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The Power of Language

Language is powerful.  We use language to form our thoughts. These thoughts influence us—our choices, our health and how we perceive the world. The recognition of the power of thought has been around for centuries. The most famous example of this is 17th century philosopher, Rene Descartes who posited, “I think, therefore I am.”

When I write this blog, I am aware of the power of words. When I describe a person as someone living with HCV, it may conjure up a different image than that of an HCV patient. The term healthcare consumer seems more powerful than the word patient does.

Professionally, the word patient has powerful connotations.  When working with patients, I serve them. Patients have the power to hire or fire me. However, when I am the patient, I have come to associate the word patient as a vulnerable and passive condition.

Troubled by my ambiguity, I looked up the word patient. The word patient comes from the Latin word “to endure pain or suffering.” According to Wikipedia, patient and patience share the same origin. Wikipedia gives this further definition: enduring trying circumstances with even temper.

This image is powerful. The notion of enduring difficulties while maintaining an even-temper seems like a lofty goal. Perhaps it is enough to endure, regardless of temperament. However, to endure with minimal anxiety or even with grace is very attractive to me. It makes being a patient a noble condition.

What do you say to yourself? What messages do you send to your body, mind, and spirit? Do not be afraid to look at yourself, to find your truth and name it. Perhaps these may deepen the discoveries about ourselves, enabling us to live in health rather than in disease.

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When Death Visits

Don Kressly

My father and me

When I was at my father’s side as he was dying, it felt as if time had stopped, and reality was shattered into a thousand tiny shards. It happened in a blink of time. But when death visits, the world continues to turn.

As your loved one gasps for breath and the scent of death permeates the room, your grandson cuts his knee and needs stitches. Your friend has a double mastectomy, the nurse locks her keys in the car, your mother nurses a broken shoulder, and the plumbing backs up.

When death drapes itself on you and your family, nothing matters. Your friend has a sinus infection and shares the details. You nod and listen, wondering if she has any idea of how ridiculous it seems to be talking about sinuses. But you listen, because you love that person and one thing that death teaches you is that you never want to miss an opportunity to be kind.

The troubles seem to keep pouring on, but in fact, life always has troubles. Normally, you just roll with the punches, but now you are too vulnerable to roll.

It all passes. If you are really lucky, you will have a moment of clarity and wonder what you are going to do with your precious life. Most of us will squander this insight, and forget that life is exquisitely short, and that every minute matters. Later you’ll turn your attention to TV, Facebook, and other devices, anything that takes your attention away from death.

Or perhaps, you will be the exception, and you grab hold of your loved ones and the precious moments of life ahead, and life is transformed beyond your wildest dreams.

I wonder which I will choose? If you are the exception, please tell me how you stopped from slipping back to old habits and how you grabbed hold of life.

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Health Humor

My body needs more humor. My last post was so heavy that I thought my readers might need antidepressants in order to survive my blog. Because it is never too late to celebrate April Fools’ Day, I thought we needed some health-restoring levity to elevate our endorphins.

The following humorous quotes were taken from actual medical records dictated by physicians. These are from a column written by Richard Lederer, Ph.D. for the Journal of Court Reporting and have been reprinted at several Internet sites and magazines.

  • By the time he was admitted, his rapid heart had stopped, and he was feeling better.
  • Patient has chest pain if she lies on her left side for over a year.
  • On the second day the knee was better and on the third day it had completely disappeared.
  • The patient experienced sudden onset of severe shortness of breath with a picture of acute pulmonary edema at home while having sex which gradually deteriorated in the emergency room.
  • She has had no rigors or shaking chills, but her husband states she was very hot in bed last night.
  • The patient has been depressed ever since she began seeing me in 1983.
  • Patient was released to outpatient department without dressing.
  • I have suggested that he loosen his pants before standing, and then, when he stands with the help of his wife, they should fall to the floor.
  • The patient is tearful and crying constantly. She also appears to be depressed.
  • Discharge status: Alive but without permission.
  • The patient will need disposition, and therefore we will get Dr. Blank to dispose of him.
  • Healthy appearing decrepit 69 year-old male, mentally alert but forgetful.
  • The patient refused an autopsy.
  • When she fainted, her eyes rolled around the room.

So, the next time your eyes roll around the room, pick up them up and keep laughing.

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End of Life Nightmare

Grass Valley Sunset

I feel like I am stuck in a Kafka novel. For those who were not tortured in school by the novels of Franz Kafka, he wrote about my worst nightmare – being stuck in something freaky because of unnecessary and bizarre rules and regulations. Merriam’s dictionary defines Kafkaesque as “of, relating to, or suggestive of Franz Kafka or his writings; having a nightmarishly complex, bizarre, or illogical quality.”

