Archive for the ‘Health Advocacy’ Category

August newsletter

| August 20th, 2012 | No Comments »

Modalities Massage Therapy

August Newsletter

 

Dear clients, This Thursday, August 23rd, is the deadline for aromatherapy orders.  Check out the webpage on direct orders for the short list of products and pricing.  Contact me by phone or email to place your order. As always, orders should be in within a week and I will contact you regarding pick-up. Beginning in September there will be some small changes in my work schedule.  I will be teaching infant massage at Mothering Touch again but on Wednesday mornings and I will no longer be working at Achieve Health Monday and Wednesday mornings.  In terms of hours here at Modalities there will be only small changes and a continuation of the ‘temporary’ addition of Tuesday mornings.  New hours as of September 1/2012 will be:

Monday: 10am to 6pm Tuesdays: 10am to 4:30pm; one 7 pm appointment Wednesdays: 12:30pm to 4:30pm Thursdays: 9am to 4:30pm; one 7 pm appointment Friday: 10am to 6pm

I have been doing some blogging lately and wanted to share those thoughts with you. The following links will take you to them: food and drug efficacy and DNR and final wishes.

As we move into the fall I hope that we all have the opportunity to enjoy some more warm weather and sunshine. For those of you coming under the influence of school I hope your return to classes goes smoothly.

Best wishes,

Sheila Hobbs, RMT

250-361-5246

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Do not Ressusitate.

| August 20th, 2012 | No Comments »

Talking with my friend, Pashta, a death midwife, always leads to interesting discoveries. As a death midwife Pashta is interesting in all matters around death and dying and so took particular interest in the changes around medical representative and do not ressusitate documents that occurred about 2 years ago. One of the issues that arose in her investigation didn’t directly have anything to do with the legislation or the preparation, but with the execution. An article I saw recently got me thinking about that issue again and triggered some thinking.

Let’s say you have all you paperwork in order, everything is in place, all your family is aware and supportive of you choice to allow your death to occur without “extraordinary measures”, you are a DNR (Do Not Ressusitate). Now what? If you have already been admited into the hospital, hospice, extended care facility, palliative care room or some such place you are okay. The administration of such places ask questions about this on admission and your wishes and paperwork will have been duly recorded and filed. Great. Or is it?

When you are out there, busy living your life and something goes awry (think stroke, etc) is when you are most likely to require/be given some pretty extreme emergency procedures to deal with the trauma. How does your DNR come into play? You have a high likelihood of being unconscious or unable to communicate. Most of us wouldn’t be carrying our paperwork, those that might would likely have something in a wallet or purse. Are you willing to bet your life, literally, that your EMT and/or ER doctor or nurse in going to look in you purse or wallet?

How do you let everyone know to leave you alone? Give you something so you do not suffer and leave you alone? More and more people are trying to solve this problem by tattooing their wishes on their body. Generally located over or around their sternum (breastbone) where anyone performing CPR or defibrilation would be looking, or at the wrist as a permanent medic alert bracelet. But, before you rush out to your local tattoo artist, ask yourself this -how many doctors or EMTs will honour a tattoo? A tattoo is permanent, but is it legal? All medical professionals are bound to provide all lifesaving measures in the absense of orders to the contrary. Many doctors report that they would not honour a DNR tattoo.

With this dilemma we run into the problem that is the log jam of so many death related issues. Can you decide to die? In Canada it has only been legal to take your own life since 1972, there is only one person in BC who currently has any recourse to request a doctor to assist her in ending her life. We have the right to vote, to fight for our countries, to do stupid and dangerous things and to live, whether we want to or not, but not the right to die. No matter how agonizing, hopeless or plain pitiful our life may be, just getting the right to end it is almost impossible. Ironically, the sicker we get, the more infirm and less able we are, the less likely we will be able to achieve our end.

Make your plans, get your tattoo, but you better start making some noise too, if you want to be sure the papers will be found, the tattoo honoured and your wishes granted. There will have to be some profound alteration in the thinking of our lawmakers, our medical caregivers, and in our society before we can expect that effort will be made to find out our wishes before action is taken. Meanwhile, make sure people – doctors, your family, and friends – know that you know what you want, and that you are counting on them to make sure you get it.

