Tag Archives: pill

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Top ten causes of death, US, 2020, and doctor time pressure

https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

There is an article about US doctors, that primary care would have to work around the clock to apply all of the guidelines, here: https://news.uchicago.edu/story/primary-care-doctors-would-need-more-24-hours-day-provide-recommended-care.

Yes, but this is not new news. There was a trio of articles twenty years ago that said the same thing. And the guidelines have only expanded. Primary care is doing the same thing it has always done: what it can. Meanwhile we go to “Continuing Medical Education” and the other specialists ALL say we are not doing enough, we need to do more. Makes a woman cynical, don’t it?

Family Practice is a specialty, did you know that? We do a three year residency. Internal medicine is also three years, but many then “sub specialize” — further training in cardiology or rheumatology or nephrology, and etc. Sometimes we get a primary care doctor who doesn’t do the extra years but gets interested in something and they learn to subspecialize. We had a pulmonologist on the peninsula here, best I’ve worked with, who had not done the fellowship but learned it on the job. She was excellent and is now retired.

So you as a patient need to be aware of the top ten causes of death and do some thinking. Heart is still number one, in spite of Covid-19. All the cancer deaths are number two, but that’s only a fraction of the cancers. You want cancer screening, to pick it up before it is lethal. Pap smears, colon cancer screening, get your skin checked. Covid-19 is number three in 2020. Let’s look at the list.

US top ten causes of death, 2020.

  • Heart disease: 696,962
  • Cancer: 602,350
  • COVID-19: 350,831
  • Accidents (unintentional injuries): 200,955
  • Stroke (cerebrovascular diseases): 160,264
  • Chronic lower respiratory diseases: 152,657
  • Alzheimer’s disease: 134,242
  • Diabetes: 102,188
  • Influenza and pneumonia: 53,544
  • Nephritis, nephrotic syndrome, and nephrosis: 52,547

The list changes. What has fallen out of the top ten, since Covid-19 was not on the list back in 2019? “Intentional self-harm” aka suicide, was number ten in 2019.

Let’s go through the list one at a time and give you some basic tools and ideas about prevention, since your physician doesn’t have enough time to deal with all of it.

