Health and HealthcareA open series about Health and Healthcare
We take the ideas we have developed over the previous episodes and use them to evaluate a a study I found online. These are things anyone can do with just a little work on Google, and the payoff is to have a good idea of whether or not you are looking at a quality study
The idea of a Hierarchy of Evidence is that there is a ranking of studies of different kinds in terms of how persuasive they are. It is not enough to simply say that “A study shows…” without also looking at what kind of study it is how powerful the results are. We look at the different kinds of studies and rank them from top to bottom.
Basing medical care and treatment on the scientific evidence should be the norm, but frequently it is not. Doctors may treat based on how they have always done it, or how other doctors do it (i.e. best practices), but there is a movement now to reorient medicine to follow the best scientific guidelines.
All medical studies are not alike. Some are of higher quality than others, and the conclusions they reach need to be evaluated based on some principles of good research. Here we take a look at some warning signs of bad or unreliable studies.
We get bombarded with breathless news stories about medical breakthroughs that may not be as reliable as they are presented. This begins our look at what is reliable and what you need to watch out for.
The best things you can do to maximize your health are to watch what you eat and make sure you get exercise. These are some of the primary tools in my kit for staying healthy and living a long life.
The last of my personal health issue shows covers two related issues, Sleep Apnea and Atrial Fibrillation. They are related because Sleep Apnea is a cause of Atrial Fibrillation. Fortunately both can be controlled if you follow medical directions.
I had surgery for cancer in 2010, and family history of cancer, which means certain things have had to be done.
My history with vision issues started when I was 3 years old, and I am still dealing with some issues. Fortunately, things are well-controlled and I am doing well.
For the last 15 years or so Diabetes has been a central fact in my life, and I needed to learn what to do about it. I think I discovered a way I can live with it and still have a good quality of life
On our refrigerator we have a note card that says "If you don't take care of your body, where will you live?" This is a very pertinent question that can open up a discussion of how to achieve a better level of health and age gracefully. This show will kick off a series that will explore various topics in how to get good medical information and improve your health.
In 2017 Obamacare was the subject of a great deal of political jockeying, and yet by the end of the year almost nothing changed. So what happened, and why?
I was partially inspired by Bitbox's really wonderful episode, "hpr2413: personal health care", to ramble on about the need for the HPR community to, maybe, start talking about a mental health crisis that touches pretty much everyone in the modern world: addiction.
Personal Health Care
hosted by Bitbox:
This show was created while sitting in my tractor cab (I'm a truck driver), it took less than 10 minutes to record. The slight background noise is my truck getting bounced around by the forklift running in and out of my trailer.
The audio was recorded on an 'Olympus VN-1000PC' pocket dictation recorder (purchased at Walmart about 10 or 12 years ago, I think, for about $20.00-US), on the built in mic. The recorder will accept a mic and/or headphone with a 3.5mm jack size. Mini usb out as a mass storage device so its easy to offload your files. The device is simple enough for a monkey to use, or a trucker...
Photos from my Android phone, a samsung s7 active. Photos transferred to my laptop using the KDE connect application (I know, I know, how 'bout an episode...)
Photo editing in "Gwenview", a gui application with fast cropping and resizing capability, plus much much more (I know, I know, how 'bout an episode...)
Audio editing in "Audacity", of course. All I did was pull the silences, and the "uh, ummmm's" out, and then export into a flac mono. (I know, I know, how 'bout an episode...wait, no that one's been done, and done,...)
The digital scale in the picture below was purchased at 'bedbath&beyond' for less than $20.00 -US, several years ago and seems quite accurate
The Omron BP cuff...lists at about $80-$90.00 US on their site. I didn't pay for that though. My mom the retired nurse did.
SHAKUBUKU - from the wikipedia entry...
Shakubuku "break and subdue" (折伏) is a term that originates in the Chinese Śrīmālādevī Siṃhanāda Sūtra. Although often associated with the teachings of Nichiren, the term appears often in the SAT Daizokyo and the works of the Chinese Tiantai patriarachs Zhiyi and Zhanran. The term has historically been used to indicate the rebuttal of false teachings, and thereby break negative patterns in one's thoughts, words and deeds.
Personally, I heard the term defined first on the movie, "Gross Pointe Blank" with Minni Driver, John Cusack, Alan Arkin and Dan Akroyd. Minnie Driver's character described SHAKUBUKU thusly,"It's a swift, spiritual kick to the head that alters your reality forever."
Both of these definitions work for me, the first being the more definitive, and the second being the somewhat simplistic, hipster/millennial definition, although the line was actually recorded around 1997 when the movie came out.
Thank you all for listening.
In previous episodes we set the stage by examining insurance, the marketplace, competing interests, tradeoffs, and costs. With that we can now understand what Obamacare attempted to do and give a tentative evaluation of the legislation and its effects.
Frank discusses his long experience with trying not to get fat by using free weights and a bicycle. Free weights are, without question, the geekiest form of exercise, having a versatility and flexibility unmatched by any alternative.
