This is a brand new website dedicated to educational writers. If there are topics you would like to see discussed here, or resources you would like to see links to, please email me at bjuettner@gmail.com. Thanks!
Posted By Bonnie on July 5, 2010
These may interest people outside the industry:
Niagara Falls Man Lists Self Storage Unit as Residence in Order to Join Mayoral Race http://to.ly/5pUC
Are women equal in the self storage industry? http://to.ly/5pU8
Posted By Bonnie on July 1, 2010
A little humor for a Thursday afternoon…short but sweet! I hope you enjoy it!
http://digg.com/odd_stuff/The_Biggest_Self_Storage_Facility_Ever”
There is a spot for comments if you are so inclined, and you can Digg or share the link with anyone you like…
I will try to get back to posting blog entries more regularly very soon–I know that many people are clamoring for more…
Posted By Bonnie on November 22, 2009
I am working on an article on personal finance for the self-employed, and have decided to share my tips with you, one at a time–I would welcome your feedback!
Tip #1: Keep track of your time.
Somewhere my boyfriend (also self-employed) is reading this tip and laughing his head off. I am famous for losing track of time, so famous that when someone we know is late, we say that person must be on “Bonnie time.” But I am working on this and so should you. The first step is to record the time you spend working on different projects. My first method for doing this was the post-it method–I looked at the clock when I started working, looked at the clock when I stopped, and recorded my time on a post-it note. I had one post-it note per project, and woe unto me if I lost one…
In this technological era, however, I am sure that you can do better than the post-it method (although the post-it method has one advantage, which is that you don’t lose your timekeeping records if you have to reformat your hard drive). Online, you can find free timekeeping software, such as Toggl, Zen Tracking, or Task Capture. (You should always look for free software online before you spend money on something new, especially if the software is intended to do something simple like keep track of time.) If you are using Elance, you can use Elance’s timekeeping software, which is built right into the Elance website.
If you forget to open your timekeeping software, however, there is a way to reconstruct when you worked on something and the amount of time that it took–although it is cumbersome. If you are using a PC, you can use Windows Explorer to find out what time you last worked on a document. At least that can tell you the days you began and ended a project. You can use the history function in your web browser to find out more, if you did Internet research as part of the work. If you used your cell phone to make calls related to the project, your cell phone history should be able to tell you exactly when the calls took place and how long they took. If nothing else, taking time to reconstruct your schedule should impress upon you the need to keep better records in the future!
Now that you’ve got records of your time, what are you going to do with it? For some of us and for certain projects, those records are essential to billing. Even when you don’t need time records for billing purposes, however, keep those time records! You should budget your time as carefully as you budget your money, and, like the receipts that you should be keeping for all your expenses (especially business-related expenses), these records will show you how that time (your most precious commodity!) is being spent.
Next time: tip #2: reducing your overhead (eliminating unnecessary expenses).
Posted By Bonnie on October 18, 2009
For work reasons, I am reading Why Geography Matters, by Harm de Blij. I have only read the first three chapters so far, but definitely recommend it. Here is my draft of a lesson plan for the first third of chapter 1–please comment, if you are so inclined…
Chapter 1
In the first part of chapter 1, de Blij sketches out the boundaries of geography as a profession, explaining what it is that geographers do, why their work can be so varied and can cross the lines of so many disciplines, and what kinds of practical, real-world problems geographers might try to solve. This lesson focuses on the theme of the book, geographic literacy, and what it might mean to look at the world spatially.
1) Class discussion: Ask students to discern the theme of this book based on the title and first chapter. Ask students what the word literacy means, and then ask what geographic literacy is. What skills do students think are necessary in order to be geographically literate? Is geographic literacy something one can learn in a class, or is it something that one has to keep practicing throughout life in order to keep up with it? What do students think that it means to look at the world spatially? Encourage students to connect the idea of looking at the world spatially to the idea of using maps and globes. What kind of space are geographers interested in?
2) Geographic literacy quiz: Split the class into pairs (or very small groups). Give each pair a globe, map, or atlas, and have the partners quiz each other on world geography. Ask partners to assess each other’s geographic literacy.
3) Newspaper: Keep the class in pairs or small groups. Give each group a recent newspaper. Have the groups go through the newspaper, finding locations of world events on a globe or world map. If possible, find national and local events on a map as well. Then discuss the relevance of geographic literacy to understanding the events in the newspaper. In order to understand the newspaper, how important it is to be geographically literate?
