Health
Information
Booklet
Presented by the Montana Chapter of the AmericanCollege of Physicians
Jay Larson, MD, FACP
Governor Montana Chapter of the AmericanCollege of Physicians
301 Saddle Drive
Helena, MT 59601
Phone (406) 442-2205 Fax (406) 442-2445
E mail:
INTRODUCTION
The following information is provided to you to complement the information your clinician provides to you during your appointments. It is not meant to replace on going follow up with your clinician. If you have any concerns or problems, be sure to see your clinician.
ACTIVITY AND DIET
Today we eat more calories and are significantly less active than 50 years ago. Most jobs now entail moving information and not anything else. We sit in front of computer screens transferring data electronically. Even some of the more labor-intensive occupations require less energy because of technology. Carpenters have air hammers, electric saws, and electric drills. Farmers have machines to help move hay bales and feed their stock.
As a result of an imbalance between increased calorie intake and less physical activity, obesity has become a greater issue in our society. More than 2/3 of Americans are overweight or obese. Obesity can lead to elevated lipids (blood fats), high blood pressure, heart disease and diabetes. A pre-diabetes condition called Metabolic Syndrome has recently been defined and affects about 20% of Americans.
Unfortunately, the approach to dealing with this imbalance between diet and exercise has been focused only on our dietary intake. Most of the time when a person tries a unique diet they are only able to stay with it for about 1-3 months and then they go back to their old eating style.
It boils down to four simple words, “Move more, Eat less”. As you continue to consume fewer calories and gradually increase your physical activity each day, you’ll find that you feel better, sleep better, have less joint pain, and your risk of cardiovascular disease and diabetes is decreased. Try to eat in a way that we are genetically designed to eat. That is, frequent small meals, not one big meal a day.
A person’s weight is also affected by stress, sleep disturbance, and several hormones and chemicals in the body. When a person is in “Fight or flight” mode, the metabolism changes to hang on to as many calories as possible.
There are several ways to increase your physical activity. Don’t drive around the parking lot for 10 minutes looking for the closest spot to the door. Park in the farthest spot and walk a further distance. Use the stairs and not the elevator. At the end of the day, instead of sitting in front of the home computer or TV, walk the dog or the kids.
Moderate physical activity (equivalent to walking 3-4 mph) should be started at 5-10 minutes per day and gradually increased as tolerated to as much as possible. Starting physical activity should be discussed with a physician before starting if medical illnesses such as lung disease, heart disease, kidney disease, arthritis, or diabetes is present.
STRESS
Stress is a common term used in American society. Many do not understand what stress truly is. Stress is overwhelming change. How many different things do you have to do in a day? When there is something different in our environment, our body’s “fight or flight” mechanism activates so that we can respond to the changing environment more quickly. Unfortunately, with information technology, everyday is jam packed with bits of different information that we need to process. We turn on our “fight or flight” mechanism in the morning and we leave it on all day.
As a result of chronic hyper-alert state our immune system weakens, pain becomes more noticeable, our brain neurochemistry changes and we start to develop anxiety, depression, sleep difficulty, and fatigue. The inside of the arteries are attacked by inflammation cells and arterial clogging (atherosclerosis) develops. Too much stress has been shown to worsen many health problems.
RELAXATION
The opposite of stress is relaxation. These are two mutually exclusive states. You cannot be stressed when you are relaxed and you cannot be relaxed when you are stressed. There are several ways to achieve relaxation, but multi-tasking is not one of them. American society is deficient in relaxation and recreation. Americans tend to boast that they have worked long hours for many days without taking a break. This is unfortunate because it only reduces productivity and adversely affects quality of life.
TOBACCO USE
Tobacco use is associated with increased risk of cancer, heart attack, stroke, lung disease, dementia, thinning of the skin and bones, and early death.
Various forms of nicotine replacement (nicotine patches, gum, nasal spray, lozenges, and inhalers), Zyban (bupropion), Chantix, support groups, Quit lines, and smoking cessation classes are helpful to quit tobacco use.
Second-hand smoke has just as many health risks as smoking cigarettes directly. Children, elderly, and those with lung disease are particularly susceptible to adverse health effects of second-hand smoke.
IF YOU HAVE NOT HEARD IT YET, THEN YOU WILL HEAR IT NOW… STOP THE USE OF ALL TOBACCO PRODUCTS!!!!
ALCOHOL ABUSE
Approximately 10 percent of Americans (10 million people) abuse alcohol. Excessive alcohol consumption is the third leading preventable cause of death in the United States.
The following categories of alcohol use are designated by National Institute on Alcohol Abuse and Alcoholism:
Moderate drinking: low risk for alcohol problems
- Women: <2 drinks per day
- Men: <3 drinks per day
-People age ≥ 65: < 2 drinks per day
Heavy drinking: at risk for alcohol problems
- Women: >7 drinks per week or 3 drinks per occasion
-Men: >14 drinks per week or 4 drinks per occasion
Binge drinking:
- Women: 4 or more drinks in a row
- Men: 5 or more drinks in a row
A simple screening test for excessive alcohol use is the CAGE questionnaire:
- Have you ever felt you should cut down on drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt guilty about your drinking?
