Category: terminology tuesday

Cognitive Load & The Pandemic

Posted on by Grayson

There’s an article that’s been going around about Surge Capacity. It’s worth reading, but it also brought up another term for me: cognitive load.

Cognitive load is the thing where it gets really hard to make decisions when you have too many options, like trying to pick from the menu at The Cheesecake Factory. You might make a decision only to lose it while looking at the menu, or you might just struggle to pick the decision that brings the most joy. If you’re like me, you’ll make a panicked decision and get something you likely didn’t want.

Cognitive load is usually used to talk about information absorption. In one common example, our memory is like an iceberg. The top part, visible to all, is our short-term memory. It can take in a fair amount, but can’t really absorb everything we expect it to throughout the day. The bottom part of the berg is our long term memory. For the most part, things that make it there are easy to remember.

When there isn’t enough room in our short-term memory, not only are we overwhelmed but we lose ideas and information. They slide off that tiny tip of the iceberg, freezing in the sea like Jack when Rose wouldn’t share her damn door.

We can prevent this, though, through receiving information in manageable chunks.

Apply that to our world right now… We have SO MUCH information coming our way, from pop culture to politics to social injustice to the absurdity of navigating video meetings that should’ve been emails…

It’s especially easy to get overwhelmed.

Thankfully, there are ways to address cognitive load. We can make life easier for ourselves that also don’t require opting out of important things like staying abreast of current events or being involved in activism.

1) Recognize and acknowledge that we’re not just working or learning or doing other things from home, but doing so during a time of great unrest. Not only does that mean extra stress from the world’s ick, but that we’re also bringing work or school into our comfy spaces. That’s a lot less space for us to be at rest, from a cognitive standpoint.

2) Try to create a space that’s only (as much as possible) for joy. Maybe only watch entertaining things like Great British Bake-Off on the TV in your bedroom versus watching the news, for example. Even if it’s a corner full of fun spooky season decor, find a way to cultivate joy specifically in your living space.

3) Listen to your brain and your body. If you’re doing school or work from home, you have deadlines and I get it. As much as you can, though, try to listen to what your body and mind are telling you. For example, I take breaks to look at social media or move around every 20-60 minutes. Sometimes I need more breaks, sometimes I need fewer.

4) For the people you live with, provide options when asking questions like “What do you want to do/eat/drink?” It’s a lot easier to pick between two concrete options when you’re frozen from cognitive load than to try to pick one thing out of several possibilities. Ask for the same when you need it.

5) If you’re in a position to give them, provide clear instructions to the people around you whether they’re kids or coworkers or partners. If you get instructions, ask for as much clarity as possible.

6) Break up bigger tasks into smaller ones. Have you ever used an organization tool like Asana? You can add a ton of smaller tasks onto a bigger one. Think like that about all the tasks in your day, from showering to cooking to work. If you haven’t used Asana or something similar, let’s talk showering. It’s not just getting into the shower, right? It’s grabbing a towel, going into the bathroom, starting the shower (and fan), taking your clothes off, maybe picking music to listen to – and that’s just before!

7) Think about the best ways you consume or take in information. Is it via audio, visual, text, or by doing? Or another way? Make sure the people around you know your learning style and try to set up the things you take in to match. If visual is best for you, maybe IG or TikTok would be fun break time things. If audio is more your thing, perhaps listening to a podcast or music would be helpful.

8) Be patient! This is a wild time in the world, and it’s not something that’s easy. Give yourself space and grace – space to grow and feel and be human, and grace when you have a rough day or make a mistake.

We’re human and it happens, especially with so much on our plates.

We are dealing with profound grief & loss, on a level that is unquestionably upsetting. What we’ve all lost during the pandemic alone is hard, but throw in it being an election year, all of Cheeto Voldemort’s BS, and bigots galore… It’s understandable to feel some type of way.

We often feel at odds, too, when we find joy during a tumultuous time. One thing a lot of us struggle with is the plurality of our existence, that we can be both excited for the next episode of the show we love and angry at politicians for not addressing racism. Look, it’s okay for that to be difficult to rationalize! Our brains like black & white, not the rainbow of colors and the nuances that happen in life.

We have to remember humans are complicated and our brains are, too

I know that, sometimes, we need to hear these things from someone other than ourselves, so buckle up…

You have permission to exist as a human right now, to feel all of the complicated and possibly upsetting things this time in history is bringing up.

As a feelings nerd, I encourage you to lean into the feelings. Investigate them down to their roots. Is it ‘just’ stuff right now giving you existential dread, or is this bringing up something from your past, too?

