How to get fit and stay fit, twenty years later (part 4, medical care)

 AboutAnything  | Greg McComb

Years ago, a visit to your doctor's office was a bit scary, at least for me. Your doctor was  viewed as a person of reverence - almost priest-like - and highly respected in your community. They usually wore a rumpled-white coat and had a stethoscope drooped around their neck.  A small-rubber hammer was close-at-hand; soon your doctor would tap your knees to test your reflexes, a practice abandoned by all but a few doctors nowadays. 

    All-of-this is nothing like the photo above of a couple of smartly-dressed modern doctors, engaged in conversation while researching the latest medical findings on their laptop. 

   Back then, I'm talking about  the 1960's and 70's when I was a youngster, there were few resources for a patient to learn more about their disease or condition. Ill-informed, you showed up to your doctor's office with an ache, pain or cough, described your condition in an emotional narrative; and your doctor would  either prescribe some medicine, or consider checking you into a hospital for further observation and testing. 

  Those were simpler times, people smoked and thought it was okay, and there were only a handful of medications for common conditions like heart disease or ulcers, most pretty ineffective. 

            Medical advancements....but

  Fast forward to 2024. Things have changed a lot; mostly for the better. Over the past 50 years, new-effective medicines and treatments have been developed for a host of common diseases like high blood pressure, plaque build-up in arteries that lead to heart attacks,

 ulcers, arthritis and numerous breakthroughs for the treatment of cancer. Only a few years ago, a cure was discovered for Hepatitis C, a debilitating disease that slowly dissolves your liver. Herbal mediations also became more widely used, a common sight on pharmacy shelves. On top of that, detailed-medical information on any disease or condition is readily available on the Internet, at peer-reviewed databases like Medline.  

    As medical care improved, life expectancy increased in lock-step, helped along by improvements to our environment - cleaner smog-free air, and a rapid decline in smoking.  In 1960, people lived to around seventy years-old whereas today, people in most developed countries are active in their 70's and are expected to live well into their eighties. Just take a look at 81-year-old Paul McCartney, still performing decades after the Beatles broke up. 

     Despite all these advancements, I sense that a lot of people have trouble accessing proper medical care. I should know, I was one of them. For years, I suffered with undiagnosed high-blood pressure. Overweight, in my mid-40's and with a history of heart disease, I was at risk: all my grandparents suffered from either strokes or heart attacks in their sixties or early

seventies. A successful Winnipeg businessman, my grandfather Frank McComb (see left) was hobbled by a severe stroke in his sixties and lost all his businesses, a successful clothing store and stable of race horses. A tragic story.   

   I also had other conditions I knew little about: a persistent cough, what was initially diagnosed as a mild form of asthma. I  coughed a lot- especially during flu season- and took over-the-counter cough syrups for years. Not very effective. Didn't help much. I also smoked a bit, casually...very addictive, very stupid habit that made my coughing worse.

  On top of all that,  I had difficulty sleeping for more than a few hours a night. Insomnia; a common condition. After a night of tossing-and-turning, I awoke feeling unrefreshed, restless and cranky. I often needed to nap in the afternoons to make up for my sleep deficit. (I'll talk about this condition more in a separate blog on the importance of sleep and rest).

           Back to the 'Fitness Pie'

  So, in my early forties I was essentially a medical basket-case. As I made early attempts to get my weight-under-control and exercise, there was a parallel story about my struggles with high-blood pressure, a persistent cough and insomnia. My argument is that solving those medical issues are just as important to fitness as diet and exercise. As the arrows in the pie chart suggests, many aspects of your fitness are interrelated. Not enough sleep and your mental health suffers. In my view, quality medical care is a little different; it's an overarching part of your wellbeing. If you don't have that, nothing else matters...

Consider this general scenario: someone in their thirties has worked hard at eating a healthy diet with lean meat, fruit, vegetables and grains; and are walking 8,000 steps-a-day, excellent life-extending cardio. Meanwhile, unbeknownst to you, a serious medical condition is lurking...it could be high-blood pressure like mine, or diabetes or the early stages of arthritis, all treatable with modern medicine. So, you may think you're fit, but you really aren't. 

   One problem with this hypothetical person is they haven't bothered to go to the doctor for a check-up. Why should they? In your mid-thirties or early forties, risk is low....isn't it?

