Sources of fiber in your diet: case

This one comes up so often there is no particular case I can describe.

Here are the resources I recommend to patients at the clinic:

Family Doctor: Fiber: How to increase the amount in your diet
Family Doctor: Irritable Bowel Syndrome: Tips on controlling your symptoms
Mayo Clinic: Dietary fiber: Essential for a healthy diet
WebMD Fibor-o-meter
HealthLink BC: Fibre and your health
BC cancer Agency: Dietary fibre content of common foods

IBS: Challenge

I get a lot of questions about irritable bowel syndrome (IBS), so I thought I would feature it today. It is another one of those conditions that gets you a list of questionable sites intermixed with authoritative ones.

As usual it is not always easy to tell one from the other, and some of the less trustworthy ones are often the most tempting because they make promises and sometimes seem to have more detailed information.

Trustworthy sites rarely, if ever, make promises, and can be very general which may be discouraging. But promises and information that are not evidence-based are unfortunately not worth much. Evidence Based Medicine provides a very good and easy to understand explanation of, you guessed it, evidence-based medicine and why it's so important.

Of course sometimes the reason there is no evidence is that the research hasn't been done, which can also be frustrating.

Another thing to keep in mind is that even trustworthy sites recommend treatments that haven't yet been approved by, say, Health Canada, but have by the FDA, the European Medicines Agency (EMEA), or whatever your country's equivalent of these bodies is (or vice versa), so it's important to be aware of what country the information is coming from.

If you are ever unsure whether you can trust a source of information, ask your health care provider, local librarian, or ask me and I'll be happy to help. The Oakland Public Library gives some good suggestions for how to judge online health information, and Behind the Medical Headlines provides expert commentary on what you're hearing about in the news.

Behind the Medical Headlines aims to provide the public and health professionals with authoritative and independent commentaries from leading medical experts on articles or news items which appear in our daily media (nationally and internationally) in an attempt to reduce the confusion which can often arise from conflicting, incomplete or misleading media reports of medical areas.

And don't forget to check for the HonCode symbol .


Finally, here are some of the evidence-based consumer resources I recommend for IBS:

Irritable bowel syndrome: tips on controlling your symptoms (American Academy of Family Physicians)
Irritable bowel syndrome (National Library of Medicine)
IBS diet: can yogurt ease symptoms? (Mayo Clinic)
Symptoms of IBS (International Foundation for Functional Gastrointestinal Disorders)
Irritable bowel syndrome (IBS) Health Center (WebMD)
Should I have tests for irritable bowel syndrome? (WebMD)
Irritable bowel syndrome: Controlling symptoms with diet (WebMD)

Omega 3 and ADHD: case

Scenario

About 15 minutes before I leave for the day, a woman calls me and would like to know whether there is any evidence that Omega 3 is a good treatment for ADHD.


Resolution

Since I don't have much time I decide to use David Rothman's Consumer Health and Patient Information Search Engine. Here's what David says about his search engine:

This (recently re-created) Custom Search Engine searches authoritative and trusted consumer health information and patient education resources recommended by the U.S. National Library of Medicine and/or by CAPHIS (the Consumer and Patient Health Information Section of the Medical Library Association).

This is a great way to do a quick search of lots of trustworthy resources at once, and there is no need to weed through crappy results the way you would using Google. Thanks David!

I run a search for Omega 3 ADHD, and sure enough every single hit on the first page is relevant, authoritative and no one is selling anything (the same search in Google retrieves a first page listing a bunch of questionable blogs and websites selling alternative therapies).

I email the following links to my patron and still have time to shut down my computer and tidy my desk:

WebMD: ADHD Medications and treatments

WebMD: ADHD diets

WebMD: How effective is Omega 3 in treating ADHD?

Medscape: Fatty acid supplementation for ADHD

Mayo Clinic: Flaxseed and flaxseed oil

Parkinson's info English and Italian: case

It's been a while since I posted a case. Here's one I like.

Scenario

A young man is referred to me by his GP. His father has been diagnosed with Parkinson's and he would like some information on the disease.

Resolution

As usual my first stop is MedlinePlus. I type in Parkinson's and in addition to the disease overview, find an interactive tutorial that might be helpful, as well as being directed to family doctor's page on the topic. I also recommend Mayo Clinic's section on the topic.

