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Health and Fitness - The Huffington Post
5 Things to Do When Symptoms Are Not 'All in Your Head'
When you're facing a changing array of debilitating physical symptoms, even the finest physician may be challenged to diagnose what's wrong. Our health care system is biased toward reacting to symptoms that demand attention and can be relieved through proper treatment. In contrast, if symptoms are recurring but in combinations the doctor doesn't recognize, he or she may be dismissive and suggest that their origin isn't physiological.
That was Val's experience, and her long search for a diagnosis reveals five important lessons for anyone who is chasing an explanation for what you believe is a real physiological problem.
Val was a bright, talented, driven and physically active teenager, eager for the adventures of young adult life. Her symptoms started in high school, with gastrointestinal issues. Her mother and grandmother had both had digestive issues, so she wasn't surprised when her primary care physician (PCP) said that she had irritable bowel syndrome (IBS). "He told me it gets worse with age and stress, and the only answer is to get used to living with it, so Pepto Bismol became my beverage of choice."
Then, in her 20s, Val's symptoms started to multiply, and controlling them on her own became increasingly difficult. Val's first important lesson emerged during that period.
1. Don't Get Locked in a Psychiatric Box
For most chronic conditions, diagnostic delays may not be life-threatening, but they are often life-altering, especially if the delays are protracted and the patient is a young adult. People whose quality of life is significantly disrupted by physical anomalies may experience emotional distress as a result of their inability to function normally. If a baffled physician faces an unfamiliar set of symptoms, can't define a physiological cause, and doubts that further testing will help to do so, he or she may imply that you're experiencing excess anxiety about your health, perhaps actually causing the physical symptoms.
Val's PCP told her to "slow down" and "get more sleep," suggesting that it might be "all in your head." She followed his recommendations, but her symptoms only got more complex. She bounced from one specialist to another for several years, being either misdiagnosed or brushed off. "It makes you reluctant to speak up when you get a flippant response from a doctor, because it belittles what you think you know about your body."
Before long, she was crying uncontrollably, not understanding why her body seemed to be in revolt. Her PCP concluded that her root problem was depression. Because Val didn't know what else could be at fault and assumed that her PCP was right, she agreed to try antidepressant medications.
She realizes now that when her physician dismissed her health concerns without continuing to seek a physiological explanation, she felt disrespected, trivialized, and powerless. She actually started to wonder if it might really all be in her head, until therapy and many different antidepressants failed to help.
That's when Val decided to assert herself differently in the diagnostic process.
2. Keep a Symptom Journal
With time, Val realized that her symptoms were so complex that she'd need to track her symptoms in detail to get doctors to take her seriously. During her early working years, Val's symptoms broadened to include fatigue, migraines, heat intolerance, dizziness, and blood pressure swings. Rarely did any one symptom seem dire, so Val wrote them off to having "a quirky body."
As time passed, she was trying to sustain a hectic career while juggling new and more alarming physical symptoms arising in unpredictable combinations. By age 29, there were days when she couldn't walk one block without resting. In desperation, she started keeping a journal.
Especially when your symptoms represent a moving target, it's important to keep good records of what's happening, how long each symptom lasts, and what are the effects on your ability to function. Also note what foods and medications you've consumed that might have triggered the symptom or caused it to recede.
Symptom patterns over time can be central to solving an apparent diagnostic mystery. Treat your symptoms like a crime scene investigation: The physician needs more than word-of-mouth to discern the pattern; he or she needs facts, and that's what a symptom journal can provide.
3. Find the Right Partners
In today's medical community, the focus is still too often on single organs or body parts rather than on full-body systems that may be throwing many body parts into turmoil. Your most critical partner will be a knowledgeable, dedicated, and holistic physician who (a) respects your knowledge of your own body and (b) thinks in untraditional ways about possible total-body-system culprits. That person can then refer you to the health care institution or center of excellence most likely to take a holistic view of your body and the kinds of conditions that might cause your multi-system disorders.
For Val, it was the hunch of an osteopath that emboldened her to consult with an endocrinologist who she was told would take her seriously despite her earlier mis-diagnosis with depression. After months of testing and a referral to an autonomic nervous system specialist, Val was finally diagnosed with both Adrenal Insufficiency and an illness called POTS.
First described in the mid-1990s, Postural Orthostatic Tachycardia Syndrome (POTS) is a malfunction of the autonomic nervous system (those automatic functions of our bodies like heart rate, blood volume and pressure, temperature control, and so on that most of us take for granted because they work without thought or deliberate intent). That's why Val experiences a severe drop in blood pressure and a radical increase in pulse rate when she stands up.
Like Val, you may find that it takes trial and error to find the right medical team, especially if your symptoms are multiple and overlap with many other conditions. Even if your condition isn't curable, coping becomes more tolerable when you know what you're facing.
4. Press Your Physician to Avoid Premature Closure
The most common cause of diagnostic error (whether a missed, misdiagnosed, or delayed diagnosis) is jumping to a diagnostic conclusion before fully considering reasonable alternatives, and thereby missing the real cause. Such premature closure errors are most common when doctors over-rely on intuitive thinking (gut feel based on their past experiences and training) and don't do enough disciplined analytical thinking (defining the other conditions that the symptoms might represent).
Physicians who want to avoid such errors will deliberately engage in slower, more deliberate, and more systematic thinking to test any initial intuitive conclusion. In doing so, they may rely on computerized decision-support tools to identify the universe of diagnosis options. Such thinking provides a sound framework (known as differential diagnosis) for dialogue with the patient and for reality testing. If the initial course of treatment doesn't alleviate the presenting symptoms, the physician can return to the drawing board for the next likely diagnostic option, and the patient's expectations can be managed accordingly.
Val's experience isn't unique, and neither is her ailment. Missed or mistaken diagnoses occur most often for relatively new and complex conditions whose symptoms present differently from one patient to another. The diagnostic challenge associated with POTS isn't that it's rare, but that medical schools have only recently begun paying attention to it.
There are many metabolic, mitochondrial, autoimmune, neuro-immune, and other "invisible," multi-system disorders that are very real for the patient but pose diagnostic challenges for physicians. It's only by listening to and trusting your recitation of symptoms (recorded in your journal) that any doctor can appreciate the full complexity of your experience; it's only by being an active medical partner that you can help the physician to help you.
