Thursday, August 26, 2010

Lauren's Straight Talk about Health, part two

The second high risk behavior I want to share with you is being overweight. Being overweight sucks. I'm not sure which sucks more. Being overweight or smoking. They might suck equally. If you are overweight AND you smoke, well, you've got issues. I'll be seeing you one day. The thing is, weight is a continuum. Smoking is an all or nothing thing. If you quit, you have to quit completely and never do it again. Eating, now that's another story. You can't give up food. Its the worst addiction to have if you think about it, because its the only thing that you can't go cold turkey on. You have to eat. You have to learn how to do it in moderation. No addiction expert would ever advise you to try just smoking in moderation. You have to go cold turkey or you won't succeed.
And if you're one of those people who thinks that their weight is not related to a food addiction...please. Tell someone else about your bad genes, thyroid issues and glandular things. Every reputable source I have ever found is pretty clear cut on this. Being overweight is about one thing and one thing only. Calories consumed exceed calories expended. Plain and simple. There is one and only one weight loss approach that is effective. I'll even tell you it for free. This is not a difficult concept. Close mouth, move ass. There is no colon cleanse, detox regiman, secret herb from the jungles of the African Sahara (hehe) special combination of foods or mantra that will alter this cold hard fact.
I am not trying to say that overweight people are just fatasses with no self control. There ARE a plethora of different situations that CAUSE people to consume more calories than they expend. Psychological issues, mobility issues that limit ones ability to expend calories and yes, even glandular issues. Those issues are only exacerbated by excess weight though, so if you don't deal with the underlying problem and get on your way to a healthier weight than you will only make those problems worse. Using it as an excuse to justify excess weight is a really bad idea.
I have seen people die for no other reason than an inability to control their weight. Diabetes, high blood pressure, high cholesterol, poor circulation, chronic pain, degenerative joint disease, anxiety, all manner of psychological disorders (if you can't get a handle on your issues with eating, then why would you think you could manage any of the other stressors in your life very well?) nonhealing wounds and skin breakdown, oh my! Granted, I know that not everyone who struggles with their weight is morbidly obese, but if you aren't headed the correct way, towards a more healthy weight, then you're most likely headed in the other direction which is morbid obesity; few people just get somewhat overweight and then stay there.
Here's the thing. I love fat people! I am not a fat phobe. I have had excellent relationships with some of my fattest patients. Also, I have some food issues myself. I have found myself elbows deep in a carton of Chubby Hubby ice cream at 2 oclock in the morning and wondered whether it would be totally insane of me to go to the store for some more because one pint was surely not going to be enough. I comfort myself with food. If I had anything to be depressed about (which I don't) I would probably weigh a metric ton. I'm writing this blog as much for myself as anyone out there. I would never ridicule overweight people gratuitously. I would never ridicule them at all.
The problem is that a lot of people who ARE overweight have not been counseled by anyone to lose weight BECAUSE it is such a sensitive issue. Your average doctor will sit there all say talking about your high blood pressure reading and the cold hard facts of what that means medically, but shys completely away from dealing with the numbers on the scale because its uncomfortable and embarassing to talk about weight. Plus, you can't look your doctor up and down and throw his own blood pressure numbers back at him, but he's secretly afraid that you WILL say something about his weight if he starts talking to you about yours.
As a society, we feel completely comfortable with criticizing and chiding those who choose to smoke. However, if we mention someone's weight, as in, "You really should think about losing some weight Deloris. Its gonna kill you someday you know," that's totally unacceptable social behavior. Why? Why is one ok and not the other? I'm not advocating that we start or continue giving anyone a hard time, whether smokers or overweight people. I'm just pointing out an interesting disparity. I happen to have one of the good doctors. One who isn't afraid to throw it out there. At 30 my cholesterol is a smidge above normal, my resting blood sugar is a trifle troubling and my abdominal circumerference is one eensy weensy inch beyond the cutoff for being high risk for heart disease. She flat out told me; "Lauren, you either lose 5 pounds and stay at that weight or don't and you'll be a diabetic in 10 or 15 years." I wouldn't appreciate hearing that information from, say, my hairdresser, but I kind of appreciated her candor since she is the person I pay to give me unpleasant facts such as that. I lost the 5 pounds and I'm doing everything I can to keep it off. I do NOT want to be a diabetic. If you can't count on your doctor to drop little bombs on you like that, then fire your doctor and find one who will.