  1. Heart: The people who have not seen a doctor for twenty years, um, go see a doctor. If you have high blood pressure for twenty years, you will also have heart failure, which means pump failure. This is bad and will kill you. Check in at least every three to five years. In the US currently, you are a “new” patient after three years, so it’s best to show up just before that three year mark. Call ahead, everyone is short staffed. Check blood pressure, cholesterol and quit smoking (that includes pot, also bad for the heart), cocaine is very effective at trashing the heart, alcohol is bad for it, so is methamphetamines, and any other silly and stupid substance “overuse”. Kratom? Bad. Fake pot? Also bad. Turn off the tube or computer and go for a daily walk. Outside. Without headphones or earbuds. Try to figure out the bird noises, ok? Eat more vegetables. Don’t be stupid.
  2. Cancer: do the screening tests. Get the HPV vaccine for your children. Get pap smears. Use sun screen. Get your colonoscopy when you hit that age. Want to read about a screening test? Go to this site: https://uspreventiveservicestaskforce.org/uspstf/home . This is the clearing house for the current guidelines AND THEY CHANGE. They get updated. The vaccines are all here too. Get them.
  3. Covid-19. If you aren’t vaccinated then I don’t even want to talk to you, unless you are seriously immunosuppressed and your docs told you not to. Otherwise your brain has been taken over by non-scientist crazy whackos. IMHO.
  4. Accidents have been rising up the list and currently number one is opioid overuse deaths. Do not buy pills on the street because even if they claim to be oxycodone they may actually be fentanyl. The drug cartels aren’t so good at diluting the fentanyl enough to not kill you. If you are on prescribed opioids you should have a shot to reverse it (narcan shot or nasal spray) and your family or friends should know where it is and how to use it. Next is guns and cars. Guns should be locked up with the ammunition locked up separately when you are not working as a policemen or hunting a deer or rhinoceros. Cars should not be driven under the influence and hello seat belts. Oh, let’s see, wear your helmet on the bicycle, roller blades, e-bike, jet-skateboard or whatever. Wear a life jacket in the boat. Don’t point Axe towards your face and try to light the spray on fire.
  5. Stroke. This is all the same stuff as heart. And also Covid-19 increases your risk of stroke.
  6. Chronic lower respiratory disease: this is mostly caused by tobacco, tobacco, tobacco, marijuana, tobacco, asbestos, tobacco and woodsmoke or firefighting. Smoke is bad. Vapor is smoke, ok? See your doctor to get help quitting smoking. My father quit after 55 years of 2 packs a day of unfiltered Camels, so don’t tell me you can’t. Also it takes an average of 8 tries or so to quit. Yes you can.
  7. Alzheimer’s: keep your brain active, eyes are important, ears are important, eat those vegetables and if you live where I do, vitamin D in the winter.
  8. Diabetes: sweet drinks are bad. Fake sweet drinks are bad. A coke has 32 grams of carbohydrate. A Starbuck’s mocha 12 oz has 60. Quit drinking sweet drinks. Your goal is no more than 15 grams of sweetener a day. Now, what exactly is a carbohydrate? It’s anything edible that is not fat or protein. However, there are lots of very low carbohydrate vegetables out there. A cup of kale only has 8 grams of carbohydrate. Sweet peas and sugar beets have a lot more. Diabetics and everyone else should have at least half of every meal be vegetables, green and yellow and orange. Fruit is sweeter and all of the portion sizes (except kale) are less than you’d like to eat. Prevention is good.
  9. Influenza and pneumonia. Get your flu shot. There are two pneumonia shots and the first is given at age 65 and the second at 66. Except in people with heart or lung problems, then they get the vaccine early and repeat at 65 and 66. I think we are going to have a group of people who always mask on planes. I am one of them.
  10. Nephritis and etc. This is kidneys. What can affect your kidneys? Pills and illegal drugs, mostly. All pills that are absorbed are metabolized (which means broken down) by either the liver or the kidneys. Kidney function goes down slowly over a lifetime with age. We are seeing a huge rise in kidney problems because of too many pills. Yes, supplements too. Natural does not mean safe and what the heck is natural about a pill anyhow? Take as few pills as possible. Take ALL the pills to show your doctor. Ok, your doctor might be clueless about supplements. We had one person nearly hit the liver transplant stage until she showed my partner her supplement’s new label “Can affect the liver.” Holy cow. Should say “Can kill you.” So back to prevention: my baseline was that people should have blood lab basic testing every five years before age 50 and every three years after that if they were on NO PILLS. If they are on ANY pills, I recommend yearly testing. Did you know that the supplement companies can change what is in the pill at any time without telling you? Isn’t that reassuring? Heck no.
  11. There are still a long list of other causes of death. Liver disease, intentional self-harm, and on.

Since your doctor does not have time to think about all of this every time you stop by, it’s partly up to you. I don’t trust Dr. Google at all, but the sites I go to are the CDC, the Mayo Clinic, NIH, AAFP (American Academy of Family Practice). I look at lots of quack sites too, to see what is being sold, but I am not advertising them!

Be careful out there.

The photograph is Elwha watching the four point buck and wondering if it will eat him or not. From last week.

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Playlist: Inimitable

This for the Ragtag Daily Prompt: Inimitable and for the website that threw me out because I “did not explicitly violate the rules”. Yep, that’s right. I am thrown out for or in spite of not breaking the rules. Can you say witch hunt? Or scapegoat?

Oh, man, do I have a song list for the website. And will I name it? Nope. Why would I ever do that? I do have friends there and a mentor. This is not about them. This is about the witch hunters. I curse their tiny brains. And I miss my friends, who outnumber the whiners.

So let’s start with songs by the boys. I’ll do songs by the girls next.

Denial

Hank Williams III: Country Heroes

Bargaining

The Offspring: The kids aren’t allright

Anger

The Offspring: Get a Job

Acting Out

Hank Williams III: Pills I Took

Revenge

The Devil Makes Three: Ten Foot Tall

Grief

The Devil Makes Three: Old number 7

Acceptance

The Devil Makes Three: All Hail

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Microbiome Dating Service

You have been perfecting your health for years.

You know the antiaging regime and you follow it religiously.

You have read Jeffrey Bland. You have been tested for the mthfr mutation. You understand pandas. You have taken a functional medicine class and you’ve studied biochemistry in your local functional medicine group. You have reversed your autoimmune symptoms by a combination of the best from Dr. Ballantyne and Dr. Perlmutter. Your adrenal fatigue is gone. You have the pajamas that Dr. Oz says help most with sleep. You know your supplements backwards and forwards and have visited the clean green factories that make them.

You are healthy.