5. Educate Yourself to Become an Active Diagnostic Partner
Even the most disciplined, careful, and engaged physician may not have time to do as much research as you'd like, especially in practices that are encouraged to manage their patient "throughput" (a productivity measure reflecting the number of patients handled in a given period). As a result, you'll want to do more research on your own (usually on the internet) to extend your own familiarity with the most likely diagnostic options; then share your learnings with your physician partner(s).
One particularly useful resource is an online symptom checker, which asks you to plug in multiple symptoms and then offers a range of potential causes. Such a tool and your physicians can steer you to the topics that you should learn about and the websites that are most trustworthy. In your early research stages, be careful that you don't let Internet research alarm you and that you're gathering information from top medical experts, rather than from websites that claim to be all-in-one medical information providers.
Once Val learned the broad areas that her physician partners were testing for (adrenal and autonomic nervous system disorders), she was able to find online support bulletin boards where people with similar issues share coping strategies and post the names of the medical centers where their physiological issues were further diagnosed.
Now, at age 39, after 13 years of declining health, Val experiences bouts of weakness, migraines, crushing fatigue, dizziness, diminished concentration (brain fog), abdominal pain, nausea, constipation, diarrhea, racing pulse, fluctuating blood pressure, low blood volume, shakiness, near-faints, heat intolerance, shortness of breath, and -- believe it or not -- still more.
Available treatments don't restore her ability to function normally. She can't sustain a job and never knows from one day to another whether she'll be able to get out of bed, walk her dog, or be stable enough to drive. On bad days, she's dependent on her parents for daily living tasks.
Even though Val now knows there's no cure (yet), knowing what's wrong and that it was never "all in her head" is better than living with the mystery that haunted her for years.
The Bottom Line: You don't need to be an M.D. to take charge of your own diagnosis in this way, but you do need to be patient, persistent, and knowledgeable enough to share the right information and ask the right questions of the right medical partners.
If you're like Val, half the battle is putting a name to your condition and understanding whether it's treatable and/or curable. The other half is trusting yourself as an accelerator and facilitator of the diagnostic process. By learning from Val's experience, you may be able to take charge and save yourself years of frustration and anguish.
That was Val's experience, and her long search for a diagnosis reveals five important lessons for anyone who is chasing an explanation for what you believe is a real physiological problem.
Val was a bright, talented, driven and physically active teenager, eager for the adventures of young adult life. Her symptoms started in high school, with gastrointestinal issues. Her mother and grandmother had both had digestive issues, so she wasn't surprised when her primary care physician (PCP) said that she had irritable bowel syndrome (IBS). "He told me it gets worse with age and stress, and the only answer is to get used to living with it, so Pepto Bismol became my beverage of choice."
Then, in her 20s, Val's symptoms started to multiply, and controlling them on her own became increasingly difficult. Val's first important lesson emerged during that period.
1. Don't Get Locked in a Psychiatric Box
For most chronic conditions, diagnostic delays may not be life-threatening, but they are often life-altering, especially if the delays are protracted and the patient is a young adult. People whose quality of life is significantly disrupted by physical anomalies may experience emotional distress as a result of their inability to function normally. If a baffled physician faces an unfamiliar set of symptoms, can't define a physiological cause, and doubts that further testing will help to do so, he or she may imply that you're experiencing excess anxiety about your health, perhaps actually causing the physical symptoms.
Val's PCP told her to "slow down" and "get more sleep," suggesting that it might be "all in your head." She followed his recommendations, but her symptoms only got more complex. She bounced from one specialist to another for several years, being either misdiagnosed or brushed off. "It makes you reluctant to speak up when you get a flippant response from a doctor, because it belittles what you think you know about your body."
Before long, she was crying uncontrollably, not understanding why her body seemed to be in revolt. Her PCP concluded that her root problem was depression. Because Val didn't know what else could be at fault and assumed that her PCP was right, she agreed to try antidepressant medications.
She realizes now that when her physician dismissed her health concerns without continuing to seek a physiological explanation, she felt disrespected, trivialized, and powerless. She actually started to wonder if it might really all be in her head, until therapy and many different antidepressants failed to help.
That's when Val decided to assert herself differently in the diagnostic process.
2. Keep a Symptom Journal
With time, Val realized that her symptoms were so complex that she'd need to track her symptoms in detail to get doctors to take her seriously. During her early working years, Val's symptoms broadened to include fatigue, migraines, heat intolerance, dizziness, and blood pressure swings. Rarely did any one symptom seem dire, so Val wrote them off to having "a quirky body."
As time passed, she was trying to sustain a hectic career while juggling new and more alarming physical symptoms arising in unpredictable combinations. By age 29, there were days when she couldn't walk one block without resting. In desperation, she started keeping a journal.
Especially when your symptoms represent a moving target, it's important to keep good records of what's happening, how long each symptom lasts, and what are the effects on your ability to function. Also note what foods and medications you've consumed that might have triggered the symptom or caused it to recede.
Symptom patterns over time can be central to solving an apparent diagnostic mystery. Treat your symptoms like a crime scene investigation: The physician needs more than word-of-mouth to discern the pattern; he or she needs facts, and that's what a symptom journal can provide.
3. Find the Right Partners
In today's medical community, the focus is still too often on single organs or body parts rather than on full-body systems that may be throwing many body parts into turmoil. Your most critical partner will be a knowledgeable, dedicated, and holistic physician who (a) respects your knowledge of your own body and (b) thinks in untraditional ways about possible total-body-system culprits. That person can then refer you to the health care institution or center of excellence most likely to take a holistic view of your body and the kinds of conditions that might cause your multi-system disorders.
For Val, it was the hunch of an osteopath that emboldened her to consult with an endocrinologist who she was told would take her seriously despite her earlier mis-diagnosis with depression. After months of testing and a referral to an autonomic nervous system specialist, Val was finally diagnosed with both Adrenal Insufficiency and an illness called POTS.
First described in the mid-1990s, Postural Orthostatic Tachycardia Syndrome (POTS) is a malfunction of the autonomic nervous system (those automatic functions of our bodies like heart rate, blood volume and pressure, temperature control, and so on that most of us take for granted because they work without thought or deliberate intent). That's why Val experiences a severe drop in blood pressure and a radical increase in pulse rate when she stands up.
