Where do we go from hear?

Been providing excellent anesthesia care for over 30 years. That's over 60,000 hours. Malcolm Gladwell would call me an expert. It was pretty much one patient at a time. Some for many hours undergoing the most dangerous and serious procedures. I have patients lives in my hands. Unconscious, paralyzed, cut open and bleeding. I breathe life into them. I monitor and control there vital signs. Sometimes we stop the heart and bring it back to life hours later. Very dangerous business for them.

Who are they?  The are people like you and I who have been dealt a poor genetic profile or, more frequently, never really felt that looking after themselves. We are not totally to blame. The food industry does studies to see what we crave and it is three items; salt, sugar, and fat. They found the "bliss point"; that point with right combination that drives us wild. Areas of the brain that light up in a scan after ingesting sugar is the same pleasure sensors that light up for cocaine.  Almost all my patients have hypertension, arthritis, many with diabetes and coronary artery disease. Hypertension and diabetes contribute to kidney disease further worsening hypertension. I take care of patients with ongoing strokes helping to rip out clot from cerebral arteries.

Thirty years and it just doesn't seem to be letting up.  The costs are staggering: $2.8 Trillion in expenses in 2012, 18% of our GDP.   Most other developed countries only spend about 9 - 11% of their GDP.  Most of our cost go to maintaining chronic disease that are preventable and reversible. We have 10,000 people turning 65 every day. People are living longer. The fastest growing sector of our population is those over 85. That sounds great. But these people are not that well though well enough to continue on upwards of 19 or so medications.  Some interacting with each other as there is very little communication among prescribers. I see the biggest culprit resulting in emergency surgery in the form of the anticoagulants for prior stroke or atrial fibrillation (an irregular beating of the heart conducive of blood clot formation and stroke). Now we have anticoagulants that cannot be reversed very easily.  These patients bump their heads, bleed into their heads, and require emergency neurosurgery to evacuate the blood. Since we can't easily reverse these new anticoagulants that can hemorrhage during surgery. Ask your doctor about that when they want to prescribe Pradaxa.  About 150,000 people die each year of proper medical therapy. Proper is a still open for judgement. Sometimes we just don't know what proper is. As much as 100,000 due of medical mistakes as reported in the 1999 report To Err Is Human by the Institute of Medicine. Medicine is a very dangerous industry.   We a growing aging population the demands on already stressed unaffordable system will only escalate. Big Pharma wants it to stay that way. Medical device companies want it to stay that way. Hospitals, doctors, nurses want it to stay that way. Most if the doctors I talk to are convinced not much can be done. I disagree. We have a dysfunctional industry.  Though I have done my best and many of us physicians have, the system is dysfunctional. How we delivery care needs to be reworked. However, there is something we all can do to increase our chances of not only survival but to prosper and live long healthy productive enjoyable lives. Chronic disease is not inevitable. It is a product of our own growth, a product of modern times.   We know what we need to do. Yes, eat better with the correct fuel and in the right amount. We have become addicted to sugar. We need detoxification just like any other drug.  Let's get started

I am a turning point in my career. I always wanted to be a physician. I became a critical care expert, an anesthesiologist.  I take care of all patients with all sorts of diseases that are affected their survival everyday.   We are not in the business of healthcare. It is better described as "sick care". We will never survive as a happy prosperous competitive nation by waiting for disease to manifest itself. Most of these diseases are already in progress. Atherosclerosis has been found in children. Type 2 diabetes is also called adult-onset diabetes. But not any more.

We are starting to wake up. Sugar taxes on sugary is on the ballot in November in San Francisco.   I am not advocating for any one method but we need to reduce sugar in our children's diets. It is addictive. We are wired for sugar. Manufacturers have figured it out. They also have made it much cheaper with the government's assistance to the corn industry in the form of the worst culprit of them all, high fructose corn syrup. Liquid fructose, like heroin but a much slower debilitating death.

So, I plan to apply to UC Berkeley School of Public Health. I just love working so much I thought I would add another 20 hours or so to my week. At a cost as well. But I think it is that important. The medical profession needs to be provided the incentives to really encourage healthy habits. Society needs to support this. Our workforce is getting sicker and heavier.  The armed forces can't find enough recruits at a healthy weight. Our security will be threatened. Corporations are spending more and more on healthcare for a sick nonproductive workforce. They will sent labor overseas.  Without our health, nothing else matters.

Sleep, so important, yet so elusive

Sleep, many times a very elusive entity, is a problem for many in society.  I see patients everyday with sleep apnea.  I don't treat sleep apnea.  I am an anesthesiologist who deals, fortunately on a very short term basis, with all of the chronic debilitating disease of our way of life.  Aside from the usual manifestations of obstructive sleep apnea (OSA) such loud snoring, daytime somnolence, irritability which by the way can be deadly as sleep deprivation on the roads is at epidemic proportions, the long term consequences of OSA can be deadly. 

Sleep apnea most frequently is cause by repetitive episodes of complete obstruction of the airway during sleep.  It is frequently preceded by loud snoring (partial obstruction) that progressively gets less and less until there is no snoring (complete obstruction) for a period of time.  The individual has no idea this is happening.  Only their significant other know for sure.  After a variable period of apnea due to complete obstruction and no air movement (you need air movement to snore), the airway unobstructs itself fortunately allowing you to live yet another day of sleepiness and irritability.  This has destroyed many a marriage but that is not the real problem. 