Here are some sample programs:
- Warm Up adapted from the Royal Canadian Air Force Exercises
Procedure: 3 sets × 8 reps, increasing to 10 reps, then add five pounds and start over with 8 reps.
Exercises (* = requires bench, **= bench desirable):
Program One: Leg Raises,* Leg Curls,* Dumbbell Flies,** Barbell Curls, Triceps Pull-Overs, Forward and Reverse Wrist Twists (using pipe with rope to raise and lower weights)
Program Two: Dumbbell Lunge, Bench Press,* Bent-Over Rows, Dumbbell Kickbacks, Zottman Curls, Forward and Reverse Wrist Curls
Program Three: Half Squats, Bench Press, Concentration Curls, Dumbbell Kickbacks, Forward and Reverse Wrist Curls.
As stated in the podcast, Frank has not found many weight-training websites appealing. The websites tend to be for fanatic bodybuilders or for pitching products. This one, though, has a pretty good catalog of exercises: http://www.weight-training-exercises.com/. Note that the same exercise may be known by several names, depending on the speaker.
The big driver to changing the healthcare system in the U.S. was the inexorable rise in healthcare costs. These costs kept rising for a number of reasons, which we look at at in this episode.
The Health Care Marketplace in the U.S. has 6 major partipants: Doctors, Hospitals, Insurance Companies, Employers, Government, and Individuals. Each of them has interests and incentives, and they tend to clash. How we resolve those competing interests has consequences for the systems we create.
Health care is a service, and like all services it needs to be paid for one way or another. This means making choices, and there are consequences and implications to whichever choice you make. But there is no free lunch, you have to pay.
In show hpr2325 Ahuka describes how Health Insurance and How It Works.
In this episode Ken reads the current state of Healthcare in the Netherlands by reading the Wikipedia entry.
Health policy is difficult and tricky. In the U.S. health care is mostly financed through insurance. How does that work, and what does it imply. There are some hard truths here.
First off a disclaimer: anything I say here is my experience and is in no way intended as advice to anyone, everyone who experiences or is at risk of a stroke is different and you must make your own lifestyle choices based on professional advice.
That clear lets get on with my show. On the 2nd February 2017 I had a Stroke, it came completely without warning. I was out with my wife, just about to start a Bridge class we were attending. I sat down at the table and just after sitting down was blasted with what I thought was White Noise from faulty hearing aids. After quickly removing them without any effect I thought I was having a sudden severe migraine, which I have from time to time. However I was unable to communicate what was happening and after several minutes my wife wrote on a paper the words “Home” and “Hospital” and I pointed to hospital. An Emergency ambulance was duly called and I was transferred to the local Emergency Department. Several hours later in the early hours of the next morning they admitted me, still not sure what had happened. It was only after a scan that afternoon that they concluded that I had had a Stroke.
I was seen by a consultant that evening who confirmed this and as I still had residual problems on my right side concluded that it was a stroke, and not a TIA (Transient Ischaemic Attack) or a mini stroke as it is sometimes called. I spent the next 12 days in hospital having further tests, including another scan, an MRI as opposed to the previous CT scan I had had on admission. After seeing the results of this scan the Consultant was amazed that I was not more severely affected, in other cases of the type of stroke I suffered the physical and cognitive damage is much more severe. It was looking like I had thankfully, dodged a bullet.
That is not to say there were no effects. My right side was effected and the fine motor control was damaged. Coordination in using my right hand and arm were initially difficult as was writing (I am predominantly right handed). Also my mouth felt like I was wearing someone’s false teeth, even though I have all my own. However the main effect has been fatigue, initially severe, but as I write this 6 weeks later this is starting to improve, although I still tire after 2-3 hours doing things that I could have done all day previously. I also still have a little feeling of weakness in my right hand and arm and writing is still an issue, thankfully most of my writing is done on a keyboard.
So what caused it I hear you yelling, well the truth is they don’t know. The most serious risks are to people that Drink alcohol excessively, Smoke and have a high fat diet. Also those over weight particularly the obese, and people with diabetes are high risk. Another major risk factor is genetic, and I remembered afterwards that my Grandfather and an Uncle had major strokes that ultimately led to their deaths. Also stress and high blood pressure can be a factor.
I don’t drink or smoke and have been a vegetarian for many years, also my blood pressure is checked regularly and was always seen as within normal range. However I was at the time of the stroke 21lb over weight, but even before it happened I had lost 7lb. Since the stroke the blood tests also show I am pre-diabetic so I need to increase my exercise (again something I had started to do), and alter my diet to reduce my blood sugars. Not major issues as I had started to attend a gym and walk more as part of the weight loss plan, and I actually prefer healthy food, and now have a reason to say to people when I’m in company why I eat what and the way I do.
The main effect for me has been the restriction on my mobility as the Consultant will not let me drive until 3 months post discharge (14th May), which means I have to rely on others or get public transport, this is not the problem but having to walk from transport stops to where I’m going is due to the fatigue. Roll on May 14th.
