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Illness as Art

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I’ve taken care of thousands of patients in 10 years of practice. I’ve shepherded patients through colds, pneumonias, urinary tract infections, and birth. I’ve been at the bedside of patients with innumerable cancers, complications from diabetes, heart attacks, brain injuries, gunshot wounds, and toe amputations. I’ve palpated acute abdomens, fussed over toenail fungus, and been the very first person in the world to touch a new baby. God help me, I adore it. 

While I’m on a first name basis with the nuts and bolts of illness and recovery, I’m fascinated by life on the other side of the examination table.  What is it to be sick, fighting for life?  I know what it’s like to wait for hours in the emergency department; to have to beg for pain pills; to feel relief as a fever comes down; but how does somebody with a more creative sensibility process the experience? The experience of caring for sick patients is specialized; the experience of being sick is human.  

I chanced upon a link today on the superb and always fascinating New York Times photojournalism blog, Lens, about a photographer with lymphoma. His images, many of which were taken while he was undergoing chemotherapy, are shown in a short movie which he narrates. They’re lovely, stark images by a gentleman facing the end of his life:

A cancer survivor and his Kodachrome

On a similar but more literal vein, artist Cathy Aten posted a video about how multiple sclerosis has affected her art and life as her physical abilities are “edited down.”  Fascinating, heart-wrenching stuff:

Healing through multiple sclerosis

Through the link you can get to her blog, where she posts essays and images about her experience. As her physical body demands more attention and assistance, she asks “What does change actually look like?”  Her struggle to document that through her art is fascinating.

Also from Lens – photos of a young Afghan boy suffering from tetanus.  An ancient disease in a boy living in an ancient civilization, interacting with very modern US field medicine. The first four photos in the sequence are harrowing, graphic, and beautiful. My maternal, physician, (amateur) photographer eyes are educated; my heart, broken.

Pictures of the Day: Afghanistan

Those of you lucky enough to be healthy right now might be rolling your eyes. But I have seen many student patients who have been quite ill – cancer, diabetes, congenital heart defects, assaults, nasty infections, emergency surgeries – and many others who have lost family members to illness; it has a way of changing your outlook. 

If you’ve had the same experience and have created art from it-a quilt, a photo, a poem, a story-or you have found somebody else’s art which helped you through it, please share!  Email me (rentel.7@osu.edu) or post a link in the comments.  I’d love to hear from you.

Victoria Rentel, MD

Cool Programs and Awesome Give-Aways for Sexual Violence Awareness Week!

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www.silc.ku.edu

In recognition of Sexual Violence Awareness Week, there will be a bunch of cool programs on campus this week to promote safety and support for students.  There will be tons of free give-aways, food, music, movies and more, so bring your friends and have a great time while you learn how to keep each other safe!

Here is the schedule for the week.  For updated information visit the Student Wellness Center website, email sves@osu.edu or call 292-4527.

TODAY

Kick Off Festival:  Music!  Food!  Prizes!     12noon – 3pm   Ohio Union Lawn

Music, tie-dyeing and other fun events will be held to help raise awareness among students about the issue of sexual violence and week of scheduled events.

When Love Turns to Fear  7-9pm   Ohio Union Ballroom, 2nd Floor

Author Lundy Bancroft will discuss intimate partner abuse, and answer questions such as: What does it look like?  What can you do? This presentation will be helpful to students who have experienced intimate partner abuse or know others who have.  Bancroft will offer information concerning:

  1. The early warning signs of an abusive relationship
  2. Different styles of abusers, how they differ, how they are similar
  3. How to tell if an abuser can change, is changing, or ever will
  4. The role of drugs and alcohol in an abusive relationship
  5. What can be fixed, and what can’t
  6. How to leave a relationship safely: Resources on Campus
  7. Specific safety challenges for intimate partner abuse among college students 

TUESDAY, APRIL 20th

T-shirt making for Clothesline Project  9am-5pm  Student Wellness Center, RPAC

Create a t-shirt design reflecting an experience of sexual violence, healing and recovery. These t-shirts become part of the OSU “Clothesline Project”: a visual awareness-raising display. 

