I first published this article on May 11, 2011. It’s January 12th and it’s snowing. The roads are “not bad” and people with bad colds, chest pain, fatigue, and a vast assortment of other symptoms are driving to my office. I’s a good time to re-post this article!
Having chest pain? Please don’t drive. Short of breath? Please don’t drive. Feeling faint? Please don’t drive. Is the room spinning? Please don’t drive. I am amazed at how many people get behind the wheel of a car when they are physically or emotionally impaired! Once a week, we call the paramedics. I guess I should be pleased that patients think enough of my care that they drive themselves to my office rather than calling the paramedics. I’m not pleased. It scares the crap out of me. It’s one thing to underestimate how sick you are and die as the result of your own misjudgment. It’s quite something else to arrive at the pearly gates with a stranger’s family in tow! Pass out behind the wheel and the car drives off the road or into oncoming traffic. What might well have been a treatable illness turns into a disaster of major magnitude. Having such severe pain that you have to pull off on the shoulder leaves you all alone in your time of need. I’m afraid that one day one of my most faithful patients is going to literally drive into my lobby. Don’t let innocents get hurt because you don’t want to bother a friend or call the paramedics! The paramedics are well trained professionals. Their ambulance is a mobile intensive care unit. Breathing is a funny thing. My patients are always breathing until they are not. They never know when they are going to stop breathing; it just happens. It usually happens when they have a severe respiratory tract infection with cough and shortness of breath. It happens when they are having the crushing chest pain of a heart attack. The paramedics can breathe for you. They can successfully start a heart that is no longer beating. They save lives, yet many people are hesitant to call them. Don’t be macho about driving. This is one case where both men and women are alike. Men can drive when they are half dead just because they are men. Women are embarrassed to make a fuss by having the paramedics show up. Dying needlessly is something to be truly embarrassed about. Driving into a ditch or through a school yard is something to be embarrassed about. Think about your family, neighbors, and friends. Call them for help if you don’t think you need the paramedics. Just don’t drive them off the road when you lose control of your car. Treat illness like alcohol. Don’t drive impaired. Help is just a phone call away. The life you save may not just be your own; it may well be the lives of the innocent!
Monthly Archives: January 2012
SUCCESS!
January 14, 2012 Yesterday was a great day. Yesterday, I worked with successful, dedicated patients! Some days are just better than others. So, what made yesterday’s patients different? Patient number one came in with a cold. She needed to be well as she was leaving for a one week trip to the Caribbean! Two years ago she had seen me due to a smoker’s cough and bronchitis. I convinced her that she had to quit smoking. She quit two years ago. Her savings from not smoking funded the trip to the Caribbean! Patient number two was an out of shape, overweight diabetic who has been working with me for a year and following Diets and Other Unnatural Acts “Chicken Steps” to success. He no longer needs insulin. He looks and feels ten years younger. We are now actively weaning his blood pressure medication. Patient number three is using his CPAP (sleep machine) and loving it. His wife insisted that he snored and that his snoring was killing her. She was sleep-deprived and thinking about killing him! Instead, she made him take an in-home sleep test and I diagnosed him with sleep apnea. He now knows what a restful night’s sleep is. She does, too! They are happily married and enjoying each other. He will never know how close he came to either dying from sleep apnea or at the hands of his wife! Patient number four came in for a full physical. He is on his way to a better, “Wellthier,” future with plans to join a gym and work on every facet of his lifestyle. He is particularly happy with his new “90 day plan.” I received multiple compliments yesterday: “Dr. Segal, how much weight did you lose?” “You look great! How did you do it?” “My wife and I loved your book.” Yesterday was a great day!
BINGE DRINKING
January 13, 2012 According to the article, “Binge drinking — defined as at least four drinks in one sitting for women and five drinks for men — carries substantial risks and high costs. It accounts for more than half of the estimated 80,000 annual deaths and three-quarters of the $223.5 billion in economic costs tied to excessive alcohol use.” The article goes on to point out, “And the problem is even larger than these self-reported data indicate, Brewer continued. Previous studies have shown that, based on alcohol sales, asking people to self-report drinking behavior captures less than one-third of presumed consumption.” Not surprisingly, the article reports, “The rate of binge drinking was highest among 18-to-24-year-olds (28.2%), as was the intensity (9.3 drinks per occasion). Both figures decreased with age. The frequency of binge drinking, however, was highest among respondents 65 and older (5.5 episodes per month).” My patients prefer to call binge drinking by the more PC term, “social drinking.” As part of assessing each patients risk for disease and injury, I ask questions about alcohol, tobacco, and other substance abuse during most visits. Mr. “X” is a 24 year old college grad, employed fulltime as an accountant. He lives with his roommate in Chicago and is actively dating several young women. Me – “Mr. “X,” do you drink alcohol?” Mr. “X” replies, “Socially, on occasion.” Me – “On which occasions?” (Did I mention I hate vague words like “occasion.”) Mr. “X” – On most weekends and occasionally during the work week.” Me – “How much do you drink on the “occasions” you drink?” Mr. “X” – “You know, a few on a weekday and a few more on weekends.” Me – “Can you be a little more precise? How many is a few?” Mr. “X,” again avoiding the truth – “Maybe 4-5 a night during the week and more on the weekend.” This young man who only drinks socially, having a “few” drinks on an “occasion,” is really a binge drinker, something he learned in college. The problem is twofold. Number one, he has no idea he is a binge drinker and therefore is unaware of the risks of his drinking. The second and larger problem is that his friends are also binge drinkers and also fail to recognize the risk of binging. These are responsible young men and women. They do not drink and drive, arriving and leaving by taxi. If they drive, they have a designated driver who mostly refrains from drinking. So, what’s the harm? According to the article, binge drinking “accounts for more than half of the estimated 80,000 annual deaths and three-quarters of the $223.5 billion in economic costs tied to excessive alcohol use.” Just think about that! Up to 40,000 deaths are related to binging! In my 30 years of practice, I have been unfortunate enough to watch young souls destroy themselves with a “few” drinks on an “occasion.” I have heard all the excuses. “Doc, haven’t young people always partied with alcohol? Didn’t you?” “I make a good living and work hard. I deserve to be able to party on the weekend!” “We are very responsible drinkers!” I have also seen many “wild and crazy” youths grow into responsible sober adults and raise “wild and crazy” binge drinkers of their own. How do you know which binge drinkers will go on to become alcoholics, or worse, die. Therein lays the conundrum! If you or your children or friends fit the definition of a binge drinker, STOP! Since there is no way of knowing if you are destined to be one of the 40,000 fatalities, avoiding binging seems to be your only sensible choice. Remember, the life you save may be your own.
According to an article I read today entitled, Binge Drinking Common Among Adults, CDC Finds, by Todd Neale, “about one in every six U.S. adults binges on alcohol.”
90 YEARS YOUNG
Editor’s note – The following article was written by my sister, Martha, as a tribute to our mother on her 90th birthday. 90 years young, complaining there aren’t enough hours in the day and still cooking three meals a day, my mother is quite a phenomenon! She just passed her drivers exam and shops at a minimum of three grocery stores a week, looking for the best bargains on healthy, fresh produce and meats. Thanks for sending me this article. January 9th marked my mother-in-law’s 90th birthday. Happy birthday, Bubbe (grandma in Yiddish)! She is a great role model and I am sure part of the inspiration for the “Live Wellthy” lifestyle that Stewart is promoting. Bubbe was one of 4 children who were first generation Americans. Her parents immigrated to the United States from Russia/Poland/Austria. Her Mother, Bubbe Brown, was a fabulous cook; and, while her recipes were wonderful, they were surely laden with ingredients that could lead to high blood pressure, high cholesterol, diabetes, etc. Bubbe learned from her siblings. She saw them experience weight gain and health issues, and changed her lifestyle. She watched what she ate and learned to cook with alternate ingredients that were healthier. While I always loved her cooking, I didn’t always enjoy sharing meals with her. She spent most of the meal discussing what substitutions she made to lower calories and fat and that seemed to take away the pleasure of eating. I have learned from her, however, that what she was doing worked. She continues to maintain a healthy diet and I am sure this had led to her longevity. Bubbe and Zayde (grandpa of blessed memory) were caterers in