Iliff Family Practice
Dr. Iliff's Practice Newsletter/Rant - 2024
Tiresome Disclaimer, Modified: Of late it has become my habit to start out assuring you that rumors of my retirement have been due to trolling by my competitors.However, in my 75th year of life and 50th year of medical practice, it behooves me to recognize that my chances of stroking or accidentally discovering pancreatic cancer are higher than when I was 24. Although I am seemingly in excellent physical and mental health, that's just an actuarial reality. Therefore I will begin the process of grooming a handpicked successor, should one appear. It wouldn't take more than a year to find such a candidate graduating from a residency if I put my mind to it, but I'm not that eager-yet. Should I experience a sudden incapacity or demise, KU-St. Francis will step in to care for my practice, as they did for Dr. Laccheo in the past. Meanwhile, back to work.
Before You Read the Next Rant: Many of you have heard me say, probably more than once, that if you had to choose between being physically fit or cosmetically slender, choose fit. It is WAY more important for both healthspan and lifespan. No change in advice: 150 minutes of moderate exercise per week, preferably outdoors. More later.
Speaking of Healthspan: If that's a term I'm seeing more and more in the medical literature, I'll bet it's popping up in what you read, too. And it's a good thing. Almost all of us want to live well more than live long. We want to be functional, useful, and capable of enjoyable activities. That is my constant objective in serving as your physician. If you think I'm just being annoying, well... that's always a possibility.
But- if you're interested in simply prolonging your life until you look like a mummy, longevity clinics are popping up for entry fees up to $100,000. There are all sorts of marginally useful biological/DNA tests available, too, as well as total body MRI scans for $2500. All the rage in Hollywood, among deep-thinking A-listers. Personally, if something could have made me age like Tom Cruise, I might have been tempted.
Oprah Throws in the Towel: "I realized I 'd been blaming myself all these years for being overweight, and I have a predisposition that no amount of willpower is going to control," said Ms. Winfrey. The billionairess has certainly had experience with weight loss that few of us can claim, including the use of a private chef and dedicated personal trainer. After participating in a panel which "disabused her of the myth that weight hinges solely on a person 's self-control" she started on one of the GLP-1 agonists (like Ozempic) which delays gastric emptying to reduce the desire to eat. Many of you have heard this lecture from me before: it is not a myth that weight loss hinges on self-control. Obesity is a condition, not a disease.It's not due to menopause, bad genes, or hypothyroidism. You eat too much, and/or exercise too little. But Oprah, and the entire medical establishment, is now trying to make you feel better by telling you a lie- and I don't think lying to the public is a good strategy. Look- there was only one fat person in my class of around 650 at Shawnee Mission East in 1967, but we didn't have McDonalds or Pizza Hut, we ran around the neighborhood all day, mother made us three meals a day (including one in our lunchbox, which has become extinct for children and fathers), and we were too poor to have junk food sitting around the house at all hours. The temptations to overeat these days are enormous, so I'm not shaming anyone. I'm just telling you the truth. You can eat less and exercise more, you can take drugs like Ozempic- or, for that matter, methamphetamines (your body will be trim, but your teeth won't look so good). We are dealing with a pandemic of affluenza. While we're at it, thumbs-down the community organizers and nonprofit grifters in suits who tell you that the problem is "food deserts" or poverty or processed food. I grew up on Frosted Flakes, bologna sandwiches, and fried chicken, as did my classmates in Prairie Village.
On the Other Hand: There are drugs even more effective than Mounjaro and Ozempic in the pipeline. When and if they are approved, I will no longer refuse weight loss therapy in order to protect the supply lines for my diabetics. I predict there will come a day when obesity will be controlled by prescriptions, like blood pressure and cholesterol. You'll still need to exercise, but with fewer joint replacements.
On the Other Other Hand: Here's a backhand from the New York Times against the appetite aversion caused by these drugs: For some people, "once you've been on this for a year or two," he said, "life is so miserably boring that you can't stand it any longer and you have to go back to your old life." Or as a patient, Aishah Simone Smith, put it: "My life needs more pleasures, not fewer. Eating adds drama, fun, energy, to my otherwise listless and dysthymic experience. When I lost my longing for food, my life lost meaning." Well, if you put it that way, who am I to deprive life of meaning? Still, as a radical alternative, there's your local church. For me, Jesus provides the meaning.
Here We Go Again on the Hygiene Hypothesis: Evidence continues to accumulate that exposure in infancy and early childhood to microbes- that is, germs- contributes to a healthy microbiome and reduces the incidence of infections, allergies, and autoimmune diseases like juvenile onset diabetes and rheumatoid arthritis later in life. Want to prevent peanut allergy? Give the kid peanut butter early on. Get a puppy and sleep with it. Play in the dirt. Apologies to any hypochondriacs or fastidious housepersons out there.
