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.

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.

Nature is full of abundance

Sometimes writers forget to take breaks. We disappear into foreign worlds deep within the pages of our notebooks or screens of our tablets. Hours fly by. We forget to look up, and rarely wander far from our project. The unfortunate side effect is that we isolate ourselves, forgetting about the outside world. Instead, we sit, restlessly struggling with how to transfer ideas to paper. Ironically, the best solution for a frustrated writer may be to break out of isolation, forget about writing, and leave it all behind, at least for a while.

Yesterday, I left all my writing gadgets behind. No pen, no paper, no phone. I left all of those inside and ventured out. The dogwood trees were in full bloom. The azaleas were at their peak. The park was full of giggling children, motivated runners, and dogs chasing frisbees. I watched for a while before continuing on my walk. My first reaction was that I would have missed this if I had stayed at the keyboard. Then, I kept looking up. I’m not sure why, but I felt compelled to look up. I saw birds and a clear sky, and I felt a rush of gratitude. 

We spend so much time striving, pushing forward, and working for tomorrow. We forget about today. Slowing down, and paying attention to what surrounds us right now may be the healthier choice. Remembering to stop, reconnect, and appreciate nature and all its life forms may renew our energy, so we can return more optimistic and productive. We work hard seeking abundance in its many forms as we grow older. But maybe there’s nothing to seek. Maybe abundance has always been here, surrounding us in all her beauty. Maybe while we sit, thinking, working, worrying, she waits patiently, waiting for us to reconnect. If we regain our awareness, forget about distractions, leave manmade walls behind, and venture outdoors, maybe then we can openly invite nature to share her abundance. 

Five ways to gain confidence as a new freelance writer

Making the decision to venture into freelance writing can be scary. Trying to generate income from your combined love of writing and education seems almost too good to be true. Imagine the scene, or, if you have been there, think back to when you began. You make contacts, perhaps by networking on LinkedIn or joining the major writing associations in your field. You build a beautiful, navigable website that highlights your services and best work. You even send out your first set of e-mail pitches for writing gigs, by far the scariest proposition of the whole process when I first started out. Achieving each of these essential first steps lays a foundation for confidence and self-belief. But the real test of your ability to persevere comes with each passing rejection or criticism. You may feel like giving up on what seems like a dream. Inside, you know that if you persist and keep trying, you will almost certainly land new assignments, which could result in regular clients. But how do you maintain confidence and not feel overwhelmed at the beginning? Here are a handful of strategies that can help you build your writing practice, while maintaining a healthy mindset as you move towards your freelance goals.

Write often. To build any skills set, you must practice. Writing is no exception. The more time you dedicate to developing your writing style, the more confident you will feel with your unique voice. You will also begin seeing trends in what types of pieces you prefer writing. As a new freelancer, you may not understand which markets, clients, and audiences you want to impact through your writing. Establishing a regular writing practice will help you identify interests and areas of knowledge that you could market. Writing each day will also help you overcome writer’s doubt. Success is motivating. You will feel a sense of accomplishment with each finished product. You will improve your basic skills in researching, outlining, and developing a first draft without being hindered by your internal editor. That’s a skills set that causes struggles even for some advanced writers! As you continue through multiple drafts, a regular writing practice will help you learn how to edit, and develop your ability to communicate clearly and concisely. If you do not have a steady flow of clients yet, practice by writing blog posts or longer pieces to include in your portfolio. Practice writing concise pitches that clearly communicate a unique concept you would like to develop for a targeted client. Establish a habit of writing each morning. Setting aside this dedicated time is critical, especially if you are starting your freelance career while still employed full-time.

Build a community. We learn from those with whom we spend the most time. As a writer, you will benefit from building a network of writers, freelancers who understand business, and those who give you positive energy. It has never been easier to access information than now. In fact, you run the risk of information overload with the amount of content available online. Take time to identify virtual and live mentors who provide you with the guidance you need now. Multidisciplinary mentorship also works well, with individual mentors for writing, business, marketing, and niche-specific topics, for example. Choose the mentors and coaches with whom you best resonate. There are many outstanding virtual mentors who offer incredible value to new freelancers. Here are a few to check out for strategic advice- Ed Gandia, High-Income Business Writing, b2blauncher; Lindy Alexander, thefreelancersyear; Janine Kelbach, WriteRN; and Michelle Guillemard, healthwriterhub. These are just a few of the many seasoned freelance writing professionals who offer online content, as well as additional courses and coaching, to help new writers succeed.

In addition to searching for virtual mentors, identify professional associations in your field that can help you achieve your goals. For example, medical and scientific writers may benefit from joining the American Medical Writers Association (AMWA). Writing associations like AMWA provide educational webinars, in-depth courses, certification programs, in-person and virtual networking, regular newsletters, and online groups to answer specific questions. These are just a few of the ways that associations can help you grow professionally.

You can also build your community by joining local or virtual writing groups. These groups foster accountability and often provide educational content, ongoing advice as questions and problems arise, and feedback to continuously improve your writing. My first writing group was virtual, and I was a little skeptical about how useful it would be. However, within the first few months, I saw a spike in my productivity and confidence. Each participant shared their weekly struggles and successes. I soon realized that my self-doubt and obstacles were shared among the group. Understanding that others, especially those who are now thriving, have dealt with the same challenges and persevered to meet their goals is reassuring. The online writing group helped me stick to my goals, broaden my writing circle, and learn from others.

