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Monday, March 2. 2020
Preventive medicine is expensive and, they say, not cost-effective but my life is not a statistic to me. I schedule it every 2 or 3 years. It's annoying and inconvenient, and leads to all sorts of annoying and inconvenient tests to make sure nothing (detectable) bad is going on anywhere. Do it in memory of my dear brother-in-law Uncle Bob, a very fit, skinny, strong athlete who dropped dead last year at age 59 on a treadmill. Avoided doctors for 30 years like an old-time Yankee. He would be alive today, still climbing the White Mountains, if anybody had known his cardiovascular situation. Never had any symptoms, and could run and climb like a monster. I remember our last run together on Cape Cod a couple of years ago. No way I could keep up.
My own doc admitted to me that he himself had not had a thorough physical for 6 years. Whatever. He's a serious athlete and presumably knows his body. He found a lump on me (harmless lipoma) and asked me if I had noticed it. "Nope," I replied. "I am not in the habit of caressing my body."
The only complaint I could come up with for him is my waking up between 1 and 2 in the morning with trouble getting back to sleep. Not to pee, just waking up with a head full of vivid memories and some sad or dark thoughts. Plus a little heartburn sometimes, especially with late suppers. He gave me some sleep meds which I have not used. Also, my darn traumatic right shoulder arthritis from sport accidents, which I do not plan to do anything about anytime soon (shoulder replacement? Not today, thank you, even though it makes handling a shotgun painful and awkward).
I do whatever he tells me to do because he will fire any patient who will not. He has a waiting list for new patients, like an exclusive club.
Besides the routine exam, he made me endure three separate sets of blood drawings, 2 full-body CAT scans (one with and one without contrast), Echo stress test, breathing test, Colonoscopy and Endoscopy, a Urologist consultation, and an Oncology consultation (cuz I had a sarcoma sliced out 15 years ago). That is called a thorough check-up but I put up with it all, somehow.
I am healthy and strong enough (passed his strength test - deadlifts by age and weight), with below-average body fat by caliper measure. Below-average body fat feels good because "average" is pudgy. Other than well-controlled blood pressure and triglycerides, I am good for now. Readers know I have a serious daily exercise regimen for what it's worth. Could get killed by a falling crane tomorrow.
What about y'all?
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Preventive medicine is expensive and, they say, not cost-effective.
Being dead is not cost effective. My late brother had "artistic differences" with his cardiologist and avoided checkups whenever possible. Went to sleep one night on vacation and never woke up, and had to be shipped home in a box. NOT cost effective.
I get regular checkups.
I am in good health.
I only go to the doctor when I am hurt. Oh wait. I kinda had a check up a couple of years ago. Was okay.
No serious exercise program. Just a little outdoor work everyday.
I avoid checkups for several reasons: 1. When you're on Medicare, all you get is a "Wellness Test" which basically consists of breathing on a mirror and if it fogs up, you're good to go. There is very little chance that my physician would actually find any life-threatening condition. All those screening tests that Bird Dog got are not Medicare approved, and the law forbids me from paying for them myself even if I wanted to. 2. I'm a pilot and, don't get annual checkups just on the off chance that the physician actually did find something that might end my flying days early.
I'm with you as to being o Medicare. There is a sign in my GP's office that says if you have more than one complaint it takes another appointment as they won't check you out for more than one thing at a time. Why bother to go in?
My doctor has the same policy. It's because Medicare pays them so little, they have to make it up on extra visits.
Medicare for everyone, anyone?
I get an annual physical because my firm pays me $300 to get an annual physical.
I know annual is 'too much' but if I get $300 to do it - then I'll do it. After all, the copay is only $20.
That said, I've found annual to be useful for 2 reasons.
1. If something is bothering me over the course of a year that's 'new', I can discuss it (I actually did have something this year which I felt was important enough to have them take a look).
