What a great BlogTalkRadio show tonight! Rebecca McCulloh (pastor and mental health counselor) was my guest again. Tonight she did most of the talking because the topic was about things that occur outside the doctor’s office. We discussed how to talk to others about your medical problems. One thing that came up was that if you ask someone about their medical problem and they can’t really describe things to you (and you know it’s not out of embarrassment), then that’s a big red flag that they may not understand what it is the doctor was telling them. You could then try to suggest that they call the doctor’s office to ask a few more questions.Rebecca also mentioned that it’s not a great idea to tell someone to call you if you need anything. The reason is that the person you’re talking to probably will never call you because they have no idea what it is you can do for them. Rather, you should say “hey, I can take you to the doctors or I could come over and babysit for you if you need a rest” etc.. Be specific about what you can do for the other person.Rebecca also discussed CaringBridge.com again and explained that it’s not just for terminally or severely ill folks but for anyone who might need to or want to be able to spread the word in a less intimate manner.Listen to the rest of the show:

Great article on how to talk to your doctor about embarrassing medical problems - Dr. Vicki Rackner has the same sense of teaching patients how to take charge of their own health and care as I do - of course, she’s much younger and seemingly more energetic so Bravo to her for championing the cause! Check her out.

The realization hit Natalie like a ton of bricks. Her mother, Joann, had literally died of embarrassment! Joann had noticed blood in her stool almost a year before she was diagnosed with colon cancer. At first she told herself it must have been those beets she ate. Then she thought it was most likely her hemorrhoids, although she had not had a flair-up of hemorrhoids since Natalie’s birth 52 years earlier.

The truth was that Joann was embarrassed to talk with her doctor about private topics such as her bowel habits. She didn’t raise the concern with her doctor until she had bloating, cramping and abdominal pain. This led to the diagnosis of colon cancer that ultimately took her life. Natalie’s brother-in-law, who was a nurse, wondered whether Joann would still be alive if she had told her doctor about the blood in her stool when she first noticed it.

Let’s face it; certain topics are embarrassing to talk about with your doctor. I call them the 5 P’s:

• Peeing
• Pooping
• Paying
• Procreating
• Psychic moaning

Although at first blush the challenge of talking with your doctor about embarrassing medical topics seems simple enough, for some people, it can cause significant suffering.

Hillary, for example, had what’s now called a shy bladder. She had not used a public restroom in over 20 years. She was too embarrassed to talk with her doctor about this; instead, she remained a prisoner to her bladder.

Ed was laid off from work and could no longer afford his asthma medications. Instead of talking with his doctor about it, he decided to do without He wound up in the emergency room with an asthma attack that could have been avoided with regular medication.

Tom had some sexual side effects from his blood pressure medicine. Instead of talking with his doctor and getting a different medicine, he just stopped taking it. The doctors wonder if this might have contributed to his heart attack.

Jerry noticed his loss of appetite and sleeping problems as his caregiver responsibilities for his aging father mounted. He wondered if he might be depressed, but dismissed the thought because real men don’t get depressed.

Imagine how each of these stories might have been different if these individuals who suffered in silence could have talked with their doctors.

Here are 6 tips that can help you talk with your doctor about embarrassing medical topics:

1. Own the embarrassment.

Say to your doctor, “This is a taboo topic in our family, so it’s hard for me to ask. Is it normal to have a funny smell coming from your belly button?"

2. Find the words.

Your doctor speaks a specialized language acquired through years of training. Sometimes patients are embarrassed because they don’t know the “right words" or have a hard time describing the problem.

Remember that your job is to communicate. You don’t need to know the fancy words to do that. If a patient said to me, “Dad had an operation on the dingle-ball thing at the back of his throat", I would know just what he meant. And, the patient would seem relieved when I said, “Oh, you mean the uvula."

The best way to make sure you and your doctor understand each other is to use anatomically correct words. Get a basic anatomy atlas. Use anatomically correct words with your children.