I thought I would record this show as a bit of a warning, and for listeners to realise that a Stroke can and does happen to anyone. On a positive note there is life after stroke and even for those who are more seriously disabled by a stroke many can and do recover most if not all the function they had before hand.
Further info on Stroke can be found here:
This is a very personal podcast, discussing minor surgery. If that sort of stuff makes you cringe at all, this may not be the recording for you. I should also point out that I am not a medical professional, you should not take this recording as medical advice, if you have any concerns about your skin, seek professional medical advice.
I am a very white person living in Queensland, Australia. Our state has amongst the highest rate of skin cancers in the world, I believe we're in a tussle with New Zealand for first place at the moment.
There are two main types of skin cancer, melanoma and non-melanoma. The non-melanoma type is slow growing, and rarely spreads to other parts of the body, while melanoma is fast growing and spreads to the rest of the body.
Both my parents have had multiple lesions excised, so something like this was always on my mind. We live in a sunny, sub-tropical environment, the sort of clothing you'd want to wear for comfort is light, breezy, and not covering much skin, exactly the wrong sort of clothes you'd need to wear to protect yourself from ultraviolet (UV) rays that help cause skin cancer.
According to the Australian BoM FAQ http://www.bom.gov.au/uv/faq.shtml the per capita risk of skin cancer in Australia is ten times higher than America and sixty times higher than the UK.
The UV scale rarely gets above eight in the UK, in Brisbane the UV scale is above eight for roughly eight months of the year.
There are a lot of variables when it comes to UV. Cloud cover is probably the most important. Something that I can't stress enough is that heat and UV are not correlated, you can definitely be exposed to lots of UV when it's cold (see New Zealand, they're much more south, much more cold, and have more exposure due to the ozone hole). Another example is snow, UV will bounce off the snow and back at you.
The link between skin cancer and UV is quite strong, 95-99% of skin cancers are caused by excess sun exposure. (http://www.cancer.org.au)
So, with all that history, I started getting yearly skin checks a couple of years ago. I'd had a couple of skin checks when I was very young, and now that I'm more advanced in years I wanted something less ad-hoc. Someone working for one such organisation gave a talk at one of the user groups I attended, and i made an appointment with Molemap. It's a full on procedure where your entire body is photographed, and each mole, freckle, bump and lump that is of possible concern is photographed from a few centimetres off the skin, and with the magnification lens sitting right on top of the mole.
I have some near 200 spots on myself that are of interest, so my follow up appointments take about two and half hours to go over all these spots, plus looking for new ones. The hope is that, by doing this close to yearly, small changes in all these spots won't go unnoticed, and we can get on top of any cancers early.
Interestingly, the spot that was actually a problem was a new one, so under a year old, and was hiding underneath my beard, so in future I'm definitely going to have my skin checked clean shaven.
The other thing I want to communicate is that early detection is key, all the skin cancers have a 90% plus survival rate (at five years) if caught early enough. This does potentially mean that a yearly check is not enough, but it's already proven it's worth to me.
Molemap only does photography of spots, and visual diagnosis. It does not do any treatment or biopsies or excisions, therefore there it has no self interest in recommending treatment on borderline cases. Molemap sprang out of a University of Queensland project, which is my alma mater. After receiving the diagnosis (via an online form, secured with a second factor sent to my phone) and panicking a fair bit, I contacted my regular doctors practice (we call them general practitioners in Australia, I'm sure they're called different things elsewhere) for an appointment with a GP who had experience with skin cancers. In QLD, most medical centres will have at least one doctor with experience in this area. As it turns out, my regular GP has such experience and I got an appointment for the following week.
I wasn't really sure what to expect from my GP appointment, but I was mostly expecting to get the diagnosis confirmed, and either get sent to a specialist to deal with it, or organise another appointment at the GP.
What actually happened was it took all of five minutes for my doctor to confirm the diagnosis, then work how he had time in his schedule, and there was a nurse free, to excise the lesion straight away. I was given a local anaesthetic, so I felt no pain whatsoever, but you still feel the doctor pulling on your skin up, down left and right, so that the complete lesion can be removed, as well as a small amount of surrounding skin in case the cancer has spread.
Here I should mention that melanomas spread very fast, and when they're excised up to a centimetre of skin may need to be removed, where as for a non-melanomic, a millimetre or so is good enough.
I got four sutures put in, they stayed for a week (we have a long easter break in Australia) so it ended up being closer to a week and a half. I had no problems, my scar healed up quickly and nicely. Now, a couple of months later, there's a little redness along the scar line, but that's about it.
So. The take aways. UV is not correlated to heat, you can get a lot of UV exposure in cold environments. If you're travelling through a high UV area, take precautions (clothes that cover a lot of your skin, hat, sunglasses, sunscreen). If you live in a high UV area, get your skin checked regularly. Also, keep an eye on your own skin. Use a diary to record any new bumps, lumps, spots etc.
The one step plan to stopping smoking: Don't smoke another one. Audio for the record scratch by Halleck http://www.freesound.org/samplesViewSingle.php?id=29938