Doctorshealthsystems

Contrary to what you might think, life expectancy charts don’t tell you much about how long you, specifically, have to live. They predict how long you, your next-door neighbor, the president, Larry Bird, and a million other men have to live-72.4 years-but that’s only on average.

Your life span, meanwhile, is how long you actually live-and that could be anywhere from 60 to 120 years. And if you’re in much better physical shape than the average Joe your age, chances are that your life span will be higher than the life expectancy. “The life span of an individual may turn out to be very different from the life expectancy. You may die tomorrow, or you could live to be more than 100 years old,” says Dr. David Smith of Northwestern University Medical School. “At times when life spans are changing rapidly, life expectancies have little predictive value for the life span of an individual. Life expectancies are a prediction of what is to occur in the distant future yet are based on data from people who have recently died, so they are not very relevant to people living or being born today,” explains Dr. Smith. In other words, just because the chart says 72 doesn’t mean that you should schedule yourself to die then.

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Aspirin is a non-steroidal ant-inflammatory drug. It is in a class of drugs called salicylates, and works by inhibiting the release of chemicals in the body that cause pain aid inflammation. In addition to its use for acute conditions such as headache, fever or period pain, small doses of aspirin are often used to prevent heart attacks and strokes in high risk individuals. Aspirin has a blood thinning effect, and in this way may reduce the chance of a blood clot blocking a blood vessel and causing a heart attack or stroke. For this purpose aspirin is taken in a smaller dose, usually l00 mg. Popular brands include Astrix, Cartia and Cardiprin.

However, aspirin is not without potential side effects, and there are questions as to whether it really reduces the risk of heart attack and stroke at all. Possible side effects of aspirin include upset stomach, abdominal cramps, skin rash, allergic skin reactions, and it contributes to the development of leaky gut syndrome; making food allergies more likely to develop. A potential serious side effect of aspirin is gastrointestinal bleeding. According to Dr John Reckless, chairman of Heart UK, “If you put the average older patient on aspirin in one year, one person in 262 would have a significant gastrointestinal bleed in that one year”. One possible symptom of gastrointestinal bleeding is black or bloody stools. If you experience this symptom it is vital you see your doctor as soon as possible.

The Women’s Health Study, which ran for ten years found that regular use of low dose aspirin does not prevent first heart attacks in women younger than 65. The group of women who took 100 milligrams of aspirin every other day was no less likely to have a heart attack than the group taking a placebo. Each group had approximately 20, 000 participants. Most previous studies showing aspirin to reduce the risk of heart attacks and strokes were done on men. The women in the study who took aspirin had a forty percent greater chance of suffering severe gastrointestinal bleeding, and they also experienced more minor bleeding and bruising. Interestingly, the incidence of hemorrhagic stroke was greater in the women who took aspirin. This is the type of stroke caused by bleeding, not blockage due to a blood clot. This makes sense since aspirin reduces the ability of the blood to clot. Therefore, if you are a woman without significant risk of heart disease, it is not recommended you take aspirin as a preventative.

An interesting study called “The warfarin/aspirin study in heart failure” was published in the American Heart Journal. Patients with congestive heart failure are considered to be at increased risk of suffering a heart attack or stroke. This particular study involved 279 patients who were diagnosed with heart failure that required medication with diuretics. The patients were divided into three groups, aspirin therapy, warfarin therapy, and no blood thinning therapy. The results of the study showed no health benefits from aspirin or warfarin to these patients; there was no difference in deaths, or non-fatal heart attacks or strokes. Significantly more patients taking aspirin were hospitalized because of worsening heart failure. The conclusion of this study was “Antithrombotic therapy in patients with heart failure is not evidence based but commonly contributes to polypharmacy “. This means that there are no proven benefits to taking blood thinning medications in patients with heart failure, and they increase the risk of side effects from adverse drug interactions.

A daily aspirin may reduce the risk of heart attacks and strokes in some individuals. However there are much safer and healthier ways to thin your blood. The omega 3 fats found in fish oil, flaxseed oil and walnuts have a powerful blood thinning effect. All antioxidants help to thin the blood; you can obtain these through regularly consuming raw vegetable juices and garlic, and taking supplements of vitamin E. Do not take vitamin E, garlic or ginkgo biloba supplements if you are on blood thinning medication without consulting your doctor.

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One of the physician’s tasks in the sleep disorders clinic is to distinguish between patients with potential sleep apnoea and those with other complaints which adversely affect the quality of sleep. Stress related insomnia, for example, has no place in the laboratory dedicated to sleep related breathing disorders. The following case studies are fairly typical of patient histories which warrant complete evaluation of their symptoms. While they do not accurately reflect the incidence of snoring or OSA in any particular age group or sex, they have been included to demonstrate a diversity of presentations.