    Not really...

    Although disease risk is lower when you are younger, health professionals still recommend you start regular doctor visits and blood workups as early as thirty. Unfortunately, people are busy with families and careers at this age, and often don't bother. When do they have time in-between picking up their children at daycare or school, working overtime to boost their careers; or cooking family suppers?

                          -------------

    In this blog, the fourth in this series - I will start with a case study on how I eventually got my health conditions under control: my blood pressure and asthma -- and how I stopped smoking.....for good. My journey to better medical care. Like my other blogs, this will be a 'warts-and-all' overview: I  had several false starts and will talk about these. 

   Next, I will provide personalized 'tips' or best practices I've learned over the past twenty years.  Similar to my blog on resistance exercises, I'll list a series of things you can do to get the best medical care. 

   So, let's get started.

    My medical history: warts-and-all

    I first learned I had high-blood pressure (or hypertension) when a nurse took my reading during a routine test for life insurance, back in the year 2000.

While my wife passed with flying colors, the nurse looked a bit shocked when she took mine. Back then, I knew little about blood pressure, what it was and why I should be concerned. I just knew that something was wrong. 

     As a first step, I read about the condition and bought a blood pressure monitor from a drugstore, one you self-administer; it wraps around your wrist. I periodically checked my levels and they were persistently high, well above the normal range of 120 over 80, sometimes 20 or 30 points. Especially on days when I was stressed, a key trigger for hypertension. I tried to bring those numbers down naturally, eating less salt and drinking less caffeine but none of that worked. I found it very difficult to reduce stress and I will talk about this in another blog on mental wellness. 

  I also sought out treatment from a doctor. Due to a doctor shortage in Canada, I had to wait several months for an appointment. During my first visit, the physician didn't prescribe any medication even though, as discussed, there are plenty of effective treatments for high-blood pressure, most with few side effects. Not sure why. Perhaps he thought my high readings were caused by the white-coat effect. 

   Time passed, I was concerned about my health but thought I would be okay. Other issues around work and family clouded my judgement. I experienced few symptoms for my hypertension; that's why it's nicknamed the silent killer.

              New 'pro-drug' doctor

   Fast forward several years, I needed to see a doctor sooner-rather-than-later because of a cough. I missed a few days of work because of a flu, returned to work, then missed more work because a bad cough would persist for weeks. In an act of desperation, I scanned

the internet  'yellow pages' and  landed an appointment with a physician in downtown Ottawa...the next day.  That doctor specialized in men's issues like low-testosterone and prostrate cancer. I guess he had only one gender to deal with, so his calendar wasn't booked solid. As I would soon learn, he was also 'pro-drug:' he was quick to prescribe medication after he made a similarly speedy diagnoses. A little like the actor Hugh Laurie in the tv series House MD. 

    Back to the examination. Although I wanted treatment for my cough, the doctor routinely took my blood pressure; and had the same shocked look on his face as the insurance nurse. Unlike the first doctor, he acted quickly and prescribed Hyzaar, a combination medication. One ingredient Losartan works by relaxing the walls of your blood vessels so they don't narrow.  A second is an old-fashioned 'water pill' that reduces salt absorption, so you retain less fluid. With less blood, there is less pressure on your artery walls. 

   Whatever the mechanisms, Hyzaar worked... Within a week or two, my blood pressure pulled back to normal or near-normal levels, 120 over 80. No side effects. Got very lucky. I've been on Losartan for over twenty years, and it continues to work.  The only glitch was recently, a few years into retirement. Without the day-to-day grind of family and work, my stress levels dropped and so did my blood pressure. Working with my current doctor, I halved the dosage, and my readings returned to normal.

  Oh yes, one other thing. I have retired to the 

Caribbean and really enjoy an expresso-latte on the beach,(see left) especially during my morning walks. Coffee served this way is chocked full of caffeine, and can get my heart racing and blood pressure pumping. As someone at risk, I know I shouldn't drink this wonderful concoction, but I see this dark-coffee as a necessary evil, a great joy. So, I continue to drink and check my blood pressure regularly using my wrist monitor. Too much coffee and my blood pressure goes north of 130, and know I have to stop...for a few days. 

