Defining success

“Mastering others is strength. Mastering yourself is true power.” -Lao Tzu

As we progress through school and the early stages of our career, the messages we receive from the outside world guide us more than they probably should. At some point, we forget to pause and carefully consider what we actually need and want. We forget to think about what’s in our best self-interest and that of our family, and not just about what’s expected of us. We forget to dream about the impact we want to have in the world and the problems we want to solve. Essentially, we forget to question and reflect.

But, most of us get to a time and place, where we turn off autopilot and realize that our definition of success may be different than what we were told. We start to understand that each person’s idea of success is highly individualized. No one can truly tell us what constitutes a successful existence; we define that for ourselves, and it is an iterative process, changing as we grow. Taking time to reflect on where you are, and asking simple questions about where you’re heading, and where you want to be, can be transformative. 

My current definitions of success are pretty basic, but drastically different from those I used to believe. I used to think that chasing the ranks of my career ladder would strengthen me as a professional. I now believe there is no single ladder that defines a career trajectory. I can create new rungs on this historical career ladder, take steps different than those of my mentors, and still grow exponentially in my work. I used to think titles mattered, and that they magically gave professionals more value. I now know that titles say nothing about the true impact an individual has had or their overall mission. Keeping close guard of my purpose, and continuously redefining what I view as my personal vision are far more useful for helping me achieve real impact than chasing a title. Internalizing external messages, I used to believe my career was about me. Today, I recognize that my career is about the people or issue I serve, and those whom I hope to positively impact or inspire. Success in my career would mean I created something good or made something better. It would mean I made someone’s path easier. Naively, I used to think that I had to make everyone happy. Today, I know that’s impossible. Today, success means that I remain true to my values unapologetically. It means I surround myself with joy, including people who keep me grounded, inspired and in a positive mindset. The real sign of success for me is when days flow with a sense of peace and fulfillment, and I am eager at dawn to get started all over again.

Take time to slow down, and reflect on what your deepest definitions of success truly are. Never stop asking questions, and be aware enough to design your career and life according to your unique definitions of success.

Key molecular regulator of uterine fibroids

Uterine leiomyomas, also called uterine fibroids, are benign tumors that originate from the smooth muscle of the uterus. Fibroids are the most common non-cancerous tumor of the female genital tract, affecting 80% of all women during their lifetime. More than half of women develop fibroids during their reproductive years, often complicating pregnancy. Fibroids are a major source of heavy uterine bleeding, pain, and reduced fertility, resulting in reduced quality of life and significant stress for many women. 

Treatments for fibroids consist of surgery, including hysterectomy or myomectomy, hormonal modulators, such as gonadotropin-releasing hormone agonists, and uterine arterial embolization (UAE), which blocks the blood supply to the tumor. The only true cure is surgical resection, with hormonal approaches and UAE estimated to shrink tumors by 30-40%. Bleeding and pain can also be significantly reduced by these treatments. However, results vary, and many women do not derive benefit from available procedures. Progress in designing new treatments has been slow, largely because we have a poor understanding of the biology of fibroids.

A new study recently identified a molecule that is expressed at abnormally high levels in fibroids. The molecule, H19, belongs to a class of molecules called long noncoding RNAs. H19 was found at increased levels in fibroid tissues from 30 women, including 20 premenopausal, compared with normal uterine myometrium tissues from the same women. High expression of H19 caused fibroid cells to double in number faster, whereas getting rid of H19 actually slowed down growth. Importantly, H19 also drove expression of molecular profiles that have previously been linked to fibroid development and growth. Thus, H19 may function upstream as a key regulator of fibroids. Estrogen and progesterone are thought to influence fibroid growth. This new study showed that combined exposure to estrogen and progesterone increased H19 expression and other fibroid-promoting genes. When H19 was eliminated, the effects of estrogen and progesterone were abolished. 

Although these results are preliminary, they are exciting for several reasons. We know so little about fibroids, and options for women who suffer from this debilitating chronic medical condition are limited. Fibroids receive little attention from the research community. The few studies that have been published in recent years are mostly preclinical in animal models and do not generally include patient samples. This new study used matched human fibroid and normal myometrium tissue from the same patients. This study also explored molecular mechanisms and biology, demonstrating cause and effect and not purely correlative findings.

Further studies are urgently needed to confirm the role of H19 and to identify other major mechanisms promoting fibroids. Identification of key regulators of fibroid development and growth moves us one step closer to understanding this disease and improving therapeutic options for women.