T-shirts and supplies are furnished, or you can bring your own t-shirt.  T-shirts will be displayed on the Oval on Wednesday, 4/21/2010.  The OSU Clothesline Project is displayed every year at the Annual Take Back The Night March and Rally, and at other events.

Options Following Sexual Violence:   Civil, Criminal and Student Judicial Affairs   12:30-1:30pm  Sphinx Suite, Room 2150, Ohio Union 2nd Floor   

Options following an incident of sexual violence (i.e. sexual assault, intimate partner abuse and stalking) will be discussed during this panel presentation.   Representatives from the Capital University Law School’s Family Advocacy Clinic, the Franklin County Prosecutor’s Office Abuse Unit, and OSU Student Judicial Affairs will offer information and answer questions.  Specifically, the criminal justice process, stalking order process and Student Judicial process will be discussed.  This presentation is designed to answer questions for attendees, as well as to provide an overview of the related processes.

Stalking 101   2:30-3:30pm  Dave Griner Room, RPAC

Learn how to identify and respond to stalking behavior.  An officer from the OSU Division of Police and the long-term advocate at the Student Wellness Center will present on what stalking may look like for college students, options for addressing the unwanted behavior and safety planning.  This workshop would be especially helpful for any student who is wondering if they, or someone they know, is experiencing stalking.

White Ribbon Campaign:  Men Working to End Violence  10am to 2pm   Oval, RPAC pavilion

The white ribbon campaign is an international awareness effort to demonstrate men’s commitment to ending sexual violence.  Men will be passing out white ribbons and providing information about sexual violence.   This event is designed to help men become involved and raise awareness about how sexual violence is not just a “woman’s issue” it’s an issue for everyone.

Tough Guise:  Men and Masculinity   7-9:30pm   RPAC Meeting Room #2

A video and presentation will be shown to encourage discussion of masculinity and hyper-masculinity, and how they intersect with sexual violence.    

WEDNESDAY, APRIL 21st

Clothesline Project on the Oval   12noon – 3pm

T-shirts made by OSU survivors and co-survivors will be displayed on the Oval.   Peer crisis intervention support will be provided in case someone needs to talk about their reaction to the t-shirt display.   

Consent Workshops  4:30-5:30pm   Sphinx Suite, Room 2150, Ohio Union, 2nd Floor

What is consent and how do I get some?

Members of the student groups, Women and Allies Rising in Resistance and Student Support for Survivors, will lead a discussion about consent to sex, and the factors that affect our ability to give and receive consent to sex. 

THURSDAY, APRIL 22nd

Sex in the Media  11:30am-12:30pm Barbie Tootle Room, Room 3156, Ohio Union, 3rd  Floor   

Nicole Nieto from the Multicultural Center will offer information and lead a discussion of how sexuality is portrayed in the media and how this portrayl may impact sexual violence.

Root Beer Pong  1-4pm  Oval

Students will have fun while learning about the connections between alcohol consumption and sexual violence.

Crossing Intimate Partner Lines:  People of Color and Intimate Partner Violence  2-3pm  Multicultural Center Lantern Room, Ohio Union, First Floor

Inter-cultural specialists from the Multicultural Center will lead a discussion about the occurance of intimate partner violence in communities of color. 

Violence in Same Sex Relationships  2:30-3:30pm  Dave Griner Room, RPAC

Violence can happen in all kinds of relationships.  Gary Heath from the Buckeye Region Anti-Violence Organization (BRAVO) will offer information about violence in same sex relationships. 

Healing Event for Survivors and Co-survivors   6:30-7:30pm  Dave Griner Room, RPAC

Activities are planned to help participants express their feelings surrounding sexual violence.  Survivors and Co-Survivors of Sexual Violence are invited to attend this healing experience.