Like Val, you may find that it takes trial and error to find the right medical team, especially if your symptoms are multiple and overlap with many other conditions. Even if your condition isn't curable, coping becomes more tolerable when you know what you're facing.
4. Press Your Physician to Avoid Premature Closure
The most common cause of diagnostic error (whether a missed, misdiagnosed, or delayed diagnosis) is jumping to a diagnostic conclusion before fully considering reasonable alternatives, and thereby missing the real cause. Such premature closure errors are most common when doctors over-rely on intuitive thinking (gut feel based on their past experiences and training) and don't do enough disciplined analytical thinking (defining the other conditions that the symptoms might represent).
Physicians who want to avoid such errors will deliberately engage in slower, more deliberate, and more systematic thinking to test any initial intuitive conclusion. In doing so, they may rely on computerized decision-support tools to identify the universe of diagnosis options. Such thinking provides a sound framework (known as differential diagnosis) for dialogue with the patient and for reality testing. If the initial course of treatment doesn't alleviate the presenting symptoms, the physician can return to the drawing board for the next likely diagnostic option, and the patient's expectations can be managed accordingly.
Val's experience isn't unique, and neither is her ailment. Missed or mistaken diagnoses occur most often for relatively new and complex conditions whose symptoms present differently from one patient to another. The diagnostic challenge associated with POTS isn't that it's rare, but that medical schools have only recently begun paying attention to it.
There are many metabolic, mitochondrial, autoimmune, neuro-immune, and other "invisible," multi-system disorders that are very real for the patient but pose diagnostic challenges for physicians. It's only by listening to and trusting your recitation of symptoms (recorded in your journal) that any doctor can appreciate the full complexity of your experience; it's only by being an active medical partner that you can help the physician to help you.
5. Educate Yourself to Become an Active Diagnostic Partner
Even the most disciplined, careful, and engaged physician may not have time to do as much research as you'd like, especially in practices that are encouraged to manage their patient "throughput" (a productivity measure reflecting the number of patients handled in a given period). As a result, you'll want to do more research on your own (usually on the internet) to extend your own familiarity with the most likely diagnostic options; then share your learnings with your physician partner(s).
One particularly useful resource is an online symptom checker, which asks you to plug in multiple symptoms and then offers a range of potential causes. Such a tool and your physicians can steer you to the topics that you should learn about and the websites that are most trustworthy. In your early research stages, be careful that you don't let Internet research alarm you and that you're gathering information from top medical experts, rather than from websites that claim to be all-in-one medical information providers.
Once Val learned the broad areas that her physician partners were testing for (adrenal and autonomic nervous system disorders), she was able to find online support bulletin boards where people with similar issues share coping strategies and post the names of the medical centers where their physiological issues were further diagnosed.
Now, at age 39, after 13 years of declining health, Val experiences bouts of weakness, migraines, crushing fatigue, dizziness, diminished concentration (brain fog), abdominal pain, nausea, constipation, diarrhea, racing pulse, fluctuating blood pressure, low blood volume, shakiness, near-faints, heat intolerance, shortness of breath, and -- believe it or not -- still more.
Available treatments don't restore her ability to function normally. She can't sustain a job and never knows from one day to another whether she'll be able to get out of bed, walk her dog, or be stable enough to drive. On bad days, she's dependent on her parents for daily living tasks.
Even though Val now knows there's no cure (yet), knowing what's wrong and that it was never "all in her head" is better than living with the mystery that haunted her for years.
The Bottom Line: You don't need to be an M.D. to take charge of your own diagnosis in this way, but you do need to be patient, persistent, and knowledgeable enough to share the right information and ask the right questions of the right medical partners.
If you're like Val, half the battle is putting a name to your condition and understanding whether it's treatable and/or curable. The other half is trusting yourself as an accelerator and facilitator of the diagnostic process. By learning from Val's experience, you may be able to take charge and save yourself years of frustration and anguish.
Sleep for Success: Why Teens Need to Start School Later
It's early on a weekday morning, so early that the streets are still filled with darkness. You walk into your teen's room. The alarm is buzzing. You reach over to turn it off while attempting to wake him or her. You wonder why this is such a daily struggle and why your lazy child can't ever seem to wake up on time for school.
What you may not realize is that your child is not lazy at all. In most cases your teen is just not getting enough sleep. Now, schools across America are recognizing this and starting to take action accordingly.
The push for later high school start times
There is a movement to change high school start times to 30 minutes later, a notion supported by U.S. Secretary of Education Arne Duncan. When you look at the neuroscience behind sleep patterns and teens in particular, you can see why pushing school start times back by a mere 30 minutes can give teens the best opportunity for a positive and successful school experience -- and so much more.
Understanding teen sleep patterns
Science has long known that teens have a different biological clock than adults. Though adults need seven to eight hours of sleep, teens -- whose bodies are still growing -- need between 8.5 to 9.5 hours each night. Their circadian rhythm, which regulates the sleep hormone melatonin, directs them to a later bedtime and awakening.
When teens get enough sleep, the benefits are bountiful:
Sleep restores the brain and metabolism, while helping memory, learning, and emotional balance.
Sleep has been known to help stave off depression, erratic behavior, truancy, absenteeism, impaired cognitive function, obesity, and even car accidents.
Sleep helps students have better focus, impulse control, homework results, improved attendance, concentration, sociability, and alertness during the day.
When teens do not get enough sleep, the problems can be very serious and affect almost every aspect of their lives. They lose the ability to focus and stay on task, they experience fatigue, mental lapses, and symptoms of ADHD, including hyperactivity and attention deficit. When your teen is stressed through the loss of sleep, the amygdala enlarges, making him or her more emotional in decision-making, while the hippocampus narrows where learning and memory live. As a result, not sleeping long enough can affect not only decision-making ability, but also creativity.
Proof that a late start works
Researchers at the Bradley Hasbro Children's Research Center in Rhode Island studied the impact of a 25-minute delay in school start time on teens. The results proved that even this small time change could make a world of difference.
Students' overall sleep time increased by an average of 29 minutes.
The percentage of students sleeping eight or more hours per night more than doubled, from 18 percent to 44 percent.
Students experienced significant reduction in daytime sleepiness, as well as improvements to mood and focus.
Student intake of caffeine dropped.
While this study eventually resulted in the school returning to its normal start time (and, not surprisingly, students returned to their sleep-deprived struggles), more schools are taking note -- and taking action.
