Wonderful Water

The view from my office window this morning looked more like mid-winter than spring!  Oh, well. Life at 7000 feet.  As I watched the snow fall, I thought again about the marvelous molecule water. In the winter when plants are dormant, it changes from a fluid to a solid that builds up as snow on the mountains. The snow is white and reflects the sun’s heat remaining in storage as the days get longer before turning back to useful fluid as the weather warms.   It’s perfect for our world of cold winters and warm summers.  It also expands when it freezes thus helping break up solids such as rock.

Wonderful water! It makes up over 80% of our body.  We drink it, boil it, run it, dump it, steam it, store it.  We need it!  Some suggestions about water and your health:

1.      Drink enough that when you go to the bathroom your urine is light colored. If your urine is dark, your kidneys are telling you you’re not drinking enough. Regardless of the time of year or the activity, this is a pretty good way to tell if you’re getting enough water. (This may not apply if you’re taking a diuretic for your heart or blood pressure – ask your doctor).

2.      Running a cool mist humidifier will help if you’ve got a cold, congestion or extra dry mouth at night. It will also help relieve symptoms of eczema (dry itchy skin).

3.      If you cut yourself – run the wound in tap water for 2-3 minutes. Studies show tap water rinsing is as good, if not better, than the rinsing we do with sterile water here in the clinic. I think it’s because of the volume of water you can move through a wound with it under a tap.

For those who like a lot of water – ski it, swim it, dive it, boat it – stay close to your life jacket and don’t forget how much kids love water!  Keep a close eye on those children when water is near.  Here’s looking forward to summer!

Water on Boulder Mountain

Blood Pressure: Why All the Fuss?

Blood pressure.   You hear it talked about a lot.  But why all the fuss?  If I feel fine, why should I worry? 

Blood pressure is the pressure generated inside your arteries from the beating heart.  The top number is the pressure generated when the heart contracts, and the bottom number is the pressure that remains between beats.  Low blood pressure causes weakness and dizziness and usually prompts a visit to the clinic.  High blood pressure, also know as hypertension, usually causes no symptoms.  Even though the blood vessels are under extra pressure and the heart has to work harder, the body compensates and we go about our normal lives.  However, the added work on the arteries and heart over the years increases the risk of heart attack, congestive heart failure, stroke, and kidney failure.  If your top number is running consistently over 140 and/or the bottom over 90, we need to talk.  If you don’t know where your blood pressure normally runs, please have it checked. Stay healthy!

Thousand Lake Mountain

Illness in the Otherwise Young and Healthy

Most of us realize if we live long enough our health will eventually fail. We can’t expect to maintain the health we enjoyed in our 20’s and 30’s into 80’s.  However, contrary to the opinion of my children, in my 50’s I still consider myself very young and I’m planning on decades of good health.  I believe this is a common optimism.  

But then disquieting events occur that remind me of my vulnerability.  Kirby Puckett, a famous baseball player about my age dies suddenly.  The non-smoking wife of Christopher Reeves loses her fight with lung cancer at age 44.  Closer to home, I see patients with really no risk factors diagnosed with cancer or suffering untimely heart attacks or strokes, diseases modern medicine is supposed to be helping prevent or postpone until the sunset of a long and happy life.  If I, a doctor who works around unexpected illness on a daily basis find this unsettling, I imagine many of you feel it even more acutely.  I wish to share my observations and offer some suggestions for the “young and healthy” who feel uncertain about their future.

Illness, injury and death are as much a part of our existence as birth, vigor and joy.  Despite its many advances, medicine is a “practice” that will ever be working toward, but never attaining perfection.  The variables of genes, genetics and environment are impossible to control or perfectly predict. Despite the many and wonderful advances made in medicine over the past one hundred years, we’ve only just begun to understand the complexities of physiology and disease.  I’m amazed at how much our understanding has changed just in the past 10 years!  But we’ve a long way to go. 

Some suggestions.  Have faith in modern medicine, but don’t “medicalize” your life.  Follow recommended health screening guidelines, take medications when prescribed, and return for indicated follow-up.  Seek medical care when ill or concerned, follow treatment plans when given, and when a cure can’t be found, move on with life and try to do the best you can.  Paradoxically, worrying about possible illness may well bring on the diseases you fear.  Unless already being treated for a chronic disease, the less you think about your doctor the better.  Health care professionals will do all they can, but remember, in most cases what you can do for your health is much more than we can do for you.  Eat right, exercise, lose that weight, stop smoking and get the rest you need; be involved with life and find joy every day!  Too much worry about tomorrow can rob you of the joy of today.  Yes, be aware of your risk factors for disease and do what you can to modify and reduce these, but ultimately, no one can predict what tomorrow will bring.  Live well today and tomorrow will be the best it possibly can. 