              My asthma diagnoses

   So, back to my persistent cough, the reason I went to the 'pro-drug' doctor in the first place. During this first appointment, I described my coughing symptoms, and he made a quick diagnosis: I had asthma and prescribed a puffer that dilates

 your bronchi allowing you to breathe freely, (the blue kind, left). 

   I have a sharp memory of the doctor demonstrating how to use it. He stood up, blew out strongly a little like the wolf in the children's story "Three Little Pigs." Then he gripped the inhaler-opening with his lips, depressed the top and sucked the mist in with an equal amount of force.  All of this shocked me; the performance just a bit, but more so the label: I was now an asthmatic. I switched doctors a few years later, and the new one refined my diagnosis; I was now someone with non-exertional  asthma, the less-severe type. I just coughed a lot during flu season, but didn't

lose my breath when exercising. The latter is the serious kind that children have; they often wheeze and lose their breath during serious asthma attacks.   

   The so-called blue inhaler worked for several years, but lost it's effectiveness over time. When I started working as a health economist, one of my colleagues with asthma told me to switch to the orange inhaler; it has a steroid and reduces inflammation. This worked even better and I eventually quit using inhalers; except on rare occasions when I  have flare-ups. 

                         Quit smoking

    I also quit smoking around this time, an incredibly addictive habit; and this helped reduce my coughing. Along with coughing, smoking causes a myriad of other health problems including lung cancer, a weakened

immune system that hampers your ability to fight off disease, a greater risk of heart attack and stroke, and wrinkly skin. Yuk! Which is why I warn people off smoking; yeah, I'm that annoying guy that does that. You can't call yourself fit if you smoke.

    It took me several attempts (and years) to quit smoking; the cravings for nicotine were so powerful I would relapse. There were two keys. The most important was to really want to quit, to have the force-of-will. Without this, you're not going anywhere. The second was to use an over-the-counter drug, Nicorette. I used the gum not the patch and it really worked to dampen those cravings.

  A few months after I quit, I would often dream about smoking, kind of weird side-effect. Years later, I look back at how bad this habit was and how it compromised my health, and made me feel sick. I wonder why I ever started, especially when I sneak a few puffs at a party and start hacking. 

              Regular blood tests

  Over the years, I met with doctors regularly, and at least once-a-year for a general physical and blood workup. I found the results of the blood tests particularly useful, and I would listen carefully

to what my doctor would say, especially when talking about anomalous results. For one test, my calcium levels were low and my doctor asked whether I was eating enough cheese or drinking milk. I wasn't, I was cutting back on these high-fat foods as part of a diet. To get more calcium in my system, I started eating more cheese (the expensive older stuff) and drank a bit more milk. It's little known that calcium deficiency not only weakens your bones; it can also weaken teeth and eyesight. Yeah, you need strong bones to be fit. Muscles aren't everything.

                           Statin fail

  Another important finding from my annual blood tests was that my cholesterol levels were elevated, not a ton but enough to be of concern.  That made sense; I have a family history of heart disease which means my arteries naturally load-up with plaque, the type that can lead to coronary artery bypass surgery. Although there's some debate, it's generally accepted in the medical community that plaque build-up is caused by high cholesteral.  

  My 'pro-drug' doctor was the first to notice this result in one of my blood tests; and he prescribed a statin, a popular class of drugs used by around 200 million people worldwide to lower

cholesterol. The drug worked well: subsequent blood tests showed my cholesterol levels dropped to within a normal range, less than 200 mg/deciliter. My doctor liked this but I didn't. The reason I didn't like it was that I was one of the rare patients who experiences major side effects from taking statins. I was getting a bit of nausea but more noticeably I had muscle pain; fairly severe in the arches of my feet. As a result, I had trouble walking....so I took myself off the drug, after trying it for about two months. It took about a month after that before I returned to normal; and I could get back to walking my 8,000 paces-a-day. 

     Over the next year, I even tried statins at a lower dose but still experienced side effects. Working with my doctors, we decided to treat my high cholesterol through diet and exercise, mainly diet. Lowering the amount of fatty and greasy foods - like fried chicken and butter  - kept my levels in check, although they're still a touch high. Not a fan of greasy foods anyways. Better this, than limping along during my morning walks....  