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m-Medicine – the future of your doctor’s smartphone?

| January 23rd, 2012 | No Comments »

This weekend I was reading an article in the Globe and Mail regarding the impact of technology on health care, specifically mobile technology.  The article referenced several areas in which mobile technologies can improve health care with remote monitoring, to i-tunes credit for diabetic teens who comply with their insulin regimes.  The focus, and one of the most exciting parts, for me was an improvement in post-surgical care monitoring.  

Dr. Semple, the surgeon-in-chief of Women’s College Hospital in Toronto, is running a pilot project to monitor the ambulatory surgery (in hospital less than 23 hours) patients under his care.  Dr. Semple and his research team have developed an app that allows patients with a smart phone or tablet to be in regular touch with him post-operatively.  This app allows patients to photograph their surgical incisions and send them to Dr. Semple along with text regarding how they are feeling.  From this information Dr. Semple can very accurately assess the progress of their recovery and make decisions regarding any need they may have to return to the hospital for follow-up care prior to their scheduled appointment.  

This seems simple, wouldn’t a phone call do the same?  I see this new evolution addressing several weaknesses in the call-in follow-up.  One, for time pressed surgeons – and patients – there is no need to mesh schedules.  Patients send in their information when they can and the doctor can pick up the information whenever he chooses.  Yes, this sounds a bit like answering machine tag, but there are other factors.  When the doctor picks up that message he is not just listening to a voice trying to squeeze their information into a brief window before the beep – he is reading a summary that the patient has been able to compile at their leisure.  He is also able to pick up that piece of information anywhere.  The other highly valuable piece of information he is getting is the visual.  They say a picture is worth a thousand words, and with this technology it may very well be so,  it may even be worth a life.  The article talks about a scenario where Dr. Semple is able to save himself, his patient and the system, time and money by preventing an unneeded hospital visit from the other side of the globe, but lets look at the other possibility.  What if his patient’s bruising wasn’t benign?

Using the app the doctor could have gotten that patient into the hospital as soon as he saw cause for concern.  Post-surgical care costs can escalate through to means – unneeded return, and delay of needed return.  The later being more costly in the end for all concerned as it would be associated with re-hospitalization, care for the complication that would be more extensive than a promptly dealt with one, and, perhaps, long term health issues or death if an infection was not dealt with for a prolonged period.  Close monitoring has always had benefits in terms of preventing complication but earlier discharge offers huge savings, higher numbers of patients processed and, frankly, more comfort for the patient.  Anyone who has spent time in hospital knows it is not very restful or healing.  The food is awful, it is noisy and people are disturbing you at all hours to check your temperature.  Who wouldn’t prefer the privacy of their own room, in their own home with undisturbed nights?  When those things can be accompanied by closer monitoring we have a winning solution both for the patient, for their health and for the system.

This week there is a conference in Toronto that offers doctor’s the opportunity to explore the options of mobile health technologies and hear from leaders in the field.  I hope my doctor is on her way there! 

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What is Epigenetics?

| November 7th, 2011 | No Comments »

I love CBC radio.  On the weekend I was listening to “Quirks and Quarks” and a discussion of epigenetics caught my ear.  Naturally, I had to find out what this things was and how it works.

For many years the research into autoimmune diseases and chronic conditions like cancer has focused on lifestyle and environmental impacts.  These diseases have a heritable component but they are not absolutely genetic, leading researchers to try to identify why and this has led into the field of epigenetics.  Epigenetics looks at the small markers that attach themselves to our DNA, especially in utero and in early life.  These markers do nothing to change the DNA you are going to pass on to your child, they simple alter how that DNA expresses itself.  Think of them as the controllers – they can turn things on and off or make things louder or quieter.

In this new field evidence is beginning to show how things like childhood poverty, child abuse and mental illness may have physiologically identifiable marks without changing the DNA.  Further, exposure to certain substances can also create epigenetic changes even late in life.  Many of the substances considered carcinogenic act this way.  They do not alter your genes, they turn on, or turn up, genes you already have (‘genetic predisposition) increasing the growth and success of cancer cells.  This brings in the fact that they can not affect genes you do not have and if you have the gene and nothing turns it on, you won’t experience the effects.