We have to fight the effects of chronic stress in our lives because it can literally be deadly. Chronic stress can add to our risk factors for emergency situations, including heart attacks and strokes – and it can bring on chronic pain.

Find your joy!

Eat all the pumpkin spice things and flip off anyone who gives you grief about it. Learn the WAP dance (but watch yourself on that split because I DID NOT). Take time to create videos on Tiktok (or just watch my guinea pig ones). Binge a show you’ve wanted to watch.

I really enjoy my job! There are definitely issues with public health, but my coworkers are really great

And I’m moving! Ian & I move to a 2br this weekend meaning we have a legit office room

Racism is a Public Health Crisis

Posted on by Grayson

More white people are waking up to how insidious racism is. It’s both great and upsetting at the same time. It should not have taken this long for people to see the issue and want to address it.

In public health, we often talk about the notion of racism and discrimination being a part of society’s culture. Some types of discrimination are especially clear in different types of settings. For example, ageism plays a huge role in pain management. Young people aren’t believed about pain. Older folks are presumed to have little quality of life, and are either over or undertreated.

While racism is not just an issue that affects only Black folx, I am focusing this piece mostly on Black pain due to racism.

When we say ‘racism is a public health crisis,’ what does that mean?

The following is from a Rolling Stone article entitled ‘Racism Kills: Why Many Are Declaring It a Public Health Crisis‘ –

When it comes to discussing racism and public health, words matter. Specifically, [Mary] Gregory says that it’s important to refer to racism as a public health “crisis” instead of an “issue.” Not only is it more accurate, she says that racism also meets the four criteria the CDC requires in order for something to be considered a public health problem. That means that (1) it places a large burden on society that continues to increase, and (2) impacts certain parts of the population more than others. In addition to that, (3) there’s evidence that preventative strategies could help, but (4) this hasn’t happened yet. And while we’re on the subject of words, Gregory wants to remind us that when we talk about “race,” we’re really talking about skin color. “There is one race on this planet — homo sapiens — and to use the word ‘race’ in talking about skin color is our first mistake,” she explains.

I highly suggest reading that article. It’s a fantastic picture of racism as a crisis.

Here in Wisconsin, it might be even worse than in some states. Still, despite Milwaukee being one of the most segregated cities in the US, Wisconsin was the first state to declare racism a public health issue.

Let’s examine just some of the ways that racism can impact someone’s life.

 

Environmental Racism

The Flint water crisis is still happening. They still do not have clean water, and it’s been SIX YEARS. The government continues to fail to address this issue in a way they wouldn’t be able to if Flint was full of white middle-class people. The only way they’re getting away with this is because the population is primarily BIPOC (Black, Indigenous, & People of Color) folx living in poverty.

 

Medical Racism

Black folx are around four times more likely to die of pregnancy complications than white folx.

Black people, on average, have a lower life expectancy than whites. In addition to outright physical violence, part of why this occurs is the chronic stress of being Black. As we well know, stress can cause and worsen chronic conditions. Combine this with a lack of access to medical care – or not trusting the medical system because it routinely engages in racism – and it’s a recipe for disaster.

Currently? We know that BIPOC are one of the groups dealing with the most impact from Covid.

 

Police

I recently covered the 2015 murder-by-cop of Madison-local Tony Robinson for my podcasts. You can listen here.

Police continue to murder Black folx at higher rates. The police ‘issue’ isn’t something we ignore, either, as half of all people murdered by cops are disabled.

A lot of people think that means the policing system needs reform. In reality, white people created policing exactly this way. The notion of police in America came out of that of the slave catchers. That’s right – the police developed from a system literally only designed to protect the property, livelihood, and well-being of white people. It likely goes without saying that, as time went on, this also meant the police attacked and oppressed anyone they saw as a threat to that – disabled, trans, queer, BIPOC, etc.

 

Institutional Racism

Each of these types of racism is a part of institutional racism. It’s much worse than most white folx realize.

Moving into the Civil Rights era, white people took special care to ramp up attacks on Black folx. Lawmakers drafted and passed laws around public housing, financial assistance, and many other areas. They did this to specifically target Black communities. These included laws against those convicted of felonies and drug charges living in public housing or lowering their job prospects. This combined with police increasing patrols and arrests in Black communities began to lead to the higher incarceration rates for Black folx – particularly Black men. That later transferred to affect all genders while simultaneously forcing those who are transgender or gender non-conforming into incorrectly gendered facilities where they face additional harm from guards and fellow inmates.