In just the last two years, high schools in California, Oklahoma, Georgia, and New York have adopted later start times. They join schools in Connecticut, North Carolina, Kentucky and Minnesota who have already implemented later start times. The Seattle school board currently is researching the issue, with advocates hopeful that a later start time will go into place by the 2016-2017 school year, if not sooner.
Such a small change, with such big benefits
As a parent, you know that life with adolescents is tough enough without adding undue stress to their schedules. So if you support your teen and honor his or her sleep biology, you will be rewarded with a healthier, happier, and more academically successful child. There is a lot at risk here for such a small consideration of 30 minutes per day.
I'm for starting school 30 minutes later. How about you?
What you may not realize is that your child is not lazy at all. In most cases your teen is just not getting enough sleep. Now, schools across America are recognizing this and starting to take action accordingly.
The push for later high school start times
There is a movement to change high school start times to 30 minutes later, a notion supported by U.S. Secretary of Education Arne Duncan. When you look at the neuroscience behind sleep patterns and teens in particular, you can see why pushing school start times back by a mere 30 minutes can give teens the best opportunity for a positive and successful school experience -- and so much more.
Understanding teen sleep patterns
Science has long known that teens have a different biological clock than adults. Though adults need seven to eight hours of sleep, teens -- whose bodies are still growing -- need between 8.5 to 9.5 hours each night. Their circadian rhythm, which regulates the sleep hormone melatonin, directs them to a later bedtime and awakening.
When teens get enough sleep, the benefits are bountiful:
Sleep restores the brain and metabolism, while helping memory, learning, and emotional balance.
Sleep has been known to help stave off depression, erratic behavior, truancy, absenteeism, impaired cognitive function, obesity, and even car accidents.
Sleep helps students have better focus, impulse control, homework results, improved attendance, concentration, sociability, and alertness during the day.
When teens do not get enough sleep, the problems can be very serious and affect almost every aspect of their lives. They lose the ability to focus and stay on task, they experience fatigue, mental lapses, and symptoms of ADHD, including hyperactivity and attention deficit. When your teen is stressed through the loss of sleep, the amygdala enlarges, making him or her more emotional in decision-making, while the hippocampus narrows where learning and memory live. As a result, not sleeping long enough can affect not only decision-making ability, but also creativity.
Proof that a late start works
Researchers at the Bradley Hasbro Children's Research Center in Rhode Island studied the impact of a 25-minute delay in school start time on teens. The results proved that even this small time change could make a world of difference.
Students' overall sleep time increased by an average of 29 minutes.
The percentage of students sleeping eight or more hours per night more than doubled, from 18 percent to 44 percent.
Students experienced significant reduction in daytime sleepiness, as well as improvements to mood and focus.
Student intake of caffeine dropped.
While this study eventually resulted in the school returning to its normal start time (and, not surprisingly, students returned to their sleep-deprived struggles), more schools are taking note -- and taking action.
In just the last two years, high schools in California, Oklahoma, Georgia, and New York have adopted later start times. They join schools in Connecticut, North Carolina, Kentucky and Minnesota who have already implemented later start times. The Seattle school board currently is researching the issue, with advocates hopeful that a later start time will go into place by the 2016-2017 school year, if not sooner.
Such a small change, with such big benefits
As a parent, you know that life with adolescents is tough enough without adding undue stress to their schedules. So if you support your teen and honor his or her sleep biology, you will be rewarded with a healthier, happier, and more academically successful child. There is a lot at risk here for such a small consideration of 30 minutes per day.
I'm for starting school 30 minutes later. How about you?
Male Breast Cancer: Grappling With a 'Woman's Disease'
Imagine that you are a male, sitting in a radiology waiting room. You just had a mammogram and a fine needle biopsy on your breast tissue. In your hands rests a pink pamphlet about breast cancer that prominently displays a woman checking her breasts. Surrounding you are women's puzzled and surprised expressions at seeing you in a bright colored pink Jonny that doesn't quite fit your frame. Someone calls out your name and as you enter the consultation room, you hear the words, "You have breast cancer." It is not often we read stories about men with breast cancer. Yet for some men, this scene is their reality.
I talked with and surveyed almost 100 men with hereditary breast cancer and/or at high risk for developing breast cancer. We are just beginning to understand the challenges men face in grappling with what is so commonly thought of as a woman's disease.
By listening to men's breast cancer narratives, it becomes clear that many of the men I spoke with felt the health care profession abandoned and trivialized their health concerns and worries even when, on a routine physical examine, they presented with a small lump in their breast and/ or some discharge coming from one of their nipples. Their initial symptoms might stretch out for months or even years before any medical intervention was initiated on the part of a health care provider. No cancer history was taken at the time of their initial examination, and for those men with a history of breast cancer in their families, none were told that perhaps they might, in fact, harbor the BRCA 1/2 mutation for breast cancer.
It is not surprising, then, that men who undergo genetic testing for the BRCA 1/2 breast cancer mutation get tested much later in their lives compared to women, and are diagnosed at a more aggressive stage that places them at a greater risk of dying from breast cancer. One participant in my study stated, "No one told us anything about having a hereditary risk for cancer. When I say no one, I had asked an oncologist in San Diego ... about it, and he told me it goes from mother to daughter and I shouldn't be worried about it."
Another participant stated, "Not only have I had men tell me that they didn't need to worry because it can only be passed to women, I've had doctors tell me that." Misinformation such as this is common, and also contributes to men's lesser awareness of the BRCA genetic mutation and its health implications.
Being at high risk for breast cancer also flies in the face of men's sense of their masculine identity that often promotes emotional distance and avoiding feelings of being vulnerable and often brushing off their own medical issues. As one of the men in this study explains, "There's an easy explanation for men's breast cancer risk denial. It's called another mutation, and the mutation is the macho gene." Such a "macho mentality" makes some men unlikely to seek genetic testing and health care treatments.
Understanding men's bodily vulnerabilities needs addressing by the healthcare community. By blaming men for their reluctance to be tested or seek treatment, we ignore a critical examination of a healthcare system whose very clinical practices often reflect a set of hidden gendered assumptions that perhaps only rise to the surface when a highly gendered disease like breast cancer comes to the fore.
