Iliff Family Practice

Dr. Iliff's Practice Newsletter - 2008

What's Your Mile? This year's emphasis in our practice will be on two issues: fitness as a measure of wellness, and electronic prescribing (see below). All of you know that I place a great deal of emphasis on prevention (as opposed to treatment of) medical disorders. It's the problem of closing the barn door after the horse has fled; by the time we get to bypass surgery or colon resection, I already feel like a failure. This much we know: fitness is more important than weight, or anything I can detect in your blood, when it comes to predicting your chance of being alive in ten years. And I'm just talking about being alive. Obviously, fit people are going to have more fun at any age. Did you notice that erectile dysfunction has just been added to the list of cardiac risk factors? Fitness is a matter of keeping your pipes clean. Clean arteries are the result of fitness. Now here's the question: how do we measure fitness? What's the vital sign, like blood pressure, blood sugar, or cholesterol, which will tell your doctor how fit you are? There is such a measure, and it's a public health scandal that it hasn't been used. How fast you can walk one mile is more important to me than anything I can measure in the office. The problem is that I can't do it to you. You have to do it for yourself, and give me the results. So this year I'm going to be asking everyone coming in for routine examinations to take the test. There are information sheets in every exam room, or you can go to the Healthy Kansas website (http://www.healthykansas.org/whats_your_mile.aspx) for details, but it ain't rocket science. You ought to be walking anyway, and once or twice a year you need to time yourself for one mile. Checking your mile time from year to year will tell you whether you're approaching that slippery slope that ends up drooling in front of the TV.

Gone to the Dogs: Join me at 11:00 on the Iliff Commons Saturday, March 22nd for a 3K run or walk with your dog. There will be a trophy for the winning pair, and medals for the top three humans. You can walk the What's Your Mile? test while you're there. As a benefit for the Helping Hands Humane Society, a $10 donation is requested, payable at the starting line.

Electronic Prescribing: The majority of preventable medical errors occur in the practice of writing a prescription and having it accurately filled in the pharmacy. I'm busy, my nurses are busy, and pharmacists are busy. Errors are inevitable. By putting all of your prescriptions in an electronic format, I can eliminate almost all of the errors on my end. This is a great deal for everybody, but like all changes, it will take some time to get rolling. Be patient. We'll all be better off by this time next year. Also: get in the habit of bringing all your pill bottles to your refill appointments. Don't trust your memory or our records. The pharmacy may have made a mistake, or another physician may have changed something that we're not aware of.

Amazing New Diet Program: Every day I answer questions about loony weight-loss-quick programs, and all I can give is the same old boring lecture about eating good food in smaller amounts. After years of research, I have devised an unbeatable, simple, willpower-free rapid diet plan. I call it Naked in November, Mirrors in May. There are no expensive supplements to buy, and no dangerous pills to consume. It works on the extensively-studied principle that naked people in the winter will consume thousands of calories every day just trying to maintain their core temperature, mostly by shivering and teeth-chattering. I am now enrolling patients for beta-testing before the full rollout in 2009. The book will be available in the spring of 2010, after the concept is “clinically proven” on at least three patients. For patients with narrow minded employers-- usually members of the Vast Right Wing Conspiracy-- or rigid dress codes, we will be selling Dashikis through the business office (WARNING: must be worn without underwear or socks for full clinical effects).
Just Kidding: OK, I was being sarcastic about the diet program, but I get tired of dealing with the same silly advertisements year after year. There are lots of scamsters out there, folks, and most of them deal with medical issues. Don't sign up for weight loss programs which sell you special food, vitamins, or prescription drugs. In other words, stick with Weight Watchers. Everything else is just a rip-off with a 99% failure rate. The only valid approach is to eat less of what you like, measuring the amounts in either points or calories, and re-educating yourself about healthy portions. That, plus regular vigorous exercise.
And “Dr. Phil”? Don't make me laugh. First off, he's a psychologist, not a physician. Second, his shows are elaborately staged and edited for maximal emotional impact, not medical or psychological truth. He's another scamster.

Good Advice for Young Parents: In lieu of my long-anticipated book on parenting, delayed until all of my children are happily married, productive citizens, and successful parents themselves, here's a nutshell summary with research and/or common sense to back it up:

1. Do not leave the television on in the presence of children younger than 3. It may screw up their brains. After that, allow them to watch carefully selected shows but do not use it as a babysitter.
2. If any other reasonable adult (teachers, friends, or neighbors who are not clearly deranged) has the courage to correct your child, express your profound gratitude. Rousseau was wrong. Children have to be trained to behave, and as the Bible says, “all discipline is for a little while painful, but afterward yields the peaceful fruit of righeousness.”
3. Don't allow yourself to be manipulated by temper tantrums, whining, pleading, threats, or verbal abuse. You're the adult. You aren't perfect, and you haven't been the perfect parent, but you've got a helluva lot more sense than they do.
4. There's no such thing as quality time without quantity time.
5. Children are way over-activitied. Make some choices. If you're giving up dinner as a family for basketball or gymnastics on a regular basis, Just Say No.
6. Read to your children on a daily basis.
7. Video games should be strictly regulated for both time and content.

