DIRECTOR'S NOTE

Late summer and fall are peak fire season in California. That’s nothing new - but what’s different in the last decade are the speed, intensity, and sheer size of wildfires. Unfortunately, people living in the western U.S. can no longer assume that a major fire can’t happen to us. The same is true of other weather disasters - extreme heat or cold leading to large-scale power outages, severe storms that bring floods or mudslides, etc. - as well as the persistent possibility of earthquakes along the West Coast. 

So, what can we do about these dangers? (The motto of this newsletter is “news you can use”, after all!) In the long run we need to pay serious attention to climate change, but closer to home we should all take steps to protect ourselves and loved ones from immediate danger. With so very many places to look for emergency preparedness advice, it can be bewildering to get started — so PlaneTree Health Library, with advice from local emergency response agencies, has created an online resource guide to bring together the most useful free online information for people in Santa Clara County in one jumping-off point. You’ll find this guide at: https://library.planetree-sv.org/disasters . It covers the range from how to get started with evacuation basics to making an emergency master plan for the whole family (even pets), and also includes advice for people with chronic or serious illness on how to cope with power outages or evacuation. Should communities in Santa Clara County be called to prepare to evacuate or shelter-in-place, you will find detailed information on the first webpage, while additional webpages cover the specific problems of different types of climate disasters (fire, flood, earthquake, power outages, extreme weather).

We hope you and your loved ones use this information to stay safe and healthy despite emergencies. Please do give us feedback or suggestions on how to make this resource guide even more useful (send comments to info@planetree-sv.org).

Lise M. Dyckman
Executive Director

 … assume that all blood tests require fasting ahead of time?

Not all blood tests do. However, for some of the most common test procedures (for example, measuring blood glucose for diabetes, or lipid panel for cholesterol levels) we should not drink anything except water, eat or chew gum, exercise, or smoke during the 8-12 hours before testing. 

That’s inconvenient, which is why these tests are often scheduled early in the morning. If a blood test has been ordered for you, ask if it must be done fasting - or check these sources:

• https://medlineplus.gov/lab-tests/what-you-need-to-know-about-blood-testing/ or
• https://medlineplus.gov/spanish/pruebas-de-laboratorio/lo-que-usted-debe-saber-sobre-los-analisis-de-sangre/
• https://medlineplus.gov/lab-tests/fasting-for-a-blood-test/  or
• https://medlineplus.gov/spanish/pruebas-de-laboratorio/ayuno-para-examenes-de-sangre/

…look for rip tides at the beach?

If you spend time in ocean water, you should learn how to identify a riptide and find out what to do if caught in one! As one former surf lifesaver points out, you must know what a rip tide looks like and identify those areas in the surf. They often occur inshore from a sandbar, and can be around a jetty, pier, or rocks in the water, says the National Ocean Service (NOAA, in English & Spanish). If you find yourself in one, try to stay afloat or, if possible, swim parallel to the shoreline to get out of the most substantial flow until it’s easier to come back to shore. Riptides are powerful at low tide, so it’s a good idea to check timetables for local tides and the National Weather Service’s Surf Zone Forecasts and Rip Current Statements before hitting the surf.

... worry about sepsis if a cut is red and inflamed?

While those are signs of an infection, sepsis isn't an infection, exactly. Sepsis is an overreaction of the immune system in response to infection. The symptoms of sepsis can be surprising, appearing more like flu or COVID-19. Sepsis can be quite dangerous especially in people with weaker immune systems, or who have been diagnosed with pneumonia, or have recently been hospitalized.

…try to talk to my Chinese parents about being depressed?

Due to numerous struggles involving cultural identity, assimilation, and reconciling traditional Asian values with American society, Asian Americans and Pacific Islanders (AAPI) unfortunately have the lowest help-seeking rate in terms of mental health as compared to other ethnic groups. 

Despite the stigma that can often be associated with seeking help, it is important to recognize that this shame is often influenced by harmful and misleading stereotypes or pressures in the community. Starting conversations in Asian families that openly discuss mental health issues is critical to breaking the silence, spreading awareness, dispelling myths, and normalizing seeking help. 

… worry about my health insurance system’s data breach?

In recent years, healthcare information has become increasingly accessible, which also means more security concerns about data breaches and compromised information. 

It is important to recognize, however, that not all cases reported are the same. A hospital losing a list of patients and phone numbers is different from losing a medication list or drug abuse treatment history, although both are data breaches. There are also questions about the recency of the data, as well as how many patients were affected. 

