You Should Know How to Do This: Be Healthy

For the last six or so weeks, I’ve been obsessed– obsessed– with my health (“to the surprise of absolutely no one,” says my roommate. “I bet you also love to read advice columns.” He’s on to me.). I’ve been thinking about it constantly. I’ve been blessed to have great health, but preventative medicine is the best medicine, or so I heard on NPR. There’s so much conflicting information out there and it makes me feel like I may as well keep doing what I’m doing, because hey, that’s not going badly, or at least not yet. I consulted with a variety of friends in the medical field about how to take care of myself– a pharmacist, someone who works in insurance, two nurses, a personal trainer, a nutritionist, a surgeon, a physical therapist, a medical journalist, and three doctors– and got a ton of information. It inspired me to take stock of my habits and practices, get my family’s complete medical records, and do some research about what options are available for me for care. It’s helping me to sleep better at night, and so I wanted to pass that along to you.

You KNOW she flosses like nine times a day.
You KNOW she flosses like nine times a day.

There’s stuff you can control, stuff you can’t control, and stuff we don’t know one way or the other, but hey, doesn’t hurt to have all the information, right? The basic questions I asked everyone were these:

  1. What’s your dream patient doing for his or her health on the day to day?
  2. What is something people don’t think about doing but would make a measurable difference in their lives?
  3. What’s something that people are doing that is either useless or harmful but they think is really good for them?
  4. If you could tell all your patients one thing, what would it be?

Most of the providers I talked with said they wished their patients would be honest, follow their directions, take medication according to the instructions, exercise, eat more carefully, and make regular appointments to check in. That seems like a pretty low bar to clear, so I was feeling good about my life choices. The advice for the second two questions varied wildly from “flossing” to “throw your vitamins away” to “eat local honey to combat allergies.” They had all reached consensus about most stuff– make sure you sleep enough, etc.– but couldn’t determine what the dumbest thing people were doing was, or the thing that they consistently watched people overlook.  A nurse I asked said you should keep track of how many times a day you pee– apparently seven is about right, and less could mean you’re dehydrated. My trainer, Becky, thinks functional fitness and stretching get overlooked too often, but my pharmacist said that you should always say “yes” when they ask if you want to talk with them, since they can tell you about side effects, interactions, and timing of doses.  Assuming you can’t afford treatment, picking your doctor based on internet ratings, and asking specifically for brand-name drugs at the doctor’s office also got mentioned. That seemed to break down more along the lines of what they see the most, which makes sense. The fourth question turned out to be dumb, because they all said, “I would tell them to stop smoking yesterday.” In case you did not do D.A.R.E. and also do not gossip with your friends about cute surgeon general nominees, it turns out smoking is really bad for you. One of these nice providers happens to be my closest friend, so she was required to talk with me about this. Hand to God, I actually made her a list delineating all my health-related choices and habits and made her go through all of them point by point to tell me if I was doing my life right. She is a saint, but then again, she can’t get dressed without calling me, so I think it evens out. Becca took some time out of her busy day to answer some questions that a lot of my friends and family have, but don’t remember to ask at their once-a-year trip to their GP. Her answers are in BOLD TYPE because they’re more important, but I guess you can also read my questions.