4) Brainstorming: Have students reconsider the concept of literacy. They know that ordinary literacy means knowing how to read and write. De Blij has introduced them to the concept of geographic literacy. Are there other kinds of literacies? Ask students what kinds of literacy they might need in order to more fully understand what they read in the newspaper. Is there such a thing as historical literacy? or civic literacy? Have students make a list of other kinds of literacies they might think of, such as mathematical literacy, scientific literacy, computer literacy, and cultural literacy. Point out that basic literacy usually means the minimum amount of knowledge that a person needs in order to get by as an adult, living in the world in which we live. What literacies do students feel are necessary to function as an adult in your community? Encourage students to play with the idea of literacy and illiteracy a little, extending the concepts. For example, is there such a thing as sports literacy? Are there literacies associated with certain hobbies, such as knitting literacy or fishing literacy? If you move to a new town or school, are you culturally illiterate in the new environment at first?
5) Homework: Write an essay explaining what geographic literacy is. What does it consist of? According to de Blij, what would a person have to do in order to become geographically literate? Support your answer with examples from this chapter. If you wish, compare and contrast geographic literacy with one or more other kinds of literacy in order to make your point.
Posted By Bonnie on October 6, 2009
Short post, but, nuff said. Go watch this. Right now.
http://www.neabigread.org/books/fahrenheit451/filmguide.php
Posted By Bonnie on September 14, 2009
The Destruction of Tenochtitlan
This chapter focuses on Cortez’ arrival in the Aztec Empire, his approach to and entrance into Tenochtitlan (the Aztec capital), Montezuma’s submission to Cortez, and the destruction of Tenochtitlan. This lesson focuses on the question of historical responsibility.
Lesson 1
1) Class Discussion: Read the first paragraph of the chapter with the class, and discuss the question of historical responsibility. Point out to students that the meeting between Cortez and Montezuma is regarded by many historians as one of the most momentous meetings in history, along with the meeting between Francisco Pizarro and the Incan emperor (in what is now Peru), which occurred only a few years later. These two meetings (Cortez and Montezuma, Pizarro and the Incan emperor) are regarded as a clash between continents as well as cultures. Why do students think the meeting between Cortez and Montezuma was so important? Could it have ended any differently? Today, historians view what happened at Tenochtitlan as a horrible tragedy, the beginning of a holocaust that swept through the Americas and left 90 percent of the indigenous population dead from massacres, battles, and especially from disease. Williams says “it was no man’s fault.” Did Cortez had a responsibility to try to save Tenochtitlan? Should he have anticipated any of what was to follow, either the destruction of Tenochtitlan in particular (an act he committed himself), or the general carnage that occurred later, the near depopulation of two American continents? Is it fair to hold any historical figure responsible for unleashing large historical events such as this? While you are discussing Cortez and Tenochtitlan, make connections to the previous chapter. Does Columbus, likewise, bear any historical responsibility for what later occurred? Why or why not?
2) Plot: Make an outline of the plot of this chapter. What happened when? You may want to outline the plot in the form of a timeline. How did the destruction of Tenochtitlan unfold? At what point do you think that it became inevitable?
3) Saving Tenochtitlan: Divide the class into small groups or partnerships. With groups or partners, have students discuss what happened to Tenochtitlan. Referring to their plot outlines, have students consider whether or not there was a point in time when Tenochtitlan could have been saved. If Tenochtitlan could have been saved, what would have to have happened differently? Or was the destruction of the city, and of the Aztec civilization, inevitable?
4) In Class Essay: Williams discusses only the destruction that Cortez and his men wrought deliberately. Williams does not mention the diseases that Cortez brought with him without meaning to. Have students write an essay on the question of historical responsibility for unintended harm. Should Cortez be held responsible for bringing the Aztecs diseases such as smallpox, even though he did not know that he was bringing disease with him? Why or why not? How do we decide who to hold responsible for historical events? Or should anyone be held responsible? Why or why not?
5) Homework: Write an essay about Montezuma. What was Montezuma’s responsibility for what happened at Tenochtitlan? How did Montezuma try to prevent it? Do you think that Montezuma’s instructions to the Aztecs to accept Cortez as their regent were intended to prevent the destruction of the city and civilization? Or was Montezuma simply overpowered by the conquerers? Use evidence from the chapter to support your answer.
Lesson 2
The Destruction of Tenochtitlan
This chapter focuses on Cortez’ arrival in the Aztec Empire, his approach to and entrance into Tenochtitlan (the Aztec capital), Montezuma’s submission to Cortez, and the destruction of Tenochtitlan. This lesson focuses on the characters of Cortez and Montezuma, and Williams’ view of each of them.
