Impacting Chronic Illness—Through Preventive Care

July 19th, 2017

What is “preventive”?  Whole-person, common-sense, logical, proactive.  And not always in line with our established, maladaptive-but-comfortable habits.

What is “chronic illness”?  For one thing, expensive.  Chronic medical conditions need constant maintenance so they don’t spin out of control.  This usually means medication in our healthcare world, or a restricted diet, or ongoing consumption of therapies like dialysis.  If that’s all it were, we could grudgingly handle it.  But unfortunately, each chronic condition doesn’t tend to stay caged in its organ system.  Chronic illness all too often leads to multi-system breakdown.  But that breakdown doesn’t usually start with all systems at once.

A chronic illness isn’t isolated but rather is incorporated into other systems, because the body is comprised of integrated organ systems.  (“Organ system” is actually a construct that we map onto the utterly complex functioning whole of a human body, in order to make sense of it.  Systems are categories that we invent.  Chinese medicine sees the body as comprised of systems that are foreign to Western medicine.)  Different genetics, different stressors, determine which system is the weakest link in the chain for each person.

The good news:  everything you do in terms of lifestyle changes affects the chronic illness that you may happen to have—as well as others you don’t have (yet).

In other words, when you make targeted changes in your lifestyle to address one chronic illness—the one you have, or the one you’re afraid you’ll get—you usually decrease your risk factors for collecting new diagnoses.  IF, if you make the right changes.  The health fad of the moment, whether it’s drinking coffee with butter or buying “gluten-free” snacks, may not be what you really need.

Until we understand more about our genome and how our external environment, activity, stressors and food impact on it, we probably won’t be able to customize health advice perfectly.  It’s already generally accepted (as profiled in a May 25, 1917 Time Magazine cover article), that no one weight-loss diet fits all, for example.  But doctors like me can help you make an educated guess about what is likely to have the biggest positive impact, and help you formulate a realistic, step-wise plan of action.  To tell the truth, you need a plan of changes in action—that’s even harder work.

What makes this hard work easier?  The fact that the plan of changes in your actions is multi-faceted.  That means that you can usually make a shift in your health in many ways, via many approaches.  Usually, there’s more than one way in.  You don’t have to start with the most challenging change in lifestyle, nor to change everything at once.  You can choose the slice of the action pie that’s most digestible.

Here’s an example:  Osteoporosis is a chronic disease that needs to be managed.  Osteoporosis has been called “the good news disease,” because the lifestyle changes you make to control osteoporosis help just about everything else.  More exercise, improving balance, better diet…the lifestyle components of treatments for osteoporosis are actually prevention for cardiovascular disease , diabetes, arthritis, etc.

The example of osteoporosis is a counterexample of the role of fear in medical care—a segue to denial and avoidance that costs patients so much good health, and the system so much money.
Fear is a large part of the reason why people don’t take action to reverse or slow chronic illness when they have it.  The bar can be set so high, the worry so gripping, that patients become frozen in their fear.  The thought of starting a new lifestyle can provoke so much anxiety that people just push it out of their minds. Or rationalize inaction. So the diet change they ought to make for their diabetes—or whatever—never happens.

Fear-based medical motivation is as likely to trigger denial as compliance.  Non-compliance with medical care is a problem that doctors grapple with, but it’s a problem of our own making.  And to minimize this problem, we have to go outside the medical system and look at our culture as a whole.  (Advertising, the rewards we give out children and ourselves….etc.)

Our current system implicitly encourages fear:  a bizarre reality show where each person is the star of what could be the drama of their medical journey—do I have heart disease yet?  Cancer?  Parkinson’s?  Titillating, but worth it to be able to walk away from an annual exam with a clean bill  of health and do what I’m doing and take the pills I’m taking (maybe with a change in dose)—till next year. Or will it be an ambulance trip to the emergency room with chest pain?  Nope, so far so good.  Don’t think about it. Or think about it and worry, instead of doing something constructive, like exercising and eating well.  As noted above, what “well” is differs slightly for different people with different conditions.

Prevention offers a way out of a fear-based mindset.

First, when you do what you do for prevention, you change the overall body system context and give chronic illnesses a chance to lift.

Second, part of getting out the exit door of the medical treatment cycle ”building” is not getting sick again.  Preventive care (vs medical care) helps the chances that you will not get another illness.

A “care” system should be one that searches for health, not one that is organized around searching and treating illness.  Illness will be found in a health-goal system just as well, if not better than in an illness-goal system—but I expect that it will be found less often because it will occur less often.

