Lost Stories

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img_2661Not far from the busy pedestrian streets in the center of Vienna, down a quiet narrow street, lies a small cobblestoned city square. Before World War II, this city neighborhood was the bustling, vibrant heart of Vienna’s Jewish Quarter, but today it is has a quiet, almost subdued feeling. Vienna’s current Jewish population is only a small fraction of what it was before the war, and the quiet feel of the square reflects this.

At one end of the square is a memorial to the thousands of Jewish individuals who lost their lives during the Holocaust. At first glance, the memorial looks like a huge square concrete block, oversized and awkwardly placed in an otherwise well-proportioned city square. As one approaches however, the details become more clear: the memorial is a library of books. But in contrast to how books are normally displayed, the books are turned inward such that the spines are in the center of the concrete block, hidden from view. Walking the perimeter of the memorial, the observer sees only the outer edges of the pages – no spines to reveal the titles or authors.

To view this memorial is thought provoking and very moving. The library symbolizes the lost stories of the Holocaust: humanity lost scientists, poets, artists, musicians, teachers – countless unique individuals who possessed knowledge, gifts, and skills that could have added to the diverse richness of humanity.  A library of humanity, knowledge and gifts, hidden from view and lost forever.

The image of the Jewish Memorial and the feelings it brought forth washed over me as I read about the many ways in which the medical profession – and human health – has benefited from the natural world. Many important, life saving medicines are derived from plants and animals in nature. For example, blood pressure and diabetes medications, cancer treatments, and blood thinners all are derived from chemicals discovered within plants or animals. In addition, modern medicine has looked to the natural world for inspiration and models for many significant advances.

However, this rich and diverse fund of knowledge – this library – is disappearing at an alarming rate. Biologists warn that Earth is losing species at an unprecedented rate, such that our current era has been called “the sixth extinction.” With every lost plant or animal, humanity  loses unique tools, lessons and examples that could help human health. In addition, as we lose biodiversity, we also become less able to adapt to changes in our environment, becoming handicapped in our ability to respond to new diseases.

Much of the Holocaust occurred while the world’s nations looked the other way, ignoring the unprecedented loss of life. Similarly, as species disappear on a daily basis in today’s world, most of us go about our daily life, attention turned elsewhere.  Humanity can not afford to ignore this destruction of the natural world. Human health will increasingly suffer from the loss of knowledge the natural world offers, and just as countless human stories were lost during the holocaust, we will lose the stories from nature that could help us live a healthy life.

There is not a simple solution to halt our current loss of biodiversity, but we all must do what we can. Every little bit helps; we can drive less, recycle, and support  laws, politicians, and businesses that value the environment, for example.

The time for action is now. The health of the natural world and the health of humans are intimately intertwined, and ultimately will enjoy or suffer the same fate.

Interconnectedness And The Flu Vaccine

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vaccineI received my flu shot the other day. I love getting vaccines. Vaccines prevent disease and help keep me healthy. To me, getting that poke in the arm gives me a feel-good sense of interconnectedness with others. I know it seems at first a little odd to make this comparison, but for me it’s true. Getting a vaccine helps keep me well, and makes me happy knowing that by not getting the flu I am keeping others healthy. Not only do I feel cared for as an individual, but in getting that shot, I enjoy a sense of caring for others.

And when it comes to caring about our community, kudos to our own Kittitas Valley Healthcare organization for working hard to prevent patients from getting the flu. KVH has adopted a very strong influenza vaccination policy, in that if a KVH employee chooses not to get the influenza vaccine, they are required to wear a mask throughout the flu season (from November 1st through March 31st!).

Getting the influenza vaccine as a healthcare worker is very important; research has shown that healthcare workers who get the flu risk infecting their patients, which can result in serious illness and death. For example, research on this topic has compared nursing homes with high rates of influenza vaccination among staff to nursing homes where staff had lower rates of vaccination. The nursing homes that had low staff influenza vaccination rates had significantly higher influenza related deaths among the residents. In other words, getting the influenza vaccine not only keeps healthcare workers healthy, but protects the people they care for.