1) Class Discussion: Discuss the characters of Cortez and Montezuma. Ask students: what do you think of these two men? what does Williams think? How can you tell what Williams thinks of them? Of Cortez, Williams says “What his hand touched went down in spite of him.” What does Williams mean by “in spite of him”? Is he saying that Cortez personally appreciated Aztec culture and the Aztec capital? Why or why not? Of Montezuma’s submission to Cortez, Williams writes, “Whether or not this be evidence on the Aztec’s part of weakness or the deepest forbearance, surely nothing like it for quiet flexibility of temper and retained dignity has ever been recorded.” He goes on to speculate that perhaps Montezuma was afraid of Cortez, but that, “Still, if this be so, Montezuma has left no trace of cowardice upon the records.” Do each of these men have characteristics that Williams considers to be an important part of the American Grain? Do students see a connection between Cortez, Montezuma, and the other characters who have been discussed in the book so far–Eric the Red, Freydis, and Columbus? What impression have they formed of the American Grain so far, based on these individuals?
2) Historical Sources: While you are discussing Cortez and Montezuma, take a moment to discuss historical sources. Point out to students that the Spanish conquistadors and the Aztecs did not speak the same language. In fact, when Cortez landed on the coast of Mexico, he met many different peoples, who spoke different languages. Cortez had to employ a translator, a woman known to history as La Malinche, who is famous in her own right, to help him communicate with the people he met. La Malinche spoke both Nahuatl, the Aztec language, and several Mayan dialects. Cortez also had another translator, Geronimo de Aguilar, a Spanish priest who had been captured by the Mayans and imprisoned by them for several years, who spoke a Mayan dialect. When Cortez spoke to the Aztecs, the Aztecs spoke to La Malinche in Nahuatl, she would translate their words into Mayan for Aguilar, and Aguilar translated into Spanish for Cortez. Do students see any problems with this system of communication? Point out that almost everything we now know about Tenochtitlan and the Aztec civilization comes to us from the accounts of the Spanish conquistadors and the priests who traveled with them (we know a little bit more from the information archeaologists have gleaned from excavations). The accounts written by conquistadors and Spanish priests were almost certainly Williams’ main sources of information about Montezuma. Does this affect students’ perception of Montezuma in any way? Why or why not?
3) Mining for Evidence: Divide the class into two groups. (Alternatively, if your class is very large, you may want to divide the class into small groups for this activity and for the class presentation that follows.) Have one half of the class mine the chapter for evidence of Williams’ opinion of Cortez. Have the other half mine the chapter for evidence of Williams’ opinion of Montezuma. Have students make notes of their evidence, by copying down quotations, or listing particular incidents. Then have students in each group draw their own conclusions about what Williams thought of each man. How does Cortez represent the American Grain? How does Montezuma?
4) Class Presentation: Reform the class into one group, and have members from each group give an oral presentation of the evidence that they found, explaining how Cortez and Montezuma relate to the American Grain. Be sure that each student has an opportunity to speak about some aspect of Cortez’ or Montezuma’s character.
5) Homework: Write an essay in which you compare and contrast the characters of Cortez and Montezuma, as depicted by Williams. How are the two men similar? How are they different? Do they differ in their appreciation for Tenochtitlan? Do they differ in the approaches they use to try to save the city? Use evidence from the chapter to support your answer.
Posted By Bonnie on September 11, 2009
Continuing my theme this week–here is another snippet from something else I’m currently working on, a study guide for William Carlos Williams’ In the American Grain. This one might be more interesting for those of you who are educators or who do textbook writing. Have you noticed that textbooks today are required to break down literary concepts and strategies for kids? This isn’t for a textbook, but it’s no doubt influenced by the textbook writing that I do.
Introduction
In the second half of this chapter, Gregory goes on to discuss the idea of sincerity, and what makes Williams’ work sincere. This lesson will discuss the concept of Sincerity.
1) Class Discussion: Introduce the concept of Sincerity. Ask students what they consider sincerity to be. What do we mean when we sign a letter, “Sincerely yours”? Is there a difference between sincerity and honesty, or are they the same thing? Is it a good thing to be sincere? Why or why not? How can you tell if someone is being sincere? In what circumstances is it most important to be sincere? Why might sincerity be important for a writer? Is it possible to judge whether or not a writer is being sincere? Can sincerity be measured objectively, or is it always subjective? Why?
