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Causes of Death in the United States in 2012

When I first started doing annual physicals I sat down and looked at the top causes of death and then organized the counseling part of the physical around them: starting with heart disease and working down the list. I think of the annual physical as my opportunity to “MOM” patients and say “STOP DRINKING LIKE A FISH OR YOU GONNA DIE EARLY,” though perhaps with a little more diplomacy. Sometimes without much diplomacy at all.

The top ten causes of death in the United States in 2012 were heart disease, cancer, chronic lower respiratory diseases, stroke, unintentional injuries, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide.

http://www.cdc.gov/nchs/data/databriefs/db168.htm#which_population

This is 2,543,279 deaths in 2012.

Let’s take the causes one by one.

Heart disease: This is number one. 599,711 deaths. 23.6% of total deaths all ages both sexes in the US in 2012. So that is where I start when I do the counseling part of a physical.

Let’s review heart disease risk factors:
hypertension
high cholesterol
family history
diabetes
kidney failure
lack of exercise
tobacco
alcohol
smoking other things…
illegal drugs
stress
obeisity
As you might guess, this part of the discussion can use up a lot of the visit….

Cancer: All the cancer deaths together are 22.9% of the 2012 total.
We can screen for a few cancers: lung cancer is now the number one killer for both sexes. A chest xray is useless for screening. There is a certain population of current or former heavy smokers where a screening CT is useful. No, I do not recommend a “screening full body CT”, that is crap. Yes, lung cancers do get picked up randomly when we do a chest film for some other reason.
We can screen for breast cancer, colon cancers, look for skin cancers, the prostate cancer screen is a counseling nightmare and I don’t recommend a PSA but will do one if the person wants and other cancers pretty much we have to watch for symptoms….stop smoking, ok? That’s what causes 70% of the lung cancer and breast cancer used to be number one in women but smoking made lung cancer beat it out….
If you want details about any screening test, go to the US Preventative Task Force site:
http://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care

Chronic lower respiratory diseases at 5.6%: ok, smoking again. Emphysema and chronic obstructive pulmonary disease, AKA COPD. Asthma too. This article is fascinating, that third generation children of smokers in a polluted part of California are worse and have inherited genetic modifications than third generation children of non-smokers who live in a less polluted part of California. Lovely. I grew up in a two pack a day camel household and no wonder my lungs are tricky.

Stroke, also called CVA, cerebrovascular accident, at 5.1% and then there are TIAs, transient ischemic accidents, the stroke warning symptom.

What are the risk factors for stroke?
Oh, smoking of course
hypertension
high cholesterol
stress
lack of exercise
obeisity
blocked carotid arteries
blood clots
atrial fibrillation

Unintentional injuries at 5.3%, also known as accidents.

Deaths from prescription medicines taken correctly outstripped deaths by MVAs, motor vehicle accidents and guns in 2007. The CDC declared an epidemic of overdose deaths, but it’s just starting to creep into newspapers and public consciousness.

Here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm

The unintentional injury counseling list includes:
wear your seatbelt
don’t drive inebriated
don’t get in the car with inebriated drivers
check your smoke alarms
in the elderly, decrease fall risk. don’t stack stuff on the stairs.
wear a helmet if you bicycle motorcycle ATV rollarblade ski or invent some new way of getting on the Darwin list. Base jump, for example.
don’t take a lot of controlled prescription medicines or combine them with each other or combine them with alcohol: opiates with benzodiazepines with alcohol with ambien or sonata with barbituates and hello, the drug dealer is not your friend and tells lies: they are cutting the methamphetamines here with tricyclic antidepressants and barbituates and my long term cocaine addict patient was getting methamphetamines with benzodiazepines when he was paying for cocaine. Really.

Alzheimer’s at 3%

This is moving up the list. Fast. Everyone dies of something. Alzheimer’s patients live an average of seven years from diagnosis….And the recent article about Human Growth Hormone transmitting not only prions but Alzheimer’s is really interesting, implies an infectious cause.

Here: http://www.nature.com/news/autopsies-reveal-signs-of-alzheimer-s-in-growth-hormone-patients-1.18331

That was HGH from cadavers. I still would not take HGH made in a lab for “anti-aging” either. Nope, nope, nope.

We don’t know how to prevent Alzheimer’s but that is not the only cause of dementia and we’re still naming different kinds. Very frequently a brain CT or MRI says “decreased white matter” or “small vessel disease”, so there is a contribution from all of the heart and stroke risk factors that can do bad things to the brain with the top ones being: tobacco, alcohol, hypertension, high cholesterol, stress, lack of exercise, diabetes, illegal drugs, and so forth. Keep your brain active and busy.

