Accidents
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The fastening of an automobile seatbelt is seldom considered as medical treatment. Seatbelts, interlock devices, speed limits, and stop signs are frequently considered bureaucratic nuisances which impede the freedom of the individual. However, preventive medicine includes eliminating the major causes of death and suffering. If you are between the ages of 15 and 35, the most likely cause of your death in the next year is an accident. The majority of these deaths occur on the highway. At this age, you can for the most part forget about cancer, strokes, heart attacks, and other major medical problems. Beware instead the show-off, the drunk, and the harming of your own passengers. Young Americans who die on the highway usually perish by the hand of another young American.
The Self Destruction Syndomes
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Your habits and Cigarettes, alcohol, drugs, fat, inactivity, and accidents-each of these sub-your health jects represents a form of suicide. The combined effect of these factors can take two years or more off your life expectancy. You can live longer and feel better by employing certain restraints in your life style. Absolute prohibition of activities is not required, but application of some discipline is necessary. It is important to remember that each of these health factors accumulates its effects. Thus, the longer you smoke, the longer you permit obesity, the longer you lack exercise, and the percentage of time you ignore your seatbelts affects the probability of death or disability. Stopping at any time is beneficial. Moderation rather than elimination is the crucial concept.
Be honest with yourself. Avoid excuses. “I hardly eat a thing.” “I don’t smoke the cigarettes all the way.” “I never drink before lunch time.” “I can handle it.” “The only exercise I want is bending my elbow.” “I don’t use the seat belt because I want to be able to get out of the car in case of an accident.” Such statements are excruciatingly self-revealing. It is embarrassing to hear them stated by apparently intelligent people. They demonstrate a painful lack of insight and self-knowledge.
How can you specifically approach the task of conquering a habit?
Unfortunately, only by hard work! Avoid self-deception. Write things down. Keep diaries. Make charts. Set goals. Weigh yourself frequently. (Do it at the same time of day and on the same scale.] After initially losing a desired amount of weight, set narrow limits and continue the discipline. Change eating habits, but don’t torture yourself. When possible, decrease the number of eggs, fatty meats, butter, and ice cream. Stop buying cigarettes. (Consider a pipe or cigars.] Consider beer and wine instead of hard liquor. Find a pleasurable exercise, and practice it regularly.
Decide to make permanent changes in your life. Crash diets, going “on the wagon,” and spurts of severe physical activity are all poor practice. When you exercise beyond your conditioning, you stress the heart. If your weight goes from high to low and back again like a yo-yo, it is probably more harmful to your heart and arteries than if you maintained a stable (yet higher] weight. The spree drinker passes from unconsciousness to shaking and back again with regularity. You are the patient. It is your life and your responsibility. Define for yourself those health goals which are important to you and to your family. Define a solid and workable program to approach these goals, and plan tc maintain that program for the rest of your life. You will live longer, fee: better, and have more energy for family and friends
Body Weight and Fitness
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Body Weight
Overeating is the most frequent of the American vices, costing the average citizen a year of life. Insurance company figures indicate that once you are 10 pounds over your ideal weight. each additional pound costs you a month
of your life. It is less well known that the fat individual doesn’t even get to eat significantly more than his thin counter-part. A day’s food for an average individual represents about one pound of body weight. If you fast for a day, you lose a pound of flesh. If you eat double, you gain a pound. A fat person may gain weight at a rate of 10 pounds each year; in a few years this rate of accumulation will result in an extremely obese individual. The ten extra pounds represent the intake of only ten extra days worth of food during the course of the year. Thus, in 365 days, the fat individual has eaten enough food for 375 days. This represents less than 3 percent difference between an appropriate diet and a diet leading to extreme obesity; hardly enough to increase the pleasure of eating. Some people never have a weight problem; others are less fortunate and are constantly plagued. We respect the difficulty of this condition, but it has a personal and not a medical solution.
It is not clear why fat people die sooner. We do know that they have higher blood pressure and higher blood fats. They develop hardening of the arteries at earlier ages. They have more surgical complications, particularly with abdominal operations. A very few people have glandular troubles which cause their weight problem, but, for most of us, there are no good reasons for being overweight. Excuses will not prevent the consequences. You must decide your own priorities. “Overworked and overweight” go together only if you let them. The vast majority of us must choose between calories and complications, between early diet and early demise.