2) Group or Partner Discussion: Gregory comments that the question of sincerity never comes up while discussing classical literature. “It seems absurd,” he says, “to question the sincerity of Homer, of Sophocles, or of Aeschylus…” When we evaluate writing of our own time, though, Gregory says that the question of sincerity does come up, and that if a writer is not sincere, we question his or her integrity. Why do we not question the sincerity of classical authors? Why do we not doubt the integrity of classical authors? Did they write for different reasons than a modern writer like William Carlos Williams?
3) Sincerity Rubric: Ask students what element of literature sincerity falls into. It is not a character, nor is it a part of plot. Except in rare essays such as Gregory’s, it is not a theme. Usually, sincerity is part of the tone of a work of literature. Have students remain in their small groups or partnerships, and come up with a set of criteria for judging a work’s sincerity. Have students make their own rubrics for judging sincerity. Then have students use their rubrics to evaluate Gregory’s Introduction and judge whether or not he is being sincere.
4) Public Speaking: Have students present their evaluation of Gregory’s Introduction to the class. Have each group explain how they could tell whether Gregory was being sincere. Encourage students to include quotations from the Introduction to support their opinions.
5) Homework: What makes a work of literature sincere? How can you tell if a writer is being sincere? Write an essay in which you take a position on this question, and defend your views. As you write, you may wish to refer to the rubric you made in class.
Posted By Bonnie on September 10, 2009
Below is a sneak preview of the first chapter of my new book for Lucent’s Disorders and Diseases series, Thyroid Disorders. Enjoy!
Chapter 1
The Body’s Thermostat
Imagine a swimmer diving into a pool on a warm day. Before diving into the pool, the swimmer may have felt warm or even hot. But the water in the pool is cooler than the temperature of the swimmer’s body. The swimmer quickly cools off and may even begin to feel cold. After some time has passed, though, the swimmer acclimates – the body seems to get used to the cool water and the swimmer warms up.
The process of warming up a cold body may seem simple. But it isn’t. The body does not just “get used to” the temperature of the water in a cold pool. First the body must send messages to the brain, explaining that the temperature is dropping. The brain constantly monitors messages from the body related to temperature, because the human body functions best within a certain temperature range. When the brain receives messages saying that the body is getting too cold, it takes action. It sends a message to the thyroid gland. The thyroid gland can release chemicals that will stimulate the body’s metabolism and produce heat – if the thyroid is healthy. If not, the swimmer may find the cold water in the pool difficult to tolerate.
The Butterfly Gland
The thyroid gland may seem like a small organ to have such an important job. It is fairly small, about the size of an egg, and weighs less than three quarters of an ounce. It is located at the front of the throat, just below the larynx, or voicebox, and is wrapped around the windpipe on three sides. The thyroid is a light purple-red in color, and is shaped like a butterfly. The middle of the thyroid is called the isthmus, and there are two to three inch long rubbery “wings” on either side.
When the thyroid gland is healthy, most people never even think about it. If it gets infected, a doctor may be able to feel swelling in the neck (this is different from the swelling of lymph glands in the neck, which a doctor may also find swollen when the body is fighting off an infection).
The Endocrine System
The thyroid gland takes its instructions from the brain. The brain has two ways to send instructions to other parts of the body. It can send electrical impulses through the nervous system, telling muscles to relax and contract. But the brain also has another message delivery system too: the endocrine system. The endocrine system uses chemicals called hormones to carry messages to the body’s cells. Hormones are produced by glands that are located all over the body. For example, the thyroid gland is in the throat, and the adrenal glands are nestled on top of the kidneys. The glands of the endocrine system are not connected to each other physically. They must use hormones to communicate with each other, as well as with the body’s cells. After the glands produce hormones, they release the hormones into the bloodstream, and the blood carries the hormones throughout the body.
As hormones travel through the body, they touch many different cells. Certain cells have receptors, places where the hormone can connect to the cell and stimulate it to take different actions. If a cell does not have a receptor for a particular hormone, the hormone passes it by and continues to travel through the body. If the cell does have a receptor, the hormone binds to it. Then it stimulates the cell to do certain things. For example, it might stimulate a cell to make a particular protein, or to make an enzyme. Some doctors compare cell receptors and hormones to locks and keys. Each key, or hormone, can only interact with a certain kind of cell receptor, or lock.
The glands of the endocrine system are not physically connected to each other, but, at the base of the brain, they are connected to the nervous system. The connection is located in a gland called the hypothalamus. The hypothalamus is located in the middle of the brain. It receives information from sensory organs, such as the skin. It also produces hormones that tell the body’s glands what hormones they should release.
