communication – in thriver words

Dig Deeper

When trying to eliminate foods that irritate, sometimes we have to dig deeper. Everything affects everything – allergies, sensitivities, disease process, gut microbiome, diet. Complex systems sometimes mean complex interactions. We want it to be simple, but sometimes it’s not. In order to be a productive member of our healthcare team, we may have to dig a little deeper and meticulously record our response to foods.

Let’s dig a little deeper into histamine intolerance. When making food choices, it could be helpful to know that the level of histamine detected in canned fish has ranged from none detected to 657.05 mg/kg as compared to fresh fish which ranges from none detected to 36.55 mg/kg. That’s a big difference. And it partially explains why you might easily tolerate canned fish in one sitting and experience significant symptoms in another.

It can also be helpful to know that the high-end range for beer is 21.60 mg/kg and for red wine, 55 mg/kg. If you can tolerate gluten, beer (other than specialty GF) may be a better choice than red wine.

And, of course, histamine consumption is cumulative so a meal of sausage (up to 357.7 mg/kg), sauerkraut (up to 10 mg/kg), and beer could leave you feeling miserable. Or maybe you pair sausage with spinach and red wine and end up missing your daughter’’s soccer game. Most of us want to avoid feeling miserable and missing out, right?

And yet it’s difficult to get the kind of specific information we need to make good decisions. And when you can find the information, some amounts will be listed in milligrams (mg). Others are listed in micrograms (mcg). Without moving lots of decimals around, it’s difficult to determine what indicates a high level or how one level compares with another.

In spite of growth in translational research, a grand gulf remains between research findings on diet and readily accessible, easy-to-understand, standardized dissemination of information to the general public. As patients, we’re often expected to follow guidelines that are so general (avoid fermented foods if you’re histamine intolerant) they seem off-base when we have sausage without beer and sauerkraut and still suffer.

No one is happy to follow a specialized diet. When a patient agrees to do so then experiences symptoms anyway, they are less likely to continue the regimen. They may even become less likely to comply with other doctors’ orders.

I can talk all day about the need to dig deeper and even if you’re willing to and have unlimited time, you may find that the healthcare system is not in a place to meet you in the middle. Translational research could be that place, well-care (well-child care) could be that place, holistic medicine could be that place, integrative medicine has some potential, but right now the gaps are great in all of these areas. The crux of the problem is insufficient communication and dissemination of information. Whether this is deliberate or results from low priority, it seems to be culturally pervasive.

I know from personal experience how frustrating that feels. I still believe that digging deeper is worth it. But I understand that the time investment may not be realistic for everyone.

The purpose of this post is to raise awareness that a prescribed dietary regimen may be appropriate. You may be complying with the guidelines you’ve been given. And you may still have symptoms due to incomplete information with which you’ve been provided and/or which is readily available for your condition.

Before you give the plan up as futile, you may want to dig deeper.

What Counts?

Tomato Tomato

Tomato tomato – when I type it you can’t hear tomato tomahto. Same with aunt aunt or either either or neither neither. And when I use jk or ftw in a text, it can be easily misconstrued. (As can that b I end up typing instead of a period at the end of LOTS of texts without realizing it before I hit send. No, I didn’t call you a b! I swear, I didn’t – even though you have it in writing.) Communication these days may be faster, but it’s not necessarily more clear.

The truth is, I can often understand the raise of a two-year-old’s eyebrow above a mask more clearly than I can comprehend the intent of a tweet or the meaning of some texts. Sometimes even essays and news stories leave me wondering.

Context helps. If I know the sender, my initial response will be tempered by our previous interactions. Length helps. The more full the exposition, the greater the chance I’ll grasp an idea in its entirety. Precise word selection helps. But tomato or tomahto, I’m going to rely on my experience to interpret what you attempt to communicate.

As a listener, I can try to gain a greater understanding by putting myself in your shoes. But there’s a limit in that my experience and yours may be similar, but they will never be the same. If I overstep and insert too much of myself, I may miss your point entirely.

So, there will be misunderstandings. So what?

It’s true. There will always be misinterpretation, miscommunication, and misunderstanding. We can’t eliminate them entirely. But an attempt to grasp as much of another’s experience as possible accomplishes many positive things that contribute to thriving.

