During the month of October, Health Literacy Month encourages everyone working to provide easy access to understandable health information. For more than 20 years, October has been recognized as Health Literacy Month. Health Literacy Month is a time of international observance when hospitals, health centers, literacy programs, libraries, social service agencies, businesses, professional associations, govern­ment agencies, consumer alliances, and many other groups work collaboratively to integrate and expand the mission of health literacy.

Low health literacy is more prevalent among:

• Older adults
• Minority populations
• Those who have low socioeconomic status
• Medically underserved people”

What Are the Consequences of Low Health Literacy? – The two major areas that are impacted by low health literacy are “economic costs to society and the health-care system, and costs in terms of the human burden of disease” (Institute of Medicine, 2004). There is also considerable psychological suffering created by low health suffering. Within those overarching categories, the results of low health literacy (as measured by reading and numeracy skills) can include:

• Shame and stigma, which can create barriers to health and behavioral health care and to improving low health literacy;
• Reduced knowledge and understanding of a person’s own medical conditions and treatment;
• Reduced knowledge and understanding of health-promoting behaviors and preventive care and services;
• Increased rates of hospitalization and use of emergency services;
• Increased rates of poor health status;
• Entry of sicker patients into healthcare systems;
• Increased health care costs and spending (Institute of Medicine, 2004).

During this time, organizations and individuals promote the importance of understandable health information along with bringing awareness to breaking down the barriers of understanding. According to health experts, there is a large gap between the way health care issues are communicated by professionals, and the ability of the average person to understand them. Most people have limited health literacy… Not just those with limited reading or writing skills. If someone struggles to understand health literacy, statistically, they are more likely to skip important medical tests, have a harder time living with conditions, and visit the emergency room more often. This is why understanding health literacy is so important for everyone.

The good news is, that many health care facilities are trying to improve the way they communicate with patients to make sure everything is clear before the patient leaves. They are doing things like simplifying their written materials, using video and photos to teach patients, and more to help doctors clearly get their message across.

There are a few things you can do to improve your own health literacy individually or as a organization:

1. Improve your communication with health professionals. Make a list of your symptoms before you go in, have questions written down, and take a few notes when your doctor is explaining things to you.

2. Make sure you know who to call with any questions when you leave.

3. Attend health education programs at a library, community center, or anywhere you can find them in your community.

4. Talk to local schools and request that kids are taught about health literacy and education so they are prepared as they get older.

5. Hold a staff training to teach staff to use simple language, short sentences, and explain medical terms.   Some useful tools for measuring individual.

6. Update materials for your organization to include similar resources in the primary language for Limited English Proficiency.

“Lung health remains a major concern within the Veteran community, as many Veterans face heightened risks due to service-related tobacco use, occupational hazards, and environmental exposures. Respiratory diseases are a prominent health issue for veterans, with the Department of Veterans Affairs diagnosing approximately 7,700 cases of lung cancer annually among Veterans and an estimated 900,000 at risk due to factors like age, smoking, and environmental conditions. In 2023, 55% of Veterans had ever smoked, compared to 32% of civilians, underscoring the need for increased lung health awareness and preventive care.

“Lung health has historically been impacted by high smoking rates among Veterans,” says Joel Nations, MD, Volunteer Spokesperson for the American Lung Association; Pulmonologist, Washington DC VA Medical Center. “This is especially true for military personnel during deployment, though many Veterans reduce smoking or quit altogether after leaving the service. However, their history of smoking keeps them at elevated risk for lung cancer. The most important steps are to avoid smoking, quit if you do smoke, and get screened if you’re at high risk.”

American Lung Association (Press Releases | American Lung Association | American Lung Association)

“Lung disease affects a staggering number of Americans. About 10 million adults are diagnosed with chronic bronchitis each year, and about 4.7 million others have ever been diagnosed with emphysema.

Chronic bronchitis and emphysema constitute the diseases that make up Chronic Obstructive Pulmonary Disease (COPD). About 25 million people live with asthma as well.

