Measuring my Growth

Hello everyone! I’m so so SOOO terribly sorry that I’ve been absent from my blog for such a long stretch of time. I just recently started back to work in a new career (woohoo!) but that transition was tough. So I really had to take some time for myself to focus on my career and my future. Delving into a new job is always tiresome, as I’m sure everyone can relate to, and I really needed to focus my efforts in that direction. So I apologize to you all for being MIA!

But starting down this new path was such a relief. Having been so focused on treatment and healing and cancer this and cancer that…I relished the fact that I could take this other path and stray from the one that had been under my feet for so long. It’s nice to pretend to be normal, you know? I get up, go to work, have lots of things to keep me busy during the day and try to avoid thinking about the past.

Like all of this was a bad dream and that I never had cancer. “Mela-what? Not here!! No siree, absolutely no mela-whats-its in THIS neck of the woods!”

But the truth is that cancer has changed my life. No matter how hard I try to pretend like I’m the same ol’ me, I’m a completely different person. I’ve become much more introspective. I care more about people, and I care more than ever before about my patients, family, and friends. I know that every second I’m on this earth is a second to be cherished.

So mentally, I’m very different. But what about physically? Yes, I still have the scars, although I swear they’ve faded dramatically since I’ve been putting a special essential oil mix on them every day. And my leg still has lymphedema so I’m wearing a compression stocking daily. I’m flying a lot for work, and on travel days I wear 2 stockings…not super pleasant, but it sure is better than letting my leg swell up.

And I also have been VERY excited to notice something else that’s been changing.

 

Slowly, every so slooooooowly, my hair has been growing back in!

Look at all that new growth!

 

 

Can I get a HECK YEAH!!

I noticed all these little fuzzies (yes, I call them my fuzzies) when I was blow drying my hair a few weeks ago. I couldn’t get them to sit down – it looked like I had put my finger in an electrical socket. (I think the static electricity of the winter months made it worse, but even today they’re straight up!) And look at all those little baby fuzzies!! It looks like I have a whole new head of hair growing in!

All my new fuzzy buddies

Aren’t they the cutest??

So for all of you out there going through treatment – it gets better. What you’re going through is incredibly hard. I know some days I didn’t make it off the couch. When I had the energy to take a shower, my hair came out like I was molting. I lost so much weight that my husband got super worried and actually talked to the nurse about it.

But after treatment, it gets better. Just hang in there. Your body is an amazing thing. And you WILL heal. You may not ever be the same, but you will heal.

And that which does not kill us can only make us stronger.

Weight Bias in Healthcare

Healthcare is an amazing field. Every day is unique, filled with different people and exciting things. Some days are interesting and filled with stories to be told later over the dinner table. Others are sad, filled with tears that you hold inside until you reach your car, and then can’t help but let them roll down your face and weep. There are days where your heart goes out to your patients as though they were your own family. And others where you’re practically running out the door to get away from the craziness.

People in healthcare have these highs and lows daily, weekly, yearly. As we have more experiences, we gain the ability and intuition to read a situation quickly. We become immune to the mundane and weird and wacky things become the norm. We develop the ability to quickly judge a patient based on our experiences and, in some cases, we develop a biased approach. Some say with only 15-20 minutes per patient, we’re almost forced to pre-judge people in order to save time.

WAIT, what?! This is a HUGE problem! Healthcare providers should NEVER forget that people are people, and everyone is unique. We cannot let ourselves develop biased attitudes towards ANY group of people. Doesn’t everyone deserve quality care?

Well, according to research, overweight and obese patients bear the brunt of this bias. A recent article out from the New York Times suggests that doctors blame many health conditions on excess weight, even when weight is not the culprit of the problems. The article even gives examples where doctors did not investigate other causes for serious symptoms (such as sudden shortness of breath) due to the patient’s weight.

Graph showing world obesity rates by country.
World wide obesity rates by country.

