Health
Wordless Wednesday
Submitted by Aldon Hynes on Wed, 12/07/2011 - 17:47The Experimental Memoir Day 23
Submitted by Aldon Hynes on Wed, 11/23/2011 - 20:29(Note: For those who are not regular readers, this is a National Novel Writing Month related entry)
It is early in the evening before Thanksgiving. Last night, the cat jumped up on the bed in the middle of the night and spent an extended period trying to get comfortable. As a result, I did not sleep well and again am very tired. I struggled through work.
Tuesday was another day that I struggled through work, but on that day, for a different reason. As I’ve gotten older my medical conditions have increased. It has been going on twenty years that I’ve been diagnosed with high blood pressure. My blood pressure had always been a bit high, as it has been, I believe, for various members of my family. One year, however, it was high enough for the doctor to recommend that I start taking medications for my blood pressure.
Simply the idea of having to start taking medications for blood pressure, which I would probably have to do for the rest of my life, was depressing. It was the first sign of frailty and coming old age, even though I was still fairly young. To make things worse, when I started taking the medication, I developed a persistent cough. I started sucking on cough drops all the time and I believe this annoyed my wife of the time as well, particularly when we went to events like the theatre or symphony.
Eventually, we found a combination of blood pressure medications that worked well, but over the years we’ve had to try different combinations. With the medications, there came a need to track my liver enzymes, and from time to time, they would be elevated.
I was sent for an ultrasound a couple times. The first time, they didn’t find anything, but the second time, they technicians appeared more concerned. Someone else was brought into the room who looked at the images, and I was told that I had a simple kidney cyst. I was told that they are not uncommon, are typically only discovered during an ultrasound and rarely were anything to be concerned about.
Over time, other conditions have developed. One year, while preparing shrimp for Kim on Mother’s Day, by hands swelled up and started breaking out. We figured it was some sort of allergic reaction, perhaps to the shrimp. So, when I had my next physical, I told the doctor. She ran some blood tests which showed indications of several allergies. I went to an allergist and was run through a battery of different allergy tests. I was, in fact, allergic to shrimp. I was also allergic to lobster and crab. I was not allergic to clams, other bivalves or fish. I was also allergic to dust, and had various allergies to pollen.
I remember as a kid always getting runny noses when playing out in the fields, so the hay fever was not a surprise, but the shrimp, lobster and crab allergies was a disappointing surprise. I had always eaten as much shrimp, lobster and crabs as I could get my hands on.
My allergy isn’t that bad. I don’t need an epi pen. In fact, I’ve eaten shrimp and crab by mistake at times without any serious consequences. I remember once, I went to a Thai restaurant. I had some sweet and sour soup to start with. I found my mouth feeling a little numb and tingly, which I attributed to the spices. However, when I got to the bottom of the bowl of soup, there was a nice big shrimp sitting in the bottom. I didn’t eat the shrimp, and continued my meal without any other incidents.
Another time, we were on Cape Cod, and I had some stuffed flounder. It was very good, but it turned out that the stuffing was made with crab. Again, there was no noticeable reaction. I’ve also eaten at Hibachi restaurants where the meal where everything was prepared on the same large grill. Eating hibachi from a grill that has been used to prepare shrimp created no ill effects.
Another condition that seems to be hereditary is high cholesterol. Eventually, I was put on medication for this. Since then, I’ve taken to eating oatmeal much more often, and sometimes, when I remember, taking fish oil capsules. Since then, my blood pressure has continued to inch upward, but my cholesterol seems to be doing pretty well.
Nonetheless, with all these pills, it is important for me to have blood tests every now and then. Some of these blood tests need to be done when you have been fasting, so, since I had had oatmeal for breakfast before my doctor’s appointment, I couldn’t have my blood test the day of the appointment.