Occupational lung diseases, which include asbestosis and mesothelioma, also affect many Americans. Occupational illnesses are estimated to cost $150 billion annually.

Chronic Obstructive Pulmonary Disease (COPD), typically caused by long-term exposure to lung irritants that damage the lungs and airways, is attributed to occupational exposure 19.2% of the time.”

Lung Institute (Healthy Lung Month – Lung Institute)

“CDC defines bullying as any unwanted aggressive behavior(s) by another youth or group of youths, who are not siblings or current dating partners. It involves an observed or perceived power imbalance, and is repeated multiple times or is highly likely to be repeated.

Bullying may inflict harm or distress on the victim including physical, psychological, social, or educational harm.1 Common types of bullying include:

• Physical such as hitting, kicking, and tripping.
• Verbal including name-calling and teasing.
• Relational or social such as spreading rumors and leaving out of the group.
• Damage to victim’s property.

Bullying is an adverse childhood experience that is widespread in the United States. Bullying harms all youth involved including those who are bullied, those who bully others, and bystanders who witness it.

Bullying is common. About one in five high school students reported being bullied on school property in the past year. More than one in six high school students reported being bullied electronically in the past year including through texting and social media.

Some youth experience bullying more than others. Female students were more likely than male students to experience bullying, both on school property and electronically.”

Center for Disease Control and Prevention – CDC (Bullying | Youth Violence Prevention | CDC)

Unless you were homeschooled in the wild or have some type of supernatural luck, you’ve probably tangled with a mean girl or bully at some point in your life. Unfortunately, bullies grow up and get jobs, so you might just run into them again in the workplace, on social media or even in your close-knit neighborhood community. Bullying is not just succumbed to childhood but it is also very prevalent in adulthood as well. Unfortunately, adult bullying behavior identically reflects childhood bully behavior: it methodically targets a person with the intention to intimidate, undermine, or degrade. The same tactics get used, too: gossip, sabotage, exclusion, public shaming, and many other conscious behaviors. Many adult victims feel as though they cannot take any action against bullying out of fear they may cause trouble, lose their job or be viewed as weak; however, there are many steps adults can take to discourage bullying and stand up to their perpetrator.

Take the issue seriously and present it in an objective manner

Yes, bullying can be a huge hit to your ego and it can lead to feelings of depression and anxiety however you must report this behavior from an objective standpoint. Whether you are reporting this behavior to school officials, your managers at work or to legal authorities; make sure you have all the facts documented in detail and try not to bring your subjective feelings into the matter. If you feel as though your boss or teacher will not take these complaints seriously then go two or three level higher up the ladder; talk to the school principal or your manager’s boss. Keep it straightforward and low on emotion. Rehearsing your story beforehand with friends, family, or your therapist will help you stay calm and collected. Use words such as “harassment”, or “abuse” as these terms have higher connotations in the legal system and oftentimes the term “bullying” may be displayed to others as juvenile.

Take care of your mental health

Bullying can be damaging to your mental health. Bullying can lead many adults to drink excessively, self-medicate, overeat and disengage from friends and family. Other adults will choose to fight back in a negative manner, which can result in self-destruction. Avoid succumbing to bad behaviors and make sure you are leaning on support from family and friends during this time.

“October is Spina Bifida Awareness Month—a time to celebrate the hundreds of thousands of people living with Spina Bifida.  Spina Bifida occurs in the first 28 days of pregnancy.  Spina Bifida is the most common permanently disabling birth defect compatible with life.  Often referred to as the “snow flake” condition.  Each year over 1,600 babies are born with this condition in the United States.  By 18 years old all those diagnosed with Spina Bifida will have had at least 8 surgeries.  There is no cure with Spina Bifida.”