Reference: Cao T et al. Oncogene 2019 May 15

Simple health and wellness: slowing down

“We fear the future because we are wasting the today… Yesterday is gone. Tomorrow has not yet come. We have only today. Let us begin.” – Mother Teresa

The last two posts in this series focused on simple ways to be more proactive about our health. The first post looked at diet and exercise, and the second addressed screening and self-education. This last post is about one central idea- slowing down and being present. 

I was reminded about the importance of slowing down last week. I had volunteered to help a group of young students learn about different local plants. We were walking on a nature trail when a little girl of about 7 years old took a photograph of flowers growing in a field. Looking down at the image on her camera, she smiled and remarked, “Everyone is always so busy; they never get to see all these amazing things.” Her comment caught me off guard. I looked around, taking in the bright colors of the plants and flowers, the sun streaming through the leaves, and the shimmering light from a lake in the distance. I was so focused on making my next point to the students that I had failed to notice how beautiful this trail was. 

There are days, many days, when I know I have been guilty of thinking too much, worrying too much, and letting amazing, beautiful things slip by unnoticed. Ironically, thinking and worrying rarely help any of us reach our goal, whereas being aware and clear-minded usually do. Anxiety and stress not only decrease our productivity and compromise our purpose, they also destroy our wellbeing. Slowing down, paying attention and appreciating what surrounds us is the quickest way to regain perspective and restore  our peace of mind.

Figuring out simple ways to re-center yourself when you are stressed will help create more balance in your life. (1) Breathe. When you become aware of physical signs of stress and anxiety, slow your breathing by inhaling and exhaling deeply. Mindful, slow breathing has an immediate calming effect and is one of the quickest, most reliable ways to reduce stress. (2) Forget busy, and figure out what truly matters to you. Limiting distractions and learning to say “no” will declutter your overly busy schedule. Creating space will allow you to slow down, be present, and spend time on the activities and people you hold dearest. (3) Become reacquainted with nature. Making time to be outdoors every day is fundamental to your health. Nature is one of the most effective healers. Being outside and noticing what surrounds you- trees, communities, schools, people, animals, parks, businesses- will automatically remind you of how much there is to appreciate. 

Life moves at a rapid pace. We miss much of what happens around us. Slowing down is a proactive choice to more fully embrace life and enjoy a greater sense of peace and wellbeing.

Simple health and wellness tips: screening and education

“No one is without knowledge except he who asks no questions.” ~ Ancient Proverb

You play an incredibly powerful role in dictating the course of your health. As discussed in the last post, 80% of chronic illnesses can be prevented through the lifestyle choices you make each day. But making informed decisions requires deliberate self-awareness and honesty. In addition to paying attention to diet and exercise, you can build self-awareness through active health screening and education. A major key to being proactive about your health is understanding your unique medical profile.

Know your body and your health risks. Routine medical, dental, and visual screenings help create a baseline profile of what’s normal for you. They may also help catch problems at early stages, when they are often easier to treat. Recommended evaluations may monitor blood pressure, cholesterol, glucose, body mass index, colorectal, breast, cervical, and/or prostate health (1). These tests are not just for primary prevention; they can help you follow ongoing concerns, so you can control progression of existing conditions. Staying up to date on immunizations, and practicing protective skin care are also important strategies for preventing serious medical problems. How frequently you decide to visit your doctor depends on your underlying health status and personal needs.

Medical visits should not be restricted to physician visits. Dental appointments are also important for your overall health. Gum disease, or periodontal disease, is diagnosed in more than 3 million people each year in the US (2). This bacterial infection is associated with poor dental care, resulting in swollen, red gums, loose teeth, and increased oral sensitivity. There is an increased risk of gum disease if you smoke or have diabetes, so dental care is especially important in these cases. Perhaps surprisingly, periodontal disease is not just an issue for your mouth. It increases your risk of developing serious systemic problems, including rheumatoid arthritis and heart disease (3). This occurs because the bacteria that cause gum disease can move through your blood, affecting blood vessels in the heart and creating harmful blood clots.

