I love animals.  Pets bring so much to a household – companionship, love, lessons in loyalty, a creature to care for that forces you to be responsible for and think of the needs of others, something to force you to go outside and take walks, protection from intruders and postal workers, and countless other benefits.

My good friend has frequently opined that one of the most important reasons for families to have pets is so that children learn to deal with death.  There’s a lot of merit to that.  When the goldfish stops swimming and floats to the top of the bowl, a young child has a pretty good visual of the concept that “the fish died.”

In addition to giving us practice in dealing with loss, our longer lived, furry companions help all of us practice, on a different scale, a number of aspects of dealing with illness, caretaking, medical decision making, and navigating a medical system.

As you may have surmised at this point, our family recently had an unwelcome, up-close-and-personal brush with the veterinary medical world.  Thankfully, it looks like our sweet dog will be ok –  we just have a few more gray hairs and a smaller bank balance to show for the ordeal.  And he has some (temporary) funny fur patterns from shaving done for surgery and procedures (honestly, he looks a bit ridiculous from certain angles).  This whole process, however, highlighted for me a number of the issues we deal with when we or others we care about suddenly get sick.

First there’s figuring out that something’s wrong.  Maybe it’s subtle at first, and it might take awhile to establish that something is actually wrong.  Then there’s deciding when it’s time to call a doctor, when to visit a doctor’s office, or when to rush to an emergency room.  When sent to a specialist, there’s the question of how to know the specialist is the right one, and how to know whom to trust.

Which diagnostic tests will be most helpful?  How to weigh the costs and benefits of the tests and treatments?  Once a diagnosis has been made, what do the statistics indicate about the prognosis of that particular diagnosis?  How does an individual differ from the general statistics?  Would a second opinion be helpful?  If so, from whom?  How long is it safe to delay action while seeking other input?

All of these questions on top of the general fear that accompanies an acute, serious illness can cause quite a bit of tension and stress.  Things can feel pretty out of control.  And there can easily be a feeling of being pushed into a corner, or of being forced down a path that seems hard to modify.

Remember to breathe.  Ask for guidance from those equipped to give it.  And always question, question, question until you understand and feel comfortable.

I read something on Facebook last week that someone had “shared” from another source, and it really bugged me.  It started with the following:  “AFTER YEARS OF TELLING PEOPLE CHEMOTHERAPY IS THE ONLY WAY TO TRY AND ELIMINATE CANCER, JOHNS HOPKINS IS FINALLY STARTING TO TELL YOU THERE IS AN ALTERNATIVE WAY …”

I could tell that the piece was in no way connected with any reputable medical center or research institution.  But I have a medical degree.  The piece was full of scientifically false statements, and full of “health” advice that is in no way espoused by the medical establishment.  There were a couple of reasonable general tips thrown in (i.e. eat lots of vegetables, exercise daily), albeit with baloney reasoning behind them, and enough simplified statements that had partial truths thrown in that someone without a health or science background could think it was real.

So why does this bother me so much?  Fraudulent “medical” posts can do a great deal of harm.  A person believing scam posts could take substances which might hurt them, either because the substances themselves may be dangerous or because they could interact with a person’s other medications.  A person may also delay seeking medical attention when necessary because they are under the illusion that researchers at a premier medical institution have stated that eating vegetables, taking unspecified supplements, breathing deeply, and avoiding milk, sugar, coffee and chocolate will cure cancer.

So how can you tell which posts are scams and which have merit?  A great first step is to check out www.snopes.com.  They don’t always get every detail right, but they do a very good job of discerning whether a circulating article is true or false, and they provide references (and links to their references).  When I read the above post, I went to the Snopes website and typed “Johns Hopkins cancer” into the search box.  The post I had seen was in the first listed result, and was listed as “false.”  It turns out that this particular scam post has been circulating for several years.

Fake “articles” like this one take people’s focus off what research actually shows to reduce cancer risk.  Thankfully, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins put out a detailed response to this fraudulent post: http://www.hopkinsmedicine.org/kimmel_cancer_center/news_events/featured/cancer_update_email_it_is_a_hoax.html

The following is a direct quote from this page (there is much more information on the page, so please follow the above link if you’re interested):

“Several Johns Hopkins experts participated in the World Cancer Research Fund – American Institute for Cancer Research report Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, published in November 2007, which is considered by cancer prevention experts to be an authoritative source of information on diet, physical activity and cancer. Their recommendations for cancer prevention and for good health in general are:

1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and foods processed with salt (sodium).
8. Don’t use supplements to protect against cancer.

