Preventive Medicine

There is a lot of talk today about healthcare in America.  Why does it cost so much?  Am I getting what I’m paying for?  How can I actually stay healthy and try to avoid being crushed by this monstrous medical juggernaut?  As with many things in life, and a majority of problems out in the country, an ounce of prevention can be worth a pound of cure! (Thank you, Ben Franklin.  Your common sense is always refreshing!).

But, where do we begin?  “What can I, without a lick of medical training, and no knowledge about medications, diseases, blah, blah, blah, do?” you ask.  Everything!!  Each individual has a responsibility to take care of his or her own body as best as they can.  Yes, there are some unlucky individuals who have very serious diseases that they are born with, and which require constant invasive high-tech medical care.  But that is not the majority of people.  The vast majority of us would not neglect our vehicle if it needed a basic tune-up or simple repairs to keep running, or clean and maintain our house to keep it from becoming dilapidated.  We need to have the same approach to our own bodies and health.

And we know some of the stuff that we need to do—eat a healthy, well-balanced diet that is low in fat, full of fruits and vegetables, low in empty calories, like those from processed sugars and saturated fats, and salty packaged foods.  Exercise regularly.  The information bombards us on the television, radio, Internet, blogosphere, newspaper (if you still get one).  I have trouble with this stuff too, but it is important to stick with, struggling to avoid that fifth chocolate chip cookie, or big bowl of chocolate ice cream, just because we are bored (excuse me a moment).

Now, where was I . . . oh yeah, health matters.  Preventive medicine is a term that is very in vogue nowadays.  But I’m not sure if everyone knows exactly what it means, or what it encompasses.  Simply stated, preventive medicine is the practice of medicine that is aimed at trying to reduce the overall risk of someone developing a disease or condition later.  For example, a classic form of preventive medicine is getting a vaccination to avoid developing a viral infection, such as mumps.

This approach to medicine is very beneficial, on several fronts.  First and foremost, it can reduce some of the unneeded suffering caused by certain diseases.  Controlling or avoiding several risk factors, which is another main thrust of preventive medicine and which will be discussed in greater detail in a little while, can greatly reduce your risk of having a heart attack, stroke, and even cancer.  But these three examples are also multifactorial diseases, or illnesses that have more than one cause.  While there are factors that you can manage to reduce your risk, there are others—like age, gender, and genetics—which are fixed, so your risk can never be zero.  Preventive medicine also helps to empower the patient (you and I) in some of the medical decision-making (how I exercise, or eat, and that I don’t smoke at all or drink excessively), so that I can try to avoid risky treatments or medicines later in life.  And, I don’t know about you, but I really like having a say in a lot of the decisions I make in life, especially as it pertains to my body.  Finally, preventive medicine helps to reduce huge medical costs, both for you and the hospital.  “So what?” you ask.  “Who cares about the hospital?  They have millions of dollars in their budget to throw around on fancy new equipment and new-fangled designer drugs.  Why should I worry about them saving money, especially since I never want to go there in the first place?”  Well, all I can say is that I hope that you never do have to go there, and, helping to reduce the overall health costs also helps to avoid the medical establishment passing their increased costs on to you, the consumer (if you can afford healthcare, which at the time of this writing, sadly, a lot of people still cannot).

So, what can you do?  What monumental, life-altering, Herculean tasks must we all shoulder in order to avoid something worse?  Well, surprisingly, it is not as difficult as you might first suspect.  Like planting the marigolds in with the vegetables, there are a lot of benefits that come from a couple of simple, straightforward steps.  Perhaps the most difficult step is to understand why we should do these things, and then developing the habit.  Personally, I like to divide the list into two halves:  those things I need to start doing to improve my health, and those things I really should avoid or try to give up.

The first, and most important, thing that I should do—but something I still struggle with—is have a regular appointment with a primary care provider (PCP).  A PCP is someone (internist, OB/GYN, nurse practitioner, physician’s assistant) who routinely (once or twice a year, or more if necessary) evaluates your overall health and makes sure you are reaching specific goals.  They can also refer you to a diverse number of specialists if you have a particular symptom or problem that needs to be addressed.  The PCP is kind of like the conductor of a symphony, with the music being your overall health.  They should know about all of your medical conditions, the list of medications you are taking, and any medical problems you might be predisposed to or at risk for.

