Retirement

There are many tasks as one prepares for retirement: where to live, take a lump sum or monthly payments from the employer, how to spend the many newly available hours. In addition to the visits to HR, the real estate agent and the financial advisor I suggest one more stop: to your physician. It’s time for a frank conversation about how long you might live and in what shape.

If you have fifty pack years of smoking, an elevated blood sugar, untreated hypertension and a cholesterol greater than 300 I have a suggestion: take the lump sum and plan to live somewhere that your spouse will be happy as a widow(er). Fit in that one really great trip since you probably won’t have a long retirement. If you have never had a colonoscopy, can’t remember the last mammogram and think that immunizations are just for kids I suggest you relocate near a major medical center. You might need a good oncology team. The crystal ball is cloudy as to how long you might live – roll the dice to determine lump sum versus payout.

If you are in good health at age 65, take all your medications as directed and follow simple guidelines for weight, exercise, preventive care and immunizations you can reasonably expect to be in good health at age 85. Plan accordingly.

The most important preparation for retirement: keeping mentally sharp. Remember: you are not retiring from, your are retiring to.

Heart Attack Beginnings

Heart attacks have beginnings – and if recognized in time, these “beginnings” can be treated before the heart is damaged. People may experience mild chest symptoms, such as pressure, burning, aching or tightness. These symptoms may come and go until finally becoming constant and severe.

 Early symptoms may include:

            Nausea
            Jaw pain
            Pain that travels down one or both arms
            Fatigue
            Shortness of breath
            Back pain
            Chest pressure, squeezing or discomfort
            Shortness of breath
            Feeling of fullness
 

85% of heart damage occurs within the first two hours of a heart attack. Knowing the subtle danger signs and acting upon them immediately could prevent heart damage. 

Heart disease causes one out of every six deaths in the United States. 

In 2011, about 785,000 Americans will have a first-time heart attack and about 470,000 will have a repeat heart attack. Every minute someone will die of a coronary event.  

Take the Early Heart Attack Care Oath.

Gluten Intolerance

Famous Philadelphia restaurateur Marc Vetri wrote about the gluten  (GI) conundrum that he faces when designing his menus. “When someone has a shrimp allergy, I don't make them something that looks and tastes like shrimp, but isn't. I make them a great meal based on foods and flavors they can actually eat. Why would they want something "shrimpy" if they don't eat it? So, when someone doesn't eat gluten, I assume they don't want something "wheaty." With so many other choices available from our kitchen, why would they want faux pasta anyway? With Italian cuisine I can make anything they want to eat. Making them a gluten-free pasta--one that's most likely going to be crumbly at best, or chewy, but bound with some sort of chemical that mimics what gluten does to pasta--is the very last thing on my mind.”

Chef Vetri prefers another definition for GI: grossly ill-informed. About 1% of the population has celiac disease and truly gets sick from gluten. “Wheat is nutritious. In its truest form, the wheat berry has so many nutrients. It has protein, fiber and minerals such as zinc, iron, magnesium and potassium. How can a grain that is a basis of human civilization be bad for us? Wheat itself is not bad for us, but how it's used is a big part of the problem. Wheat nutrition depends entirely on the form in which you eat it, and weight gain is actually inversely associated with the intake of high-fiber whole grains.” It is what we have done to wheat that is the problem: over-processing and stripping out all the nutrition.

I am a fan of eating a wide variety of food and not excluding any one group. We should strive to eat minimally processed food and consider the source. Food comes out of the ground – not wrapped in plastic from a factory. If someone has reason to think that GI is a problem, consulting a physician is appropriate. Blood tests can be helpful and the definitive diagnosis is made with a small bowel biopsy.

The original Marc Vetri post.

A discussion about food allergies and intolerances. 

Under-Exercising

Recently published research indicates that under-exercising, rather than over-eating, is at the heart of the obesity epidemic. Over the past twenty years, the number of women who report getting no exercise has jumped from 19% to more than half. Black and Mexican-American women showed the greatest decrease in exercise. Men have a four-fold increase in lack of exercise. Children with an obese sibling were more likely to be obese, and the hours of screen time are directly correlated with weight.