So. in closing, don't get fat. If You ARE fat already, lose weight. If you are impossibly skinny and you can eat whatever you want to and not gain weight, you suck. Go back to your home planet.

Lauren's Straight Talk about Health, part one

OK, I'm not a public health expert. Nor do I work for the CDC. I am just a wee humble ICU nurse who has spent the past 7 years (amongst other things) taking care of the sick and dying amongst our society. And in that time, I have noticed a few things. For lack of any better inspiration on what to write about on my blog I'm going to do a straight talk on health series. If you have delicate feelings, please avert your eyes and back away from the computer screen. If you appreciate getting your health information in CNN formatted, Dr. Sanjay Gupta type sound bite form, this won't be for you. I tend to ramble, expelling lots of unnecessary information along the way. Self editing is not my strong suit.
Let's assume that you, like most people out there, want to live a long and healthy life. Let's assume that you have at least a smidgen of interest in that. From the front lines, I can tell you what is making people sick these days. I can tell you what causes people to die in their 60's. Now, I know that there are a lot of people who will scoff and say, "What do I want to live to be OLD for? I'd rather live my life and enjoy it! Who wants to live to be a hundred anyway?"
First of all, I do. And I can tell you that I have seen a lot of really old people who are in their 80's and 90's who come in to my ICU and say, "I don't want to be rescusitated. I've had a good life. I'm at peace no matter what happens." I have seen a lot of people in their 50's and 60's who come in and are really sick and I haven't met a single one yet who says, "Well, I didn't really want to be old anyway. I'm ready to go." Funny thing about that. Old people = at peace and ready to die. Middle aged people = bitter, sad and not ready to say goodbye to their loved ones yet. I love taking care of the really old ones. Sometimes we even send them home for another 5 or 10 years. The 50 and 60 year old sad and bitter ones? Not so much fun.
So if you don't want to be 50 or 60 and sitting in an ICU bed waiting for death to take you, you might want to pay attention to what I have to say. Because I have just about narrowed it down to a few risky behaviors that put you at extremely high risk for being one of my patients. I haven't ever actually crunched the numbers but I'm pretty sure about 90% of the people I take care of fall into one of three categories. They smoke. They are overweight. They drink more alcohol than what would be considered moderate. These three things just about sum up the modifiable risk factors (read: you can control and change them) that cause a vast majority of the many acute illnesses that bring people into the ICU and often kill them.
I'm going to address the first of these today. In my opinion, one of the top things you can do to ensure that you will not live long enough to collect social security...
Smoking. Duh! Are you an idiot? Remember when we were kids and they used to tell us that if we smoke we might die of (gasp!) lung cancer? Well, "they" didn't know what they were talking about. If you smoke and you get lung cancer, that sucks. Yeah. Its a pretty sure likelihood that you will die. They might try to save you by cutting out part or all of your lung, putting toxic chemicals into your body to try and kill the cancer (without killing you...a tricky task), and then see how your other lung, the one you've also been inhaling poisenous gas through for years, handles it. However, its highly likely that you will just die. Case closed. End of story.
