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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
FAST FACTS
New Year's Resolutions your Primary Care Doctor Wishes you had
1) Know your numbers: fasting blood sugar, weight (body mass index or BMI), blood pressure, and your cholesterol PANEL (LDL, HDL, triglycerides). These numbers help you assess your risk for stroke and heart disease and you can MODIFY these!
2) Get enough sleep. Yet another study recently published in the Journal of the American Medical Association (JAMA) found that people who slept only 5-7 hours a night had more evidence of narrowing in the coronary arteries after 5 years than those who slept more. Need more convincing? Depression, weight gain, heart disease and anxiety disorders are all worse in the face of sleep deprivation. Eight, crazy eights, that is your resolution.
3) Pay attention to your mood. Depression and anxiety may creep up on you and win you over. Physical symptoms associated with mild depression and anxiety are impressive (nausea, weight gain, muscle and joint aches, shortness of breath) and will improve with management of your mood disorder.
4) Use it or lose it. Use your mind in a way you don't in your regular job. No question that studies show doing 15-30 minutes a day of mental stimulation (puzzles, memory games, Sudoku) helps prevent cognitive decline. Join in with your kids when they are doing complicated puzzles; help them do their homework even if you have to relearn basic algebra because it may help you down the line hold off dementia and mental decline.
5) Pick one of your vices to get rid of. I know this is cliché but as a primary care Doctor I don't care as much about nail biting or shopping but I do care about smoking, overeating, a sedentary lifestyle and staying up too late so I would love you to change that.
6) Worry less about which supplements to take and more about adding some organic vegetables and fruits to your diet. Sure, there are some very important supplements I would like you to take: folic acid for prevention of neural tube defects during pregnancy, omega 3 Fatty Acids for heart disease prevention, depression, asthma and dementia among other conditions and iron if you are anemic. Supplemental Vitamin C, Vitamin E, and the B vitamins just don't carry the impressive results for prevention of any medical conditions and I'd rather have you obtain them through your diet. I know, organic fruits and vegetables are expensive but if you have a local farmer's market you can get them cheaper so please try.
7) Lose Weight. You were hoping I wouldn't bring up the SAME old resolution but I am. How much weight? Rather than looking up your ideal body mass index (BMI) which may be too much to ask, just have your doctor go back to your documented weight in the last 5 years. Most of you put on 2-3 lbs a year and I'd like you to go back to what you were 5-10 years ago, that's a start.
8) Make sure you are up to date with your routine health screening: mammograms, pap smears, colonoscopy, PSA or rectal exam for men, bone density scan for osteoporosis, and vaccinations. There is so much we can't watch out for so let's work together to head off what we can.
9) Stretch! Flexibility is more important than strength as we get older no question. Stiff, sore muscles and joints limit my older patients more than anything from doing all the great things they want to do when they retire. Stretch people! Low back exercises, hip flexor stretches, hamstring and plantar fasciitis exercise can be found in good sites on the internet or ask your doctor for a handout. Stay loose and you will improve your hip, back and heel pain.
10) Exercise. Last but not least adding exercise will improve most of the things on this list. You will sleep better, you may lose weight, and your mood will improve. I have two kinds of patients: those who move around and those who don't and I guarantee to you you want to be part of the former. Two to three times a week, 20-30 minutes each time and it can even be a brisk walk. Please start moving around and make it part of your life and you will be rewarded in spades, I promise.
Happy New Year!
Dr O.
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Displaying comments 14-1 of 14
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This myth needs to go away once and for all.
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Dr. O, As I was reading your story above and the key points you made, I couldn't help but notice how much it has in common with a my personnal study into heart disease and longevity.
Some of the common denominators of populations with low rates of heart disease and longevity are consuming an organic, or wild caught, all natural diet free from commercial food processing. They also are naturally active outdoors. They have to work for their food. They go to bed early, rise early and begin physical labor.
The lifestyle items you list above are also great for reducing CRP.
As I study the world, the items you mentioned are practiced by populations that enjoy good health and longevity. This includes the Centenarians I have studied.
A higher HDL is certainly associated with good health and longevity, but much to my surprise, and a real shocker for me, I have found no relationship between low total cholesterol and low LDL cholesterol in heart disease and longevity.
For many people LDL may stand for "little Devil Lurking". But after completeing my research, I found LDL to stand for "Long Deserved Life"
Granted I could be wrong. But when I look at populations with Higher LDL, and they are the ones who have the lowest rates of heart disease and the best longevity, it stops me in my tracks and makes me scratch my head with a bewildered look on my face.