In the Old Days, parents believed that some kids are bad influences. They were right. Know who your kids hang around with, and steer them in the right direction. Sometimes you can't overcome an unhealthy peer group, and changing schools is less disruptive than drug addiction.

Generic prescriptions: You hardly ever read about good news in pharmaceuticals, but the truth is that I can manage most major public health problems-- including hypertension, diabetes, cholesterol, gastroesophageal reflux, depression, and arthritis-- using excellent generic medicine costing $4 per month. Don't just plunk down your insurance copay for generics. It may cost less to pay cash. And shop around! The difference in cost among pharmacies for the same drug is astounding. Truth is, the pharmaceutical industry has its back to the wall. There aren't new drugs coming down the line, and with the exception of cancer and infectious disease, we can do a pretty good job with what we've got right now.

Internet Information: Google searches for medical information have gotten so good that I usually start there. Look for reputable organizations, like the National Institutes of Heath or the Mayo Clinic.

Gastroesophageal Reflux Disease (GERD) has become an epidemic in America, and despite effective medicine for symptom relief, we're seeing an increase in esophageal cancer. Go to the Family Practice area of the website (near the newsletters) for my new approach to management.

Avoiding Infectious Disease: This is the time of year when I get lots of questions about ducking infections. Handwashing is of limited usefulness, because most germs are airborne. We ought to wear masks, like the Orientals do; but all your friends would think you have tuberculosis, and you wouldn't get invited to holiday parties. Best bet: avoid the malls and movie theaters and go to early church service; take a daily fresh air walk; get plenty of rest; and drink fluids. Just like Mom said.

Colorado Condo Rentals: In the past we have rented our Keystone condominium in the off-season at sub-market rates. It was not available last year because my oldest son and his family have been living there while he contracts a home. It will be available again this spring. Call me at home (I'm in the book) or ask me at the office for information if you are interested. It has two bedrooms and two baths and is a great location for family activities.

Clearing Wax Buildup With Ear Candles: Because I've heard so many goofy remedies over a long career, I consider myself fairly immune to balderdash. But I fell for this one, and if I've advocated this as an alternative treatment for ear wax, forgive me. Experiments have proven that the wax removed comes from the candle, not the canal. And you can accidentally get molten candle wax in your ear, which doesn't feel so hot. Nevertheless, some people find ear candling to be deeply relaxing. Help yourself.

More Medical Baloney: There's a new book out-- I missed the name on the NPR radio broadcast-- which debunks all the myths we were taught by parents and teachers, and have now passed on to our children. The one I heard involved “you only use 10% of your brain.” Ever fall for that one, and try really, really hard to use even 20% more when exams were coming up? Turns out someone pulled that out of their hat, or wherever, about a century ago. PET scan images prove that we use most of our brain most of the time, all of it some of the time, and missing any part (stroke, for instance) always causes a problem. So relax. You're not an underachiever after all. As my father taught me, “you don't have an inferiority complex-- you're really inferior.”

The Caveman Cure: This sounds hokey, too, but I'd put money on it. A psychologist and professor at K.U., Dr. Stephen Ilardi, has identified six steps to beating depression without drugs, based on returning to a more natural way of life. They include:

1. Increased sleep, preferably eight hours per night
2. Regular aerobic exercise; four vigorous sessions of 30 minutes, or four moderate sessions of 45 minutes, per week
3. Daily exposure to bright light, either natural or artificial
4. Regular social interaction with family, friends, or groups; that means restricting your internet surfing and solo TV watching
5. Omega-3 fatty acid supplement, 1000 mg per day
6. Replace rumination (stewing about your problems or the state of the world) with productive activity

Dr. Ilardi runs a 14 week program, but I would recommend doing it the rest of your life. There's a reason that depression rates have risen tenfold in the last half century. We're living stressed-out, artificial lives with no connection to our neighbors or nature, and no use for our bodies.

“Misdiagnosis Led to Man's Death” Here I go on Dr. Gott again (Gott means “God” in German, but I don't think so). It seems a husband was treated for four months for carpal tunnel syndrome before his malignant brain tumor was discovered. He had no other symptoms, such as headaches, vision loss, or paralysis in the beginning. The grieving widow urges all patients with numb hands to insist on an MRI of the head, and Dr. Gott doesn't disagree. Here's the blunt bad news: we can't afford, as a society, to do an MRI on everyone with numb hands. Or headaches. Or a change in vision. We have to be selective, judicious, and wise, or the government will take over, and we'll be waiting six months for MRIs which really should be done. That cost-effectiveness should ever influence medical decision-making bothers some people, but those same people will be outraged at the jump in their health insurance costs. We can't have it both ways. Life is full of compromises, and medicine is part of life.

Prior Authorization--a new way to torture doctors and patients: With 2008 came a new challenge. Insurors, dealing from many formularies of approved drugs, are raising the telephone time demands to get prescriptions approved. We're trying.