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Diabetes, Diet, Exercise, Prevention, Weight Loss
Many people use the occasion of the New Year to reflect on the last year and make specific goals for the next. Resolutions can be very helpful motivators if they are specific, realistic and written down. Just as people make goals for their careers and their relationships, resolutions for your health are a smart way to work for achievable targets in the health-related struggles you face.
So I encourage you this week to write down your health resolutions for 2009. Obviously, what progress is achievable is as varied as the people making resolutions. An elderly lady with balance problems may resolve to attend physical therapy and use her walker consistently and have an entire year without falling. A younger more active woman may resolve to train for and compete in a triathlon. There is no objective marker for your goals. You just have to balance ambition with realism.
My suggestion is to make the resolutions as specific as possible. Detailed planning will help overcome procrastination and a specific goal will keep you accountable. So don’t write
but instead write something like
If you have diabetes, you should be following your glycated hemoglobin (or hemoglobin A1C). Write down a goal for it. If you’re struggling with your cholesterol, pick a goal for your LDL. If your blood pressure is too high, write down something like
If you’re smoking, 2009 is the perfect year to quit (on a specific date that you should pick now). Obviously, some of these goals may require your physician’s help in terms of adjusting your medications, but your doctor can’t do it alone.
Making yourself accountable to others can also help keep you on track. Give a copy of your resolutions to your spouse, to your doctor to attach to your chart, to anyone who knows you too well and cares for you too much to let you cheat yourself.
I wish us all a year of peace, health, prosperity and happiness.
Every year the British Medical Journal has a Christmas issue devoted to more offbeat and lighthearted scientific studies. This year’s issue had an article reviewing holiday themed medical myths.
The article debunks the following myths:
Peruse the article if you want to learn the details.
Thanks to Carina M. for pointing me to the LA Times article. Merry Christmas and Happy Hanukah to everyone!
Learn more:
Los Angeles Times article: The year in weird science and myth-busting
British Medical Journal article: Christmas 2008: Seasonal Fayre
Or: Just Give it to Me Straight, Doc
Any primary care physician from time to time has to give a patient bad news, sometimes terrible news. These conversations can be extremely difficult for the patient and his loved ones, but also for the doctor. When the patient is too sick to understand or participate in conversations about his prognosis and his treatment options, the terrible burden falls on his loved ones to have these conversations and make decisions on the patient’s behalf. When the news is particularly bad, as when the patient is unlikely to survive the hospitalization, many physicians are reluctant to fully disclose the gravity of the prognosis. Some doctors believe that to be fully honest would take away the family’s hope, or that the family is emotionally incapable of processing the bad news.
An important study in this issue of the Annals of Internal Medicine tested that belief. The study found 179 critically ill patients in the intensive care units of the UCSF Medical Center who required a ventilator (breathing machine), could not participate in a discussion about their condition and had a high likelihood of dying during this hospitalization. Structured interviews were conducted with the relatives or loved ones who identified themselves as the decision makers for the patient.
The interview sought to discover the families’ attitudes towards maintaining hope and receiving truthful prognostic information. The interview started with the question “Some physicians are reluctant to discuss news of a poor prognosis with family members of a critically ill patient because they do not want to take away the families’ hope. Do you think physicians should avoid discussing prognosis in order to maintain hope?”
The results solidly refute the idea that families want to be protected from the truth. 93% said that avoiding discussions about prognosis was not an acceptable way of maintaining families’ hope.
The themes discovered in the study and the individual quotes are quite poignant. Many relatives said that discussing the prognosis is part of what they expect doctors to do. One said “Also, I think it’s a matter of respect and I wouldn’t want a doctor assuming that I couldn’t handle something or that I wouldn’t understand something. That’s demeaning to me.” And many relatives spoke of sources of hope outside of what is offered by physicians. “My hope is not based on what doctors tell me; it’s based on how I feel as a person, my spiritual beliefs, how my family and I interact and hold each other up.”
We physicians should learn from this study that families want the truth; we owe it to them. And we should admit to ourselves that the reason we are so desperate to sugar-coat the prognosis isn’t to maintain the family’s hope; it’s because giving bad news is so difficult.
Learn more:
Annals of Internal Medicine article: Hope, Truth, and Preparing for Death: Perspectives of Surrogate Decision Makers
Annals of Internal Medicine Summaries for Patients: Family Members’ Opinions about Sharing Bad News
This week an FDA advisory panel reviewed the evidence on asthma medication and released recommendations about a class of inhaled medications that may be unsafe. Their conclusions drew much media attention.
The panel’s concern is the increasingly worrisome evidence about long-acting beta agonists (LABAs). LABAs are a family of inhaled medications including Serevent and Foradil which are frequently used to treat asthma. Studies have shown increased numbers of asthma exacerbations in patients taking LABAs, and one study showed an increased risk of death. Since most patients take most medicines to avoid death, this is an inconvenient side effect.
Fortunately inhaled steroids, which are another class of medications for asthma, appear to eliminate the adverse side effects of LABAs. Advair and Symbicort are inhalers which combine a LABA with an inhaled steroid. The FDA advisory panel judged these combination medications safe, but said that the risks of Serevent and Foradil may outweigh the benefits.
Obviously, don’t stop your asthma inhalers without talking to your doctor, but if you’re using Serevent or Foradil without also using a daily inhaled steroid, a visit with your doctor is in order.
Learn more:
Reuters article: US FDA panel: Two asthma drugs risky but Advair OK
WebMD article: FDA Panel Asks: Are Asthma Drugs Safe?
Almost everyone at some time becomes anxious about his health. Even people who can stay calm through a stock market crash can get worried about new or nagging symptoms. And while some anxiety about our health is perfectly normal, in some it can reach a level that interferes with day-to-day functioning and becomes incapacitating. Even when it’s not that bad, anxiety about health is frequently misguided. Your headache is thousands of times more likely to be due to muscle tension than a brain tumor, and all those brain tumor patient support websites you’re reading won’t make your tension headache any better.
The internet is a very powerful resource to help non-experts educate themselves about their health, but it also frequently escalates anxiety. Two scientists at Microsoft published an article last month that studied how web search behavior can increase health-related anxiety. The researchers call this cyberchondria – “the unfounded escalation of concerns about common symptomatology based on the review of search results and literature on the web.”
The researchers studied how people searched the web, and what patterns tended to increase or decrease their anxiety about their symptoms. They found that many people, when searching the web for a symptom, mistake the rank order of search results as the order of likelihood of the diagnoses found. For example, a search for “headache” will return lots of results about caffeine withdrawal, muscle tension and brain tumors (and lots of other causes). But the order in which those results appear has nothing to do with the likelihood of these conditions. Brain tumors may appear first simply because there is more written about brain tumors and more research being done on brain tumors, but they are exceedingly rare especially compared to common causes of headaches.
Many physicians went through a similar experience as medical students. We would become convinced that we had whatever obscure disease we were studying. The ongoing joke was “I think I have lupus, and I think you do too.” The common theme between medical student anxiety and cyberchondria is access to information in great excess to judgment or experience. Now, with the internet, we can all be first year medical students.
(Thanks to Timo K. for pointing me to the Microsoft article and to my cyberchondriac patients for realizing they probably don’t have lupus.)
Learn more:
Microsoft Research article: Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search
NY Times article: Microsoft Examines Causes of ‘Cyberchondria’