Spina Bifida Association (https://www.spinabifidaassociation.org/awareness-month/facts/)

“The cause of spina bifida is still unknown. Researchers believe it may be a combination of genetics and the environment that causes the condition. There are some things women who are pregnant or could get pregnant can do to help prevent spina bifida, including:

• Take at least 400 micrograms of folic acid each day. Spina bifida happens early in a pregnancy, often before a woman even knows she is pregnant. All women who are sexually active should take folic acid supplements. While taking folic acid and getting the best prenatal care cannot completely prevent spina bifida, it can reduce the risk.
• Talk with your primary care physician or pharmacist. If you’re planning to get pregnant or are sexually active, understanding how any prescriptions, over-the-counter medicines or supplements could affect a potential pregnancy can help you make decisions about your care.
• Work with your provider to monitor and manage your medical conditions. If you have a condition such as Type 1 or Type 2 diabetes or are overweight, you will want to work with your OB/GYN or primary care provider before getting pregnant. Once you are pregnant, your OB/GYN may refer you to a maternal-fetal medicine specialist to get extra care during your pregnancy.
• Avoid overheating your body (such as in a sauna or hot tub), and treat any fever you may have.”

NORTON Children’s (https://nortonchildrens.com/news/news-what-is-spina-bifida/)

“October is Spina Bifida Awareness Month—a time to celebrate the hundreds of thousands of people living with Spina Bifida. Every October, we highlight community stories that challenge us to raise more awareness and support for those living with Spina Bifida.  As a community, we can do this by raising awareness about Spina Bifida either in our own circles or larger networks. It’s also a great time for us to challenge ourselves to find new ways to get involved in raising awareness and advocacy activities.

Spina Bifida is a birth defect that is something you are born with, its not something you develop over time.  There is no cure to Spina Bifida. ”

Spina Bifida Association (https://www.spinabifidaassociation.org/awareness-month/)

“A pulmonary embolism (PE) is a blood clot that blocks the flow of blood to part of one lung. Many people with this condition have two or more clots in one or both lungs. Symptoms of a pulmonary embolism can vary as subtle to pronounced.  A pulmonary embolism is a serious and potentially life-threatening condition, but there are ways to help prevent it.

Because almost all pulmonary emboli originate from a DVT, and the risk factors and treatment of both are similar, doctors often use the umbrella term venous thromboembolic (VTE) disease to cover both conditions.

Thrombus occurs when a blood clot forms locally in a blood vessel and slows or blocks the flow of blood. There are two types of thrombosis: venous and arterial.

An embolus is any foreign substance that moves in your bloodstream until it blocks a blood vessel. An embolism is often caused when a thrombus or a piece of thrombus breaks off from where it formed and travels to another area of your body.

An embolism is a life-threatening condition and can cause serious complications such as stroke (clot in the brain) and pulmonary embolism (clot or blockage in the lung).

Pulmonary emboli affect about 900,000 people in the U.S. each year. They can happen to anyone at any stage of life, even very healthy people. Depending on the size of the clot and which blood vessels are blocked, a pulmonary embolism can be life-threatening.”

Harvard Health Publishing/Harvard Medical School (Pulmonary embolism: Symptoms, causes, risk factors, and treatment – Harvard Health)

Pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE, is a sudden blockage in a lung artery. The blockage usually is caused by a blood clot that travels to the lung from a vein in the leg.  The clot gets to the right side of the heart and goes into the upper chamber (atrium) down to the lower chamber (ventricles) to the pulmonary artery bringing the clot into the lungs.

A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus (EM-bo-lus).

PE is a serious condition that can:

• Damage part of your lung because of a lack of blood flow to your lung tissue. This damage may lead to pulmonary hypertension (increased pressure in the pulmonary arteries).
• Cause low oxygen levels in your blood.
• Damage other organs in your body because of a lack of oxygen.

If a blood clot is large, or if there are many clots, PE can cause death.

Overview

PE most often is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the body—most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery.

Deep vein clots are not like clots in veins close to the skin’s surface. Those clots remain in place and do not cause PE.

Outlook

The exact number of people affected by DVT and PE isn’t known. Estimates suggest these conditions affect 300,000 to 600,000 people in the United States each year.

If left untreated, about 30 percent of patients who have PE will die. Most of those who die do so within the first few hours of the event.

