High blood pressure.

High cholesterol.

Excess weight.

These are the risk factors for heart disease that your doctor typically talks to you about.  Yet, there is a risk factor that most doctors never discuss that can have as much impact as the ones I just listed — Depression.

Your mood plays a significant role in whether or not you get heart disease.  Study after study shows that the biological changes involved with depression– increased cortisol, elevated adrenaline, and decreased serotonin – causes changes in how well your heart functions.  It directly impacts how well your heart pumps as well as how much plaque develops in your arteries. Intense emotions and acute anxiety can literally change the shape of the heart. It’s a condition called Takotsubo cardiomyopathy and often referred to as “broken heart syndrome.”

Why is no one talking about this?

Even though we have made progress in recent years around the mind-body connection, we often don’t implement it in clinical practice. We create silos with physical health managed by physicians trained in internal and family medicine and mental health largely managed by psychiatry.  We need to be integrating and acknowledging there is no physical health without mental health, and there is no mental health without physical health.  It doesn’t make sense to only address risk factors such as blood pressure, cholesterol and weight – and then have mood as some time of afterthought.

If you follow some of my writing, you know I’m a big fan of risk calculators. Perhaps it’s time to update those that help calculate risk of cardiovascular disease and add depression/anxiety in the calculation of the risk score. That might force folks to be more explicit and proactive about managing mood as part of a primary prevention program.

Like many other aspects of heart disease, we wait until someone has a heart attack to adequately address it.  We talk about the need to reduce stress after patients experience chest pain – we should be talking about mood before they get to that point!

We have made amazing advances in the treatment of heart disease but sometime still dies of a heart attack every thirty- five seconds. Given the mental health challenges that many people have experienced during the past two years, I expect deaths from heart disease will increase unless we take proactive steps in reducing risk.  Addressing depression and other mental health conditions must be an important part of plan.

The post Heart Disease and Depression appeared first on Medika Life.

This land is your land, this land is my land
From California to the New York island,
From the redwood forest to the Gulf Stream waters;
This land was made for you and me.

That Guthrie song, with its heartfelt words, offered conflicting images of a nation’s greatness and the great strife of its people – the never-ending tension between grander and affliction. The power of his lyrics – with verses too conveniently edited out to make the song a patriotic hymnal rather than the composer’s original intent – is a call to social consciousness. The classic 1940s folk song was written to spark a social impact edge to address the needs of overlooked citizens.  The poverty Guthrie saw as he crisscrossed America’s dustbowl states continues. The reasons may be different; however, the suffering remains.

In a recent New York Times opinion piece, Tony Pipa, a senior fellow at the Center for Sustainable Development at the Brookings Institution, who leads the Reimagining Rural Policy Initiative, working to transform U.S. policy to enable equitable and sustainable development across rural America, writes:

“Too often policymakers mistake agricultural policy for rural policy. Farming now accounts for just 7 percent of rural employment. Service jobs, retailing, manufacturing and government employment all outweigh agriculture. And while $163 million of the relief the Trump administration distributed during the peak of the trade war with China went to high-income farmers making more than $900,000 annually, small-scale and family farmers are increasingly taking off-farm jobs just to get by.”

Today, more than 46 million Americans live in rural communities.  On average, rural locales lag behind non-rural communities on every measure of prosperity, from poverty rates to employment opportunities. This land may have been “made for you and me,” yet, when it comes to access to care, rural Americans live hours away from basic medical care, emergency services, and specialist providers.  Their well-being – survival – often hangs on a limited broadband connection. The system to address their needs is usually based on urban and suburban expectations.

Rural community populations trend older than urban and suburban regions, and while age is an invitation to health risks, rural areas have 20 percent fewer primary care physicians. Rural counties often do not have a psychiatrist to deal with mental health needs, and 81 percent do not have a psychiatric nurse practitioner.

LOSE THE IMAGE OF A WHITE FARMER ON A TRACTOR

Rural America’s needs are a bi-partisan issue impacting blue and red states. Congress has prioritized the rural communities’ needs for many good reasons.  People of color – often the most vulnerable in the health system – comprise 24 percent of the rural population. This includes rural Indigenous Americans and more than half of impoverished Black Americans. That compares with 18 percent of rural whites.

While politicians look for fixes to the problem, physicians, payers, private citizens and retailers are stepping forward to help address the care in access and quality gap.