Hi, Becca! Obviously we’ve known each other for awhile, but could you tell the  Chronderlust readers a little bit about your background?
I’m in my 4th year (out of 5 – almost there!) in a joint MD-MPH program at Yale, and my personal research interest is in chronic disease and medication adherence. I also have a bachelor’s degree in the history of science from Harvard, and I come from a family of physicians.
So, this blog post stems from an ongoing conversation you and I have had about best practices, preventative medicine, and sound, research-backed advice that is both doable and practical. Can you tell me a little about how to start making a plan for a healthy life?
When we talk about risk factors for the development of disease, we often break it down into modifiable and non-modifiable risk factors. So if the risk relates to gender (for example, women are far more likely to get breast cancer than men), then there’s nothing we can really do to change that. But for most of the big diseases that we worry about today, there are modifiable risk factors. There are changes that you can make in your lifestyle practices to reduce your risk of disease.
What would you say are the top modifiable risk factors?
The top 5 causes of death in the US are heart disease, cancer (with lung cancer causing the most deaths), lower respiratory disease (like COPD), stroke, and accidents. There are a few things you can do that can reduce your risk of developing many of these conditions at once. Not smoking is #1, 2, and 3 on my list. Even if you’ve smoked in the past, once you stop smoking, your risk of lung cancer, heart disease, COPD, and stroke start decreasing; it’s never too late to quit smoking! And if you’ve never smoked, don’t start.
Oh, darn! I’ve been meaning to start. I guess that’s a definitive no from you.
Regular exercise is really important as well, and this doesn’t have to be as extreme as you might think. This can reduce your risk of heart disease, stroke, and diabetes (which is out of the top 5 but, as we all probably know, still really prevalent and serious). The current recommendations are 150 minutes a week of moderate-intense exercise or 75 minutes a week of vigorous exercise. Moderately intense can be something like walking or light jogging, going on the elliptical; that sort of thing. Vigorous exercise is jogging or running, lap swimming, or hardcore sports, that sort of thing. 
Wow, that’s so much more doable than people think it is. No need to like, do 12 days of bikram and run a marathon each week.
Right! I know that it can be hard to fit into your schedule, but if you can find half an hour to go for a run three times a week, that’s technically all they recommend. If something moderate is more your speed, it’s still just half an hour five times a week.
Even walking to work a couple times a week cuts your risks.
Exactly. Speaking of work, they’ve found that even if you get the recommended amount of exercise, if you have sedentary lifestyle (as most of us with desk-jobs tend to have) you still have increased risk of developing these diseases and of dying from them. So anything you can do to break up the time you spend sitting (like getting a standing desk, or even just walking around the office once an hour) can improve your health. 
Easy peasy.  I feel like I should take this opportunity to tell you that I do these super embarrassing exercises at my desk/office throughout the day because I love to really mark myself as a weirdo, and the mayor’s fan club coffee mug isn’t enough. So let’s talk about family medical records, which was something I hadn’t ever thought about before you mentioned them to me last week. Why are they important?
Well this is what comes into play with the non-modifiable risk factors. For many diseases, especially cancers, the biggest risk factor is if you have a first-degree relative (parent, sibling, or child) who had the disease.
Okay, so they can give you a guide for what to be on the lookout for.
Exactly. Along those lines, the recommended screenings for cancers like colon cancer and breast cancer can differ based on your family history, so it’s important for your primary care doctor to know about this.
This form is a good one for the basics, but some of the information is pretty personal. Can you give us some pointers for how to talk to our families about health histories? This is really scary to me, and I’m not sure how to approach it. One one hand, I don’t want to discuss something people would rather forget, but on the other, I don’t want to be blindsided by uterine cancer or a debilitating stroke when there are tests I should have gotten or lifestyle tweaks I could have made to prevent them.
I think the big thing is to identify which person in your family is going to know the most about this. If all of the people you need to talk to are still alive, it obviously is much easier, but that’s often not the case. So if you know that your uncle was the one who was really around helping your grandparents with their health decisions before they passed away, he might be the best one to talk to. I think the way to present it is that you’re trying to figure out what diseases run in the family so that we can all know what we’re at risk for. And then offer to share what you find with everyone at the end so that it doesn’t have to be done multiple times. There are obviously some diseases that have a lot of associated stigma (mental illness and sexually transmitted infections come to mind) but if you just keep presenting it as a way to keep everyone healthier in the future, hopefully people will be open about their own diagnoses and the diagnoses of others.
Right, okay, that makes perfect sense. The one that comes to mind specifically is asking about miscarriages or stillbirths, since those are so traumatic, or mental illness, since that carries an undeserved stigma for some. Is there a particularly delicate way to find out about that? Obviously all families are different, but any pointers would be great.
My experience with this is a little different because I’ve usually asked about sensitive topics as a medical provider rather than someone who’s involved in a person’s daily life. But one thing we try to do is to normalize whatever we’re asking about. Before taking a sexual history, for example, we often say “these are questions that I ask all of my patients because they can affect what diseases you’re at risk for.” So a family-specific corollary to that might be “Some of the stuff I’m going to ask about might be uncomfortable, but I’m asking everyone about it so we can have the most reliable information about our family’s risks.” Another option might be to give people a sheet to fill out rather than asking them in person, because sometimes people are more likely to be honest when they don’t have to look at you and tell you directly.
How should I pick my doctor? Any suggestions for what to do if you feel like a doctor isn’t understanding your concerns or doesn’t care about them?