The good news is that a prompt diagnosis and proper treatment can save lives and help prevent the complications of PE.

Other Names for Pulmonary Embolism

• Venous thromboembolism (VTE). This term is used for both pulmonary embolism and deep vein thrombosis.

What Causes Pulmonary Embolism?

Major Causes

Pulmonary embolism (PE) usually begins as a blood clot in a deep vein of the leg. This condition is called deep vein thrombosis. The clot can break free, travel through the bloodstream to the lungs, and block an artery.

Blood clots can form in the deep veins of the legs if blood flow is restricted and slows down. This can happen if you don’t move around for long periods, such as:

• After some types of surgery
• During a long trip in a car or airplane
• If you must stay in bed for an extended time

Blood clots are more likely to develop in veins damaged from surgery or injured in other ways.

Other Causes

Rarely, an air bubble, part of a tumor, or other tissue travels to the lungs and causes PE. Also, if a large bone in the body (such as the thigh bone) breaks, fat from the bone marrow can travel through the blood. If the fat reaches the lungs, it can cause PE.

Who Is at Risk for Pulmonary Embolism?

Pulmonary embolism (PE) occurs equally in men and women. The risk increases with age. For every 10 years after age 60, the risk of having PE doubles.

Certain inherited conditions, such as factor V Leiden, increase the risk of blood clotting and PE.

Major Risk Factors

Your risk for PE is high if you have deep vein thrombosis (DVT) or a history of DVT. In DVT, blood clots form in the deep veins of the body—most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery.

Your risk for PE also is high if you’ve had the condition before.

Other Risk Factors

Other factors also can increase the risk for PE, such as:

• Being bedridden or unable to move around much
• Having surgery or breaking a bone (the risk goes up in the weeks following the surgery or injury)
• Having certain diseases or conditions, such as a stroke, paralysis (an inability to move), chronic heart disease, or high blood pressure
• Smoking

People who have recently been treated for cancer or who have a central venous catheter are more likely to develop DVT, which increases their risk for PE. A central venous catheter is a tube placed in a vein to allow easy access to the bloodstream for medical treatment.  A clot can form at the end of it but usually in preventing this if not heparin bolus (ex.300 U in 5 cc of normal saline) is flushed in the catheter if not just flushing the catheter with 10cc of normal saline the prevent the clot forming every 8 hrs or 12 hrs.

Other risk factors for DVT include sitting for long periods (such as during long car or airplane rides), pregnancy and the 6-week period after pregnancy, and being overweight or obese. Women who take hormone therapy pills or birth control pills also are at increased risk for DVT.

The risk of developing blood clots increases as your number of risk factors increases.

What Are the Signs and Symptoms of Pulmonary Embolism?

Major Signs and Symptoms

Signs and symptoms of pulmonary embolism (PE) include unexplained shortness of breath, problems breathing, chest pain, coughing, or coughing up blood. An arrhythmia (irregular heartbeat) also may suggest that you have PE.

Sometimes the only signs and symptoms are related to deep vein thrombosis (DVT). These include swelling of the leg or along a vein in the leg, pain or tenderness in the leg, a feeling of increased warmth in the area of the leg that’s swollen or tender, and red or discolored skin on the affected leg.

See your doctor right away if you have any signs or symptoms of PE or DVT. It’s also possible to have PE and not have any signs or symptoms.

Other Signs and Symptoms

Some people who have PE have feelings of anxiety or dread, light-headedness or fainting, rapid breathing, sweating, or an increased heart rate.

How Is Pulmonary Embolism Diagnosed?

Pulmonary embolism (PE) is diagnosed based on your medical history, a physical exam, and test results.

Doctors who treat patients in the emergency room often are the ones to diagnose PE with the help of a radiologist. A radiologist is a doctor who deals with x rays and other similar tests.

Medical History and Physical Exam

To diagnose PE, the doctor will ask about your medical history. He or she will want to:

• Find out your deep vein thrombosis (DVT) and PE risk factors
• See how likely it is that you could have PE
• Rule out other possible causes for your symptoms

Your doctor also will do a physical exam. During the exam, he or she will check your legs for signs of DVT. He or she also will check your blood pressure and your heart and lungs.

