Dr. Iliff’s Practice Newsletter/Rant

Two Easy Ways to Help Us Provide Better Care to YOU: 1. Bring your medicine bottles to your appointment. 2. CALL for an appointment when your medicine has NO REFILLS, and BEFORE YOU ARE DOWN TO TWO PILLS! That keeps phone lines free and avoids the chance of inadvertent mistakes.

Last summer I reached my 70th birthday: Which means I have reached a milestone— I have lived my full biblical allotment of years, three score and ten. Now I’m in overtime— extra innings— stoppage time. Not that I’m planning to stop, barring mental disability (be sure and let me know). However, given this milestone, I’m going to stretch out on a limb and give some paternal advice by decade.

0-10: Play in the dirt. Insist on a dog for Christmas. Don’t wash your hands every time before stuffing food in your mouth. Don’t quarantine yourself from sick friends, as long as you don’t have an immunodeficiency syndrome. Get all your immunizations grouped in as few injections as possible, unless your parents are punishing you. Fears about combinations are baloney. He who gets the most antibodies in childhood wins. Antibodies come from antigen exposure, as frequently as possible. Oh— and books are better for your brain than screens.

11-20: This is the age where kids get fat, or if they are fat already, ought to be losing it. Your metabolism will never be higher. Weight loss will never be easier. Never eat anything after dinner. Do not overdo social media— it’s a highway to anxiety, depression, and attention deficit disorders. Spend time with friends, in person. Best way is in athletics. Best athletics involve running, a lot. And whatever you do, don’t let anyone turn you into a victim. Victimhood is a mentality, and it will make you a loser. Stand up straight with your shoulders back. For further instructions, buy a copy of Jordan Peterson’s 12 Rules. Don’t let anyone make you into a Snowflake.

21-30: Educate yourself into a career which will support a family without making you hate Monday morning. If at first you don’t succeed, try, try again. (My father reinvented his career twice.) Team sports won’t work anymore, because you’re too busy. Now is the time to establish a lifetime habit of exercise. Doesn’t matter what it is, as long as it gets your heart rate above 100 for 20 or 30 minutes several times a week. If it’s fun, so much the better. Running was never fun for me, but I learned to enjoy it. As Jack LaLanne said: I hate exercise— I just like the way it makes me feel the rest of the time. You will, too.

41-50: Uh-oh. This is where things start to go wrong. Diabetes shows up if you’re fat. Hypertension shows up if you’re not active. Cholesterol shows up no matter who you are or what you do if you picked the wrong combination of parents. Now you need pills, and if you’re male (that is, thick-headed and in denial) I’ll have to see you several times before you take those pills, unless you have erectile dysfunction, in which case you’ll fill that prescription on the way home. Remember that pornography, hypertension, diabetes, and cholesterol all contribute to ED. Keep your pipes and mind clean. Take the one mile walk test, and aim for 14 minutes (male) or 15 (female). See 31-40.

51-70: If you haven’t started exercising, it’s never too late— but you have to start slow and work your way up. Now you need cross-training, because your muscles and joints won’t take the same thing day after day. I can choose between power walking, running, swimming (May-October), mountain biking (indoors on a stand in winter), elliptical, rowing, and a Bowflex machine. All of them are free, or cheap (the rower and Bowflex are 20 years old, and my Nordic Track was 30 before I gave it away.) You need a TV to watch, music to listen to, or a book to read while you’re on a machine indoors. If you’re really overweight and/or your knees are shot, your butt needs to carry your weight; a recumbent bike might be ideal. From now on, unless you get a bad-luck disease, it’s the quality of your pipes that will determine the quality of your life— how well you move, and how well you think. Much of dementia is not Alzheimer’s, but rather little pipes in your brain finally clogging up.

71-100: How would I know? I just got here! However, I read a good book by Jeff Galloway called Run Till You’re 100, and I’m paying attention to what he advises. He’s the guy who prescribed my marathon training program 30 years ago. Check back in a decade. At this age, balance training is essential. Try standing on one foot at a time every day. Strength training (twice weekly) and aerobic activities (five times a week) are more important than ever if you want to delay geezerhood.

Lookin’ Good: The dangerous part of aging is what’s happening to our innards, but we all pay more attention to our outards, so let me give you a couple of pointers. First, it’s smoking and sunshine that make your face look like a prune when you mature. Second, all the expensive stuff that women put on their faces starting at age 29 don’t do a doggone thing except enrich the producers— although they may feel good. There is only one product— ignoring fillers, Botox, and plastic surgery— which can prevent, to some extent, the small crevices of aging skin on the face. That would be tretinoin, which you might have used as a teenager for acne. I’ll give you a prescription if you ask.

