magic lever | Danny van Leeuwen Health Hats - Part 4

Focusing on the Basics

By Caregiver, Consumer, ePatient, Family man No Comments

I just want to focus on the basics! 

In life I reach for the sky. I’m wired that way. I’m frustrated by less. In my health journey or anyone’s health journey where I’m along for the ride I want the best possible health given the circumstances. However, its complex, it’s hard, it’s a long journey to the sky. So I think, OK, let’s focus on the basics.  The journey is built on the basics. But what are the basics? No brainer, logical, common sense stuff – the magic levers – good diet, sufficient exercise and rest, family/individual/work balance, stress reduction, an aligned team? Unfortunately, the basics shift, vary from person to person and from team to team. Basics can be the hardest to attain. When under new or added stress – the basics suffer. Good habits suffer. I learned from a fabulous grief counselor, to attend to the basics first, then I would be better able to handle the unmanageable, unpredictable stresses of death, dying, and grief. Eureka, it was true. Attention to sleep, diet, exercise increased my capacity and resilience. I need help with the basics – reminders, tracking, companionship. Lord, help me with my defensiveness and resistance to help.  I can’t make it without. So hard to accept. The health journey is paved with the basics.
Photo by Patrick Hendry on Unsplash

Xmas: Honor the Caregivers. Help the Helpers.

By Caregiver, Consumer, Family man No Comments
92 million caregivers in the US. Lord, so many.  Only growing. How many of these caregivers need care? My wife, an occupational therapist, comes home with stories of 90+ year-old spouses taking care of their 90+ year-old honeys.  In health, the focus is often on the person at the center of care, the person with a diagnosis or with symptoms. Yet it’s their community that needs care – their health team. I remember when our son Mike was sick and dying. People wanted to know how they could help.  We spent quite a bit of time parsing out all there was to do into bite sized pieces that people could take part in. They’re entitled to express their caring and love. My suggestion for this holiday season is to name the caregivers among you, and contribute to their health.  Take something small off their plate-run an errand. Offer them the magic levers of best health: diet, exercise, rest, humor, distraction, spirit.
Please find my Holiday here. Be well. Keep in touch.

Found a new neurologist! So relieved

By Consumer, ePatient No Comments
Found a new neurologist! So relieved. What if … I have a relapse and have no doc? Anyway. First good sign – he had read my record before the visit and had a list of questions for me. “What’s important to you?” He wrote down my answer, “maintain function as long as possible, no meds that will make me depressed.”  Next, asked what works for my symptoms. When I told him about massage and acupuncture, he said, “I know about drugs. I’m delighted when something else works.” Asked him how do I get hold of him? “E-mail works best if it’s not emergent. I’ll respond within 24 hours. If its urgent, call my office and tell my staff to tell me to check my e-mail.” When I asked about my prognosis, he said, “I’ve no crystal ball. Stay strong as you can,less likely to fall, less like to have a serious injury when you do. I’ll help you manage any symptoms of progression.” My  kind of team member!

On another note: Nelson Mandela died this week. You know I’m into magic levers – small things that have profound effect. As Seth Godin said about Mandela, “Your lever is far longer than you imagine it is, if you choose to use it.” Inspires me.

Giving Thanks

By Advocate, Caregiver, Consumer, ePatient, Family man One Comment
My super power is accepting what is. Doesn’t mean I settle for what is. After all I’m a catalyst for change. Accepting and appreciating what is makes for a solid foundation and a realistic start. I can’t get from here to there if I don’t know – and value – where here is. I give thanks for my super power. I didn’t do anything to get this super power. No degree for it, no lightening strike – I was born with it – lucky genes and family history, felt safe growing up. I give thanks for (value) clean drinkable tap water, regular garbage pick-up, laden grocery shelves, the sun shining as often as it does. I give thanks for my sons, their wives, my grandkids, my extended family, my home life, my inspiring co-workers, my health and especially, my honey. I give thanks for the health problems our system has – I don’t live in a refugee camp outside Syria.