My Kafkaesque story is too long to write about in the detail it deserves, but here is the short version. My father and his wife have been dealing with serious cancers diagnoses.  We aren’t sure who will live longer. My father lost his balance and he grabbed onto my stepmother, taking both to the ground. As a result he has a broken back; she broke 3 ribs and her shoulder. He is in the hospital with multiple medical problems. My sister is taking care of my stepmother.

My father wants to die. His doctors confirm he is dying. Treatment has been stopped. In order for him to go into a hospice program, he has to have a place where he can receive hospice care, and the hospital won’t start it until we have this place. My stepmother has too much to dealing with and she isn’t ready for assisted living, so they have chosen to find him a skilled nursing facility. It means he will spend the rest of his precious life there. So, we are frantically looking for a place for him so he can receive hospice care. This seems so wrong.

What is my point? I have no idea. I was going to dive into a discussion on end-of-life planning, long term care insurance, and so on. I am not. What I most want to say is that life is precious and short. I intend to milk the most out of it. Wish I had something profound to say, but I don’t. I am going to go watch the sunset and say a prayer of gratitude for this glorious day.

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Deciphering Food Labels

If you have ever dieted, you probably read food labels. Nutrition starts with studying food packaging information. When looking at labels, start with portion size. Compare the two labels below. Both have the same serving size—½ cup. However, if I ate the entire can of Brand A I would consume 840 calories and 3720 mg of sodium. An entire can of Brand B will net me 315 calories and 805 mg of sodium. Both provide lots of fiber, but I don’t want to think of what would happen if I ate all of Brand A.

BRAND A CANNED BAKED BEANS                             BRAND B CANNED LENTILS

Nutrition Facts

Serving Size: ½ cup

Servings Per Container 6

Amount Per Serving

Calories 140  Calories from Fat 10

% Daily Value

Total Fat 1g                           2%

Saturated Fat 0g            0%

Trans Fat 0g                0%

Cholesterol 0g                        0%

Sodium 620 mg                     26%

Total Carbohydrates 28 g            9%     

 Dietary Fiber 5g        20%

Sugars 11g

Protein 6g

Vitamin A 0%      Vitamin C 2%

Calcium 6%          Iron 10%

 

Ingredients: water, prepared white beans, sugar, maple cured bacon, mustard, salt, vinegar, corn starch, onion powder, caramel color, tapioca, maltodextrin, autolyzed yeast extract, bacon fat, natural flavors, natural smoke flavor

Nutrition Facts

Serving Size: ½ cup

Servings Per Container 3.5

Amount Per Serving

Calories 90     Calories from Fat 0

% Daily Value

Total Fat 0g                           0%

Saturated Fat 0g            0%

Trans Fat 0g                0%

Cholesterol 0 mg                   0%

Sodium 230 mg                      9%

Potassium 230 mg                 7%

Total Carbohydrates 13g            4%

Dietary Fiber 4g         16%

Sugars 0g

Protein 8g

Calcium 4%    Iron 10%

Thiamine 6% Riboflavin 4%

Niacin 4%       Phosphorus 15%

Magnesium 8%           Zinc 10%

Ingredients: organic lentils, water, organic tomato puree, sea salt, organic onion, organic garlic, organic bay leaf

Nutrients are listed under calories.  These include fat, cholesterol, sodium, carbohydrates, protein, vitamins and minerals.  Fat, cholesterol, and sodium are first because we need to strive for less of these. Current recommendations are to limit saturated fat and avoid trans fat.

Labels must list amounts for calcium, iron, vitamins A and C. The listing of other vitamins and minerals is voluntary unless the product carries a health claim about a specific nutrient. Brand B’s label provides more information than is required by law.

The % daily value is based on a 2000 calorie per day diet. Assuming I need 2000 calories daily, if I ate ½ can of Brand A beans, I’d get a lot of sodium.

Ingredients must be listed by weight in order—starting with the highest. Brand A’s ingredient list has a few items that I’d prefer not to consume, especially compared with those in Brand B. Note that Brand B did not have to add natural flavors because it started as a natural food.  Is adding natural flavor an oxymoron?

For those monitoring sugar intake, note that sugar has many names. High fructose corn syrup, fruit juice concentrate, glucose, maltose, dextrose, sucrose, honey and maple syrup are all sugars.  If corn syrup is the first listed ingredient, then that is what you are eating the most of in that salad dressing.

One guideline I live by is that if I can’t pronounce an ingredient, perhaps I shouldn’t eat it. Maltodextrin found in Brand A is a carbohydrate made from a starch that is absorbed rapidly like glucose. Do I really need that?