The Thyroid in Action
Consider the example of the swimmer who jumped into a cold pool. The skin contains special cells, called thermoreceptors, whose job it is to monitor the skin’s temperature. When the skin becomes cold, the thermoreceptors send an electrical impulse through the nervous system to the hypothalamus. In response, the hypothalamus releases a chemical known as TRH (TSH-releasing hormone). The TRH travels through several short blood vessels to the pituitary gland, a gland just below the hypothalamus in the middle of the brain. The TRH binds to receptors on cells in the pituitary gland, stimulating them to produce another hormone, TSH (thyroid-stimulating hormone).
After the pituitary releases TSH, the TSH travels through the bloodstream to the neck. It enters the thyroid, and binds to receptors on thyroid cells. There it stimulates them to release thyroxine, a hormone that causes cells to speed up and become more active. The cells begin to use more nutrients, breaking the nutrients down into energy. The range of processes that take place as the body’s cells break down oxygen and calories to make energy is called the metabolism. As the cells become more active, they produce heat, and the body’s temperature increases. That is why people who tend to be warm all the time often say that their bodies have a faster metabolism.
Because the body has become warmer, thermoreceptors in the skin stop sending signals to the hypothalamus saying that the body is cold. By now the swimmer feels warm, or at least comfortable, in the pool. He or she has become used to the temperature of the water. All this is possible because the swimmer’s endocrine system, especially the thyroid gland, is strong and healthy. People whose overall health, including the health of the endocrine system, has been weakened by a cold or flu, or by age, may have a harder time adjusting to cold water in a pool, or to cold outdoor temperatures in the winter. Likewise, difficulty coping with cold or warm temperatures is one of the most common symptoms of a thyroid disorder. The thyroid is so important in the regulation of the body’s temperature that many people call it the body’s thermostat.
If the water starts to get colder, the body’s feedback loop of thermoreceptors to hypothalamus to pituitary to thyroid to the body’s cells may be triggered again. The brain constantly monitors conditions in the body, and reacts when conditions, such as temperature, become unfavorable. The hypothalamus and pituitary continually adjust and readjust the amounts of hormones that they release, trying to keep the body’s temperature consistently within a certain range.
The Thyroid’s Job Description
Regulating the body’s temperature is just one of the thyroid’s functions in the body. Hormones released by the thyroid affect every cell in the body. Why? The thyroid gland governs the body’s metabolism. Metabolism refers to all of the processes used by the body to generate and use energy. Every system in the body uses energy, so every system in the body has to make energy or convert it from some other substance.
All the cells in the human body must go through the same basic process to get energy. The digestive system breaks food down into tiny molecules of sugar, such as glucose. Cells use glucose to make energy. But they need more than just glucose. They also need oxygen. They also need their own genes to tell them how to convert glucose and oxygen to energy. That is why thyroid hormones are so important. When a cell encounters thyroid hormones, it takes the thyroid hormones into its nucleus. The nucleus contains the cell’s genes, and some of those genes have receptors for thyroid hormones. The thyroid hormones stick to those receptors, turning some genes on and other genes off. By doing so, the hormones control the speed at which the cell metabolizes energy.
When doctors and biologists talk about the body’s metabolism, they mean all of the processes that relate to how the body gets energy: eating and digesting food, eliminating waste, breathing, circulation, the functioning of the brain and the nervous system, and the conversion of nutrients and oxygen to energy by the body’s cells. Thyroid hormones control the speed at which all those processes occur. The thyroid can slow all the body’s processes down or speed them all up. It affects the rate at which the heart beats, and the speed of digestion. It even determines the speed of operations in the brain – which means that a healthy thyroid can make a big difference in how fast a person thinks, talks, and works. It also affects people’s weight. People with less active thyroids have slower metabolisms and tend to gain weight easily. People with more active thyroids tend to have faster metabolisms and have a harder time gaining weight.
Growth and Development
By controlling the metabolism, the thyroid also governs growth and development. It can cause a developing child to grow more quickly or more slowly than normal. As a result, having a healthy thyroid gland is especially important for babies and children. Children with healthy thyroids grow at a normal pace and hit their developmental milestones at regular intervals. Children with thyroid disorders, however, may not develop normally. They may be much smaller than other children of the same age, or much taller. If a woman has a thyroid disorder during pregnancy, her baby may not develop properly and may be born with birth defects or brain damage. Babies who develop thyroid disorders after birth are at risk for mental retardation, and the damage is often permanent. Sometimes the damage is not as severe, and in these cases, babies and children with hypothyroidism may end up with milder developmental delays or learning disabilities. Hypothyroidism can also affect the onset of puberty, causing it to be delayed or to start several years early.