Norfolk, Virginia, home of the world’s largest Naval Base. They used to cater the Navy ship’s parties and provided meals to thousands of sailors a night. When Zayde died, unlike many of her widowed friends, Bubbe continued to cook meals for herself instead of eating out and resorting to fast food. She can cook for 1,000 or for 1 and still loves doing it. She eats lots of fresh vegetables and prepares meals that are both nutritious and delicious. Another factor that has contributed to Bubbe’s good health is regular exercise. When my husband, her oldest son, was a teenager, the first health club opened near their home in Ward’s Corner. Bubbe joined the health club and bought Alan a membership as well. Both of them learned the benefits of a regular exercise routine and continue to see the benefits of this in their health assessments. Bubbe is also a cancer survivor. Her attention to nutrition and exercise continue to enable her to live an active, vibrant life. So take a lesson from Bubbe on her 90th and “Live Wellthy.” Here’s hoping we can wish each of you a Happy 90th birthday someday! Martha
Fall Down Three Times But Get Up Four
January 11, 2012 During today’s visit, I gave Mr. “B” a present/reward for maintaining his healthy habits for one year. Today, I reduced Mr. “B’s” insulin, his blood pressure meds, and his cholesterol meds! Mr. “B” gave me a present, as well. Mr. “B” has been the source of many of my articles; and today, Mr. “B” gave me one more. “My daddy always told me, ‘Fall down three times but get up four.’” Mr. “B’s” road to success has not been easy. He has worked hard on defining and refining himself and has fallen on several occasions. Each time he has fallen, he has gotten back up, dusted himself off, and gone back to work on “being all that you can be.” So, when your New Year’s resolutions start to falter, when you start to fall, remember, “Fall down three times but get up four!” Mr. “B” likes to share his wellth with others. Share your success with others. When you see someone fall, help him up, dust him off and teach him “B’s” lesson. When you fall down, get up immediately and go back to work at being “all that you can be!”
Mr. “B” was in this AM for his weekly weigh in and medication check. Mr. “B” is living the “Wellthy” lifestyle. Over the last year, his diet has improved remarkably, his exercise routine has become a permanent way of life, and he has given up his last vice. Mr. “B” survived the Christmas/New Year eating orgy and is looking forward to a happy and healthy new year!
Another Type of An Affair
January 10, 2012 A work affair can be worse than a physical entanglement with another human. It can be harder to break up with work than with a human lover. An affair with your job can be just as destructive to your marriage and can cost you your life. Not long ago, I saw a leader of American industry whose job took precedence over all else. Being responsible for a Fortune 500 company’s success is an awesome responsibility. The company demands constant attention, nurturing and stroking the company’s growth. Responding to changing needs. Being a successful corporate leader requires long hours, travel, business meals, and more, leaving no time for self and family. As in any affair, denial plays a major role. The unfaithful spouse will deny any impropriety, claiming that his/her long hours at work are spent on behalf of his family! He/she claims that he/she works long hours in order to provide financial security for his/her family. He/she claims that, one day, he/she will retire and enjoy his/her family and life. As a patient, the office bigamist often neglects his health, skipping appointments, running out of medicine, and complaining that there is never time for exercise. Certainly, business lunches and dinner are not amenable to proper eating habits. Diets and Other Unnatural Acts was partially inspired by just such a corporate giant. Being married to your business may provide for financial success and security, but money without health and family is worthless. Carl was living proof. Are you married to your work? Is your work an abusive spouse? Does it demand so much of you that there is no time to take care of yourself or others? Or are you a stress junky? A success junky? Sometimes business demands are not the problem. Sometimes the personal need for success creates stresses that are self-imposed. I’ve written about the two brothers, one whose has “everything” and the other who has “enough.” Both brothers have identical assets, the difference is perspective. Whether you are a work bigamist or a stress/success junky, it’s time to change your perspective! Money without health is worthless. Over the last 30 years, I have seen many patients sacrifice their health and family relationships in the name of making a living. I have seen many spouses cheat on their loved ones by marrying their businesses. In every case, the only thing the family ever wanted was time with their father/mother/spouse. Success in your job is important. Success as a spouse and family man/woman is more important. They need not be exclusive of one another. Make your health and your family your primary responsibility. They will be with you long after your business is gone. Don’t wait until your health fails or your family is irreversibly estranged. Remember, the life you save may be your own and that life is important to others.
Is your loved one having an affair? No, not a sexual affair with another human. I’m referring to an affair with his job! Yes, some people are bigamists, married to their jobs and their spouses. Is your spouse married to his work?
WILL POWER IS MISSING
January 9, 2012 Have you seen my friend, Will Power? Will and I have been hanging out together since I published my book. Will’s my best friend. He’s the sensible one, always keeping me out of trouble. With Will Power at my side, I have flourished. Today, Will and I walked into the Garden Fresh Super Market together. Will thought we should stop for lunch first but I was in a hurry to get home and prepare for my mother’s 90th birthday. On entering the store I noted an attractive young woman standing at a table selling her goods, so I stopped to see what she was offering. Will was with me one minute and gone the next. I figured he wandered off for a moment and would return shortly. Mr. Will Power is a loyal friend; he wouldn’t abandon me! Anyway, this young woman was sampling a multitude of cheese spreads on delicious, gluten free, crunchy, whole grain crackers. Any idiot knows not to walk into a grocery store when he is hungry but I figured I was safe since Will Power was with me. Unfortunately, with Will missing in action, I was doomed! They sure were delicious. All seven varieties! I quickly gained my composure and started searching for Will. Searching the aisle at Garden Fresh was like maneuvering through a mine field. One aisle over was another sampling of cheesy treats. Two more aisles to the north and I was accosted by samples of fresh baked goods. I figured Will Power would be waiting for me in the healthy produce area so I ate my way through the mine field, seeking refuge in the green leafy aisles. They were waiting for me and Will was nowhere in sight! Taco salsa and guacamole dip and chips tripped me as I turned the corner. They assaulted my mouth with jalapeño peppers. Over by the celery was another woman, offering tastes of hot dogs and queso blanco. I searched for Will while working my way towards safety in the fruit aisle and the hope of getting to the checkout counter without any other treats. I’m home now. I’m calling everyone, asking for help finding my friend. I’m not worried about Mr. Will Power. He’s tough and can handle himself. I’m worried about me. Without Will Power, I’m afraid I’ll fall off the wagon. I know what they say, “If you fall three times, get up four;” but, without Will Power’s help, it’s going to be tough. When I find Will, I’ll apologize for not listening to him. I’ll never go grocery shopping when hungry again. I’ll also walk right by pretty young women peddling their wares. If you see my friend Will, tell him I miss him!
“The harder you work the luckier you get.”
January 8, 2011
One of my more successful patients stated, “The harder you work, the luckier you get.” Apparently, Gary Player is the originator of this particular quote and my patient and I agree with him.
In the past, I have written about the difference between “trying” to accomplish a task and “working” to accomplish that same task. The only thing I ask of my patients is that they work at being healthy. The implications of working on a project are many.
Foremost among the many implications of working on a job is that you go to work every day regardless of whether you want to or not. I don’t care who you are or how much you love your job, there will be days you just don’t want to work. The successful person gets his act together and not only goes to work, but gives it his all.
Another important aspect of working on a job is the knowledge that you will make mistakes and that you will correct those mistakes as soon as you identify them. The successful worker goes one step further, he learns from each mistake so as not to repeat it in the future.
Finally, incumbent in every job is the knowledge that your work must be finished within a prescribed length of time. The successful worker learns how to pace himself so as to complete his task in an efficient and timely manner. The end result may look like luck to an outsider, but as Gary Player put it, “The harder you work, the luckier you get.”
If you look at managing diabetes, hypertension, or high cholesterol as a job, you will succeed at controlling the underlying disorder with a minimum of medications and interventions. If you look at getting off of your cigarettes as a full time occupation, you will succeed. Hire yourself to work on being healthy. Health does come at a cost! The cost is learning good nutritional, exercise, emotional, and spiritual habits.
If you are retired, come out of retirement and work 2 hours a day on maintaining your body in tiptop shape! If you work long hours and don’t have time for your “self,” learn to “Time Wrap!”