Candlelight Vigil   8:30-9:30pm   RPAC Pavilion

The candlelight vigil will follow the healing event for survivors and co-survivors.  However, it is open to anyone who wants to participate in a symbolic act to show our unity.  Sexual violence affects everyone and, at the Ohio State University, we have pledged and proclaimed our desire to end sexual violence.  This event will help recognize our shared goal and provide an opportunity for reflection on the week of events.

FRIDAY, APRIL 23rd

Free showing of “Precious: Based on the novel Push by Sapphire”   7-9pm   Hagerty Hall 180

This movie depicts a survivor’s story and if you’ve wanted to see it, this can be one way to watch it in good company. Students are encouraged to come and bring a friend.  Advocates will be available, if participants need to talk.

SATURDAY, APRIL 24TH

Spring 2010 Power Puff Championship Game  3:30pm (after the Buckeye Spring Game) on turf field behind RPAC.    Playoff games on 4/13 and 4/23. 

Keep your passwords locked up tighter than a chastity belt

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babble.com

In the next quarter or two (or thereabouts) – you will be able to communicate with your health care provider at the Student Health Center via a secure emailing system.  Some of you might already see non-SHS physicians who communicate by email, or have set up secure access to your health information on-line; under the recently passed healthcare reform bill there are incentives aimed at driving all healthcare systems and providers to get your information wired.

In this brave new world, there are all kinds of important security considerations to consider as we move to an all electronic health record.  What if the power goes out?  What if the server goes down? What if that server is hacked?  Who can and can’t have access?  Health care organizations and providers are really struggling with these questions – and many more – as we try to figure out how to migrate your records from paper to pixels.   

Frankly, I’m not completely comfortable with the thought of my personal health information floating around in the clouds, and I’m online pretty much 24 hours a day. I mean, my Visa card information has been has been out there for years… and has been stolen four times in the last six months! (Although I refuse to shut down my Amazon shopping habit – that’s just letting the bad guys win).  My own wonderful doctor has put my info out there on her electronic record.  It’s about as interesting as a shoe box, but still.

With all this in mind, I chanced (via Lifehacker) on a most sobering article:

How I’d Hack Your Weak Passwords | One Man’s Blog

No matter how many real and virtual security guards there are between the world and your health, banking, social, shopping or other personal online information, it’s only as good as your lamest password. Seriously, read the post. Consider that the difference in hackability between a six character lowercase password and an 8 character mash-up is measured in CENTURIES.  And that your email account can be a freeway that exits straight into your bank account. Jeepers.

Must. Change. Password.

Victoria Rentel, MD

My boyfriend is a med student – can he see my personal health information?

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examiner.com

Q:  My boyfriend is a medical student.  Can he see my Electronic Health Record?  How would I know?

A:  This is an excellent question, and very timely since this week is Health Information Privacy and Security Week.  (No, I’m not kidding.  Seriously… who comes up with these things?)

Anyway, the answer is a resounding NO, he could not access your personal health information at the Student Health Center.  From a technical standpoint, our EHR system is separate and unconnected to the Medical Center’s, so our records are not accessible to people using the medical center system, like your boyfriend. 

But let’s say you saw a doctor at the medical center, or you got really sick one night and ended up in the ER, or your boyfriend did a rotation with us at the Student Health Center.  Technically speaking, he could access your health records, but he would be risking serious trouble if he did.

There is a federal law called HIPAA (Health Insurance Portability and Accountability Act) that contains privacy and security regulations to protect patient health information.  The HIPAA privacy rule contains a very important standard called Minimum Necessary – healthcare providers may only access personal health information that is necessary to their job.  So your boyfriend could only access your health records if he was directly involved in your care.

If he just snoops around in your chart because he was curious – he’s breaking the law.  If you ask him to check your records to see what the doctor said about you or to get the results of that scan you had at 3 in the morning that you can’t remember because you were puking your guts out – he’s breaking the law.  Let me put it this way.  If he was seen as a patient at the medical center and looks at his own health records, he’s breaking the law.  Unless it’s necessary for him to do his job, he can’t do it.