Another important consideration for growing and protecting your confidence is your immediate circle of contacts. Not everyone understands the desire to live the life of a freelancer or a writer. Combining the two? Well, you will meet many who won’t understand your decision. Try to minimize time spent with people who drain you of the energy you need to feel strong and self-sufficient. Surround yourself with empowering, positive people who will help keep you grounded and driven in pursuit of your goals.

Understand your goals. Defining 3- to 5-year goals is important for guiding your intentions, but for new freelancers, starting small could be a worthwhile approach. Clarify your top three daily, weekly, and monthly goals. These could be as straightforward as creating a draft homepage for your website, listening to and acting on a podcast, writing a blog post, or submitting 10 new pitches. Make your short-term goals specific, measurable, realistically achievable within the time frame, and relevant to your long-term goals. One approach is to write down your top three goals for the next day each evening. Similarly, spend 15 minutes on Sunday thinking through and writing down your top three weekly goals, which should be broader but still encompass most of your daily goals for that week. Dedicate time for reflection and forward planning during the last few days of each month. The time investment for setting these small goals is minor, and the payoffs are huge.

Know your strengths. One reason new writers often feel discouraged is that they feel they have nothing new to contribute. Take time to reflect and understand your unique background. Consider the following questions. What have you excelled at professionally and personally during the past three years? What degrees, certificates, specialized training, awards, testimonials, or recognition have you received? What or who have you impacted through your work or personal life? Where do you spend your free time and weekends? In what areas do others seek your advice? Going through these questions thoughtfully, and jotting down lists of responses will help you identify themes related to your unique interests and skills. Identifying these strengths will help you understand the value you bring to prospective clients.

Reframe how you view writing. Stop worrying about the end goal; instead, focus on the words. Writing is a process, a lifelong learning process. Once you shift your mindset to embrace writing with a growth, rather than fixed, mindset, you will change your trajectory and start experiencing success. When you adopt a growth mindset as a writer, you seek to learn from each writing experience. You willingly look at feedback as information you need to improve, and you understand that challenges will strengthen you. As a new freelance writer, you know that hard work and persistence are required to gain new clients or publish your work. When your results are not working out, seek help, learn from others and your perceived failures, and redesign your path to achieve your goals. Adopt a positive attitude about writing by viewing it as an opportunity to continuously learn and educate. Reframing what it means to be a writer can open up a world of opportunity, helping you remain mentally tough, so you can keep moving forward.

Immunotherapy for triple-negative breast cancer

The FDA has granted accelerated approval for the combination of atezolizumab with nab-paclitaxel for locally advanced or metastatic triple-negative breast cancers that cannot be surgically resected and express programmed death ligand-1 (PD-L1).

Triple-negative breast cancers, which account for about 15% of breast cancers, lack detectable expression of three molecules- estrogen receptor (ER), progesterone receptor, and human epidermal growth factor receptor 2 (HER2). Drugs targeting ER and HER2 are approved and available for subgroups of patients whose breast tumors express these molecules. However, few options outside of standard chemotherapy exist for patients with triple-negative breast cancer.

The majority of chemotherapy drugs target non-specific processes, such as DNA synthesis or cell division, which are increased in cancer cells but also occur in many normal cells. Because of this non-specific effect on normal cells, many chemotherapy drugs cause debilitating side effects, such as nausea, fatigue, hair loss, and increased risk of infection. In an attempt to improve tumor-targeting and reduce non-specific toxicities, cancer researchers have developed many classes of molecularly targeted agents, including those that target ER and HER2 as mentioned above.

Immunotherapy is a relatively new cancer therapy approach that attempts to stimulate the patient’s immune response against cancer cells. There are many types of immunotherapies in development or approved for other types of cancer. Atezolizumab is an antibody that targets a molecule called PD-L1, which is expressed on some cancer cells. PD-L1 normally interacts with a group of immune cells, inhibiting their function. By blocking PD-L1, atezolizumab disrupts cancer-immune cell interactions, theoretically allowing immune cells to function and kill cancer cells.

This week’s drug combination approval is based on results from a phase 3 trial of atezolizumab combined with the chemotherapy agent nab-paclitaxel (1). The trial included more than 900 patients with previously untreated metastatic triple-negative breast cancer. The combination showed a statistically significant increase in median progression-free survival of about 2 months, including among those with PD-L1-positive tumors, compared with the chemotherapy plus a placebo. Although this increase in progression-free survival may appear modest, metastatic triple-negative breast cancer currently carries a poor overall survival rate.

Progression-free survival is viewed as a potential marker of overall survival. The FDA grants accelerated approvals to agents that show promise based on a marker of clinical benefit, such as progression-free survival, in patients with serious diseases. Ongoing trials will seek to determine whether the combination successfully extends overall survival of patients with advanced or metastatic triple-negative breast cancer compared with chemotherapy alone.

(1) Schmid et al. N Engl J Med. 2018 Nov 29;379(22):2108-2121