Wendy Harpham on Healthy Survivorship

Doctors vs Computers

A front-page story in today's Science Times poses a provocative question in the rapidly changing world of medical diagnostics: Can computer software ever replace physicians to ensure timely, correct diagnoses?

How We Die: Love and Dementia

Writers choose words and phrases with care. In all my years of writing, only once or twice have I repeated a sentence word-for-word in a single essay. So when surgeon Nuland did so in How We Die, I took notice.

How We Die: Discriminate Specialization

In my last post I share my discomfort with a passage from How We Die. Reading on, however, Nuland offers a useful insight about a risk of increasing specialization:

How We Die: The Problem With Specialists

Most pages of my copy of Nuland's How We Die sport underlinings and check marks. On page 72, though, I drew a big question mark in the margin beside a paragraph that preceded another that earned a "great insight!"

How Long Do I Have?

Few questions evoke physicians' discomfort like “Doctor, how much time do I have?”

In oncology it's a common question that comes with the territory, forcing clinicians and patients to grapple with issues of trust, hope, uncertainty, disappointment, and grief....

How We Die: Natural Law

Dr. Nuland opens Chapter 2 of How We Die saying, "No one dies of old age, or so it would be legislated if actuaries ruled the world."  Later in the chapter he introduces a perspective on aging that can serve Healthy Survivors well.

How We Die: Naturally Bad Responses

In Chapter 2 of How We Die, Dr. Nuland illustrates how sometimes the body's natural response to injury or illness is maladaptive, a notion critical to a Healthy Survivor's understanding of treatment.

How We Die: Ischemia

Nuland's book, How We Die, helps readers understand and recognize common features of most deaths. In Chapter 1, Nuland introduces some of the book's fundamental themes, including...

How We Die

How We Die. Reflections on Life's Final Chapter was not what I expected when I bought it. Surgeon Sherwin B. Nuland's elegantly crafted insights and conclusions have changed how I think about life, death and modern medicine.

Talking about Pain with Your Doctors

As both a physician and a patient, I've experienced the difficulties of talking about pain at doctor visits. In a handout for patients in chronic pain, I offer insights and tips. Here are just a few:

Lessons on Managing Pain

In a recent column, I offer clinicians "some of the insights and tips that have helped me [as a patient], and I hope can help you when caring for survivors...." Below, an excerpt:

Proud to be Old

Driving home from a visit with my oncologist, I looked over at the car to my right while waiting for the light to turn green. In the sedan, an elderly woman stretched to see over the top of the steering wheel. My first thought was:

Supporting people with cancer all year long

Along with candy corn and pumpkins, pink ribbons are popping up everywhere. Is buying products with pink lids the best way for you to make a difference for patients with breast cancer?

Think Twice Before Praising Weight Loss

Until recently, if I saw someone who had lost excess weight, without hesitation I'd say something positive like, "Wow, you look terrific!"

Then I read "Why You Should Think Twice Before You Praise Someone For Losing Weight."

Power of words

For the past 22 years, I've spent hours almost every day searching for words that communicate ideas in engaging and memorable ways.

Dilemma of a Cure

In my last post I asked: Would I complete a clinical trial if researchers came up with a sure cure for me? Or would I drop out and go for the cure?

Parents Seeking Cure

In my post about a promising technology for cancer patients, I expressed concern about a mother's comment that if the treatment her son is now receiving doesn't work, "'we have the home run in the back pocket.'”

What's wrong with hoping for a home run?

Seeking Cures, Patients Enlist Mice

In 1993, my long-term prognosis was terrible. I reassured myself that my prognosis was based on groups of past patients who were in similar situations, and not on Wendy Harphams with blue eyes, brown hair and a freckle on the left elbow.

Now, according to a NYTimes article, scientists are moving closer to developing those needed clones.

Obesity Paradox (Part II)

In my last post, I introduced the Obesity Paradox: Overweight patients with certain chronic diseases do better than normal- or underweight patients with the same disease.

I wish we could do this trial:

Obesity Paradox

The NYTimes ran a story titled "In 'Obesity Paradox,' Thinner May Mean Sicker." If skimmed, the piece could easily lead readers to the wrong conclusion.

Power Struggles

Healthy Survivors understand the distinction between their unequal position in the doctor-patient relationship and their ultimate power. 

Brain Attack

You're probably familiar with the classic signs of a heart attack (pressure or squeezing sensation in chest, radiating to left arm and/or jaw, worsened with exertion, relieved with rest, associated with shortness of breath). You probably know what to do, too: Go immediately to the ER.

Do you know the signs of a stroke?