Diabetes at 2.9%
Ok, it can make you more likely to have a heart attack. Also the biggest cause of blindness in US adults and the biggest cause of lower limb, yes, foot or leg amputation and the biggest cause of kidney failure in adults. Also if your legs are numb from uncontrolled diabetes, you don’t feel injuries and are less able to heal infections. And if blood sugar is high, there are lots of bacteria and especially staph and strep that LIKE high sugar.

influenza and pneumonia at 2.1%

Get Your Flu Shot. Really. And if you are 65 or older or you have tricky lungs or you have a tricky heart, get the pneumovax shot. The pneumovax protects against pneumococcal pneumonia ONLY, not all the colds or influenza or hemophilus influenza. And get your Tdap, because that stands for Tetnus, Diptheria, acellular Pertussis. Pertussis is whooping cough. It’s back. We’ve had three outbreaks in our county in five years. It kills babies under six months. They don’t whoop, they just stop breathing, apnea. Other people whoop, but even with antibiotics, they can cough for MONTHS. The flu shot usually gives 80% protection by two weeks after the shot. Only 80%, people say? Well, are you perfect?

Kidney disease at 1.8%

Causes: kidneys get worse as we age, for one thing.
diabetes
supplements and drugs: kidney failure is on the rise! Everything that we absorb and metabolize is metabolized by either the liver or the kidneys. Liver function can be perfect at age 100: that is, if it has not been trashed by alcohol, hepatitis B or C, drugs, supplements, mushrooms, whatever. Kidney function usually drops by age 80 and I am there calculating the function before I choose an antibiotic because you have to use lower doses in the over 80 crowd and the early kidney failure crowd. If you take ANY PILLS you should have a yearly test of your kidneys and liver function.
infection can hurt kidneys
inherited disorders

Suicide at 1.6%
40,600 deaths in the United States in 2013

Risk Factors http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html

Family history of suicide
Family history of child maltreatment
Previous suicide attempt(s)
History of mental disorders, particularly clinical depression
History of alcohol and substance abuse
Feelings of hopelessness
Impulsive or aggressive tendencies
Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)
Local epidemics of suicide
Isolation, a feeling of being cut off from other people
Barriers to accessing mental health treatment
Loss (relational, social, work, or financial)
Physical illness
Easy access to lethal methods
Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

And for those who want in depth information, 15 leading causes of death by state:
http://www.cdc.gov/nchs/nvss/mortality/lcwk9.htm

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small pirate

In September at the Wooden Boat Festival I went down to look at the boats. There was a square rigger with a pirate. A 22 foot square rigger with the largest sail about the size of a baby blanket. After we had exchanged introductions, Captain Jack explained that his grandfather had built the square rigger to play with his grandchildren and he has restored it. It has an outboard in the middle, well, an inboard outboard so to speak. I asked how it sailed and he said, “Downwind.” I asked about hull speed and currents and he replied “AAARRRR, don’t talk to me about current.” A small child came by towing parents and he handed a pirate toy over from a big gold chest.
Then another small child came up. Very small with red hair. He gave her a pirate flag, which she waved. But she still looked at the boat. “You can come aboard,” he said. He told dad to bring her. Dad stepped aboard with her and Captain Jack put a black bandanna hat with a skull and crossbones on her. Then she saw the swords. Cutlasses made of foam! She reached for one. “Go ahead, you can have a sword fight with your father!” IMG_20150913_131056
She did, with me and mom laughing. “Would you like to take the wheel, matey?” said Captain Jack. She nodded. She and dad went back in the very small wheelhouse and she practiced steering the squarerigger. “Me boat has been shanghied, I’d better escape!” said Captain Jack, stepping ashore and leaving her and dad in full possession. The small pirate was very serious the whole time. This seemed to be new territory and she was concentrating on all of it.
Captain jack told me that he came to the festival last year and got invited back. He was very pleased and towed his boat from the inland lake. Hooray for Captain Jack and for all of the boat owners and contributors to the Wooden Boat Festival that encourage the children to be involved and Joey Pipia and all of the play pirates….

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what I miss

what I miss after 8 years of divorce and 14 years of marriage is sleeping with a warm body not you but anyone after you fill the U-Haul and are surprised because you think that I am the packrat and all the stuff is mine but you have a piano and bicyles and a motorcycle and clothes and music and books and really you are one too, it’s just that I am worse and you drive away and I can’t sleep though really it did start before then we did over a year of couselling and I slept alone some and then kick you out and sleep alone more our daughter moves into the room across the hall up from the basement when you leave and in the middle of the night she comes up with me because you are gone to Colorado and now 6 years later she asks about it and I say you came in with me and she says she didn’t know that and would wonder why I would steal her in the middle of the night and I say I didn’t but as she is older and moves back two flights down to have that distance that one needs from a parent when one is in puberty and growing up and away and I wake at four am and now that same sex marriages are legal I wonder about buying an asian bride and then I would have a body a warm body to sleep with but it wouldn’t work and yes I miss sex too but not in the same way it’s the warm breath and heartbeat and movements and I am the monkey longing for a mother to cling to and I too make do with a pillow I could make a scarecrow for my bed a body not an inflatable too cold but something warm and I could put a watch in its chest an old one that ticked it doesn’t actually help to be in love because I am not sleeping with my love and that makes it all the worse I long for a warm body really no I long for my warm love this particular body and breath and heartbeat and I wake often longing for my warm love

the picture is my sister, who died in 2012 of breast cancer. I made her stuffed animals and puppets for years starting when we were little. I made the red eared puppet and bought her the puppet with legs that year….

