Power drills vs. dental drills

At the beginning of this year I went to the dentist for the first time in… a while, and learned I had five cavities. Five! I brush my teeth – I even floss! – but somehow three of my old fillings had failed me and two new ones were needed. This wouldn’t have been that big of a deal except… and now you’re really going to judge me… I am afraid of Novocaine.

Now, let me say as clearly as I can: this is a 95% irrational fear. Novocaine is extremely safe and I trust my dentist to use it properly, and I am even fairly certain if I used it nothing bad would happen. But because I have an anxiety brain, this was my thought process upon learning I needed five fillings:

Shit, that’s going to be expensive and take a while. Also, crap, they’ll give me Novocaine, and that has the potential to cause heart palpitations, and I’ll probably already be having them because I’ll be nervous, and that could create a dangerous situation, oh shit shit how do I get around this?

Again, Novocaine is extremely safe. Irregular heart beat is a very rare potential side effect associated with many medications – it’s part of the generic list of allergic reactions a step above itchiness and swelling. But since I’ve dealt (rather poorly, I’ll admit) with heart palpitations caused by stress and anxiety for years, I am hyper-vigilant about avoiding situations that might cause them. So, how did I get around it? I opted out. I said no to the Novocaine and sucked it up. And yeah, it hurt. I spaced the procedure out into three visits to spread out both the cost and the pain. In the end, each procedure took less time than it would have with numbing, and I was able to eat and drink right afterward. Most of all, I survived (which of course I would have regardless). The dentists and hygienists kept calling me a badass and saying how well I handled the pain, but I wasn’t proud; I was honestly a little embarrassed, and exhausted, and sore.

As I waited in the chair for each procedure to start, I stared at a flat screen monitor. The first time it scrolled through pictures of cute kids and puppies (including a truly awesome slideshow of dogs that look like other things); on my second visit it was a silent presentation about my dentist’s trip to Haiti, complete with facts about the country; and on the third and final visit I was treated to calming videos of waves crashing on sand.

During each procedure, there was a moment or two when I thought I couldn’t handle any more – when the drill would hit a specific spot on the tooth that was just too close to a nerve. During those times, I had the old calming television standby to distract me from another monitor on the ceiling: HGTV. (I have seen this in at least one other dental office and several specialists’ offices – there’s just something about Chip and Joanna…) And I have to tell you, these things worked. In the moments I would have gritted my teeth at the pain (which was obviously impossible) I instead focused all of my energy and attention on the wall demo or sconce selection happening on the ceiling screen. And it worked, in the sense that avoiding a full-on panic attack or biting off my dentist’s fingers = “working.” Which… I’ll take it!

It’s not shiplap that helps with pain and anxiety in the dental chair – it’s that shift in energy and attention. And it still works on me even though I know this. And I actually found myself thinking, as I left the dental office for the last time (for a while, at least…I hope…) that I really wish more medical offices had this kind of programming. Not just HGTV, but slideshows and silent videos made with the explicit goal of helping patients calm down. Not just cheesy quotes about serenity, but soothing images that are scientifically correlated with lower blood pressure and cortisol. Imagine if more clinicians acknowledged that we might be anxious, and rather than ignoring that or explaining it away, just empathized with it and tried to set a calmer tone. This sort of thing is relatively common in dentistry and in pediatrics; imagine if our anxiety and potential medical trauma was taken more seriously even in cardiology, physical therapy, dermatology, and other offices! I think it’s something to work toward.

 

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Empathy in the ER

On Monday night I started to feel sick, and thought I might be coming down with the cold that had been going around my office. Unfortunately, a few hours later I realized it was more likely that I’d gotten food poisoning from my lunch. The next hours were a blur, but at a certain point I decided that I needed some help rehydrating. So my husband called an Uber and we headed to the nearest hospital, the driver mercifully avoiding every pothole.

If you’ve ever been to an emergency room in New York City, you probably know to expect a long wait. I don’t even know how long we waited after I went through triage – I was still in a haze – but after I got a bed the minutes seemed to drag. I could hear people being treated all around me, and every time a nurse or doctor walked near my bed I got my hopes up, only to be let down. I was in pain, but I was also in line, behind people whose needs were more dire. Knowing that didn’t make me feel better, but it did help that the people my husband spoke to were calm and polite. At one point, a man waiting with a patient in the bed next to mine got agitated. He started to rant and rave, but even in the face of that, the nurses remained calm.