Losing Our Mind: Dementia is one of the greatest fears of everyone over 40. As with so many other conditions, your exercise capacity is the most important factor in preserving cognitive function. Controlling blood pressure, blood sugar, and cholesterol is next. After that come the mind games. Chess, poker, bridge, crossword puzzles, Clue- all of these exercise the memory. When you go on a walk, don't multitask- concentrate on what you're seeing and hearing. Try to remember your grocery list or driving directions. Fiction requires more cognitive challenge than nonfiction; you have to remember who so-and-so was from 56 pages back. But any reading is better than just watching TV or surfing the web.
Emotional Health of Children: In 2021, 44% of high school students said they felt persistently sad or hopeless. Suicides continue to rise- and are an overwhelmingly greater problem than random school shootings. Meanwhile, only 25% of children ate seven or more family meals together each week. Guess what correlates with mental health? Bingo. It's family interaction. What's gone wrong with society since I grew up in Prairie Village? You got it. I realize the seduction of kids' activities. We all want them to be active and engaged, but spontaneous, kid-created neighborhood games have gone the way of the dodo. That was happening even when I was raising my kids, and one of the objectives when we started Cair Paravel School was to limit the impact of sports and activities on family togetherness. However you do it, do it. And for God's sake, don't let the kids have their cell phones open at dinner.
The 2024 Pleasure Mafia Report: Processed meat, like sliced ham, bacon, and sausage, has been linked to heart disease, diabetes, high blood pressure, dementia, erectile dysfunction, toenail fungus, skin tags, and bad breath. Well, I'm exaggerating a little, but not much. I grew up on peanut butter and jelly sandwiches in my lunch box, and I lived to confess it. Look- ignore this stuff in the lay press. At least they seemed to lay off coffee this year. They have to capture eyeballs with something. If it weren't for bacon and sausage, I wouldn't have any protein for breakfast, and that's what keeps me out of the cookies at 10 a.m. Did you hear that the World Health Organization is worried that aspartame causes cancer? Oh, that rascally WHO. They're no fun at all. But they were all over the source of the Covid epidemic. (And, it now seems, the Chinese double-billed us for Covid creation. We paid, too.)
Tongue-tie Release: is the latest weirdism in dentistry and pediatrics. The need for it is rare, really.
Only Political Comment: When German Chancellor Otto Von Bismarck proposed the first retirement benefit in 1881, he set it at 70 years- when the average lifespan was 40. When FDR did the same for American, only 60% of the population lived to 65, Is it any wonder that Social Security and Medicare are headed for bankruptcy? Glad I'm not a politician, because I'd have to dive into that Third Rail, which would guarantee that I'd be a one-termer. It appears that there are no statespersons left in Washington, but get ready- we're going to hit the wall. We could have solved this problem by indexing retirement benefits to lifespan or partial privatization twenty years ago, but hey- party on, Dude!
Tortoise and Hare, Round Two: It looks like interval training (short bursts of high intensity exercise alternating with rest) gives more benefit in less time than long stretches of moderate intensity. I'm all for efficiency, so this is good news. Interval training has long been part of training for endurance athletes, but for the rest of us noncompetitors, this is wonderful. The last time I ran three miles continuously, my knees hurt for days. Now I run 150 paces and walk 100, repeated at least 10 times, once or twice a week. I walk the dogs a couple of miles every day without getting short of wind, and use the elliptical, rower, or swim 20 minutes or so three times a week. That's at least double the research-tested recommendation for maximal health, and it doesn't hurt as much as it used to.
Q tips were invented by Leo Gerstenzang in 1923 when he saw his wife swirling cotton onto toothpicks to clean crevices in their baby. Everyone knows how useful they are for cleaning or makeup, and every package specifically warns that they should not be inserted in the ear canal. Au contraire, I claim. Unless you already have a lump of wax in your canal, Q-tips are the perfect instrument for cleaning or lubrication. I've done that for over 60 years without a problem. The original Q-tips are boosting profits by cutting down cotton at the tip, so I'm changing to Amazon's "double tipped" cotton swabs. Never get the plastic stick variety. The cotton comes off too easily.
Cheap Trick for Colds, Sinusitis, Allergic Rhinitis, and Snoring: Twice each day, squirt each nostril with a nasal steroid (fluticasone, sold as Flonase over the counter, or others by prescription) and a nasal decongestant (oxymetazolone, sold as Afrin and many other trade names). Oxymetazolone will say not to use it more than 3 days because of addiction, but that doesn 't apply with a steroid spray at the same time. You can also use the same combination at bedtime if you snore because of nasal stuffiness. I 've done it for years.
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, or naproxen 220 mg 2 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, including the tramadol that is 5 or 6 pills 3 times a day. But it 's better than narcotics! If you have muscle spasms, I might throw in carisoprodol 350 mg every 8 hours. Don't worry-- all these medicines play well together, and are cheap and effective.