Health, Longevity, and a Few Select Digressions

One of the more pleasant aspects of my professional life is to read excellent medical journals and publications. I personally read, skim, or speed read quite a few; mostly in my own specialty of internal medicine. (And, yes, "Internal Medicine" IS a specialty. I have never liked the term "Primary Care Medicine", and I almost never use it. I consider it to be a meaningless non-medical term of economic convenience for those who do not know the essence of medicine.) It is fascinating to read in these terrific journals about new advances and better understanding of disease mechanisms. It is also gratifying to read reviews or validations about established concepts. I still read the hard copy print editions, preferring ink and paper; but just about all the journals are now accessible on the internet as well. Journal reading makes me a better physician, as it keeps my mind sharp and always open to new concepts. It helps make me a real internal medicine physician who constantly must ask himself and his colleagues not just WHAT disorder a patient might have, but also WHY the patient might have it. For example, it is not enough diagnose "hypertension", "asthma", or "stroke". A physician must constantly ask himself or herself "why does the patient have this or that?"; "why did it get worse?", etc. The journals I read set the tone and pace for me as I approach the mysteries of each patient.

I digress a bit now to state what might be obvious-- a journal editor sets the tone and pace of his or her journal. In my opinion, one of the best editors is Joseph Alpert, MD; Professor Of Medicine at The University Of Arizona College Of Medicine (in Tucson), and Editor-In-Chief of "The American Journal Of Medicine" (also affectionately known as "The Green Journal", because of its distinctive dark green cover). Always one of the foremost internal medicine journals, it is now better than ever; due in large part to Dr. Alpert's dedication to clinical matters, including the primacy of the history and physical examination as the cornerstone of all medical practice. Dr. Alpert also incorporates common sense into our complex world where bad science and unsubstantiated opinions frequently interfere with good science. I share with you now some words of wisdom from Dr. Alpert. In the July, 2008, issue of "The American Journal Of Medicine" (Vol 121, No. 7), his commentary piece includes "12 Guides To Health, Happiness, and Longevity...strategies to enable patients to live longer and feel happier during their journey to old age". In summary form, including now some of my own (EG) interspersed comments, this is what Dr. Alpert wrote: 1) Be aware that hereditary factors (ie "genes) DO influence health and longevity. 2) NEVER smoke! If you do, quit now. (Hard to imagine anything that contributes more to poor health and misery than does smoking. EG) 3) Exercise regularly. (Ideally 5-6 days per week. The exercises should include a variety of aerobic and resistance components, and should be enjoyable. The exercise should not be so intense that it leads to pain or exhaustion. For seniors, regularity of exercise is more important than intensity of exercise. EG) 4) Avoid extreme diets of any kind. (Good foods in moderation and in balance constitute the correct diet for every one. EG) 5) Eat a healthy diet, low in saturated (animal) fats and high in unsaturated and polyunsaturated fats; with 5-8 servings of fruits and vegetables each day. Hold back on "white carbohydrates" (ie sugar, white flour, white rice, white potatoes). 6) Don't get fat. It is okay to be a few pounds (and only a few pounds) over your ideal weight. If you are fifteen pounds or more over your ideal body weight, start a program of dieting and exercise. Consult your doctor or nutritionist about a reasonable program, and check out the reliable online resources on weight management and fitness. Avoid fad diets (See #4 & # 5). 7) Be moderate in your use of alcohol. Some studies have demonstrated improved longevity with moderate alcohol consumption. However, the benefit disappears after more than two drinks per day. So, drink moderately. Whether or not red wine is the healthiest form of alcohol to drink has not been definitely decided. 8) Periodically consult your doctor for preventive health measures such as cholesterol, blood sugar, blood pressure checks, cancer screenings, and flu vaccinations. If you are a woman, get Pap smears, mammograms, and bone density scans (as per your physician's recommendations that should take into account your individual circumstances. EG). 9 Cultivate family and friends. Enjoy conversation, dining, and recreation with people who you like (for example, your spouse). Spend as little time as possible with folks you don't like or who make you uncomfortable. 10) Cultivate an avocation that occurs away from your work day. For example, play a musical instrument alone or with someone; engage in sports such as golf or tennis; read interesting books; etc. If you can do this with someone you like (#9), so much the better. 11) Be informed, but try not to be overwhelmed by current events as portrayed by the popular media. "Yellow" journalism abounds. Most of the daily news is comprised of stories of murder, rape, terrorism, pollution, vandalism, and other acts of violence. Watch less televison; turn off the daily news; and become less fat in the process, as you will now have more time to exercise. 12) Do your best to avoid being irritated by the little things. Every one of us experiences small daily irritations that can eventually lead to surprising degrees of anger and depression. Try to put things in perspective. Words of wisdom, indeed, from Dr. Alpert, a superb physician-educator. And to Dr Alpert's thoughts, I take the liberty to add a few of my own: Enjoy life. Have a sense of purpose. Maintain your dignity. To the extent that you can, help others to do so as well. But, do not depend on the medical profession alone to bring these entities to you. Do not use medical resources either to prolong unnecessarily your time in this world, or to determine the exact time of your departure from this world to your entry into "the world to come". Or, put more bluntly: while it is reasonable to expect the medical profession to gain inspiration from the divine spirit of the universe, it is not proper to expect the medical profession to take on the role of the divine spirit-- that from which ultimately both life and death derive. Eli Goodman, MD

(This piece appeared several years ago on the senior citizens resource website: SilverPlanet.com.)