FITNESS
Without exercise, the muscles get flabby. The bones become brittle. The heart muscle becomes soft; in medical terms, “cardiac reserve” is lost. The weakened heart muscle is less able to respond to the needs of stressful situations. Improved muscle tone and increased activity strengthens bones and ligaments as well as muscles.
No exact figures document the extent to which exercise is important for life-expectancy. However, most authorities believe that lack of physical activity in the United States accounts for much of our poor record in longevity. Nearly everyone newly involved in a regular exercise program feels more energetic. The ability to withstand stress such as surgery or heart attacks is directly related to the physical condition of the body. Walking, jogging, swimming, and bicycling are easy and pleasurable ways to put regular physical activity back into your life.
Drugs
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The history of humankind has shown that all drugs can be used to excess, with harmful consequences. This is known to be true for the major drugs of our society: alcohol, nicotine, and caffeine. Evidence suggests strongly that this situation holds also for the drugs of the “youth culture” and for the medically prescribed “happiness pills” of their parents.
Marijuana is a rather mild drug with a soothing effect. However, experiments indicate that large amounts of marijuana used over a long period of time may cause genetic damage in animals. Its effects on humans are not fully known. Thus while marijuana may not prove to be as harmful as alcohol, it is impossible, at present, to say what its hazards may be. Amphetamines and “speed” stimulate the body, creating an illusion of extra energy, but they almost certainly increase some forms of heart disease by constricting the small blood vessels. The “hard” drugs and narcotics (such as heroin, cocaine, morphine, demerol, and methadone) have potential for fatal overdose, and addiction invariably leads to social degeneration of the user. A large fraction of crimes, both violent and nonviolent, are related to these drugs; not because the user is directly influenced by the drug, but because money must be obtained to buy more.
The indiscriminate introduction of tranquilizers and other mood-changing agents into general medicine has been viewed with dismay by many observers, including ourselves. Many of these drugs now top the list of prescription medications; they are prescribed more frequently than any other drugs. In the language of the street, they can be divided into “uppers” and “downers.”
The “uppers” are the amphetamines. They are often prescribed in a misguided attempt to help the patient to lose weight. They do not assist in weight reduction, except temporarily, and studies attempting to demonstrate their effectiveness as weight aids have failed. They cause severe mood changes, tightening of the small arteries, and impose an extra strain on the heart. These drugs have been used in the athletic arena by trainers and players, because they create the illusion of physical prowess. Careful studies in track-and-field events, where direct measurement of performance is possible, show that they neither help nor hinder performance of events such as the hundred-yard dash or the mile, but have a tendency to impair performance in events requiring coordination, such as the hurdles and pole vault.
The “downers” are even more popular, and for even less understandable reasons. They are frequently prescribed when a patient reports “nervousness” or “anxiety.” That is, they are given for symptoms reflecting difficulty in coping. But these drugs further impair the ability to cope with the immediate environment! One standard tablet of most of these medications (such as Librium, Valium] is roughly equivalent, as a sedative, to a one ounce alcoholic drink. Most would agree that taking one or two drinks four times a day is not a successful way to solve life’s problems.
Sedatives are also given to “help” patients sleep. Insomnia is a troublesome complaint, but it is not a disease. The body’s instinct for restorative sleep is extremely powerful; when sleep is truly needed, it is demanded by the body. In many adults, four to six hours of sleep may be perfectly ample. In some individuals, a feeling of poor sleep for one night is followed by an early bedtime the second night, with periods of wakefulness that night leading to an impression of poor sleep, which stimulates an even earlier bedtime the following night. True insomnia requiring medical treatment is very rare. Sedatives are seldom necessary.
If you do use sedatives, you or your child or your neighbor may die of an overdose of them. They affect enzymes in the liver, leading to complications when other drugs are used at the same time. They may carryover into a morning hangover, and they increase the chance that your children won’t listen to you when you tell them about the evils of their drugs. Drugs are chemicals. In the bloodstream, the drugs which you swallow react with other drugs or with various chemicals already made by your body. If several drugs are being taken at once, the complexity of these interactions is such that no physician understands them. Many symptoms and side-effects may come from a medication or a combination of medications taken. It is now estimated that between 10 and 20 percent of hospital admissions are the direct result of complications of prescription drugs. The majority of drugs which cause these reactions are medically optional and are not required to maintain the health of the patient. Even common laxatives have been associated with a number of medical complications. Medications do not make you healthy so don’t look for health in a pill bottle.