Combine all of that with the increase in social workers stealing children to put them in foster care under false pretenses, the school-to-prison pipeline, and rapid underfunding of any organization that might actually be able to help? It’s a recipe for disaster.

Black people are then gaslit and told that these systemic forms of oppression are their fault. While nothing could be further from the truth, the impact of those lies cannot be understated.

 

Epigenetics

Now, imagine this going on for any of our families for half a millennium. Consider what it would mean if we couldn’t even trace our ancestry back that far because no one had cared to collect our family stories. There’s a lot of trauma that can affect people in many ways.

Epigenetics is the study of how our DNA changes how it expresses itself in response to things like diet, exercise, and stress. Toxic stress can cause long-term problems including post-traumatic stress, changes in brain physiology, and more. These changes pass down through generations. The stress of going through abuse can be passed down to the abused person’s children, etc. This applies to historical trauma, such as slavery, too.

Epigenetics is such a new field of study that we have no knowledge yet around how to help heal those wounds. There is a specific type of post-traumatic stress called Post-Traumatic Slave Syndrome. Things like therapy can be helpful for our own experiences, but can they touch on historic pain? Not really.

 

What do we do now?

If you’re white – and, from my readership stats, I know you probably are – it’s time to start learning. Here are a few resources:

What is Public Health?

Posted on by Grayson

With the current pandemic, we’ve seen a lot about Public Health departments or professionals. From local news to national briefings, these individuals often share warnings and other information. But, what is Public Health?

Well, it’s a little complicated to explain.

Definitions of Public Health

The short version? Public health is the study of preventing disease and improving life for the general public.

One of the leaders in public health, Charles-Edward A. Winslow, described it as:

The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individuals in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health. (Schneider, Mary-Jane, 2006. Introduction to Public Health. pg 5)

This is a pretty confusing definition in my opinion. But, it also encompasses much of what those in this field do. Part of why it’s difficult to nail down is that this field is huge. It includes epidemiologists (those who study determinants of health and diseases), public policy personnel, and reproductive/sexual health educators. We often see medical professionals involved, too, such as nurses, doctors, and therapists.

The world of medicine is often focused on how to diagnose and treat conditions. In contrast, public health is focused on what makes people more susceptible, countering anti-vaccination misinformation, educating the public, and tracing infections. It takes an interdisciplinary team to handle the issues we find. That’s especially true in a pandemic! This includes the distribution of tests, recommendations for how to keep us safe, and tracing who infected individuals may have had contact with.

What does this look like in action?

One great illustration of what this field looks like is the Centers for Disease Control and Prevention, AKA the CDC. The main goal of the CDC is to protect the general public. They do this with a staff full of those who study diseases and outbreaks, health promotion, preventing injuries, and tracking chronic disease statistics. The CDC also talks a lot about emergency preparedness, something integral to the public’s wellbeing.

Another great example is your state’s Department of Health Services. Public health measures often live here and maybe their own department or division under the DHS umbrella. DHS may cover the following aspects of public health:

  • Certifications for caregivers
  • Alcohol licenses
  • Healthcare coverage information (particularly Medicaid & Medicare)
  • Long-term care information
  • Mental health resources
  • Climate change
  • Specific health challenges for marginalized communities (e.g., Black and Brown folx, migrants, refugees, LGBTQ+)
  • Nutrition and food assistance
  • Vaccination rates
  • Demographic and population information
  • Chronic disease statistics, interventions, and prevention

They also work on grants from places like the CDC to see how to make positive changes in communities, especially around chronic diseases.

Local universities will also often be involved in these efforts, especially in areas with world-renowned higher education facilities. Departments there involved might include the medical school, school of nursing, epidemiology, oncology, population health, and more.

Cool, right?

I’m a nerd, so, of course, I think it’s cool. I also just started officially working in public health!

I get to help improve communications for the chronic disease prevention team. They work a lot on efforts related to stroke, heart disease, type 2 diabetes, and oral health. I’m really excited!

So, do you have questions about Public Health?

Terminology Tuesday: HAIs

Posted on by Grayson

An HAI is a pretty common occurrence sadly, and they can be horrific and deadly.

Healthcare Associated Infections can occur whether we simply visit our primary care physician, have an injection, or have a major surgery. According to the Office of Disease Prevention & Health Promotion, the majority of HAIs are UTIs, surgery-related, bloodstream-related, or pneumonia. The CDC notes that C. diff is pretty damn common as well.

I’ll add that it feels like death from the inside out and has lasting effects.