The first step that your PCP should perform, after introducing him or herself, is sitting down and doing a complete medical history and physical exam.  This will serve as a baseline of your health, which can be referenced and compared to in the future, especially in emergency situations.  The medical history is basically you telling your PCP all about yourself—how you feel, any aches and pains, past injuries or surgeries, anything you’re being treated for now, all medicines (including over-the-counters, herbs, and supplements), allergies, how much you drink or smoke, where you live, and what you do for a living.  Whew!  It is a lot, I know, and it is personal, but don’t you want your doctor to know that you have a serious allergy to penicillin when prescribing an antibiotic for your pneumonia, or that antihistamines like Benadryl completely knock you out?

The physical exam will consist of taking several vital signs, such as height, weight, temperature, blood pressure, pulse, respirations, and pain score.  It also includes a thorough head-to-toe check of everything—your skin, eyes, ears, nose, throat, listening to your heart beat and lungs, feeling your pulse in your arms and legs, testing your strength, seeing you walk, checking your balance.  The exam is like the test drive for your car, especially a pre-owned car—it’s to make sure that all the systems are in working order, and to see if there is anything to keep an eye on (like that dash warning light which keeps flashing on and off, or that pesky freckle right between your shoulder blades that looks okay right now, but seems to itch every once and a while).

All of this information and examination, then, is very important to know and to track (hence the name vital signs), but I would have to say, especially in our society today, the one that is the most important but most overlooked would have to be the blood pressure.  I know, I know, you were thinking that I was going to say weight, but you know what we need to do about that.  I mentioned it above, I’m working on it too, and I’m not going to beat a dead horse.

Now, let’s move on to blood pressure.  Why would you think that I would feel that these two simple numbers are so important? (Just a footnote: the upper number, the systolic pressure, measures the blood pressure as the heart is contracting, or pushing blood through the body, while the lower number, or diastolic pressure, measures while the heart is relaxed.)  Well, as I mentioned earlier, there are a couple of things that we can do currently to reduce our risk of heart attacks and strokes.  Managing our blood pressure is perhaps one of the most important.  Hypertension, or high blood pressure, is also one of the most dangerous, and insidious, diseases we face in the medical profession. There are no symptoms, no pain, no signs of danger, until it is too late.  I know people say that their vision blurs, or they hear their pulses, or have headaches, or some other symptom.  But these do not always correlate with blood pressure, and your blood pressure can still be elevated, even when you feel completely normal.

Treating hypertension is usually a team effort between you and your PCP.  The diagnosis of hypertension is made after having three successive blood pressure readings above 140/90.  Some people are able to lower and maintain their blood pressure through diet and lifestyle modifications alone.  These consist of limiting or reducing salt intake, diets high in fruits and vegetables, and regular aerobic exercise.  This is tried in all patients for about three months.  If lifestyle modification is unsuccessful, however, then it is usually necessary to talk to your PCP about starting a medication.  There are a lot of choices for antihypertensives, which impact blood pressure differently.  Different people respond differently, and it is important to figure out which medicine is right for you.  But the take-home message about hypertension is that once you start taking a medication—continue taking it—no matter how good you feel.  Hypertension is a silent killer, but with regular follow-ups, monitoring, and medication use, the disease can be managed and many of its serious complications can be avoided.

One other major action you can take, again with your PCP’s help, is to routinely monitor your blood sugar at semi-annual office visits for surveillance, or several times a day if you already have diabetes.  Diabetes is a disease of elevated blood sugar (glucose), resulting from the body’s inability to maintain normal sugar levels because of a deficiency of or decreased sensitivity to the hormone insulin.  Insulin is the molecular key that unlocks many cellular doors to let glucose inside.  Elevated blood sugar has devastating effects on many sensitive tissues, including the brain, eyes, blood vessels, and nerves.  Diabetes is also a risk factor for suffering a heart attack or having a stroke, as well as causing kidney failure, and eventually requiring dialysis (artificial filtering of the blood to remove toxins that normally pass out of the body in the urine).  But with adequate blood sugar monitoring and control, following a diabetic diet, and the proper use of insulin and other diabetic medications, these symptoms can be lessened and complications avoided.

Monitoring and controlling your blood pressure and blood sugar are two powerful ways of keeping yourself healthy and helping to avoid very serious disease complications.  Two other important preventive health measures involve avoidance, in particular, avoiding tobacco and excessive sun.  With these additional habits, you can significantly reduce your chances of developing many different types of cancer.