- Have you ever taken a drink in the morning as an eye opener to steady your nerves or get rid of a hangover?
A positive response to two or more questions may mean an alcohol drinking problem.
Potential adverse health problems associated with excessive alcohol use include: accidents, memory problems, sleep disturbance, anxiety, depression, suicide risk, nerve damage, hallucinations, paranoia, intestinal bleeding, liver damage, increased risk of cancer, blood abnormalities, heart failure, stroke, high blood pressure, seizures, impotence, muscle damage, malnutrition, driving difficulties, legal difficulties, social and interpersonal difficulties, fetal malformation, and early death.
If concerned about excess alcohol use, contact Alcoholic Anonymous or see a counselor who specializes in alcohol abuse (found in the yellow pages under Alcoholism).
CHEMICAL DEPENDENCY
In addition to alcohol and tobacco, there are other substances that can be used to temporarily improve how a person feels and to cope with the trials and tribulations of life. These substances include cocaine, amphetamines, narcotics, marijuana, and inappropriate use of prescription medications used to treat anxiety, insomnia, and pain. If these substances are overused they can cause early death as well as driving, legal, social, and interpersonal difficulties. There are chemical dependency counselors available. Seek help if concerned about chemical dependency.
SAFE SEX
It is important for a person to use safe sex practices. Sexually transmitted diseases include the human papilloma virus (HPV) which increases a woman’s risk of cervical cancer, chlamydia and gonorrhea which may lead to sterility, syphilis which may lead to neurologic damage, genital herpes which may cause recurrent painful sores, and HIV which may lead to chronic illness and increased risk of infection.
Symptoms of a sexually transmitted disease include: Burning in the genital area when urinating, abnormal discharge from the vagina or penis, pain in the pelvis or abdomen, irritation or burning with intercourse, and redness, sores, bumps, rashes, or blisters in the genital area.
Many people with sexually transmitted diseases may not experience symptoms. If sexually active and unsure if partner is infected with a sexually transmitted disease it is recommended to:
Correctly use a new latex condom from beginning throughout the duration of the sex act every time with vaginal, anal, or oral sex.
Avoid contact with body fluids and tissues, such as vaginal fluids, semen, and open sores.
THINGS TO DO CHECKLIST
OBTAIN MEDICAL ID
If chronic medical problems or medication allergies are present, it is important to carry medical ID stating medical problems in the event of unconsciousness. Medical ID is recommended for those with diabetes, heart disease, seizure disorder, kidney failure, asthma, an artificial heart valve or joint, pacemaker, ICD (implanted defibrillator), latex allergies, warfarin (Coumadin) use, and dementia. Listing allergies can reduce the chance of receiving that medication or similar medications. A MedicAlert medical ID can be obtained by calling 1-800-432-5378.
FILL OUT LIVING WILL AND ADVANCED DIRECTIVES
A Living Will is a document stating that if a terminal illness is present and death is expected despite treatment, that resuscitation and other treatments to extend life are not be used. The Living Will, however, only applies to terminal illnesses and not to other disabling conditions such as advanced dementia or severe head injury.
An Advanced Directive is a document stating what treatments desired for medical conditions other than a terminal illness. The shortcoming of an Advanced Directive, however, is that medical treatment is very complex and unexpected events happen. A person can be designated Durable Power of Attorney for Healthcare to make decisions if incapacity develops.
It’s very important to have an open discussion with friends and family about what is desired in the event of a terminal or a significantly disabling condition.
Discuss what is important in regards to self-values.
Is quality of life important or quantity of life important?
What treatment is desired if a terminal condition develops and further treatment would not extend life?
What treatment is desired if a significant brain injury due to trauma, stroke, or Alzheimer’s disease occurs but is not considered terminal?
What treatments would be desired to above conditions:
Antibiotics to treat infection?
Surgery to treat surgical conditions?
IV hydration in the event of dehydration?
Tube feeding if unable to swallow?
A respirator or breathing machine to assist breathing?
CPR and resuscitation if heart or breathing stops?
Advanced Directives are important to discuss at a time that does not involve a crisis. Living Wills, Advanced Directives, and Durable Power of Attorney only apply to situations of incapacity. A Living Will and Advanced Directive can be revoked at any time.
Advanced Directives do not mean that physicians do not continue to strive toward keeping a person as comfortable as possible if they are suffering.
When a person is in the hospital and they stop breathing or their heart stops, resuscitation efforts are initiated unless a “do not resuscitate” or “DNR” order is written in the chart by the attending physician. If a person does not want to be resuscitated they should make sure that the physician knows this.
A good Living Will is “Five Wishes” designed by the Aging with Dignity organization. A copy can be obtained by calling 1-888-5-wishes.
Montana Provider Orders For Life-Sustaining Treatment (POLST) is an advanced directive form. The form can be found on the mt.gov website at:
CONSIDER ORGAN DONATION
There are over 100,000 persons in need of an organ transplant every year. If you decide to be an organ donor, it is important to discuss with your family.