The doctor wrote up an order for me to get my blood tested at the lab at her office. However, that would require me to come into work late another day. Since I work for a health clinic, I asked to see if I could get my lab work down with the lab the clinic uses. In fact, that worked out better. The doctor could send the request electronically and get the results electronically.
So, on Tuesday, I skipped my morning oatmeal and headed into work. As if often the case, it was a chaotic morning, and I didn’t get a chance to head over to the lab to get my blood drawn until later in the morning. However, I wanted to get it done as quickly as possible so I could break my fast with some yoghurt and fruit I had brought to the office.
I went to the lab, and the phlebotomist said that she could see me right away. She went on the computer and got the lab request that my doctor had submitted and printed it out, along with the bar coded labels for the tubes of blood she would draw. She was a congenial woman and we chatted about various things.
I’ve never been great with needles, and always flinch when I get shots or have blood drawn. When I was a kid, my father would also give blood at the local blood drives. When I went off to college, I resolved to do the same thing. However, I skipped my senior year of high school and started college when I was seventeen. Because of this, they wouldn’t accept my blood the first time I tried to donate, unless a parent came along and gave permission. My parents were hundreds of miles away, so I didn’t start giving blood until my sophomore year of college.
I would explain to the blood drive workers my strong dislike of needles and my hope to get over it by giving blood at blood drives. I gave blood in college. I gave blood when I was home on summer vacation. When I moved to New York, I gave blood at various places I worked. After a few years, however, AIDS came onto the scene. The screening was a lot more rigorous and it just made the time it took to give blood take longer. Friends of mine who were gay were told they couldn’t give blood and the whole experience started to sour for me, so I drifted away from giving blood.
Now, I give a few vials of blood when I need to, to check my cholesterol, liver enzymes, and anything else that might need testing.
The blood was quickly drawn, with a minimum of discomfort and I headed back to my office.
Another reason that I wanted to use the lab that I did was that it is possible to get your results back online. I’m very interested in personal and electronic health records and I hope to be able to get the test results online. Some of the results, like my cholesterol are numbers that I have a good sense at the acceptable levels. Other numbers, I’ll have no idea what they really mean. For them, I expect the doctor will simply say that they’re in an acceptable range.
However, other times that I’ve been to the doctor, I’ve been told what my cholesterol levels were, but I typically forget them on the way home, except for the general range. I would be nice to be able to look them up at any point, as well as to track them year to year.
The system that the lab uses requires the doctor to give a pin to the patient that can be used to verify that the doctor has given permission to the patient to see the data. I can understand the reasons doctors might want that. However, I believe the government just put into effect a ruling that patients should be able to get to the data without requiring the doctors permission. I may try to find that ruling and contact the lab and ask them to permission my account, even without the doctor’s permission.
This is for a few reasons. One, I like to stir things up a little bit. Two, I would like to encourage the lab to get with the new Federal ruling. Three, while I don’t imagine my doctor would have any objection issuing a pin to me to access the data, it is just one more thing that the doctor’s shouldn’t have to be dealing with. Their time is busy enough already without needing more medical bureaucracy.
#ff #hcsmct
Submitted by Aldon Hynes on Fri, 11/11/2011 - 19:59@chiefmaven @brandonframe @src_changeagent @elizabethradl @heangtan @healthjusticect @cthealth @chnctfoundation @chchealthcorps @cshhc @CHCConnecticut
This week, I attended two different events related to health care social media in Connecticut (#hcsmct). The first was a tweet up breakfast for various people working on health issues in Connecticut using social media. It was a great breakfast and we are planning on meeting monthly, as well as having weekly Tweet Chats. The first Monday of every month, we'll meet for breakfast and the other Mondays we'll have a Tweet Chat in the afternoon. The first chat will be next Monday at 3 PM with the #hcsmct hash tag.
The second event was a forum sponsored by Health Justice CT on Social media for social change. Joining me on the panel was @chiefmaven @brandonframe. They are both interesting people, well worth the follow.
