At the moment, I’m tired.  A good tired, actually.  A tired that comes from a densely packed four-day adventure with a lot of high school kids.

Not all tired is good tired.  There’s the tired that comes from hearing about yet another tragedy on the news.  There’s the tired that comes from having an ailing loved one.  There’s the tired that results from work frustrations.  Or from working too many hours over too long a time.  Or from working under too much pressure.  Or from deep worry.  You feel stressed.  You can feel your heart beating, but you haven’t exercised – you just don’t feel quite right.  You want to sleep, but you don’t sleep well.  There’s no shortage of bad tired causes, and the bad kind of tired takes its toll on a person, both psychologically and physically.

For some of these bad tireds, a good tired can help.  You know that feeling after a long day of hiking?  You went many miles, breathing the fresh air, marvelling at the views, listening to the sounds of the forest, carrying a backpack.  You get back to your tent or your motel room or your house, and you sit down to eat something.  Your legs are a little sore.  As you sit for a few minutes, you realize that you simply must go to bed.  And you sleep magnificently.  A day of skiing does this, too.  Or a day of canoeing.  And it can provide significant relief from some of the worried or stressed or frustrated tireds.

The good kind of tired can also come from too little sleep because of a brief period of recreation.  For example, chaperoning a high school band trip to New York City.  A long overnight bus ride (sleeping done in really uncomfortable short spurts), counting kids, a whirlwind tour of a world-class city – walking from one sight to another, counting kids, carrying instruments, counting kids, sharing in the awe of a herd of teenagers seeing Times Square lit up at night, following them from hat store to candy store to the toy store (yes, there’s still plenty at FAO Schwartz too keep teens entertained), counting kids, playing the latest versions of hackey sack, counting kids, setting up for concerts, seeing concerts, counting kids, tucking kids into hotel rooms late at night, getting up early to have breakfast with them each day, checking their rooms to see what they forgot to pack, counting kids, reminding them to bring their jackets on the cold days, giving your jacket to the kid that didn’t bring his, counting kids through Central Park, carrying more instruments, a long overnight bus ride home, unloading suitcases, checking the bus for forgotten socks, jackets, shoes, music folders, money, drinks, a string of Christmas lights (really, not making that up)……

A really good tired refreshes.  It renews.  It relieves.  And I’m ready for my head to hit my pillow for that magnificent sleep tonight!

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.