LEARN CPR
CPR is the technique used to help someone who has collapsed. Learn CPR. This is especially important if family or friends have heart disease.
HAVE ANNUAL EYE AND DENTAL EXAMS
Have eyes and teeth checked by a qualified professional on a regular basis. Brush teeth and floss regularly.
INSTALL CARBON MONOXIDE AND SMOKE DETECTORS AND KEEP BATTERIES CHARGED
Carbon monoxide is an odorless gas that pushes oxygen off red blood cells so that less oxygen is carried to tissues. Carbon monoxide is produced by combustion. It is very important to have a carbon monoxide monitor in the household to detect elevated levels of carbon monoxide.
Smoke detectors should be installed in several household locations. Periodically replace batteries in battery operated detectors.
USE SAFETY BELTS AND HELMETS
Always wear safety belts when in a motor vehicle and wear a helmet if downhill skiing or riding a horse, motorcycle, bike, or four-wheeler.
KEEP FIREARMS SAFE
Make sure firearms are in a safe place, unloaded, and away from ammunition and children.
DRIVE SAFELY
The driver should be able determine if they are safe to operate a motor vehicle. Several medications or health problems can impair the ability to drive safely and impair the driver’s ability to determine that they are a safe driver. Aging may slow reflexes, diminish vision, and reduce hearing. Never drive while intoxicated or sedated. Always be well rested when driving. Do not drive if sleepy. Always follow posted speed limits. Do not rush. Do not be distracted by using a cell phone nor text messaging.
OBTAIN SAFETY IF EXPOSED TO DOMESTIC ABUSE
If physically hurt or threatened, feel unsafe, or controlled by partner, domestic abuse is a potential risk. Leave the situation before harm occurs. Shelter phone numbers can be found in the Community Service Numbers at the front of the phonebook.
PREVENT FALLS
Falls may lead to significant injury, especially with aging. To prevent falls, make sure there is adequate lighting at nighttime. Remove loose rugs and cords from walking paths. Use banisters when going up and down stairways. Use a walker or cane if walking or balance problems. Avoid wet or freshly waxed floors. Avoid ice and slippery pathways. Wear shoes with good traction.
USE HEARING AND EYE PROTECTION
Noise pollution is common. Use adequate hearing protection if using firearms, power tools, machinery, or small gas engines such as lawnmowers. Hearing loss may not develop for 10-20 years. Use eye protection if around equipment that might flick particles into the eyes.
ASSUME RESPONSIBILITY FOR YOUR HEALTH AND EMPOWER YOURSELF TO MAKE HEALTHY CHOICES
You are responsible for your health. A clinician is only a guide that can help direct you toward a healthier lifestyle. You choose your own path. Often, clinicians recommend treatments that are not followed through by individuals. That’s an individual’s choice. You choose what information you wish to believe and not believe. You choose your lifestyle.
You are responsible for knowing your health insurance coverage. There are dozens of different insurance plans, each with their own nuances. It is impossible for a physician to know what services are covered by the different health insurance plans. If an insurance company does not cover a service, address it with the insurance company. If a clinician orders a test or medication, but your insurance does not cover the test or medication, it is still your choice to follow your clinician’s recommendations.
You are responsible for keeping track of your medications and taking them as directed. Do not allow the medication to run out and call the office in a panic. Make sure you have your medications renewed before the prescription has run out. If you choose to wait until there are no more refills, you may not be able to have the prescription renewed promptly.
You are also responsible for your happiness or unhappiness. You can choose to blame someone if something bad happens, or you can choose to move on the best way you can looking for the good in life. If you choose to blame someone or something else for your unhappiness, you will never be happy.
USE ANTIBIOTICS PRIOR TO DENTAL WORK, GASTROINTESTINAL, AND URINARY PROCEDURESIF ARTIFICIAL HEART VALVE OR ARTIFICIAL JOINTS
Artificial heart valves and artificial joints are at risk of becoming infected with dental, gastrointestinal, and urinary procedures. Antibiotics given before certain procedures may reduce the risk of infection.
Recommended antibiotics for dental procedures (especially tooth extraction, gum surgery, implant placement)
Amoxicillin 2,000 mg 1 hour before procedure
Clindamycin 600 mg 1 hour before procedure
Cephalexin 2,000 mg 1 hour before procedure
Zithromax 500 mg 1 hour before procedure
Biaxin 500 mg 1 hour before procedure
Recommended antibiotics for gastrointestinal or urinary procedures are intravenous and depends on the procedure.
PARTICIPATE IN BREAST CANCER SCREENING
Risk factors for breast cancer include age greater than 50 years old, a family history of breast cancer, onset of menstrual periods less than 12 years old, menopause after 55 years old, age of first live birth older than 30, history of breast biopsies, history of atypical hyperplasia on breast biopsies, and hormone replacement therapy. A Breast Cancer Risk Assessment Tool to calculate five year and lifetime risk of breast cancer can be accessed at This program uses information about risk factors to calculate risk of breast cancer. If a woman’s risk of breast cancer is substantially increased, options include bilateral mastectomy (breast removal) and tamoxifen. There are potential risks associated with both of these treatments and they should be discussed with a physician.