Lastly, if you are having problems finishing your tasks in your every day job, often turning to a co-worker will help you find the solutions you need to succeed. If you are having problems maintaining your health, turn to your doc for suggestions and help! Remember, the life you save may be your own.
HOW MANY CANCERS CAN BE PREVENTED?
January 7, 2012 Please open the chart (by clicking on the highlighted word) at the Cancer Research UK site. At first glance (and second glance), the chart is confusing. Despite its complexity, it is a brilliant depiction answering the question, “How many cancers can be prevented?” In keeping with the KISS principal, the right side of the page shows 14 modifiable attributes that are associated with cancer. The middle of the page shows the 29 cancers that could be preventable by modifying risk factors associated with cancer. What would you be willing to do to prevent cancer? Stop smoking? Lose weight? Improve your diet? Reduce your alcohol intake? Avoid the sun? I’ve spent the last few months writing about “Living Wellthy” and my book Diets and Other Unnatural Acts. I’ve written about the need to first define who you are and then refine who you are. I’ve discussed “being all that you can be.” It’s time to define what your risk of cancer is and then work at removing as many risk factors for cancer from your life as you can. It’s hard to “be all that you can be” while being treated for cancer!
“How many cancers can be prevented?” is a great question. An even better question is, “What would you do to prevent cancer?” What would you be willing to give up? Cancer Research UK is a great internet site, full of information on cancer and the preventable causes of cancer.
PARTNERS
January 6, 2012 Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are supposed to be the working partner and I’m supposed to be the consulting partner. My job as the consulting partner is to offer sagely medical advice to the boss (working partner). As a consultant, I’m supposed to help in the making of key decisions, find the appropriate tools to help make the boss healthy and happy, and instruct the boss in how to implement those tools should he decide to follow my advice. As the boss and working partner, my patient is supposed to weigh his options, institute those procedures and treatments as prescribed and to keep me updated on how he is doing. His job should also entail reviewing key health decisions with me prior to making changes in his overall healthcare. Lately, my patients have been making unilateral decisions. In other words, they have not been consulting with me, their doc, prior to changing or stopping their medications or other treatments. While it is well within their rights to institute or stop any medical intervention on their own, it is often wiser to utilize the services of a trained consultant/doc. This latest trend toward patient autonomy baffles me. Yes, the internet is full of information and advice; however, the internet’s info and advice is uncensored, impersonal, and biased. Much of what the internet claims is gospel is really the carefully disguised marketing of junk. The legitimate, scientific data that can be gleaned from the internet often exists in a vacuum. Case in point: When researching Actos, a medication used to control diabetes, the internet will inform you that recent studies suggest that the use of Actos may be associated with a rare form of bladder cancer. While the operative words are “may be” and “rare,” the only thing my patient sees is “CANCER!” Rather than coming in to discuss this new finding with her doc, my patient stops her Actos. Three months later, her blood sugar is out of control. Her kidney function is now abnormal and her primary disease, diabetes, is having its way with her. The internet failed to inform my patient that Actos was instrumental in the control of her diabetes. The internet failed to inform my patient of the benefits of being on Actos. The internet did not know my patient. It did not take into account her individual needs or the damage done by invoking the fear of “CANCER!” As a consultant, my job is to take all of those factors into account. My job is to “care” for the individual. The internet is “careless” (without care) by its very nature. So, what am I doing wrong? I’m in the office 5-6 days a week. When I’m not in the office, I’m on call. I don’t leave the office until every last one of my messages is dealt with. I write this column daily, teaching people to be self-empowered. Maybe that’s the problem! Perhaps the problem is that people underestimate the risk of being empowered and making unilateral medical decisions! Stopping the wrong medication can lead to heart attack, stroke, or even death. Stopping other medications can lead to uncomfortable or dangerous withdrawal symptoms. Deciding not to do critical tests can cost you your life or diminish the quality of the life you have. Yes, the patient is the boss! Most successful bosses have trusted consultants who help them stay ahead of the game. Form a partnership with your doc. Use him/her as trusted consultants before making any healthcare decisions. The life you save may be your own.