During these periods of OSA which can happen many time per hour all night long day in and day out, the body's oxygenation level drops.  What that does to your brain is a whole other discussion.  There more common manifestations due to the repetitative stress of hypoxemia (low oxygen content) in the blood is high blood pressure.  Most people with obstructive sleep apnea have hypertension.  In fact, if the OSA is adequately treated, or better yet prevented, the high blood pressure frequently goes away.  Ultimately his high blood pressure will damage organs.  One of the vitals organs that can succumb to this repetitive stress is the heart.  Untreated sleep apnea can and will eventually lead to heart failure.

This epidemic of OSA is directly correlated to the epidemic in obesity in this country.  Obesity leads to obstructive sleep apnea.  Loss the weight and you will no doubt sleep much better and feel much better during the day.  If this sounds too familiar I encourage you to seek medical advice for this condition as it will result in chronic illness and an early demise.

You Are What You Eat

We put better gas in our cars than food in our bodies. Every general article on healthcare cost makes only a very brief mention of the role of prevention. Healthcare costs have steadily risen since the 80's. At $2.6 trillion dollars in 2010, it is 10 times what it was back then. 17.9% of our GDP goes to healthcare costs. New drugs and new medical technology, some of which is neither cost effective or very efficacious, are a major reason for the increase in costs. In our profit driven society, healthcare included, this is not going to slow down any time soon. 75% of our healthcare dollars goes to the treatment of chronic medical conditions such as heArt disease, hypertension, hypercholesteremia, diabetes, arthritis,and now, may we add a new one, obesity. These are primarily lifestyle associated diseases. These chronic illness are for the most part preventable. 75% of our 2.6 trillion dollars per year goes to treat preventable disease. This is only the money side of the crisis.

The third leading cause of death in the US (2002 data) behind heart disease and cancer is "medical care". Roughly a quarter of a million people per year die of medical care meant to alleviate our suffering and disease. Many of these deaths too are preventable through safeguards to prevent errors in care. However, roughly 106,000 patients die per year from appropriate care. These are bad reactions to drugs and procedures that are no one's fault. Call it had luck or whatever. Healthcare is risky business.

Having been in the profession as an anesthesiologist with cardiac anesthesia training, I have personally seen our population grow sideways. Diabetes, heart disease, hypertension, increased cholesterol are rampant. I calculate BMI's (body mass index, a measurement of obesity) on my patients that come to surgery and it is now rare to find a patient in the normal range of < 25kg/m-squared. Just the other day I met a 9 year old, 224 lbs and 5'1" with a BMI over 42 (greater than 40 is "morbid" obesity)
Obesity is a direct contributor to much of our chronic lifestyle diseases particularly type 2 diabetes, or so-called adult-onset diabetes. This adult-onset classification will no doubt need to be change as we are now seeing this is children. This type of diabetes is, itself, a direct cause of much of our chronic illness.

We live in a society driven by profit and at the present time, and for the past 40 years, unhealthy high animal-protein, high sugar food are the most profitable. We are what we eat. It we continue to consume such foods we will continue to increase the prevalence of chronic illness. Healthcare costs will continue to escalate. The will not only rise but they will exponentially increase as 10,000 baby boomers reach 65 years of age every day bringing with them all their maladies.

We need a major paradigm shift and the food industry itself is going to need to take the lead. Until we have support of industry it is virtually impossible to get our populous to change. We also need to change. We need to take more responsibility for our health. The healthcare profession is a risky industry. It also is a very profitable industry and very few players want it to change. Pharmaceutical companies do not want to cure anything. They want us to be dependent on their medications forever. Don't let anybody fool you. Few people do anything in this country if there is not a profit to be made.

We need to wake up. If we wait to long, most of our profit will be needed to pay for a sick malnourished, obese population. Our workforce will be very expensive to take care of. A company, a hospital though all companies will follow suit, refuses to hire people over a BMI of 35. That is 250 lbs, 5'10". Companies will increase outsourcing of labor to a healthier workforce. Unemployment will rise to levels not seen before. The only hope would be to label "obesity" a disability and then failure to hire based on it would be deemed illegal. What are we doing to ourselves.

When are we going to wake up. Look at the facts. I don't hear anyone really talking about this. Animal-based protein causes heart disease and many cancers. yes, this is a major paradigm shift. Yes, it may disrupt our economy temporarily. But not changing what we put in our bodies will destroy our economy. I have absolutely no doubt about that.

Chronic Disease is Preventable

"Obesity will crush the United States and we will fade in the rear view mirror in oblivion. We could have done something different. We should have done something different. We lacked the moral fiber and love for our children to do the right thing". (Weight of The Nation, part 3)


"What a tragedy, after all of these years of building up our healthcare in a circumstance where people are saved from premature disability and death, we can turn that all around. We can lose all of those gains. Do you want your children and your grandchildren to inherit a society where their hopes for a long and healthy life are not not even as good as your are? That can't be the right thing to do". ("The Weight of The Nation" HBO miniseries part 3)

We Need a Paradigm Shift

Great documentary on HBO, The Weight Of The Nation, about the obesity epidemic in this country.  The Bogalusa, AL obesity study followed children into adulthood from the early '70s. Unbelievable, very disconcerting. You think healthcare cost are expensive now, just wait. Almost 20% is children are obese. 70% of adults will become obese. The beginnings of atherosclerosis is being discovered in children as young as 5 years old. Adult-onset diabetes is not so much adult-onset anymore.

Obesity is the single most influential factor in the causation of the majority of our most prevalent chronic illness today: hypertension, diabetes, coronary artery disease, heart failure, sleep apnea, arthritis just to name a few. How are we going to put our nation on a diet?