2. If another family member has something, it's a good time to update my medical/family history. 2 years ago, my father told me he had an aortic anomaly that was genetic in nature and I should have it looked at. Indeed, I had it as well. Nothing to worry about, just something to pay attention to. In addition, over the last 3 years my brother had had his hips replaced and come down with adult onset diabetes. My sugar, despite the fact I do not eat sweets, has always been on the high side of 'normal' - 98-100. So it's good to know that's more genetic than due to poor eating habits.
Maybe Uncle Bob avoided the crane falling on him a week later.
I'm looking forward to dying in 14 years at work on the farm.
I love what I have been blessed with to do, helping to feed 50,000+/- people a day. Employing many fine people, and a couple sobs.
Looking at my father at 85 wishing he could die is nothing to look forward to either. He was a firm believer that doctors could fix things. But they can't fix who you are inside.
"I want to get a power chair to drive to the tractor" was truly the day he was no longer allowed to work. If you can't even walk to the rig, you're not going to be turned loose to place others at risk. He got a power chair at the Home and the rest of the residents are wondering what is wrong with him to give up walking for no reason. Use it or lose it.
My last physical was at Army induction, 45 years ago. Never had a flu shot. Amazed at the self healing ability of this body I walk around in. Longevity was never a goal of mine. Be right with God. We are in this world, not of it.
Let me add to get an vision checkup too. In my late 40's my eyesight went from excellent to needing reading glasses. This was normal. In my 60's slowly my eyesight got better and I didn't need glasses at all. Whoop, whoop! What I didn't know is I was developing glaucoma. Now in my mid 70's I began to notice that parts of my vision was missing in spots. Not terribly but still odd. My Ophthalmologist said I could have prevented that loss of eyesight if I had come in for a checkup. Not good!!
You are so right One Guy.
I haven't been to the eye doctor in 6 years and need to get back. Though I don't believe I have any problems, my mom has early glaucoma (as long as she takes her drops she will be okay) and Dad has the dry MCD.
I need to get back. Eye exams are important.
Skipping checkups is for young people. Find a good internist when you're still in robust health and stick with them (mine is presently Out of Network but worth it). They are generally more curious than a GP and know a lot more about how one's systems interact and regulate. The good ones have an expanded definition of 'normal' and can do a lot to help you, in your later years, enjoy a very long 'normalcy'. Treat your teeth and your eyes like a Cadillac with a Platinum warranty service level; they are not replaceable.
I never go. Life is too short to do doctors' appointments.
At an advanced age there's a large gathering of diseases waiting for you soon anyway, even if you were to beat one or two.
And time flies by.
Not to mention taking one regular drug leads to taking drugs for side effects of previous drugs. You avoid iiatrogenic effects.
If you're actually sick it's another matter.
Just had my annual physical with the Doc I've had for 35 years. He's retiring next month. He said I'm the healthiest guy he'll see all week. I follow his direction plus walk 4-5 miles per day. All labs were right where they should be and I tested out to be at least 10 years younger than my chronological age.
It pays to stay on top of things. Yo only get one life. Take care of it.
Last year, I had my first checkup in probably 30 years. Never had any health issues so I didn't see the point but I'm getting older (65 last year), so I thought it might not be a bad idea. Doc hears something with his stethoscope, sends me for an echo cardiogram and a month later, I had open heart surgery to replace a failing heart valve. A birth defect. Nobody ever noticed it before and if I hadn't done anything, I'd have had maybe three years to live.
So there's that.
Ivor Cummins of the Irish Heart Foundation makes a convincing case that the most important test you can get for heart disease is the Coronary Artery Calcium Score (CAC). It actually will show if you have progression of the disease even if you are able to pass stress tests the look clear, and it is cheap and easy.
CAC can be misleading in older male athletes and lead to unnecessary and sometimes dangerous testing.
I'm a pretty fit overall 62 year old; I get an annual check-up since work pays for it. A few years ago I asked my Dr about getting some cardiac tests; he asked me how far I had run the day before, and when I told him 8 miles he said "it would be a waste for you to have any tests, you're fine". I took his word for it, but now Bird Dog has me questioning that.
