogger rightly mentioned that mental health treatment is still considered a ‘voodoo science’ even in the medical community. Great Point! Let’s face some other hard facts.

Overburdened PCP’s have been asked to handle mental health issues for too long

Mental health treatment has the stigma of a second class citizen in the medical community

Many educated persons can’t tell you the difference between a psychologist, psychiatrist, and a social worker

Mental health treatment is shunned by insurance companies

Few patients can pay for mental health services

It is no wonder that services are under-funded and quality mental health providers are hard to find. Based on these facts, anyone going into the mental health field should have their head examined.

We need to face the fact that relationship problems, community violence, job loss, financial stress and depression are increasing along with mortgage foreclosures. There is a lot more to do in dealing with these problems than reaching for Prozac! Most mental health patients get very little in the way of targeted treatment, and often receive a treat ‘em and street ‘em approach characterized by promiscuous prescribing practices and embarrassing treatment outcomes if not outright fraud.

The Mental Health Parity Act promises better days ahead, but it is no bail-out. In fact, it will be a while yet before anyone can receive help. The parity act has been delayed until 2010.

I am proud to be affiliated with a helpful resource that is affordable, effective, and readily available here with eDocAmerica.

Check out the website, ask a question of one of our experts and post a comment on our blog.

Wednesday, April 15, 2009

A Patient with a Uterine Mass: The Case for becoming an E patient

This article was co-authored by Elyse Chapman, who became an e-patient through the following process:

I recently became acquainted with a woman in Iowa, Elyse Chapman, who was concerned about her “fibroids”. I heard about her from a colleague whose online moniker is “e-Patient Dave”. Dave deBronkart used information from the internet to successfully steer the course of his own therapy for kidney cancer . Elyse is a friend of Dave’s who was scheduled for a hysterectomy because of a very large, mass, probably a uterine fibroid, a benign but often problematic tumor of the smooth muscle fibers of the uterus. She had problems with excessive painful cramping, bladder pressure and a sensation of swelling and bloating in her abdomen. A CT scan was ordered and showed a mass either on the ovary or uterus. The mass was so large that her doctors wanted to make sure that this was not a malignant tumor of the uterus or ovary. They had scheduled a total hysterectomy via exploratory laparotomy in 3 weeks and Dave was “consulting” with his online friends to see if anyone knew of a patient group with whom she could collaborate to see if there was an alternative to major surgery.

I volunteered to help. Shortly thereafter, I received an e-mail from Elyse and then gave her a call. I heard more details about her history, learned that she had lost her husband recently, and as a single parent, felt very shaky about the prospects of recovering from major surgery without help at home. She wondered why her doctors were so focused on performing a total hysterectomy and why she wouldn’t be a candidate for a laparoscopic approach. She also wondered if she really even needed to undergo surgery now, or could she safely wait and watch for a time.

Unable to determine for certain that an alternative approach was feasible in her case, I encouraged her, at the very least, to become more assertive about getting answers to her questions: If she wasn’t a candidate for laparoscopy, why not? I told her I’d do some further research about this and get back in touch with her. I looked this up on the internet and then sent her this e-mail:

I looked at some sites on laparoscopic hysterectomy. Here is one I thought was good: what I can tell, it should be possible to remove even a large uterine mass via laparoscopy.Good luck getting an answer on this that makes sense to you. Let me know if I can help any further.

Elyse actually communicated directly with a nurse at the above site and it bolstered her belief that it may not be necessary to undergo a total abdominal hysterectomy. She communicated this to her doctors in Iowa who were still uncomfortable exploring alternative options. So, she sent me the following e-mail:

Charlie, have you heard of this — nuking the fibroid with ultrasound while using MRI to view and target the waves? Just learned of it today.Seems to me that U of I is wanting to just yank everything out even though there's no proof that this growth is malignant. Sounds to my laywoman’s brain like at very worst there’s a 50-50 chance of malignancy, yet they do not want to do a biopsy for fear of rupturing something that might be ovarian and malignant, causing easy spread of malignant cells. What I don’t understand is how anyone can determine if its malignant without a biopsy, but obviously someone knows how to do that, because links in the above results say the ultrasound procedure works well for non malignant fibroids, which means that somehow there’s a way to determine malignancy or no without too much fuss.U of I insists that there is no better imaging method than the CT scan I had, but at least some of the above links state that MRI is better. Huh?? Who is right? Is this a case of “we only know how to use a hammer, so everything we see must be a nail” or maybe “we’re financially invested in [name your imaging method of choice], so we’re going to use and promote that”?Thoughts, please?


Well, truthfully, I had not heard of this technique, so I did some additional research and found that the number of sites offering the procedure were limited, but sent these to her, with some additional links from the internet. In addition, this e-mail string reminded me that an increasing number of doctors and patients are opting for uterine artery embolization. I mentioned this, and she e-mailed me back that she was unable to find links for this procedure that I mentioned.

Here is my reply to her:


I should have used the “correct” term: uterine artery embolization.
This is another very reasonable alternative for you to consider, maybe even more realistic than the ultrasound approach.


After several more fax and phone exchanges between Elyse and the physician in California who published the web site noted above, and after phone exchanges with the physicians in Iowa, Elyse underwent an ultrasound examination that confirmed a large, single uterine fibroid about 6 or 7 cm in diameter. The Gynecologist/Oncologist in California felt that surgery was entirely optional at this point, noting that Elyse would likely experience shrinkage of the mass following menopause within a few years.

