Archive for the ‘Wellness’ Category
I checked out a link on twitter today and loved the article so much I just had to write a bit about it
Written by an animal loving leukemia patient the article shares her experience of getting ‘prescribed’ a puppy during her recovery. She focuses on the many benefits she has experienced in her life and I think some of her points are ones that anyone who knows a cancer patient should think about.
The puppy has provided a positive attention draw, she is no longer identified as the ‘bald-lady with cancer’, she is now ‘the (bald) lady with the sweet puppy’ to the general public and that is freeing, she is more than her diagnosis or disease, she is not just a receiver of care, but a giver of care.
In her more intimate relationship with her boyfriend this has provided the both of them a focus for their attentions that doesn’t have to do with treatment or symptom management.
Taking the puppy walking and to obedience classes also get her out into the wider world regularly, providing both stimulation (mental and social) and exercise (an important part of regaining her “normal” life).
I particularly loved the idea of the comfort and cheer listening to the puupy’s heartbeat and feeling his warmth bring to her. I was reminded of new Mom’s being encouraged to hold their children close to their bodies to soothe them with their warmth, scent and the sound of their hearts. Research has demonstrated that this snuggling lowers babies heart rates, reduces their stress levels and that they fuss less often – perhaps she is enjoying similar benefits.
If you know people going through cancer treatment – especially long and/or high-risk treatments – remember that though you and they need the opportunity to talk about the illness that your relationship goes beyond that and that they may already have had lots of opportunity to talk about their treatment. Be open to talking about their disease and treatment but remember they are not just a patient, their your friend.
Once upon a time, because of the risk of cross-infection with your pet, or your pet bringing in dirt and contaminants the ill and the elderly were not encouraged to have pets. In recent years that has been changing. Cats, and sometimes dogs, can now be found in nursing and retirement facilities as group pets. These animals provide the residents with company and entertainment. HIV/AIDS patients, with their lowered immune function, were encouraged to give up pets they had, not just avoid adding a pet, in earlier days. Now the emotional and social benefits of having a pet to love and care for and to be cared for by have been show to improve immune function and reduce depression in patients.
Modalities Massage Therapy
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
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.
Sheila Hobbs, RMT
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.
I am not talking about the FDA (Food and Drug Administration – the entity in the US that approves food and drug sales) in this blog, or at least not directly, but the title just called out to me. What I am talking about is how the food you eat and the drink you drink impact the drugs you might take. I got inspired by a couple of tweets I checked out and re-tweeted that I found really interesting.
The question of food and pharmaceuticals, for most, likely brings to mind the little stickers you find on your prescriptions bottles or warnings on the labels of over the counter drugs that mainly circle around whether or not to have with food or alcohol and the safety of heavy machinery operation while using. I recently was put on doxycycline, a fairly potent antibiotic, and for the first time had a warning about dairy food specifically. Why do we receive these warnings? We get instruction of food and drink consumption – both specific types and generally – because of the risk of over or under-dosing. Some drugs have greater impact with food, some less; certain minerals can alter how drugs work for all of these reasons we get little stickers and warnings. This website has very complete information on drug interactions including foods.
How exactly do food and drink influence how drugs are absorbed and broken down in the body? There are a few answers to that question but one of the main ones is – enzymes. Enzymes are complex protein molecules that bring about cellular reactions within the body. Enzymes are how we digest food and are used to speed up, slow down, allow or disallow various chemical reactions to occur. Enzymes are produced by living cells and found in our bodies and in the things we eat and drink. Some enzymes also are able to block each other from acting – they shut down other enzymes. How drugs are processed by the body – especially how long they take to be broken down and absorbed impact how effective they are and how often and how much we need to take.