Earlier this year, Walmart and Medscape released Healthcare Professionals’ Perspectives on Healthcare in Rural America, the most extensive survey to assess barriers and solutions to care delivery from the perspectives of professionals on the front lines of health care in rural and non-rural communities. More than 10,000 primary care health care professionals (HCPs) shared opinions that quality care is the most significant concern in their day-to-day efforts for their communities, particularly for people with chronic care and mental health concerns.

FORGET TECH – THE GAP IS ABOUT QUALITY CARE

Rural healthcare professionals are already utilizing telehealth and tapping into electronic medical records to improve quality care delivery. While there is plenty of buzz about remote patient monitoring and digital health technologies as tools that will enhance access to care, the biggest concern among physicians on the frontlines of addressing patient needs is clinical training and financial assistance to keep community hospitals operating. 

Physicians cite building on what they already utilize to care for their remote patients: state-of-the-art medical equipment, 5G internet service, and expanding use of electronic health records to guide their patients on self-care strategies. While technology helps with a care connection, it can only measure and monitor the substandard status quo.

PHYSICIANS IN RURAL AMERICA SEEK UPSKILLING

“We have known the systematic problems within the current health care system for decades. The Walmart-Medscape report emphasizes how health care professionals, like their patients, are most concerned about the quality of care, and we can no longer wait for old models to work,” said John Whyte, Chief Medical Officer at WebMD and Medscape and a Medika Life contributor. “This underscores the need for innovative solutions that look beyond the walls of the doctor’s office, similar to how Walmart is innovating in the space, driven by those who live and work in communities they serve.”

Often people in rural communities want to be cared for by people they know and trust and understand their local challenges and needs where they live and work. Experts addressing rural health needs know that staying well requires additional components beyond a physician visit.  The advocates seek to tackle social determinants of health, improved clinical care, and environmental factors.

Retailers like Walmart are partnering with health plans, advocacy groups, and third-party health associations like the American Heart Association to fill these gaps. Major retail pharmacies such as Walgreens are showing commitment by investing in efforts to address health drivers such as food insecurity, maternal and infant health, diabetes and hypertension solutions to reduce health disparities.

PRIVATE CITIZENS SEEK TO TRANSFORM RURAL COMMUNITIES

“Challenges to rural Americans cause suffering, which drives despair and feeds discord. Dialogue that elevates awareness of people’s difficulties is an important step in providing a remedy, and communication is the first step in providing viable solutions,” said Peter Finn, who founded, with his wife Sara Finn, a Foundation to address the pressing needs within his Upper New York State community of Hunter. Finn taps communication and creativity to make a difference and transform rural communities.

“I have been a long-time resident of Hunter, one of the far too many rural communities struggling in Upstate New York. The town was economically depressed and quickly deteriorating, but rather than abandon Hunter and shut our eyes to what was happening. We chose to get involved by raising awareness and mobilizing others to create the Catskill Mountain Foundation,” he adds. 

The Foundation calls upon the arts – music, creativity and dance – to draw people into the community all year round. Today, Hunter’s streets are lined with inns, restaurants, antique shops, and art galleries. Visitors come to enjoy the fall foliage, hike, and ski. The example of Hunter, New York, and other living laboratories proves how volunteering spirit, creativity and caring about rural community needs can shift the tide of events.

Others are contributing their talents to give voice to the diverse challenges rural Americans face.  “Living in the heartland has become increasingly difficult for Americans, and with this unprecedented narrative podcast documentary, we will present noted policy, community, and industry leaders working to change this reality,” reflects Matthew Zachary, co-founder and executive producer of the award-winning podcast network of OffScrip Health. 

Zachary, who is no stranger to tackling life-threatening issues, is looking to create the first audio documentary on the struggles of rural Americans, tapping into the network of companies, rural community leaders and government leaders who want to share how they are shifting from rehashing old issues to rolling-up their sleeves to solve problems.

CONFRONTING STIGMA – MENTAL HEALTH IN RURAL AMERICA

People with mental health needs face stigma.  That remains among the biggest hurdles to seeking care – the thought of “What will people think?” For people in rural communities, anticipating the negative reactions of family and community is an added emotional challenge that keeps people from seeking the care needed. Like any illness with progressive influence, failure to treat mental illness has life-threatening possibilities. Suicide rates increase as population density decreases. According to the Centers for Disease Control, suicide rates among people living in rural areas are as much as 68 percent higher than in large urban areas.