But let’s say that despite all of these legal and ethical restrictions, your boyfriend just can’t help himself and peeks into your electronic health record.  How would you know? 

The Security Rules of HIPAA require that healthcare organizations monitor the security of consumer personal health information.  Both the medical center and Student Health Services utilize tools that report each and every individual who accesses a patient’s health record.  If we (or the medical center) discover an unauthorized access to your health information, we are required by law to notify you and the Department of Health and Human Services. 

All health care professionals – including medical students – take this stuff very seriously so I’m sure you have nothing to worry about when it comes to your boyfriend checking out your electronic health record.  Now when it comes to him checking out the sunbathers on the Oval, you’re on your own…

Melissa Ames, RHIA, CHPS 

Health Information Manager, Ohio State Student Health Services

So how do I get rid of warts?

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Mediplast - click to enlarge

daddytypes.com

Q:  So how do I get rid of these warts?

A:  In my post last week, I hopefully reassured you that you don’t have to worry about warts on your hands spreading to more sensitive areas.  Now let’s talk about what you can do to get rid of those annoying little suckers!

Cryotherapy:  This is the granddaddy of wart treatments.  We soak a cotton swab in liquid nitrogen and apply it to the wart to freeze it and the surrounding skin.  You can get an over-the-counter kit to do this yourself but they’re kind of expensive and we can usually do a better job for you.  About 75% of warts clear with liquid nitrogen therapy, but it often takes at least a couple of treatments spaced a few weeks apart to get the job done.  It stings a little but the freezing kind of numbs the area so it isn’t too bad; most people get some redness and irritation for a few days afterwards, but it’s pretty mild.

Salicylic acid: There are a lot of over-the-counter (OTC) salicylic acid preparations available out there – Compound W is probably the most recognizable brand name.  The Student Health Pharmacy also has a plaster (MediPlast) that is a lot stronger and more effective for tougher warts and those in areas with thicker skin, like plantar warts.  They are available without a prescription and cost less than 2 bucks each.  They’re about the size of an index card – you cut off a piece big enough to cover the wart, peel the paper off the back, stick it onto the wart and leave it on for 24-48 hours.  You can cover the plaster with a piece of tape to hold it in place if necessary.  You peel it off and then scrub away the dead skin and repeat the process until you get to the bottom of the wart.  It may take a few weeks, but is also about 70-80% effective at cure.

Squaric acid: The new kid on the block for wart treatment at SHS is squaric acid.  It is a 0.2% liquid compound that you apply directly to the wart once a week for 6-8 weeks, leaving it on for 24 hours at a time.  How it works isn’t exactly known, but it sensitizes the skin and stimulates the immune system to attack the wart.  There isn’t a lot of research into how effective it is compared to other treatment options, but in my limited experience with it, it has been effective when other treatments failed.  It requires a prescription and is also inexpensive. 

Duct tape: People have been using good old fashioned duct tape to treat warts for a long time.  Medical researchers have actually looked into this and some studies found it to be effective while others didn’t.  The best I can tell you is if you’re going to try it, use the silver form of the tape since the rubber-based adhesive sticks to the skin better (unless, of course, you’re allergic to latex).  The studies that showed benefit had people leaving the tape on for 6 straight days, then removing it, soaking the wart and scrubbing away the dead skin.  The process was repeated until it was gone.  You can apply a 17% OTC salicylic acid to the wart before covering it with the duct tape but if you do, remove the tape and check the wart every 24 hours since this increases the chance of having a more severe reaction.

There are a few other options out there which we can discuss with you, but those are the biggies.  If you’re having trouble with warts, or any other skin problems, come in to see us at Student Health – we’re happy to check it out!

duct tape photo: daddytypes.com

mediplast photo: concentric.net

John A. Vaughn, MD
Student Health Services
The Ohio State University

Should I always see the same provider at Student Health?