A few of the people at the breakfast were @src_changeagent @elizabethradl @heangtan. These are their individual ids on twitter. I had already met @elizabethradl and @heangtan. Again, highly recommended. It was the first time i met @src_changeagent and I look forward to working with her on various health issues going forward.
These people and about a half dozen others were at the breakfast representing the following groups: @healthjusticect @cthealth @chnctfoundation @chchealthcorps @cshhc @CHCConnecticut . All of them are groups that I feel it is very important to retweet their messages, and I hope more people will follow them and retweet them.
That's it for this week.
Voting and Healthy Outcomes
Submitted by Aldon Hynes on Thu, 10/27/2011 - 19:45When I started working at the Community Health Center, I connected with people at the National Association of Community Health Centers (NACHC)and starting learning about their programs.
One program that caught my attention was the Community Health Vote Campaign.
NACHC has initiated the Community Health Vote Campaign to encourage and assist Health Centers in developing and implementing local programs to educate their patients and their families about public policy issues affecting their access to health care and to increase significantly voter registration and participation in the nearly 7000 communities in which Health Centers are located.
Since my wife works for Common Cause, it seemed like an interesting way we could tie our work together. I suggested that my wife do a voter registration drive and the one of the health centers and suggested to people at NACHC that they might want to connect with Common Cause nationally. I met some resistance, and it took me a while to get a sense of the concern.
It boils down to this. Voter registration should be some special drive done every once in a while at a community health center, it should be a normal part of way the health center works. Essentially, the intake and screening of patients should include a question, are you registered to vote? Those patients that are eligible to vote should be encouraged to register and vote, and where possible, registration forms should be part of the stack of forms a new patient fills out, no different than filling out an insurance or HIPAA form.
Thinking about it, it makes a lot of sense. An important part of successful primary care is to empower patients to take better care of themselves. This may include quitting smoking, losing weight, or working on developing a better self image. Voting is part of this. It is a way to take a little more control of ones life.
This led me to an interesting thought. Is voting a social determinant of health? There are various factors that determine health outcomes for various populations. How easy is it to get health food? What opportunities are there in the community to get exercise? These are often related to racial and economic disparities in health.
Thinking it through, it seemed like there should be a correlation. There is correlation between poverty and poor health outcomes. There is a correlation between poverty and low voter turnout. So, is there a correlation between low voter turnout and poor health outcomes?
The topic came up in a Tweetchat today, so I finally decided to try and find some data that would help me answer this question. I went to the website, County Health Rankings. From this site, you can download health data on a county by county basis for any state.
I then did a bit of searching to find voter turnout records and found Wisconsin Voter Turnout By County. Combining all of this into Excel, I could do a little analysis.
First, some caveats. I looked at correlation. Remember, correlation does not necessarily imply causation. One could argue that low voter turnout causes poor health outcomes, that poor health outcomes causes low voter turnout, or that while the two are related, there is no causation one way or another.
The data I have is limited. In this case, I’m looking at 72 counties in Wisconsin. It would be great to look at this on a much broader basis. Also, there are time issues. The voter turnout is for the 2010 election, yet different parts of the health data comes from different time periods.
Nonetheless, I was struck by some of the results. The correlation between health outcome rank and voter turnout rank was .34. The correlation is even stronger, when you compare percentage turnout to the standardize health scores, in this case -.45 (where the lower the score, the higher the ranking).
Looking at health factors, it became even more pronounced with a -.56 correlation factor. Digging deeper, certain underlying factors jumped out. Health factors had a -.52 correlation, social and economic factors had a -.47 correlation. My understanding is that there is other research supporting the correlations between social and economic factors and voting turnout, so this was not a surprise. The bigger surprise is that mortality rates where correlated to voter turnout at -.45, while morbidity was only correlated at -.33
Digging further into the factors, the correlation between unprotected sex and voter turnout was -.58. Income was -.46, smoking -.36, diet and exercise -.32, and alcohol use -.25.