The greater the body mass index (BMI), the greater the risk of dying from underlying disease. People with a BMI greater than 40 are ‘robbed of 6 ½ years of expected life span.’ The most obese will die 14 years earlier (controlling for other diseases and conditions).

It doesn’t take a lot of exercise to make a big difference. One hour of exercise can counteract the effect of sitting for seven hours at the workplace. Sustained exercise for thirty minutes gives the most cardiovascular benefit, but committing to six ten minute intervals over the course of the day will put a person into a different statistical risk pool. An hour is too much? The Surgeon General recommends 30 minutes of exercise most days of the week.

 The 20% Boost Program

BMI Calculator

Empty Stomach

It’s fairly clear what “take with food” means – not withstanding the details of how much, what types, etc. Much less clear is the instruction “take on an empty stomach.”

In short, “take on an empty stomach” means having nothing to eat for at least two hours before taking the medicine and then not eating for at least thirty minutes. The medication should be taken with a full glass of water (not juice or coffee). Two examples of medications that should be taken on an empty stomach are thyroid supplements and stomach acid blockers. Most people take these medications upon awakening; by the time they have finished washing and brushing a half hour has passed. Others are too rushed in the morning – taking the medication before bed is fine as long as there has not been any after-dinner snacking.

When in doubt, consult with the pharmacist. And while you are asking: are there any medications that should be taken at different times? It’s tempting to just swallow a handful of pills all at once but there could be interactions.

How To Remove a Tick

Tick removal is easy – you might need to have some help since ticks have a way of attaching in inconvenient places. The key goal is to remove the entire live tick gently without it regurgitating potential pathogens (Lyme and worse).

I like the technique in this excellent video but rather than use tweezers I prefer tick pliers. I use these in the office with little danger of beheading the tick.

There is often redness at the site of the bite and there might be a black center that lingers for days. If the tick was removed in one piece, the black area does not contain tick fragment but is dead tissue from the tick saliva. An enlarging red area, hardness or pain merits an office visit as does a bull’s eye rash. By the way, the bull’s eye rash can be anywhere, not just the site of the bite.

Above all – no bathroom surgery! There is no reason to engage sharp implements.

Mosquito Bites

Mosquito bites are a fact of summer. The typical reaction is immediate swelling at the site of the bite followed by redness about twenty minutes later. A firm itchy nodule develops over the next 24 to 36 hours and will last about 7-10 days.

People who have never been exposed to a particular species of mosquitos don’t develop reactions to the initial bites. Subsequent bites result in the appearance of delayed local skin reactions. After repeated bites, immediate swelling occurs. With further exposure, the delayed local reactions wane and eventually disappear, although the immediate reactions persist. People who are repeatedly exposed to bites from the same species of mosquito eventually also lose their immediate reactions. The duration of each of these five different stages differs, depending on the intensity and timing of mosquito exposure.

Large local reactions to mosquito bites have been named the Skeeter Syndrome. Large local reactions develop within hours of the bite, progress over 8 to 12 hours or more, and resolve within 3 to 10 days. The area can blister and looked bruised. Severe large local reactions can be accompanied by low- grade fever and malaise. It can be difficult to differentiate between allergic inflammation caused by mosquito bites and inflammation caused by secondary bacterial infection after scratching the bites. Large local reactions typically begin within hours. Secondary bacterial infections typically begin within days.

The goal of treatment of local reactions to mosquito bites is to reduce symptoms. The first line of therapy is a non-sedating antihistamine such as certirizine (Zyrtec). A topical steroid cream can be very helpful to reduce itching and swelling; prescription products are more powerful and may be more effective. If the bite causes eye swelling that interferes with vision, lip swelling that interferes with eating or drinking or it’s difficult to use a limb, oral steroids can be used.

Prevention is the best medicine! Cover up, avoid going out at dawn and dusk and avoid wetlands, tall grass and brush. Insect repellents are appropriate for emergency use.