Case 1

A 38 year old travelling salesman had been a heavy snorer for years, aggravated to some extent by the consequences of a broken nose. He was a restless sleeper and often awoke in the morning with a headache. Daytime drowsiness was beginning to affect his attention span and driving competence which eventually led to his falling asleep while driving the car on a long business trip. He was not seriously hurt but the incident prompted investigation of his daytime sleepiness. Examination by his local doctor found him to be moderately overweight for his height and it was noted that he enjoyed five or six cans of beer at night. The doctor advised that his long working hours and drinking habits could explain the worsening symptoms and suggested he lose some weight and take time off for a holiday. Some weeks later he was involved in another near miss driving incident, prompting him to seek advice from another practitioner who referred him to a sleep disorders clinic. Overnight studies confirmed OSA and he began a trial of nasal CPAP which he tolerated well. His quality of sleep and daytime alertness were improved to the extent that he purchased his own CPAP equipment for use both at home and in motel rooms when required to sleep away from home. Weight loss and reduction of alcohol intake improved his condition slightly but not enough to eliminate his dependence on nightly CPAP, a situation he has come to accept as necessary for his wellbeing in the foreseeable future.

Comment: An example of OSA as it is most commonly seen. The patient is middle aged, male, overweight, drinks alcohol at night and has a predisposing factor to airway obstruction (a broken nose). For those who have suffered the symptoms of OSA for years, CPAP offers remarkable relief, an advantage which clearly outweighs the disadvantages and inconvenience associated with its use.

Case 2

A 32 year old woman enjoyed good health and led a particularly busy life with three young children and a part time job. She and her husband heard a discussion about snoring and OSA on a late night variety show on television which they viewed with mild amusement until some of the more serious aspects of the syndrome were aired. The wife was in fact a snorer but it rarely disturbed her husband as he was a very sound sleeper. Some months later she had reason to see her doctor on an unrelated matter and although rather embarrassed, she brought up the subject of her snoring. On examination she was found to have excessive fleshy tissue associated with the soft palate at the back of her throat, narrowing the entrance to the upper airway. There was no history of daytime breathing difficulty and no evidence of underlying disease. Referral to a sleep disorders unit confirmed her husband’s account of nocturnal snoring but there were no episodes of complete airway obstruction and none of the measurable features of OSA. Surgery to remove tissue from the throat was an option but as neither the patient nor her husband was particularly disturbed by the snoring, they chose not to intervene.

Comment: This woman’s state of health and level of physical activity makes the diagnosis of OSA extremely unlikely. The exclusion of underlying sleep disorders is reassuring for both doctor and patient and should never be considered a waste of time.

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Preventive medicine is very difficult to define and today it is no longer acceptable to think simply in terms of preventing the occurrence of specific disease processes. With current trends to whole-person health there is a more holistic approach which involves a more positive approach to preventive health care. Most people understand preventive medicine in terms of public health activities such as immunization for children, the control of fresh water supplies, safe sewage disposal, an assurance that foods and drugs are safe and the detection and control of infectious diseases. These activities are routinely and effectively carried out by local health authorities in most western countries, and we tend to take them for granted. Today we face new problems of prevention, with chronic diseases and self-induced environmental hazards causing a substantial proportion of all illnesses and deaths.

Partly because of the way that preventive medicine has grown out of public health and sanitation and partly because of the way that health care is centered on after-the-fact Procedures, preventive medicine is poorly regarded within medical and health circles and most doctors simply pay lip-service to the concept. This statement is borne out by the fact that only 4 per cent of the total US medical expenditure goes on prevention and only 1.5 per cent of all that country’s doctors are involved in full-time preventive medicine! The figures are not much better in other western countries. The influence of preventive medicine is also obstructed by the fact that it needs little that modern technology has to offer and therefore appears to be outdated and simplistic. All of this limits its appeal to those doctors and other health-care professionals who are looking for drama in medicine rather than what is best for society as a whole.

Unfortunately, prevention also tends to be handicapped in another way. Because of the difficulties already mentioned those who do go into it become so frustrated at the small resources and slow progress that they tend to become somewhat evangelical in their zeal to get things changed, so that they alienate even some potential allies. As one expert put it: ‘If there is one thing more difficult than submitting oneself to a regime, it is refraining from imposing it on other people’

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If one person on a weight-loss program is good, then one person with a partner must be better, right? In most cases, the answer is yes.

A buddy can be an encourager, a confidante, a co-conspirator, and a calming influence. She can persuade you to put on your walking shoes and go for a stroll when you’d rather be vegging out in front of the TV or pigging out at the mall. She’ll listen attentively when you confess to eating a whole bag of chocolate-chip cookies, then suggest that the two of you play a couple of sets of tennis that afternoon.

So how do you go about recruiting someone for this all-important position? Use some common sense, and trust your instincts. If you run into trouble every morning at the office when the pastry cart comes around, consider asking the person in the next cubicle to be your morale booster. If you need someone to coax you out of bed for your 6:00 A.M. workout, maybe your spouse is the weight-loss partner for you.

Nobody at home with you? Look on the Internet. There are all kinds of weight-loss chat rooms, including those connected with the Web sites of organizations like Weight Watchers and Jenny Craig.

Once you think that you’ve found your weight-loss buddy, tell that person what you expect. Are you looking for moral support? A workout partner? Somebody to talk to when the going gets rough? Make your wants and needs clear. That’s the only way that your buddy can help you.

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