I believe that I have seen this in action in my family.  My maternal grandfather and both of his daughters (my Mom and my aunt) have died of very similar, very aggressive lung cancers – but not my uncle.  In the cases of my grandfather and my mother they also died at about the same age (51 and 52), but my aunt survived until she was in her middle 60’s.   Strong genetic evidence – early onset, aggressive, similar patterns of meta – why did my aunt live the extra decade?  I believe the simple answer is – she didn’t smoke.  My grandparents and parent were smokers meaning life long exposure to the carcinogens in cigarettes.  My aunt, though she grew up in a smoking household didn’t smoke herself.  Epigenetically speaking, she didn’t turn up the gene.  With my uncle, he has passed his early fifties, and is a non-smoker, so the question is, did he get the gene at all?  Time shall tell.  To contrast this heritage, my maternal grandmother smoked her entire life, and lived until 80, never getting lung cancer.  No gene?  Seem so.

This is excellent reason for me and my sister – we can’t change our genetic inheritance (and there is not current test for a lung cancer gene, though they do know there is one) but we can choose our lifestyle.  Neither of us has ever smoked, neither of us drink as heavily as our parent or grandparent, we eat healthy diets with lots of fruits and veggies, and my sister (not so much me) has kept her weight low.  We our doing our part to ensure the volume stays down on our genes, only time will tell if we succeed.

On the human level the field of epigenetics brings weight to our life choices adding to the pressure many feel to “live well”.  The weight of a healthy lifestyle becomes a punishing burden as every choice seems to have dire effects not just for themselves but their children.  Women especially receive barrages of information and direction on what to eat, drink, and expose themselves to during pregnancy and breastfeeding.  I have felt that pressure, but ultimately I try to remind myself that I can only do my best and the stress of trying to manage everything carries as many negatives as a lot of the things we try to manage.   I also try to remember that this gives me power, I can impact how my body acts, I am not at the mercy of my genes, how I live, and how I teach my children to live will change what happens to us. 

From the perspective of the medical field epigenetics creates a field of unique, crafted interventions that has never existed.  We can begin to more clearly understand the most profoundly impacting life events and behaviours to allow both early intervention or to create uniquely personal watch lists given our histories.  How intriguing.

 

LINKS: 

 

epigenetics and poverty

nurturing rats and epigenetics

epigenetics of bipolar and schizophrenia

epigenetics of child abuse

 

 

 

 

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BC Generations – onsite visit

| October 21st, 2011 | No Comments »

The last step in the initial intake for participation in the BC Generations is to do the on site visit.  The visit was very quick, I don’t think I was even there 20 minutes.  I arrived a few minutes late (sigh) but was quickly signed in and there was the standard double checking to ensure I was who they thought I was by a young man at the front desk who had a package with my name and lots of coded stickers to put on my forms.    He gave me my blood and urine lab form and directed me to give my samples before the end of November.  He then led me to an adjacent room divided  into separate cubicles where a research nurse greeted me.

The nurse asked me a series of screening questions (pregnant – no; hand arthritis – no; pacemaker – no, etc to ensure they could do all the tests and get the right outcomes.  She then got to the tests.

First, my blood pressure and heart rate, twice, of course.  All good in the blood pressure department.  Next was a revisit of the waist and hip measures (only once) where I discovered that I had been too precise in following their waist measurement instructions – I would have like it they had used her explanation – measure at the belly button!  Then height, both standing and sitting (this will let them determine spinal shortening).  

Next – all the cool toys!  First a grip device – where I discovered that my left hand is puny and my right is super strong – enough to offset the left’s puniness in the combined total.  I guess I can now tell clients I have one strong hand when they comment on how strong my hand are!  After that, my most dreaded machine – BMI calculator.  I am not going to share the exact results of my weight, BMI and percent of fat.  I will say that I definitely have some losing to do!  And some really detailed motivational number.  I now know that my body fat is fairly evenly distributed (though my arms are the fattest – who knew!) and that my right leg and left arm are fatter and stronger than their opposites.  Finally I stuck my foot in this machine that assessed the bone density of my heel (calcaneus) bone.  Here again was some good news – very dense bones.  In part this has to do with weighing so much (the bones get denser to support your mass), and with being on my feet a fair amount for work (lots of weight-bearing). 

The sum up is that I am as fat as I thought, but I am not doing too bad in terms of strength, blood pressure and bone density.  Basically I am healthy enough that I can  lose the weight to fix the other measures with relative ease.  That is my own personal project though – not the BC Generation’s responsibility.

There you are, that is the total of my experience to date.  In future they may phone to ask me to participate in specific studies (which I can decline if I choose) or to come back in for a repeat of the on site visit I had (or perhaps some similar type of visit).  They now have my permission to check in on any testing results I get within the medical system.  Not to big an impact on my life given how much could come of it – an hour or so of my time now to provide information for studies over the next 25 years.  

