REPOST: 5 New Year's Resolutions That Can Save Your Life

Making New Year’s resolutions (and not keeping them) is one of the most oft-mocked aspects of the passing of years. However, making an annual commitment and sticking to it can have its upsides. 
Dr. Robert Pearl shares in Forbes.com the health benefits of keeping a number of resolutions that can lead to a longer, healthier, and happier life.  

With the New Year approaching, this is the time many of us make resolutions about our lives – often tied to our health and wellness.

Image Source: Forbes.com

As the health care industry enters a new era of consumerism, people are seeking more and more ways to take ownership over their health and health care. While data about doctors, hospitals and health outcomes are becoming more available and transparent, we still have a long way to go.

Perhaps in a decade, all physicians will share electronic medical records so they can view all our medical information in one place. Perhaps by then, “big data” will allow patients to quickly and reliably compare physicians and hospitals. But until then, there are some things we can do to put health care in our own hands. These five simple New Year’s resolutions can change your health for the better – in spite of the limitations of the current health care system. In fact, these resolutions might just save your life in 2014.

1. Be the guardian of your medical information

Most physicians record information in paper medical records or enter data into office-based electronic health records. Either way, your doctor’s files are most likely disconnected from the records of the other doctors or hospitals you’ve visited. If you want to minimize the risk of error, you need to create a summary of your own medical records and bring them to every doctor’s visit or hospital admission. At minimum, keep a personal record of:

Your family medical history. You may be predisposed to many medical problems. Inheritable conditions can range from cardiovascular disease to cancer, from depression to other forms of mental illness. Detailed knowledge of your genetic susceptibility is very important to the doctor caring for you.

Your personal medical history. Do you suffer from diabetes? Do you smoke cigarettes? Have allergies to certain medications? Physicians need this information so they can hone in on the cause of a specific symptom or avoid post-operative complications. Keep this information handy, particularly when seeing a specialist who may not routinely ask for each of these details.

Your medications. Different drugs can interact with one another in negative and potentially deadly ways. Providing a list of your medications (including the dosage) at the start of each medical visit can reduce the chance of a problematic drug interaction. This is particularly important when the physician you are seeing works in a narrow specialty and may not be as familiar with the types of drugs you have been prescribed by other physicians.

2. Check publicly available information before making health-related decisions

Most of us assume the doctors we see and the hospitals we use provide excellent medical care. But do we really know? While the data on the quality of their outcomes is difficult to obtain, there is information available.

We know, for instance, that there are huge variations in quality based on the health insurance company you select. Patients over 65 who are enrolled in Medicare Advantage can obtain such data by checking the Medicare Star ratings. For younger patients and families, data on quality outcomes is published by the National Committee for Quality Assurance (NCQA).

Hospitals also deserve your due diligence. After all, hospital errors are the third leading cause of death in the U.S. Most states maintain public data on surgical outcomes, corrected for the severity of the health condition in the patients they have treated. But this information is only helpful if you use it to decide whether to have a major procedure in a particular hospital.

3. Be prepared for your doctor’s visit

A “successful” visit to your physician occurs when your questions are answered and your concerns addressed. To prepare for a successful appointment, write down your specific concerns, a description of your symptoms, and any therapies that you have tried – especially if they were prescribed by another physician. These are the main pieces of data a physician uses to figure out what is wrong.

With this information in hand, you can have a more productive conversation with your doctor. When your physician understands exactly what is happening, he or she can provide a higher quality of care and you can be more confident you will receive the right treatment for your medical problem the first time. 

4. Narrate your own after-visit summary

Do not leave the doctor’s office until you are certain that you understand what the doctor has said and what the plan is. This will allow you to take more control of your own health in 2014.
Before leaving the examination room, ask yourself some or all of the following questions:

Do I understand what I have been told about my symptoms or condition? Do I understand why diagnostic tests were ordered or why treatments were prescribed? What does my prescribed medication do and what side effects should I watch for? If referred to another specialist, do I understand why and what questions to ask? If undergoing a procedure, what are the potential risks? And how much experience does the physician have in performing the procedure? If the treatment does not work or if new problems arise, how and when should I communicate this to my physician?

5. Know your health status and take action

Certain actions can make a major difference in your health. Although serious medical problems can happen regardless of how diligent you are, there are steps you can take to reduce your chances of developing diabetes, heart disease, cancer or stroke. For instance, pay attention to age- and gender-specific preventive screening recommendations. Manage your weight with regular exercise. Stop smoking.