The article goes on to explain that many specialized bariatric hospitals don’t have the necessary equipment to fully care for obese patients. Surgeons can refuse to do surgery on obese patients due to safety concerns and higher risk to the patient. Many hospitals and surgeons are reluctant to perform surgeries due to quality markers needed for reimbursement from state and federal agencies such as Medicare and Medicaid. Higher risk patients lead to more complications and lower quality scores, leading many hospitals to turn people away. But how can this be justified?? Again, doesn’t everyone deserve quality care?

Another article by Anesthesia LLC  shows that anesthesiologists are not immune to this same bias. In a survey by Medscape, 62% of emergency medicine physicians and 44% of anesthesiologists reported having biases towards certain groups of patients. These are physicians who are WILLING to admit they have biases! Think about how many more physicians who actually HAVE biases who aren’t willing to admit it!!

According to these articles, obese patients are less likely to trust their doctors due to fear of bias. They feel as though they are not being “fat-shamed” and treated unfairly, and studies show doctors are 35% less likely to treat obese patients with empathy and concern. How are you supposed to trust someone who doesn’t treat you like they actually care about your wellbeing?

Courtesy of DrLinda-MD.com
Courtesy of DrLinda-MD.com

Many doctors understand that obesity increases a person’s risk for other health concerns and increases the cost of healthcare. If this is your argument for a bias against obese patients, then you have it all wrong. You should be biased TOWARDS helping those who are overweight regain their health. Shouldn’t we, as providers, do MORE to help people regain their health and wellbeing? Let’s start by seeing the person inside the body. Let’s start by listening.

Let’s start by caring!!

Please…for your own wellbeing…find a provider who cares! There are lots of duds out there (I’ve definitely had a few of my own!) but there are also thousands of doctors who truly care about you and your health. If you don’t like your doctor, if you can’t tell them all your health concerns or feel as though your concerns are being brushed aside, please…keep looking. Find a provider you are comfortable with who treats you like family. Find a provider who listens. You are putting your health and your life into someone else’s hands…make sure you can trust them before you do so.

The Fifth and Final Step to a Great Office Visit!

Remember in elementary school when all the teachers insisted that you use the buddy system? Crossing the street, you had to grab a buddy, hold hands, and look both ways. Going on a field trip? Grab a buddy. Going to the bus stop? Grab a buddy.

Going to the doctor’s office? Grab a buddy!

It doesn’t matter how old or how smart you are, there are certain things about going to the doctor’s office that can be too much for us to handle. Whenever there is something important to be discussed at a doctor’s visit, bring a buddy.

Courtesy of http://www.pmslweb.com/
Courtesy of http://www.pmslweb.com/

Why is this, you ask?

1 – They can advocate for you

Many of us get overwhelmed at the doctor’s office. No matter how much you control your stress and prepare, it is very easy to get caught up in the fear of the moment and freeze. A buddy can speak for you when the cat’s got your tongue.

If you know that this happens to you, let your buddy know ahead of time the questions you want to ask. (I always suggest you write them down!) Having a buddy helps to make sure ALL of your questions are answered to their full extent.

Having a buddy also helps to make sure all your important symptoms are communicated to the team. There were many times that my husband would chime in about different symptoms of mine that I forgot to mention or didn’t even notice!

For example, when I was on Interferon, my brain fog was intense. To me, it was annoying, but I thought I was getting by pretty well. I didn’t know how bad it was until my husband made it clear to the doctor that he was frightened by how poorly I was functioning mentally and he was INCREDIBLY glad we were changing treatments!

Wow!! I had no idea – my dear husband wasn’t about to tell me I was a blubbering idiot for the past 3 months, but he was very willing to tell the doctor it was a problem that needed to be fixed. He was trying to help me get through that period of time by not telling me.

Moral of the story? Your buddy = instant advocate

Me and my favorite buddy at the Miles for Melanoma event in Boston

2 – They give you a second set of eyes and ears

Have you ever gotten directions from someone and as you start to drive, you forget what they just said? “Was it a right at the light and a left at the stop sign? Or a left at the light and a right at the stop sign?” If two people listened to those same directions, you’re twice as likely to remember them.

(This doesn’t apply now with smart phones and GPS, but I know you folks who feel me on this one are out there!!)