I’m not sure if we can call this empathy. Saying “I’m sorry” in a flat tone doesn’t express much actual sorrow. But when you have to say it over and over, dozens if not hundreds of times a day, it’s bound to sound trite eventually. When I finally did see a nurse and a doctor, they were both efficient, though not cold. They struck a balance of responding to my questions and concerns without entertaining them too much. It didn’t feel like empathy, but it was enough. I got my IV and some medication and was quickly on the mend, and that was what mattered.

But there’s a growing body of research that shows doctors could stand to be more empathetic, both for our patients’ sake and their own. A 2011 survey of 800 people who had been recently hospitalized found that only 53 percent of them felt empathy from their doctors. Another study videotaped encounters between doctors and patients with cancer, and found that doctors often tended to dismiss patients’ complaints rather than take them seriously, responding with empathy only 22 percent of the time. More recently, a study published in the journal of the Royal Society of Medicine argued that doctors need to develop better empathy skills in order to protect themselves as well: “Doctors are at risk not only of personal distress but eventually burnout if their feelings of sympathy and compassion for patients override the more nuanced stance of empathy,” wrote Dr David Jeffrey, an honorary lecturer in palliative medicine at the Centre for Population Health Sciences in Edinburgh in the U.K. Instead of imagining themselves going through what patients are going through, Dr. Jeffrey wrote, they should imagine being the patient undergoing the patient’s experience.

Leslie Jamison took this issue on in a more literary way in her book The Empathy Exams. I’ll leave you with this essay from the book: A Medical Actor Writes Her Own Script.

Research Roundup

It’s been a while since I’ve talked about any cool health science, and a lot of really interesting research has been released over the past few weeks. These all happen to be from the Journal of the American Medical Association.

Suicide among veterans: At the beginning of the month, JAMA Psychiatry announced that a recent study had found no association between deployment in support of U.S. operations in Iraq and a higher rate of suicide. This is interesting because psychiatrists and other researchers have been trying to figure out for years exactly why so many soldiers do end up taking their own lives upon returning home, and how to potentially prevent those suicides. This study showed that while there was an increased risk of suicide associated with “separation from military service,” regardless of whether the person had deployed. This raises a lot of questions, including – Is there something about being in the military (or maybe having the predisposition to want to join the military) that may increase risk of suicide, as opposed to the long-assumed answer that the experience of combat is simply too much for some people to bear? As usual, more research is needed, but the researchers do note that leaving the military after less than four years and leaving without an honorable discharge were risk factors.

Autism: Two pretty important studies about children on the autism spectrum have been released over the last couple of months. The first, a population-based study of twins in the U.K., found that the likelihood of showing symptoms of Autism Spectrum Disorder was more closely correlated with genetic traits than with environmental factors. And the second, just released a few days ago, is yet another study showing that there is no link between the MMR vaccine and autism. This particular report shows that in a large sample of privately insured children, getting the MMR vaccine had no impact on the likelihood of having autism, regardless of whether an older sibling was on the spectrum. (Important point in the comments below about why the siblings were included.)

Sickle cell anemia: All I can say about this is: look out for an interesting study about sickle cell anemia. This disease only affects a specific part of the population but the way treatments for it are approached is telling and important.

excitement and questions about vasalgel

Last week, news spread that a long-sought version of reversible birth control for men had reached a new milestone. Known as Vasalgel, the polymer that is injected into the vas deferens to prevent sperm from passing through, is proving effective in baboons and will soon be tested on humans, according to its developer the Parsemus Foundation.

There were a lot of triumphant headlines – and a few questioning whether the average man will be willing to undergo the procedure – but the fact that the only information I could find about Vasalgel on the internet was sourced from its developer raised my eyebrows a bit. Not that this organization, which focuses its efforts on “neglected research,” and its work aren’t legitimate, but it seems like a good idea to be skeptical when one press release from a company working on a drug or procedure sets off a cascade of laudatory articles.

There were some interesting pieces that took the skeptic’s view, and it seems that an important conversation has been started about the cultural impact a male birth control could have, but what seemed to be missing from a lot of the articles covering this development was a detailed explanation of just how it works.