On the Other Hand: Too little sun exposure means that your vitamin D levels will be low, which means you need supplements to prevent osteoporosis; your risk of multiple sclerosis rises; and you are more likely to be depressed. So get some exercise in the sun, without sunscreen (except on your face) on a regular basis.

You Know About Placebos: Sugar pills “work” 25-40% of the time. But you may not have heard about the “nocebo effect.” If I warn you about a side effect of a drug, you are more likely to experience that symptom than if I don’t tell you about it. That’s why I don’t tell you about it, unless it’s common, and serious.

Statins and Muscle Pain: 1 out of 1000 patients get muscle pain from statins. The rest are coincidence or a “nocebo affect.”

Biggest Health News of the Year: For heart disease, stents and bypass surgery aren’t more effective than medical management in preventing deaths, although they do offer relief from angina if that is a problem. You know how I’ve been pushing statin drugs aggressively for 30 years? Why wait until you have a heart attack to keep your pipes clean?

Weight Loss Surgery: After following 13,000 obese patients for 8 years after procedures, the Cleveland Clinic found a 40% reduction in heart disease, strokes, and deaths from all causes. It’s expensive and often not covered by insurance in the U.S., but an excellent clinic in Tijuana will do it for about $4000 cash, all costs included. They’ll even pick you up at the border.

The Great Outdoors is Really Great: Danish researchers, matching their country’s cradle-to-grave medical records with satellite imagery, found a 55% reduction in adult mental health disorders if children were raised around vegetation— leafy suburbs, parks, countryside. That explains the difference between citizens in flyover states and residents of cities on the left and right coasts. The latter is my opinion, only. Bring your kids to the Iliff Commons for an extended walk.

Why Forgetfulness Might Be Good: As we age, it becomes harder to recall routine things like names of relatives, songs, books, or events. Researchers think this is probably helpful, by unclogging brain circuits in order to free up creative thinking. Lots of you come to me fearing the onset of dementia as you age. Don’t be too hard on yourself. If you set out for Lawrence and end up in Manhattan, we need to talk.

Lifespan vs. Healthspan: Medicine has done a good job of increasing lifespan. The result is fewer people dying of heart disease, and more dying of dementia. The former was quick, cheap, and easy; the latter is long, expensive, and distressing, especially for relatives. How to increase Healthspan? Could you guess? Diet and exercise.

What You Read About Medicine: Is drastically distorted by the lay press, and sometimes the medical press (which should know better). Nutritional information is over reported, and usually wrong. Exercise information is overreported, and usually right. The rest is just a minefield. Observational studies (education is a good example) are notoriously unreliable, but overreported. Placebo controlled trials are more reliable, but underreported, and if they don’t show a positive result, ignored. What to do? Short take: exercise, lose weight, don’t smoke. If you read or hear that diet drinks or black coffee cause premature death— bollocks!

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!

Germophobes, Beware: There are more bacteria ON your body, right now, than you have cells IN your body. Hand sanitizers don’t sterilize. Air dryers for your hands blast germs around the restroom. Blowing out birthday candles sends 37,000 bacteria into the icing. I could go on, but I’m just going to gross you out, and it doesn’t matter anyway. We can’t escape viruses and bacteria, and if we could, we’d be less healthy by weakening our immune systems. Wash your hands before you eat, brush your teeth, and get every immunization you can, including flu shots every year. Buy your kid a dog, and let her play in the dirt. How many germs do I run into every day? I’ve only missed one day of work because of illness in a quarter century or more. I kid you not.

Heartburn: I have information sheets with more information in the exam rooms, but here are the basics: 1. Don’t eat after dinner, or within 2 hours of bedtime. 2. If that doesn’t solve the problem, take an antacid at bedtime. 3. If you still suffer, buy a pair of GI bed blocks and put them under the head of the bed. 4. Next, try Zantac at bedtime. 5. Finally, Nexium.

Special Note About GoodRx: Good Rx has been a godsend, but pharmacy chains are catching on. Dillons now has their own “club,” as does Walgreens, and Sams/Walmart won’t take GoodRx. Still doesn’t hurt to look. Website outlines options for different places.

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. Yes, that is 6 pills 3 times a day. But it’s better than narcotics!

Printer Friendly