Men's breast cancer narratives can offer the medical community important lessons and recommendations for general clinical practice. For starters, any general physical exam should specifically ask men about their general health concerns, one that requires careful listening. It means clinicians need to think outside their traditional gender role box regarding men's healthcare. Yes, and by the way, it means checking men's breasts! That is what some of the men in my study wanted me to tell you.
When I asked one of my male participants what, if anything, their doctors could have done better after receiving their breast cancer diagnosis, one said, "All I wanted them to do was to talk with me one-on-one and to listen to how I was feeling. Instead, what I got from the medical team was more clinical talk about my diagnosis." What men in my study also taught me is that when they feel they are in a safe space, one where they can speak freely, they can and do share their medical concerns and issues as well as their hopes and fears for the future.
The lack of research into men's experiences with BRCA 1/2 hereditary breast cancer is disconcerting, and the healthcare field needs to develop a broader understanding of how illness, especially the threat of having breast cancer or a breast cancer diagnosis impacts men's lives. The Boston College BRCA Men's Study addresses this knowledge gap and invites you to understand the complicated emotional, social, economic, and psychological factors that come into play for BRCA 1/2 positive mutation male carriers and how it affects their loved ones.
But we need to learn more. If you are a male who is at high risk for breast cancer or who has taken the genetic test for the BRCA1/2 mutation, or who has been diagnosed with breast cancer, we want to hear from you. To take our survey and contribute to our research, please visit http://ift.tt/OPE1Kc. You can find more information about our research on our Facebook page, Boston College BRCA Study (http://ift.tt/1kBqSnb), and keep up with what we are doing by following us on Twitter (@BRCAStudyBC).
Don't be another invisible man in a sea of pink. Let your story be told.
Dr. Sharlene Hesse-Biber is a Professor of Sociology and Director of the Women's and Gender Studies Program at Boston College. Her latest monograph, Waiting for Cancer to Come: Genetic Testing and Women's Medical Decision Making for Breast and Ovarian Cancer (University of Michigan Press), will be published June 2014. You can learn more about her past and current publications and research at www.drhessebiber.com.
I talked with and surveyed almost 100 men with hereditary breast cancer and/or at high risk for developing breast cancer. We are just beginning to understand the challenges men face in grappling with what is so commonly thought of as a woman's disease.
By listening to men's breast cancer narratives, it becomes clear that many of the men I spoke with felt the health care profession abandoned and trivialized their health concerns and worries even when, on a routine physical examine, they presented with a small lump in their breast and/ or some discharge coming from one of their nipples. Their initial symptoms might stretch out for months or even years before any medical intervention was initiated on the part of a health care provider. No cancer history was taken at the time of their initial examination, and for those men with a history of breast cancer in their families, none were told that perhaps they might, in fact, harbor the BRCA 1/2 mutation for breast cancer.
It is not surprising, then, that men who undergo genetic testing for the BRCA 1/2 breast cancer mutation get tested much later in their lives compared to women, and are diagnosed at a more aggressive stage that places them at a greater risk of dying from breast cancer. One participant in my study stated, "No one told us anything about having a hereditary risk for cancer. When I say no one, I had asked an oncologist in San Diego ... about it, and he told me it goes from mother to daughter and I shouldn't be worried about it."
Another participant stated, "Not only have I had men tell me that they didn't need to worry because it can only be passed to women, I've had doctors tell me that." Misinformation such as this is common, and also contributes to men's lesser awareness of the BRCA genetic mutation and its health implications.
Being at high risk for breast cancer also flies in the face of men's sense of their masculine identity that often promotes emotional distance and avoiding feelings of being vulnerable and often brushing off their own medical issues. As one of the men in this study explains, "There's an easy explanation for men's breast cancer risk denial. It's called another mutation, and the mutation is the macho gene." Such a "macho mentality" makes some men unlikely to seek genetic testing and health care treatments.
Understanding men's bodily vulnerabilities needs addressing by the healthcare community. By blaming men for their reluctance to be tested or seek treatment, we ignore a critical examination of a healthcare system whose very clinical practices often reflect a set of hidden gendered assumptions that perhaps only rise to the surface when a highly gendered disease like breast cancer comes to the fore.
Men's breast cancer narratives can offer the medical community important lessons and recommendations for general clinical practice. For starters, any general physical exam should specifically ask men about their general health concerns, one that requires careful listening. It means clinicians need to think outside their traditional gender role box regarding men's healthcare. Yes, and by the way, it means checking men's breasts! That is what some of the men in my study wanted me to tell you.
When I asked one of my male participants what, if anything, their doctors could have done better after receiving their breast cancer diagnosis, one said, "All I wanted them to do was to talk with me one-on-one and to listen to how I was feeling. Instead, what I got from the medical team was more clinical talk about my diagnosis." What men in my study also taught me is that when they feel they are in a safe space, one where they can speak freely, they can and do share their medical concerns and issues as well as their hopes and fears for the future.
The lack of research into men's experiences with BRCA 1/2 hereditary breast cancer is disconcerting, and the healthcare field needs to develop a broader understanding of how illness, especially the threat of having breast cancer or a breast cancer diagnosis impacts men's lives. The Boston College BRCA Men's Study addresses this knowledge gap and invites you to understand the complicated emotional, social, economic, and psychological factors that come into play for BRCA 1/2 positive mutation male carriers and how it affects their loved ones.
But we need to learn more. If you are a male who is at high risk for breast cancer or who has taken the genetic test for the BRCA1/2 mutation, or who has been diagnosed with breast cancer, we want to hear from you. To take our survey and contribute to our research, please visit http://ift.tt/OPE1Kc. You can find more information about our research on our Facebook page, Boston College BRCA Study (http://ift.tt/1kBqSnb), and keep up with what we are doing by following us on Twitter (@BRCAStudyBC).
Don't be another invisible man in a sea of pink. Let your story be told.
Dr. Sharlene Hesse-Biber is a Professor of Sociology and Director of the Women's and Gender Studies Program at Boston College. Her latest monograph, Waiting for Cancer to Come: Genetic Testing and Women's Medical Decision Making for Breast and Ovarian Cancer (University of Michigan Press), will be published June 2014. You can learn more about her past and current publications and research at www.drhessebiber.com.
Why Calories Don't Matter
The vast majority of conventional nutritionists and doctors have it mostly wrong when it comes to weight loss. Let's face it: If their advice were good and doable, we would all be thin and healthy by now. But as a general rule, it's not. And the mainstream media messages often confuse things even more. It is based on many "food lies."