At least, I finally got my first grown-up IV out of the way

These infections cost people their time, health, and even sometimes their lives. However, most of these are extremely preventable if health care workers follow workflows, execute proper sterilization and cleaning, WASH THEIR HANDS properly, and stop overprescribing antibiotics.

There are things that we can do as patients, as well, to keep ourselves safe:

Thanks, CDC!

These infections have affected people I love in so many ways, but currently, I have a close friend whose family is dealing with the repercussions of an HAI. Randy is an amazing man who wound up with a staph infection as a result of a run-of-the-mill steroid injection. He’s been in and out of the hospital and other facilities since April of 2014.

This is one of the most amazing and sweetest families I know. For this to happen to them is incredibly hard to watch. There’s a GoFundMe for those of you who can help here.

Sources:

 http://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections

 http://www.cdc.gov/hai/

 http://health.gov/hcq/prevent-hai.asp


Terminology Tuesday: Zone of Openness

Posted on by Grayson

 

A ‘zone of openness’ is one of the main tenets of patient advocacy & engagement… so why does it sound so foreign to so many of us?

The term itself is fairly new in practice, though the theory has been around since the days of Seinfeld. An article about the PCORI project associated with this term explains the main issue:

In a 1996 episode of the television show Seinfeld, Elaine objects to putting on a paper gown because the rash that brought her to the doctor’s office is already visible on her arm. After she challenges the label of “difficult” that she sees in her chart, the physician refuses to take her rash seriously. A doctor Elaine subsequently visits sees the notation in her chart and also disregards her problem.

Although this scenario was played up for laughs on TV, real-life patients do worry about being perceived as difficult, researchers at the Palo Alto Medical Foundation Research Institute (PAMFRI) learned in a recent study. Patients believe such a label can lead to lower quality care. “We refer to ‘Elaine’ when we discuss this fear,” says Dominick Frosch, PhD, formerly of PAMFRI and now at the Gordon and Betty Moore Foundation.

The zone of opennes, then, is the creation of a space where an ‘Elaine’ cannot happen, where patients’ concerns and issues are fully heard and understood by their physicians, and where physicians act on that information instead of creating negative personality-judgment comments that really have no place being in the chart anyway.

Sources:

http://www.pcori.org/research-in-action/creating-%E2%80%9Czone-openness%E2%80%9D-doctor%E2%80%99s-office

Terminology Tuesday: ankylosing spondylitis

Posted on by Grayson
Ankylosing spondylitis is sure a mouthful!
If we break down the name, though, we can learn a lot about the disease before we even get into specifics.
Ankylosis – meaning stiffness or immobility of a joint
Spondylitis – meaning inflammation of the vertebrae
AS is a type of autoimmune arthritis that affects the spine primarily. It affects men more than women and can, over time, fuse the vertebrae in your back. Most specifically, the SI joints can become affected.
Other areas of the body that can be affected are the eyes, shoulders, and hands and feet.
AS is one of the autoimmune arthritis types that actually has a genetic marker – HLA-B27. If you have this marker, it doesn’t mean you’ll have AS – and you can even have AS without it – so it may not be of much help. In addition to blood tests, a person will undergo imaging tests to check out the areas most affected.
Medications for AS are pretty much those you’ve come to expect from autoimmune arthritis/rheumatic diseases – NSAIDs, methotrexate, TNF inhibitors like Enbrel, etc. Physical therapy and surgery can help as well.
Moving and stretching is incredibly important with AS.
Sources:
 
http://www.merriam-webster.com/dictionary/ankylosis
 
http://www.merriam-webster.com/dictionary/spondylitis
 
http://www.eorthopod.com/images/ContentImages/spine/spine_lumbar/lumbar_spine_SI_joint/SI_joint_anatomy01.jpg
 
https://www.spondylitis.org/Learn-About-Spondyloarthritis/Ankylosing-Spondylitis
 
http://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/definition/con-20019766
 
https://www.spondylitis.org/Portals/0/pdfs/learn-about-spondyloarthritis/spondyloarthritis-overview-qa-dr-walsh.pdf
 
https://www.nlm.nih.gov/medlineplus/ankylosingspondylitis.html

Terminology Tuesday: CAPS

Posted on by Grayson

CAPS stands for Cryopyrin-Associated Autoinflammatory Syndrome, but in reality, this ‘syndrome’ is actually three different syndromes:

  1. Neonatal Onset Multisystem Inflammatory Disease (NOMID)This is the rarest and most severe type of CAPS, causing infection-like symptoms like rashes and fevers in newborns where no infection is present. The disease can cause blindness, stunted growth, and chronic joint pain later in life.
  2. Muckle-Wells SyndromeSymptoms of this syndrome include fever, rash, joint pain, headaches, red eyes, and GI upset/nausea. Hearing can even be affected.
  3. Familial Cold Autoinflammatory SyndromeExposure to cold temperatures causes a rash similar to hives with this syndrome, bringing fevers, GI upset/nausea, and joint pain as well.
These conditions are genetic and are caused by a mutation in the protein cryopyrin. Diagnosis can be made via genetic testing (which isn’t always accurate), and other sometimes invasive tests like lumbar punctures.
Kineret, Ilaris, and Arcalyst, all focusing on interleukins, help to treat this series of syndromes the best.
As with other genetic issues in the periodic fever family, kidney disease can be common, especially for un- or undertreated patients.
Sources:
 
http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Cryopyrin-Associated-Autoinflammatory-Syndrome-CAPS-Juvenile
 
http://www.capscommunity.com/caps_fact_caps_md.html
 
http://www.arthritis.org/about-arthritis/types/cryopyrin-associated-periodic-syndromes-caps/
 
http://www.nyas.org/image.axd?id=7a2e9daf-d10b-42ba-ad26-e8de00a41a28&t=633807535794630000

Terminology Tuesday: CRPS

Posted on by Grayson

CRPS stands for Complex Regional Pain Syndrome. This syndrome can be caused by trauma or injury to a part of the body, resulting in nerve and other chronic pain. It’s an interesting syndrome in that there are people without a documented injury to the affected part of the body that are diagnosed. CRPS can affect the immune system, blood vessels and flow, and other parts of the nervous system.

Other symptoms include allodynia, changes to the skin surrounding the affected area, stiffness, and tremors.

Since some of these symptoms mirror rheumatic diseases, there is a lot of exclusionary testing with this diagnosis.

Treatment varies significantly from case to case. Steroids and NSAIDs can help, or nerve medications like Lyrica may need to be used. There are more severe methods of treating this disease as well including surgery, nerve blocks, and more.

Sources:

http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm

Terminology Tuesday: TRAPS

Posted on by Grayson

TRAPS stands for Tumor-necrosis-factor Receptor-Associated Periodic Fever Syndrome. It is in the Periodic Fever Syndrome family, which is also where Systemic JIA has been placed lately.

The syndrome is an inherited one due to a malfunction to the TNF protein.

Since the symptoms of TRAPS generally fall within the rheumatology realm, a rheumatologist is generally who primarily treats the syndrome. Symptoms can include muscle and joint pain, fevers, rashes, uveitis, stomach upset and GI issues, and more. It can take a long time to get a diagnosis with TRAPS, sometimes up to and over ten years.

Medications like Enbrel and Humira can be effective, but Kineret and other interleukin-based medications have been seen to be more effective lately.

If you or someone you know has TRAPS, making sure to get the proper treatment is key as it can easily affect your kidneys and cause chronic kidney disease.

Sources: 

https://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/periodic-fever-syndrome

https://www.rareconnect.org/en/community/traps-syndrome/article/traps-infographic

http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Tumor-Necrosis-Factor-Receptor-Associated-Periodic-Syndrome-Juvenile

https://www.pinterest.com/aalliancesaid/traps-tnf-receptor-associated-periodic-syndrome/

http://ghr.nlm.nih.gov/condition/tumor-necrosis-factor-receptor-associated-periodic-syndrome

Terminology Tuesday: ICD

Posted on by Grayson

You may hear from your physicians or see on your chart a very odd number series next to your diagnosis.

For example, in August I altered the original picture here to add 714.30 which is the ICD code for systemic juvenile idiopathic arthritis.

ICD stands for the International Classification of Diseases.

Essentially what ICD does is make it easier to communicate diagnoses across healthcare systems and between healthcare professionals.

The newest version is ICD-10, which some places are just finally implementing, is slightly different in that it is more specific for some illnesses and injuries like an ear infection. Physicians now have to list a lot more information including which ear, if it’s chronic, etc.

And, with that, some codes have been updated. Above you have 714.30 for SJIA. M08.20 is the new code, however, and it is much more specific to SJIA/Still’s. The old 714.30 was very vague, which M08.20 is only SJIA/Still’s patients.

So, if you see new weird codes on your billing statements, it’s likely because the CDC forced everyone to finally adopt ICD-10 in October 2015.