3. Practice saying the words.

Sometimes embarrassing words can be hard to get out of your mouth. Gertrude, a 90-year-old patient said to me, “You youngsters don’t understand how much things have changed. When I got breast cancer in the 1962, the words ‘breast’ and ‘cancer’ were not uttered in polite company." Some words are still embarrassing to say. Practice saying these words out loud when you’re alone! That will make it easier to say them at the doctor’s office

4. Find the right person to ask.

You may have an easy rapport with the nurse or physician’s assistant at your doctor’s office. You can bring up the sensitive topic with them. Say, “Trish, could you please give the doctor a heads up. I want to know why I should say no to those steroids my buddies at the gym are offering me. I would love to look like they do."

5. Find the right way to ask.

Maybe it’s easier for you to drop a note or a cartoon to your doctor rather than ask in person. Find the style that works best for you.

6. Remember that your doctor is there to help you, not to judge you.

Your doctor has heard it all before. I promise! Your doctor will not think less of you for asking an embarrassing medical question; in fact, your doctor with think more of you for overcoming your fear and helping you take charge of your health.

Dr. Vicki is a board-certified surgeon who left the operating room to help families take the most direct path from illness to optimal health. Her book, “The Personal Health Journal", can save your life today by helping you understand your health story. Empower yourself with the tips and tools that will help you direct your story and partner with your doctor more effectively at: http://www.drvicki.org/drvicki-store-health-journal.html 

Great article on how to talk to your doctor about embarrassing medical problems - Dr. Vicki Rackner has the same sense of teaching patients how to take charge of their own health and care as I do - of course, she’s much younger and seemingly more energetic so Bravo to her for championing the cause! Check her out.

The realization hit Natalie like a ton of bricks. Her mother, Joann, had literally died of embarrassment! Joann had noticed blood in her stool almost a year before she was diagnosed with colon cancer. At first she told herself it must have been those beets she ate. Then she thought it was most likely her hemorrhoids, although she had not had a flair-up of hemorrhoids since Natalie’s birth 52 years earlier.

The truth was that Joann was embarrassed to talk with her doctor about private topics such as her bowel habits. She didn’t raise the concern with her doctor until she had bloating, cramping and abdominal pain. This led to the diagnosis of colon cancer that ultimately took her life. Natalie’s brother-in-law, who was a nurse, wondered whether Joann would still be alive if she had told her doctor about the blood in her stool when she first noticed it.

Let’s face it; certain topics are embarrassing to talk about with your doctor. I call them the 5 P’s:

• Peeing
• Pooping
• Paying
• Procreating
• Psychic moaning

Although at first blush the challenge of talking with your doctor about embarrassing medical topics seems simple enough, for some people, it can cause significant suffering.

Hillary, for example, had what’s now called a shy bladder. She had not used a public restroom in over 20 years. She was too embarrassed to talk with her doctor about this; instead, she remained a prisoner to her bladder.

Ed was laid off from work and could no longer afford his asthma medications. Instead of talking with his doctor about it, he decided to do without He wound up in the emergency room with an asthma attack that could have been avoided with regular medication.

Tom had some sexual side effects from his blood pressure medicine. Instead of talking with his doctor and getting a different medicine, he just stopped taking it. The doctors wonder if this might have contributed to his heart attack.

Jerry noticed his loss of appetite and sleeping problems as his caregiver responsibilities for his aging father mounted. He wondered if he might be depressed, but dismissed the thought because real men don’t get depressed.

Imagine how each of these stories might have been different if these individuals who suffered in silence could have talked with their doctors.

Here are 6 tips that can help you talk with your doctor about embarrassing medical topics:

1. Own the embarrassment.

Say to your doctor, “This is a taboo topic in our family, so it’s hard for me to ask. Is it normal to have a funny smell coming from your belly button?"

2. Find the words.

Your doctor speaks a specialized language acquired through years of training. Sometimes patients are embarrassed because they don’t know the “right words" or have a hard time describing the problem.

Remember that your job is to communicate. You don’t need to know the fancy words to do that. If a patient said to me, “Dad had an operation on the dingle-ball thing at the back of his throat", I would know just what he meant. And, the patient would seem relieved when I said, “Oh, you mean the uvula."