Outside of scheduled appointments, self-examination and an ongoing awareness of your physical and emotional wellness are critical. Recommended monthly self-exams include breast, testicular, and skin checks. Any sudden or persistent changes, such as lumps, pain, color, swelling, or rashes, can help identify problems early, increasing the probability of treating and curing an illness. As an example, if a woman feels a lump in her breast, she should act immediately and see a doctor. If a cancer is diagnosed and restricted to the breast, her chance of surviving 5 years is almost 99% based on statistics for women in the US (4). However, the 5-year survival from cancer that has spread from the breast to distant organs falls to 27%. These statistics vary patient to patient but emphasize the importance of early detection. Detecting the cancer before it spreads makes a significant difference in survival.

Despite the tremendous benefits of healthy lifestyle choices, our genetics are intimately tied to our risk profile of developing medical conditions. Therefore, to truly know your health risks, you must know your family history. It’s particularly important to keep a record of medical problems among first-degree relatives, meaning your parents, siblings, and children, since you share substantial genetic overlap. The National Institutes of Health actually recommends keeping a medical record for three generations of your family (5). The idea is to be aware of medical patterns in your family, including diseases for which you may have increased risk. It does not mean that you are going to develop the disease, but it does suggest that you should be proactive about taking steps to reduce your risk.

Understand your personal health record. A personal health record is a comprehensive set of your health information that you maintain and control. Everything about your health should be kept in this record. It may be a paper data set, electronic, or a combination. The information should be as complete as possible, including past and current illnesses, allergies, medications, health evaluations, surgeries, and family medical history. Ask your healthcare providers for records, such as images and reports, so you have them accessible when you want them. Having this record readily available is important for your peace of mind and that of your family. Simply creating the record is not enough; take steps to clearly understand everything in your record, including the side effect profiles of your medications, and how your medications interact with one another. Another advantage of having a personal health record is that you do not have to be dependent on your healthcare team for information. If you need information for work, travel, or a new doctor, you will have it available. If there’s an emergency, a family member can consult your record when contacting the hospital. Here is additional information to help you develop your personal health record.

Ask lots of questions, and know where to look for information. Our knowledge is only as deep as the quality and honesty of our questions. Ask openly about risk factors, prevention strategies, health and fitness, medications, and lifestyle changes. Even if your healthcare practitioner does not know the answer, he or she should be able to guide you to an appropriate source. If you feel that your questions are not being answered, or that you are being rushed, find a provider who will support your health enough to address your questions. If you have concerns about identifying credible written sources, ask your physician for advice. Scholarly databases, such as the National Library of Medicine, Medline Plus, and PubMed, are good places to start. Check out this site for great tips about credible sources of health information. When you read health articles online, pay attention to the affiliations, credentials and conflicts of interests of the website and author, as these may bias their advice. Medical research evolves rapidly, so check the date on your article to make sure you are reading the most recent information. It’s also useful to read articles with referenced sources, so you can go back and check the original articles. Checking multiple sites or articles for consistency of information, and consulting with your physician for advice are important steps towards ensuring that you can trust the information you are reading.

In our next post, we’ll cover simple strategies for integrating greater levels of balance and wellness into our lives.

Simple health and wellness tips: diet and exercise

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” – Hippocrates

Sometimes we become so busy that we forget to prioritize our health. Only when our bodies send us a physical reminder, do we remember to take care of ourselves. What if we were mindful about our health more often and practiced preventive, proactive healthcare? The Centers for Disease Control and Prevention estimate that 70% of deaths and 80% of hospital admissions in the US are due to chronic, long-term illnesses, such as diabetes and cancer (1). Much of this morbidity and mortality is preventable through improved diet, regular exercise, and eliminating tobacco use. In fact, as much as 40% of cancers and 80% of heart disease, strokes, and diabetes may be prevented by lifestyle changes. These statistics are relevant to everyone, with at least 80% of the world’s chronic illnesses occurring in middle- and low-income regions (2).

This is the first of three posts discussing easy steps you can fit into a regular routine to help regain control of your health and wellness. 

Drink water. Our bodies need water for most biological processes- digestion, maintaining body temperature, even brain function. Adult men should get about 16 cups of water a day from food and drinks, and women about 12 cups. About 80% of that (9-13 cups) should come from beverages, with fresh, filtered water the best choice. Actual needs vary based on the heat and humidity where you live, your age, activity level, overall health, and if you’re pregnant or breastfeeding. Why do we need so much water? Our bodies are actually 60% water, including 80% of our blood and 70% of our brain (3), (4), (5). If you want to perform at your best, drinking water is a quick way to get there.

