Thursday, May 5, 2011

Your Car or Your Life

I missed my appointment and was furious at myself. How could I forget my appointment with my auto dealership for 60,000 miles maintenance check? I should have been upset; I need my car to run smoothly for me to reach my destination. I am sure you can relate to that. After a while, my thought drifted to other machines that require maintenance on a regular basis. Our heating and air conditioning unit, our lawn mowers, our roofs and gutters to name a few. Most of us are good at maintaining our autos, machines and houses. Are we as diligent about maintaining our own body? Think about it.

In my 25 years experience as a physician, I have seen countless patients who find out about their hypertension only during a mandatory medical exam for truck driving or they find out that they are diabetic only during the medical examination required by the insurance company. In late 1980s, I worked on a National Institute of Health’s research project on kidney failure in diabetic patients. We noticed that some patients developed renal failure in about 10 years while it took 25 years for others. So what was the biggest difference in the two groups? Yes, how effectively one controlled blood sugar was a factor, however the finding that surprised us was that blood pressure control was as important. Some, who developed kidney failure in a very short time, were not even aware that they had diabetes and high blood pressure.

The irony is that screening for blood pressure and diabetes are about the simplest, least expensive tests in medicine. So what are we to do? Everyone, even the healthiest among us, should go for a physical once a year. Clearly, our body deserves at the very least as much attention as our cars. So what is more important to you, your car or your life?

It reminds me of Jack Benny radio sketch. A mugger corners Jack Benny in a deserted alley, shows him his gun, and asks him. ‘Your money or your life?’ When he hears no response, he asks the question again, this time more forcefully. To this Jack Benny replies, ‘Don’t rush me, I am thinking, I am thinking’.

Sunday, April 24, 2011

Prevention is the Cure

We equate better health care to expensive diagnostic tests and miracle drugs. We spend 80% of our health care dollars in the last year of life when it is too late. We pay attention to our bodies only when it really hurts. How wise is it? Let us see what one of our highly respected leadership and organizational expert has to say about this.
Stephen R. Covey in his book ‘The 7 Habits of Highly Effective People’ teaches us how to manage time and resources. He categorizes daily tasks into quadrants: Quadrant 1 is for things that are urgent and important. He calls it the ‘Symptom quadrant’ and the time spent in this quadrant as ‘crisis management’. The second quadrant is for things that are important but not urgent. He calls it the ‘Cure quadrant’. Mr. Covey urges us to spend most of our time and resources in this quadrant. The activities in this ‘cure quadrant’ include planning, preparation, relationship building and prevention. Yes prevention in the ‘Cure quadrant’. Thus prevention is not better than cure, as the old saying suggests. Prevention is the cure.

Tuesday, April 19, 2011

Are you concerned about your weight?

It was a rare slow day at my clinic. I saw my last patient an hour ago and was eagerly awaiting the arrival of my next patient, a top executive of national company. I enjoyed doing these Executive physicals as these physicals were geared towards the preventive aspects of medicine, a subject that interests me immensely. Mr. Rothberg arrived, a tall, well-built gentleman and apologized for being late. When I asked him what his main concern was, he said, ‘I am very concerned about my weight’. This surprised me. I could see well-developed muscles under his medical gown. I asked him ‘Why does it concern him so much?’
He told me ‘Doctor, according to the weight chart I am 20 lbs above my ideal weight. I have been exercising for 45 minutes 5 days a week and the weight does not seem to budge. If anything, I may have gained a couple of pounds’.
I smiled and wished my other patients would have this ‘problem’ too.
You see Mr. Rothberg did not have a ‘weight problem’, he had an ‘weight chart problem’.

Typical weight charts may mislead you if you are highly muscular. For an equal mass, muscles weigh more than fat. In reality, Mr. Rothberg could have a low level of fat with excellent body composition (the proportion of muscle to fat in the body). Conversely, many people who weigh in at the ideal weight may have too much fat on their body, and too little muscle - in effect, a poor body composition.

Ideally, it is important not to lose lean weight, as it is mainly this lean muscle tissue that maintains your metabolism, the rate at which your body burns the calories.

Key to effective weight management.

The greater the lean weight, the faster the body burns energy at rest and during exercise. Therefore, it is particularly important to maintain and even increase lean weight during weight-reducing Exercise/diet programs.

The normal Range for lean weight is 80 - 86 %

Body water—an important part of Body Lean. Water is the most important for human life. Water keeps your system moving, flushes out impurities, and cools the inner organs, regulating your body temperature.
Some fad diets tend to lower your weight by simply lowering your body’s water content. These diets seem to ‘work’ because your bathroom scales show your weight to be less. When in fact all you lost was water and water Loss may be dangerous. Normal Range of water in the body is 55 - 65 %

Fat weight and not total weight determines health risk, it is clearly advantageous to maintain bodyfat levels within the recommended normal range.

So Fat is Bad. We should get rid of Fat as much as possible. Right?
The answer: Not necessarily. Not all fat is useless.

You see, here are two forms of fat tissue:

Essential fat (approx. 4% for men and 10% for women) serves as a shock absorber and protective shield to the vital organs of the body such as the heart, liver, kidneys, brain and spinal cord.

Subcutaneous fat stored beneath the skin acts as an insulator to protect the body against the weather. Any excess calories derived from food intake will be stored here as fat.

As fats are essential for normal body functions, body fat should not be reduced below the recommended lower limit unless under the supervision of a health care professional
So what is the Acceptable range of fat?
Acceptable range of fat is 14-20% . Men should strive for the lower end of this range while women may stay at the higher end of the range.

I measured Mr. Rothberg’s percentage body fat with the help of body composition machine. His percentage body fat was well within a healthy range.
I shared the above information with Mr. Rothberg. The anxiety on his face was gone and he was positively smiling. As he left, I could not help notice a certain spring in his stride.