The best way to make sure you and your doctor understand each other is to use anatomically correct words. Get a basic anatomy atlas. Use anatomically correct words with your children.

3. Practice saying the words.

Sometimes embarrassing words can be hard to get out of your mouth. Gertrude, a 90-year-old patient said to me, “You youngsters don’t understand how much things have changed. When I got breast cancer in the 1962, the words ‘breast’ and ‘cancer’ were not uttered in polite company." Some words are still embarrassing to say. Practice saying these words out loud when you’re alone! That will make it easier to say them at the doctor’s office

4. Find the right person to ask.

You may have an easy rapport with the nurse or physician’s assistant at your doctor’s office. You can bring up the sensitive topic with them. Say, “Trish, could you please give the doctor a heads up. I want to know why I should say no to those steroids my buddies at the gym are offering me. I would love to look like they do."

5. Find the right way to ask.

Maybe it’s easier for you to drop a note or a cartoon to your doctor rather than ask in person. Find the style that works best for you.

6. Remember that your doctor is there to help you, not to judge you.

Your doctor has heard it all before. I promise! Your doctor will not think less of you for asking an embarrassing medical question; in fact, your doctor with think more of you for overcoming your fear and helping you take charge of your health.

Dr. Vicki is a board-certified surgeon who left the operating room to help families take the most direct path from illness to optimal health. Her book, “The Personal Health Journal", can save your life today by helping you understand your health story. Empower yourself with the tips and tools that will help you direct your story and partner with your doctor more effectively at: http://www.drvicki.org/drvicki-store-health-journal.html 

I recorded something on being embarrassed when you go to the doctor…

Listen here:

Terrie

Watch The Video!

Join us Thursday night 8 March 2007!!

5 p.m Pacific, 7 p.m. Central, 8 p.m. Eastern

Just fill out the form

Make the most of your 15 minutes: how to make every second of you doctor’s visit count

So you only have 15 minutes with your doctor. Learn to make the most of every second. Try these techniques and see how much time you save - save for clarification and questions.

If you’ve kept up with your "index card system" you’re one step ahead of the game. You can read from the cards or give them to the doctor - the cards have your list of medical problems and your medications.

Keep the symptom diary and write out the list of symptoms, time of onset and any changes since they began. Practice talking about your symptoms ahead of time. Solicit the help of a spouse or friend to listen to you. Have that person practice looking away from you and looking at you so you experience both methods of exposure and you can get more comfortable talking about embarrassing symptoms to another person.

Remember to just list them with minimal conversational tone. That saves a ton of time.

Bring paper and a pencil so that you can take notes as the doctor asks you questions or says things you’re not sure of. Tell the doctor early on that you may need to interrupt to adequately understand what he’s asking of you or what he’s telling you. If you say this and ask "permission", you’ll get off on the right foot. But keep your notes anyway. While you’re waiting for the doctor, jot things down that you think of as you’re sitting there. After the doctor’s been in there, write down questions. Ask the nurses if you have the opportunity when they come in. Ask the nurses how to approach the doctor with questions if they can’t answer them.

Consider bringing a tape recorder- ask the doctor if you can record the encounter so that you don’t have to worry about misinterpreting what he said. Explain that you want your spouse to know what went on and "what the doctor said". You can even make a joke of it with him because I’m sure he’s heard many times before that the patient has problems remembering enough to satisfy the spouse.

Write, write, write. If you have chronic problems, you should get a stenographer’s pad and label that as your doctor pad. Use it to record your symptoms and take it with you to put your notes in. This way it’s always available for reference and you don’t have to worry about small pieces of paper and worrying about losing them.

Stop worrying about whether you’re saying the right thing or not or whether you’re answering questions correctly. Just say what comes to mind. There is no answer the doctor is looking for - he wants to hear what’s going on with you.

Don’t worry about whether the doctor looks at your or seems friendly. This will distract you from the purposes of your visit - to relay your symptoms accurately and succinctly and to receive information back. That should be your only focus.

Focusing on these two purposes will help you make the most of your time - those precious 15 minutes will seem a lot longer.

Hope this helps!