As we become better listeners, we find more common ground. I don’t think there’s any question we need to rediscover our common ground these days.

Feeling heard and accepted is easier when we share common ground. And those feelings make me more likely to hear and cooperate with you.

Experiencing your acceptance of me makes me more likely to accept and empathize with you.

We continue to live through a pandemic that’s pulling us further and further into opposing camps. It’s also highlighting systemic problems that need to be fixed.

Every day, we face choices that can have the effect of improving the future or tearing it down. What we do matters. It has an effect. We may not feel we can change the world, but we can certainly change someone’s day. And each person we touch will affect many others.

Sometimes, we may feel we must fight to defend our position. Fighting can contribute to the improvement of society. But we must be clear on our values, see our flaws realistically, and be able to envision the long-term effect of the battle we’re fighting. Knowing which battles to choose and how to wage them requires opening our minds and our hearts, listening carefully, gaining insight, and exercising courage.

Condemning, othering, labeling, dismissing, and jumping to conclusions based on today’s hurried, abbreviated communication is dangerous territory. Appallingly, I see some form of those every day.

As a culture, we’re precariously balanced. A fight over the pronunciation of tomato will not move us forward.

Putting in the effort to communicate well and consciously consider the effect of our words can help us thrive.

Responsiveness Matters to All of Us

Let Me Be Clear

I’ve been compiling a list of phrases I want to retire next year and “let me be clear” is right up there near the top. How many times per week can I listen to that phrase followed by a statement clearly intended to muddy the water and not lose my mind? If you said, 10,472 you’d probably be close.

There’s nothing wrong with the words or an intent to be clear. My problem is that the phrase is rarely used to mean the speaker wants to be clear. More often it means the speaker wants you to pay attention to a half-truth or full-fledged lie that creates the illusion they desire for you to see. So enough with deliberate misuse, misrepresentation, and misdirection already. Please stop!

Let’s all be clear!

Clarity is important. It’s crucial for a recipe. Without clarity, you may not end up with the intended result. But we all speak using unique turns of phrase. What’s crystal clear to me may not be clear to you. That’s where consistent format, industry-specific terminology, and formulaic rules can help – think grammar for instance. But no matter how carefully we craft, what content we create, which words we write, and how we verbalize sentences, our communication is subject to each consumer’s context.

Clarity is even more important for health guidelines. It’s critical when writing conclusions drawn from data. And each time we pull back, hedge, or try to soften the message, we run the risk of confusing people.

So how can we communicate clearly?

I cannot possibly outline a way to avoid all misunderstanding, but I will give you five tips for drafting clear communication.

Determine the scope and purpose of the communication.
Identify and research your audience. Communication must be delivered in language that will be easily understood using an accessible method.
Assume nothing. Draft every document, policy, and procedure as if nothing has preceded it and nothing will follow it. Write it as if it must stand on its own. Once the draft is done, document any overlap with other relevant documents. Keep a log of this overlap. Reference other existing documents and remove duplication when possible.
Put all pertinent facts that live in your head in the draft. Once that all-inclusive version is written, review and pare down to essentials. It’s tempting to pare down first, but this creates one of the most common errors I see – critical information is left out. Since the information is known to you, you are less likely to recognize its omission upon review.
Stick with the facts. Do not embellish or diminish them. Resolve conflicting statements prior to publication. Be conscious of word choice, but recognize that you may not please everyone. It is best to be concise and straightforward.

I realize this topic may be a stretch for this blog, but I feel really hungry for clear, concise communication that I can rely on for facts. I don’t think I’m alone in that. And, if you follow these tips, there should be no reason to say, “Let me be clear….” And not hearing that will work very nicely for me.

Food or Feud

In my family, it can be food or feud. The simple solution is for us to eat on time. But what happens when things aren’t simple? food or fued I am sitting in 3000 square feet of emptiness looking up at the ducts on the ceiling 22′ above me. My head is hurting. I planned to be here until 1pm. Now the heat & air installers say it may be 4pm. I am hungry for more than the cheese and crackers I brought to tide me over until 1. It may be fall, but it is hot!