Horseshoe Canyon on a beautiful fall day

Physical Fitness and Fiscal Fitness

Every year around tax time, I’m forced to reevaluate my fiscal fitness.  How am I doing! Am I putting enough away for retirement?  Can I put more away for the children’s college expenses?  Are my investments paying off?   What are my priorities?  Am I reaching my goals?     

Think for a moment.  What is your most important investment?  Is it the 401K at work? The family farm?  Perhaps it’s our children’s education?   I’d suggest our most important investment is our health.

On a regular basis I’m reminded of just how fast our lives can change.  What would you do if you suddenly could no longer work in your current line of employment?  If you think that poor performing mutual fund was a drain, just think of the money you would lose if your pay check suddenly stopped because of an accident or illness! 

            Let’s consider our health investment, our IPFA (Individual Physical Fitness Account) if I may.  Are we making regular contributions?    Regular exercise is truly interest compounded.  Not only do we feel better now, it pays large future dividends in lower blood pressure, decreased weight, fewer heart attacks and strokes, less diabetes and less arthritis.  Daily deposits of good food choices along with the safe habits of seat belts, helmets and life jackets diversifies our IPFA and helps protect us from the market down-turns of accidents and illness. 

            I hope when we consider our financial plans our health leads the list of economic priorities.  Are we as vigilant in reviewing or quarterly or annual “health statements” as we are our bank statements and portfolios?  Do we check our weight and blood pressure regularly?  Have we had recommended health screenings?  Let’s never forget the close relationship of our physical and fiscal fitness!

East side of Thousand Lake in the spring

Chest Pain; When to Worry

Our bodies are blessed with many duplicate parts; two eyes, two ears, two lungs, two kidneys, two legs, two arms, etc.  If we loose a finger in the table saw, it’s a terrible thing, but unless we make a living as a musician, we can usually compensate.  However, we’ve only one heart.  When it goes, there are no backups! Because heart disease is the leading cause of death in the United States and chest pain is the most common symptom of heart disease, chest pain is something that cannot be taken lightly or joked about.  Not all chest pain comes from the heart, but I’m especially concerned when:

1. You have a history of previous heart problems or have one or more risk factors for heart disease.  These risk factors include:  age (men over age 40 and women over age 50), tobacco use, severe obesity, sedentary life style, family members who have had heart disease, or a  history of high blood pressure, high cholesterol, or diabetes.  (As a side note, it’s important that you have regular medical checks to determine if you are at risk and to begin reducing your risks through treatment.)
2. The pain is mid chest with a squeezing or heaviness sensation ( it feels like there’s a weight on your chest or a band being tightened).
3. The pain is worsened by exertion.  If the pain gets worse every time you strain or get your heart rate up, you need an evaluation. 
4. The pain is severe.  If you’re hurting bad, you need to be seen.
5. The pain is accompanied by shortness of breath, nausea or perspiration.

Finally, I’d like to urge all patients with chest pain to have a medical evaluation.  Chest pain may also be related to problems with the lungs, chest wall, nerves or esophagus.  While trouble with these organs may not be as critical as heart problems, they can still be dangerous.  Also, at times it can be difficult to determine the origin of chest pain.  Could that chest pain be simple indigestion?  Yes, but remember, you’ve only one heart.

Jeff Chappell, M.D.

Great day with friends

The Curious Case of Cholesterol Meds

What to do about your cholesterol?  That’s a rather complicated answer now-a-days! First, if you have diabetes or have known coronary artery disease, the answer is pretty clear: get on a statin med (statins are a class of cholesterol meds that include Lipitor, Zocor, Pravachol, Crestor and their generics) and make sure your bad cholesterol (LDL) is under 80.  If you don’t, well, let’s have a conversation.