Healthcare for a time of uncertainty

May 10th, 2017

Healthcare can fail in a number of ways: it can fail to find a treatment, it can fail to find a diagnosis, or it can fail to be accessible. I’ve built my practice around the treatment of people with complex or confusing illnesses—people for whom the medical system has failed. I’ve had patients who simply could not figure out what was wrong with them. I’ve had patients who knew their diagnosis, but could not afford or tolerate the treatment. I’ve had patients who had many diagnoses, but no combination of treatments that worked for them. The one thing that is common to these people is that they are uncommon. If there is an 80-20 rule in medicine, they are the 20 percent. Their illness (or illnesses) do not follow conventional wisdom, nor do they respond to conventional treatment. Most importantly, they do not fit in the mold. They are outliers. Medicine in our country has become streamlined to treat the mainstream, and so these people needed to find someone who is not.

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Snoring? Little Things That Make a Big Difference

October 23rd, 2016

starry nightSnore? Just a little chortle? Or, you know you snore loudly, but you think it isn’t a big deal-it’s not ruining your sleep? Think again! You may not realize how much your sleep is disrupted–and how a few sinple changes may help.

Maybe you don’t know whether you snore or not, you just know that you don’t sleep well and you don’t awaken feeling rested. Maybe you just developed high blood pressure. What you may not know is that a sleep problem could be the reason.

Snoring may seem innocent enough–not worth the trouble to do anything about, let alone go to your doctor and get a full evaluation. But snoring can make a big difference in your health. In a bad way! It can lead to fatigue, high blood pressure, non-restorative sleep and accelerated aging—not to mention angry, irritable, tired family members. Don’t ignore it because you think that the only ways to fix it are high tech, high hassle and high cost. Not true! There are a number of little things you can try to make it better.

Do you want to know if you snore–or how bad it is? Do you have a bed partner who needs to be convinced? The answer can be as simple as downloading an app on your smartphone, such as Snore Clock, Dream Talk Recorder, Sleep Talk Recorder, and Snore Lab. (Read the reviews on these apps and other similar ones.)

If snoring isn’t severe, or if finances are an issue, try some so-it-yourself approaches before going on to the next step, which is a formal evaluation of your sleep and snoring, along with whatever other sleep disruptions that are lurking in the background.

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Sick Pet Symptoms: Six Surprising Signs of Illness

September 20th, 2015

Looking back, clues were there. Olivia, a robust Rottweiler/Shepherd mix, knocked at the door to come back in after just a few minutes outside in the yard she used to love–a real change in behavior. She pawed at her ear, had more eye goop, started sneezing. Most telling, our other dog began to lick her face months ago–before any of the other changes. He knew…it wasn’t allergies.
The CT scan showed a huge tumor that went from her nose to her brain, 8 by 4 centimeters. Yet she continued to play, run, love her walks, and adore food. (All food!)
The clues were there; I just didn’t know how to read them. As a doctor, I assumed I’d be able to pick up on signs of serious illness in my dogs. I was wrong! So I’m passing this article on to you, hoping it will help you help your pets.

sick pet symptoms infographic


Risks of Pill-Popping: Side Effects in the News

September 1st, 2015

By Cathie Dunal, MD, MPH:  A few months ago we were astonished to learn that common medications—sleep meds like Sonata and Ambien, anxiety meds like Xanax and Valium, and over-the-counter allergy meds like Benadryl and Chlor-Trimeton—are all associated with increased risk of Alzheimer’s disease.  A five percent increased risk with as little as ninety days of use in your lifetime! Yikes!

The latest medicine surprise is NSAIDS, or non-steroidal anti-inflammatories. They bring a ten to fifty percent increased risk of “cardiovascular thrombotic events”—heart attacks and strokes.  We pop these pills like candy—the most common are Motrin/ibuprofen, Aleve/naproxen, and prescription anti-inflammatories.  The new advisory from the FDA is to take as little as possible for as short a time as possible.

My take is that we ought to wake up to the possibility that popping a pill isn’t the optimal first step to treating medical conditions.  (Note that I’m not talking about serious infections, endocrine conditions, etc.)  The first step should be prevention via lifestyle.  The next first step, assuming a problem is already raising its ugly head, is lifestyle treatment.  Then—but only after addressing immediate and preventive lifestyle interventions—we should delve into non-pharmacological interventions–and prescriptions.

Let’s take aches and pains as an example.  Continue reading »