Hot, hungry, and tired with a headache that won’t quit can be a recipe for a family feud or at least a lot of misunderstanding! When someone in my family starts to become easily annoyed, we immediately look for food. We know that we’re grumpy when we’re hungry. Because of this, we’re pretty good planners and we always have a snack handy, but the unexpected can still sometimes catch us unprepared.

If you’re one of those folks who can go all day without a meal, you’ll have no idea why this is significant. If, on the other hand, you begin to feel shaky, confused, sweaty, and sick if you don’t eat on time, you’ll understand why I’m writing this.It’s hard to count the number of times I’ve told a travel companion that I’m hungry only to have them stall me for 3 or 4 hours. Long before that time is up, I feel like I’m going to throw up my guts. I physically hurt. I cannot think straight enough to tell you what I want to eat.

What I’m describing has happened to me all of my life. It also happens to my son. It probably happened to my grandfather who could not tolerate sugar. He never ate cake, pie, cobbler, or cereal with added sugar. He would occasionally eat chocolate covered cherries. I don’t remember, but I’m guessing he ate those after a meal when they would have less effect.
I say this because that’s my experience with sugar. I can tolerate some after a meal, but feed me pancakes with syrup or a glazed doughnut for breakfast and I will be puking them up in 5 minutes. I will feel a horrible sinking sensation, then wretchedly nauseous.

My grandfather and his sisters who shared this sugar sensitivity were never diagnosed with a condition or disease. I have had blood work done just after two of these episodes. It is always in the normal range. My body may struggle to break down sugars because of celiac disease, but no one has been able to tell me that with any certainty.

That’s the thing sometimes. You know how you’re feeling isn’t normal, but whatever you have isn’t showing up, isn’t being tested for, or falls in the “normal” range. That can feel really frustrating. But life goes on. You learn to recognize when you’re approaching critical and do your best to stay ahead of the problem.

But when a plan suddenly changes, things run late, or there is an unexpected problem, what I most need is for you to believe me when I say I need to eat. I may say it matter-of-factly and without drama, but I need for you to understand that it will soon be more than I can do to remain calm if you ignore repeated requests to stop at the next place we come to.

I know that you may be trying to get to a better restaurant 10 miles down the road, but what I need for you to get is that once I hit a certain point, I do not care whether the food will taste good, I just need it in my tummy. Telling me to hang on because there’s a great restaurant in the next town is like telling me you’re going to break my arm. If I respond as though that’s what you’ve said, it is because that is how it feels to me.

When I am using my energy to stay calm, ask politely, and try not to puke or cry, it is overwhelming to ask me to choose a restaurant, name what I want, or really to communicate at all. Keep in mind that I will have attempted to address the oncoming problem I am sensing before I get to this point. If you did not recognize that those attempts were important, you may not recognize that I want to cooperate, but am feeling as though my situation is dire. Boom! Argument, misunderstanding, or meltdown may be imminent.

While I may get into a situation in which grabbing a handful of crackers from the table is tempting, since becoming gluten-free I have never made that choice. And that adds a second layer of distress when communication becomes difficult.
Today, when I began to feel vague hunger pangs, I ate some cheese and crackers. An hour later, I was getting seriously hungry. About that time, I received the news that my stay would be extended several hours past what I had planned for. I recognized that it was important to either stop the crew and go get food, or find a way to get some brought to me.

I did not wait until I could no longer think straight. I made a short list of people who could help, decided what I would request they do, and proceeded to call the list. Before the next hour was up, I had eaten lunch and no longer had a headache.
plate
Today, things worked out well. Other times, they have not. Most often those have been times that I was accommodating a group or an individual with little insight or empathy. Occasionally it has been at times that I was forced to deal with a person who simply can’t be reasoned with or does not value how I feel.

What’s the best plan in those instances?

Recognize that not everyone you come into contact with has your best interest at heart. If there are people in your life who are routinely difficult and make it hard to take care of yourself, avoid situations that make you dependent on dealing with them. Take a separate car. Choose a different work group. Volunteer for a different committee. Say no if you have to.
Know that you will never be able to make an unreasonable person be reasonable. They must come to a point where they choose to see their contribution to a situation that distresses you before you can reach them. How you feel can be communicated and cooperation can be requested, but it is helpful to know that you cannot force understanding.