She is still in the process of finalizing her decision whether to proceed with a laparoscopic hysterectomy or take the “watch and wait” approach but is certain of one thing: she is NOT going to proceed with the scheduled total abdominal hysterectomy.

So, that is where we stand. But, what is the point? Well, the HUGE point is, Elyse is no longer content to blindly follow her doctor’s suggestions. Whereas they suggested she undergo a major surgical procedure, they didn’t even mention two significant new, less invasive procedures that might well be appropriate for her to consider, and did not give her clear information to consider the option of just watching and waiting.

The other point of the story is that a wealth of information is available on the web, but patients often need encouragement to seek it, and help interpreting it and applying it to their own situations. Peer support groups on line are one way to accomplish this and finding an interested, available physician to serve as an “e-patient advisor” is another way.

Either way, it is a good example of how patients are moving into the e-patient revolution and, through this process, the health care system is changing. In the meantime, join me in hoping Elyse soon finds the perfect solution for herself and has a great outcome.

Thursday, April 9, 2009

Want To Prevent Stroke? Take 4 Steps

Stroke is a major cause of disability and death in the U.S. and worldwide. Modern medicines like statins (and old ones like aspirin) are helpful in preventing both initial and secondary stroke in patients at risk. But, are there simple things you can do to lower risk?

Yes, you say! Well, indeed, you are correct. Twenty thousand men and women (age range, 40–79) without histories of stroke or heart attack were recently analysed in the U.K. for the effect of 4 simple behaviors: not smoking, regular physical activity, moderate alcohol intake (1–14 drinks weekly), and high fruit and vegetable intake .

Patients engaging in 3 or 4 of the activities were significantly less likely (2 times!) to suffer a stroke over the next decade. Patients who slipped up a bit and only did 1 or 2 of the activities did have significant stroke risk, though not quite as much as those who sat on the sideline and engaged none of the behaviors.

So, grab the baton and step up to prevent stroke. As always, questions and comments are welcome.

Can e-social Networks be the Latest New Health Hazard?

We are all looking for ways to handle today’s difficult economic realities. As unemployment heads toward record levels many people are turning to the comfort of e-social networking instead of seeking opportunities for actual face-to-face social interaction.

In a recent blog, I mentioned how unemployment is hitting the male machismo right where it hurts. More and more unemployed people are conducting their job searches entirely online with little or no face-to-face reinforcement to the actual employer. Now, new research indicates that there may be long term health risks and higher rates of premature death among those who heavily rely on e-social networking rather than physical social interaction. Preliminary research suggests that e-social networking may not have very much social benefit after all, especially when it takes the place of meaningful literal social activity. Dr Sigman spells out his warning in the spring issue of Biologist, the journal of the Institute of Biology, and maintains that social networking sites have played a significant role in people becoming more isolated.

For many of us, the bombardment of email, FaceBook, MySpace , Twitter and the like can leave us too mentally weary to seek out face-to-face social activities. Perhaps using e-social networks to augment social interaction, rather than replace, would be a better way to go. In everything, there must be balance.

What we must guard against is the tendency to use e-social networking as a security blanket to avoid sharpening our social skills in the flesh. It can be all too easy to hide behind the keyboard to escape sometimes awkward social realities. However awkward face-to-face interaction may initially be, we learn from each encounter. By using our computers as a distancing object in our interaction with others, we reinforce this unhealthy comfort zone, become more sedentary and more socially isolated.

Are we using social networks as a substitution for social interaction? If so, we may be doing so at the expense of our health. Maybe we all need to get off the keyboard and find a healthy balance of social interaction the old fashion way.

Start monitoring your e-social time tomorrow, because we would really like to hear from you today! Comments, criticisms, manifestos and questions are always welcome.

What Is Insulin Resistance?

You may have heard the term "insulin resistance" and wonder what it means. It does not sound like a good thing, and it isn't. You probably know that insulin has something to do with diabetes, and wonder if it means you have diabetes. Let me shed some light on this and help you avoid insulin resistance, an important risk factor for heart disease.

The official definition of insulin resistance from the NIH is "a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. Glucose is a form of sugar that is the body’s main source of energy." In other words, you have plenty of insulin being produced but there is "resistance" at the cell level from it doing its job, and your blood sugar stays high. This is the underlying cause of most type 2 diabetes, the most common form of diabetes.

Besides a high blood sugar, people with insulin resistance usually have an abnormal cholesterol pattern. They have a lower level of "good" cholesterol (HDL cholesterol) and a higher level of the "bad" cholesterol (LDL and VLDL cholesterol). This combination causes plaque to form faster in our blood vessels leading to the blockages that cause heart attacks and stroke.

While there is an important family history (genetic) component to insulin resistance, there is something that you can do to reduce or even eliminate it. The degree of insulin resistance you have is directly related to our fat cells. The more body fat, the more insulin resistance. The less body fat, that is becoming lean, the less insulin resistance. That alone is a strong motivator to lose body fat. Also, a healthy diet of less saturated fat and more vegetables, and exercise, all help to lower insulin resistance.

Hopefully you are now able to understand and explain this important concept. There is no blood test that measures insulin resistance specifically. Your doctor can estimate it presence based on your blood sugar and your cholesterol pattern. Ask about that at your next check-up.

Good source for more information: