Iliff Family Practice
Dr. Iliff's Practice Newsletter/Rant - 2016
Ageism: I don't want to contribute to the epidemic of people whining about discrimination. However… here's a link to an interesting article purporting to show that old folks who have a good attitude toward aging do better. The interesting thing to me was that on a number of important measures (having good health and enough energy, financial security, supportive/loving relationships, being happy with our community) people over 65 score significantly better that younger age groups. That's not to say you just need to suck it up if you're not feeling good about life-- but there's no reason to expect that happiness goes downhill as you age. Don't give in to that myth, and don‘t let young whippersnappers lay it on you. http://www.wsj.com/articles/to-age-well-change-how-you-feel-about-aging-1445220002
Aging: Based on twin studies, researchers believe that about 20% of aging is genetic, and the rest behavioral. The best overall test of your physiologic age is the time it takes to walk one mile (see the next paragraph). Strength decreases 1% per year starting at age 40, but you can prevent that by twice-weekly strength training. Balance is a big factor; tai chi, yoga, trail walking, or simply putting on your underwear while standing on one leg at a time will prevent deterioration in that essential ability. Fitness, strength, balance-- not as sexy as the Olympic motto (faster, higher, stronger) but way, way more important-- unless you intend to spend the rest of your life in front of the TV. By the way-- regular exercise also contributes to having a good attitude (see previous paragraph). Now all you have to add is mental preservation (don't ever retire; if you do, make sure you have a meaningful reason to get out of bed every day) and spiritual development (if you don't attend a good church, start now).
Tilting at Windmills: Some of you may remember when I was on the Governor's Fitness Council several years ago and pioneered the one-mile walk test. It is now the official fitness “vital sign” of Kansas as declared by the Kansas Medical Society. I'm going to start pushing it again, because it's more important than any other test I do. In each exam room there is a card explaining how you can come to the Iliff Commons and test yourself. Just do it. Every year. Then watch…
23 1/2 Hours: Go to doctoriliff.com, and at the bottom of the page you'll see PLEASE WATCH NOW!!! in red letters. Follow those instructions carefully. Once you've mastered the secret instructions included in that decoded message, Google The Simple 7. Then take the assessment. You've already mastered one of the 7-- the most important-- after putting 23 1/2 hours into practice. Only 6 more to go! Weight Loss? Why We Get Fat by Gary Taubes. Less than $10 from Amazon.
Vitamin D for Exercise: One of the many annoying things about the aging process is that our recovery from injury is slower. And that's not just for geezers like me, either. The careers of professional athletes often end, not because they can't run as fast or jump as high, but rather because they can't heal from nagging injuries fast enough to be economically useful. Now professional sports teams have discovered that players who get dumped from training camps for injuries have lower levels of Vitamin D, and athletes of all sorts are starting to take supplements at their training tables. No, don't ask me to run a level on you. Because of sunscreens and indoor employment, we're all deficient. I'll just assure you that you need a cheap multiple vitamin (like Centrum) instead of an expensive DEXA scan. Look for something with 800 or 1,000 IUs per pill.
Muscle Building for Morons: Last April the FDA issued a warning that a supplement named Tri-Methyl Xtreme causes severe liver damage. It supposedly contained anabolic steroids. “Supposedly” is the operative word. Whenever you buy something at a health food store, whatever claim it makes on the label is a marketing tool, not a scientific fact. Furthermore, the office of New York Attorney General Eric Schneiderman found that only 21% of herbal supplements sold at certain major retailers actually had DNA from the plants advertised on the labels. Biggest suckers are body builders and high school boys. Protein supplements are largely a waste of money unless you're a vegetarian. Here's a thought: you know how male athletes are always spitting? Then buying protein drinks? Mucus is a good source of protein, and they're wasting a free, natural supplement. Just swallow it, unless you‘re expectorating tobacco juice.
The Key to Sleeping Well: I have a boatload of patients on zolpidem for sleep, so this must be a big problem in our society. Now a new report comes along claiming that we sleep better when our core temperatures are lower. The recommendation is that the house thermostat should be set at 65-67 degrees, and that we sleep under more covers, if necessary for comfort. I read 60 letters in response to this report, and the overwhelming consensus was that people sleep better in cool environments. Come to think of it, for two years in college I slept in an open-air dorm under an electric blanket with 100 other guys. Nobody complained of insomnia. The problem was trying to get them out of bed to go to class.
The Astounding Rise in Cancer Drug Prices: Cancer therapy now averages $100-150,000 per year, and the worldwide cost almost doubles the next highest class of drugs. Medicare costs are being driven into a ditch. Is this a failure of the free market system? No. There are three problems. First, we're all going to die. As we reduce cardiovascular disease we live longer, and cancer becomes a bigger problem. Second, America subsidizes research on all kinds of drugs for the rest of the world, where anti-free market practices control costs. Third, the free market doesn't apply to drug sales. In a free market, the consumer makes the decision and pays the freight. When Other Peoples' Money pays, no one has much incentive to refuse, for instance, a drug which extends life an average of 6 weeks at a cost of $80,000. Given these insoluble problems, politicians will bloviate but do nothing, because We The People don't want anything done.
Distracted Driving: All the sirens up in my neighborhood were the result of a four car accident caused by a 17 year old who drove full speed into a car trying to turn left from K-4. Now, I ask you: how can you not see a car in front of you on a highway? We all know the answer. He wasn't looking at the road. Teenage drivers have always been a hazard, because they haven't been trained by experience to see things which veteran drivers do. That, plus cranking up the 8-track and jabbering with friends. But cell phones have put us in a whole new era of danger. Are you the parent of a teenage driver? Why not consider doing random text testing? Note what time he or she was on the road, grab the cell phone, and see if any calls or texts were made during that time span. Violations might result in confiscation for a month. I know, that might cause suicidal protestation, since it represents the end of life as teenagers know it-- but not the kind of life which is irretrievable. I'm just sayin‘…
More for Germaphobes to Contemplate: We've known for a long time that babies born by C-section are more prone to infections, celiac disease, type 1 diabetes, and more derangements of the immune system. The problem seems to be that they don't get the bacteria from the vagina on their way into the world, and those germs are beneficial to immune development. So now there's a new experiment going on. Before a C-section, the investigators swab out the vagina with a sponge, and then swab the baby's face and mouth with the sponge after delivery. Stay tuned. Don't try this at home.
Fiber and Breast Cancer: Up to now, no one has figured out a way to get teenage girls to eat their veggies. Recently a huge retrospective study published in Pediatrics revealed that women who self-reported eating more fiber in childhood (before fast food eliminated fruits and vegetables from the adolescent diet) have a much lower incidence of breast cancer. And, miracle of miracles, this information DOES seem to have an impact on teenage dietary habits. Spread the word.
Help From Apps: Serious about diet and exercise? MyFitnessPal. Trouble remembering to take your pills? MedicineCabinet. Shopping with cash for the cheapest drugs at local pharmacies? GoodRx. Help with training plans? RunKeeper
Get Real: “Mountain Oak is a charter school that offers an education inspired by Waldorf, a progressive model that encourages exploration of the natural world and rejects the use of technology in the classroom and even in the home. When I ask later in the afternoon about the ditch digging, eighth-grade teacher Jeffrey Holmes smiles. ‘Oh, they're playing Minecraft,‘ he says, referring to the popular online game. Last year ‘they had a whole system of ditches and they were bartering with rocks too.'” This is the world my wife and I grew up in. It's gone forever. Believe me, I wouldn't trade my word processor for pencil and paper. But parents and grandparents need to limit screen time to two hours a day, or less. That's the word from the American Academy of Pediatrics, and I'm in complete agreement. Teachers at Mountain Oak say they can immediately tell which kids are using devices at home: “We see it in their behavioral problems, their ability to reason, their cognitive skills, even their ability to communicate with other people.” And here's the kicker: this model of education is popular with wealthy Silicon Valley parents.
Statins and Diabetes: As many of you know, I've been a big fan of statins (Lipitor, Zocor, etc.) to control high cholesterol for 30 years. There have been hints that statins predispose to diabetes, and a large, well-controlled study recently confirmed this. People who took statins were 17% more likely to develop diabetes. There were also 30% less likely to die. So there you have it. Name your poison. Give me diabetes, or give me death (with apologies to Patrick Henry).
Low T: I rarely watch television ads, having learned the joys of digital video recording, but every now and then I catch a glimpse of what audiences are subjected to. Here's a general rule: anything you see advertised on TV is overpriced, and “treatments” for low testosterone are a good example. Are you fatigued? Then start an exercise program. Low libido? If you're addicted to pornography and have depleted your brain dopamine by over-stimulation, it takes six weeks of abstinence to get normal. Otherwise, we'll draw two morning testosterone levels, and if you're really low, I'm not going to give you Androgel for $3000 per year. You'll get clomiphene for $150 per year, which will fool your brain into sending out a hormone to kick your testicles back into action. But you won't see that advertised.
Pain Relief Without Narcotics: Start with extended-release acetaminophen 650 mg (Tylenol Arthritis), 2 pills every 8 hours. Then, as long as you aren't diabetic or suffering kidney disease, add ibuprofen 200 mg (Advil), 3 pills every 8 hours. You can take both drugs at the same time. That will handle almost all acute and chronic pain. Next stop: tramadol 50 mg (prescription) every 8 hours