Our experts recommend that people meet their nutritional needs through their food choices. While vitamin supplements can be helpful in people with nutritional deficiencies, evidence suggests that supplementation above what the body can use provides no added health benefit.”

I get forwarded hoax e-mails frequently, and see them on Facebook all the time.  Before I even turn to Snopes, one clue that tells me that an article is fraudulent is a lack of a citation or link to the original source.  Another sign is that the post begins with something to the effect of “Hey Everyone, I checked this out on Snopes and it’s true!”  Pretty much every time I see this, when I go to the Snopes site it turns out to be blatantly false.

A lot of the “warning” posts or missing person posts out there are hoaxes.  Aside from being a general nuisance, these posts can cause a boy-who-cried-wolf effect and end up causing people to just ignore all of them, even the ones that are true.

Why do people start these rumors/urban legends/hoaxes?  Some of them may be put out there to sell a particular product (e.g. “Did you know that you can cure X by simply taking 200 milligrams of Y twice daily?”), and a lot of them seem to be out there just because someone wanted to feel the power of starting a rumor.  We all have a limit to the number of issues that can take up active space in our brains – if that space is taken up by falsehoods, we may miss the true and important ones.

My eldest son is now in the 2nd half of 11th grade, so a high percentage of thoughts in our household seem to revolve around college.  Where to apply?  What looks like a “good fit” on paper?  What’s it actually feel like when visiting?  Can he get in?  If colleges considered letters of recommendation from applicants’ mothers, I’m sure he’d be a shoe-in anywhere.  But the “holistic approach” to reviewing applications which every college and university currently claims to espouse notwithstanding, a lot of specific numbers come into play.

GPA.  Weighted GPA.  Class rank.  Standardized test scores.  The higher the aforementioned numbers in an entering class, the higher the college/university will be ranked.  And it will be ranked even higher when the number of applicants goes up and the percentage of students admitted goes down.

But what do those aggregate numbers actually say about a college?  And what do the individual numbers actually say about a student?  We all make inferences, whether fair or not, based on certain numbers.  Sometimes the inferences are accurate, and sometimes they aren’t.  They tend to be more accurate when more than one number is taken into account.  And even more so when more information is considered.  There’s a forest to discern from those trees.

When the nurse sticks a needle in the inside of your elbow and fills a few tubes with the red stuff, you’ll soon have a report filled with numbers.  “Good” cholesterol.  “Bad” cholesterol.  Blood sugar.  All kinds of data.  Very occasionally, one number by itself can give you a crucial, relevant, helpful piece of information.  But usually there’s a lot of contextual information that determines how a particular number should be interpreted.

For example, a blood sugar level twice the upper limit of normal must be a big problem, right?  Well, what if it had been three times the limit two hours ago?  Or what if the blood sample had been taken from a vein that had an IV running into it that had sugar in the IV fluid?  Might those circumstances not influence a doctor’s evaluation and interpretation of that one particular number?

An actual visit to a college campus helps a person see beyond the numbers as he meets students, hears how the school presents itself in an information session, and observes the interactions within the buildings and on the grounds.  Reading an essay and holding an interview with a student helps a school go beyond the numbers as the admissions representative sees how a student expresses himself, and the school gets a glimpse of how the student interacts with others.  The numbers can then be integrated back into the pictures to provide more contextually complete representations.

In general, doctors need not to react just to specific numbers, but to take into account the entire clinical picture.  Contextual clues can help guide which numbers and laboratory data to check, and can help indicate an erroneous lab value.   A doctor needs to look at a total cholesterol level, then look at the breakdown of cholesterol subtypes, and factor in her patient’s weight, medical history, and family medical history in order to decide how to interpret that lab data.

I would like my son either to go to a college or university that sees him as more than just a GPA and ACT score, where people care about his development as a person, or I’d like him to figure out a way to find a sub-community of peers and mentors who look beyond the numbers if he ends up in an overall impersonal, numbers-driven environment.

I would hope that people find themselves with doctors who look at them as whole people, who take the time to explain the numbers, and figure out what they mean within the context of the whole person.  Or, I would hope that they can find a medical advocate who can teach them, and empower them to communicate beyond the numbers with their own physicians.  My ears are open if you need me, and I am currently taking on clients in the southern and central parts of Oakland County if you know of someone there who could use my help – just send them to peek at www.practicalmedicalinsights.com.