Hormones relating to growth and development affect adults too. They stimulate the formation of new cells and tissue in the heart, brain, eyes, skin, muscle, bone, liver, kidneys, and intestines. They also stimulate the body’s cells to reproduce themselves when necessary to repair damaged or infected tissues.
Recognizing Thyroid Disorders
Most primary care doctors have not been trained to recognize thyroid disorders. One study showed that doctors in HMOs (Health Management Organizations) accurately diagnose thyroid disorders in fewer than 50 percent of their depressed patients. (Depression, like fatigue and intolerance of hot and cold, is a common symptom of thyroid patients.) However, lack of training is not the only obstacle that doctors face when trying to diagnose a thyroid disorder. Because thyroid hormones affect the entire body, symptoms of a thyroid disorder can show up in any of the body’s organs and organ systems. A person with a thyroid disorder may have symptoms that, to a doctor, seem vague, random and unrelated to each other. The doctor may suspect that nothing is wrong with the patient at all and that the disorder, if there is one, is entirely mental or emotional.
Another obstacle to getting a diagnosis is that people with thyroid disorders may not realize themselves that anything is wrong. The symptoms of thyroid disorders tend to be things like fatigue, weight gain or loss, a tendency to feel too hot or too cold, dry skin, constipation, and anxiety or irritability. Patients often blame themselves and their lifestyles for symptoms such as fatigue and changes in weight. Rather than talk to a doctor, they may try to address the symptoms themselves by getting more rest, eating healthfully, and exercising. If lifestyle changes do not work, patients may blame themselves, thinking that they did not make enough of a change or did not try hard enough.
Screening for Thyroid Disorders
Because it is so hard to diagnose thyroid disorders based on the symptoms, some doctors are taking the approach of routinely ordering a blood test to check the thyroid hormone levels of patients who fall into certain categories. For instance, newborns are always checked for hypothyroidism, not because they are at more risk, but because untreated hypothyroidism is so dangerous for babies.
Some doctors ask about a family history of thyroid disorders and autoimmune disorders when they take an adult patient’s medical history. If there is a family history of thyroid disease, doctors may plan to check for it periodically even if the patient has not mentioned any symptoms. People who have a family history of thyroid disease or a family history of an autoimmune disorder such as diabetes, lupus, or rheumatoid arthritis are more at risk for developing thyroid disorders themselves. About half of patients whose parents have thyroid disorders will develop a thyroid disorder too.
Many gynecologists also routinely order thyroid panels as part of their annual checkup for women over the age of 30, knowing that women are much more likely to develop thyroid disorders than men, and that a woman’s chances of developing a thyroid disorder increase with age. Some psychiatrists also routinely check thyroid function in their patients, since thyroid disorders are a common cause of depression, anxiety, and other mood disorders. Once the possibility of a thyroid disorder has been raised, it is much easier for doctors to diagnose it.
Blood Tests
Doctors used to diagnose thyroid disorders based on a patient’s medical history and symptoms. But now it is possible to test a patient’s blood for thyroid hormones. Many doctors feel that the most sensitive blood test for thyroid disease is a TSH test – a test of the levels of thyroid stimulating hormone released by the pituitary gland.
A blood test can show the levels in the blood of hormones that were made by the thyroid. This kind of blood test checks for thyroxine, called T4, and for triiodothyronine, called T3. (These hormones are called T3 and T4 because they contain iodine atoms – three iodine atoms in T3 and four in T4). Tests of T3 and T4 can be used as a way to follow up on an abnormal TSH result or to help a doctor interpret an abnormal TSH result.
Patients who have an underactive thyroid, or hypothyroidism, will normally have higher than average levels of TSH in their blood, because the pituitary releases more and more TSH in an attempt to stimulate an underactive thyroid. In these cases, a doctor would expect to see low levels of T3 and T4. On the other hand, patients who have an overactive thyroid, or hyperthyroidism, will normally have much lower than normal levels of TSH in their blood, because the pituitary will stop trying to stimulate a thyroid gland that is already too active. These patients are likely to have high levels of T3 and T4.
What Is Normal?