Diagnostic Tests

Many tests can help diagnose PE. Which tests you have will depend on how you feel when you get to the hospital, your risk factors, available testing options, and other conditions you could possibly have. You may have one or more of the following tests.

Ultrasound

Doctors can use ultrasound to look for blood clots in your legs. Ultrasound uses sound waves to check blood flow in your veins.

For this test, gel is put on the skin of your legs. A hand-held device called a transducer is moved back and forth over the affected areas. The transducer gives off ultrasound waves and detects their echoes as they bounce off the vein walls and blood cells.

A computer turns the echoes into a picture on a computer screen, allowing the doctor to see blood flow in your legs. If the doctor finds blood clots in the deep veins of your legs, he or she will recommend treatment.

DVT and PE both are treated with the same medicines.

Computed Tomography Scans

Doctors can use computed tomography (to-MOG-rah-fee) scans, or CT scans, to look for blood clots in the lungs and legs.

For this test, dye is injected into a vein in your arm. The dye makes the blood vessels in your lungs and legs show up on x-ray images. You’ll lie on a table, and an x-ray tube will rotate around you. The tube will take pictures from many angles.

This test allows doctors to detect most cases of PE. The test only takes a few minutes. Results are available shortly after the scan is done.

Lung Ventilation/Perfusion Scan

A lung ventilation/perfusion scan, or VQ scan, uses a radioactive substance to show how well oxygen and blood are flowing to all areas of your lungs. This test can help detect PE.

Pulmonary Angiography

Pulmonary angiography (an-jee-OG-rah-fee) is another test used to diagnose PE. This test isn’t available at all hospitals, and a trained specialist must do the test.

For this test, a flexible tube called a catheter is threaded through the groin (upper thigh) or arm to the blood vessels in the lungs. Dye is injected into the blood vessels through the catheter.

X-ray pictures are taken to show blood flowing through the blood vessels in the lungs. If a blood clot is found, your doctor may use the catheter to remove it or deliver medicine to dissolve it.

Blood Tests

Certain blood tests may help your doctor find out whether you’re likely to have PE.

A D-dimer test measures a substance in the blood that’s released when a blood clot breaks down. High levels of the substance may mean a clot is present. If your test is normal and you have few risk factors, PE isn’t likely.

Other blood tests check for inherited disorders that cause blood clots. Blood tests also can measure the amount of oxygen and carbon dioxide in your blood. A clot in a blood vessel in your lungs may lower the level of oxygen in your blood.

Other Tests

To rule out other possible causes of your symptoms, your doctor may use one or more of the following tests.

• Echocardiography (echo). This test uses sound waves to create a moving picture of your heart. Doctors use echo to check heart function and detect blood clots inside the heart.
• EKG (electrocardiogram). An EKG is a simple, painless test that detects and records the heart’s electrical activity.
• Chest x ray. This test creates pictures of your lungs, heart, large arteries, ribs, and diaphragm (the muscle below your lungs).
• Chest MRI (magnetic resonance imaging). This test uses radio waves and magnetic fields to create pictures of organs and structures inside the body. MRI often can provide more information than an x ray.

How Is Pulmonary Embolism Treated?

Pulmonary embolism (PE) is treated with medicines, procedures, and other therapies. The main goals of treating PE are to stop the blood clot from getting bigger and keep new clots from forming.

Treatment may include medicines to thin the blood and slow its ability to clot. If your symptoms are life threatening, your doctor may give you medicine to quickly dissolve the clot. Rarely, your doctor may use surgery or another procedure to remove the clot.

Medicines

Anticoagulants (AN-te-ko-AG-u-lants), or blood thinners, decrease your blood’s ability to clot. They’re used to stop blood clots from getting larger and prevent clots from forming. Blood thinners don’t break up blood clots that have already formed. (The body dissolves most clots with time.)

