Month: October 2021

Do you use water/stain-resistant products and clothing? You could be exposing yourself and others to persistent, harmful chemicals… And since some products that contain these chemicals don’t say so on the label, you could be completely unaware they are there.

Per- and Poly-Fluorinated Alkyl Substances (PFAS) are a newer class of chemicals used to make products resist oil and water. They’re supposed to be safer than the older PFOS (Perfluoro Octane Sulfonates) like Teflon and Scotchgard. But are they?

These chemicals have been detected in over 98% of blood samples of tested Canadians and are showing up in the environment, sometimes in levels high enough to harm wildlife (and us!). And some of them disappear quickly from the blood but are stored in organ tissues (such as lungs). Researchers are learning how they disrupt our hormones and immune systems…

What are PFAS chemicals?

The PFAS class of chemicals are used to waterproof fabrics and clothing; to stain-proof fabrics, carpets and furniture; in coatings for non-stick pans; to keep food wrap paper from soaking up grease; for water-resistant cosmetics, and in fire-fighting foams.

The chemicals are only loosely attached to fabrics so are often detected in measurable amounts in house dust. They are persistent and mobile: they do not break down for decades and travel easily in the atmosphere. They concentrate in animals high in the food chain, resulting in higher levels in larger animals and humans as we eat contaminated food. Levels gradually increase over time from these low-level exposures, because the chemicals are not eliminated from our bodies or broken down over time.

What do PFAS do to us?

There are over 5,000 different PFAS chemicals that have been synthesized. The harmful effects vary, but some are known to either block or mimic our hormones, and inhibit the effectiveness of our immune systems. Sadly, these chemicals have been presumed to be safe, partly because they are so stable. Like cigarettes, the burden of proving they are harmful falls to governments and environmental groups, rather than requiring the companies who manufacture them to prove they are safe long-term.

One early sign there was a problem was when an increase in cases of breast cancer in women and testicular cancer in men were noted in firefighters regularly exposed to high levels of PFAS in firefighting foams. As well as exposure while putting out fires and during training, their protective equipment often contains similar chemicals, so they were being exposed to these chemicals more than most. “Canaries in the mine…”

Other diseases and conditions have also been found to be associated with exposure to these chemicals, too. Some of these include:

· increased risk of prostate, liver and kidney cancer,

· ulcerative colitis (inflammatory bowel disease),

· increased blood cholesterol,

· increased blood pressure during pregnancy,

· thyroid and other hormone changes,

· early menopause,

· decreased birth weight in babies,

· decreased fertility,

· changes in bone density, and

· Type 2 diabetes.

A 3M sponsored study in the 1970s showed this type of chemical could decrease immune response in monkeys, and another at Harvard University in 2015 showed the same in humans. A 2015 study in children demonstrated that higher levels of PFAS in the blood were associated with a decreased immune response to vaccines.

Ongoing studies report that patients with higher levels of PFAS, especially one known as PFBA that deposits in lung tissue, tend to have worse outcomes from COVID-19 infection. The fact that men and older individuals tend to have higher levels of these chemicals may explain the increased risk these groups have of more severe COVID infection. Note that PFBA was thought to be safer because less was detected in the blood, while instead it was being pulled directly into the lungs where it appears to be having a local effect in lowering the immune response there.

CEPA, the Canadian Environmental Protection Act, was written in 1999 and is now outdated. It needs to take into consideration newer studies, vulnerable populations (like those working in the industry), those who live near hot spots (like previous spills or plants that create or use these chemicals), possible contamination of food by packaging, and babies born to mothers who are affected. PFAS and the similar, older PFOS are excreted in breast milk and can result in babies having 10 times the level of the mother, at a crucial time in the development of the immune system.