What was also particularly striking was access and quality of care metrics. There was no correlation between access to care and voter turnout (0.01). Yet when you look at the quality of care, there was a strong correlation, or -.46. That is, if you live in an area with higher voter turnout, you live in an area with a higher quality of care.
There is plenty more data that can be dug into and it looks like it may well be worth the effort. Here in Connecticut, it might be possible to get a larger set based on towns. It might also be interesting to look at this on the international level in terms of health outcomes and voter turnout.
While the data may not be definitive, it does reinforce my belief that voter participation is a social determinant of health that needs to be investigated, and while it is being investigated, it seems like medical providers should be encouraging all their patients to become civically engaged, for the sake of democracy, and perhaps for the sake of their own health.
At the Doctor’s Office
Submitted by Aldon Hynes on Mon, 10/24/2011 - 20:01I’ve never paid a lot of attention to the doctors’ offices that I’ve gone to. Mostly, I’ve just wanted to get through my appointment with as little distraction as possible. However, as I’ve gotten older, met more people, and especially, as I’ve started working for a health center, my whole approach to doctors’ offices has changed a lot.
Today, I had my annual physical. Between high blood pressure, high cholesterol and getting past fifty, I have more things to attend to, although it is nothing compared to what friends who have chronic or potentially terminal conditions go through when they go to the doctors’ office.
The process of checking in went about as expected. I had changed jobs since my last physical, so I needed to show them a copy of my new insurance card. Of course, I couldn’t find it, but they had a copy of it on file from my wife’s most recent doctor’s visit.
I didn’t have to wait long for the medical assistant to see me. She checked my vital statistics; height and weight have stayed the same, blood pressure was a little high, still no surprises. They took an ECG, another test I’m used to having. However, this time, instead of having a machine printing out the graph on a piece of paper, she plugged the machine into her laptop and the data was automatically stored in my electronic health record.
I glanced at it. I wouldn’t recognize it if there was anything out of the ordinary, but still I looked. It was interesting. With all the data gathered, the medical assistant left the examination room, telling me the doctor would see me soon. She pointed to a pile of magazines and suggested I could read them while I wait.
Two of the things that people complain about most during doctors’ visits is waiting in the waiting room and then waiting in the examination room. So far, there was minimal waiting and there were efforts to make sure that I would have something to read, to make the wait less tedious.
Unfortunately, the choice of magazines was not particularly inspiring. There was People, Shape, and some magazine about fitness for pregnant women, or something like that. All of the magazines seemed focused on thin young white women. Now, I admit, if they include Sports Illustrated, or Field and Stream I wouldn’t have been much more interested. My taste in magazines is probably more towards Ploughshares, Paris Review or Prairie Schooner.
So, I read messages on my cellphones until they both died. Then, I glanced around the room. There were several posters about osteoporosis. Each poster sported the name of one pharmaceutical company or another. There were other posters about high blood pressure, asthma and various other conditions, but it seemed as if while the magazines were aimed at younger women, the posters were aimed at older women.
There was also a chart on one of the walls listing different medications that could be purchased inexpensively at a large local box store. All in all the room was clean and efficiently laid out. However, there were a couple boxes on the floor in various locations. Far enough out of the way to not be a hazard, but they would probably be flagged as a violation if The Joint Commission or some other organization came buy on a surprise visit. My mind wandered back to the lab, which had a big sign on the refrigerator door. The fridge was clearly marked as a place to store vaccines. Employees should not store their lunch in that fridge.
The doctor ended up being delayed at the hospital, but the wait wasn’t that bad. After reviewing recent aspects of my health history, I was on my way; nothing serious to be concerned about.
Yet from my time learning more about the medical system and talking with patient activists, I came away feeling that I had a much keener sense of all that was involved with my physical. As we struggle as a nation on how to deal with health care, perhaps a good starting point is for everyone to just be a little more observant during their trips to the doctors office.