You are ready for the perfect relationship. But…. would you want to date someone who doesn’t take care of themselves? What if they don’t care? What if their bacteria invade YOU?

WELCOME TO THE MICROBIOME DATING SERVICE!

We will remove your fears and cares. All clients agree to a monthly detailed microbiome stool screen. You will date healthy people. If a screen fails, a client is notified and all dating partners are notified as well. Clients agree to EXCLUSIVE DATING with other healthy people, tested and monitored.

You are healthy. You want to stay that way. WELCOME TO THE MICROBIOME DATING SERVICE!

WE KEEP YOU SAFE.


http://www.nytimes.com/2013/05/19/magazine/say-hello-to-the-100-trillion-bacteria-that-make-up-your-microbiome.html?_r=1

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Deep Vein Thrombosis

Our clinic had a band back before 2009. Me and 4 of the nurses. We were into heavy metal. This was when I was working for Port Townsend Family Physicians. The county let me go and PTFP changed their name. Could not have been because we wore our band regalia to work, right? After all, it was Halloween.

Maybe they were afraid that the songs would catch on.

Little blue pill

Don’t code in the waiting room

Evidence based BM

Probiotics make you psychotic

Better that way

Alcohol is better than benzos

Mr. Sable is Unable

Buprenorphine: better n morphine

EMR means Eat My Rear

The 18 Patient Blues

Idaho Gigolo

I played flute and saw. J played fiddle and air siren. The others, well, you should ask them. I think all the tapes got burned by the hospital. Too bad, so sad.

I can’t credit the photographer. I don’t know who took it.

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P for prior authorization

The letter P and my theme is happy things. But what comes to mind are these P words: prior authorization,  pharmaceutical, payer.

Prior authorizations are NOT a happy thing. The latest twist from insurance companies, three different ones in the last week, is that they are requiring prior authorization for old inexpensive medicines. I ordered a muscle relaxant for night time only on Thursday last week for a person with a flare of back pain. Friday I was dismayed to see that the insurance company was requiring a prior authorization. I have to prioritize the order of urgency of all the work: I did not have time. I called the patient who had paid cash for it. The insurance company wins. They didn’t have to pay for a covered medicine because they made it difficult to get. They keep the patient’s money.

Prior authorizations are on the rise very rapidly. With over 800 insurance companies, each with a different website, each with multiple insurance “products”, no one can keep up with it. It is a shell game, the ball under the cup, three cups moving, but the ball is the money and it’s already palmed by the insurance companies. I predict that this will continue to get worse. We do need a single payer system for the simple reason that physicians will not be able to hire enough staff to learn and navigate 800 different websites. I do most prior authorizations on the phone in the room with the patient: the other day we spent 35 minutes on the phone only to have the insurance company say that we had called the wrong number. Call another one. Not the one on the insurance card. We could complain to the state insurance commissioner, but my patient is afraid of losing their insurance. Time’s up. The prior authorization is not obtained, and we are five minutes into the next patient’s visit. People are finding that the medicine they have taken for 20 years suddenly requires prior authorization.

And remember: prior authorization is your insurance company making rules and extra paperwork for your physician. It is advertised as a way to save money, but it costs YOU money. Back in 2009, the estimate was that physicians in the US had to spend 90,000$ per year EACH on employees to do prior authorizations by computer or phone. And YOUR insurance dollars go to the employees at the insurance company refusing medicines and dreaming up new medicines to refuse. They change the contract. Every year and during the year. The law is now that 80 cents of each dollar must go to healthcare, not profit, but those computer and phone employees are counted as healthcare. Do we really think that is healthcare?

Take CT scans. Medicare does NOT require prior authorization. But most insurance companies do. Think about that. Is age the difference? CT scans increase cancer risk over time so physicians don’t order them by reflex.

And for pharmaceuticals, insurance companies often have an on line formulary. But it is different for every insurance “product” in individual companies. A patient and I were trying to sort out a less expensive medicine on a website and we were having difficulty figuring out which insurance she had. Multiple abbreviations and color coding and we could spend the entire clinic visit just figuring it out. Is that what medicine is in the United States? You can say that someone else in the office could do it, but the more employees your physician hires, the less time the physician will spend with you, because he or she has to pay all of those people.

If there was one set of rules, one website, I would learn it. Medicare for all, single payer, when will the United States people wake up and tell congress: if you want our vote, make it so.