Similarly, when a individual in our community gets the influenza vaccine, they not only  improve the chances of not getting the flu themselves, but also of not giving it to others they come into contact with. Regardless of our profession or daily activities, we inevitably interact with other community members, some of whom may have medical conditions that make them more vulnerable to getting sick with influenza. For example, it’s almost impossible to know if the person we stand in line with at the grocery store has cancer and is taking medicine that suppresses their immune system. Why take the chance of getting someone else sick?

My advice is to take action to keep yourself, friends, family, and fellow community members healthy. Get the influenza vaccine. In addition to being healthier, by receiving the vaccine you promote the health of others. Take a moment to reflect upon what that vaccine is doing not only for yourself, but for every person in your life.

Gun Violence: A Public Health Crisis

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We can use the scientific process…to help us learn how firearms can be safer. 

The numbers are daunting. Over 33,000 people die from guns in the United States each year, more than any other industrialized country.  The homicide rate in our country is twenty times higher than countries similar to ours. While mass shootings are occurring at increasing frequency and dominate newspaper headlines, most deaths –two thirds– are from suicide.  And perhaps most disturbing is that children less than 18 years old in America die from guns at a rate that is eleven times that of other countries; suicide is the second most common cause of death for our youth.

I tend to look at health and medicine from an optimistic, “glass half full” perspective. For most health topics, I find it relatively easy to take this perspective.  However, it is difficult to do so with gun violence.  Put bluntly, there is nothing good guns do for human health. Every death from firearms is tragic, sudden, and disturbing. Every death from firearms did not have to happen.

I also like to look at health recommendations from what is considered an “evidence-based” perspective. “Evidence- based” means that recommendations are based on scientific evidence and research. The scientific process attempts to look at questions from an objective viewpoint, and continually reevaluates previous conclusions to confirm their accuracy. Using science to guide us is our best chance at knowing what “works” for health problems.

Americans own more guns per capita than any other industrialized country in the world. Meanwhile, the second amendment protects the rights of Americans to bear arms. These facts will not change. What can potentially change, however, is the creation of a safer environment in which guns and people coexist. My hope– my “glass half full” perspective–  is that by approaching firearm safety as we have other public health issues, we can come together as a nation and take rational, evidence based actions to reduce harm from firearms.

By reviewing past public health challenges, our country can learn how to reduce deaths from firearms. A good example is how we have approached harm caused from motor vehicle crashes. Because of research studies, we learned that wearing seat belts and having airbags save lives. Meanwhile, the statistics have overwhelmingly supported the notion that driving intoxicated increases the risk of being killed — and killing others– in motor vehicle crashes. As a result, laws were enacted that required cars to be made with airbags, drivers to wear seat belts, and that have enforced not driving intoxicated. Even more importantly, because of what has been learned through research, driving culture has changed. It is not acceptable in our country to drive drunk or without a seatbelt. In other words, research illuminates important health and safety facts, laws support those facts, and behaviors change.

Similarly, if we ask questions and arrive at answers through objective research studies, we can use the scientific process as an important tool to help us learn how firearms can be safer in the United States. Already we know that gun safes and locks reduce suicides and accidental shootings in the home, but we need to learn more. We need to use scientific, evidence-based research to learn what other interventions can help make the presence of firearms in the home safer.

In our current era of political divisiveness, it is time to come together as a country to reduce gun deaths. Gun violence in America is a complex problem and solutions are often not simple, but if we approach this topic as we do other public health topics, and utilize an evidence-based perspective, as a country we may be able to make progress in reducing the number of deaths each year from firearms.

Listen in on my discussion with Dr. Mark Larson on “Gun Violence as a Public Health Problem”.

Above the Clouds

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cloudsRecently I was graced by the presence of a friend who is in the midst of battling cancer. It was a very special privilege, a reminder of how precious we each are, and how every day is a gift.

