Monday, May 2, 2011

Health Literacy: Does It Matter?

Can you read this sentence?  If so, thank your teachers (and our men & women who defend our right to be educated).  But can you actually understand all the drivel that I've been composing the last several months?

I often find myself walking a tightrope trying to decide to whom I am addressing my post, eg my colleagues or my patients (no insult intended - please just realize that there's a lot of specialized terminology in medicine as in most other professions & even hobbies).  In fact, back in January, during our Nevada Academy of Family Physician's Annual Winter Conference, we even had a presentation/lecture on health literacy.

As you know, I've recently taken to answering questions posed on two different websites (I'm sure there're many more).  I've always prided myself on being able to explain medical issues to patients without being condescending, so much so that many patients (and colleagues) have remarked on my use of analogies to communicate and make difficult concepts easier to understand.

So of course I was quite taken aback when the very educated person who posted a question responded, very nicely, that his healthcare background helped him understand the information I gave in my original answer.  This was the second admonishment that I'd received (the first from a 16 year old).  What this means is that my attempt to convey information to a broad range of readers probably failed.  Worse, I'm not sure how much is getting through to the right people.

The reason this is important is that if you can't understand what I'm telling you, how will you understand/remember what to do?  Upon what will you base your decisions?  In a study published last week in JAMA, the authors followed 2,156 patients w/heart failure for over a year and noted that low health literacy was associated with double the all-cause mortality compared to those w/high health literacy (probably in no small part due to the very tricky & complicated pharmaceutical regimen required to medically manage this chronic condition).

It's no surprise that the USA Today is written for a 10 grader (although I've heard reports that lately, its reading difficulty has been lowered down to a 5th grade level).  Most of us can keep our noses clean and avoid having to worry about legal matters (although I doubt too many of you, myself included, really take the time to read the small print & disclaimers, much less understand them).  Various computerized tax applications have simplified the US Tax Code enough for us to complete our own yearly income tax forms (while only a few of us need the skills of an accountant to understand the written intricacies of the IRS).

Unfortunately, health literacy requires a greater reading skill for all of us as very few people can avoid a sporadic visit with their physician, whether for themselves or a loved one.  So if you don't understand what your doctor just said, raise your hand and ask him/her to repeat it in a different way so that you can understand and improve your health.

Sunday, May 1, 2011

Q&A Session at Avvo.com

Who can I go to next about jaw pain?

Q&A Session at Avvo.com

I am unable to urinate when I need to for a medical test.

Q&A Session at Avvo.com

Recently I've had stabbing shotting pains above my right eye and nausea. What is this?

Q&A Session at Avvo.com

Stressed out and drinking to cope with my issues.

Q&A Session at Avvo.com

Getting skinnier, everything is fine, is it stress? what helps?

Q&A Session at Avvo.com

how can I know if my father has dementia or if it is just old age??

Q&A Session at Avvo.com

is my tb test positive or negative? does scratching it mess with the results

Q&A Session at Avvo.com

I am a 63yo male. I have urinary incontinence. Not real serious,but annoying and embarrassing.

Q&A Session at Avvo.com

Hi I have had a cold and urinary discomfort,pain,increased frequency,sensation of urgency.

Q&A Session at Avvo.com

Why does it feel different when I urinate?

Q&A Session at Avvo.com

WHEN DO I TAKE SYNTHROID?

Q&A Session at Avvo.com

I have hypothyroid, I would like to know if it is safe to detox?

Friday, April 29, 2011

Testosterone's Effect in Women

We've known for known for a while that testosterone (T) increases bone mineral density (BMD) & lean body mass (LBM) while decreasing total body fat in men.  But what about in women?

In a study published in this month's Journal of Clinical Endocrinology & Metabolism, the authors evaluated 232 healthy community-dwelling women between the ages of 67-94 who had enrolled in the Cardiovascular Health Study and noted that total T was associated with lumbar spine & hip BMD and that free T was associated with hip BMD, LBM, and total fat mass.

But let's not forget that association is not the same as causation.  This study allows us to develop the hypothesis that increasing T levels in women might serve to increase BMD & LBM while decreasing body fat.  The bigger issues will be deciding in whom to supplement and for what duration.

Clearly, we understand (some of) the risks associated w/supplementation in men but they might not apply to women (at least we won't have to worry about prostate cancer in the ladies!).  Let's hope Proctor & Gamble gets more information based upon their world-wide sales of Intrinsa before they come back to the FDA to try again for approval (for indications unrelated to above).

Thursday, April 28, 2011

Progesterone vs Progestins

You say either and I say either
You say neither and I say neither
Either, either, Neither, neither
Let's call the whole thing off.
You like potato and I like potahto
You like tomato and I like tomahto
Potato, potahto, Tomato, tomahto
Let's call the whole thing off.

- Let's Call The Whole Thing Off
by Louis Armstrong

The above comes off better when you get a chance to listen to him sing the lyrics but I think you get the idea.  Sometimes it doesn't matter, but other times it does.

For instance, bio-identical hormones.  Progesterone is what our bodies produce (out of the class of steroid hormones known as progestogens).  In a very small study published in this month's Journal of Clinical Endocrinology & Metabolism, the authors demonstrated that oral progesterone given nightly can help restore normal sleep pattern (whereas currently marketed sedative-hypnotics tend to inhibit deep sleep).  In fact, they noted that progesterone actually improved growth hormone release.

On the other hand, in a case-cohort study just published in the British Medical Journal, the authors noted a doubling of the risk for non-fatal venous thromboembolism in those women who took oral contraceptives containing drosperinone compared to those who received contraception containing levonorgestrel.  Granted both drospirenone & levonorgestrel are non-bio-identical progestins, but it would appear that the latter is significantly safer than the former.

Given that women have a large number of (oral) contraceptives from which to choose, we might want to consider safety & side effect profile in addition to efficacy.  However, before abruptly stopping one's oral contraceptive (since pregnancy & delivery are fraught w/health risks), one needs to review one's options w/one's prescribing physician, be it your family physician or obstetrician.

So while potato & potahto and tomato & tomahto may refer to the same things, remember that progesterone and progestins don't.

One last item:  in another study also published in this month's JCEM, the authors found no increase risk of  heart disease regardless of the type of progestin used in contraception and regardless of the route of administration of said progestin.  I'll take good news any way I can.

Wednesday, April 27, 2011

Energy Drinks + Alcohol = Combination Best Avoided

Remember that recent commentary published in JAMA discussing the phenomena of "wide-awake drunkeness"?  In a study just released online, some authors randomized 56 participants to either alcohol alone, energy drink alone, combination of alcohol plus energy drink, or placebo.  Baseline objective performance as well as subjective self-assessment was performed prior to imbibing and then repeated after quaffing their drinks.  As expected, those who consumed alcohol demonstrated worsening of performance.

However, those who consumed the combination of energy drink mixed with their alcohol increased their self-reported sense of awakeness but did nothing to improve their objective performance. Thus, the authors felt that the combination was even riskier than consumption of alcohol alone in that the caffeine & sugar fought off the sedating effects of the alcohol without improving performance.