 

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BC Generations – the forms

| October 20th, 2011 | No Comments »

My first step as a participant of the BC Generations project is the intake form.  This is a fairly thick bundle of papers you receive in the mail a few days after signing up.  Along with the intake you receive information about the project, its purpose, and a release for you to sign saying you understand and agree to participate. 

Going through the form probably took 20 minutes.  Most of the questions are quite easy to answer, though I found it interesting they always give you the option to say “I don’t know”.  First you give your vital statistics (name, age, gender, etc.) you answer questions about you lifestyle (servings of fruit and vegetables in a day, amounts of exercise within a week and its intensity) and other health habits like amount and type of drinking and smoking.  These are easy, you just have to think about your habits a bit – which I found a bit revealing.  For instance, I discovered that I do not eat as many fruits and vegetables as I thought.  My activity level, which I knew was low, registered even lower as so many of the things I do involve shorter spans of activity than they were looking for.

The next section if the intake is family history and make up, along with the medical stuff.  You are asked to identify you ethnic background and where your parents and grandparent were born.  A bit more thought there, but still pretty easy.  They also ask about the make up of your family of origin (who you grew up with) and your current family and relationship status (married or not, kids or not, etc).  This section finishes with the questions I expected sooner – your history of illness (or not) and that of you parents and biological siblings.  Here things get a bit more specific and you need to think a bit – for me my sister was the trickiest as I have never had been a caregiver for her.  Depending on how close you are to your siblings (who they lump together in one set of questions) you may have to ask them – or choose the “I don’t know” box.

The final section of the questionnaire is the one I have been dreading.  Having put on weight lately I was dreading taking measurements and writing down my weight numbers.  This part is a bit of a bother as they want you to do two measurements of both and I found the waist location description not great.  I made it  through this though I disliked the numbers as much as I expected.  

Overall, pretty easy.  I only had to go looking for one piece of information (the DIN of my prescription – and I am guessing most everyone would have to go reference that one) and the need to find a tape measure – and my dread – meant that the questions got answered a few days before the measurements got taken.  

 

 

Next – the on site intake….

 

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A new gig for me…

| September 13th, 2011 | No Comments »

My baby...back when he was...

(more…)

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Intuition and the Proactive Patient

| July 4th, 2011 | No Comments »

I have a friend, named Magdalen, whose periodic blogs always make me think about the insubstantial aspects of being human that somehow form the grounding and weight of our lives. Today, I received one of her links and it lived up to that expectation in full.  In addition to reminding me to trust in myself, it provided me with an insight into my work as a wellness consultant.  This blog is about the intuitions I gained from that article.

I encourage my clients to make themselves participants in their health and wellness care.  I provide them with information, support, time and resources.  While reading Magdalen’s blog I realized that I also try, in my own way, to hold the “calm crucible” that I know she so strongly projects.  I want to ensure that any “knowing” that my clients have is given the opportunity to surface through the worry and stress that seems to always accompany medical decisions so that they can make their best choices from the start.

Given my emphasis on complete, quality information, how does what I do fit with the definition from, the Psychology of Intuition that intuition is “the process of reaching accurate conclusions based on inadequate information” that Magdalen references?  Though your doctor is unlikely to say this, the very nature of medical care requires that we use intuition.  Medicine is not about miracle cures, it is about options for hope.  Despite the wonders of modern medicine -antibiotics,  CT scanners and robotic neuro-surgery, etc. – there are still many times when you have two patients with the same diagnosis, who get the same treatment, but have different outcomes.

You must take the knowledge of what you have and what you know could be done about it; couple those with your deep knowing of yourself to decide on the best option.  This path leads to satisfaction with and belief in your chosen path, which is often the most powerful tool in determining the destination.

I can help with the information, I can hold the “calm crucible”, but only the person experiencing the process can decide what is best suited to their wellness.  Once you have the facts, it is your intuition, your innate knowing, that will lead you onto the best path for you.  So thanks to Magi and her words for helping me find my words.

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E-patients

| June 29th, 2011 | No Comments »

I love TED Talks.  A few months ago now my husband introduced me to TED and I have become a huge fan.  I follow TED on facebook so that every day I can see what is up in that world.  Their talks range in subject matter from recycled fashion to architecture to engineered silk to transplants and pleuri-potent cells.  I never know what I might find on TED or how it may thrill me.