The first step in any preventive health measure is to write down your goals. Make sure they’re specific, measurable and attainable. Take advantage of the programs and resources at your disposal. For example, some employers sponsor smoking cessation programs. Check out diet plans like the ubiquitous Weight Watchers program. Assess your progress every day and engage family and friends to hold you accountable.

The first few weeks are the hardest time for a lifestyle change. But once these activities become habits, they much are easier to maintain.

Own your health in 2014

What we want from our health care system is very different from what we can easily obtain today. Ideally, we’d our like physicians to have all of our medical information available. We’d like to know how competent our physicians are and how safe a particular hospital is.

Modern technology has equipped consumers with the knowledge and visibility necessary to make informed decisions in most areas of life. We easily can compare prices, quality and availability for retail products and automobiles. But we still have a ways to go before we can expect the same from health care.

Until these realities change, these five relatively simple steps can help health care consumers bridge the gap. Resolving to do each is a great way to start your 2014.

Mark Adkins, M.D., is a New York-based heart surgeon. Follow this Twitter account for more updates on cardiac health.

REPOST: License to Eat: Why You Shouldn’t Deprive Yourself This Thanksgiving

In time for Thanksgiving, Alexandra Sifferlin of TIME.com gives everyone a free pass to indulge during the holiday.  

This Thanksgiving, have your mashed potatoes and eat them too.

That advice, surprisingly, doesn’t come from you grandmother but from more dieticians and nutritionists who are actually helping people to maintain healthy weights. Yes, in addition to the usual roll-out of “How to Slim-down Your Thanksgiving” and tips on how to avoid packing on the pounds, some health experts are advising that we go a little easier on ourselves over the holidays. They’re certainly not recommending that you scarf up everything you see, but the key to keeping cravings and temptations in check may be to give in to some — in moderation.

Image Source: Time.com

That advice is based on some solid research. Studies show, for example, that when you put certain foods on a do-not-eat list, people end up wanting, and eating them more, and actually gaining weight. A 2012 study by researchers at Tel Aviv University found that dieters who ate a pastry every day lost more weight than dieters who avoided them completely. While both groups of dieters were on a low-calorie diet, the pastry group ate a cookie, slice of cake, doughnut or piece of chocolate every morning. Although by the end of the 16 week study, both groups had lost an average of 33 lbs, the group who treated themselves to dessert every morning went on to lose another 15 lbs on average, and reported feeling less hunger and cravings during that time. And researchers from the University of British Columbia reported that when people are told certain foods or objects are forbidden, the brain concentrates on them more than usual.

Other studies in mice have found that when the animals were only enticed with the occasional bit of sugar, then deprived of it, they were more likely to overindulge in sugar once it was brought back into their diet.

“Holiday asceticism makes no sense, because it ruins the holiday and is too little, too late anyway,” says Dr. David Katz, the director of the Yale-Griffin Prevention Research Center and author of the new book Disease Proof: The Remarkable Truth About What Makes Us Well. Watching everyone else dig into the feast is going to be tough if you insist on sitting it out. “The problem is when we deprive ourselves of foods that we love, it makes us want them more. Then, when we finally do have them, we overeat them. We lose the ability to control how much we eat of those foods,” says Keri Gans, a registered dietitian and author of The Small Change Diet.

But the key to this approach is maintaining a balance between what you eat with physical activity to burn off the added calories. “I, for one, will be enjoying a feast on Thanksgiving,” says Katz. “Of course, I will also spend a lot of time hiking, biking and playing football with my family and friends over the holiday weekend.”

So go ahead and substitute the sour cream with fat-free Greek yogurt if you like, or skip the mashed potatoes. But don’t feel so bad if you don’t. If you’re watching your portions, and not overloading your plate with gravy, it’s okay to have the higher calorie staples over the holidays.

“My whole thing about the holidays is that I am not big on making every dish a low-calorie dish. I’m not against it, but I feel like people should really look at a holiday as just a day. They should be able to enjoy the foods that are served. And just not over do it,” says Gans. “What I always encourage is that people enjoy the foods that they love and they learn to watch the portion size. I find if they don’t eliminate it, and still include it, when they do it eat it, they can be satisfied with the smaller portion.”

Katz says that overeating high calorie, fatty or sugary foods consistently makes the body only want more. So dipping into them every once in a while may actually help to minimize cravings and release you from a dependence on decadence. “The real defense of health resides with taking good care of yourself routinely, year round. If you do that, you can certainly afford a bit of indulgence at holiday time and,  it’s likely even your indulgence will be fairly salutary,” says Katz.