I can see that the man wants as much information as possible, as this is a new diagnosis and he is the primary caregiver. So, I add eMedicine's section on Parkinson's to my recommendations. I also don't want to get lazy and just recommend the same ones over and over out of habit, while overlooking other excellent ones.

A couple of other useful resources I recommend for someone wanting as much information as possible:

• CMA.ca provides Canadian drug information (the drugs Canadian doctors prescribe are often not listed in American resources by the same name) .

• Lab tests online, which provides information on whatever tests might be ordered in relation to a specific condition. In this case, Parkinson's is not listed as one of the conditions, however I explain that he can look up each test separately as well.

While we are talking he wonders whether it might be possible to find some information for his father in Italian. Luckily I speak Italian which will make the search easier, however I have already discovered that there is a dearth of reliable resources in Italian.

The first thing I do is take a look at Medline's new multiple language resource to see if anything is there. Unfortunately there is not. I was very excited when the resource was launched a few weeks ago, as I'm sure many people were. Since then the initial excitement has worn off. There is great potential, but not much on offer just yet. I will keep checking as new topics are entered.

The first thing I do is look up the exact term in Italian. I go the the HONselect tool that allows you to look up MeSH headings in different languages. I type in parkinson's, select Parkinson disease, click on Italian and am told that the correct term is Malattia di parkinson. So far so good. I then go to the one Italian HONcode resource I have been able to find: Paginemediche.it*. I type in the term and get a list of clustered results. Under malattie e condizioni (diseases and conditions) I see 9 hits. Unfortunately none of these hits is directly relevant. I click on one to see how it relates to Parkinson's and discover that in this resource it is listed as Morbo di Parkinson. So now I do a search for that, only to discover that, while listed in the glossary and referred to in relation to malnutrition, incontinence, Huntington's etc., there is no page on that topic. So I have reached a dead end.

I do a Google search which I am unable to recall at the time of writing, and am able to find a multiple language resource that is new to me, NSW Multicultural Health Communication Service, and this one has a long list of topics in Italian, including the one I'm looking for. I am not surprised to find that NSW is Australian, as the country always has excellent health resources in multiple languages. Along with the one on Parkinson's I print the full list of topics for the man in case any other questions come up., and I add the resource to MyHq.


*This resource is only useful if you speak Italian, as there is no English version.

Prostate cancer treatment options and decision aids: case

I have gotten several requests for information on the topic of prostate cancer, both from patients and from health professionals, so I thought I would share what I found.

Before I do so, I thought it might be helpful to explain what a decision aid (or guide) is, in case anybody reading this has never seen one or is not sure what one is.

I had a hell of a time finding a definition. I checked MedlinePlus' medical dictionary and encyclopedia, and neither had one. Cambridge Dictionaries Online didn't list the term, and neither did the Merriam-Webster online medical dictionary. This time even Google failed me. (I am searching online since I am at the clinic and so don't have access to print resources, much as the average patient or family member wouldn't.) I am finally able to find one definition though. According to the US Department of Health and Human Services,

Decision aids are mechanisms or interventions that have been developed to improve communication between health professionals and patients, and to help involve patients in making decisions regarding their health care. Decision aids can include brochures, videotapes or interactive computer programs. Recent reviews have suggested that decision aids may be effective in supporting general health care decisions.

But what does that mean in plain English? You could say that any information that helps you make a decision could be considered a decision aid, but there two types of tools that are usually referred to using the term decision aid or decision guide.

One kind works like a sort of "choose your own adventure." At each step in the process you are given your options and depending on which you pick, or which is recommended based on test results, other choices are then offered and so on, branching out like a little tree. This makes it possible to see what might happen if you chose one treatment over another.

The other kind brings up important questions and help you make a list of pros and cons, much the same way you might do if you were making any other decision.

Scenario

Information on prostate cancer treatment options and decision aids.

Resolution

Here are a few resources that I found useful:

Treatment options:

National Cancer Institute: What you need to know about prostate cancer.

National Cancer Institute: Prostate cancer treatment

Family Doctor: Prostate cancer treatment options

Canadian Cancer Society: What is prostate cancer?


Decision aids:

Mayo Clinic: Prostate cancer guide

American Cancer Society: Detailed guide- prostate cancer

National Comprehensive Cancer Network treatment guidelines for patients: prostate cancer (for very advanced readers)


These are for screening but might still be of interest:

Centres for Disease Control and Prevention: Prostate cancer screening decision guide

Lab Tests Online: Prostate cancer tests