Take Charge of Your Health! How to Advocate for Yourself.

StethoscopeKaitlyn Parrotte, PT, DPT

Board-Certified Clinical Specialist in Orthopaedic Physical Therapy (OCS)

Certified Functional Manual Therapist (CFMT)

The new year is in full swing, and many of us have set goals to help start things off with renewed energy. One area in which, many people make goals in is health. While some folks vow to go to the gym regularly, or eat healthily, many other individuals commit to having medical check-ups, or taking care of a long-festering issue, such as a painful knee or abdominal pain. No matter what type of healthcare provider you are visiting, it is imperative that you come prepared to make sure you are getting all the facts, and are able to advocate for yourself to ensure you are receiving the best treatment for you.

Come with a Plan

One way you can advocate for yourself is to come prepared to a medical consultation by bringing a list of questions and subjective information with you. Be prepared to discuss what is bringing you to see that health care provider. What symptoms you might be experiencing? When these symptoms began? What makes you feel better and worse? How your symptoms make you feel limited in your daily life, and what you are hoping to get out of seeing that practitioner (i.e. a referral to a specialist, pain relief, etc.,.)? Many questions can arise during a medical examination, so don’t be afraid to ask for clarification, and make sure you understand the information you have been given. Research has shown, that individuals who ask specific questions about their health, may receive more comprehensive care. For example, in a 2015 article from the Journal of Family Medicine and Community Health, researchers found that when older patients were more proactive with communication to their doctors, primary care physicians were more likely to recommend both cancer screening and cancer prevention to their patients.1

On Second Opinions

When you receive a medical result, do not be afraid to get a second opinion. People seek out second opinions for various reasons: to get reassurance on a treatment protocol, to confirm the findings of a particular healthcare provider, to verify the reputation of a given institution, and even due to patient dissatisfaction in the communication or relationship with a practitioner.2-3 Whatever your reason, know that it is your right to have a second opinion to ensure you are getting the best possible care. Some research has found that second opinions have changed the diagnosis and/or course of treatment. In two studies that look at different patient populations with cancer, they found that in cases where a specialized practitioner was consulted, the accuracy of initial staging for a diagnosis increased, treatment and management of the condition was affected in about 20% of cases, and unnecessary surgeries were prevented in about 7% of cases.4-5 Thus, getting a second opinion can be very beneficial to you. Whether it changes the course of a treatment, or simply reinforces what you have already been told, seeking a second opinion can help you make educated decisions regarding your care.

Consider Both Risks and Benefits

If you are given a diagnosis and are informed of your treatment options, make sure to ask about, and consider, the risk-benefit analysis for each. The “risk-benefit analysis” is defined as “the consideration of whether a medical or surgical procedure, particularly a radical approach, is worth the risk to the patient as compared with possible benefits if the procedure is successful.”6 What this means is, it is important to weigh any treatment’s potential outcome on your quality of life, as well as your values and goals, when determining what route of care you’d like to embark on. If the risks outweigh the benefits for you personally, then it may not be a treatment worth trying. However, that is a very specific and personal decision, that must occur between you and those close to you, under the guidance of your health care provider.

Prevent Illness Before it Happens

While it is very important to be well-informed and prepared for a visit so you can better advocate for yourself, taking steps to prevent illness or injury in the first place, is crucial to promote overall well-being. Two major changes you can make in enhancing your health are diet and exercise. According to the Dietary Guidelines for Americans, 2015-2020, 117 million individuals, which is about half of all American adults, “have one or more preventable chronic diseases,”7 which include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers (i.e. colorectal and postmenopausal breast cancer), and poor bone health. Theses chronic diseases are related to poor quality eating habits and physical inactivity. Furthermore, more than two-thirds of adults, and nearly one-third of children, are overweight or obese, which is associated with increased health risks and higher healthcare costs.7 Key recommendations for a “healthy eating pattern” include: eating a variety of vegetables, fruits, grains, proteins, and oils, as well as fat-free or low-fat dairy, while limiting saturated fats, trans fats, added sugars, and sodium.7 Research has found that most Americans do not eat enough fruits and vegetables. However, those that do tend to eat more fruit at breakfast and in snacks throughout the day, while more vegetables are consumed at lunch and dinner.8 This is something that can be added to your routine easily to ensure you are consuming a balanced diet.