Jeff Winton is the Founder and Chairman of Rural Minds, a nonprofit organization working to end the suffering, silence and stigma surrounding mental illness in rural America. He is a part of the multigenerational farm Wall Street Dairy, LLC — a working dairy farm in Chautauqua County, New York – and founder of a major communications firm that addresses health issues.

In his opinion piece appearing on the National Alliance on Mental Illness (NAMI) website, Winton writes:

“Increasing awareness that mental illness is a health condition — just like cancer, heart disease, or diabetes — is one way to help overcome the stigma in rural communities. In addition, talking openly with others about lived experiences with mental health challenges helps to normalize the conversation and diffuse the stigma surrounding mental illness. The simple act of sharing stories can be an important first step for people to seek help for their own mental health challenges and encourage others to admit that they are struggling.”

The physical and mental health challenges to rural Americans cause suffering, which drives despair and feeds discord. Dialogue that elevates awareness of people’s difficulties is essential in providing a remedy, and awareness is a crucial step toward viable solutions.

OVERCOMING DESPAIR, DISEASE AND DEATH

Apathy and poverty double team are the domino of rural health killers. Walmart and Walgreen, and other major retailers are engaged.  Individuals with passion are leaning into the challenge and inviting others to join in their efforts.  Health organizations such as the American Heart Association, American Telemedicine Association, Blue Cross Blue Shield, National Rural Health Association, and many others have joined the effort to raise quality and ensure access to care.

Rural America is vast, with a remarkably diverse population and needs. The biggest problem isn’t decision-makers’ willingness to dedicate money or their readiness to align blue and red forces in bipartisan action to the challenge. The government often seeks big solutions to significant challenges.  However, the image we have long held onto of rural America – the proud and industrious farmer in a ballcap sitting on a tractor – is as outdated as the stoic, proud tiller of the land.  These citizens need our help urgently.  How do we resolve these problems? We start by recognizing that a one-sized solution does not fit all.

Woody Guthrie, while some verses of your ballad were conveniently edited out, we know your question:

As they stood there hungry, I stood there asking,
Is this land made for you and me?

Yes, it is!  Woody, we still remember.

The post Rural America – A Generational Struggle for Health Equality appeared first on Medika Life.

“OMG, am I dying?”

“I read that this vaccine is dangerous”.

“I want to try this new supplement, does it work?”

“Is this normal, or. . .”

Have you ever put one of these queries into a search engine? Was it helpful? I get lots of questions about health information that folks have run across online. It can be great to read up and educate yourself, but it can also be really hard to tell what’s legitimate, what’s relevant, and what’s not.

What started out as a well-intentioned fact-finding mission can quickly spiral out of control as you try to make sense of the stew of opinions, science, sales pitches, and general noise that is in the online health space. Before we go any further, a disclaimer: nothing you read online is ever a substitute for personalized, professional medical advice. If you are experiencing an emergency, you should always seek medical care from a professional, not from an online search.

OK? Good. Now, let’s go through some of the places you might land when you’re googling health topics and identify the best ways to use what you find.

University and government sites

If you are looking for solid, reliable, mainstream information about a health condition, seek out a university or government sites (.edu or .gov). National charities associated with a particular condition (like the national Eczema Association or Crohn’s & Colitis Foundation) are also usually good sources.

You can use these to learn the background and basics of disease and to understand general treatment options. Keep in mind that there are limitations to applying this information to yourself without additional context or expertise.

Not everything that’s generally true about the topic will be relevant to you. Overall, trust these sources as generally accurate but not tailored to you.

Message boards

These are great places to find personal narratives from individuals. It can be helpful to share experiences and build community with other patients. This can be really validating and can also sometimes uncover patterns and new information that you might not have thought of or noticed.

However, this kind of forum can also spread misinformation when people generalize their experiences to apply to everyone. When you are only considering a handful of people, you can’t truly know what’s related to a medical condition or treatment and what’s not.

Scientific evidence is how we determine whether treatments are safe as well as whether they work, and this means systematically comparing groups of people. Another issue with online health communities is that just like our bodies can respond well to the placebo effect by improving, we can also be influenced by our expectations that things won’t go well — this is sometimes called the “nocebo” effect.