And the biggest lie of them all is this: All calories are created equal.
Is this really true? Not really. Let us explore why.
Take a class of sixth graders. Show them a picture of 1,000 calories of broccoli and 1,000 calories of soda. Ask them if they have the same effect on our bodies. Their unanimous response will be "NO!" We all intuitively know that equal caloric amounts of soda and broccoli can't be the same nutritionally. But as Mark Twain said, "The problem with common sense is that it is not too common."
I guess that is why the medical profession, nutritionists, our government, the food industry, and the media are all still actively promoting the outdated, scientifically disproven idea that all calories are created equal. Yes, that well-worn notion -- that as long as you burn more calories than you consume, you will lose weight -- is simply dead wrong.
Newton's first law of thermodynamics states that the energy of an isolated system is constant. In other words, in a laboratory, or "isolated system," 1,000 calories of broccoli and 1,000 calories of soda are, in fact, the same. I'm not saying Newton was wrong about that. It's true that when burned in a laboratory setting, 1,000 calories of broccoli and 1,000 calories of soda would indeed release the same amount of energy.
But sorry, Mr. Newton; your law of thermodynamics doesn't apply in living, breathing, digesting systems. When you eat food, the "isolated system" part of the equation goes out the window. The food interacts with your biology, a complex adaptive system that instantly transforms every bite.
To illustrate how this works, let's follow 750 calories of soda and 750 calories of broccoli once they enter your body. First, soda: 750 calories is the amount in a Double Gulp from 7-Eleven, which is 100 percent sugar and contains 186 grams, or 46 teaspoons, of sugar. Many people actually do consume this amount of soda. They are considered the "heavy users."
Your gut quickly absorbs the fiber-free sugars in the soda, fructose, and glucose. The glucose spikes your blood sugar, starting a domino effect of high insulin and a cascade of hormonal responses that kicks bad biochemistry into gear. The high insulin increases storage of belly fat, increases inflammation, raises triglycerides and lowers HDL, raises blood pressure, lowers testosterone in men, and contributes to infertility in women.
Your appetite is increased because of insulin's effect on your brain chemistry. The insulin blocks your appetite-control hormone leptin. You become more leptin resistant, so the brain never gets the "I'm full" signal. Instead, it thinks you are starving. Your pleasure-based reward center is triggered, driving you to consume more sugar and fueling your addiction.
The fructose makes things worse. It goes right to your liver, where it starts manufacturing fat, which triggers more insulin resistance and causes chronically elevated blood insulin levels, driving your body to store everything you eat as dangerous belly fat. You also get a fatty liver, which generates more inflammation. Chronic inflammation causes more weight gain and diabesity. Anything that causes inflammation will worsen insulin resistance. Another problem with fructose is that it doesn't send informational feedback to the brain, signaling that a load of calories just hit the body. Nor does it reduce ghrelin, the appetite hormone that is usually reduced when you eat real food.
Now you can see just how easily 750 calories of soda can create biochemical chaos. In addition, the soda contains no fiber, vitamins, minerals, or phytonutrients to help you process the calories you are consuming. These are "empty" calories devoid of any nutritional value. But they are "full" of trouble. Your body doesn't register soda as food, so you eat more all day long. Plus, your taste buds get hijacked, so anything that is not super-sweet doesn't taste very good to you.
Think I'm exaggerating? Cut out all sugar for a week, then have a cup of blueberries. Super-sweet. But eat those same blueberries after bingeing on soda and they will taste like bland and boring.
Now let's look at the 750 calories of broccoli. As with the soda, these calories are made up primarily (although not entirely) of carbohydrates -- but let's clarify just what that means, because the varying characteristics of carbs will factor significantly into the contrast I'm about to illustrate.
Carbohydrates are plant-based compounds comprised of carbon, hydrogen, and oxygen. They come in many varieties, but they are all technically sugars or starches, which convert to sugar in the body. The important difference is in how they affect your blood sugar. High-fiber, low-sugar carbohydrates such as broccoli are slowly digested and don't lead to blood sugar and insulin spikes, while table sugar and bread are quickly digested carbs that spike your blood sugar. Therein lies the difference. Slow carbs like broccoli heal rather than harm.
Those 750 calories of broccoli make up 21 cups and contain 67 grams of fiber (the average American consumes 10 to 15 grams of fiber a day). Broccoli is 23 percent protein, 9 percent fat, and 68 percent carbohydrate, or 510 calories from carbs. The "sugar" in 21 cups of broccoli is the equivalent of only 1.5 teaspoons; the rest of the carbohydrates are the low-glycemic type found in all non-starchy vegetables, which are very slowly absorbed.
Still, are the 750 calories in broccoli really the same as the 750 calories in soda? Kindergarten class response: "No way!" So why do we all think that's true, and why has every major governmental and independent organization bought into this nonsense?
Let's take a closer look at just how different these two sets of calories really are.
First, you wouldn't be able to eat 21 cups of broccoli, because it wouldn't fit in your stomach. But assuming you could, what would happen? They contain so much fiber that very few of the calories would actually get absorbed. Those that did would get absorbed very slowly. There'd be no blood sugar or insulin spike, no fatty liver, no hormonal chaos. Your stomach would distend (which it doesn't with soda; bloat from carbonation doesn't count!), sending signals to your brain that you were full. There would be no triggering of the addiction reward center in the brain. You'd also get many extra benefits that optimize metabolism, lower cholesterol, reduce inflammation, and boost detoxification. The phytonutrients in broccoli (glucosinolates) boost your liver's ability to detoxify environmental chemicals, and the flavonoid kaempferol is a powerful anti-inflammatory. Broccoli also contains high levels of vitamin C and folate, which protect against cancer and heart disease. The glucosinolates and sulphorophanes in broccoli change the expression of your genes to help balance your sex hormones, reducing breast and other cancers.
What I'm trying to illustrate here (and this is probably the single most important idea in this book) is that all calories are NOT created equal. The same number of calories from different types of food can have very different biological effects.
If you still think a calorie is just a calorie, maybe this study will convince you otherwise. In a study of 154 countries that looked at the correlation of calories, sugar, and diabetes, scientists found that adding 150 calories a day to the diet barely raised the risk of diabetes in the population, but if those 150 calories came from soda, the risk of diabetes went up by 700 percent.