In terms of picking a doctor, really my only advice is find someone you feel comfortable with and it feels like they listen to you and you listen to them. I think most of the online rating systems aren’t that reliable, so I wouldn’t necessarily use that as a benchmark. If you’re moving or switching doctors, get your current doctor to give you a print out of your most recent labs and see if they can write a transfer of care note that kind of summarizes what happened during your time with them. It can really be helpful for your new physician. In terms of your doctor not listening or understanding, I’ve had some doctors recently who I felt weren’t connecting with me and that’s a really tough situation. In that situation, I switched off between visits seeing the doctor and a nurse practitioner, who I really liked a lot. So it might be useful to see if there are nurse practitioners or PAs at your physician’s office that you could see in addition to your doctor. I think that the medical profession is actually really bad at acknowledging that it’s hard to make lifestyle changes when the things we need to change are so wrapped up in other aspects of our lives. We all make choices that are bad for our health at certain points of our lives, even doctors. But as much as I’d like to change the medical training system and get doctors to realize how hard it is to follow their recommendations, that’s probably not going to happen anytime soon. it’s important as patients to not take offense to the recommendations that are made and try to make small, realistic changes in our lives that will allow us to be healthier. Running 5 miles every morning isn’t going to be realistic for most of us, but going for a 20 minute walk during your lunch break can have a bigger impact than you might think.
Could you give some advice about preparing for a doctor’s appointment?
To prepare for a doctor’s appointment, the biggest thing is to just gather your thoughts about whatever you want to discuss, and it can help to have them written down. I’m now medically trained, I suppose, and at my last doctors appointment there were 2 things I wanted to bring up, and I forgot both of them. So it can help to have an agenda.
 WebMD– force for good or evil?
I think WebMD is the worst. I think their goal of trying to make medicine accessible is admirable, but, as anyone who has used it has probably realized, it’s really inaccurate. Or rather, it gives you such a broad differential diagnosis that it’s impossible to know if you need to go to the ER right now or don’t need to see a doctor at all. It just can’t collect information with the level of detail that you really need for a medical visit, so it ends up causing more confusion than it resolves.
Okay. So I know your suggestion to me when I call you bleeding or hacking or DTing is to proceed immediately to the doctor. I also know that you LOVE IT LOVE IT LOVE IT when I do this because it makes you feel close to me and also extremely useful. We both know that people tend to take a more wait-and-see approach. Is there a good way to inform yourself or make an educated guess that isn’t Googling?
Well, my recommendations to you are often out of fear because I don’t trust myself to triage via phone this early in my career. But sometimes, especially in the middle of the night or after hours, you can call your doctor’s office and talk to the on-call provider. That way you have someone weighing in who is medically trained and may even have access to your medical records if they have a networked electronic medical records system. So they can help triage you and let you know if it’s something you need to worry about or not. I think if everyone did this before going to the ER, we’d have a lot fewer unnecessary ER visits.
A lot of people are pretty bad at getting tested for _________ regularly. What would you say are the things absolutely not to skip out on, whether it be flu shots, a daily vitamin, genetic testing, or whatever?
So I’m a big proponent of flu shots and childhood vaccines. I know there’s been controversy about all of these vaccinations in the media over the last decade, but the scientific data is pretty conclusive that they do NOT cause autism and that they have saved probably hundreds of thousands of lives over the last half century.
Yeah, roger that. Don’t get your medical advice from Jenny McCarthy, everyone.
Yeah, no. For many diseases, the tests are only reliable if you are at high risk for the disease. In populations where the disease prevalence is low, more of the positive results will be false positives than true positives. So things like genetic testing or even testing for infectious diseases that you’re at low risk for having, often they’ll do more harm (i.e., extensive further workup for you if you have a false positive result) than good. But that’s why it’s important to be really honest with your healthcare providers about what your habits really are. We all have the best of intentions with our personal health practices, but if your providers don’t know about what your actual habits look like, we can’t recommend the appropriate screenings for you. I guarantee, pretty much no matter what your vice is, your doctor has seen worse.
This is actually the same argument I use about your aesthetician. So what’s a thing people are doing for their health that isn’t actually helping? And what’s something people aren’t doing that they don’t even realize could be really beneficial?
So, in terms of things people do that aren’t healthy, I think that you should be suspect of any dietary option that recommends cutting out any food group entirely. I think we should all work towards balance in our diets, and towards cutting back on processed foods which have a lot of salt, but I don’t think that the answer is cutting out a whole food group.  Of course, this probably just reflects my bias as a “fake vegetarian” who eats seafood and occasionally meat if I really want it– ha! In terms of things you could be doing to improve your health that you might not think of, I’d advocate good sleep habits. There’s a lot of evidence out there that not getting enough sleep can change your body’s hormonal patterns and can lead to obesity, cardiovascular disease, and stroke. People who have obstructive sleep apnea, in which your upper airway can close off during sleep and transiently wake you up, interfering with the quality of sleep, have much higher rates of cardiovascular disease, high blood pressure, and other negative health outcomes. It’s been found that treating this disorder leads to much better outcomes in patients, even if they’ve already had a heart attack or stroke. The majority of us won’t have this problem, necessarily, but I’d be willing to bet that most of us don’t have great sleep habits.
Tell me the weirdest thing you’ve learned about bodies in school.
Oh, man, this is my favorite thing. So, you know how some people’s pee smells funny after they have had asparagus, and some people’s doesn’t?
Yes! [A mutual friend]’s favorite fact to tell people about asparagus!  DO YOU KNOW WHY? OH MY GOD YOU KNOW WHY.
So, I have the inside scoop on this
The truth is that everyone’s pee smells funny after they have had asparagus, but some people have the gene for the scent receptor that smells that particular smell, and some people don’t. This is my favorite thing I’ve learned in medical school.

Becca was great to take time to talk to us about all this, and if you have any questions about ways to take care of yourself, please leave them in the comments. I took her advice about taking down my family’s medical history– it took about two hours and was a hugely beneficial conversation to have with my relatives that explained and illuminated some things for me.

What is your top preventative thing you do? What kind of weird hippie dippie home remedies do you swear by? What’s the disease you WebMD once a week to check and see if you have?

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