The first piece of advice is to avoid too much sun exposure.  Now, don’t get me wrong.  I like being outside and working as much as the next person, probably more so than some, since I have to be inside a lot at my other job in the hospital.  What I am saying is not to be a sun-worshipper.  For example, if you plan on a long day of fieldwork, try to wear light, reflective clothing that will cover and protect sensitive areas from sunburns, such as a broad-brimmed hat for your head and face (including the tips of your nose and ears, which we sometimes forget), as well as longer sleeves and trousers for your arms and legs, respectively.  Sunburns are actually skin damage at the molecular, or DNA, level.  The ultraviolet, or invisible high energy, component of sunlight penetrates the top layers of skin and slams into portions of your DNA molecules, knocking out atomic bonds and causing mutations.  Your cells are able to fix some of them, but others cause cell death, leading to the sunburn, which is actually classified as a type 1 or 2 skin burn, depending on if it blisters or not.

Rarely, some of the mutations do not cause cell death, however, but rather let the cell grow and divide uncontrollably.  This leads to skin cancer.  If you are a fair-skinned individual with a lot of moles or freckles, you and your PCP need to regularly monitor your skin for changes that could signal the presence of early skin cancer.  While your healthcare provider can give you more details, and pictures and diagrams are readily available on-line (just look under melanoma and symptoms), it is important to remember ABCD.  This acronym is to help remember that, for each mole or freckle, if there is any change in its Appearance, Border, Color or Diameter, it needs to be looked at by a healthcare professional and potentially biopsied.  Please do not think that it is “nothing” and ignore it.  Skin cancer diagnosed early is very treatable, and there is a high chance of cure if it has not spread outside of the skin.

Now, what I am going to say next is very close to my heart and very personal, too, because I have someone close to me struggling with this particular problem right now.  Stop using tobacco, whether it is smoking cigarettes or chewing it.  If you don’t smoke or chew, don’t ever start.  If you are currently using a tobacco product, and are thinking about quitting, do everything in your power to meet this goal.  If you have tried and failed in the past, try again.  If you don’t think that you need to, consider this: nicotine is one of the most addictive substances known to man.  The substances in cigarette smoke, which include hundreds of carcinogens (cancer-causing agents), are poisonous to blood vessels.  It damages blood vessels in the heart and brain, and is a major reversible cause of heart attacks and stroke.  Smoking has also been linked with numerous types of cancers, including lung and skin cancer.  These are both usually advanced and incurable when they are diagnosed, and the risk of developing them can be dramatically reduced by quitting.  There is a whole laundry list of other health problems linked to smoking, including emphysema, chronic bronchitis, asthma, birth defects, sudden infant death syndrome, problems with circulation and blood clots, and the list goes on.

Chewing tobacco is another dangerous, addictive, unhealthy habit.  I have heard of some patients who quit smoking but started chewing, because they thought it was safer.  It isn’t.  Chewing tobacco also contains a lot of carcinogens and toxins, and has been linked to many types of mouth and throat cancers.  It is not less dangerous than smoking—it only shifts the cancer site upward.  And it can actually be more gruesome, especially when the surgeons have to remove the whole jaw in order to save the patient’s life.  However, it is a life confined to silence and drinking every meal.

But there are many methods, tools, support groups, and medications available to help you in your attempt to quit.  Only you and your PCP can determine which tobacco cessation program will work best for you.  I just pray that you try, and if you have not been successful yet, please continue.  You will be, and it will be the best gift you can give yourself and your loved ones—the gift of life and health.

I wanted to introduce the power, premise, and promise behind preventive medicine.  And with these several (relatively) straightforward changes, you and I can go a long way to living healthier lifestyles.  But I have only given a couple examples of steps we can take to improve our overall health.  There are many, many more:  avoiding drinking alcohol in excess, making sure that eat enough dietary fiber, routine cancer screening and monitoring, with colonoscopy, mammograms, breast and testicular self-exams, and so on.  But the most important step is the first one.  Please start taking care of yourself.  Our personal health is very important, and by taking a few simple steps, we can all hopefully enjoy many more wonderful years in the country.  Oh, and by the way, I was able to avoid temptation (this time), and I didn’t get a chocolate dessert earlier (one of my many weaknesses), if anyone was worried.

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