 Another clip from Medical News Today about the number of pills and Daily Adherence to medication. Although it focuses on certain conditions, the issue is applicable to everyone and every condition. Compliance (adherence to instructions) is such a big factor in health success that we all (doctors and patients alike) must pay attention to what will improve a person’s ability to follow the advice/instructions:

New Study Suggests Number Of Pills Not A Factor When It Comes To Daily Adherence To Medication

There is no correlation between the daily number of pills a patient is prescribed to take and how well a patient will adhere to a dosing regimen, suggests a new study presented recently at the 19th Annual Meeting of the Academy of Managed Care Pharmacy (AMCP) held in San Diego (April 11-14). The large-scale study looked at patients taking a variety of high blood pressure medicines, specifically calcium channel blockers (CCBs), and provides more supportive evidence that adherence to prescribed medication is influenced by a multitude of factors. The study specifically examined dosing regimen to see if there was a relationship between that factor and adherence in patients with a co-payment of at least $20.

More on Do You Take Your Medicines As Prescribed?

If you have Ulcerative Colitis or know someone who has it, read this…. 

This shows that it is a good thing to have those ads on TV that talk about Ulcerative Colitis - just as it is good to have the ads about erectile dysfunction - we need to raise awareness about these conditions for those who know nothing about them - and it helps people know they are not alone and there are treatments out there for them.

Ulcerative Colitis (UC) Sufferers Find UC Quite Disruptive to Many Aspects of Daily Life

UC’s Overall Psychological Toll Is Greater Than for Asthma, Rheumatoid Arthritis and Migraines

WAYNE, Pa., May 17 /PRNewswire/ — Nearly three out of four ulcerative colitis (UC) sufferers (73 percent) responding to a new nationwide survey say not feeling well has become a normal part of life. Furthermore, they describe UC as disruptive when it comes to their relationship with a spouse (64 percent), their sexual relations (75 percent) and their emotional state (82 percent).

UC patients "normalize" aspects of their experience to the point that they resign themselves to these burdens. The majority say that there is not much they can do beyond what they are already doing to feel better (70 percent) and they have learned to live with the disruptions that UC causes (83 percent).

"The findings sound an alarm because a diagnosis of UC shouldn’t mean patients are settling for the level of burden reported in this survey for the next 50 or 60 years. UC is a manageable disease with the appropriate therapy," says David Rubin, M.D., a gastroenterologist and assistant professor of medicine at the University of Chicago Medical Center who helped design the surveys.

UC is a chronic autoimmune disease that causes inflammation in the intestine and can lead to symptoms such as severe abdominal pain and cramping, uncontrollable bloody diarrhea several times a day, fatigue and weight loss. It is typically first diagnosed in people between the ages of 15 to 30 and is estimated to affect nearly 700,000 Americans.

The objective of the surveys was to understand how UC affects patients’ lives, including definitions of what’s normal, the threshold for letting the disease disrupt life, and how patients manage their condition. The surveys, titled "UC: NORMAL (New Observations on Remission Management and Lifestyle)" were sponsored by Shire Pharmaceuticals, a specialty biopharmaceutical company which markets UC medications LIALDA(TM) and PENTASA(R) (mesalamines). Please see Important Safety Information included below.

UC patients generally report more stress/depression compared to other diseases

The findings illustrate that UC takes a heavy psychological toll, which is further brought to light when comparing UC patient responses to the survey responses of people with three other chronic health conditions — migraines, rheumatoid arthritis (RA) and asthma, who were also surveyed as part of UC: NORMAL. Eighty-two percent of UC patients said their condition made life more stressful versus 75 percent of migraine patients, 69 percent of RA patients and 46 percent of asthma patients. Furthermore, 62 percent of UC patients reported feeling sometimes or always depressed about having their condition, versus 49 percent of migraine patients, 52 percent of RA patients and 25 percent of asthma patients.

More than four out of five people (84 percent) with UC say they worry about the long-term health effects of having UC, compared to 45 percent of migraine patients, 72 percent of RA patients and 58 percent of asthma patients. Specific worries most commonly mentioned by UC patients were developing colon cancer, having their colon removed, requiring surgery and public fecal incontinence.