So absolutely, communicate with other people to share experiences and frustrations, but keep your common sense intact. Make sure that if you’re going to try something new, it doesn’t carry risks that you might not have thought about. This might mean asking a healthcare professional about it, especially if you’re going to try a drug or supplement with the hopes of treating a medical problem.

The bottom line is, value others’ experiences and let them help you think about your own, but do not assume that what works for others is definitely right for you.

Symptom checkers

Want to hear your doctor’s best-exasperated sigh? Mention that you found something on WebMD. There’s a disclaimer on the symptom checker page on WebMD that reads “this tool does not provide medical advice”. Please heed this warning.

The two major pitfalls of WebMD and other symptom-checking sites are that it gives you a worst-case scenario, and it can lead you to anchor on a particular idea that’s hard to let go of if it turns out to be incorrect. I searched “headache in the morning” just now, and the list it gave me included “cerebral hemorrhage” and “pneumococcal meningitis” along with a lot of other stuff. Of course this will freak you out!

But those things could be effectively ruled out by some quick screening questions from someone who knows what they’re doing. If you’re thinking “brain tumor” and your doctor says to just drink more water and pop an ibuprofen, it’s easy to feel like you’re not being taken seriously. This doesn’t necessarily mean your doctor isn’t listening! They are able to interpret your symptoms in context in a way that you may not, and their expertise is why you went to see them in the first place.

You’d be better off skipping the google search, starting with some basic self-care, and being on the lookout for symptoms that are really and truly unusual or distressing for you. Look for things that are severe or persistent. This means knowing your body and what’s really “out of range” for you. Most little body quirks aren’t concerning despite what WebMD might come up with. If you choose to check your symptoms online, try not to fixate on the rare and serious things. There’s a saying in medicine that “true disease declares itself”. Remember this and don’t talk yourself into a catastrophe every time you notice something slightly off with your body.

Facebook

Please don’t crowdsource your symptoms on Facebook. You will hear terrible ideas from a lot of people who are high on confidence and low on knowledge. I have seen some frighteningly bad advice given in Facebook comments by people who are well-intentioned. And for some reason, everyone loves to share their horror stories here. Don’t do it. You will feel worse 100% of the time.

PubMed

If you have any background in science and you’re curious, you might enjoy looking at scientific papers. This is for more of a deep dive on a topic than it is for practical advice. The best place to search the scientific literature for peer-reviewed papers is the PubMed database.

The peer-review process increases the credibility of the information by ensuring some degree of scientific merit. For the highest quality evidence, look for systematic reviews and meta-analyses, studies done with humans (not animals), look at the size and diversity of the samples. If you’re intellectually curious, scientifically educated, or interested in what might be coming down the pipeline, PubMed can be a great place to deepen your knowledge.

Alternative websites and blogs

Skepticism of the mainstream isn’t necessarily always a bad thing; sometimes the scientific establishment does miss the boat. How do you know if a non-mainstream source is legitimate or not? I suggest that you start with the idea of trusting science and also respecting its limitations.

When seeking out information and opinions that are not well established, consider the motivations and general philosophical orientation of the source. Some blogs that appear to provide alternative health information are vehicles for selling “alternative cures” that have no basis. Some are politically motivated disinformation. And some are really, truly reasonable sources of information about topics that don’t have a solid body of evidence behind them simply because they haven’t been sufficiently studied.

This category includes conditions that disproportionately impact women, poor people, and people of color, rare diseases, and conditions that are hard to diagnose with the methods currently in use. I suggest bringing an open mind and a critical eye to such sources.

If the source acknowledges and respects science and explains why its positions fall outside of the mainstream, it can be worth considering in the context of other available information. If it contains inflammatory political language, sells products, or is not clear about who its authors are, you should not consider it a credible source of health information.

Social media feeds

Consider the difference between active and passive information exposure. It’s good to seek information about a specific health issue or concern you might have, but it can be problematic to passively absorb what others are promoting, often with a vested interest. If your feed is full of health influencers, it can get really confusing really fast. It’s hard to tell who’s a true expert, who’s selling something, and who might be well-intentioned but not right for you. I suggest keeping this kind of content at arm’s length. Fill your social feed with pictures of cute dogs, and save the health stuff for times when you have specific needs. Then, you can seek out the right sources instead of whatever rose to the top of the algorithm that day.

I hope this helps you sort the good from the bad and the ugly, and remember you can always talk to a health professional who knows you if you have specific concerns. Keep learning!

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