Or maybe you’re driving and start thinking about work or the kids, and next thing you know, your passengers yell “There’s the exit!” and you have to swerve to make it at the last second?

We can’t see or hear everything all the time. Having a buddy helps to make sure that all the important information from a visit gets noted. This helps to make sure that every important detail, every treatment option, every little fact and statistic gets remembered. As the saying goes, two heads are better than one!

When a consult only lasts 15 minutes, there’s a LOT of information coming at you. If you can’t take notes, much of this information will go in one ear and out the other – it’s just entirely too much for you to soak in. Follow-ups, future testing, etc can be easily forgotten with such a large load of info. Having a buddy also helps you stay on schedule with your busy calendar of appointments.

3 – They support you

Last, but most definitely not least, a buddy is a support system. They can hold your hand and keep you calm during your visit. They can crack jokes with you in the waiting room to keep your mind off of things. They can give you a hug or a high five after good news. Or give you a shoulder to cry on after bad news.

And a buddy doesn’t have to be a spouse or a partner. Many people bring friends, relatives, kids, whoever you love and know you can trust. I try and go to as many family-related doctor’s visits and appointments as possible, because my family trusts me to advocate for them and interpret medical jargon. And I bring my husband to all my oncology appointments because he can make me laugh with just a funny look. Less stress for me always means a better visit.

No matter how big or small the visit may seem, always follow your teacher’s advice and bring a buddy. They can keep your stress level down, be your advocate, and help you remember information and future appointments. Help yourself by allowing others to help you through your doctor’s visits. This will help you have a better doctor’s visit and lead a happy, healthy life!

Comments? Questions? Concerns? I’d love to hear them! Email me at Lauren@WithinMySkin.com

How a specialized surgeon may save your life

I am fascinated with this article that just came out from the Wall Street Journal. Absolutely fascinated. There are so few studies out about operating room life, and this is MY life. It’s my home away from home.

But the OR tends to be like Vegas…what happens there, stays there. No patient is told that their surgeon threw a temper tantrum in the middle of their surgery and threw an instrument at the wall. No patient is told that their surgeon sucks and has a higher than average infection rate.

Don’t get me wrong. There are tons and tons of amazing surgeons out there. But just like any occupation, there is a bell curve of excellence. Many are average, some are phenomenal, and others…not so much.

This is why I URGE you to ask questions. How else are you going to know what side of the bell curve you’re getting? A little homework can go a looooooong way, and according to this Wall Street Journal article, it may even save your life.

The article was published in the July issue of the British Journal of Medicine. (Nothing to sneeze at there.) It reviewed 695,000 surgeries by 25,000 surgeons. This is a huge sample size, but narrowed in scope by the type of surgery – they only reviewed eight different types of complex cancer and heart surgeries.

It’s unfortunate that they narrowed their study to only eight surgeries. But IMHO, your surgeon’s skill matters no matter WHAT type of surgery you are about to have. A surgeon’s skill (or lack thereof) can help (or seriously harm) a patient in ANY type of surgery.

From the article: Dr. Wayne Moschetti, left, and his team, including resident Matt Sabatino, right, perform a total hip replacement in the operating room at Dartmouth-Hitchcock in New Hampshire. A new study has found that doctors who specialize in a single procedure may provide the best odds for a successful operation. PHOTO: DARTMOUTH-HITCHCOCK/MARK WASHBURN
From the article: Dr. Wayne Moschetti, left, and his team, including resident Matt Sabatino, right, perform a total hip replacement in the operating room at Dartmouth-Hitchcock in New Hampshire. A new study has found that doctors who specialize in a single procedure may provide the best odds for a successful operation. PHOTO: DARTMOUTH-HITCHCOCK/MARK WASHBURN

The article goes on to specify that patients of highly specialized, busy surgeons fared better after surgery. For six out of the eight surgeries studied, “patients were less likely to die in the first month after surgery when the operation they underwent accounted for a larger share of surgeons’ overall practices.” So more surgeries of a specific kind make for better results. This is true across the board for all surgeons, really, from what I’ve seen in practice. You never want to have a part-time surgeon or be the guinea pig.