Older chemical safety tests generally consisted of a 1-time high dose test in an animal, but what about chronic low dose exposure? Because these chemicals do not break down and are stored in body fat, they accumulate in us over the years. Chronic low dose exposure is now considered more harmful than a single large dose exposure, in which the body appears to have a better chance of eliminating the chemical. These kinds of exposures need to be tested, too, before deciding a chemical is safe.

Although none of these chemicals are currently manufactured in Canada, according to a report I read, they are found in products we import. A recent CBC Marketplace investigation found 1 in 5 imported children’s clothing items they examined contained elevated levels of harmful chemicals, including PFAS, lead and phthalates (chemicals used in plastic that can contaminate the product packaged in it). On a positive note, all the companies were contacted and immediately removed the affected products from sale. They also committed to examining their supply chains for other harmful products.

Meanwhile, like PCBs and dioxins, these chemicals appear to be concentrating in the North. They travel easily through the atmosphere, enter the food chain there and concentrate in larger animals, like seals and polar bears… and humans.

Chemicals are too often considered safe until proven dangerous. Even with evidence, laws are slow to change. We saw this in the many years it took for tobacco to be considered a harmful substance (and it is still being sold today for daily use!). Because of their persistence and stability, we will continue to be exposed to forever chemicals like PFAS for many years after they are finally banned from use.

Current regulations need to be updated, and safety testing must improve to protect us from potential harm from newly synthesized chemicals. It’s just not acceptable to allow persistent substances to be sold with insufficient testing, only to discover the harm they cause after years of exposure to the public. Full labelling of chemicals added to products needs to be required.

So, how can you avoid these chemicals?

Be suspicious of any product that is water, grease, or stain resistant. These include food packaging, rain gear, waterproof cosmetics, stain resistant carpets and furniture, and non-stick pans. I’m choosing to cook in stainless steel and cast-iron pots these days!

References:

A new class of ‘forever chemicals’ is an emerging threat to our health and environment—CBC Radio series: Quirks and Quarks episodes on Oct 9, Oct 23 and Nov 6, 2020 (find it on the CBC Listen app)

Experts warn of high levels of chemicals in clothes by some fast-fashion retailers—CBC News Marketplace

PFAS exposure linked with worse COVID-19 outcomes—Harvard T.H.Chan School of Public Health

Severity of COVID-19 at elevated exposure to perfluorinated alkylates—PLOS ONE

Photo by Alex Kondratiev on Unsplash

#ForeverChemicals #PFAS

For most of us, “hypnosis” brings to mind a stage show where people are made to do silly things by a hypnotist. But any hypnotist will tell you the participants do these things willingly, eager to be part of the show, and that they can’t really hypnotize anyone into doing something they don’t want to do. They’ve all had skeptics who just sat on the chair, wanting to prove hypnosis doesn’t “work”.

But the Practical Pain Management website tells us that “Hypnosis is a cognitive (mental) process such as imagination in which a patient is guided to respond to suggestions for changes in perceptions, sensations, thoughts, feelings, and behaviors. It involves learning how to use your mind and thoughts to manage emotional distress (such as anxiety), unpleasant physical symptoms (such as pain), and certain habits or behaviors (such as quitting smoking). People can be trained to self-hypnotize, guiding themselves through a hypnotic procedure.”

You could think of hypnosis as a combination of the placebo effect, meditation and positive affirmation. When we focus on something positive we want, eliminating other thoughts, we can encourage our subconscious mind to help us work toward our goal.

Placebo effect

With the placebo effect, believing that a medication or treatment will work activates the immune system and when they work together you can expect a better result. All valid drug trials are required to compare the medication to a placebo, and it is the difference that shows the effect of the drug. The placebo effect can be as high as 90% for some treatments, for example tension headaches. This is an example of how influencing the mind can have physical effects.

Pharmacist, Émile Coué (1857-1926), noted that more of his patients got better when he praised the effects of the medications he dispensed, than when he did not. Today, pharmacists are taught to always share the benefits of a drug before talking about the side effects to promote a positive attitude toward the treatment.