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cardiophile.com

Q: Why do the appointments people always try to get me to see the same provider?

A: While familiarity might breed contempt in family and friends, it breeds better care from your doctor.   

To do my job well, I have a bunch of balls to keep in the air. First, there’s sorting out whatever brought you in for an appointment.  You tell me this, I ask about that. I listen to this, poke that, move another thing, gathering as much objective information as I can to figure out what is wrong and how sick you are. This is usually the most straightforward part of an appointment. 

I also have to cover historical information. Your past medical issues, your family history, medication history, tobacco use, surgeries, etc. The first time I see you this can take a while.

I’m also trying to figure out you. This is hard work, as I have a limited amount of time at any one appointment. Who are you? Where do you live? Who do you live with? Where do you come from? What has your experience with healthcare been? Are you formal or casual? Big words or a minimalist? Native English speaker?  Nervous? Relaxed? Suspicious? Assertive? Informed and interactive? Taciturn or frightened? The more I know about who you are, what you bring to the table, and how you think, the better I’m able to tailor an effective treatment plan and sell it.

Now, this might not all seem relevant for a sore throat or an ankle sprain – and it might not always be.  But I can’t become a “you” expert in one appointment; I pick up clues over many visits. Sure, your visit today for a runny nose might be easy, but I used the time to dig into how stressed out you are about your research, which helps me in a month when your hair is falling out or you can’t sleep. Once I really get to know you after that first information-intensive appointment, little nuggets of useful, often vital contextual information fall like raindrops in a thunderstorm.

Care with the same provider is usually more efficient. It saves both of us time if you don’t have to answer the same 8 billion questions about medication reactions, chronic health problems, etc.  I can really dig into the problem at hand, whether it is a cough that just won’t go away or diabetes that you and I have been beating into submission over years. 

Of course, I’m not here all the time. I, like you, am a mere mortal and have been known to get sick and take vacations. For self-limited problems-ankle sprains, the occasional cold, rashes-it’s okay to see somebody else in a pinch.  Occasionally it’s even helpful to have a fresh set of eyes look and think about complicated problem.  But in general, even though any other health care provider can open your chart and meet the “virtual” you, it won’t compare to how well I know the real thing. 

Victoria Rentel, MD (OSU SHS)

Last chances for free and confidential STI testing through Student Wellness and Columbus Public Health!

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The Student Wellness Center and the Columbus Public Health Department will offer walk-in STI testing two more times this quarter:

On Tuesday, February 16th from 4-7pm: free, walk-in HIV rapid testing using the oral swab specimen will be available.  ONLY RAPID HIV TESTING WILL BE AVAILABLE ON THIS DATE.

On Thursday, 18 February from 4-7pm: In addition to the free, walk-in HIV rapid testing (oral swab) offered by Student Wellness, Columbus Public Health will offer free and confidential testing for Chlamydia and Gonorrhea (urine sample) and syphilis (blood draw).

Both events will be held at Hillel (46 E. 16th Avenue).  Click on the map at right for a larger view.

If you have any questions, please feel free to contact the Student Wellness Center at 614-292-4527 (2-4527 from a campus phone).

If you are unable to attend these sessions, confidential and comprehensive STI screening is always available by appointment at the Student Health Center.  The Comprehensive Student Health Insurance Plan pays for STI screening once a year.  If you have another insurance plan, you can check with them for coverage.  Call 614-292-4321 to make an appointment.

John A. Vaughn, MD

Get Prepared for Life After College!

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From Classmates to Colleagues: Come gain the knowledge that will help you get a job!

University Career Services Committee, the Student Wellness Center, Office for Disability Services, and The Alumni Association are sponsoring a free event for anyone who wants to prepare for a job or internship.

You will have the opportunity to meet with recent alumni, wellness professionals, and career experts to assist you with life after college transitions, particularly in light of the changing economy. You can attend workshops that address managing finances, coping with life after college challenges, marketing your college experience, finding alternatives to 9-5 work, and learning how to network. Additionally, a resource room will be available for you to get free resume critiques, access to helpful career handouts, and meet representatives from a few organizations in the community.