You will never be able to make crazy behavior make sense. It is not necessarily important to understand why someone does something. If they exhibit a pattern of behavior that is detrimental to you, it is enough to know they do it and that it is not acceptable to you.

Once you determine that, you have many choices for what to do next:
Set and enforce better boundaries.
Minimize your exposure.
Leave behind friendships, romantic relationships, jobs, or distant relatives that hurt you.
Become realistic about your contribution to any friction in a relationship and apologize for your part in a misunderstanding.
Refuse to be lured into apologizing for taking care of yourself so long as you have managed to remain calm and kind and have tried your best not to inconvenience anyone else. You cannot control every circumstance.

On the flip side, you also have choices about how you view another’s actions:
Extend the benefit of the doubt. Some people mean you no harm, but will inadvertently hurt you anyway.
Be present. We are all less likely to hurt each other when we are fully aware of the effect we’re having in the moment.
Allow yourself to see and feel the discomfort of someone else’s distress. Being attuned to subtle signs will change how you respond. Isn’t this what we want from others?

I wish for a partner who understands my physical limitation to the extent that in a pinch he is willing to voluntarily bring me something to eat that doesn’t take much energy to digest – a banana, a glass of milk, or some Greek yogurt. It sounds so simple. I’m sure any man who has failed to do so would read this and say, “I would do that.”

Of course you would if it seemed important at the time. But what if you got distracted by a work call or the kids throwing a fit or trying to figure out how we’re going to pay for replacing a heat & air system we haven’t budgeted for? What if you felt annoyed when I repeated a request for food when you’re planning to EVENTUALLY honor that request? What if you were in the mood for a really good meal and thought I’d be ruining my appetite by eating before our 9pm reservation? What if your mother believes I am trying to avoid eating the meal that’s taking extra time to prepare because she’s making it gluten-free for me? What if you simply don’t believe how sick I feel because you’ve never experienced it and my test results are normal?

We all like to see ourselves as reflected only by our best moments. In real life, we’re experienced by those around us as a sum of our level of presence, our tolerance for vulnerability, our priority in the moment, our insight, our ability to empathize, our reliability, our helpfulness, kindness, and thoughtfulness, our flexibility, stability, and mindfulness, our willingness to entertain different points of view, our truthfulness, genuineness, respect for others, and our courage to make the difficult choice. Other’s experience of us may not match up with what we believe about ourselves.

So what?

We are surrounded by evidence that many of us have difficulty taking care of ourselves. If we were consistently receiving the message that we matter, we are important, we are valued, others wish us well, and our loved ones are willing to help us, would we have a rapidly increasing number of pervasive, preventable, chronic health problems? Would we ignore simple lifestyle changes that can give us the ability to live longer, more productive, more comfortable, and more joyous lives? I don’t think so. I think part of the struggle to eat in a manner that maximizes our health comes from the messages we receive on a daily basis.

Why does that matter?

Only you know how significant, painful, overwhelming, exhausting, or stressful something is to you. You may communicate that clearly and still find yourself without assistance. That does not mean there is something wrong with you, that you should not take care of yourself, or that you do not deserve help. It could mean you need a better communication strategy, or it could mean that you are surrounded by relationships that need to be reexamined.

For my family, it’s food or feud, so there are repeated opportunities to observe, examine, and improve our interactions. Most of us accept each other’s limitations and work together to take care of each other. We also accept that some family members will choose to make things more difficult and that we have many options for dealing with this. Those options may not be easy choices and may require some self-sacrifice to maintain a relationship. We accept that at some point a relationship could become be too harmful to continue. At that point, we can choose to let it go.

Eating on time may not be a feuding issue for your family. Your point of contention could center around eating gluten-free or vegetarian It could be that a battle breaks out every time you try to convince your sister that your diabetic mother doesn’t need carbs. It could that no one but you lives near Grandma, but the rest of the family condemns you for wanting to put her in long-term care.

The specific issue may vary. The importance of expressions of empathy, kindness, helpfulness, thoughtfulness, care and concern, and acceptance for ourselves and each other cannot be overstated. These expressions are critical to our health, our families, our communities, and our nation. They make a difference. They can make THE difference, especially when things don’t go according to plan.

https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

http://www.webmd.com/diabetes/tc/hypoglycemia-low-blood-sugar-in-people-without-diabetes-topic-overview#1