And if you do overdo it this holiday season, just start fresh the next day. “I recommend, what happens in Vegas stays in Vegas. [People] should forget about feeling guilty and they should get right back on track. That is the most important thing they should do. They should not all of a sudden get a diet mentality because that won’t work. They need to leave it behind,” says Gans.

Not worrying about what you can eat, and what you shouldn’t eat can also divert your attention away from food, and that can lead to a healthier relationship with your diet as well. The holidays are about spending time with friends and family, and food is part of that enjoyment — not obsessing about what’s on the table.

Mark Adkins, M.D. is a cardiac surgeon based in New York City. Visit this Twitter page for updates on health and wellness.

REPOST: Testosterone treatments linked to heart risks

Men should be more careful when undergoing testosterone treatments as such may increase the risks of heart attack.  USA Today has the details.

CHICAGO (AP) — Testosterone treatments may increase risks for heart attacks, strokes and death in older men with low hormone levels and other health problems, a big Veterans Affairs study suggests.

The results raise concerns about the widely used testosterone gels, patches or injections that are heavily marketed for low sex drive, fatigue and purported anti-aging benefits, the authors and other doctors said.

Men who used testosterone were 30 percent more likely to have a heart attack or stroke or to die during a three-year period than men with low hormone levels who didn't take the supplements. Hormone users and nonusers were in their early 60s on average, and most had other health problems including high blood pressure, unhealthy cholesterol and diabetes.

The research doesn't prove that testosterone caused the heart attacks, strokes or death, but echoes a previous study in older men and should prompt doctors and patients to discuss potential risks and benefits of using the products, said study lead author Dr. Michael Ho, a cardiologist with the VA's Eastern Colorado Health System in Denver.

The nationwide study involved an analysis of health data on 8,700 veterans with low levels of testosterone, the main male sex hormone. All had undergone a heart imaging test and many had risk factors for heart problems, including blocked heart arteries. Risks linked with testosterone were similar in men with and without existing heart problems.

Nearly 26 percent of men using testosterone had one of the bad outcomes within three years of the heart test, compared with 20 percent of nonusers. It's unclear how the hormone might increase heart risks but possibilities include evidence that testosterone might make blood substances called platelets stick together, which could lead to blood clots, the study authors said.

Previous studies on the supplements' health effects have had mixed results, with some research suggesting potential heart benefits but none of the studies has been conclusive.

The drug Axiron is an underarm gel used for boosting levels of testosterone. The male sex hormone declines with age. Millions of men have been prescribed testosterone gel, patches or shots. Image Source: www.usatoday.com

The new study was published Tuesday in the Journal of the American Medical Association.

An editorial in the journal said it is uncertain if the study results apply to other groups of men, including younger men using the hormone for supposed anti-aging benefits.

"There is only anecdotal evidence that testosterone is safe for these men," said editorial author Dr. Anne Cappola, a hormone expert at University of Pennsylvania and an associate journal editor.

"In light of the high volume of prescriptions and aggressive marketing by testosterone manufacturers, prescribers and patients should be wary" and more research is needed, she wrote.

Annual prescriptions for testosterone supplements have increased more than five-fold in recent years, climbing to more than 5 million and $1.6 billion in U.S. sales in 2011, the study noted.

Dr. Nathaniel Polnaszek, a urologist with Scott & White Healthcare in Round Rock, Texas, said he prescribes testosterone for many men, mostly in their 40s and 50s, with low levels and erectile dysfunction or other symptoms. He called the study "concerning."

"This is something I'm going to be discussing with my patients," he said.

Testosterone levels gradually decline as men age, and guidelines from doctors who specialize in hormone-related problems say hormone supplements should only be considered in men with symptoms of low levels, including sexual dysfunction.

They're not advised for men with prostate cancer because of concerns they could make the disease spread, said Dr. Robert Carey, a former Endocrine Society president and a professor of medicine at the University of Virginia Health System.

AbbVie, Inc., makers of one heavily marketed testosterone supplement, AndroGel, issued a statement in response to the study, noting that testosterone treatments are approved by the Food and Drug Administration, and the risks are listed.

Possible side effects shown on the package insert include high blood pressure, blood clots in the legs, and body swelling that may occur with or without heart failure. "This may cause serious problems for people who have heart, kidney or liver disease," the insert says.

"We encourage discussion between physicians and patients that leads to proper diagnosis based on symptoms, lab tests and a patient's other health needs," AbbVie said.

Mark Adkins, M.D. is a practicing cardiac surgeon specializing in coronary arterial revascularization, mitral valve repair, aortic root replacement, repair of aortic aneurysm, and other cardio-thoracic procedures.  Follow this Twitter page for more updates about his practice.