       Naturopathy and the sickness debate

     Although this blog talks mostly about 'standard' medical care  - doctor visits and drugs - there is growing dissent to this model of care. The most vocal are people who

promote or practice naturopathy. I actually like (most of) their approach: instead of focusing on sickness or disease and ways to treat it with the latest drugs or surgery, their philosophy is one of prevention. To use their own words, "naturopathy supports a person to live a healthy lifestyle...a healthy diet, clean fresh water, sunlight, exercise and stress management." (click for reference). This is essentially what I advocate for; an approach to fitness or health that is well-rounded and includes a healthy diet, exercise (cardio and resistance) as well as medical care and mental well-being. I certainly don't think that living a sedentary life and eating fast food; (like so many North Americans) then taking drugs when you get sick is the way to go. Prevention is key.

  Where I depart from naturopaths is their views on modern medical care and the education, research and testing that supports it.  As a health economist, I managed a

research project called the New Drug Pipeline Monitor (see left) that reviewed ongoing clinical trials for new drugs. All drugs go through rigorous double-blind trials that can last ten years, and cover three phases from discovery to approval by a regulatory agency like the U.S. Federal Drug Agency. In my view, naturopaths' emphasis on herbal and other 'natural' treatments aren't sufficient to treat severe or chronic diseases like arthritis, hepatitis C, cancer or high-blood pressure. To treat these diseases, you need modern medicine that has gone through rigorous testing. 

    The same goes for a naturopath practitioner, a course that lasts a few years compared to a doctor, who is screened in with an A-or-better average in pre-med school, four years of medical school and three to seven years of residency at a hospital. As discussed, it's better to listen to counsel from a doctor with his advanced education and suite of treatments and tests, than a naturopath practitioner, with a course of only a few years. In my view, the key is developing an informed relationship with your doctor and researching and understanding whatever disease afflicts you. The next section will deal with this.

                Tips for better medical care

   In this section, I will provide a series of tips on how to get better medical care. These tips will draw on my personal experience over the past twenty years, things I've talked about in the first part of this blog. 

  So, let's get started: 

      1) Get a doctor, not so easy

     If I've learned anything over the past two decades, it's that you need to have regular

 checkups with your doctor, along with blood workups at least once-a-year.  Don't wait until you're old-and-sick, start regular checkups in your twenties. 

     To do this, you first-of-all need to find a doctor, not an easy task in a country like Canada with an acute shortage. This may be a project in itself: I had a friend who was on a waiting list for  years and after making numerous inquiries, found they had lost her name. Bureaucratic bungle. Numerous-harried phone calls over several months, pleading that she had a child with a chronic condition that needed attention -- and she landed an M.D.  I finally got lucky with a men's doctor who had a short patient list, after a search that lasted several years. So, persistence is the key. Just keep on trying. 

  Situations in other countries may differ but the key is to get a doctor, a general practitioner  (G.P). Without asking, your doctor will create a file with all your tests and their notes.   That's your medical history, very important. 

      2) Don't talk about misinformation

   Now that you have a doctor, it's important to  cultivate a long-term relationship, a bit-of-a challenge. 

 Especially in these times when there is so much misinformation seemingly everywhere: in social media posts, websites run by conspiracy theorists and endless replies and rants to websites run by who-knows-whom. This started before the pandemic but the social isolation caused by all the lockdowns only amplified this trend. I get this... Everyone went a little nuts during the pandemic, myself included. So, the worst thing you could do during a doctor appointment is to rant or argue about health misinformation gleaned from the Internet. Won't win you any brownie points...don't do this.

           3) Ignore hard-sell of new drugs

   A second challenge is how aggressively the pharmaceutical industry promotes new drugs: on TV with sophisticated ads, and with direct sales pitches to influential doctors. In the U.S,

pharmaceutical drugs made up half of new TV ads in the first half of 2023, while numerous movies including Pain Hustlers have dramatized the lives of drug sales reps; this one a rags-to-riches story starring  Emily Blunt as a struggling-single mom.  

   

    So, what-not-to-do: don't show up to your doctor's office with the sole-purpose of getting a prescription for a new drug you've seen on TV, or read about in the news. Many of these ads are very convincing, but drugs aren't like a breakfast cereal or the latest smartphone; one-size-fits-all. The drug you have been persuaded to want-and-need may not be suited to the complexities of your specific disease or condition... 