Meet Me Where I Am

I wet my bed, after months of gold stars on my chart. At four years old, this is my way of telling you I’m afraid of the dark. I’m not at home; I’m visiting fear. Don’t scream at me. For now, forget my past progress; forgive this accident. Please meet me where I am.

Like Caring for a Child

People say, "Caring for a loved one with progressive dementia is like caring for a child."

It's not.

Happy Healthy Survivors

It's been a long time since I've offered a microvacation post. Today's link takes you on a 5-minute world tour of people dancing. As always, I see some valuable lessons for Healthy Survivors. 

Neti-Pot Risk

Neti-pot irrigation can be an effective non-pharmaceutical intervention for many sufferers of chronic sinus congestion.

As a physician-patient, I usually prefer safe, effective treatments that avoid lifelong systemic medications for chronic conditions. But an ABC News story highlighted a serious risk of improper Neti pot use: life-threatening infection with a rare water-borne amoeba (Naegleria fowleri).

A Living Legacy

My August 5th post, What a Difference a Letter Can Make, extolls the virtue of writing letters to your young children if you have a terminal illness. What I didn't say is that writing these letters does not mean you have given up hope of recovery.

Help Me Live

Have you ever worried about saying the wrong thing to someone facing a medical challenge? If you are a patient, have you ever been hurt by something someone said?

Journalist and cancer survivor Lori Hope answered "Yes" to both questions and decided to do something about it. 

Helping a Family in which a Parent has Cancer

Four of the most challenging pages I've ever written were published in the introductory material to When a Parent has Cancer. A Guide to Caring for your Children (WAPHC). 

In response to people concerned about children whose parents choose to keep the parent's illness a secret, I wrote "Important Message to Parents, Friends, and Extended Family." 

What a Difference a Letter Can Make

When young parents are dying, they face the loss of everything they know and hold dear. Arguably their greatest pain is losing the chance to raise their child(ren). To help such parents find hope in desperate times, I offer a suggestion:

Surviving "How Are You?"

Debbie commented on my last blog post: "This definitely reminds me of the question 'How are you?' and how tricky a question it can be. Thank you for helping me become a more sensitive friend."

It is I who should be thanking Debbie. Almost two decades ago, our discussions prompted me to write the following essay in an attempt to understand my problem with people asking "How are you?" It helped me. I hope you find it useful.

What Not to Say to a Cancer Patient

Last year Melissa Shultz interviewed me for an article titled, "What Not to Say to a Cancer Patient." Yesterday she received The Texas Medical Association’s Anson Jones, MD, First Place Award for her piece. Here's an excerpt:

Talking about cancer can be painful and awkward for both the patient and the well-wisher. Here’s advice from cancer survivors and medical professionals on what not to say to someone with cancer, as well as helpful alternatives.
 
“My friend died of cancer”
 
Dr. Wendy Harpham, 56, doctor of internal medicine and mother of three from Dallas, learned she had non-Hodgkins lymphoma in 1990. As both a patient and a physician, cancer tales have been the narrative of her life for the last 21 years.
 
“Patients don’t want to hear other people’s bad cancer stories — and sometimes not even good stories — because they’re focused on themselves. It can make them feel badly if you set the bar too high with stories about how well someone did during treatment.”
 
..."In 1992 I had to close my solo practice to receive more cancer treatment, which meant closing the door on my life-long dream and facing a worsening prognosis.”
 
When people told her she needed to be positive it only added to her stress and closed the door to talking about her feelings authentically. “It also put a layer of blame on me: If I don’t get well, it will be because I didn’t have a positive enough attitude,” she says.

Congrats and thanks, Melissa.

[Complete article, click here.]

Dietary Pattern for Health

After a cancer diagnosis, patients ask, "What should I eat? What foods should I avoid?

The answers found in magazines and offered by clinicians and purveyors of alternative therapies often paint a confusing picture of contradictions.

R & R After Cancer

In mid-May I discussed the updated Nutrition and Physical Activity Guidelines for Cancer Survivors.

Let's return to that document to highlight an idea about recovery after treatment for cancer or other illness or injury that can promote healing.

Doctor Says "Stop Whining"

Earlier this summer I was invited to write a guest blog post for cancerwise, a blog sponsored by MD Anderson Cancer Center in Houston. So I submitted a post titled "Doctor Says, 'Stop Whining.'"

A Lesson on Second Opinions - Part II

Dr. Ronan Kavanagh's excellent story -- An Unexpected Second Opinion of Rheumatoid Arthritis -- offers a useful lesson for Healthy Survivors: With time and experience, people become better at making the correct diagnosis. Let's look at this lesson more closely.

