Essential thrombocythemia: When is drug therapy necessary?

Essential thrombocythemia refers to a high platelet count for which no cause can be determined. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter.

Treatment of essential thrombocythemia depends on the individual's risk of a blood clot or bleeding episode. Not everyone who has essential thrombocythemia requires treatment with platelet-lowering medications. But those who may benefit from platelet-lowering medications — such as hydroxyurea, interferon alpha or anagrelide — include:

• Individuals who are older than age 60
• Individuals who have had a previous blood clot or bleeding episode
• Individuals who are younger than age 60 and have not had a previous blood clot or bleeding but have risk factors for cardiovascular disease, such as prior heart attack or stroke, or high cholesterol
• Individuals with a platelet count greater than 1.5 million platelets per microliter

The choice of which medication to use is complex and based on various factors, such as side effects, potential risks and cost. The most solid data from randomized trials suggest that hydroxyurea is the best first-line therapy for those requiring treatment. However, there are many reasons why one of the other medications may need to be considered. It is important to discuss this with a doctor who is familiar with essential thrombocythemia before considering a treatment.

Low-dose aspirin lowers the risk of blood clots in individuals with essential thrombocythemia but has no effect on platelet count.

People develop different styles of communication based on their life experiences. For many people, communication style becomes such an ingrained habit that they're not even aware of how they're communicating. And they tend to stick to the same style even when it's ineffective or harmful.

In the majority of situations, being assertive is most effective. Assertive communication revolves around mutual respect — giving and getting respect. Assertiveness shows self-respect because it means that you stand up for your personal rights, protect your self-interests and express your feelings, needs and ideas in a way that is honest and direct.

It's not just what you say — your message — but how you say it that's important. If you communicate in a way that's passive or aggressive, the content of your message may be completely lost because the people you are communicating with are too busy reacting to your delivery. Assertive communication gives you the best chance to deliver your message successfully.

Aggression is assertiveness gone bad. Aggressive people disregard the needs, feelings and opinions of others. They may feel or act self-righteous or superior. They may bully others, humiliate them, degrade them or even act physically threatening.

Aggression doesn't foster mutual respect. Instead, it indicates a desire for power and domination — winning at the other person's expense. Someone who's aggressive may get too close to you, point his or her finger at you, yell, shove you, and tell you that your opinion doesn't matter.

Some people appear naturally assertive. But if you tend to be more passive, you can learn assertiveness skills with a little practice. And if you tend to be aggressive, you can learn how to tone down your communication style.

Here are some steps in assertiveness training you can try on your own:

• Honestly assess your communication style. Do you voice your opinions or remain silent? Do you say yes to additional chores or tasks even when your plate is already full? Do others consider you to act on the aggressive or passive side? Are you quick to judge or blame? Do others seem to dread or fear talking to you?
• Use assertive language. Use "I" statements so that others know what you're thinking and you don't sound accusatory or blaming. For instance, say, "I disagree," rather than, "You're wrong." Don't beat around the bush — be direct. If you have a hard time turning down requests, simply say, "No, I can't do that now." Give a brief explanation, if appropriate.
• Rehearse what you want to say. If you have a particular issue in mind, focus on that. Otherwise, rehearse typical scenarios you encounter. For instance, if you want to ask for a raise, practice what you want to say. It may help to write a script. Say it out loud. Consider role playing with a friend or colleague and ask for blunt feedback.
• Remember your body language. Assertive communication isn't just verbal. It also involves body language. Act as if you're confident even if you aren't. Keep an upright posture but lean forward a bit. Hold eye contact. Respect the other person's personal space — don't get too close. Maintain a neutral or positive facial expression. Don't wring your hands or use dramatic gestures. Practice in front of a mirror.
• Keep your emotions in check. You may be full of pent-up anger and frustration. Some people may cry when faced with conflict. If you feel too emotional going into a situation, wait a bit if possible. Then, remain calm. Breathe slowly. Keep your voice even and firm.
• Start with small wins. At first, practice your new skills in situations that are low risk. For instance, you may want to try out your assertiveness on a partner or friend before tackling a difficult situation at work. Evaluate yourself afterward and tweak your approach, if necessary.

Remember, being assertive takes time and practice. If you've spent years silencing yourself, becoming more assertive probably won't happen overnight. On the flip side, if you're driven to aggressive communication because of anger issues, you can learn anger management tips to help cool down.

But if you do rehearse and aim for small wins yet still don't seem to achieve your goals, consider formal assertiveness training. And if you simply feel too overwhelmed, stressed, anxious or angry to cope on your own, consider talking to a mental health provider. Working on these skills with a professional can be both fun and empowering.

Self-talk is the endless stream of thoughts that run through your head every day. These automatic thoughts can be positive or negative. Some of your self-talk comes from logic and reason. Other self-talk may arise from misconceptions that you create because of lack of information.

If the thoughts that run through your head are mostly negative, your outlook on life is likely pessimistic. If your thoughts are mostly positive, you're likely an optimist — someone who practices positive thinking.

Researchers continue to explore the effects of positive thinking and optimism on health. Health benefits that positive thinking may provide include:

• Decreased negative stress
• Greater resistance to catching the common cold
• A sense of well-being and improved health
• Reduced risk of coronary artery disease
• Easier breathing if you have certain lung diseases, such as emphysema
• Improved coping ability for women with high-risk pregnancies
• Better coping skills during hardships

It's unclear why people who engage in positive thinking experience these health benefits. But one theory is that having a positive outlook enables you to cope better with stressful situations, which reduces the harmful health effects of stress on your body.

If you tend to have a negative outlook, don't expect to become an optimist overnight. But with practice, eventually your self-talk will automatically contain less self-criticism and more self-acceptance. You may also become less critical of the world around you.

Practicing positive self-talk will improve your outlook. When your state of mind is generally optimistic, you're able to handle everyday stress in a constructive way. That ability may contribute to the widely observed health benefits of positive thinking.