To have an aggressive or advanced cancer and to meet it head on transports that person and their loved ones into a different state of being. Most people not facing a life threatening disease go about their daily life with an underlying sense that the future is measured in many years. There is time to think about what might happen next year, to plan for retirement; there is time to day dream about the future. But cancer changes all that. What is important is now: family, friends, the warm sun and the beautiful blue sky. Now is so very precious and important. Now is the time to tell your spouse you love them, to notice and share the beauty in your child. The present is alive with the beautiful energy of life and love. It is almost as if the people without cancer are living on the surface of the earth, below the clouds on a partly sunny day, while those absorbed in the intensity of living with cancer have the opportunity to rise up and see those clouds not from below, but from above, to experience the radiant blue sky and the brilliance of the tops of white clouds and bright sunlight.

I know this heightened awareness of living, as my life was once acutely threatened by cancer. I felt uncertainty and fear, but when I was able to move through and above those feelings, I experienced a clarity of perspective, a vivid awareness of the beauty of life. I know it, I have lived it, but am not there now. As far as I know, if my good fortune continues, I am free of my cancer. Over the past couple of years, I have gradually rejoined the cancer-free crowd, and as such have slipped into the inevitable routine of thinking and feeling too often into the future. Because I am not acutely threatened as I once was, I have slipped out of that special, heightened state of being. I love to appreciate the present and try to take nothing for granted, but it is not the same. There is no substitute for the real thing.

Spending an hour with this very special person who was immersed in the cancer experience, whose eyes sparkled as she smiled at her daughter and told her husband she loved him, was truly a gift. It reminded me of my experience, and how important it is to strive – all of us – to experience and appreciate life to the fullest. Just by trying, we can make our lives and the lives of those around us that much more close to that special, almost divine, state of being.

Past and Present: Rubella and Zika

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Dengue, zika and chikungunya fever mosquito (aedes aegypti) on human skin

The past can teach us important lessons if we are observant. This is especially true for infectious diseases and the power of immunizations. Vaccines have turned diseases of epidemic proportion into distant memories; it is critical to remember these past events and to use their lessons to guide us as we face new health challenges today.

I invite you to travel back in time. It is the winter of 1964, and Philadelphia and New York are the epicenters of a worldwide viral epidemic that has swept into America from Europe. Transmitted like the common cold, the viral infection is typically not severe. Those afflicted experience a sore throat, watery eyes, and a faint rash, followed by complete recovery. However, if the infection occurs early in pregnancy, the consequences for the developing baby are potentially catastrophic. One percent of infants born to mothers who acquire the infection during the first few months of pregnancy are born with severe birth defects; most of the affected babies experience deafness, heart defects, and cataracts, but virtually every organ of the developing infant can be affected. Twenty thousand babies are born with these abnormalities, and eleven thousand die.  This is the story of the Rubella Virus.

Fast forward to present day, Miami. A viral epidemic is sweeping into the United States from South America. While this virus is transmitted by a mosquito, it also produces mild symptoms: a sore throat, sore joints, and a faint rash.  Many people are not even aware they have been infected. And yet, like the Rubella Virus, an infection that occurs early in pregnancy can be devastating. One percent of infants born to mothers who acquire the infection early in their pregnancy will give birth to babies with severe birth defects, most commonly microcephaly.

The epidemic is happening now and the future is unclear. This is the unfolding story of the Zika Virus.

The epidemic that swept America in 1964 is uncanny in its similarity to what is happening today. Will twenty thousand newborns be born with severe birth defects, as in 1964?

Let’s travel back in time again. Returning to Philadelphia, it is 1969 and a vaccine has been developed. Due to vaccination efforts, by 2004 the Rubella Virus that spread into America from Europe has been completely eradicated from The United States. And just last year, in 2015, the virus was declared eradicated from the Americas.  This is the happy ending to the story of Rubella, and a testimony to the power of vaccines.

As of today, 2016, there is no vaccine for the Zika Virus that is spreading into the northern hemisphere from the south. We need a vaccine, as it will be the ultimate cure. And yet, in the present day United States there are individuals who are skeptical about the benefits of vaccines.

The past is a powerful teacher. As Zika knocks at our door, one only needs to pause and remember the story of Rubella. The benefits of vaccines become crystal clear.

The Skinny On Weight Loss

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Losing weight is hard work, but…it is worth the effort.