Eat well. Despite an obesity epidemic in many industrialized nations, we have a serious problem with malnutrition due to high consumption of nutrient-deficient foods. One essential health tip is to eat natural foods and omit processed products. The National Health Service Eatwell and US Department of Agriculture MyPlate guides provide visual representations of how much of each food group you should consume per meal. The Harvard School of Public Health has also released excellent guidance in the HealthyEating Plate with comparison to MyPlate available. They emphasize including a variety of colorful vegetables and fruits on half the plate, and whole grains and protein sources on the other half. Limit red meat, and avoid processed foods (6), (7). The Healthy Eating Plate also includes advice about drinking plenty of water, limiting unhealthy fats, omitting sugary drinks, and emphasizes the importance of maintaining an active lifestyle.

Limit sugar. Regular intake of sugar can contribute to weight gain, type 2 diabetes, and heart problems. The CDC suggests limiting sugar to less than 10% of daily calories (8). The Healthy Eating Plate advises against sugary drinks and recommends limiting fruit juice to one small glass a day. They also recommend limiting starchy foods like potatoes, which increase blood sugar. Foods that are rapidly digested and cause a spike in blood sugar have a high glycemic index. Stick with foods that have a medium to low glycemic index, as listed here.

Be active. Exercise is beneficial all around, for our physical, mental and emotional wellness. There’s a vast amount of data supporting the protective effects of exercise against chronic illnesses, aging-related problems, weight gain, and depression. A standard recommendation is to engage in moderate-level activity for 30 minutes each day (9). This could include walking, gardening, dancing, or cleaning the house. There are different ways to quickly increase the amount of activity you get in a day, including taking the stairs, parking further and walking, standing while working, or having walking meetings with colleagues and friends.

Eliminate tobacco. Smoking rates in the US have gone down by half during the past four decades. However, about 34 million US adults still use tobacco, and 58 million nonsmokers are exposed to secondhand smoke (10). One of five deaths in the US is attributed to the effects of cigarette smoking, which also accounts for 87% of lung cancer deaths and 30% or more of all cancer deaths each year. Quitting smoking before you’re 50 years old can reduce the risk of smoking-related death by half over the next 15 years. That’s huge! Quitting smoking also improves the long-term outlook and quality of life for those who spend time with you. There are a number of evidence-backed approaches to stop smoking. Speak with your healthcare provider about the best options for you. Follow up with your healthcare team as often as needed to keep you on track, and build the support team you need to help you succeed.

Electronic apps take the hard work out of remembering what or how much you’re drinking or eating. Many of these apps also track steps and allow entry of other types of physical activity. Keeping food diaries and logging your activity levels can help you achieve your fitness goals. These strategies make a difference when applied consistently.

In our next post, we’ll cover simple strategies for being more proactive about our healthcare, focusing on screening and education.

Five ways to improve your health writing skills

Health writing is a broad field, filled with a number of smaller niches. You may be focused on fitness, nutrition, women’s health, or cancer, just to name a few. Whatever your specific interest or specialty is, getting started as a writer can be intimidating. Here are a few simple strategies that can help improve your writing.

Read content from other health writers. Writing styles differ according to author, niche, and audience. Read a variety of content from health writers. Identify articles written for the same types of audiences you want to target. Note the structure and tone of the writing. Break the article down by paragraph, and decide what purpose each paragraph fills in the article. Effective nonfiction writing is usually centered on key messages, as explained here. Identify the main teaching points in the article you are reading. What is the overall take-home message? How does the author organize these objectives and messages to create a clear, concise story? Take note of research that is cited to understand the types and numbers of sources you may need as supporting evidence to write a piece of similar length or style. The tone and voice will vary more than structure when you start comparing articles; that’s what makes each author unique. Still, there are some patterns to notice. For example, if a piece is written for a patient, how does the writer maintain a positive, helpful message, even when discussing a serious condition? What reading level does the piece appear to target, and how does that affect word choice? If a piece is written primarily for healthcare professionals or researchers, how does the author make the article interesting and engaging, rather than purely academic? Annotate each article as you go through this exercise. You’ll begin spotting patterns in health writing articles that are targeted to similar audiences. You can apply these general patterns in structure and voice to your own outlines as you build your health writing practice.

Keep up with news from your niche. This is critical. Health research moves at a ridiculously rapid pace. Understand what constitutes a credible source in your field, and read these sources regularly. For example, if your focus is oncology, read abstracts from the top-tier oncology journals on PubMed each week to identify new articles. You can set up automatic alerts based on keyword searches. Follow blogs from the major oncology associations and reputable oncology news websites daily. Many of these sources offer e-mail newsletters that can automatically be sent to you. Also, mine abstract databases from major annual oncology conferences to stay in touch with breaking news. Health writers must stay up-to-date, or their content risks becoming obsolete and irrelevant, and possibly filled with errors if something new has been learned.