Some calories are addictive, others healing, some fattening, some metabolism-boosting. That's because food doesn't just contain calories, it contains information. Every bite of food you eat broadcasts a set of coded instructions to your body -- instructions that can create either health or disease.
So what will it be, a Double Gulp or a big bunch of broccoli?
If you're inspired to detox, to end your food addiction and your sugar and carb cravings and renew and reboot your health, check out my #1 best-selling book The Blood Sugar Solution 10-Day Detox Diet! Plus, get these great bonus gifts right away to jump-start your program:
In the Kitchen with Dr. Mark Hyman -- In this three-part online video series, I teach you how to cook amazingly delicious healing foods quickly.
The Missing Ingredient Report -- Why we get stuck and how we can sustain our weight loss goals.
Dieting 101 Guide -- My review of the top 10 weight loss programs, in which I share what works and what doesn't and WHY?
---
Mark Hyman, MD, believes that we all deserve a life of vitality--and that we have the potential to create it for ourselves. That's why he is dedicated to tackling the root causes of chronic disease by harnessing the power of Functional Medicine to transform health care. Dr. Hyman and his team work every day to empower people, organizations, and communities to heal their bodies and minds, and improve our social and economic resilience.
Dr. Hyman is a practicing family physician, a seven-time #1 New York Times bestselling author, and an internationally recognized leader, speaker, educator, and advocate in his field. He is also the founder and medical director of The UltraWellness Center, chairman of the board of the Institute for Functional Medicine, a medical editor of The Huffington Post, and a regular medical contributor on Katie Couric's TV show, Katie.
Dr. Hyman works with individuals and organizations, as well as policy makers and influencers. He has testified before both the White House Commission on Complementary and Alternative Medicine and the Senate Working Group on Health Care Reform on Functional Medicine. He has consulted with the Surgeon General on diabetes prevention and participated in the 2009 White House Forum on Prevention and Wellness. Senator Tom Harkin of Iowa nominated Dr. Hyman for the President's Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. In addition, Dr. Hyman has worked with President Clinton, presenting at the Clinton Foundation's Health Matters, Achieving Wellness in Every Generation conference and the Clinton Global Initiative, as well as with the World Economic Forum on global health issues.
Dr. Hyman also works with fellow leaders in his field to help people and communities thrive. With Rick Warren, Dr. Mehmet Oz, and Dr. Daniel Amen, he created The Daniel Plan, a faith-based initiative that helped The Saddleback Church collectively lose 250,000 pounds. He has appeared as an advisor on The Dr. Oz Show and is on the board of Dr. Oz's HealthCorps, which tackles the obesity epidemic by educating American students about nutrition. With Dr. Dean Ornish and Dr. Michael Roizen, Dr. Hyman crafted and helped introduce the Take Back Your Health Act of 2009 to the United States Senate to provide for reimbursement of lifestyle treatment of chronic disease.
Join Dr. Hyman on his path to revolutionize the way we think about and take care of our health and our societies at DrHyman.com, on Twitter, on Instagram @MarkHymanmd, and on Facebook.
And the biggest lie of them all is this: All calories are created equal.
Is this really true? Not really. Let us explore why.
Take a class of sixth graders. Show them a picture of 1,000 calories of broccoli and 1,000 calories of soda. Ask them if they have the same effect on our bodies. Their unanimous response will be "NO!" We all intuitively know that equal caloric amounts of soda and broccoli can't be the same nutritionally. But as Mark Twain said, "The problem with common sense is that it is not too common."
I guess that is why the medical profession, nutritionists, our government, the food industry, and the media are all still actively promoting the outdated, scientifically disproven idea that all calories are created equal. Yes, that well-worn notion -- that as long as you burn more calories than you consume, you will lose weight -- is simply dead wrong.
Newton's first law of thermodynamics states that the energy of an isolated system is constant. In other words, in a laboratory, or "isolated system," 1,000 calories of broccoli and 1,000 calories of soda are, in fact, the same. I'm not saying Newton was wrong about that. It's true that when burned in a laboratory setting, 1,000 calories of broccoli and 1,000 calories of soda would indeed release the same amount of energy.
But sorry, Mr. Newton; your law of thermodynamics doesn't apply in living, breathing, digesting systems. When you eat food, the "isolated system" part of the equation goes out the window. The food interacts with your biology, a complex adaptive system that instantly transforms every bite.
To illustrate how this works, let's follow 750 calories of soda and 750 calories of broccoli once they enter your body. First, soda: 750 calories is the amount in a Double Gulp from 7-Eleven, which is 100 percent sugar and contains 186 grams, or 46 teaspoons, of sugar. Many people actually do consume this amount of soda. They are considered the "heavy users."
Your gut quickly absorbs the fiber-free sugars in the soda, fructose, and glucose. The glucose spikes your blood sugar, starting a domino effect of high insulin and a cascade of hormonal responses that kicks bad biochemistry into gear. The high insulin increases storage of belly fat, increases inflammation, raises triglycerides and lowers HDL, raises blood pressure, lowers testosterone in men, and contributes to infertility in women.
Your appetite is increased because of insulin's effect on your brain chemistry. The insulin blocks your appetite-control hormone leptin. You become more leptin resistant, so the brain never gets the "I'm full" signal. Instead, it thinks you are starving. Your pleasure-based reward center is triggered, driving you to consume more sugar and fueling your addiction.
The fructose makes things worse. It goes right to your liver, where it starts manufacturing fat, which triggers more insulin resistance and causes chronically elevated blood insulin levels, driving your body to store everything you eat as dangerous belly fat. You also get a fatty liver, which generates more inflammation. Chronic inflammation causes more weight gain and diabesity. Anything that causes inflammation will worsen insulin resistance. Another problem with fructose is that it doesn't send informational feedback to the brain, signaling that a load of calories just hit the body. Nor does it reduce ghrelin, the appetite hormone that is usually reduced when you eat real food.
Now you can see just how easily 750 calories of soda can create biochemical chaos. In addition, the soda contains no fiber, vitamins, minerals, or phytonutrients to help you process the calories you are consuming. These are "empty" calories devoid of any nutritional value. But they are "full" of trouble. Your body doesn't register soda as food, so you eat more all day long. Plus, your taste buds get hijacked, so anything that is not super-sweet doesn't taste very good to you.
