Sunday, August 23, 2015


Walking Dead

    The practice I was asked to absorb in January has the typical population patterns for rural America but I have been able to care for quite a few more senior citizens which I consider an honor.  I have met some great 80 yr olds -very active at home, in the garden, in the neighborhood.  I unfortunately have also adopted a large army of middle aged patients with an equally large surplus of prescription medicines.  Anyone who knows me can attest to the fact that I use prescription medicines but I usually make a good run at conservative measures first ….(unless symptoms are severe).  In some cases when the disease presenting in the patient is advanced, “I go straight to big guns” and not worry about throwing rocks at the problem (although rocks can win a war too).  The complication is when first meeting these patients, they come in for refill…appalled that they have to schedule an “expensive office visit” just to have me re-up their 4-8 prescriptions for another 6-12 months after viewing the usually normal blood tests.  Little do my patients realize is that I may be ordering cursory blood tests like the preceding doctor, but I am also piecing together a plan of lifestyle change that usually starts with looking for deficiency.  Average primary care doctor coming out of residency can read the scientific journals and keep an eye out for flagrant red flags (high blood pressure, high cholesterol, high sugar, anxiety, depression, hot flashes and impotence) and divvy out a prescription for each of the problems found.  By stabilizing the metric that was found abnormal, the doctor has done his/her job and can reevaluate in 6-12months.  This was probably ok for the 90’s when the population was less obese and drug companies were just starting direct-to-consumer advertising.  Now that we have DVR’s, DVD dispensers at the pharmacy, addictive TV on demand, fast food restaurants that deliver without you moving off your couch or out of your car, obesity going from 1in5 to 1in2……I do not think JUST STABILIZING the abnormal metric (bp, cholesterol, sugar, panic, sadness, the change, ED) with 1-2 prescriptions will work to hold off progressing disease. 
    I was able to do that in 95 and watch the progression of aging and disease presentation and when a patient would outrun their temporary prescription and still have symptoms, then I would get specialists involved with 2nd opinions to instill fear and perhaps that would get people to change lifestyle.  I would embrace exercise and nutrition but the only thing that was big back then included Richard Simmons, The South Beach Diet and weight loss pills.  Bariatric medicine started in the millennium and everyone that was unsuccessful with their own lifestyle remodeling was getting their stomach cut.  It was getting so hot, I remember an 18 yr old coming to my office asking for surgery before I left CDH (I didn’t agree with the way medical insurance encouraged dis empowering patients).  This is my biggest contention….I believe just doing minimal with STABLIZING a symptom or measurement is not enough.  Once the acute problem is neutralized, then the architect is supposed to evaluate, look for weakness in structure, anticipate failure and redesign.  I admit when looking at patients I sometimes will put on my “invisible glasses” and see through the patient to look for flaws that may have contributed to current disease manifestation.  With Andy Weils foresight in offering education to doctors and Deepak Chopras knack for defining modern medicine with ancient healing…I am very comfortable with designing and redesigning different ways to break the mold and get back to feeling young again.  
    THAT’S IT!!!  Feeling young.  I always wanted to make my patients live to 90 with as little medicines and surgeries as possible….but….since starting back into primary care and true wellness, I have been blessed to see some 80 year olds driving to their appointments on their own, living independently, taking few medicines…..and most of all-smiling and happy enjoying life and giving back.  In reading Dan Beuttners Blue Zones and the population studies he presented, living to 100 is more common in other parts of the world.  No, I don’t mean the American version of 100 (nursing home, incontinent, immobile and in a vegetative state), I mean European, South American, Asian centenarians that look like how the current US 70 year olds appear.  I can’t really do much for the current patient that comes in at 70-80 with end stage diseases…..but I can do something for the middle age folk that are on their way to a long, painful and demoralizing retirement.  (…some already forced to stop working and apply for disability!).
This is my picture of the current middle age American:
-Stressed with life
-On 3 to 5 medicines
-Still with aches and pains
-Not able to exercise
-Poor sleep
-Alcohol dependant
-Postponing falling in love again (I don't mean singles, I mean married people seeing spouses on the weekend and occasionally in the bathroom before bed)
     When I hike or run or work out in the gym, everyone seems so blunted with emotion (and that is the portion of society trying to make a change!!!).  I will sometimes decide to walk through a mall or grocery and just smile.  I will force eye contact and flash a smile to as many people I can.  Last time I went to Jewel Osco to buy office flowers, it seemed like everyone was walking around like they were near dead or wounded.  Big belly, bad knees (from the big belly), achey back (from the altered moving knees), lack of hair (from poor sleep due to pain medicine), cart full of large volume processed food (due to craving from the pain medicine and poor sleep), refilled prescription in hand (to control the side effects from the first prescriptions).  What kind of existence is this!?!?!?!  Most people really have to reach rock bottom before they are inspired enough to change life….I see that places like Cancer Treatment Centers of America have been able to capitalize on this.  Here they get people with live or die choices that no longer have a choice-they have to change.  CTCA also has done more than just getting like minded western trained doctors together…they hire on the team- mind body medicine, traditional chinese medicine, yoga, naturopathy, herbal and plant based medicines….all to increase the chances people will get to 100 and be loving life.  
     Don't just be content with filling out the medicines to satisfy algorithms and control symptoms. This is disease management at best -creating a society of Walking Dead.  "Health Care" is taking someone off balance and getting them back into balance, feeling healthy no matter what age.  I love the way Chris Crowley gets it in Younger Next Year.  He and Dr Henry Lodge give a template of how to enter into your 40’s, 50’s and 60’s feeling like you did in college…..and maintaining that level of youth.  When sitting in the room with a new patient, I try to inspire patients into change without making them feel guilty.  The problem is most people don't realize that as years go by (now it’s more like months) the medical community and advanced medical testing will find more and more things abnormal that will only be fixed with another medicine or surgery.  If you look in the mirror and tell yourself, I will work on that stomach tomorrow, or I’ll indulge in that extra portion of highly processed food "cause I deserve it", or I don’t have the money for those vitamins this year… is a matter of time before you walk around slower, make poorer choices, and start losing the feeling of happiness. 
     Modern medicine will not allow you to die outright, you will have a stent here, a joint replacement there, a medicine to control emotional outbursts, a medicine to help you get to sleep, a medicine to wake you up, a medicine to help the heart work, a medicine to cool down digestive fire………YOU WILL BECOME THE WALKING DEAD so dont just wait for the signal that it's too late...........look for a sustainable change now.