As previously mentioned, physical inactivity can contribute to poor health; however, engaging in regular physical activity helps improve your overall health and fitness, and reduces your risk for many chronic diseases. According to the 2008 Physical Activity Guidelines for Americans, adults aged 18-64 need at least 2 hours and 30 minutes of moderate-intensity aerobic activity (i.e. brisk walking), and at least 2 days of muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms). The same recommendations are given to older adults over the age the 65 years.9 That may sound like a lot of time that you don’t have; however, the CDC reports that engaging in aerobic exercise for even 10 minutes at a time can be beneficial.9 So get on your walking shoes and start power-walking to your appointments, or to the breakroom at work!

Ok. That was a lot of information, so here is a recap:

  1. Being well-informed and prepared with questions for medical consultations allows you to better advocate for yourself, and may help you to receive more comprehensive care.
  2. Seeking a second opinion, especially when considering a major medical procedure, is something that is your right as a consumer, and can impact your diagnosis and/or course of treatment.
  3. Considering the risk-benefit of any medical or surgical intervention is important to ensure that a given treatment is appropriate for your quality of life, values, and goals.
  4. While being educated and engaged when dealing with a medical concern is important, helping to prevent illness or injury through diet and exercise are critical for maintaining a healthy life.

If you are saying to yourself, “this is too overwhelming; there is no way I can do this!”, then I will leave you with a quote from Audrey Hepburn: “Nothing is impossible. The word itself says I’m possible!” You have the information; now it is time to get out there and start leading a healthy life, so the energy and inspiration of the new year keep ringing all year long!

Sources:

  1. Kahana E, Lee JE, Kahana B, Langendoerfer KB, Marshall GL. 2015. Patient planning and initiative enhances physician recommendations for cancer screening and prevention. J Fam Med Community Health, 2(9), pii 1066.
  2. Mordechai O, Tamir S, Weyl-Ben-Arush M.2015. Seeking a second opinion in pediatric oncology. Pediatr Hematol Oncol; 32 (4): 284-9.
  3. van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J. 2001. Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy, 6 (4): 195-201.
  4. Sawan P, Rebeiz K, Schoder H, Battevi C, Moskowitz A, Ulaner GA, Dunphy GA, Mannelli L. 2017. Specialized second-opinion radiology review of PET/CT examinations for patients with diffuse large B-cell lymphoma impacts patient care and management. Medicine, 96 (51), doi: 10.1097/MD.0000000000009411.
  5. Lakhman Y, D’Anastasi M, Micco M, et al. 2016. Second-opinion interpretations of gynecologic oncologic MRI examinations by sub-specialized radiologists influence patient care. Eur Radiol;26:2089–98.
  6. “The Free Dictionary by Farlex – Medical Dictionary.” https://medical-dictionary.the freedictionary.com/risk-benefit+analysis.
  7. U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. Washington, DC: U.S. Government Printing Office; 2015.
  8. Moore LV, Hammer HC, Kim SA, et al. 2016. Common ways Americans are incorporating fruits and vegetables into their diet: intake patterns by meal, source and form, National Health and Nutrition Examination Survey 2007-2010. Public Health Nutr; 19 (14): 2535-9.
  9. “Physical Activity Basics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 June 2015, http://www.cdc.gov/physicalactivity/basics /index.htm.

World Aids Day

banner1

Today, December 1st 2016, is World AIDS Day. World Aids Day has been held on the first of every December since 1988. World AIDS Day works to spread awareness of the disease and to remind the general public that AIDS and HIV still must be taken seriously and that there is still a lot of work to do in order to prevent the transmission of new cases, as well as to better care for those who are infected with the disease.

What is AIDS/HIV?

AIDS (acquired immunodeficiency syndrome), is caused by a virus called human immunodeficiency virus (HIV). HIV can be treated in order to prevent AIDS, however there is currently no cure for HIV.

HIV causes AIDS by attacking the immune cells of a person’s body, which can leave a person vulnerable to infections that otherwise would not have made them sick. These infections are referred to as opportunistic infections, an opportunistic infection is a signal that someone’s HIV may have progressed into AIDS.

As said earlier, HIV doesn’t always have to progress to AIDS. Antiretroviral therapy (ART)  can work to help keep the immune system healthy, as well as lower the risk of transmitting the virus to others. People on ART have dramatically improved lifespans. It is imperative to get on ART as soon as possible to lessen the effects the HIV virus has on your immune system.