Think I'm exaggerating? Cut out all sugar for a week, then have a cup of blueberries. Super-sweet. But eat those same blueberries after bingeing on soda and they will taste like bland and boring.
Now let's look at the 750 calories of broccoli. As with the soda, these calories are made up primarily (although not entirely) of carbohydrates -- but let's clarify just what that means, because the varying characteristics of carbs will factor significantly into the contrast I'm about to illustrate.
Carbohydrates are plant-based compounds comprised of carbon, hydrogen, and oxygen. They come in many varieties, but they are all technically sugars or starches, which convert to sugar in the body. The important difference is in how they affect your blood sugar. High-fiber, low-sugar carbohydrates such as broccoli are slowly digested and don't lead to blood sugar and insulin spikes, while table sugar and bread are quickly digested carbs that spike your blood sugar. Therein lies the difference. Slow carbs like broccoli heal rather than harm.
Those 750 calories of broccoli make up 21 cups and contain 67 grams of fiber (the average American consumes 10 to 15 grams of fiber a day). Broccoli is 23 percent protein, 9 percent fat, and 68 percent carbohydrate, or 510 calories from carbs. The "sugar" in 21 cups of broccoli is the equivalent of only 1.5 teaspoons; the rest of the carbohydrates are the low-glycemic type found in all non-starchy vegetables, which are very slowly absorbed.
Still, are the 750 calories in broccoli really the same as the 750 calories in soda? Kindergarten class response: "No way!" So why do we all think that's true, and why has every major governmental and independent organization bought into this nonsense?
Let's take a closer look at just how different these two sets of calories really are.
First, you wouldn't be able to eat 21 cups of broccoli, because it wouldn't fit in your stomach. But assuming you could, what would happen? They contain so much fiber that very few of the calories would actually get absorbed. Those that did would get absorbed very slowly. There'd be no blood sugar or insulin spike, no fatty liver, no hormonal chaos. Your stomach would distend (which it doesn't with soda; bloat from carbonation doesn't count!), sending signals to your brain that you were full. There would be no triggering of the addiction reward center in the brain. You'd also get many extra benefits that optimize metabolism, lower cholesterol, reduce inflammation, and boost detoxification. The phytonutrients in broccoli (glucosinolates) boost your liver's ability to detoxify environmental chemicals, and the flavonoid kaempferol is a powerful anti-inflammatory. Broccoli also contains high levels of vitamin C and folate, which protect against cancer and heart disease. The glucosinolates and sulphorophanes in broccoli change the expression of your genes to help balance your sex hormones, reducing breast and other cancers.
What I'm trying to illustrate here (and this is probably the single most important idea in this book) is that all calories are NOT created equal. The same number of calories from different types of food can have very different biological effects.
If you still think a calorie is just a calorie, maybe this study will convince you otherwise. In a study of 154 countries that looked at the correlation of calories, sugar, and diabetes, scientists found that adding 150 calories a day to the diet barely raised the risk of diabetes in the population, but if those 150 calories came from soda, the risk of diabetes went up by 700 percent.
Some calories are addictive, others healing, some fattening, some metabolism-boosting. That's because food doesn't just contain calories, it contains information. Every bite of food you eat broadcasts a set of coded instructions to your body -- instructions that can create either health or disease.
So what will it be, a Double Gulp or a big bunch of broccoli?
If you're inspired to detox, to end your food addiction and your sugar and carb cravings and renew and reboot your health, check out my #1 best-selling book The Blood Sugar Solution 10-Day Detox Diet! Plus, get these great bonus gifts right away to jump-start your program:
In the Kitchen with Dr. Mark Hyman -- In this three-part online video series, I teach you how to cook amazingly delicious healing foods quickly.
The Missing Ingredient Report -- Why we get stuck and how we can sustain our weight loss goals.
Dieting 101 Guide -- My review of the top 10 weight loss programs, in which I share what works and what doesn't and WHY?
---
Mark Hyman, MD, believes that we all deserve a life of vitality--and that we have the potential to create it for ourselves. That's why he is dedicated to tackling the root causes of chronic disease by harnessing the power of Functional Medicine to transform health care. Dr. Hyman and his team work every day to empower people, organizations, and communities to heal their bodies and minds, and improve our social and economic resilience.
Dr. Hyman is a practicing family physician, a seven-time #1 New York Times bestselling author, and an internationally recognized leader, speaker, educator, and advocate in his field. He is also the founder and medical director of The UltraWellness Center, chairman of the board of the Institute for Functional Medicine, a medical editor of The Huffington Post, and a regular medical contributor on Katie Couric's TV show, Katie.
Dr. Hyman works with individuals and organizations, as well as policy makers and influencers. He has testified before both the White House Commission on Complementary and Alternative Medicine and the Senate Working Group on Health Care Reform on Functional Medicine. He has consulted with the Surgeon General on diabetes prevention and participated in the 2009 White House Forum on Prevention and Wellness. Senator Tom Harkin of Iowa nominated Dr. Hyman for the President's Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. In addition, Dr. Hyman has worked with President Clinton, presenting at the Clinton Foundation's Health Matters, Achieving Wellness in Every Generation conference and the Clinton Global Initiative, as well as with the World Economic Forum on global health issues.
Dr. Hyman also works with fellow leaders in his field to help people and communities thrive. With Rick Warren, Dr. Mehmet Oz, and Dr. Daniel Amen, he created The Daniel Plan, a faith-based initiative that helped The Saddleback Church collectively lose 250,000 pounds. He has appeared as an advisor on The Dr. Oz Show and is on the board of Dr. Oz's HealthCorps, which tackles the obesity epidemic by educating American students about nutrition. With Dr. Dean Ornish and Dr. Michael Roizen, Dr. Hyman crafted and helped introduce the Take Back Your Health Act of 2009 to the United States Senate to provide for reimbursement of lifestyle treatment of chronic disease.
Join Dr. Hyman on his path to revolutionize the way we think about and take care of our health and our societies at DrHyman.com, on Twitter, on Instagram @MarkHymanmd, and on Facebook.
#idahomentalhealth
from Anxiety Agoraphobia Bipolar Disorder Evaluations and Treatment in Boise, Treasure Valley, Idaho http://ift.tt/1qopEe6