For many people, losing weight or maintaining a healthy weight is very challenging.  To make a difficult process worse, there is a plethora of weight loss advice, diets, and supplements to choose from; weight loss diets are a big business and everyone has an opinion.  Attempting to lose weight in our country seems much more complicated and confusing than it needs to be. To help sort out fact from fiction, it helps to look at what good quality medical research says about weight loss.

Diet.  This topic is perhaps the most important– as well as most confusing– topic to address.  What type of diet should one follow? Many medical studies have been done in an attempt to address this question.  The conclusion is that no one diet is superior to another. While a specific diet may claim theirs is the best (and may present a rationale that seems to make sense), no specific diet is more effective than any other. What is important though, is picking a diet that makes sense to you as an individual, and sticking with it.  If a diet with reduced calories is followed, weight is lost.  No matter how one looks at this topic, weight loss boils down to paying attention to what one ingests and ingesting less calories.  Not surprisingly, once a specific diet is stopped, weight is typically regained.  This weight regain is because less attention is paid towards what one eats, and more calories are ingested.

How many calories an individual should try to reduce from his or her diet depends on how overweight one is, and how aggressive a weight loss program they wish to pursue.  For most people, reducing caloric intake by 500 calories per day will result in a gradual, steady weight loss.

Exercise. While the health benefits of exercise are immense, medical research has shown that exercise has a relatively small impact upon successful weight loss. Weight loss is best achieved through reduced calories. With that said, exercise is quite helpful at maintaining a new weight once one has lost weight. In addition, exercise helps build muscle and reduces the chance of developing many diseases, such as heart disease, diabetes, arthritis, and even some types of cancer.

There are a number of common perceptions regarding weight loss that may be true, but in which the jury is still out. For example, in general, the medical research supports the notion of ingesting most of one’s calories by the afternoon, and avoiding a large dinner.  However, we don’t know for sure how important this is for weight loss. Similarly, the importance of eating breakfast is traditionally recommended to help with weight loss, but the medical research has not given us a clear answer regarding how important this is either.

We do know that over the counter supplements have no proven benefit with weight loss. Prescription medications are of limited use and must be taken indefinitely to help with weight loss. Bariatric surgery clearly helps, but is indicated in only in very specific situations, and as is the case with any major surgery, there is a very real risk of serious surgical complications.

Losing weight is hard work, but it is attainable and worth the effort. My advice is to keep it simple, and to go with what scientific research supports.  Pick a diet–or strategy– that seems right for you. Reduce your daily caloric intake by about 500 calories, and stick with your plan for the long haul. Make your lifestyle changes permanent, otherwise lost weight will probably be regained.  Meanwhile, work exercise into your life, which will help keep the weight off. If after sincere effort you are still having difficulty with weight loss, consider seeing your doctor to discuss other options.

It would be nice to have a “magic bullet” that makes weight loss effortless and lasting.  While there is no such special supplement or proprietary diet that makes it easy to lose weight, there is a refreshing simplicity to the advice medical research has to offer.

Cutting the Ribbon

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I was recently given the honor of cutting the ribbon to begin the “survivor lap” at our local Relay For Life. It was a very moving experience, and one I will not easily forget.  I took my place between the purple ribbon and the other cancer survivors. Men, women, old and young, we were bound together by the common thread of cancer. The large shiny ribbon that stretched across the track reminded me of wrapped presents and special occasions. I wasn’t sure what feelings might come to me when it was time to cut the ribbon.  However, similar to the anticipation one experiences before opening a special gift, I felt excited and knew it was going to be a special experience. One by one, these feelings came forth…

I felt a profound sense of respect and camaraderie for those around me. While each person’s cancer journey is truly unique, there is also commonality to the experience. To experience cancer is to endure physical as well as emotional hardship, and the journey encourages one to dig deep into ones soul to find inner strength. Having cancer is difficult and is inevitably life changing.  I stood among individuals who had experienced the trauma of having had cancer, and who had weathered the hardships of cancer treatments. Each person was a hero in my book.

I was overwhelmed with humility and gratitude. We were survivors. We were granted the gift of life.  It is tempting to think that one survives cancer because of a positive mental attitude or a healthy lifestyle, but truthfully, there is not a good reason why some are fortunate and others not.  Many healthy, vibrant and wonderful people are struck down by cancer every day. I stood among those who had survived; I was honored to be among them, and I was thankful.