People are more than numbers.

(Note: I began writing this post before the International Olympic Committee decided that ping-pong was a more Olympics-worthy sport than wrestling.  There is now a Keep Wrestling in the Olympics page on Facebook which you can follow if you are interested, or you can visit www.TheMat.com)

All three are very athletic, and I’m sure they’d be pretty good, and they’ve all begged, but I don’t let my kids play football.  Flag football is fine.  So are neighborhood impromptus.  But not official-school-team football where you have 250-pound kids running into 130-pound kids.

It’s not that I’m afraid of my kids’ getting hurt.  Well, yes it is, but it’s a little more complicated.  Given the paragraph above, you might be surprised to hear that my youngest son, who just turned 12, is a wrestler.  For the past few months, I’ve been delightedly watching him compete in tournaments with our local youth wrestling club, and he’s moved up from “novice” (first-year wrestlers only) to “open” since he’s doing so well.

Have you ever watched a high school or college wrestling match?  It doesn’t have the theatrics of professional wrestling.  Instead, it has remarkably strong individuals using incredible force and twisting maneuvers in order to get their opponents off-balance, onto the floor, and into specific positions or “pinning” them on their backs.  It’s actually really exciting.  And it’s really exciting to watch my baby do it.  At least, it is when he’s in the better position, which so far he’s been in the vast majority of the time.  But I did NOT like it when an opponent had a hold of my child’s foot in what looked like a really unnatural position.

So how did an “absolutely-no-football” mom become an enthusiastic wrestling mom?  It actually wasn’t much of a transformation.  My boys are competitive athletes.  They run track and cross country.  They’ve played basketball.  They ride bikes.  They climb trees.  They know how to skateboard.  They’ve learned martial arts.  We hike in national parks.  We do not live a life free from risk.  There is no such thing.  If you hide inside your whole life, that brings it’s own set of dangers.

I look at data.  A doctor’s job is to look at data and assess risks.  To weigh the risks of doing one thing with the risks doing a different thing, or of doing nothing.  I did this with every patient, I help elucidate this for every client, and I of course do it with my family.

Virtually every sport carries a not-insignificant risk of injury.  Different sports have different rates of different types of injury.  One of the most dangerous aspects of high school and collegiate wrestling has been trying to lose a lot of weight quickly in order to “make weight” (since there are weight categories in wrestling, and you get to wrestle someone smaller if you drop into a lighter category, but of course becoming dehydrated and malnourished is a pretty stupid way to prepare for a battle of strength).  There are now rules in place (at least at the high school level) that limit how low each wrestler is allowed to go in weight.

There are a lot of upper extremity injuries in wrestling.  There are a lot of blown-out knees in football.  As awful as these are, they wouldn’t stop me from allowing my kids to reap the benefits of the sports – teamwork, physical fitness, accountability, commitment, sportsmanship, etc..  But the knee and shoulder injuries don’t scare me as much as potential high-velocity collisions or the long-term effects of repetitive head injuries.

Here’s my thinking:  Wrestling has weight classes.  It’s really not possible in wrestling, outside of heavyweight, to have a huge weight differential, but in football it’s quite possible for someone to be run into by someone who outweighs him by a factor of two.  Football, by its nature, involves full-speed body collisions, while wrestling is more of a steady-force-pushing kind of thing.  Yes, there are take-downs in wrestling that involve hitting the floor, but the rates of concussions differ significantly between the two sports.  Also, football practice involves repetitive collisions, and while each impact may be less than what is needed to cause a concussion, a cumulative high volume of sub-concussion head trauma is showing in current research to have long-term effects on the brain.  Again, no sport is totally free of this (cross country or track runners can certainly collide), but I can’t ignore how much of it there is in football.

For now, I am accepting the risks of wrestling because I see how much my son loves it, how much he loves learning the techniques and strategy, how strong he is becoming, and how good it makes him feel about himself.

Risks and benefits.  Different for every individual.  What risks are you willing to take for what benefits?

Snow day!  Kids slept in.  In our kitchen, making waffles, my boys happily complaining that it was too bad the snow day hit on a day they had jazz band, but they’d take the snow day anyway.  Wait a minute.  Jazz band.  Band.  Instruments.  “Uh, Mom, do we have rehearsal this Sunday?”  “Yes.  Why?”  “Because our instruments are at school.”