Compliance is a challenge

The survey found that 32 percent of UC patients are not currently taking medication to treat their UC. For patients who are taking medications, compliance is an issue. Of those UC patients taking aminosalicylates (5-ASAs), the first-line therapy and most commonly prescribed class of medication for UC, only about half (54 percent) reported that they have taken all of their 5-ASA medications in the past seven days.

Past studies confirm compliance challenges and report that patients who are noncompliant with their prescribed UC medications have a five-fold greater risk of flare-ups than compliant patients. Traditionally, 5-ASA therapies required two to four times daily dosing and up to 6 to 16 pills a day.

"It’s troubling that almost one-third of UC patients are not taking medication because the standard of care is that all patients with a diagnosis of UC should be on medication to maintain control of the condition and reduce the likelihood of relapse," says Dr. Rubin. "The other challenge we need to address is compliance. More convenient dosing regimens such as once-daily dosage formulations may be part of the solution."

Bridging the physician/patient gap

Patients are also normalizing their experiences with flare-ups, a serious worsening of UC symptoms. UC patients reported an average of eight flare-ups per year. Four out of five (81 percent) of those surveyed say they consider the number of flare-ups they experience to be "normal" for their condition. On the other hand, in a survey of gastroenterologists also done as part of UC: NORMAL, physicians reported that a "typical" number of flare-ups per year on average is three among all patients (2 flare-ups if condition is mild; 4 if condition is moderate; 5 if condition is severe).

UC patients admit that they do not report all of their flare-ups to their physicians, making it difficult for physicians to understand the impact of UC on their patients’ lives. One-third (34 percent) said they are sometimes reluctant to tell their doctor about flare-ups.

"If patients are experiencing multiple flare-ups a year, they should feel empowered to talk to their physicians openly about their disease and ask if their current therapy is appropriate for them," says Dr. Rubin. "As physicians, we need to ask questions to encourage patients to be forthcoming and open with us about the challenges they face and the concerns they have."

As a company committed to educating patients and working with physicians, Shire is developing a program that will launch this fall and is designed to help foster increased discussion between physicians and patients about UC and its management.

Low public awareness

Further confounding the challenges for UC patients, their disease is relatively unknown among the general public. According to UC: NORMAL’s survey of a cross section of the general public, 74 percent of Americans have either never heard of UC or have heard of it but know little about it, even though UC’s prevalence approaches the numbers for HIV/AIDS and Parkinson’s in the United States.

More than two-thirds of UC patients report that having UC is embarrassing to them (70 percent) and that they are reluctant to tell people about their condition (66 percent). With low public awareness and this hesitation to talk openly about their UC, feeling isolated is a risk for UC patients.

"This survey highlights the need to raise awareness and engage the public in a discussion about UC," says Richard Geswell, president, Crohn’s and Colitis Foundation of America (CCFA). "There’s a scarcity of data relating to patient experience and opinions of UC and its treatment, so I hope these findings will help bring this disease to the forefront and assist the ulcerative colitis community in identifying areas to focus our efforts."

"Like many other chronic diseases, there’s no medical cure for ulcerative colitis, but with better management of quality of life issues, improved patient communication and by getting patients on effective therapies, we can help patients live more normal, fulfilling and productive lives," concludes Dr. Rubin. "I hope the survey will spark a national dialogue about UC. I know I’ll use it as a conversation starter in my practice."

The surveys were conducted by Richard Day Research and included a total of 1,975 people: 451 UC patients, 300 gastroenterologists, 309 RA patients, 305 asthma patients, 305 migraine patients and 305 adults from the general U.S. population who may have chronic health conditions. All patient surveys and the general public survey were fielded through an online panel that closely reflects the U.S. adult population overall. Physicians were recruited from a list of all board certified gastroenterologists in the U.S. Assuming no sample bias, the margin of error for the sample of 451 UC patients is +/- 5 percent; assuming no sample bias, the margin of error for a sample of 300 (the other surveys) is +/- 6 percent.

For more information about the survey, visit http://www.ucnormal.com/. For more information on ulcerative colitis, visit http://www.managinguc.com/.