So I did a little bit of research, and found that the researchers don’t seem to be exactly sure themselves. (This is where curiosity overtakes skepticism, for the record. I am not a doctor or a scientist and my skepticism lies solely with the way so many news organizations seem to lap up press releases without digging much deeper. I’m not out to prove anyone wrong or question their methods or motives, only to learn as much as possible about something that intrigues me).

Vasalgel was inspired by RISUG, or Reversible Inhibition of Sperm Under Guidance, a procedure developed by Indian biomedical engineer Sujoy Guha. According to the website for RISUG, within minutes of the polymer being injected into the vas deferens as part of a minimally invasive procedure, it solidifes, clings to the “microscopic folds” of the walls of the vas deferens and essentially kills the sperm by causing a combination of positive and negative charges that make the sperm membranes burst. Probably.

That’s the hypothesis confirmed in at least one study Guha conducted with colleagues in 2004, but they aren’t 100 percent sure that’s what’s happening. Of course, one could argue that science is never 100 percent sure about anything, but I just found it interesting that even on the RISUG site, the language says that this is “reportedly” what happens to the sperm.

How exactly the sperm are stopped from leaving the vas deferens and fertilizing an egg may not be important in the scheme of things; if the point is to create a male version of birth control, that it works is what matters. And so far, it seems to, at least with baboons. I’ll be excited to watch as more research is done on this; Parsemus just received a new grant from the Packard Foundation, so maybe they will be able to answer some of the questions that others have not yet been able to tackle.

apple’s healthkit: use and privacy

Along with announcing new phones and a smart watch, today Apple also formally launched HealthKit, its software meant to help developers ensure that all of your health and fitness apps work together.

Apple is billing HealthKit as the start of a “healthcare revolution” that, along with the new Health dashboard on the new Apple products, will help users keep better track of diet, exercise, doctor appointments and other health matters. There’s a lot of skepticism out there too, of course. Most of my personal skepticism is aimed where HealthKit and the smart watch intersect, but I’m one of those people who could never get into the FitBit either, so maybe that’s just me.

There’s some interesting research out there about how and whether people will use something like this to really track their health, though.

To coincide with the launch, health and technology expert Susannah Fox tweeted a link to a study she worked on last year at the Pew Research Internet Project showing that 7 in 10 U.S. adults have tracked their own health or someone else’s. Of that group, 34 percent said they share their records with others, and half of those people reported sharing the information they’ve gathered with a doctor, according to Fox and her co-author Maeve Duggan.

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Source: Pew Internet http://www.pewinternet.org/2013/01/28/tracking-for-health/

The catch? Fox and Duggan say half of the people tracking their health or someone else’s are doing so “in their heads.” About a third take things down on paper, and only one-fifth use technology, which may or may not mean an app, depending on the individual.

But Fox tweeted that she believes there is a big market for HealthKit, since 45% of U.S. adults report living with at least one chronic illness and research has shown that tracking one’s health can be effective.

There also appear to be privacy concerns, however. Hackers are apparently targeting hospitals for patient information at an alarming rate; one recent study suggested that the number of such attacks has skyrocketed 600 percent in the last 10 months alone. And just days before unveiling its new capabilities for storing your health information, Apple itself was subject to scrutiny in the wake of an iCloud hack that resulted in the release of female celebrities’ private nude photos.

Apple later said it wasn’t a problem with iCloud, and that hackers had gained access to the celebrities’ accounts specifically. But it still warned HealthKit’s developers not to store information in the cloud, though explained its reasoning as having more to do with legal standards for how medical data is handled.

Medical data is governed by HIPAA, and an interesting debate has started in the healthcare industry about whether and how software like HealthKit will be compliant. Next Wave Connect is hosting a Twitter chat about this tonight at 8pm CST, using the hashtags #HealthcareChat and #HealthKit. Probably worth checking out if you are interested in healthcare innovations, privacy and/or are considering using Apple’s new software.

 

Race and health

As often happens with tragedies like the death of Mike Brown, as the shock has worn off a little for those not in the immediate vicinity of Ferguson, a single striking event has turned thoughts to broader, related issues. In this case, the biggest issue is being most widely discussed is clearly racism, but that’s too simple a description.

In the days since Brown’s death, I have seen reported articles and editorials discussing everything from police militarization (particularly in black communities), how poverty impacts crime (particularly in those same communities), how black and white people perceive the police and their actions differently, and how the experiences of black women often get drowned out by outrage over police violence against black men.

Today, I came across something that hit on yet another part of life touched by racial inequality in our country: health care.