WHEN: Monday, February 22, 2010 from 4:30PM-8:00PM

WHERE: 3rd Floor RPAC Meeting Rooms

FOR MORE INFO: website and Facebook page and attached flier (click on link at right to open)

There is limited seating for the workshops so please plan to arrive early!

Business Casual Dress Recommended!

Kiss Me Deadly!

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click to enlarge

Q: Can someone who is allergic to a food die from kissing someone who just ate that food?

A:  A few years ago, there was a big story in the news about a woman with a peanut allergy who supposedly died after kissing her boyfriend who had just eaten a food with peanuts in it.  It turns out that this was more of an urban myth – the woman actually died of another cause, but I guess the idea of a “deadly kiss” was too good of a story to pass up.

We just heard a presentation from the allergy experts at Nationwide Children’s Hospital and they did tell us stories of moms who just ate a Reese’s Peanut butter Cup giving their child a big hive on their cheek after kissing them, and people walking into a restaurant with peanut shells on the floor (like 5 Guys Burgers and Fries) and just the peanut dust in the air causing them to have a wheezing reaction.  The key factor is the amount of protein you’re exposed to.  So theoretically if you’re boyfriend just ate a whole handful of peanuts and you guys immediately start playing some serious tonsil hockey, you could be in trouble.  But to date no one has been kissed to death.

However, food allergies – especially to peanuts and shellfish – can be life threatening so it is absolutely (and literally) vital for you to be careful.  If you’re allergic to peanuts or other tree nuts, you should:

  • Avoid bakeries, ice cream parlors and Asian restaurants
  • ALWAYS ask about food ingredients and read labels when eating food you didn’t prepare
  • Wear a bracelet or necklace that identifies the type of allergy you have
  • Have an EpiPen with you at all times and make sure you know how to use it! (I’ve taken care of more than one person who in the heat of the moment held the pen backwards and injected their thumbs, and since epinephrine makes blood vessels constrict that makes for a nervous 20 minutes waiting to see if the blood flow returns to the digit).

The Food Allergy and Anaphylaxis Network has a great website with more information about food allergies.  In addition, allergy testing services are available through the Wilce Student Health Center.  If you have any questions or concerns, call us at 614-292-4321 to schedule an appointment. 

John A. Vaughn, MD (OSU SHS)

photo: mediabucket.com

Can we link our student health records with online personal health services?

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Q:  Can we link our health records at the student health center with Google Health or other online personal health services?

A:  Great Question!  Seems pretty straightforward, right?  Student health keeps its records in electronic format, Google Health is all about health records in electronic format, so let’s just get ‘em talking to each other!  If only it were that easy.

While Google Health is probably the most well known, there are actually many players in the Personal Health Information (PHI) market.  Each of these systems offers you a way to store your health information in one location and they all claim that this will allow you to have your information automatically updated from doctor offices, hospitals, pharmacies and more.  AND they all say that it will be easy.  It’s not. 

Each of these vendors has its own way of doing things.  In order to transfer information to one of these systems, Student Health would have to: make sure you are who you say you are, extract your health data, modify it to look the way your specific PHI needs it to look, and finally upload the information to the PHI system via a secure channel that is compliant with HIPAA, the federal law that enforces strict privacy of your personal health information.   

But while we aren’t likely to be linked up with Google Health any time soon, we are working on some pretty tech-savvy things that will be implemented in the very near future.  The most exciting is our new health portal, which will allow you to:

  • View and print your immunization record
  • Schedule your appointments
  • Send and receive secure messages to/from your provider

We’re really psyched about that last feature.  No more playing phone tag with your provider to get your lab results!  They’ll be sent to you via a secure message to which you can reply and ask questions at your convenience.  And that, my friend, is something even the mighty Google can’t do!

Tina Comston, Systems Specialist (OSU SHS)