          4) Be patient with your diagnosis

   ...That's your doctor's job, to diagnose your disease -- through a detailed patient interview, blood tests or other diagnostic tools. And then your doctor will prescribe a treatment,  and monitor how that treatment works, intensely

over the first few months and then over the long-term. That treatment will likely involve a combination of several things such as specific changes to your diet or exercise, self-testing like monitoring blood sugar levels or blood pressure -- on top of whatever medications are prescribed, if any-at-all. Most doctors try 'natural' treatments like changes to diet and exercise first before prescribing a drug. And buckle-your-seatbelt...most diagnosis are definitely not quick-and-dirty. It may take months or even years - and visits to several specialists - before your G.P. is able to pinpoint what it is that afflicts you. My personal-case studies on blood pressure, statins and asthma are pretty typical of how long it takes. Patience is the key, along with persistence. 

      5) Do your research, the real kind

   So, I've talked a lot about what sort of information you should not take to your doctor's office: misinformation from conspiracy websites or by parroting claims made in persuasive drug commercials.  

  But should you do any research about whatever disease afflicts you? Some say no, your doctor is-in-charge and he knows best. After all, he's got the advanced degree, white

coat, stethoscope and years of experience diagnosing patients. Keep quiet and listen to a higher authority.  

   I don't agree with this. I think it's a good idea to do some research before your doctor appointment. In short, be prepared...don't blather on about whatever ache or pain you have. Scan some reputable websites, carefully make-a-list of your symptoms and make a best-guess about what you-think you have. This helps...really.  

   Despite their advanced knowledge, your doctor is a busy person: my last G.P. handled more than a thousand patients-a-year in a series of fifteen-minute appointments. Not a lot of time to make a preliminary diagnosis. Your research will give them a head start. 

  Let me give you an example. Years ago, I returned from a vacation in the Caribbean with strange symptoms: nausea, red splotches on my arms and legs, and hot-cold-reversal. Yeah,

really strange. Several family members had the same thing. After scanning numerous reputable websites, and talking to my siblings; I made a guess that we had ciguatera fish poisoning. We all ate barracuda at a family dinner, and the online literature pointed to this higher-order reef fish: it concentrates this nerve toxin in its tissues.

 I can still remember that appointment, although it was a decade ago. At the start, I apologized and told my doctor I was going to attempt to diagnose my sickness using information I had found on the Internet. He laughed, pulled out his Ipad and after a brief search of a medical database, agreed with me. 

 

    Unfortunately, there is no treatment for ciguatera except for time. It normally takes about three months for the nerve toxin to clear

your system, and that's about how long it took. The only recommended change is to diet: abstain from alcohol, it's a trigger for ciguatera nausea. A regular pub goer, I switched to the 'medicinal' beer Guinness for several months and this kept my nausea within manageable levels.

   So, I've used the word 'reputable' to describe the websites I access for medical information, and warned you off conspiracy websites and drug commercials. So, what are reputable websites? There is no acid test but I always look for information from well-known and respected institutions. One of my favorites is the Mayo Clinic, it's one of the top-ranked hospitals in the United States. They also host a searchable website with concise information on just about any disease or condition. For this example on high cholesterol, the Mayo Clinic provided detailed information on causes, risk factors, prevention, diagnosis and treatment. 

  A similar searchable-website is hosted by the Centers for Disease Control and Prevention, known more commonly by its acronym, the

CDC. The CDC is research-based institute that takes a lead on health 'scares' like the pandemic and other diseases that could spread quickly, and put the population at risk. For this example, I did a search for high blood pressure and it provided information similar to the Mayo Clinic, outlining symptoms and causes. 

  If you feel like rolling up your sleeves and digging deeper into data and studies, the National Library of Medicine hosts a searchable database of journal articles and books called PubMed. I would warn the output from these searches is quite technical, not for the faint of heart. However, if you have been diagnosed with a disease and you want to learn more about it, these searches will let you know about ongoing research in the medical community. 

  So, that's about it for part 4, medical care. Part 5 will cover the topic of 'sleep and rest' and its importance in overall fitness.