A Lesson on Second Opinions

In order to share a 279-word story with a lesson for Healthy Survivors, I'm breaking my 250-word limit. It will be worth it.

Here's the story I found on KevinMD.com blog and written by Ronan Kavanagh, a rheumatologist who blogs at Dr. Ronan Kavanagh’s Blog:

In my first few months working as a rheumatologist a referral letter arrived from a local doctor about a lady with rheumatoid arthritis. She had recently moved to the West of Ireland from the UK, where her original diagnosis had been made. Her GP had originally referred her to a
general physician in a small local hospital who had struggled with her care and
she was looking for second opinion.

After assessing her, it quickly became apparent that original diagnosis had been incorrect. The patient had numerous explanations for her pain other than rheumatoid arthritis and the investigation that was likely to have prompted her original diagnosis (a positive rheumatoid factor test) as due to the fact that she had Sjogren’s syndrome (a condition which causes dryness of the eyes and mouth).

My specialist pride congratulated itself on making such a clever diagnosis and for being smarter than either the physician who had cared for her of late or the rheumatologist who had made the original diagnosis. Gosh I’m good, I thought.

“That’s wonderful news doctor. You mean I don’t have rheumatoid arthritis after all?”

“Not in my opinion you don’t.”

“It’s great to see someone who knows what he’s talking about. Do you mind me asking where you did your training?”

“In the UK. In Cambridge mainly.”

“Really, doctor? In Addenbrooke’s?”

“I was there for 4 years.”    

“That’s amazing. That’s where I was told I had rheumatoid.”

With that she thanked me, stood up to leave, and just before she left the room, turned to me and said, “I knew you looked familiar.”

It’s never a bad idea to get a second opinion. Even if it’s from yourself.

The lesson is that with time and experience, people become better at making the correct diagnosis.

Coming up: A brief discussion.

 

Generativity and Healthy Survivorship

A second lesson on Healthy Survivorship gleaned from a cursory look at the work of psychologist Erik Erickson has to do with so-called generativity.

Epigenetic Principle and Healthy Survivorship

Reading about Erik Erikson's eight psychosocial stages of human development helped me think about Healthy Survivorship in a new way. I'll paraphrase and oversimplify (and not get into the virtue aspect of Erikson's theory) to talk about the first of two ideas that prompted this post: The Epigenetic Principle.

Experience Corps

Recent posts highlight the research of geriatrician Dr. Linda P. Fried that adds to our knowledge. Today let's look at her work that uses current knowledge to take effective action.

Dr. Fried: Advocate for Aging Healthy Survivors

Epidemiologist and geriatrician Dr. Linda P. Fried uses the science of aging to promote the art of caring for the aged.

Learning about her efforts inspires me to persevere with my personal mission: Helping others through the synergy of science and caring.

A Firm Diagnosis of Frailty

A recent article by NYTimes columnist Karen Pennar focuses on an ordinary word that has specific meaning in the context of healthcare: frailty.

Life Interrupted

Suleika Jaouad wrote a piece for the NYTimes titled, "Life Interrupted: Fighting Cancer, and Myself." She wrote," I am realizing that “beating” cancer isn’t about winning or losing...my challenge will be to develop a new brand of acceptance."

 

Decreasing The Risk of Delirium

A study designed to determine risks associated with hospitalization and delirium in patients with Alzheimer's Disease (AD) contains important lessons for Healthy Survivors.

Managing Expectations

Patients' efforts to manage their expectations can help calm anxiety. Asking your surgeon how long you can expect to experience pain following a procedure helps prevent you from wondering and worrying about why you are sore or how long your pain will last.

What is a Modern Patient?

For years, my elevator speech when asked about my work has been, "I explore, write and speak about how modern patients get good care and live as fully as possible."

Last week someone responded with a question, "Wendy, what do you mean by a 'modern patient'"?

Best Father's Day Gift Ever

I don't feel guilty for surviving while other parents with young children have not. But I do feel an ache in my chest.

Questions are the Answer

The Agency for Healthcare Research and Quality (AHRQ) recently launched a campaign, "Questions are the Answer."

I've just watched all the videos. If you are interested in strengthening your clinician-patient bonds:

How To Convince Your Doctor

In response to the April 18th post on the Choosing Wisely™  campaign, a blogger emailed me about her doctor insisting on repeating blood tests done 5 weeks before her scheduled procedure, because they were outside the 4-week window. She asked, "How does a patient convince the doctor to NOT order a test?"

Exercise During Cancer Treatment

The ACS document, Nutrition and Physical Activity Guidelines for Cancer Survivors, highlights the therapeutic value of exercise during primary cancer treatment. "[E]vidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning, fatigue, and multiple aspects of quality of life."