For those with high cholesterol that can’t be controlled with exercise and diet, medicines have been the answer and have been prescribed now for years.   If one medicine didn’t work, time to increase the dose, change to another med, or add a second medicine from a different class.   The common thought in medicine was that anything that could get the cholesterol lower was a good thing and was good for patients.  However, in the past couple of years, we’ve found that some meds that lower cholesterol don’t lower risk for heart disease (niacin) or may even increase the risk (Zetia).  We’ve also found that for those with very little risk for heart disease, the benefits of any medicine at all may be very small.  

First, if you’re older than a teenager you really should know your cholesterol and have had a discussion with a medical professional about what it means.   If you’re already on cholesterol meds and you are not diabetic or have no known heart disease, please visit with your doctor and discuss with him your overall risk for heart disease and the relative benefit you would get from medicine.  There are calculators that can be used to determine that risk. It may be that you are getting a big benefit from the meds, or it may be that you are not.

Let me give you an example of a middle aged man with whom I’m very familiar (Ok, it’s me, and I’m sharing some pretty personal information – hopefully that won’t be used to steal my identity!)  My most recent total cholesterol was 209 with a good cholesterol (HLD) of 39 and a bad (LDL) of 156.  I’m not very proud of these numbers and in the past would have been inclined to discuss cholesterol meds with someone with similar findings.  However, where I have very few risk factors other than a sub-optimal cholesterol panel, my 10 year risk for some type of heart event is only 8%.  If I were to go on cholesterol meds and get my levels to more optimal ranges, I could decrease my 10 year risk to 5%.

So, let’s see.  With meds I have a 92% chance of not having an event in the next 10 years, and with the meds I would have a 95% chance of not having an event.  Are the costs (prescriptions, office visits, labs) and potential side effects (muscle aches, memory effects, liver inflammation)  worth that extra 3%?  I thought not and have been involved in an aggressive exercise regimen and improved diet (still struggling with chocolate). 

Don’t get me wrong.  I am a strong believer in medication for cholesterol and for many it is truly a life or death issue - please don’t change any of your meds without first discussing them with your doctor!  But in addition to your cholesterol number, you need to know your risk in order to determine if meds are right for you.  And remember, exercise and a healthy diet are always helpful in preventing heart disease!  The side effects (more energy, increased stamina, better self-esteem, lower risk for other diseases) aren’t bad either!  Until next time, keep on moving and stay out of the pantry!

Eat More Fish!

Some misconceptions about the flu shot

Flu Shot Time Again!

The cool in the air combined with falling leaves in the mountains reminds us all flu season is fast approaching. While we encourage all to receive the shot, if you’re under 5 and over 50, or you’ve a chronic illness such as asthma or diabetes, you’re at high risk for complications of influenza and should receive a shot.  These complications include pneumonia, dehydration and hospitalization.   The only true contraindication for the shot is a history of severe egg allergy or having had a serious reaction to a previous flu shot.

In an effort to encourage more of our community members to receive the flu shot, I’d like to address some of the misconceptions regarding the shot. 

1. “The flu shot gives me the flu”.  While older forms of the vaccine may have caused occasional fever and body aches, the current, more purified form causes very few side effects.  The flu shot only protects against true influenza (a severe respiratory infection associated with high fevers, body aches and cough) not against the many other respiratory viruses that can cause colds and, at times, more serious respiratory illnesses similar to influenza.  “Stomach Flu” (nausea, vomiting and diarrhea) is causes by intestinal viruses unrelated to true influenza.  Having the flu shot will not protect you against all viruses, but it will protect you against the most serious virus, influenza, that we see each winter.
2. “The flu shot is not safe in young children”.  The safety and efficacy of influenza vaccination in children has been well studied.  While we do not recommend the flu shot for children under 6 months of age, we highly recommend it for those 6 months to 5 years.  They are at particular risk of suffering complications from influenza.  The side effects of the shot are minimal and there has been nothing to suggest that adding the flu shot to their regular vaccinations is harmful. The shot can be given even when the child is suffering from a cold. 
3. “Pregnant women should not be vaccinated”.  Pregnant women are actually included in those considered high risk of influenza complications.  Not only is it safe, it is highly recommended for all women who will be pregnant during the flu season.

We encourage all those at high risk and any others who wish to receive the vaccine to call your local clinic today to arrange for a shot.  We also recommend any who have close contact with high risk individuals to have the flu shot. There's no shortage of vaccine this year, so do yourself and those at risk around you a favor. Go get that shot!

Sun Rise at Deep Creek.  Thousand Lake Mountain