Meditation

Relaxing the body and clearing your mind, focusing on pleasant thoughts and images, and “mindfulness” techniques of focusing on the present (rather than dwelling on the past or worrying about the future) are techniques used in inducing a state of hypnosis that are similar to meditation.

Positive affirmation

Seeking help from a professional hypnotist to change a habit—for example quitting smoking—can help you bolster your determination to succeed. One technique used is to repeat a statement of the result you want, for example “I am a non-smoker” to change your beliefs deep in your sub-conscious. Of course, if you really don’t want to quit, the hypnosis just won’t work. You need to want the change and be ready to do what it takes. Hypnosis just helps increase your determination and belief that you will succeed.

So, what about self-hypnosis? Do you need to worry that you won’t “wake up”? When can it be useful? Is it difficult to do? I was curious, so I decided to read about it. Here is some of what I learned…

Hypnosis has been used as a medical treatment for centuries. The name comes from the sleep temples, or “hypnos” used by the Greeks to treat ailments. Imagery (picturing yourself on a beach), chants, drumming and dancing rituals while focussing on a goal could all be considered forms of hypnosis. However, it is less well-known than other alternative therapies, as most medical schools do not include it in their curricula.

It can be used to provide analgesia, reduce stress, relieve anxiety, improve sleep, improve mood, and reduce the need for strong pain medication such as opioids. It is not recommended for anyone with a severe, untreated psychological disorder, those under the influence of recreational drugs or alcohol or a person who has delusions or hallucinations at the time of treatment.

Hypnosis by a professional achieves its goals more quickly than trying to do it by yourself. If you are wanting to help address a more serious issue or habit, it’s the way to go. But for simpler goals, it might be worthwhile giving self-hypnosis a try. There are several techniques that can be successful, depending on the person. Professional hypnotists will sometimes teach patients self-hypnosis or provide recordings to continue the benefit of treatments between appointments.

We know that anxiety can increase pain perception and that distraction can reduce it. I used iPad games for years to reduce the pain of injections I was giving to children. Even a simple “Take a deep breath” was often enough of a distraction to help adults feel less needle pain. Closing your eyes and picturing yourself on a beach (or wherever your favourite vacation place might be) can help you reduce anxiety, decrease pain or fall asleep more quickly. Our dentist even has a TV mounted on the office ceiling for distraction!

So, I can understand how hypnosis can be beneficial. You’re basically learning to distract yourself and replace negative thoughts with positive ones more effectively. So, I gave it a try… but I found it was harder to achieve pain reduction than I thought it might be. Apparently, it takes practice!

But, several methods are suggested, and some work better than others, depending on the person. Here are some basic strategies used by professional hypnotists:

1. Autosuggestion—This is repeating suggestions to yourself, while closing the eyes to decrease other sensations and distractions

2. Autogenic training—This involves learning to create physical change from within, with the use of meditation, visualization and the mind’s ability to control the autonomic (“automatic”) nervous system that controls the body functions we don’t think about, like blood pressure, heart beat, reaction to stress, etc.

3. Progressive muscle relaxation—Consciously tensing then relaxing muscles (for example, from head to foot) helps reverse unconscious muscle tension, inducing relaxation.

4. Mindfulness—Focusing thoughts on the present with no worry about the past or anticipation of what the future holds. Focusing on the breath can be used to relax, clear and focus the mind in preparation to receive desired suggestions.

Steps used in hypnosis:

a. Induction of a trance or focus—guiding or being guided to focus your attention. Note that a trance state occurs any time you are selectively focused so deeply on something that you block out other sensations and stimuli.

b. Deepen focus—increasingly relax and focus your mind on the task you want to accomplish. Assistance from a professional would be helpful in this stage.

c. Auto-suggest (make a positive suggestion to yourself)—Make suggestions for the outcome you want to align your actions with your desires. For example, say “I am a non-smoker” rather than “I want to quit smoking”. This can be done by using a recording of your voice or by speaking to yourself repeatedly. Identify and write or record your mantra before you begin.

d. Termination—in self-hypnosis, you are always awake and can end the session whenever you choose.