When we take statins, we do so with the expectation of better health and longevity by being spared a cardiac event. But when I look at the Absolute Risk Reduction of statins its not very encouraging. And when I look at life expectancy on statins vs. placebo, we are splitting hairs on the difference plus or minus.
But when I look at life expectancy from the things you mentioned in your article above, you get about 12 years more for practicing what you preached.
Bobby
Re. supplements: quality supplements are necessary as commercially grown or raised food including processeed ones lack vitamins and minerals and trace elements but have harmful chemical residues. Beware of synthetic supplements. Like dl alphatocopherol for synthetic Viatmin E, versus d alphatocopherol for natural E. Easy to overlook dl and d.-
Re. some strength training needed too so glucose have muscles to get into. Monitoring daily glucose levels will indicate being in range or out of range so we can finetune. Out of range period past 7 is where the damage occures.
Re. cholesterol: scaremongering propaganda and aggressive profit drive is the web is awash with. And with statins the false silver bullet. It is true it lowers cholesterol but by the same mode of action also lowers CoQ10 essential for every cell most of all heart muscle cells!
Atherosclerosis starts with injury to the lumen (not by cholesterol) but by biological, chemical, hormonal, nutritional (like vegetable oils other them extra virgin cold pressed olive oil. Most others are by virtue of being omega 6 which is pro-inflammatory in the absence of omega 3 long chain which is anti-inflammatory or their ratio is down to 1:20 to 1:50), substances that provoke subclinical chronic inflammation. Oxidized cholesterol becomes part of the plaques and juvenile thinking did not look deeper and jumped into conclusion since they found cholesterol in the plaque. The rabbits used in experiments to "prove" cholestrol rich diet increased plaque formation in the rabbits they extrapolated this to humans neglecting the difference betweeen the two organisms metabolism. Rats or pigs or monkeys could have been better choices.
Re: unreliability of studies, scandalls time to time about advisory panels recommending guidelines, also the method of how the final guidelines arrived at is scary! Add to it that drug company reps. visit doctors to "educate them" about the drugs they make to be prescribed, but as added leverage they give gifts and reminders.
Re: the Hyppocratic Oath; FIRST DO NO HARM! Good doctors following protocols unquestioningly and being ignorant of actually doing harm some instances by following some guidelines or not looking deeper if some individual may not be helped by or worse by some prescriptions. It may not be easy to open the eyes of our doctors but not to try is to our detriment. Unfortunately some patiets place their blind trust into the hands of their doctor and would not even dare to question or ask questions other intelligent patients do. Akin to religious faith based conviction they can't handle doubt and lull themselves into denial a misplaced defense mechanism. I am being attacked by friends and even family to leave them alone and don't disturb their "peace".
They say I am arrogant saying that I hired my G.P. and I keep educating him. Someone said that doctor must be a silly person letting me influence him!... The person who said it came down with heart disease then cancer I tried to save her from over 40 years!-
My doctor doesn't care what my BMI is or my triglyceride levels are and I don't have the money to have them tested. I have no insurance, no money, no job and pretty soon I'll have no home.
I'm a night owl by nature so being up late is normal for me. It's being up at 8 am that creates a problem. When I had a job I was up much earlier than I should have been but hey, those were the hours I was assigned. Who am I to demand the place stay open later so I can sleep on my schedule? Lack of sleep is no more an excuse in the rest of the working world as it is for the medical community.
I agree with mindlesley about doctors and sleep. If sleep is so important for US to have why is it OK for doctors (especially Interns) to work 36 hours without sleep? How can we be comfortable putting our lives in the hands of overworked physicians?
It would be nice also if doctors were more knowledgable about supplements and herbs instead of just writing prescriptions for everything. Would it be better if we got all our vitamins from food? Yes of course, but it's not likely, especially since some things our body needs (like say CoenzymeQ-10) are difficult to get from diet alone and the body makes less of it as we get older. It would also be nice if the medical community didn't scoff at patients seeking alternative treatments. After all, its OUR body. WE have to live in it every day. I think anyone with a chronic ailment would LOVE to have their doctor live in their body for a week or two.
I would also like to see a doctor who LISTENS to me and doesn't rush me out the door (with a new prescription) in 15 minutes so he can get the NEXT patient in and make his HMO's 'quota' for the day.
My mom worked for doctors until 18 months before she died. In the end, the profession she'd so faithfully served all those years failed her and she died of a TOTALLY preventable complication. I was raised to believe doctors were good people who cared about their patients. I don't believe that any more.
I'm sorry I can't be more gracious because I'm sure you mean well in posting this but for me, and for a lot of other people, it's unrealistic
to even think of doing. We have to work with what we've got and a lot fo us don't have the luxury of having expensive tests done and all the rest of it.
Dr O.