I give thanks, for you, my loyal readers.  I look forward to this virtual community every week that welcomes my musing on the magic levers of best health. Happy Thanksgiving!

Monitor and Alert

By Caregiver, ePatient, Family man 2 Comments
Working in Quality Management in health care, I’m driven by 3 things: 1) that we do no harm, 2) that we meet our standards and commitments, and 3) that we continually improve the care we give the people we serve. Health care is risky business. People are in need, their defenses are down. Providers of health care use to tools of medicine, surgery, and life style change to try to affect health. Nothing always just does as hoped. There are side effects to everything, even life style changes – For example, increased activity can lead to injuries. Anyway, this month I’ve focused on Monitoring and Alert systems at work.  We serve people with complex challenges in programs funded and regulated by many state agencies, insurance companies, and contracts. Families, neighbors care about and are affected by the people we serve. How can we monitor everything to make sure we meet our commitments and do no harm? How do we alert the people who run the programs and are served by the programs when we find something that can be improved?  A challenge is monitoring effectively and efficiently. We could spend a fortune monitoring thoroughly, but then we’d have no money left to give the services.  It’s a balance of science and art.

Monitoring and alerting for personal health is similar. We don’t want harm to come to ourselves or our loved ones. We want to keep our fingers on the pulse of our heart, our activity, our mood, our discomfort, etc. We’d like to know if we are approaching danger before it hits us. We could get tested for everything on the chance something gets uncovered-think full body scans, genome analysis. We could stay indoors to avoid an accident outside-boring. For monitoring I keep a spreadsheet of my weight, miles walked, miles on the stationary bike, hours playing saxophone, hours of sleep. When any of them (except weight) go down that’s an alert. When my wife tells me to go sit down because I’m exhausted and unstable on my feet, that’s an alert.  Monitor and alert – a magic lever of best health.

Honoring and aligning silos

By Advocate, Caregiver, Clinician, Consumer, Leader, Musician No Comments
Teaching in a nursing leadership academy this week about acting as a change agent or change catalyst in an organization or team. Common theme for the participants – frustration overcoming silos, working across silos, aligning silos – silos, silos, silos. As a family member, as a nurse, as a band member, as a person with MS, as a team leader, I respect and value silos. Defined boundaries – them and us – helps with identity, internal effectiveness and growth, focus, controlled expertise, and protection. At the same time I’m the health hats guy – proud of my many hats, teams, identities. I try to connect dots, align, reach across, welcome, join, participate. I’m anti-silo. Quite a tension. Who doesn’t deal with this challenge?  How do we value silos and overcome them? Appreciation, trust and alignment.

First, appreciate other silos as reservoirs of ability, history, perspective, and value. Next, be trustworthy to other silos – share, deliver, respect. Trust in each other’s strength, abilities, integrity. Finally, align. Clarify joint mission – together we’re trying to do something – better life, spread knowledge, entertain, growth and development, best health. So if we know what we’re trying to do together, if we act in a trustworthy way, and appreciate each other’s value, then we can honor and overcome silos. A magic lever of best health.

Health Literacy – a Magic Lever

By Clinician, Consumer, ePatient No Comments
How do I take two tablets twice a day? What did the lab work show? I don’t want to take that kind of medicine. I just want to walk daughter down the aisle. My shoulder hurts when I’m trying to sleep. Can I believe what I read on the web? When do I go back to this doctor? How much will the ER visit cost? So much information and so many people join us in our journey of best health. Information can be heard or be written on paper or on the web. We could be sharing information about ourselves. Questions are asked and answered – or not. People who care about each other and very familiar with each other can struggle to communicate. Their experience, skills, language, ways of thinking and speaking are different, are diverse. Is it any wonder that sharing health information can be so hard?  Some people refer to this communication challenge as health literacy. For a long time I thought that health literacy was about being as simple as possible and I used Microsoft Word’s Readability Statistics to see what grade level my writing was. Goal: 8th grade, 5th grade. (This post scores at a 9.3 grade) As my vision deteriorated I noticed that color and white space affected me. Design made a difference. As I exercise my listening muscles, I find that active listening affects the speaker and the listener.

