Are you concerned about how much you’re spending on health care? Are you wondering if the blood test, X-ray, or MRI your doctor recommends is absolutely necessary? Maybe you don’t make it a habit to discuss the pros and cons of testing with your doctor because, after all, he or she is your doctor and always chooses wisely what is best for you, right? I do trust my own primary doctor’s recommendations, because she listens to me, closely. And she carefully considers whether or not a test is needed, then explains to me the reasons for her recommendation. Here’s the rub: We have a conversation about evidence-based practices before making any final decisions. In other words, she engages with me, as a human being – someone with worries, fears, doubts, and needs. So why am I sharing this with you? Last fall my husband went to his primary doctor for a physical exam. A month later we received a bill from the hospital she is affiliated with; the charges for routine blood work were far greater than I had expected. Though we have health insurance, like most people, we must first fulfill a yearly deductible, which doesn’t include copays and coinsurance. When I asked a representative from the health insurance company how they arrived at the number my husband and I were responsible to pay, and who decides on the formula, he answered with what amounted to the following: hospital charge – some random number chosen by a faceless person = contracted rate – deductible – ten percent co-insurance. I had no choice but to reach for the Advil in the kitchen cabinet nearby.

There’s more. Health insurance company administrators treat people not as human beings but as fixed codes that should fit snuggly into pre-printed, micro-millimeter boxes. So, since my husband’s doctor advised him to take Vitamin D supplements, because his lab work showed it to be low, we received another bill charging us a nominal fee for what our health insurance called a “consult.” (That single blood test alone cost us a chunk of $125.29.) It didn’t matter that the “consult” took place during his physical – it didn’t fit into the insurance company’s pre-fab, coded square for “preventative care.” But isn’t that why we have physicals, not only to be examined, but also to discuss what measures we can take to improve our overall health? That sounds a lot like the dictionary definition of “preventative”: the branch of medicine concerned with prolonging life and preventing disease.” If my husband’s doctor didn’t speak with him about his Vitamin D level, how else would he have known that he needed supplements? Health care has become much like an a la carte menu.

Here’s the good news: A friend and author at Strategy Health Care, Dr. Gene Lindsey, led me to a handy resource when I reached out to him with my concern about health care costs. That resource is Choosing Wisely. Launched, in 2012 by Advancing Medical Professionalism to Improve Health Care (ABIM), the goal of Choosing Wisely is to encourage dialogue between providers and patients in an effort to prevent unnecessary medical tests, treatments, and procedures. A practitioner of cardiology for nearly four decades, and President and CEO Emeritus of Atrius Health and Harvard Vanguard Medical Associates, I trusted Dr. Lindsey’s recommendation, as much as I trust my own primary doctor.

Choosing Wisely offers lists of health-related topics created by medical specialty societies, and represents evidence-based recommendations providers and patients should discuss. Topics range from plantar fasciitis to cancer drugs. Each topic includes information about when tests and procedures are deemed appropriate. The recommendations should not be relied upon to decide health care coverage, but to provoke conversation about whether or not particular treatments are necessary.

While reading through the list on Vitamin D testing and supplementation, this is what I learned: Testing doesn’t improve treatment. Most of us have low Vitamin D levels, but not “seriously low levels.” It’s recommended that we get a little more sun, eat foods rich in Vitamin D, and if we don’t get a lot of sun or eat enough D-rich foods, we should talk to our doctor about supplements. According to Choosing Wisely, “Getting tests that you don’t need often leads to treatments you don’t need, or treatments that can even be harmful. For example, if you take too much vitamin D, it can damage your kidneys and other organs.” And “doctors are ordering tests six times as often as in 2008.” Of course, there are conditions that warrant Vitamin D supplementation, like osteoporosis, and any disease that damages the body’s ability to absorb the vitamin.

Take a look at Choosing Wisely, and look out for yourself, your body, your health, because it’s you that matters.

Did you know that at least sixty areas of the brain are involved with the processing of visual information, and that seventy percent of all sensory information is visual? I didn’t know this. I learned that fiber of trivia from Amy Pruszenski, a doctor of optometry, during her talk about post-traumatic vision syndrome (PTVS) at the Brain Injury Association of Vermont annual conference this past October. Simply put, PTVS is a disruption in flow within the complex network of nerves, tracts, and subsystems of the brain. Such disruption prevents the processing of visual data. This is not an uncommon occurrence in people who have sustained a traumatic brain injury (TBI). So, if you’ve sustained a TBI, including a concussion, and you’ve been wondering whether or not you have PTVS, keep reading.

Some common problems associated with PTVS include blurred vision, sensitivity to light, reading difficulties (words may appear to move on the page), poor comprehension, difficulty concentrating, poor memory, double vision, headaches when straining eyes, eye pain, squinting, closing one eye, poor depth and spatial judgment, and strabismus, or misalignment of the eyes. The list is endless.