A session with a professional hypnotist may have several more steps than this. Most are trained psychologists who explore your underlying issues before beginning and combine hypnosis with other psychological techniques. Therapists will often teach clients self-hypnosis so they can continue the benefit between treatments.

When training patients to perform self-hypnosis, some hypnotists will suggest placing a reminder in a prominent place, for example, writing your mantra with dry-erase marker on the bathroom mirror or on a sticky note on the edge of your computer screen. I like the mirror idea as it would remind you every morning and evening, ideal times to set your mood and intentions for the day, and to relax you for a good night’s sleep…

One hypnotist-author whose work I read suggests following the P.O.W.E.R. acronym to organize a self-hypnosis treatment:

P—Present. Don’t worry about the past or the future. Allow your mind to only consider the present.

O—Open your mind to using your internal creativity and intuition to solve your problem.

W—Written affirmation. State the change you want to accomplish and 1 to 3 actions that will make this happen.

E—Explore. Spend a few minutes exploring the benefits of embracing and achieving your affirmation.

R—Ratify. Commit to the outcome in your affirmation. Lock your mind around it. Put the idea of success exclusively in your mind.

Biofeedback

There is another similar technique, called biofeedback, that uses instruments (for example a blood pressure cuff) to motivate and confirm the patient’s success in influencing actions that are under the control of the autonomic (subconscious) nervous system. Studies have found people can be taught to lower blood pressure, slow heart rate, reduce anxiety, increase blood flow to certain areas of the body, and modify other similar parameters using various instruments as an external source of motivation rather than an internal one as with hypnosis. Since the instruments also confirm success, biofeedback is considered more scientific by some people than hypnosis, but the processes are actually quite similar.

The bottom line…

Self-hypnosis can only do what is physically possible. For most people, it should be regarded as an “add on” to other standard treatments, not as a substitute. And it takes practice. As I read various articles plus a book about hypnosis over the past couple of weeks, I tried some of the techniques. The best I was able to achieve was a slight and very temporary reduction in pain, so I won’t be throwing away my Tylenol any time soon! But I could see that hypnosis could be helpful in some situations, and the benefit of consulting a professional if you are serious about learning self-hypnosis. I also learned you would need plenty of practice to achieve lasting benefit.

PS: The “mandala” drawing above is a relaxing, meditative form of art that I learned this summer… a Zen combination of drawing, colouring and meditation!

References:

Hypnosis: Tool for Pain Management—Practical Pain Management

The Seven Most Effective Methods of Self-hypnosis: How to Create Rapid Change in your Health, Wealth, and Habits—Richard K. Nongard, Certified Professional Hypnotist

Biofeedback—Mayo Clinic

Chronic back pain: Can psychological therapy be an effective treatment? Medical News Today

After my “Falling through the cracks” blog a couple of weeks ago, I received a lot of comments and notes from people who have experienced healthcare hiccups like I have. One reader shared two excellent suggestions to add to my list, based on her experiences, that hadn’t occurred to me when writing. I thought they were worth sharing…

1. Don’t self-diagnose. Give all your information to your doctor (don’t hold anything back that might be relevant!) and get a diagnosis from a professional.

Many of us turn to “Dr. Google” when we have symptoms (I’m guilty of it too!) but, of course, there’s a lot of misinformation out there. And even if you’re reading a reputable website, it often takes background knowledge and expertise to interpret your symptoms– that’s why your doctor’s training and experience are so important. They know the questions to ask to rule out that disease you’re worried about, or to suspect a condition unfamiliar to you. Sometimes a test or physical examination is needed to find what is wrong.