Just a few comments (from a physician who is skeptical of many in his profession):
1. I'm going to assume that by "preventive medicine" you mean a physical exam. We should all be doing preventive medicine - exercise, nutrition, proper sleep, avoid smoking/drugs, treat high blood pressure, etc. - every day. That's the only way it works.
2. RE Uncle Bob. That's something many people don't realize: a heart attack or sudden death are very often the first symptoms of cardiac disease.
3. In general, "sleep medicines" mask a problem - and may make it worse or create new ones (see Jordan Peterson) - rethaer than treating it. Handing out sleeping pills rather than finding and dealing with the problem correctly is effing lazy. See any of Shawn Stevenson's stuff on sleep for a good layman's presentation of how to deal with insomnia.
4. Without some real indication, I not sure why your doc subjected you to the radiation involved in a FULL BODY CT scan. Having a pulse is NOT an indication. A limited CT scan of the chest (lungs) would only be appropriate for someone with risk factors, e.g. smoking, for lung cancer. Are you sure he wasn't looking for a recurrence of your sarcoma?
5. Sadly, the same goes for much of what he made you endure. This is not a "thorough check up." It's what we call a wallet biopsy.
I had the same reaction to the TWO full-body CT scans. That's a lot of radiation, equal to something like 400 chest x-rays.
The only complaint I could come up with for him is my waking up between 1 and 2 in the morning with trouble getting back to sleep.
Me too. Five or six years ago in my late-50s I started taking 25mg Trazadone (50mg pill cut in half.) Problem solved.
It's the only drug I take. From what I understand Trazadone is one of the first antidepressants and while it didn't work well for its intended purpose, it does have the side effect of stopping waking up in the middle of the night and not being about to get back to sleep.
I'm guessing older folks waking up in the middle of the night has an evolutionary component: Night watchmen/women so the young, strong hunter/gatherers get uninterrupted rest.
After six weeks of brutal insomnia I took Ambien for some relief. Within four days I was paranoid, delusional, and suffering hallucinations. I believed I was on a Mission From God, and the forces of evil were conspiring against me. Worse, I had never felt so clear-headed, and certain in my life. I had absolutely no idea that anything was wrong. I came very near to ruining a project I had worked hard on for over two years, and destroying a friendship and a business partner. By the grace of God, I had a moment of clarity, and threw the pills away. I was able to patch up the damage with my friends. I got off lucky. Afterwards I read up on Ambien. There are nightmarish stories in abundance on the stuff. It is still the number one drug prescribed for insomnia.
on the sleep a suggestion (im a doc who has what i suspect you have, sleep maintenance insomnia):
when you wake up after 3-5 hrs of sleep, give in to it. go to a different room and read/pray/meditate--anything peaceful. at about the 1.5 hr wakefulness point, go back to bed and you'll likely be ready to fall asleep again within 20 minutes or so.
"1st sleep" and "2nd sleep" used to be common pre-industrially. works for many.
I moved and had to find a new doc. My husband lucked into a great one...an internist who really spends time with you. Have all kinds of fun tests lined up in the ensuing months. I just hit 50, so time for all that stuff. All of my complaints are small ones, but the doc took each one seriously. This is when I really need to be vigilant and see a doctor regularly so nothing gets out of hand. Now taking baby aspirin, as prescribed, every day. He also told me that my weight is 'fine' and that women are always too hard on themselves. That was a relief, as I hate getting on the scale, even though I usually know about where it will hit.
BD, don't rule out a fix for your shoulder arthritis. Last week my right shoulder was scoped, had to do the left one five years ago. Surgeon just removed some bone spurs, cleaned up some adhesions, etc.
Six weeks of pain and physical therapy, then more improvement over time. The left one was fine six months later, and quality of life much improved. Your case may be different, but the orthopod does a lot of similar cases on guys our age, the fit and active ones all recover very well.
I do an annual wellness check, and colonoscopy every five years, I'm fine with no regular medications at all.
"I do whatever he tells me to do because he will fire any patient who will not. He has a waiting list for new patients, like an exclusive club." Then you're an idiot. Trust but verify.