Even with blood test results, though, thyroid disorders can sometimes be difficult to diagnose. Tests of TSH and of T3 and T4 levels are only about thirty years old. Doctors are still trying to determine what levels of these hormones in the blood should be considered normal. For most laboratory blood tests, the normal range is determined by using the range that is found in a control group — a large group of people who are classified as normal. The average result from a person in that group is considered the middle of the normal range. Then labs analyze the statistics for the whole group to determine what the upper and lower ranges of normal are. This approach does not work well for thyroid disease, though, because thyroid disease is so common that many people in the control group actually had undiagnosed thyroid disorders. As a result, the blood tests were classifying some patients as normal even though they actually had hypothyroidism or hyperthyroidism. That is what happened to 54-year-old Mary, who later wrote about her experience:
My first symptoms…were depression and fatigue. Prozac overcame the depression but not the chronic tiredness.
Every doctor’s visit yielded a different diagnosis. Severe cramps and constipation were labeled diverticulosis….when my hair started falling out in clumps, the doctor said the cause was stress….after two emergency room visits, I was referred to a rheumologist, who promptly diagnosed rheumatoid arthritis….Only once did a doctor order a thyroid screening—after I mentioned having gained twenty pounds (from 105 to 125) in six months. The TSH was elevated according to today’s guidelines but at that time was considered “high normal.”
As Mary’s story shows, today the level of each thyroid hormone in the blood that is considered normal keeps changing as doctors work more with the test and develop a better understanding of thyroid disease. Doctors who specialize in thyroid disorders know this and are very careful in how they interpret blood test results, especially when the results are normal but still at the low or high end of the normal range.
More Tests
If initial blood test results are uncertain, or more testing is needed, a lab can also test the patient’s blood for antibodies that are produced by patients who have Hashimoto’s thyroiditis (the disease that is responsible for most hypothyroidism) or Graves’ disease (the disease that is responsible for most hyperthyroidism). Another option is to test the blood for other substances that are made by the thyroid gland. For example, the thyroid produces higher than usual levels of thyroglobulin when it is inflamed or injured, or when a patient has thyroid cancer. It produces higher levels of calcitonin, a hormone, when a nodule of a rare form of thyroid cancer (medullary thyroid cancer) has developed.
If blood tests are inconclusive, doctors can order other tests. One option is a radioactive iodine uptake scan. One of the thyroid’s jobs in the body is to collect and store iodine. If a patient takes a dose of radioactive iodine, the thyroid will collect it, and a few hours later, technicians can take a scan of the thyroid using a tool that measures radioactivity. The scan shows how much iodine was collected by the thyroid. A lower than normal uptake indicates that the thyroid is underactive, while a higher than normal uptake indicates a hyperactive thyroid.
In Mary’s case, above, doctors did not diagnose thyroid disorder on their own. Like many patients, Mary finally decided to take matters into her own hands. She gathered her medical records together, did her research, and concluded that she had hypothyroidism. Then she found a new doctor and demanded more tests. “Within three days,” Mary says, “I was diagnosed with hypothyroidism and received a prescription for thyroid hormone. I gradually discontinued my other medications, and within six months I felt like my old self, only better.”
Fortunately, thyroid disorders are relatively simple to treat once they have been diagnosed. Most patients can be treated with thyroid hormones. Like Mary, patients may have to be patient and give their bodies time to adjust to the changes in their hormone levels. After a few months, though, patients often find that they feel much better. Fatigue and mental fog lift, moods tend to improve, and the odd random symptoms such as constipation and hair loss start to clear up. Doctors who specialize in thyroid disorders often find it very satisfying to treat patients who have been trying for months or years to figure out what was wrong with them. Kenneth Ain, the director of the University of Kentucky Thyroid Clinic, explains that he became interested in the thyroid when he was a new intern working in the intensive care unit of a hospital. He writes,
As a new intern, my first intensive care patient was a comatose gentleman whose illness had defied understanding for three weeks. What a triumph for a new physician to diagnose myxedema (hypothyroid) coma and see my patient awaken after sufficient treatment with thyroid hormone!
Posted By Bonnie on September 3, 2009
I haven’t had a chance to watch all of this yet, but will shortly–these are video clips of an interview with my karate teacher, Nancy Lanoue, and one of my Senpai, Marie O’Brien–well worth your viewing, especially if you are an educator looking for new ideas about violence prevention, school, and kids.
http://www.youtube.com/watch?v=N8pwXT5IHKI
http://www.youtube.com/watch?v=XbyQr31jFvc&feature=related
Posted By Bonnie on August 29, 2009
In this blog, I don’t usually write about the work I’m currently doing. I’m going to talk about my own work this time, though, because it’s posing organizational challenges that I think must be common to many other writers who may read this blog. Currently, I am finishing a long book on Thyroid Disorders for Lucent’s Diseases and Disorders series. I am also setting up my book writing schedule for the next few months. It’s going to consist of Monsters: Genies, for KidHaven; Diet and Disease, for Cengage’s new Nutrition and Health series; and A Great Idea: Invisibility Cloaks (yes, you read that right) for Norwood House. At the same time, I am also working on several small, short projects — some 500-word articles on health topics for a Guru.com client, webpages for a natural remedies website, a monthly literature study guide for Bookrags, mentoring other writers for Mindbounce. I am staying busy! I am doing a lot more work than I used to do, now that my youngest child is in school full time and I can work full time.
