If life teaches anything, it is that you really never know what to expect. I was buried in basically a coffin three feet under the snow with the temperature 55 degrees Fahrenheit below zero outside. Accompanying me in my grave like accommodations were two Inuit guides and another hunter all in pursuit of big Musk Ox.
We had arrived into the outpost community of Holman, high up in the Arctic a few days prior. We were quickly transported to the local “hotel” and given the hunting options. First, the easier of the two: hunting out of the hotel for not so wary Musk Ox. Option 2 was more of an experience: take a bone jarring trip in a wooden sled pulled behind a snow mobile in the sub-zero temperatures for about a hundred miles. Having selected option number two, we were informed that we would be staying the nights in small coffin like structures made of 4x8 sheets of plywood that are buried well beneath the snow and our food would be sparse. I believe the intention was to dissuade any and all comers from wanting to leave the “hotel” and its relative comfort. The Inuit guide almost fell out of his chair when I and one other hunter choose option 2. All the other hunters had already had enough of the weather just being transported from the plane to the “hotel” and apparently had no interest in braving the elements any further.
Our two Inuit guides were really excited that two southerners wanted to experience a true Arctic hunting adventure with them in a traditional manner. We had a fantastic hunt with now deeply rooted memories despite the brutally cold April temperatures. Both Musk Ox that we harvested made the record books no matter which book you go by. Sometimes, it is the hardships of the trip that make the fond memories but monster trophies don’t hurt either.
The odd and unexpected event was a conversation that occurred after all four of us finally were able to slide down the steep snow chute late that first evening that led into our nighttime coffin. After we all four squeezed into the cramped quarters alternating our sleeping bags head to toes, the other hunter asked what I did for a living. After telling him that I was a doctor that specialized in taking care for adults, he said, “Doc, what kind of things should I do to keep me healthy or have my doctor check to make sure I am OK? He only sees me or checks things when I go in and tell him I am sick?” Here way above magnetic north hunting the magnificent Musk Ox in some of the most brutal conditions the earth, sleeping way closer to any other grown male that I ever have in the past and my companion wants to talk medical and not hunting!
The first recommendation that came to my mind was to avoid being buried under the snow out in the wilderness with scant supplies, the temperature 55 degrees below zero and have no clue how to get back to where you came from but I refrained from that. I will spare you the hours of conversation that followed late into the night that delved deeply into his specific family history and medical issues. What we want to do in the space below is to broadly talk about preventative medicine.
The “health of the nation” is related to the health care of the nation. As such costs and policies are of significance. This is an election year in the USA and candidates from the city to the national level all feel the need to speak on the subject. You will hear a lot of words and it is important to understand what they really mean. Let’s start will one of the most common and that is “primary care”.
The aim of primary care is to prevent the development of disease and complications of disease. Primary care doctors naturally treat illness, but the push in the last 15 years toward primary care providers is really about prevention, especially chronic illnesses. Diabetes and hypertension are illustrative cases. By encouraging weight control, providing nutritional education and helping the patient develop an active lifestyle these diseases may be avoided (sometimes) or at least mitigated.
Now here is where the rubber meets the road. Each and every disease you can imagine as well as the ones you can’t has an advocacy group. Think about the Cancer society, Easter seals, etc. Each of these groups working with legitimate public health PhD’s and MD’s has an idealized primary prevention strategy. As well, the companies involved in the screening business (medical equipment, testing supplies) also have reasonable plans to prevent (or manage early) your illness. This leads to the unintended consequence; preventative medicine is expensive. Cost savings, if they exist, are long term. Remember that everyone who stops smoking will die from something and that will have health care costs as well.
This irony is not lost on us, so when you read the list below recognize that the goal is your individual health and well being. Now, we don’t fancy ourselves experts capable to solve the issues of the nation. Nearly forty years of combined practice experience has taught us a couple of things nonetheless. The cost of prevention is priceless if you are the person whose illness was either prevented or caught very early on. Basically if you are the one in a thousand than the cost to find that one case (your problem) seems perfectly worthwhile, yet to policy makers and the other nine hundred and ninety nine who share the cost burden may believe it to be an absurd expenditure. We as physicians took an oath to treat the patient and not deem what each person’s life is worth in dollars or to cost average per diagnosis. This maybe different from the practice you are involved with, but it represents an approach that has extended quality and quantity of life for real people in our practices. Each and every time a patient comes in regardless of the reason for the appointment, we have a check off list that makes sure everything below is up to date. So with that said, here we go.
1. Complete set of blood work (CBC, Complete Metabolic Profile, Thyroid function tests, Lipid/Cholesterol Profile and PSA for males over 40) and a urine analysis and an EKG once in your 20’s, twice in your 30’s, every other year in your 40’s and yearly after 50. Get your Blood Pressure checked and your cardiovascular system evaluated at these times as well. These time frames are based on the idea that all is well. If problems are discovered than individual time frames will be adjusted.
2. Women – Get your baseline mammogram at age 35, unless a strong family history suggests an earlier baseline is indicated. If all is well, typically start regular mammograms every year at age 40 and do self breast exams monthly. PAP smears should be done yearly. A Bone Density assessment should be done at age 50 or earlier if you have had a total Hysterectomy. If you have a very strong family history of Breast Cancer make sure you obtain the genetic testing that is available via simple blood work.
3. For everyone at age 40 consider getting a Coronary Calcium score every five years or so. This one test will pick up coronary plaques far earlier than any other test. See our previous article on Heart Disease or visit our website listed below. Remember that 50% of all deaths in the US have some type of cardiac related issue.
4. Make sure you personally inspect all your skin every few months and notify your doctor if you find anything new, especially if it is changing or different then your other funky spots. Demonstrate common sense with sun exposure.
5. Vaccines – Tetanus Booster (DPT) every ten years, Pneumovax every ten years after age 65 or otherwise prescribed by your doctor. Other vaccines that may be needed depend on your travel, life style and living conditions. Flu vaccination yearly.
6. Colonoscopy every ten years at age 50 unless you have a family history of Colon cancer or pre-malignant polyps. Then you may start as early as age forty. Don’t let concerns about the technical aspects of the test dissuade you from preventing cancer! With the new sedatives that are used, you will not feel nor remember a thing!
7. Simple Chest X-Ray and Pulmonary Function Test (PFT) every year if you smoke. We will catch a lot of flak for this recommendation but in 15 years of doing this, there has been only one of our patients who died of lung cancer out of eleven found and ten were caught early enough to have all ten of those patients alive and well because of early detection. Maybe this is luck and some real complex statistical analysis will make us feel real stupid, but we will get over it when we see the ten folks this year who are doing just fine. Some who smoke will develop Emphysema and the PFT will pick it up way before you notice shortness of breath.
8. Unless contraindicated, an aspirin a day for all males and females over the age of 40 will significantly reduce your risk of a heart attack, stroke and colon cancer.
9. A very high quality complete multi-vitamin/supplement per day has been recommended by numerous medical associations for all adults. None is better than Sportsmen’s Edge. The common ones we all know by heart provide only the minimal amount to prevent third world type illness and not enough of the good stuff to make a difference.
10. Everything listed above is general preventative medicine that should be followed by about everyone. Now if you have a significant family history for a particular disease process or you have a medical condition and/or taking some medications other testing/screening may be necessary over and above what is listed above and should be discussed with your doctor. Remember, all patients are individuals and should be examined and treated as such.
We hope this has been helpful. We receive emails questions regarding prevention and as well, others because one of the readers followed one of our suggestions and they picked up something early or avoided a catastrophe.
Be safe and enjoy the outdoors.