I have seen the recommendation, though, that if you suspect you have a particular medical condition, you should mention it to your doctor, whether it’s something you’ve had previously, you know someone with the condition, or it’s just something you’ve just read about. Your doctor will explain why they know your problem isn’t what you suspect (putting your mind at ease!) or, especially if it’s a condition you’ve had before, they might consider it in their search for a potential diagnosis.

I recall an elderly gentleman years ago, asking at the pharmacy counter where he might find the non-prescription muscle relaxant tablets. As I escorted him to the shelf where the product was displayed, he grumbled that he wasn’t confident in the young doctor who had recommended this treatment… he’d had back pain for years and “knew” it was arthritis. Apparently, he didn’t think it was important to inform the doctor of this. And the young physician, obviously, didn’t ask about the duration of the pain. Diagnosing is like solving a puzzle, and every piece of information is important!

2. If you are not getting results with your doctor and your symptoms are getting worse, head to the emergency room (or local after-hours) for a second opinion. Be sure to tell them all details of treatments you’ve tried thus far.

You know the saying: two heads are better than one. And, in medicine, knowing what treatments didn’t work also helps to find the correct diagnosis. So, even returning to your own doctor when a treatment doesn’t work, will help her figure out what’s causing your problem.

But doctors do put their heads together to discuss patients who aren’t improving as expected with treatment. In hospital, they call these meetings “grand rounds” and the meetings include many different health professionals, all sharing their expertise and suggestions for treatment. In an ideal world, this would happen in community medical clinics too. A goal to strive for!

But it can sometimes take time to get an appointment with your family doctor – they have many patients to keep up with and personal lives too. And some offices are better at triaging who needs to be seen sooner than others and keep slots open for those who shouldn’t wait to be seen.

If you are in immediate distress, for example with severe pain or difficulty breathing, the emergency department is the place to go. Or call an ambulance if it might be life-threatening, especially if you live a distance from the hospital. Often the ability to conduct blood tests or scans can take a lot of the educated guesswork out of diagnosing the problem on the first try. However, booking a follow-up appointment with your doctor later will ensure they know about new developments, and they will be able to monitor the results of any prescribed treatment.

Knowledge is good

Of course, knowledge about any medical condition you have is a good thing. If you do decide to learn more about a disease you have, ask your doctor to recommend a source of information. There are often non-drug approaches you can incorporate into your lifestyle that can improve your condition or reduce the risk of it developing again. Websites hosted by established medical clinics, universities, government, and medical schools are generally based on science, and monitored and updated regularly. National health organizations (for example, a national diabetes association, if you are diagnosed with diabetes) often provide good quality patient information that is easy to read and understand. If you are unsure of the validity of any information, ask your doctor to confirm that it is correct and applies to you.

Most high-quality websites will show the references used to supply information for the article. You have probably noticed that I do this most of the time (apart from opinion articles and those based on personal experiences, when I will be clear that is what the article is). In fact, when I read an interesting health-related article, I also look up the original references they used to gather information for the article to learn more, as well as to verify their interpretation of the information. I’d encourage you to do the same!

Of course, today’s blog is in the “personal experiences” category so no references. But I will mention a few of my favourite sites… they include Mayo Clinic, Health Canada, British and American government sites, and I love Google Scholar—the search engine that searches published scientific literature. Sadly, more and more articles are now behind paywalls, unlike when I first started using it in the early 2000s. In an ideal world, knowledge would be shared for the benefit of all, enabling better evidence-based decisions and furthering research and treatments.

PS…

So, more good news on a personal level… I won’t have to wait months for treatment as the receptionist warned me I might. Pain has been called the 4th vital sign—it’s important to let your healthcare provider know the level of pain you are experiencing and how long you’ve had it. I think that’s probably what made the difference for me… I have an appointment on October 21st! Just 3 weeks away.

Hopefully I will be able to put all this behind me, but I’ll continue to look for ways to improve our health system and to help others navigate it efficiently. Nice to know it all works when you really need it, though! Communication is key.