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Introducing Fast Spider

This post is to introduce Fast Spider, a Scioness of Local Spiders in my area. Just a web on a car? Well, I would think that too, but it’s been built every day for the last month or more, so apparently Fast Spider likes the wind in her legs. That sounds racy, but there it is. I think that she must hide in a crevice when I turn the engine on. I am enjoying thinking about the sort of lady spider who would build her web daily on …. of course…. a Scion.

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Adverse Childhood Experiences 6: Reactivity

I hear people say, “Why is this person so reactive?” “They are suspicious.” “They just aren’t nice. Why can’t they be nice?”

When I get a new patient in clinic who is not friendly and looks suspicious at my questions and is not warm, I do not react. I assume that this person has been hurt and has a past that has a lot of dark in it.

Recently I was talking to a person about chronic pain. We were nearly out of time and I was describing Adverse Childhood Experience scores.

“I have the highest possible score,” he said.

I said, “I believe you.” and waited. He had my attention.

He did not want to tell me about it and he knew we were out of time. “I ran away to live on the streets when I was six.” he said flatly.

I said, “Yes, if things were that bad, I think you would have the highest possible score.”

That was the end of that visit. I gave him the link to the CDC website about ACE scores and studies and set up a follow up.

But think about that. He ran away at age six and lived on the streets. Not with a sibling or a parent or an adult. He was by himself.

He told me a little more on the second visit. I knew he could read. I pictured street classes under bridges. “How did you learn to read?” I asked.

“The authorities kept picking me up. I would run away from foster care as soon as they placed me. Usually the same day. When I was fifteen, a judge said “If you get your GED, I will emancipate you.” It took me a year and three months, but I got my GED.”

So is this your image of a street person? All losers? All crazy? This is a man who left because the street was safer than home and got a GED living on the streets.

He said, “My life has all been like that.”

I said, “Chronic pain is not exactly surprising then, is it?”

There is a song by The Devil Makes Three with this line: “I grew up fast and I grew up mean, there’s a thousand things inside my head I wish I ain’t seen. Now I just wander through a real bad dream, feeling like I’m coming apart at the seams.” That song speaks to me and speaks about the people who view the world with suspicion and fear and whose porcupine defensive spines are quickly raised if they feel threatened. I do well with them because I am the same way and I mostly don’t react to them. I don’t tell them to calm down. I don’t get scared or angry. I stay present and wait. And sometimes they will tell me what happened to them.

How can any of us blame an adult for their fearful terrible childhood? Instead we need to give them space and not reject them out of hand. All that does is reinforce the damage. I think that people can heal, but we must make room for them and behave ourselves and not react.

The photo is my daughter at the Wooden Boat Festival in 2009.

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Thank you for this

Oh Beloved

Oh thank you from my deepest being from all of me from every cell for this touch this kiss this day this cat this daughter this son this family this work this rose this farm box these vegetables tomatoes in my yard and deer outside the fence in town crossing at the crosswalk

the motor working the sailboat flying across the water my aunt laughing my uncle hanging the hammock up in the house the farmer’s market the panda trailer friends new bunnies who barely have fur and sniff at my alien scent in my hand teen bunnies who delight in celery patients and patience and enough

books a box from Wisconsin with a vintage suit fake fur collar and cuffs that unbutton and a woman in a wheelchair laughing when I show her the collar and cuffs and getting through another week and catching up on some of the paperwork a massage to look forward to music and song and a photograph of my father at 6 and my aunt at 3 and my great grandfather and great grandmother in about 1900, he was born in 1881 showing the photos to my daughter and my niece

physical delight that morning comes the wind in the sails of the boat hugs hands touching me and me touching the taste of the tomatoes blueberries a cream puff with whipped cream and strawberries soft cashmere yarn on sail in downtown and my daughter wants just the right hat knit of this yarn just so and it must not come down to her eyebrows we all laugh

loons mink crows raccoons deer a flock of cedar waxwings by the church who stop curious when I try to do their call cat fish frog nuthatches snapping turtle small bunnies

I am afraid to feel happy happy doesn’t stay I hold it away how can I be happy what disaster will strike next but little by little Oh Beloved I let the feeling rise and feel happy

Oh Beloved thank you for this and all

My photograph of common mergansers on Lake Matinenda, Ontario, Canada, 8/2015