When it comes to nutrition, simplicity reigns.  Choose single-ingredient foods are you are likely to avoid additives.  What can be simpler than fresh fruit or vegetables? Dried beans, fish, eggs, nuts or dried fruit don’t have complicated food labels.  Not all single-ingredient food is healthy, such as cane sugar or lard, but you get the picture.

Knowing what is in food can help us make better choices.  Eating a healthy diet is like training to be an athlete. It takes education, preparation, and practice. Spend some time educating yourself, develop a plan of action and make a commitment to yourself. Read food labels. You are worth it.

Further Resources

Information from the FDA about how to read food labels:

www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm274593.htm

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I enjoy looking at health statistics. In my world, data are my friends. Data are tools that help me make choices. For instance, the odds that I will be killed in a shark attack are nearly one in 4 million; my chances of dying from a heart attack are one in five. Given these odds, I am focusing on maintain a strong heart and clear arteries. However, despite these odds, I am not going to jump into a frenzy of sharks, whereas I might skip my daily walk.

Back to health statistics, I was looking at the leading causes of death in the United States. Here are the number of deaths for the top ten according to the National Center for Health Statistics:

  • Heart disease: 614,348
  • Cancer: 591,699
  • Chronic lower respiratory diseases: 147,101
  • Accidents (unintentional injuries): 136,053
  • Stroke (cerebrovascular diseases): 133,103
  • Alzheimer’s disease: 93,541
  • Diabetes: 76,488
  • Influenza and pneumonia: 55,227
  • Nephritis, nephrotic syndrome, and nephrosis: 48,146
  • Intentional self-harm (suicide): 42,773

This list looks very straight forward, but is it? In a paper published in the BMJ (May 2016), Martin Makary and Michael Daniel reported that medical error is the third leading cause of death in the U.S. They estimate a death rate of above 400,000 annually. This high-ranking killer is not included on death certificates and thus does not show up in rankings as a cause of death.

This is scarier to me than jumping into a shark tank. When we are sick, we are vulnerable. Even if we trust our doctors, we are still at the mercy of a system that is bigger than our primary care providers. Between our medical team, pharmacy staff, insurance, labs, and so on, there are lots of opportunity for medical error.

You aren’t entirely helpless. There are measures you can take to minimize your risk of being a medical error victim. The U.S. Department of Health and Human Services has published the following 20 tips by the Agency for Health Quality and Research:

What You Can Do To Stay Safe

The best way you can help to prevent errors is to be an active member of your health care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. 

Medicines

Make sure that all of your doctors know about every medicine you are taking. This includes prescription and over-the-counter medicines and dietary supplements, such as vitamins and herbs.

Bring all of your medicines and supplements to your doctor visits. “Brown bagging” your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date and help you get better quality care.

Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you to avoid getting a medicine that could harm you.

When your doctor writes a prescription for you, make sure you can read it. If you cannot read your doctor’s handwriting, your pharmacist might not be able to either.

Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you get them:

  • What is the medicine for?
  • How am I supposed to take it and for how long?
  • What side effects are likely? What do I do if they occur?
  • Is this medicine safe to take with other medicines or dietary supplements I am taking?
  • What food, drink, or activities should I avoid while taking this medicine?
  • When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed?

If you have any questions about the directions on your medicine labels, ask. Medicine labels can be hard to understand. For example, ask if “four times daily” means taking a dose every 6 hours around the clock or just during regular waking hours.

Ask your pharmacist for the best device to measure your liquid medicine. For example, many people use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people measure the right dose.

Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does or if something unexpected happens.

Hospital Stays

If you are in a hospital, consider asking all health care workers who will touch you whether they have washed their hands. Handwashing can prevent the spread of infections in hospitals.

When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow at home. This includes learning about your new medicines, making sure you know when to schedule follow-up appointments, and finding out when you can get back to your regular activities.

It is important to know whether or not you should keep taking the medicines you were taking before your hospital stay. Getting clear instructions may help prevent an unexpected return trip to the hospital.

Surgery

If you are having surgery, make sure that you, your doctor, and your surgeon all agree on exactly what will be done. Having surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.

If you have a choice, choose a hospital where many patients have had the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

Other Steps

Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.

Make sure that someone, such as your primary care doctor, coordinates your care.

This is especially important if you have many health problems or are in the hospital.

Make sure that all your doctors have your important health information. Do not assume that everyone has all the information they need.

Ask a family member or friend to go to appointments with you. Even if you do not need help now, you might need it later.

Know that “more” is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

If you have a test, do not assume that no news is good news. Ask how and when you will get the results.

Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment options based on the latest scientific evidence are available from the Effective Health Care Web site. Ask your doctor if your treatment is based on the latest evidence.”

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