You can take blood thinners as either a pill, an injection, or through a needle or tube inserted into a vein (called intravenous, or IV, injection). Warfarin is given as a pill. (Coumadin^® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube; usually given as Heparin drip than when Counmadin starts within 24 hrs the drip is discontinued in the hospital and the patient stays on coumadin or some type of blood thinner as the MD prescribes.

At times, your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once warfarin starts to work, heparin usually is stopped.

Pregnant women usually are treated with heparin only, because warfarin is dangerous for the pregnancy.

If you have deep vein thrombosis, treatment with blood thinners usually lasts for 3 to 6 months. If you’ve had blood clots before, you may need a longer period of treatment. If you’re being treated for another illness, such as cancer, you may need to take blood thinners as long as PE risk factors are present.

The most common side effect of blood thinners is bleeding. This can happen if the medicine thins your blood too much. This side effect can be life threatening.

Sometimes the bleeding is internal, which is why people treated with blood thinners usually have routine blood tests. These tests, called PT and PTT tests, measure the blood’s ability to clot. These tests also help your doctor make sure you’re taking the right amount of medicine. Call your doctor right away if you’re bruising or bleeding easily.

Thrombin inhibitors are a newer type of blood-thinning medicine. They’re used to treat some types of blood clots in people who can’t take heparin.

Emergency Treatment

When PE is life threatening, a doctor may use treatments that remove or break up the blood clot. These treatments are given in an emergency room or hospital.

Thrombolytics (THROM-bo-LIT-iks) are medicines that can quickly dissolve a blood clot. They’re used to treat large clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they’re used only in life-threatening situations.

Sometimes a doctor may use a catheter (a flexible tube) to reach the blood clot. The catheter is inserted into a vein in the groin (upper thigh) or arm and threaded to the clot in the lung. The doctor may use the catheter to remove the clot or deliver medicine to dissolve it.

Rarely, surgery may be needed to remove the blood clot.

Other Types of Treatment

If you can’t take medicines to thin your blood, or if the medicines don’t work, your doctor may suggest a vena cava filter. This device keeps blood clots from traveling to your lungs.

The filter is inserted inside a large vein called the inferior vena cava. (This vein carries blood from the body back to the heart). The filter catches clots before they travel to the lungs. This type of treatment can prevent PE, but it won’t stop other blood clots from forming.

Graduated compression stockings can reduce the chronic (ongoing) swelling that a blood clot in the leg may cause.

Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the ankle and become looser as they go up the leg. This causes gentle compression (pressure) up the leg. The pressure keeps blood from pooling and clotting.

“Safety Support Solidarity!

Like safety, there is no one-size-fits-all definition of support for survivors. Often the most important thing you can do to support the survivors in your life is to simply be there for them, without judgement or expectation. If you are an advocate or other helping professional, you likely know this already, as supporting survivors is a huge part of your work. That said, we can all find ways to support the survivors in our lives, regardless of our profession.

What does “safety” look like to you? Freedom from violence? A roof over your head? When we say that survivors deserve safety, we mean that all survivors – and in fact, all people – deserve to live in safety and dignity, however they define it for themselves. This can include, but is not limited to:

• Physical safety: freedom from violence, safe housing, adequate food, access to medical care
• Emotional safety: trusting and respectful relationships, being able to express thoughts and feelings without judgement or ridicule, feeling a sense of belonging
• Financial safety: stability, access to finances, freedom from housing/food insecurity”

VAW net (How can I stand with survivors for Domestic Violence Awareness Month and beyond?)

“October is Domestic Violence Month—and a good time to be reminded that women are not the only victims. Men are victims too.

Domestic violence statistics updated October 2024 by the U.S. Centers for Disease Control and Prevention (CDC):

• In the United States, nearly every 1 in 2 women and more than 2 in 5 men reported experiencing intimate partner violence at some point in their lifetime.
• Every minute, 32 people experience intimate partner violence in the United States.
• 1 in 4 men in the United States has endured severe physical violence from an intimate partner.”

Psychology Today (Male Victims of Intimate Partner Violence | Psychology Today)