Alteration in drug processing in the body has profound ripple effects in terms of side-effects, efficacy and costs. The more of a drug you take the more likely you are to have side effects so if the dose can be lowered you have fewer side effects. The reason we often have to tolerate side effects is to ensure we receive enough of a drug to actually have it do the job it is supposed to do. The longer a drug stays at an effective level in our body the more of an impact it can have on our system, slowing down the bodies natural breakdown of a drug into its components can allow a drug to do more. Cost obviously ends up going down if we use less of a drug making lower doses desirable both medically and fiscally, especially in an era of rising medical budgets.
The particular article I read was speaking of grapefruit juice and the cancer drug, sirolimus. When ingested with grapefruit juice a one-third dose of sirolimus had the same effect. This represents a huge cost savings and a potential reduction in side effects as the lower does was accompanied by fewer side effect. Here is the interesting bit. Some dosing is lowered and ordered with a particular accompaniment; in other case, like sirolimus at this time, you take more and are told to avoid the food/beverage that increases the effectiveness of the drug to avoid overdose. I personally hope that current research will lead to increases the incidence of the former and reduces the latter.
The other interesting point that came up in the article is that not only will what you do or don’t take with drug impact their breakdown and bioavailability to your cells but it can also alter how your cells welcome the drug. Recent studies have shown that pre-treatment fasting (of 2-3 days) by chemotherapy recipients increases the impact of the treatment on cancer cell, but even more delightfully, it reduces the impact of the same treatments on the healthy cells. Basically, in healthy cell fasting creates decreased activity, basically the seek to reduce their consumption of fuel, in contrast cancer cells, which are already gluttons become even more ravenous when exposed to fasting causing them to absorb greater quantities of the chemotherapy drugs.
A 2-3 day fast is not a small thing but I suspect this news would be less daunting to the many cancer patients who have appetite loss as part of the symptoms or drug side effects. The reward of less nausea, headaches, malaise, nerve damage and hair loss – just to name a few – would be a nice reward for a bit of fasting too. Further, for those cancer patients and their families who face daily struggles to get enough food into themselves or their loved ones a brief respite would not be bad and all the parties could then focus their food efforts on their inter-treatment time. The volunteers with the trolleys of cookies and juice that wheel through the chemo room though would become a thing of the past.
What I find most interesting about all of these pieces of data is that they can be implemented with minimal hassle, little to no harm and many benefits. There is no costly drug research, no need for gene therapy the research I am talking about is from human and animal trials and new human trials are moving forward in several places already. This is exciting as a new drug or therapy can take years and years to even reach human trial stage. Plus, the cost of all of these options are negligible or well offset by saving. Not very often is that the case with modern medical innovation.
The tweets I’m talking about:
As a health and wellness professional I think of myself as well informed and a good clinician. I encourage people to be thoughtful with their wellness and think about all aspects of a situation when making decisions. I even offer my services as a wellness consultant to help other with this process. This morning I had a moment when I was reminded that no one does it right all the time – especially when dealing with family.
One of my stepsons has eczema. Until this fall he had been symptom-free for about two years. Then he had a flare up Since that time we have been struggling to bring the symptoms back under control. They have abated at times and are in a moderate level of irritation right now. We have tired some corticosteroid cream with not great results – for either the itching or the state of the eczema itself. He is oatmeal bathing frequently which offers temporary relief. We have got him off of dairy – mostly – as that helped in the past. I modified some of my bare bottom bum cream with different essential oils, which has helped as much as anything. I got him to add an Omega 3/6 supplement as that helped with some itching I had during pregnancy. Overall, some symptom management has been our best outcome.
How does that moment I described fit into all of this? I was putting cream on my own legs and thinking how dry they are with the colder weather, which led to thoughts of other skin drying activities, which led to thoughts of my stepson being in and out of hot baths multiple times a week. Suddenly I wanted to kick myself. In all the other suggestions we have tried, in all the recommendations, I couldn’t remember ever saying “moisturize after your bath”.
Such a simple concept, one anyone with dry skin will tell you is a necessity, and it never crossed our minds. We shall see now whether it is the missing piece. Will some intensive moisturizing help? Post bath and – if I can convince him – overnight will be the next phase of treatment.