The real horror story, though, is not what MIGHT happen to you in the form of cancer. The really tough stuff is the chronic obstructive pulmonary disease that you are virtually guaranteed to develop in your middle years as a result of smoking. If you smoke, you WILL have COPD. Count on it. What is COPD, you ask? Its what causes smokers to slowly lose any and all tolerance for physical activity as they get older, until they end up living on the couch, hooked up to oxygen, still smoking (thereby putting everyone in their near vacinity at risk for dying of an explosion when their tank catches fire)and waiting to go into respiratory failure. This is no sudden death. COPD kills you slowly, over 10 or 20 years, in a gradually increasing web of personal misery culminating in a horrifying death of, basically, strangulation. I have seen people in their 50's and 60's who live on the couch. They come in to the hospital in respiratory failure, still reeking of cigerette smoke and we try to stabilize them. Sometimes we succeed with breathing treatments and such. Other times we have to intubate them and put them on a breathing machine. We keep them intubated for several days, do the best we can to fix whatever underlying thing caused them to go over the edge (whether it be pneumonia or just an exacerbation of their COPD)and if they are lucky, we extubate them a few days later. The first thing a lot of them ask for is a cigerette. Sometimes we aren't able to stabilize them for a long time and then we have to send them off for a tracheostomy. That's when they cut a hole in your neck for you to breathe through. That we we can easily put you back on the breathing machine if it becomes necessary. There is one certain thing: And remember, I have seen this happen many times and followed the same people who come in again and again with the same issue. Eventually, these people die. There is a downwardly spiraling continuum of what happens in every single case. At first, its just coming in to the ER with CBS (can't breathe syndrome) and getting tanked up with some breathing treatments and nebulizers. This tends to become normal to them after awhile, to the point that they know the EMS guys who come to their houses to get them when they dial 911 and can just about tell them exactly what to do to fix them. Then, they might get admitted to the floor with mild pneumonia or emphysema a few times. Eventually they will be in total respiratory failure and have to be intubated. If they survive that a time or two, they end up trached. The family will eventually have to make the decision whether they want to intubate AGAIN. If they make that decision, then awhile later they will have to make the decision to pull the plug. Because it doesn't get better at that point. It is a chronically degenerative disease, meaning it gets worse over time, not better. And if you don't smoke, it is virtually guaranteed not to happen to you. If you do smoke, it is virtually guaranteed to happen to you.
That's if your heart doesn't give out first. Because did I mention that smoking also causes hardening of all your blood vessels, putting you at very high risk of heart attacks, pulmonary embolisms and strokes? I frequently see people in their
30's and 40's who come in with their very first heart attack (aww, isn't that cute?) and the only risk factor they have is smoking. They look at me like I'm nuts when I tell them that it was smoking that caused their heart attack. How come their high school health teacher didn't mention that? They thought they only had to worry about lung cancer!
So if you don't want to die young or spend your final ten years or so in and out of the hospital, QUIT SMOKING knucklehead! It doesn't get any easier the longer you wait. And even if you do smoke and you've begun to experience the downward spiral that is COPD, quitting smoking will vastly improve your quality of life. Even though you may not be able to totally reverse the disease, quitting will most likely buy you some more time here on this Earth. I have heard every excuse known to man for why people smoke. You can blame it on whomever you want, but in the end, its you who will die because of it. In my opinion, the medical community doesn't do enough to stress the importance of quitting smoking. The pharmaceutical industry has some really cool medications they want to put you on to help you "manage" your COPD. Your primary doctor will eventually refer you to a pulmonologist to help you "manage" your disease. At the hospital we have a really helpful handout that we give to you to advise you of the benefits of quitting. The long and the short of it is that the only reasonable treatment is to stop immediately and hope to God that you haven't done any irreversible damage.
Those of you who don't smoke are probably nodding your heads smugly, saying, that's right! Dumbass smokers! Your all gonna die! Well, we're not through yet. We have a few steps to go before you can decide if you're likely to live a long and healthy life. And remember, I'm only talking about modifiable risk factors here. You can't change your genes. If you have bad genes, then you REALLY better listen, because you need to do everything you can to not make matters worse. Be sure to stop back in a few days to read my scintillating thoughts on being overweight and what that means for your health.