When the moment came to cut the ribbon though, I experienced what ultimately was the most powerful feeling I experienced that day. It bubbled up inside me, light and happy: Joy!  We were survivors, and we were celebrating!  Cutting the ribbon symbolically opened the gift I felt within, a gift cancer often bestows upon survivors and their loved ones:  profound and joyous, the appreciation of being alive.

Death and dying simplified

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couple in sunspotTalking about death and dying is not typically a top choice for dinner conversation; in fact, almost any other topic seems easier to talk about. Understandably, thinking about death is unnerving. There are many uncertainties, and much that may feel out of our control. It is difficult to know when death will arrive or what it will be like for us, physically as well as emotionally. It is easier and more comfortable to avoid the topic, and after all, what’s the rush?  Dying is hopefully a long way off.

Although there is a tendency to avoid addressing this seemingly heavy topic of death, it is also natural to muse over what we would like the end of our life to be like. For example, I think it is safe to say that most people want to be old when they die, but not so old that one lingers in poor health. And I suspect no one would object to the notion that death be a peaceful and painless process, and that when it does come, there is a chance to say goodbye to our loved ones.

On one hand is a desire to have death come at the right time and to be a certain way, and yet on the other hand there is so much out of our control. The good news is that there are simple, easy actions we can do now to increase the chances of leaving this earth in a manner consistent with our individual preferences.  With a little effort, we can increase the chances of having some control over this very significant time of our life.

First, designate one or more loved ones as your “Durable Power of Attorney for Healthcare,” which allows the people who know you best to be your spokesperson regarding medical decisions if you are not able to speak for yourself.  Creating a DPA for Healthcare is a simple process that does not require a lawyer. The forms necessary to complete a DPA for Healthcare are readily available on the internet, and do not need to be notarized in Washington State.

Equally- if not more- important, talk to your loved ones about what is important to you.

The “Living Will,” popularized during the 1980s, attempts to spell out preferences regarding whether one would want prolonged life-support on a ventilator, or to be kept alive by nutrition delivered through a tube.  I suggest not spending very much time on these subjects; most people don’t want to live out their remaining days kept alive by machines.

Instead, talk about what is truly important and meaningful to you; what makes your life worth living?  Think about what gives you joy, and tell your Durable Power of Attorney for Health Care about these values. For example, an avid reader’s life may become less meaningful if they cannot read, or an outdoorsman may not want to carry on if the natural world cannot be experienced.

Similarly, help your loved ones by sharing what would give you peace during the dying process. For example, the type of music, the presence of nature, certain visitors or foods may be very important to you, and can help create the environment for leaving this life in the best possible way. It is these kinds of preferences that guide your loved ones in honoring you as a unique individual.

Talking about death may feel overwhelming, but I suspect talking about what you love does not. Try approaching death and dying from this different angle: what gives your life meaning? What is important to you? What is worth fighting for, and when would you want to call it quits?  It may be just the perfect topic to chat about over dinner.

Listen to Dr. John’s podcast on Hospice and Advance Directives, with Dr. Kevin Martin.

Choosing wisely

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White medical pills.

Doctors have long overprescribed antibiotics.

Big versus small, more versus less; having it all versus having just the right amount. There is a tension in America between these two mentalities. If some is good, more must be better: big houses, big cars, big meals. Meanwhile, Americans also embrace the notion that small is beautiful;  self reliance and simplicity are deep rooted values in America.

This tension between more versus less is reflected in the healthcare we receive. The United States is known for spending the most per capita on medical care in the world. Traditionally we have wanted all that medicine has to offer with nothing withheld, and we have wanted it in a timely fashion with little regard to cost. Meanwhile, not providing a medical test or treatment traditionally has been associated with governmental interference, rationed care, or because it helped the bottom line of insurance companies.