Speaking of guinea pigs…I’d like to fill you in on a true story of what happened to me at the start of my cancer battle. I was in Florida and being treated at a teaching hospital. I had undergone a SLNB and was informed that a CLND was necessary, and my surgical oncologist suggested I undergo a lymphaticoveinular bypass at the same time.

I was referred to a plastic surgeon, who explained that a lymphaticoveinular bypass would decrease my chances of lymphedema.

My ears perked.

He went on to explain that he’s done this many times and he has good results with breast cancer patients.

I was intrigued.

So I then asked what his results were like for a groin bypass (since mine would be in the groin). He paused and said something along the lines of “well I’m not sure.”

So I asked how many of these bypasses he’s done on the groin.

His reply? None. I would be the first one.

THE FIRST ONE?!?!? My jaw dropped. He had never even DONE this surgery before, but here he was touting his good results!!! I couldn’t believe it. He was SELLING this procedure to me. He wanted me to be his guinea pig!!

If I hadn’t asked these specific questions, I would NEVER have known these important details.

Moral of the story? First, lots of practice makes perfect. And second, ask questions to see how much practice your surgeon has had!

Question EVERYTHING! Part #4 of “Getting more out of your doctor’s visit”

The absolute BEST way to make sure you get the most out of your visit with the doctor is to ask questions. LOTS and LOTS of questions.

I always try and view my doctor as a teacher of medicine. A teacher WANTS you to know and understand your health. The main objective of your doctor is to diagnose your problems and explain how you can get better.

Unlike teachers, however, doctors are taught more about medicine and less about how to instruct and assist theif patients. Everyone learns differently…teachers learn how to instruct with different methods and speeds so that everyone in the classroom can learn. Doctors are not taught these methods, nor can they possibly fit every piece of information into a 15 minute consultation.

This leads to a spiral of rushed visits where you don’t get to the “meat” of what you need to know. You’re left feeling lost and brushed aside. If your doctor brushes it aside, it must not be THAT important…right?

Wrong.

This is YOUR body. YOUR health. YOUR future. The only one who can fight for your future health is YOU! Don’t stick your head in the sand and ignore it just because you don’t understand it. Make your healthcare provider do their job and TEACH you! That’s what you pay them for! Hold them accountable so that you can understand your diagnosis and become a healthier you. Always.

photo-sep-19-2-34-23-pm

Don’t know what to ask? Here’s a list of questions for you.

What is my diagnosis?
What is my prognosis?
What has lead to this problem/disease?
What is the treatment?
What side effects does the treatment have? What should I look for in terms of serious side effects?
How long is the treatment? How long do side effects last?
Is there anything I can do at home to help improve or reverse this condition?
Will my insurance cover this treatment?

If speaking with a surgeon:
If I was your mother/father, would you suggest I have this surgery? Why/why not?
How long will the incision be?
Where will the incision be?
How long will the recovery take?
Will I need physical therapy? If so, how long and how often?
How long will the procedure take?

What kind of anesthesia will be used?

(AKA general anesthesia where you are totally asleep, twilight anesthesia where you won’t feel anything but you are not completely asleep, or local anesthesia where you are completely awake and they use numbing medication)

What is the risk of infection? The risk of complications?
What are YOUR infection rates? What are YOUR complication rates?

(It’s so important to ask this, because all surgeons are NOT created equal!!! And trust me, they know these rates off the top of their head!!!)

Will I stay overnight in the hospital? If so, how many nights?
What will be my limitations after surgery? Will I be able to _____? (Walk, drive, go back to work, etc)
I’m most scared of ____ happening!

(This is great to open communication about what you DON’T want to happen! This will allow the surgeon to reassure you and put those fears to rest.)

I always suggest that people write down their questions before the visit with the doctor. This makes sure that all your questions get answered and you don’t forget anything in the moment!

Did this list help you? Let me know in the comments section and stay tuned for my final step on how to have a better doctor’s visit!