Nonetheless, if you have received an alert about a breach, check to see if you qualify for free credit monitoring services, or consider monitoring your own credit. Change passwords and use two-factor authentication to improve security at your end, and be proactive in finding out what information was lost, and with whom it was shared.

… take up yoga to cure a bad back?

Many people have found that yoga relieves low-back pain and neck pain, and sometimes also pain from tension-type headaches and knee osteoarthritis. (Those are not the same as a cure, but can be very helpful nonetheless.) However, yoga is not universally safe for everyone. Seniors and people with certain medical conditions may need to modify some positions (and avoid other positions), as explained in this booklet that can be downloaded from the NCCIH.

On August 23 the FDA gave full approval to the PFizer/BioNTech vaccine. The other vaccines that were approved on an emergency basis (Moderna and Johnson & Johnson) are expected to be fully approved soon. Full approval is much more than a rubber-stamp detail. It is significant in several ways, as this epidemiologist explains. One of those changes is that mandating workers to be (or get) vaccinated is now legally defensible. Recently the U.S. federal government has announced vaccination mandates for health care settings, for businesses that employ more than 100 people, and for federal agency employees, including worker support to be able to get vaccinated.

Caring for a loved one from a distance - never an easy task - has changed irrevocably with this pandemic, as explored in this article from AARP.

While antibody tests are important tools for epidemiologists and public health, they’re actually not particularly useful as a measure of how vulnerable someone might be to SARS-CoV-2.

Both of these have been in the news lately, surfacing as a concern with COVID-19. Clots can form in the blood from many different causes, in response to an infection, to a chronic disease, from genetic factors, or from habits like smoking or diet.  Likewise, inflammation of the heart  can be caused by infection (viral or bacterial, including from tick bites), autoimmune diseases, as a side effect of medications, or environmental factors. Different terms are used for heart inflammation depending on where it occurs: pericarditis (the protective layer around the heart); endocarditis (inner lining of the heart chambers and valves); and myocarditis (inflammation of the heart muscles themselves). Myocarditis can also be called cardiomyopathy  especially when it is chronic. Mild cases of myocarditis may only need rest to recover, but all cases of heart inflammation should be monitored with follow-up care. 

The last issue of PlaneTalk covered some tips and techniques for getting more time and attention paid to patients’ questions at medical appointments. This issue goes into the whys and wherefores of annual checkups, how to find out more about routine tests, why you may be asked what seem to be irrelevant questions, and what informed consent has to do with all that.

Many of us have been puzzled by seemingly irrelevant questions we are asked as patients in medical appointments. If my problem is a sprained ankle, why does the medical office need to know how often I drink alcohol, or if I smoke? The reasons are two-fold. One is that human bodies are astonishingly complex, and there might well be some connection between seemingly unrelated lifestyle habits, environments, or past health events and what is causing the current problem. 

More often, though, those seemingly irrelevant questions asked on every medical office’s intake form, and those routine medical tests we go through, have to do with preventive care standards in U.S. healthcare. Over the last 70 years medical researchers, health insurance companies, and public health authorities have been paying more and more attention to the top 10 or 15 causes of death in the U.S., and to the factors that make it more likely (statistically) for someone to develop that condition. That led first to collecting data on factors leading to those causes of death for every patient. Later it led to establishing preventive medicine guidelines for testing or screening anyone who might fit the statistical profile for any of those top causes of death. So now we have health maintenance standards for tests or screening exams for men 40-64, men 65 and older, women 40 - 64, women 65 and older, seniors with Medicare, and so on. It is also why questions about health habits (like drinking alcohol) or social issues (like family violence) are routinely asked of every patient.

In other words, in addition to treating the specific problem that brought an individual patient into their office, healthcare professionals are also looking to treat problems often found in the general population at large. Doing so can be a real life-saver if that particular individual patient happens to also have one of those common problems and it’s caught early. But there is also concern that in some cases medical practice in the U.S. has gone too far, and that patients are being over-tested unnecessarily (especially if patients have to pay the bill for tests that they don’t really need).

That’s where informed consent comes into play. Patients have the right to know why a medical course of action - even a medical test - is recommended to them. Patients have the responsibility to ask questions, so they have correct information that applies to them specifically, and not just to “people in general”. And for the most part patients have the right to reject a procedure, treatment, medication, or test if they do not think it is necessary. 

Our job as patients is to help our healthcare team by compiling answers to preventive medicine questions, by checking into the routine screening tests that are recommended for people our age and gender (or genetic background), and by making sure that we know why a procedure, treatment, medication, consultation, test or screen is being suggested to us (and how much it will cost to us, if that’s a concern).

The best way to make sure we know why is to ask lots of questions.