-by Foghat
This one sling shots off my previous discussion on sept on "hitting the Wall". Nice couple came in and a guy in his mid to late 30's had a bad headache. Claims it was tolerable but he started with left eye twitching and became worried. Looked alittle overweight, dressed ok, not disheveled but could use a makeover. Wife pretty, good weight, possible smoker. He wasnt in distress andjust wanted to make sure it wasnt cancer. No history of it but he didn't want to be the first and has no time to get sick. I cleared him with an extensive physical exam and in history apparently had a history of headache like this before and worse. Doesnt complain too much and has a high tolerance for pain. Turns out he also has recently worsened his already poor sleep, drinking about 1 and 1/2 pots of coffee a day, no time to eat right. Has been heavier but is overweight and has no time for exercise with 50-60 hours a week of work. Cant take time off since someone will be pissed off with himat work. Wife says he has been stopping breathing at night with sleep.
So everyone reading can see where I am going with my diagnosis. I reassured him of the high possibility for headache due to sleep disorder, sleep apnea, caffeine dependance and SAD. Certainly cant rule out a brain tumor but with everything else occurring, I told him likelyhood of morbidity from the other previous problems mentioned is high. If he keeps up the pace over the next few years, he will be on several medicines by 40y/o. Told him if he cant afford the switch in careers now, better start saving up money over the next 8-12months and go back to school. (he already told me with the increase in weight, he has been told there is a blood pressure issue).
The Saguil Approach is to put bandaids on most of the symptoms with the understanding that he shouldn't be on the medicines for more than a month. (I fear with alleviation of some basic symptoms he will continue on his lifestyle direction and just rely on meds) Medicines are always a short cut but only to allow an avenue for the body to heal and get stronger with nutrition, sleep and exercise. How does he do this with all the obligations? I dont know that answer. I can only jump to the future and one road he may end up on is diabetes, high cholesterol, high blood pressure and sleep apnea. At a minimum, 2-3 medicines and a sleep mask-(not to mention viagra). Many docs and patients for that matter, get the bandaid meds but are given refills for a long duration since they have no other alternative than to continue with the meds for symptom suppression since they keep on returning. It does take alot of sit down time to get the point accross that the road they are taking is going to a bad place. Most docs and patients dont have this time.
We-(the docs) usually give this "face to face" time when the diagnosis we find is terminal and time is short. When noone is going to die soon, most find it hard to schedule a family intervention and it is also very demanding on the office staff to coordinate. This is ashame but when the patient cant make a job switch and the doc cant afford staff to make extra phone calls, the short cut is taken. I have spoken about the truncated interactions with the doctor and how its easier to prescribe meds than do 60 minutes of counseling in the past and it seems this is where medicine in now. There are places you can get more attention but it typically comes at a premium and is cash up front. I think its worth it especially if eventually the visits are only 2 times a year when health is improved. (Compared to insurance premiums for a family approaching 800-1000 dollars a month even without having to see a doctor!...thats just the premium to maintain the insurance policy!) I should stop now before I get on my soap box about industrialization of the bond between doctor and patient. Placing a value on and "interaction" is impossible no matter what statistics say. Every high level medical officer will always refer to statistics when explaining how the average patient and doctor visit should be in the US. Then that same high level person will make a phone call to a personal doctor as soon as he or his family gets sick all the while bypassing all the hurdles his administration has set to care for people in a timely manner since the numbers speak for themselves. I remember one of the board members in a previous hospital, pushed to save money and close the express cares during times that were nonproductive, then the rumor was when his kid was sick and he couldnt avail of the expresscare in his neighborhood, he complained and magically of the all the expresscares with the hospital, his local expresscare stayed open later than the others!
The Saguil Approach:
1. see a doc to make sure you are not going to die
2. take some bandaid meds for a designated time period
3. get deeper sleep with meds or herbs or a vacation or medical leave
4. get off red meat and eat more veggies....depending on the season, I like dominics, target and of course whole foods. Trader joes and the local farmers are also popular.
5. save money now for a possible layoff for 3 months(this would be the amount of time to find another life style or the same job but a different place.
6. stress reduction, exercise, sleep and family spirituality have to be learned, can't get it in a prescription....try working in a homeless shelter, the va, or a cancer center and it will ground you that life isn't that bad that you don't have a choice.