My colleagues from the Society of Participatory Medicine, Peggy Zuckerman and Kathy Kastner have been orienting me to the vast world of health literacy. They tell me that the US Department of Health and Human Services defines health literacy as:

“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”

The report continues:

“Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.

 Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more “consumer-centric” health care system as part of an overall effort to improve the quality of health care and to reduce health care costs, individuals need to take an even more active role in health care related decisions. To accomplish this people need strong health information skills.

What are the skills we need for Health Literacy?

ePatients are often faced with complex information and treatment decisions. Some of the specific tasks people are required to carry out may include:

* evaluating information for credibility and quality,

* analyzing relative risks and benefits,

* calculating dosages,

* interpreting test results, or

* locating health information.

 In order to accomplish these tasks, individuals may need to be:

* visually literate (able to understand graphs or other visual information),

* computer literate (able to operate a computer),

* information literate (able to obtain and apply relevant information), and

* numerically or computationally literate (able to calculate or reason numerically).

 Oral language skills are important as well. [People] need to articulate their health concerns and describe their symptoms accurately. They need to ask pertinent questions, and they need to understand spoken medical advice or treatment directions. In an age of shared responsibility between physician and ePatient for health care, people need strong decision-making skills. With the development of the Internet as a source of health information, health literacy may also include the ability to search the Internet and evaluate websites.

Health literacy is a magic lever of best health.

Photo by Markus Winkler on Unsplash

Trust and choice: magic levers

By Family man One Comment
We had a family birthday party this morning. I’m reflecting on the tragedies we’ve weathered, the illnesses we’ve endured, the fun we’ve had as our kids grew up.  Now our kids are parents with grandsons learning to value and trust family while testing boundaries and making decisions about their environment and relationships. Talking now with my wife, highlighted that all our kids knew was trust and that we took action in the face of tragedy or setback. Our kids parents didn’t die young, no one was assaulted or abused, they didn’t go hungry. We rallied in the face of challenges – death of loved ones, losing a job, no money.  When our son, Mike, received a terminal diagnosis, we took action, consciously putting one foot in front of the other and finding things for others who cared to do. It helps to be busy. After Mike died we tried to adopt a teenager.  It never worked out, but these young people clearly didn’t trust, didn’t have solid boundaries, and weren’t able to make choices in their lives. A feature of the adoption program we used was that the teens would be making their own decisions about adoption.  The one young lady we would have adopted decided not to be adopted by us. Big step for her. Sad for us. Trust and self-determination: magic levers of best health.

Stoking the Fires

By Uncategorized No Comments
Woke up each morning last week wondering where I would find the energy to managing everything? Exercise, diet, music, family time, work, blog, other professional endeavors, medication, massage, acupuncture. Feel like my health depends on fine balance of all these things.  Made me wonder how people do it who don’t have the good fortune, the family, the health team, the opportunities, the cognition I do. How do the caregivers find the motivation, the strength, the stamina? What helps stoke or bank the fire needed to keep moving forward in the difficult moments, hours, days, of our health journey? Reflection, laughter, meditation, exercise, sharing, rest, relief, distraction, silence, recognition, and unexpected appreciation. My grief counselor said that so much in life can’t be controlled. You find the strength where and when you can. In the meantime, he focused me on the things I could control-many of the magic levers of best health-rest, diet, exercise, other stress reduction. Now we’re back to the beginning.

Love – Magic Lever to Best Health?

By Caregiver, Family man 2 Comments
My aunt got married to her longtime partner last week. Mazel Tov! My wife and I just celebrated our 38th wedding anniversary – we’re in love. My parents were in love, yet my dad was gay. Love is complicated. Especially when you add other people – society. I hail the recent Supreme Court decision to strike down the Defense of Marriage Act. Loving relationships can be a magic lever to best health, but it’s no guarantee.