Now eczema isn’t deadly, no permanent harm is likely to come of this, but as my stepson would attest, it is a pain, very distracting and not helpful to life as a whole, but why make this a blog? I keen on reminding anyone I am imperfect, but I did want a reminder of what happens when I don’t slow down and think things through. The other reasons are: to help others remember that lesson too, and to remind them too that when dealing with family, it is easy to forget some of the most basic things. Dealing with family we can often be both more concerned and less careful than normal. Not careless for their well being, but sometimes, in the rush of daily life, if you never sit down and give proper, systemic thought you can miss the obvious. Next time you or one of your family members comes up against a wellness issue, give it the thoughtfulness it deserves. And if the issue is a larger one be sure to give it its due and if you need too, get some support.
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.
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.
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….
I have, over the last few months, gained some weight. I am very aware of the irony of being a health professional and being unhealthy on such a fundamental level. My dissatisfaction has led me to spend time thinking and exploring eating, exercise and weight loss options. All this looking around led me to the various surgical options – which I have always considered risky and extreme – to my surprise there is a high success rate and low risk factor. I believe firmly that eating habits and exercise are the best way to lose weight – have I been wrong?
In the end I think not. When it comes to weight if you burn more calories than you consume you will lose it. If food in and calories burned are the same, your weight will be steady. This equation is not in question. The questions circle how best to do this, how best to successfully lose weight. How do weight loss surgeries have such success? Simply put, the success of weight loss surgery comes from reducing stomach size to force you to eat less. Yes, eat less, reduce the size and frequency of meals, you know, a diet. Basically you are having someone put you a surgically induced diet. Ultimately this means that reducing your eating works.
A recent study actually shows that the family members living with gastric bypass patients lose weight in concert with the patient, believed to be due to the diet and exercise programs they have participated in with the patient. In fact the more I read the more it became clear that the surgery is just the first step in the process of weight reduction. The surgery is a step that is followed by nutritional and personal counselling, personal training and life changes. It turns out I am right – diet and exercise are keys. Whether you get a surgical boost or not, it is how you eat, and how much you move, that determine your weight.
The medical community is coming out more and more in favour of surgical intervention for weight-loss and we are seeing coverage by provincial and extended health carriers. One of the reasons for people to consider surgery is persistent lack of success with diet and exercise. My question is – if we were to divert the $15,000 (the low-end of the cost for gastric bypass – high is $50,000) to offering nutritional counselling and paying for personal trainers (which have no to very low coverage) would the success rate be better for the non-surgical intervention? You can buy a couple of years of 3 day a week personal training sessions for $15,000.
I think this preference for surgery is a part and parcel of our health care system’s preference for fixing with intervention rather than offering outpatient support. For my situation I would love to access enough money to support my having a personal trainer for a few months to get me back to a reasonable weight and to support some life changes now, when I have no weight-related health problems. Instead I have to do it on my own, or wait until I am worse off in terms of weight and attendant health problems before I can get help – and even then the support will only be for a doctor altering my body – not for me trying to alter my body.
More about weight-reducing surgery:
- In BC the only type of weight-reduction (bariatric) surgery covered by MSP is what is commonly called gastric bypass – which results in the largest weigh losses
- The most common weight-reducing surgery is gastric banding – which has the quickest recovery but there are more complications and a lower level of weight loss
- the newest weight-reduction surgery being offered is the insertion of a balloon into the stomach which is then inflated in the stomach. This is fast, reversible and seems to be working. It is the only option that requires no incision and no general anaesthetic.
- In a study of 243 gastric bypass patients those in the obese and morbidly obese categories had excellent levels of loss and maintenance The “super obese” class (BMI > 50 at time of surgery) had the least success both in terms of amount of weight loss and the maintenance over time.
- Gastric bypass surgery can cost anywhere from $15,000 to $50,000 NOT including personal training, the bulk of counselling suggested, the wardrobe changes or the cost of any plastic surgery to deal with the changes in body shape that result.