I’ve become increasingly interested in everything health-related over the last several years, for both personal and professional reasons, so I’ve been spending more time studying how our health system works and how people of different backgrounds experience it. This piece in Vox today explores how white privilege — that unrequested, unearned position those of us with white skin have over those with darker complexions thanks to the structure of our culture — may extend not just to hiring and police treatment and incarceration and media representation, but to how we are treated by our doctors as well.

Emotions are running high on all sides with all of the talk about race over the last couple of weeks. I have been told by multiple friends that if the media would just stop talking about racism, if we would just stop reminding everyone that some white people hate black people, things would be better. Though I certainly think there is room to improve in the way that we cover such things, I am happy to see that many publications are not shying away from this topic, because the fact remains that people of different races experience life differently. That problem won’t be solved by ignoring it. So it’s with that mindset that I read this Vox piece, which, regardless of your feelings about how we talk about race, shares some really interesting statistics:

  • Black women have a 43 percent higher risk than white women for delivering their babies prematurely. They are also between two and three times as likely to have babies dangerously early, in less than 32 weeks.
  • When it comes to nursing, black mothers are consistently less likely to breastfeed than white mothers, despite the guidelines suggesting all mothers do so because of well-documented health benefits. This gap has been explained by everything from preference to a lack of access and education about health benefits, to a dearth of support for new moms.
  • In childhood, black kids are more likely to suffer asthma and obesity.
  • By the end of a life, all these health disadvantages add up to a lifespan that’s cut short: black men can stillexpect to live five years fewer than white men, and black women can expect to live four years fewer than white women. There are no biological or genetic explanations for this difference.

One doctor who spoke to Vox also argues that even the “microaggressions,” the small, possibly even subconscious acts of racism that black people experience on a daily basis, can have a negative impact on their health, increasing stress and weakening the immune system.

It’s an interesting piece, and a very interesting topic that I think deserves more attention. I’d be interested to see how women of all races fare in their health care experiences in comparison to men, and maybe how mothers fare in comparison to women who don’t have children. And what about those with disabilities? What about transgender patients? It seems that the research on patient experience has only reached the tip of the iceberg, and as many hospital systems begin to move toward “population health,” focusing on the ailments and opportunities present in the demographics of their particular community, an understanding of different experiences will be vital to creating more parity.

Roundup: Outdoors Rx and An Uncontacted Tribe Gets The Flu

A couple of really interesting stories caught my eye this week:

Doctors Prescribe New Medicine For Kids: Go Outside – The Takeaway on WNYC

The Takeaway had a segment this week about a new program at Massachusetts General Hospital that doctors are calling “Outdoors Rx.” They’re training pediatricians to write actual prescriptions for outdoor play, in a new approach to preventative medicine in an always-connected world. Dr. Christina Scirica told the hosts that she’s seen an increase in the number of young people with symptoms that usually don’t show up until later in life, including pre-diabetes, high blood pressure and joint pain, among others. Studies show that spending more time active outdoors can help prevent these and other conditions.

Scirica is the director of Outdoors Rx, which works with the Appalachian Mountain Club to get kids outside, and she’s hoping to take the program national.

Callers and commenters mentioned that when TV first became popular, doctors often told kids to spend more time outside. But it’s not clear whether there’s ever been a push to have it be a literal prescription. Boston Magazine actually wrote about Outdoors Rx last year, and explained that patients’ parents get a prescription and can then register their families on the Outdoors Rx website to get information about available outdoor activities, as well as track their progress.

Indians Emerge From Jungle, Catch Deadly Flu – Forbes

Five men and two women from one of the few remaining tribes in Peru left their village last month and traveled to Ashaninka in Brazil, where they all contracted influenza, according to Brazil’s national Indian foundation Funai.

The people, from the Chitonahua tribe, are reportedly hunter-gatherers, and Carlos Travassos of Funai told Forbes earlier this week that doctors were flown in and interpreters used to convince them to take medication to lower the chance that they spread the potentially deadly sickness to their tribe.

It seemed like an odd story to be reading in 2014. Many researchers believe that entire tribes of people were wiped out by flu-like illnesses contracted after their homes and nearby lands were occupied by outsiders. We learn about this in school, but this week’s story is a stark reminder that the few remaining tribes who still live “uncontacted” are at a very real risk, especially as logging and other industries increasingly encroach on wild lands in South America.