P

But wait, where are the happy things? I am so happy that I still am in business in my small clinic, p for patients and patience and prayer and single payer, we will have medicare for all in my lifetime. Whether I am still a practicing physician in the US at that time is uncertain. If I can’t afford my own health insurance, my clinic will close. Wouldn’t that be ironic?

 

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Vital signs II

Pain is not a vital sign anymore, as I described in yesterday’s post. I wrote this poem in 2006, about pain  being the fifth vital sign. I disagreed.

Vital signs II

Pain
Is now a vital sign
On a scale of 1:10
What is your pain?
The nurses document
Every shift

Why isn’t joy
a vital sign?

In the hospital
we do see joy

and pain

I want feeling cared for
to be a vital sign

My initial thought
is that it isn’t
because we can’t treat it

But that isn’t true

I have been brainwashed

We can’t treat it
with drugs

We measure pain
and are told to treat it
helpful pamphlets
sponsored by the pharmaceutical companies
have articles
from experts

Pain is under treated
by primary care
in the hospital
and there are all
these helpful medicines

I find
in my practice
that much of the pain
I see
cannot be treated
with narcotics
and responds better
to my ear

To have someone
really listen
and be curious
and be present
when the person
speaks

If feeling cared for
were a vital sign
imagine

Some people
I think
have almost never felt cared for
in their lives

They might say
I feel cared for 2 on a scale of 10

And what could the nurses do?

No pills to fix the problem

But perhaps
if that question
were followed by another

Is there anything we can do
to make you feel more cared for?

I wonder
if asking the question
is all we need

first draft 5/20/06

I took the photograph Friday afternoon from the beach: two fronts were meeting. What is that like in the sky? Do they fight or welcome each other?

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fraud in medicine: cow thymus guinea pig

We are making a change in clinic. We ask all new patients to bring ALL the pills they take. Prescription, vitamin, supplement. Most of them don’t. So now we are telling patients that they need to bring all pills or they will be rescheduled.

I want to know what my patients are taking. My town is a delightful spectrum mix from very conservative to very liberal and some libertarians thrown in. But I look at the ingredients of the bottles.

With prescription medicines, people will say “I am on metoprolol.”

“What strength?” I say, “And is it the short acting, middle or long acting?”

Some patients: “Uh…. it’s blue. It’s a small blue round pill.”

Eye rolling would be unprofessional. I pick the lowest dose and type in “unsure dose”. “Bring it next time.”

I examine vitamin bottles. Some contain multiple herbs as well as vitamins. Most people don’t seem aware of this. Sometimes people have four different vitamins with vitamin A in them. “The fat soluble vitamins A, D, E and K can build up in your tissues and people have managed to kill themselves. I would recommend you take less then you are taking.” And then there are the high dose vitamins: one with 3999% of the recommended daily allowance of vitamin A. Hello. Why is this being sold? I guess people have the right to take things that can kill them. But I wish they wouldn’t.

Supplements. I read the ingredients. One ingredient is cow thymus. “This has cow thymus in it.” I say. Medicine seems a bit vague on what the thymus does, though it is involved with myasthenia gravis: http://www.mayoclinic.org/diseases-conditions/myasthenia-gravis/multimedia/thymus-gland/img-20007802

“Oh.” says my patient.

“I am very unenthusiastic about taking cow thymus.” I say. “Unless you are working with a naturopath who has prescribed it for a compelling reason. Who prescribed it?”

“Uh, it’s not prescribed. It’s made by a good company.”

Right. Like I trust corporations. Scamming thieves and liars. Sell anything that isn’t nailed down in pill form. Including cow thymus.

My medical philosophy is as few pills as possible. Prescription, vitamin or supplement. Eat food, exercise, make friends, work well, be kind to yourself and others and avoid pills unless necessary. We don’t know how cow thymus and metoprolol interact. The FDA considers supplements to be natural, like a carrot. A pill is not a carrot. It doesn’t grow on a tree or in the ground. It has to be made by people. The supplement companies do not have to do any testing for medical safety and efficacy and I frankly hate the pills with multiple herbs in them. They have to use ingredients that are “generally recognized as safe” which is pretty lukewarm: http://www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/. Also, kidney failure is on the rise from too many pills. Everything is metabolized by either the kidneys or the liver and kidney failure is in the top ten causes of death in the US.

And I don’t want to be a guinea pig. I don’t want to be the personal home chemistry trial of cow thymus plus metoprolol. No way. And I will bet that you don’t want to be a personal home guinea pig either.

I took the photograph with a zoom lens looking down from the dock in Port Townsend Bay in 2014.