HIV Testing

1 in 7 people infected with HIV do not know they have the virus. Testing is necessary to start treatment and reduce harm done to your immune system as well as risk of transmission to others.

According to AIDS.gov, you should be tested if:

  • You have had sex with someone who is HIV positive, or someone whose status you were unsure of since your last test
  • Had tuberculosis or hepatitis
  • Used shared needles
  • Been diagnosed with another type of sexually transmitted disease

HIV/ AIDS and Physical Therapy

Physical Therapists do not treat AIDS or HIV, rather, they treat the symptoms of AIDS/HIV and HIV/AIDS treatment to allow patients to live as fully and independently as possible. Both the disease itself and the treatment for it have effects like increasing fatigue, decreasing strength and endurance, and increased pain. Physical therapy can help by tailoring programs to help with pain, ability to perform everyday tasks, improve heart health, balance, endurance, strength and flexibility.

You can mark today by doing a number of things:

Wear a red ribbon to spread awareness

Donate to groups that work to help people living with AIDS and help to prevent its transmission:

United Nations (UN AIDS)

https://donations.unaids.org/

UNICEF

https://www.unicefusa.org/donate/support-unicefs-hivaids-programs

Sources:

AIDS.gov

Resources:

HIV/Screening:

National HIV Testing database: https://gettested.cdc.gov/

Ooo La La, La! Rééducation Périnéale: Pelvic Floor En France

Fiona McMahon, DPTpregnant en frnace

Bonjour les femmes et les hommes! Did you know that in France, after you have a baby, you get government sponsored pelvic floor physical therapy? That’s right, the French send their new mothers to pelvic floor reeducation, La Rééducation Périnéale. It is free of charge and this type of physical therapy has become the standard of care for postpartum mothers.

We all know childbirth can cause things “down there” to need a little TLC and that after childbirth, things like sex and maintaining continence may become more difficult. Women in France as well as in all countries, including the US, regularly benefit from programs of pelvic floor physical therapy, to address restrictions and areas of tightness in the vagina, vaginal muscle tone changes, and teach the muscles of the vagina to work properly again. What makes France standout is that for women in France, these postpartum physical therapy sessions are free.

The French healthcare system is a little different than ours. The people of France receive government insurance (which draws its financing from a 5.25% of earned income, paid into social security by every French worker), but they also may pay for private insurance to cover any costs that fall outside of what is covered insurance. In France the entire cost of pelvic floor physical therapy is covered by the government.

For new mothers, 10 weeks of pelvic floor physical therapy are provided after giving birth. There are a bevy of think pieces (many cited below), that recount the experience of American- expats’ feeling like they had been magically gifted some strange and exotic European vagina personal training. In these pieces, the explanations for why France foots the bill to rehab your pelvic floor are varied and not all in agreement. Some of the authors cite that because of the European Union’s already dwindling population, and that rehabbing their pelvic floors allows mothers to return to baby-making more quickly than they would have had they only received the 6 week post-partum OBGYN checkup, which is common practice in the United States.

Another more practical explanation is, that because France’s healthcare system is largely funded by the French state. It behooves the French to foot the relatively small bill of pelvic floor physical therapy, versus paying for more expensive problems like incontinence and prolapse, which can occur if pelvic floor issues are ignored. It really is a wise investment for both the French government as well the new mothers, who are investing their time in treatment.

Regardless of the rationale, French women are given a great service. The benefit of Pelvic floor physical therapy has been shown over and over again in many different studies. Rehabbing your pelvic floor after a traumatic event like childbirth, both cesarean and vaginal, can help relieve troublesome symptoms like pain, incontinence, and symptoms of prolapse. It is important that if you feel you need some extra help after your birth, that you seek out a pelvic floor physical therapist. The rewards can be great, and they are much easier to obtain the sooner you enroll in physical therapy! To read more about the benefits of pelvic floor physical therapy, check out these blogs from our archives!