Write regularly and listen to feedback. Write as many different types of content targeted to your primary audience as you can. As long as you practice consistently, you will improve. Seek feedback from clients, colleagues, mentors, and writing groups. Feedback is most effective when it highlights your strengths and weaknesses, so you know exactly what’s working, and what needs to be improved. Don’t be afraid to try new types of deliverables. There are so many possibilities in health writing; articles, blogs, book chapters, abstracts, news summaries, and medical needs assessments are just a few examples. Research and read other writers’ work. Then, try writing something new, and ask for feedback; it’s the only way to learn and become a strong health writer capable of writing diverse types of content.

Join classes and professional organizations. Formal courses, online writing programs, and professional organizations often provide resources to help improve health writing skills. Identify health writing groups or classes online or in your area, and see if they offer feedback, specialized teaching, books, or certifications that will help you grow as a writer. In addition to medical and science writing associations, there are freelance health writers who offer online courses. Check out this link for additional advice.

Write for your audience. Health writers are educators. Your content is designed to teach an audience something new about a specific health topic. Keeping your reader in mind as you write will automatically focus your attention and improve your writing. Imagine your audience as you write. What concerns do they have? As you practice writing for the same general audience a few times, you’ll learn how to address their major needs and anxieties. Targeting your writing to help your audience is one of the most effective ways to improve the tone, clarity, and quality of your health writing.

These are just a handful of easy tips to help you on your way to becoming a strong, impactful health writer. It’s a continuous process, and regardless of how senior a writer is, there is always something new to learn. Be kind to yourself, and approach writing with a growth mindset, so that you are open to learning and evolving even when new challenges present themselves.

How to find a focus for your blog

Deciding what you want to blog about can be challenging, especially if you have a variety of interests. Narrowing down your niche is probably the most important decision you’ll make during the early construction of your blog. If you don’t take time to define your niche, you risk becoming unfocused, which can become incredibly frustrating for writers and readers. Being unfocused negatively impacts your abilities to generate topics for future posts, reach specific audiences, and maintain the drive and purpose behind your blog. Clarify your niche by considering the following questions. 

What’s your overall goal? Bloggers have many different reasons for why they write. Why do you want to blog? Consider why you want to start your blog and what purpose it will serve. Maybe you want to establish expertise in a specific area, spread inspirational messages, provoke thoughtful conversations, or just gain peace by getting your thoughts out there. The motivations behind starting a blog are countless. Think carefully about your motivations; there may be more than one. Write these down. 

Where’s your expertise? Consider your professional skills, degrees, specialized training, awards, and recognitions. What are the parts of your job you enjoy the most? Are there common areas in which colleagues or people in your personal life seek your advice? 

What are your passions? Better yet, what are your obsessions? Think about the genres of books you read most often, your favorite podcasts, writers, and websites. How do you spend your free time? Defining passions as those things you would do for free, are there passions you would want to blog about? Write these down. Obsessions are those things we can never really stop thinking about; they trouble or excite us that much. Obsessions often revolve around serious issues. Consider what problems you want to help solve and how your blog can meet that purpose.

What’s your unique story? We all have unique life experiences. Have you experienced something that, if shared, could help someone else who is going through a similar journey? 

Who’s your target audience? Who do you want to help? As you identify the problems you want to work on, your main interests, unique characteristics, and the reasons you want to blog, imagine your readers. Are they fellow bloggers, prospective clients, or people who are trying to achieve a specific goal or learn a special skill? Narrowing down who you envision reaching through your blog will help focus your writing and the messages you deliver to readers.

What about profitability? If your intentions include monetizing your blog, market research will help determine demand and profitability. Strategies for market research can be found here.

Asking deep, open-ended questions to clarify your intentions will help focus your blog niche. As you answer these questions, circle common themes that pop up. If you have more than one idea, select one to try, and track readership and your interest level. You’re never locked in to any one idea. Allow yourself to pivot and redesign your niche as needed. Defining your blog focus will help target your writing, making it easier to generate ideas for individual posts. Most importantly, it will fill your blog writing with purpose and intention, making the process more meaningful for you and your audience.