Coffin Nails and The Two-Martini Lunch
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Coffin Nails and The Two-Martini Lunch
Cigarette smoking is hazardous to your health. Physicians define “pack years” as the number of packs smoked per day multiplied by the number of years you have smoked. For example, if you smoked two packs per day for five years, you are a ten pack-year smoker. For each pack-year which you smoke, your life expectancy is decreased by about one month. A heavy smoker, smoking two packs daily for 30 years, or 60 pack-years, has decreased life expectancy by 5 years.
Just as important, the last years of a cigarette smoker are not a thing of grace and beauty. Tortuous wheezing, swollen purple lips, and nearsuffocation when you’re resting mark this condition. In medical jargon, the late-stage cigarette smoker is called a “blue bloater.” Fortunately, however, present evidence suggests that the ex-cigarette smoker can improve life expectancy, although not back to that of the nonsmoker. Pipes and cigars, when not inhaled, are less hazardous and account for only a fraction of the problems of inhaled cigarette smoking.
THE TWO-MARTINI LUNCH
Alcohol is enjoyed by the great majority of individuals in the United States. In moderation, it may improve circulation, reduce blood pressure, and act as a mild and safe sedative. However, some 10 percent of our population have serious drinking problems. These people make up 20 percent of our hospitalized patients. Typically, they are ill with a variety of serious problems. Liver disease, ulcer disease, bleeding from the bowel, and vitamin deficiencies are among the most frequent. Sometimes they show signs of mental derangement, or exhibit the spectacular “delirium tremens”-the “DT’s” or “the shakes.” Alcohol is high in calories. With heavy drinking, there is a tendency to eat less nutritional food. This can result in a variety of nutritional problems as well as cirrhosis of the liver.
Treatment of the alcoholic continues to be a frustrating, often unsuccessful venture. Within the medical community, enthusiasm waxes and wanes for a wide variety of treatment methods. Nonmedical organizations, especially Alcoholics Anonymous, enjoy a success rate which at least equals that of any “medical” method. Associated organizations, such as Al Anon, which work with the families of alcoholics, also show great promise.
Your Habits and Health
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For the most part, your health is up to you, You can do much more than any physician to maintain your own good health and wellbeing. With the exception of those diseases which are prevented by immunizations, surprisingly few diseases can be prevented by the physician. On occasion, the physician may detect that you have tuberculosis, high blood pressure, or an early and treatable cancer. Diagnostic tools as the chest x-ray, the blood pressure cuff, and the Pap smear may be used to make such a diagnosis. In these instances, medical treatment is able to significantly contribute to your long-term health, Unfortunately, such instances are rare, For the majority of diseases, it makes little difference when they are recognized because there is no effective way to prevent their progression,On the other hand, the elements of health controlled by the patient affect every individual’s well-being. Your doctor’s examination of your heart will not prevent a heart attack, but you can decrease your chances of a heart attack by simple measures of diet and exercise, You don’t really need a physician to remind you that alcohol acts to destroy the liver and stomach lining or that you can avoid lung diseases if you quit smoking tar-laden cigarettes, or that fat people have more health problems than do slim ones.
If we could eliminate all unhealthy habits, what would happen? Lung cancer and emphysema would almost completely disappear, death due to all cancers would decrease by 25 percent, cirrhosis of the liver would become a rare disease; peptic ulcers, gastritis, and esophagitis (inflammation of the stomach and esophagus) would decrease in frequency; massive upper G.!. hemorrhage (bleeding from the stomach) would be unusual; pancreatitis (inflammation of the pancreas) would be rare; elevated blood pressure would be less common; atherosclerosis (hardening of the arteries) would decrease in frequency; and accidental injuries would become less frequent. Without the help of the patient, medicine can make no such promises. Let’s examine some habits that directly affect our health.