Tuesday, June 14, 2011

Some of My Medical Observations and Thoughts

     1) A bowel movement a day is not  necessary for good health, nor are coffee enemas.

     2) No one knows how many glasses of fluid  the human body requires in a 24 hour period. We do know that if we ingest 0.5 L of water a day we can clear all the byproducts of our metabolism if we have normal kidneys.

     3) For men, as a rule, if your urine is darker than light yellow, you are relatively dehydrated.

     4) Whether your stools float or sink has nothing to do with your health or wellness.

     5) We don't know how many hours of sleep an adult needs, but we do know that different people have different needs. One way to test yourself is to see how much later you sleep on Saturday or Sunday morning when you don't have to get up.

     6) Eating salt will not cause you to have high blood pressure any more than eating sugar will give you diabetes. (But being severely overweight puts you at risk for both of these disorders.) And we don't understand why some patients lose weight easily on the Ornish diet, while others lose weight more easily with the Atkins diet.

     7) It is probably true that the reason many women and almost no men need bunion surgery is that high heels shift the force of your weight forward on to your big toe, and by Wolff's Law, pressure and/or weight-bearing on a bone causes the bone to grow and enlarge just where the force is applied (i.e. the big toe).

     8) An alcoholic is defined as  anyone who has two or more drinks a day than his/her doctor does.

     9) There are no eye exercises to improve myopia (near-sightedness), and wearing glasses does not make your eyes weaker. There is some evidence that ultraviolet rays may contribute to the formation of cataracts; if this is so then wearing sunglasses should help to forestall the development of cataracts.

   10) No doctor ever got sued for doing a test, but only for not doing one (And the jury will never agree with the doctor's reason  for not doing the test if the patient got injured or died.)

   11) An hour of sleep before midnight is not worth two hours after midnight.

   12) Caffeine improves mental performance on written tests, and shortens your reflex time in hand-eye coordination sports. (No-Doz worked!)

    13) The majority of women dream in color, and the majority of men dream in black and white.

    14) No one knows how may meals we should eat a day for optimum health, nor do we know whether the biggest meal should be in the AM, at noon, in the PM or in the evening.

    15) We don't know why in the Far East adults with the higher BMI   (body weight) have a lower rate of heart attacks.

    16) We don't know the optimum interval for a complete physical: 6, 12, 18 , or 24 months or whatever. The same is true for the frequency of eye exams, mammograms, pap smears, colonoscopies or ANY periodic medical exam or medical blood test or Xray, even if the doctor is following a disease you have.

    17) Only we and the guinea pig need Vitamin C as part of our diet to prevent scurvy. All other animals possess the gene necessary to synthesize it. And your body only sees the chemical we call "Vitamin C",  AKA ascorbic acid, and it cannot tell where it came from, whether  "natural" or man-made, since any chemical process depends on the structure of the chemicals, and not their origin.

    18 An alcoholic  drink a day (beer, wine, or whiskey) seems to help prevent death from heart disease, but the US Government refuses to recommend it.

    19) Vegetables do not need Vitamin B-12 to make their DNA, so vegetables contain no DNA. All animal cells contain DNA, including eggs and fish. So if you have a purely vegan diet, you will develop a Vitamin B-12 deficiency which in turn will lead to pernicious anemia and/or irreversible  damage to your peripheral motor and sensory nerves as well as to your brain.

   20) Patients always lie to doctors, so as to put themselves in the best possible light. They don't realize that we have seen it and much more many times before.

   21) We don't know in America if tall people live longer than do short people, or if righties live longer than lefties. We do know that the lower your social-econonomic station in life, the greater is the risk of disease and early death.

    22)Men are  possessive of their women, and the double standard still applies.When a married man asks me for an AIDS test because he is about to start an affair, , and I ask him could his wife also be having an affair, the answer in always a resounding "Impossible".

    23 Most abdominal pains feel worse in the late afternoon and evening, and any abdominal pain in an adult that lasts for 6 or more hours may  represent a surgical condition, and should be evaluated in an Emergency Room.

    24) If a doctor spends more time talking about his/her problems than listening to your problems, it is time to find a new doctor, especially if the doctor cries while doing so.

    25) If the spouse wants your patient to have a test, it is almost impossible to avoid ordering the test. Many such patients  will eventually ask for the test, even after reassurance by the doctor that the test is not necessary, just to "keep peace in the house".

    26) It's your body, and it is the doctor's privilege to be  allowed to attend to it, so NEVER feel guilty about leaving a doctor you feel uncomfortable with, or telling the referring doctor why you don't like the specialist to whom you were referred. I never took it personally if a patient left me, since my ego is not on the line, and I feel that the patient is (almost) always right.

    27) After you have given your spouse your medical opinion for the second time, you have been heard, and anything further is nagging. Many patients can't put into words why they don't follow their doctor's advice, let alone their spouses'. For instance, all smokers  know that smoking is unhealthy.

    28) I practice in an upscale community, and generally see teenagers for the first time at their pre-college physical. As a rule approximately 25% of female high school seniors have never seen a gynecologist. I refuse to sign off on their physical until they do so, because I firmly believe that a woman's first pelvic should be done by an experienced gynecologist, and not by  whoever happens to be serving as one at the college health clinic.

    29) We could avoid many vegetable-based epidemics, such as the recent E.Coli outbreak in Germany, if we irradiated all food in the warehouse to kill all possible germs (and parasites), but the public fear of radiation will never permit the politicians to pass such a law.

    30) You may or may not get lung cancer if you smoke  cigarettes, but I can guarantee that 100% of smokers will develop symptomatic emphysema and end their lives attached to an oxygen tank if they live long enough.

    31) Question: Should the better (and I leave the definition of and determination of such) doctor be allowed to charge more for his/her services? Neither Medicare nor the HMO's seem to think so, which is contrary to classical economic theory. Lawyers have absolutely no problem with the "better" lawyers (define them how you will) charging higher hourly fees, and this does follow classical American economic theory that the man with a better mousetrap should be allowed charge more for  his services.