GETTYSBURG MEDICAL NEWS
The Clinical View
By P. E. Hoffsten, M.D.
26 December 2007

ANOTHER RUN AT NEW YEAR’S RESOLUTIONS

          This week right before the New Year has always provided the time when individuals could contemplate their past year and make promises (resolutions) on how they are going to change for the better this coming year.  Adherence to these promises has always been somewhat of a joke, but indeed the concept and intent does have application.  Last year’s column at this time was devoted to a 56 (now 57 -year-old) gentleman who came in for a health check up.  I saw him the week after Christmas last year and again a month later in January, 2007 to follow up the two medications that he started to treat his high blood pressure and high blood cholesterol.  He had his colonoscopy performed and was safe there.  He had already gotten his flu shot.  On his annual follow-up December, 2007 he had maintained his weight very well and his blood pressure and cholesterol were now comfortably down in the normal range.  I congratulated him on his effort and wished him well for another good year. 

          This gentleman’s two major factors impairing his health were high blood cholesterol and high blood pressure.  Neither of these was related to actions on his part, but were rather hereditary traits that now, fortunately, can be dealt with to markedly reduce the risk of heart attack and stroke.  This gentleman’s problems were acts of omission (things he did not do) in which he either didn’t know about or simply neglected to address hereditary problems.

          But, we in the healthcare industry continue to have our minds just boggled day in, day out watching the general population involved in acts of commission in which they are gleefully performing self-destructive behavior.  I have never understood why a person would choose self-destructive behavior when simple normal taking care of oneself is not that hard, but so infrequently done.  Without taking one pill or doing one piece of surgery, 90 plus percent of the grief we encounter from health problems can be avoided through the simple rule of “don’t hurt yourself.”  The overwhelming single worst health hazard in our society today is smoking cigarettes.  If a person smokes cigarettes there is a 50 percent chance that the person’s death will come from that act.  Along the way they will encounter lung disease, heart attacks, peripheral vascular disease, and erectile dysfunction.  These are all the exact opposite of the macho image that gets some poor 16 -year-old started smoking and hooks you for the rest of your life.  The habit is expensive, foul smelling, now outlawed in many places, and the leading single item expense in our medical budget.  Still about 25 percent of our adult population smokes cigarettes.  It boggles the healthcare professional’s mind as to why people would do that.

          The second leading problem in our society now is morbid obesity and the resulting diabetic epidemic that is coming.  Diabetes robs a person of their eyes, their kidneys, and their nerves in their feet.  It causes strokes and heart attacks and the vast majority of cases can be completely prevented simply by dietary control and maintenance of a near normal body weight.  In the past 25 years, the computer age and all of our labor saving devices have resulted in a mushroom explosion of obesity and diabetes in our society.  Unfortunately, the worst is yet to come.  This epidemic is still growing.  Try as healthcare professionals will, this problem is a test of individual discipline and will.  Only the individual person can stop eating excessive amounts of food that is going on in our society today.

          In the past two decades, I have watched with alarm as “physical education” was phased out of our curricula in our schools.  It was something you could do if you wanted to as though it wasn’t really important in long-term well being and health.  Nothing could have been a bigger mistake.  Physical fitness independent of weight is a marker of longevity and capability with that longevity.  Physical fitness is associated with a decreased incidence of cognitive impairment and dementia.  Physical fitness doesn’t necessarily mean jogging.  Simply walking three miles a day is a tremendous help, but I promise you, 90 percent of those who think that walking around the Capitol or the hospital gets them three miles a day aren’t even close.  Get a pedometer and measure how far you walk.  Any of the fitness clubs of the YMCA for whatever extra activity is enjoyable has a tremendous health benefit.

          It is interesting how time changes the need and usefulness of some of our practices.  In the 1600s, drinking rum or beer became an alternative to drinking contaminated water and avoiding infectious diseases.  Alcoholic beverages avoided polluted contaminated water and done in moderation was life saving.  Many studies have since shown that those in our society who are capable of having an average of two alcoholic beverages per day live longer and better than those who don’t drink at all.  While the tea toatalers continue to look askance at this piece of information, it has now been shown in several different countries and many studies over the last 30 years.  Note that an average of two drinks per day does not equate to a 14 drink binge on Saturday night to get your weekly average.  The major problem with alcohol excess (more than four drinks per day) is a slow deterioration of central nervous system function with a development of cognitive impairment and dementia.  Cirrhosis of the liver is something relatively rare, but the loss of capability of original thought is the hallmark of chronic alcoholic excess.  Remember that 50,000 people die in automobile accidents yearly and fully half of those are alcohol related.

          Then there are a bunch of little things that done in excess become a problem.  The sun worshipers have a disproportionate number of skin cancers and especially the poor red heads.  Unfortunately, those cancers don’t come for 15 to 20 years after the excessive sun is done by teenagers and 20 year olds.  But there are a lot of rich dermatologists out there cleaning up the mess that too much sun created.

          The last self-destructive habit in our society really tastes good.  We have these wonderful convenience stores on many corners in our communities.  They are stocked with candy bars, and sweet rolls, and cupcakes, and cookies, and sugar pop, and cappuccino, and anything else our food industry can find that will concentrate an inordinate number of calories in a little tiny amount of food.  What is not recognized as that berries and nuts and fruits that grow on trees, and potatoes and carrots that grow underground and the flesh of the animals that we eat are not concentrated sugars.  Those are the natural foods that through the history of mankind have sustained us.  But now we have incredibly concentrated calorie sources that our digestive systems simply were not designed to deal with.  As a result, we wear out our insulin secretory apparatus and can’t deal with sugar, which then runs too high causing diabetes.  It is estimated that there is 15 percent of our population that is diabetic at this time and another 15 percent that is “pre-diabetic” and headed toward diabetes very fast. 

          Some people that read this column will respond that they just want to live their life their way and they don’t want to be bothered with all this advice or New Year’s resolutions.  This is a free country and people can do just exactly that until they have tried to break natural law.  There are darn few reprieves and no pardons for those who break natural law.  Best medical advice: take care of yourself.  It is not that hard and you are the only one that can do it.