But there’s no reason to walk around fearful that you’re about to fall over because you’re visual processing system is out of wack – you swear that every time you go out for a walk, the sidewalk curb shifts just as you are about to step off it to cross the street. Fortunately, there are treatments and behavioral changes that can help improve the flow and processing of information between the eyes and brain. Corrective lenses can help with blurry vision and magnification of objects, and can improve both close-up and distance vision. Prism glasses have a ground prism in or on the lens, which changes how the light enters the eye. These might help alleviate double vision and improve peripheral vision. Some optometrists recommend patching one eye to help with double vision. Doing so prevents information that causes double vision from entering the brain. After testing a patch during Amy’s talk, and having had to wear one as a kid to strengthen my “lazy eye,” I can tell you that this is not the most appealing option, especially if you are prone to claustrophobia.

Some behavioral changes Amy suggested, which apply to people without a TBI too, sounded tempting. Of course, they require discipline and training. Every twenty minutes, step twenty feet away from your computer, and focus on something else for at least twenty seconds. (I must do as Amy urged and set a timer to remind myself to turn away from the screen – I’ve been staring at it for more than an hour now.) Also, try what Amy calls a “Palm Break.” Block your eyes with your palms to block out all visual stimulation. But it’s not only the length of time engaged in an activity that affects visual processing; the type of activity affects it too. For instance, computer work is more strenuous on the eyes and brain than, say, washing the dishes.

Here are a few more tips to help avoid visual overload: remove clutter in your home and at work. (You don’t want to be around me when my home is a mess.) Prioritize activities, and don’t set yourself up to do too much in a day. (I still think I’m the super-woman I was before my TBI and list five or six brain-heavy tasks in my date book each day.) And shut down your computer, ipad, iphone, iwhatever, even the television, two to three hours before bedtime. (I know, this is a tough one, especially if you’re like me and must watch just one more episode of Call the Midwife before you click the off button on the remote.) The short wavelengths emitted from these kinds of devices suppress melatonin, a hormone that controls wake and sleep cycles. The suppression of melatonin not only interferes with sleep, it has also been linked to all kinds of bodily dysfunctions: cancer, diabetes, heart disease, obesity.

Rather than leaving you bloated with worry about how to fit in yet another self-care activity into your busy day, I’ll end with a shout of encouragement from Amy: “Celebrate accomplishments!”

In Lucy Grealy’s memoir, Autobiography of a Face, the focus remains on the author’s identity struggle as she faces years of cancer treatment in which one third of her jaw is removed. How does she take us on her conflicted journey of needing to be accepted for who she is versus succumbing to society’s notion of acceptance?

She implants particular objects that carry the story forward: the hat she almost never takes off, and the turtleneck her mother encourages her to wear to hide her balding head and disfigured jaw. The mirror, her reflection, is Grealy’s nemesis: she says she is an “imposter” when she looks in the mirror (220). And she avoids looking at the details of her face: “Though I had looked at the scar running down the side of my still swollen face, it hadn’t occurred to me to scrutinize how I looked. I was missing a section of my jaw, but the extreme swelling, which stayed with me for two months, hid the defect (62).”

By employing phrases – “I tried to camouflage myself by sitting in the middle of the group,” and “I felt as if my illness were a blanket the world had thrown over me” – Grealy evinces her identity struggle. She does the same through metaphor: “Our house was falling apart,” and “Our home’s drastic state of disrepair” (35, 80). Her house is in disarray like that of her body and emotional state.

By narrowing in on the transformative events – surgeries, hair loss from chemotherapy, becoming a teenager and growing into a woman, interactions with men – Grealy maintains an integrated story of identity. In doing so, the reader is brought into her world, a world colliding with emotions: fear and anger, longing and loneliness, humiliation, denial, sadness.

But ultimately Grealy moves toward self-recognition: she matures from a 9-year old, unaware of what it means to have cancer and naïve as to how to cope with significant deformities, to an adult where she becomes mired in the conflict between acceptance of herself as she exists versus the desire to appear pretty in order to be accepted. She does not achieve complete resolution on, and off, the page – complete resolution is asking a lot of the writer who has suffered any kind of illness, or trauma. But, while at a café with a new lover, Grealy “experiences a moment of freedom,” and arrives at understanding (222):

As a child, I had expected my liberation to come from getting a new face to put on, but now I saw it came from shedding, shedding my image. Society … tells us again and again that we can most be ourselves by acting and looking like someone else, only to leave our original faces behind to turn into ghosts that will inevitably resent and haunt us (222).

And so, as Grealy says, “I looked with curiosity at the window … to see if I could recognize myself (223).”

Grealy, Lucy. Autobiography of a Face. New York: Harper Perennial, 1995. Print.