Sex After Pregnancy

https://beyondbasicspt.wordpress.com/2015/06/10/sex-after-pregnancy/

The Pain No One Wants to Talk About

https://beyondbasicspt.wordpress.com/2015/05/13/the-pain-no-one-wants-to-talk-about/

Sources

Giovanni J. We will teach you to make love again. The Guardian.  Wednesday 25, March 2009

Lundberg C. “The French Government Wants to Tone my Vagina”. Slate. Accessed October 14, 2015. http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.2.html

Rochman B. “Why France pays for postpartum women to “re-educate” their vagina. Time. Feb 22, 2012

Pelvic Pain in the Media

This coming Friday, May 9, at 5pm EST, 2pm PST, Amy will be participating in a discussion about pelvic pain in the media on The Pelvic Messenger radio show, hosted by founder Elisabeth Oas.

Pelvic pain has, to say the least, been very underrepresented in media. Amy will be discussing her experience promoting pelvic pain awareness. This will include what changes she has seen in the media as a pelvic health expert for the last 15 years, from her experience on Dr. Oz and ABC’s 20/20 to Prevention magazine and Elle magazine.

Amy will also be discussing her new DVD, Healing Pelvic and Abdominal Pain: The Ultimate Home Program Guide and a Guide for Practitioners. If you have a question about the Dr. Oz show on which Amy appeared, or the Prevention or Elle articles, please call into the show! Elisabeth and Amy will randomly be selecting callers to receive a free copy of Amy’s new DVD.

Screen Shot 2014-04-30 at 6.16.29 PM

To Medicate or Not to Medicate?

By Riva Preil

Perhaps this would have been Shakespeare’s question had the medical technology at our disposal been available to him. The questions we are able to ask nowadays far surpass those asked even one generation ago thanks to the vast amount of research performed since. One such question many women  “at risk” of developing breast cancer (ex. family history or personal history of the disease) may find themselves asking is whether or not they should prophylactically take tamoxifen or raloxifene, medication that decreases the likelihood of developing breast cancer.  The upside of these medications is that they interfere with effects of estrogen, which is associated with the growth of breast cancer tumors. However, the downside of these medications is that on rare occasion, they can result in stroke, blood clots, and endometrial cancer.  Scary, no?  Wouldn’t it be great if doctors could predict for each person, on an individualized case by case basis, how they are likely to respond to medications?  Absolutely, because if that were the case, then women with an extremely low likelihood of developing the negative side effects could breathe a sigh of relief if they decide to take preventative measures by opting for the medication.

Well, thanks to Dr.  James N. Ingle of the Mayo Clinic along with his international team of researchers, the answer to the question may be within reach.  Dr. Ingle discovered two single-nucleotide polymorphisms (SNPs), ZNF423 and CTSO, which presented amongst the more than 33,000 high-risk participants in two different versions, a “good” version and a “bad” version.  These two genes have never been linked to breast cancer in the past, however this study revealed that women with a “good” version of both genes were SIX TIMES LESS LIKELY TO DEVELOP BREAST CANCER than women who had the “bad” versions.  With this promising research, doctors will hopefully have the ability to guide their patients in informed decision making to promote optimal health.

Beat the Heat!

By Riva Preil

During these hot and humid summer days, it’s important to be mindful of taking appropriate precautions to stay healthy. Unfortunately, hundreds of deaths occur in the United States annually due to extreme heat. Taking the proper precautions to ensure summer safety is crucial.

sun1

Sweating is our body’s natural cooling process.  Heat is carried away from the surface of the body as sweat evaporates from the skin which decreases one’s body temperature.  When sweating alone is not able to restore the body’s homeostatic balance, one is at risk for developing hyperthermia (elevated body temperature), a dangerous condition which can impair brain, heart, or other organ function. Untreated hyperthermia can cause heat cramps (painful muscle tightening), heat edema (ankle and foot swelling), heat exhaustion (characterized by dizziness, thirst, nausea, and weakness), and in worst case scenarios, heat stroke (body temperature elevation to 104 degrees or higher, potentially fatal).

Scary, no?  But preventable? YES!  Please make sure to keep your cool in the following ways:

  • Take breaks from the sun, especially in air conditioned rooms

  • Hydrate, hydrate, hydrate…especially with water.  Remember that alcohol and coffee DEhydrate, so please drink 2 cups of water for every 1 cup of coffee or alcohol.

  • Wear light colored and loose fitting clothes

  • Shower or bathe in cool water

  • Pull the curtains or blinds CLOSED during the hottest, sunniest parts of the day

A little common sense goes a long way…good luck beating the heat in the safest way possible!