But with all this work coming in, I find that I have to upgrade my organizational systems. There are two sets of problems: organizing my research, and organizing the paperwork for my business. I’m curious to know how other writers handle these problems.
To keep track of my research, I have tried several strategies recently, and not all have been equally effective. I’ve tried using software that allows me to cut and paste any Internet sources into an electronic binder, such as the OneNote program available in Microsoft Office. I found OneNote somewhat cumbersome, though. It doesn’t allow me to input my hard copy sources (unless I scan them in). And since I use just one computer at a time, it’s frustrating to click back and forth between a OneNote research notebook and the Microsoft Word program that I have my manuscript in.
I’ve also tried using a physical three-ring binder and taking notes on legal pads that already have three holes punched into them. So far, this method is working well for me, although it’s an odd system for a technophile to become enamored of. I like taking notes on paper, as it helps me to remember what I am reading. It helps the information to stay in my head longer than it would if I simply printed webpages or made copies of book pages and then highlighted pertinent information and/or added margin notes. But in the past I threw all my notes into a manila folder and they sometimes got mixed up. When they are in a three-ring binder they stay neat and organized. When I make copies or print documents, I put them in folders that are made for the three-ring binder, so they can stay next to the legal pad notes that they relate to. I have used this system the whole time that I’ve been writing Thyroid Disorders, and I’ve had a much easier time than usual keeping track of information, and finding articles again that I know I have copies of somewhere in my research…I like this system, even if it does make me feel as though I am in the 9th grade.
Of course, I also have a stack of library books that relate to each project that I am working on. My new system for keeping track of them isn’t very technological either. Technology helps me with library books on one end–I use the library website to locate, reserve, and later renew books. Once I have them in hand, though, I have taken to storing them in a file crate along with my three-ring research notebook for that project. Then I can grab my laptop and my file crate and ensconce myself anywhere I’d like to work for the day, or for the next few hours, since I don’t like to be tethered to my desk.
So I’m finding that for the traditional research and writing side of my work, I use technology to help me find my research sources, but once I have them, I like to use traditional methods to store and work with my research. (No note cards, though–I’m not THAT traditional!) For the business side of my work, though, technology is vital. I am not big on paperwork…I find that I use my computer to store electronic copies of contracts and invoices, and I use the Guru and Elance websites to keep track of projects, relying on those sites to store old project proposals, communications with clients, and invoices and payment history (which I will need for tax purposes). I use the Google calendar to keep track of my writing deadlines (and then I download them to my phone using GooSync). I have started sending all my receipts to Shoeboxed.com, a service that will scan receipts and let you categorize them later. (Of course I’ve sent Shoeboxed a mountain of receipts and have barely begun to categorize them.) I also store my client information, and time the hours I spend on each project, using software that is actually meant for law firms, but which keeps track of my hours and my client contact information, and will, once I learn to use it more, keep track of my invoices and accounts receivable as well. I am not sure whether all this reliance on technology is protecting me or making me more vulnerable. I’m very good at losing pieces of paper, and anything on my computer will stay in one place, where I can find it. But if I forget to back up my data, I could be in trouble!
I am considering morphing to a new system that combines various elements of my old systems. I’m thinking of saving, or at least backing up, my current projects to an online workspace such as Huddle, or even Google Documents. Has anyone tried this? My thinking is that if my work is stored in an online space, just as my Gmail and Google Calendar is, then I can’t lose it if something happens to my computer. I find myself already feeling grateful that I can’t lose my Guru, Elance, Gmail, or Shoeboxed information, because it’s not physically in my hands. Most of my work does go through Gmail at some point or other, so Gmail does provide me with a de facto backup for most things. But I’d like to have a more organized space that does the same thing but is indexed so that I can find things quickly rather than scrolling through old Gmail attachments. I don’t know…sounds like the next time I have some spare time (what’s that?) a trip to Lifehacker and various other productivity websites is in order! Do any of you writers who are reading this have other systems that you would like to share with me and my readers? Please comment below! Thanks.
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