Today, I got an extra big thrill from “e-patient Dave” (aka Dave deBronkart).  You wouldn’t think Dave is a cancer patient, would you?  He is a man of about 60 who was diagnosed 4 years ago with a cancer that gave him 6 months to live.  Through networking with other patients online he managed to find a treatment that has allowed him to live on in good health for four years so far.  A treatment his doctor did not know about.

The reason I found Dave so thrilling is that he is advocating for the type of proactive patient behaviour that I want to support and encourage.  Dave emboldens patients to go out and find for themselves the information they need.  To be “e-patients” that is: equipped, engaged, empowered and enabled (as coined by Dr. Tom Ferguson).  To make themselves heard as the vaulable resources they are in their own care.

The services I offer as a wellness consultant are aimed at supporting people in becoming e-patients.  I can give you the tools and support to jump start you in this role.  I can also offer ongoing support, advocacy and time to your quest to become the star in your health care.

We need doctors and health care professionals to provide us with services and exercises the skills they work very hard to master and maintain…and they need us.  Doctors need us not as mute recipients of their skills but as vital contributors to our care.  We need to offer our expertise about ourselves.  We need to gather resources and information that best serve us and our needs so that our health professionals can better serve those needs.

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Insured Visits

| June 6th, 2011 | No Comments »

Registered Massage Therapy can be a costly affair and the provincial health plan does not offer a great deal of coverage, however various extended insurers and third party groups do offer some support.  When you go looking though it is often a very confusing process and can come with some time restraints.  Each plan offers its own type of coverage and decrees how its members and their care providers may claim that coverage.   Do not assume that one Blue Cross plan is like all Blue Cross plans – the variety is actually endless.  MSP, Worksafe and ICBC also each have their own type of coverage and ways of submitting claims.  It is always wise to inquire with them if you believe you may be eligible.

What follows is what I am willing to take on in terms of types of coverage, direct and indirect billing.  This is my set of choices, other RMTs make different choices.  This information will remain on my website and as current as I can keep it, but this is where I stand now….

Worksafe BC: As part of the Worksafe BC Massage Therapy Network  I provide service to WorkSafe claimants in accordance with the agreement between the Massage Therapists Association of BC (MTABC) and Worksafe BC.  Given the fee schedule set by this agreement I have specific appointment lengths for Worksafe BC patients.  Initial Visits are 35 mins in duration and include history taking and assessment.  Subsequent treatments are of 20 min duration and have a small re-assessment component included.  I am not able to treat anything other than the injured area that is in the claim.  Worksafe BC does allow me to address areas excluding the injured area for a Injured Worker if a separate appointment is booked.  The separate appointments may be booked consecutively with the covered appointment.  If an Injured Worker is receiving care from another practitioner (ie. physio) I may not bill Worksafe BC without permission from Worksafe BC

MSP: I am opted out from MSP, which means I take privately paying clients and submit a claim to MSP for their visit.  Patients receive a re-imbursement of $23.00 per appointment within 2-4 weeks.  Only those on subsidy from MSP are eligible for any coverage and they have a limit of 10 visits from a pool of 5 practitioner types (massage, chiropractic, physiotherapy, podiatry and acupuncture).  Additional visits are sometimes available but require your GP to authorize them (this is the last I heard, it may have changed)

ICBC: At this time I am not accepting clients for direct billing to ICBC.  Inquire with your adjustor if they will cover your privately paid appointments. ICBC has a quite strict 8 week time frame for coverage, so do not delay!

Blue Cross: I have a billing number with Blue Cross that allows me to bill directly for RCMP, military and DVA patients in accordance with their plans.  Re-imbursement is available to University of Victoria grad students who are covered by the UVIC grad student health.  Others covered under Blue Cross should inquire with their plan contact as to how their plan deals with massage therapy billing.

Greenshields: I am registered with Greenshields and can provide direct billing to some plans (UVIC undergrads and staff).  Please inquire with your provider as to their policies regarding massage therapy

Great West Life: Some GWL plans allow for direct billing by RMTs.  Shaw Cable is one employer whose plan allows for direct billing. Others covered under GWL should inquire with their plan contact as to how their plan deals with massage therapy billing.

Other providers: Please inquire with your carrier to find out how they deal with Registered Massage Therapists.


 

 

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