Crud.  This really hadn’t been an expected snow day, so I couldn’t legitimately yell at my boys for not planning ahead (not that doing that would help the situation anyway, even if it had been “their fault”).  Think.  Think.  Phone call to high school office – no answer.  Quick phone call to friend who teaches at the high school to see if anyone’s usually there on snow days.  She said theoretically someone from the custodial staff should be there, so we should try to see if any door to the building is open and catch one of the custodians to let us into the band room, and if we couldn’t get in, she has a key to the building and could go up there with us to let us into the school to look for a custodian.

Sent my high schoolers to try to get in (the main roads had been plowed by this time).  As they were trying a door, a custodian was leaving through another door and yelled to them that everything was now locked and the alarms were on so no one could get in today.  My boys tried to yell back to let him know what was happening, but they must not have been loud enough (surprising for a couple kids who can be plenty loud when they are of the opinion that their parents are being unreasonable), because the custodian got into his car and left.

Crud.  Called teacher friend again to tell her about the situation and to ask if there are generally people in the building on Saturdays, so that we could try again tomorrow morning.  She said that the fitness center should be open, but that the athletic area was locked from the rest of the building, and the alarms would be set.  She suggested emailing the principal in case he checked his email and could contact someone from the custodial staff to meet us there and help us during fitness center hours.

Zipped off an email to the principal.  Hoped he would see it.  Thought some more.  Checked to see what was up on Facebook.  Saw a post that talked about how snow days were decided.  Clicked to read the full article.  There was a quote from the superintendent.  The superintendent……. maybe he would be in his office?  Zipped him an email, and then called his office – he answered his phone!  I explained our predicament.  He said he’d call me back in a minute.  Phone rang a minute later, and our superintendent told me that the head of the district’s custodial staff would meet us at the east doors in 15 minutes to let us in.

Disaster averted.  Instruments retrieved.  And in the meantime, the principal had emailed back that there would be someone in the building Saturday morning who could help, so even if we hadn’t been saved today, the situation could have been fixed tomorrow.  Thank you emails were sent to everyone involved.  Snow day has been enjoyed to its fullest, with a houseful of teenage boys (and one 12-year-old, but I’ll count him as an honorary teen).

So here’s where Doc Thoughts come in.  It’s easy to panic, but panic doesn’t get you anywhere.  When you take a deep breath, you can think of people who might be able to help you, and even if they can’t help you directly, they probably know someone who can.  I had a new client this week who was referred to me by someone I had just met earlier that day, who realized that this person was in a state of crisis and could use my help.

How many steps to link any actor to Kevin Bacon?  How many steps to find someone who can help you?  Networking works.  We all know people.  A large part of what I do professionally is figuring out who to go to and where to get the right information to help people.  Sometimes it takes a few steps, but I get there.

Breathe.  Think.  Make a couple calls.  Send a few emails.  Someone likely will be able to unlock the door for you.

Call me crazy, but I really enjoy shoveling snow.  There are a (very) few household chores which center me, calm me, and satisfy me, and shoveling is close to the top of that short list.  I was speaking to a friend the other day who shares some of my gratification in this particular job, with her satisfaction stemming from the finite nature of the task, the physical workout, and her ability to see progress along the way.

I certainly appreciate those aspects of the enterprise, and for me it goes even further.  There’s the simple freshness and beauty of a new snowfall.  There’s the dampening of background sound that occurs with a thick blanket of snow.  There’s the meditative nature of coordinating my breathing with the work of lifting the shovel, and of following the right-right-left-left patterns of evening out the muscle work on my two sides.  I like the detail of following the lines of the lawn along the driveway, widening the path a bit around the doors of the car. 

I appreciate the brief solitude as I begin the task, and then the teamwork as family members come outside to join me.  A few years ago we split the cost of a snowblower with our nextdoor neighbors, and they keep it at their house (we didn’t want to keep gasoline cans in our garage when the kids were young).  Very rarely do we make use of the machine – generally just when time is a big factor.  I don’t like the smell of the gasoline, the sound of the motor, or the vibration of the handle. 

I much prefer the brief, repetitive scrape of the shovel blade against the pavement, and the soft “thunk” of the snow as it’s dropped along the side of the path.  I enjoy the ability to focus on the signals given to me by my own body, speeding up and slowing down as my strength, endurance and energy directs me, resting frequently to breathe and to survey what I have completed and what is left to do.  I am one with my shovel.

*Note: Please check with your doctor to make sure you have no medical contraindications to shoveling snow if you decide to take this up.