Can there be too much care?
However, quantity does not always translate into quality, in life as well as in healthcare. There is a growing “less is more” mentality in medical practice, and this time, “less” medical intervention means “just right,” with the ultimate outcome of healthier people. Medical research is bringing to light that certain medical tests or treatments, when done too often or when not needed, can result in unnecessary medications or operations that cause harm. “Too much” medical care is not beneficial, and can be bad for one’s health.

I’ll share some examples.

Antibiotics: Doctors have long overprescribed antibiotics while patients have unknowingly contributed to the problem by insisting on being treated with antibiotics. And now we are paying the price: many bacteria are resistant to antibiotics, and antibiotics can adversely effect the “healthy bacteria” in our body. Most doctors in 2016 are more careful about prescribing these powerful medications;  the goal is to prescribe antibiotics only when it seems clear they are absolutely necessary.

Cancer Screening: Research is showing that if tests are done too frequently, or at too young or at too old an age, they can result in worse health outcomes. Rather than helping, testing too much can result in medical interventions that are not necessary, and these unnecessary interventions sometimes lead to complications that can harm the body.  Today doctors are doing PAP tests and mammograms less frequently for women, and screening for prostate cancer with the PSA test for men is no longer routinely recommended.  Less tests in 2016, because less means just right.

The less-is-better movement
It is an exciting time in medicine. More is not better. Instead, the focus is on determining what just the right amount is. The motivating force behind this new perspective is not the federal government’s budget or insurance companies’ bottom lines, but rather it is on improving health and reducing harm.  Because of the underlying- what is best for health- motivation, this “less is better” movement will only continue to grow. The list of medical tests and interventions that should be done less often, or not at all, is quite extensive.

There is a website I encourage you to check out that embodies this new mentality and is endorsed by over 70 medical organizations, including The American Academy of Family Physicians, The American Board of Internal Medicine, and The American Academy of Pediatrics; it is called “Choosing Wisely.”  Go to www.choosingwisely.org and see for yourself.

Naturcise

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Exercise + Nature = Maximum benefits for health

Doctors diagnose health problems, and doctors often prescribe medications. These treatments usually help, but also may cause side effects. Doctors are sometimes accused of prescribing too many drugs.  I prescribe plenty of medications, and I am going to reveal a couple of my favorite drugs with you. They are extremely powerful, have no side effects, are just about free, and can be very addictive; I happily prescribe them whenever possible.  The “drugs,” these outstanding medications, I refer to here don’t come as a pill.

 

The first drug is exercise.
Moving the body helps one feel well, live longer, and have less pain; take this drug regularly and you will be less likely to need a cane, walker or wheelchair as you age.  Exercise is frequently at the top of the list of beneficial treatments for most medical problems. It is even good for the brain too, and is one of the most powerful ways of reducing the chance of developing dementia.

To those who do it regularly, exercise comes as second nature. To those unaccustomed to it however, exercise can seem painful and even scary.  Developing an exercise habit, however, is worth every ounce of effort. Even small amounts can have profound effects. Walking, in my opinion, is the best way to try this drug out. Almost everyone can walk, it is easy to stop and rest, and there is a low risk of injury. As confidence increases, one can walk further, or even try some hills. Exercise truly works wonders for health.

Nature is a drug too, a very beneficial one.
While the health benefits of exercise have been studied by medical research for many years, the effects of nature on human health is a relatively recent area of medical research. Here is what the research is revealing: getting outside into nature helps us solve problems better, be more creative, feel more positive, be happier, experience less stress, and be more at peace. Nature even helps people be more kind and generous. It appears that being in nature activates the parts of our brain involved in these beneficial behaviors. It is a perfect drug, and you don’t have to spend a week in the mountains to experience it. The research shows that walking in a forest, a city park, or even just spending a small amount of time noticing trees, the sky, or any aspect of the natural world, helps.

These two “drugs,” physical activity and experiencing nature, are beneficial separately, but my recommendation is to combine them for maximal benefit.  Here in Kittitas County we have what we need right at our doorstep to experience this one-two punch of exercise and nature to boost our health. Try out the trails along the Yakima River at Irene Reinhart Park, climb the Roslyn Ridge, explore Umptanum Creek in the Yakima Canyon, or my favorite, join the many Ellensburgers who enjoy hiking Manastash Ridge.