Monthly Archives: April 2011

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More About Pros And Cons

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Last time I spoke about listing your pros & cons whenever you are considering changing one of your behaviors, whether it’s smoking, losing weight, or starting an exercise program.  I thought an example might be helpful, so here is such a list regarding following a weight loss program that includes healthier eating and exercise components.  It’s very similar to the one I used after my heart attack and cardiac arrest to help me make the changes necessary to live a healthier life.

Pros Cons
I’ll probably have more energy. I’ll have to limit what I eat.
I’ll look better – slimmer. I’ll have to limit the amount of food I eat – measure my portions.
It will help control my blood pressure & cholesterol. I’ll have to find time in my daily routine to exercise at least 4-5 times a week.
It will decrease my risk for heart disease. I’ll have to read food labels when I shop.
I’ll feel proud of making such a change.  
It will decrease the strain on my knees.  They probably won’t hurt as much.  

When I first wrote these I used “It would” instead of “It will” and “I’d” instead of”I’ll.”  It may be subtle, but using “will” gives it a more positive tone, a tone of commitment.  As you can see, there are more reasons to start a weight loss program than not.  In addition, the value of the Pros far outweighs the inconvenience and effort represented by the Cons.  In this list the Pros are greater than the Cons in quality as well as in quantity.

In my next post, I’ll talk about listing the barriers to the successful implementation of your plan along with what you’ll do to overcome them. 

For Your Health – Dr. Bob

When To Get Care

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In a previous post I talked about how by listening to my symptoms and going to my doctor, I saved my life.  This time I’ll talk about what to consider when new symptoms occur to help you decide whether to call your doctor or not.

First of all, though a physician, I am not practicing medicine or giving medical advice on this blog.  I am providing some insights as to what to consider in this and other health care decisions.

So what should you think about if you start having a new symptom?  First of all, think about whether it could affect your survival, either directly or indirectly.   If you are having trouble breathing or having chest pain that could be due to your heart, your survival could be directly at risk.  Similarly, if you lose consciousness even briefly, your life (or the lives of others) could be indirectly at risk. Clearly, passing out while driving could result in a fatal accident.

Other considerations are the severity and duration of symptoms. Very severe symptoms could require a call to 911 no matter how brief the duration of those symptoms  Pain in your head, chest or abdomen that prevents you from carrying out your usual activities should prompt you to call your physician.  Often symptoms will get better on their own. But persistent symptoms, even if they occur off and on, should be evaluated by your physician. If the symptom quickly passed, it still makes sense to contact your doctor, especially if you are older or have some other chronic condition.  Certain chronic conditions such as diabetes, chronic lung disease and heart disease can raise the risks of having other illnesses but can also worsen when other illnesses occur.  If you have any questions, you should contact your doctor.  Even if it is the weekend or after hours, your doctor or one of his associates will be on call to respond to these sudden situations.  While it is true your doctor’s associate won’t know you as well as your own physician, they can handle these kinds of situations very expertly and advise you what to do next.  Not only that, they may have access to your medical record and may be able to contact your own physician to get specific details of your history.

In my next post, I’ll talk about when to contact your physician for worsening symptoms.

For Your health – Dr. Bob

Pros And Cons

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As you identify your motivations for changing your habits of eating and exercise in order to lose weight, listing the pros and cons of making the changes can be helpful. This process helps to validate your decision to make those lifestyle changes.

The actual process is simple. Just draw a vertical line down the middle of a sheet of paper. Then at the top of the left column write Pros and on the right, Cons. Take some time to list reasons for making the change on the left and the reasons not to make the change on the right. Most people easily come up with more reasons to change their behavior than reasons not to make the effort.

For weight loss, most people list the health benefits, improvements in appearance and increases in confidence as the main benefits they will obtain if they lose weight. The health benefits alone include decreasing the risk of heart disease, diabetes and certain kinds of cancer. In addition, weight loss decreases the stress on your knees and hips.

The negative aspects of changing one’s eating and exercise habits is that it isn’t easy and requires work. You need to take the effort to substitute your new healthier behaviors for your old unhealthy ones.

After my heart attack, finding motivation wasn’t very difficult. The pros of minimizing my chances of having a second heart attack or dying far outweighed the work necessary to change my habits. Ideally, you won’t have to have a heart attack before you change your lifestyle for the better.

Save your list of pros and cons. When you get discouraged as you work through your behavior changes, pull it out to remind yourself of the benefits you’ll get if you reach your goal.

For Your Health – Dr. Bob

When Delay Can Cost You Your Life

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People make poor decisions about when to call their physicians when they are faced with new or worsening symptoms regardless of their level of education.  I came close to making a similar mistake about 8 years ago that could have cost me my life.

It was early in the Fall of 2003 when I started having symptoms of an aching pain in my left shoulder.  It would come and go, and I thought it was due to some sort of musculoskeletal strain of that shoulder or referred pain from a neck problem.  I started noticing it would occur when I was walking or doing other exercise.  My wife & I were on vacation, and during a round of golf I noticed it when I had to walk across the fairway to my ball.  Again, though in the back of my mind I thought it could be my heart, I denied that possibility.  I thought it was due to the fact I hadn’t swung a golf club in years.  What made me face the possibility of something more serious occurred about a week later.  When my wife & I were walking our dog on a Sunday evening it became clear that the pain was brought on by walking.  Adding to my concern and suspicions of something more ominous was an accompanying profound tiredness and shortness of breath relieved by rest.  I called my primary care physician the next morning.  He suggested I call a cardiologist since I would probably need a stress test or possibly a cardiac catheterization.  I immediately called one of the cardiologists I knew, and he scheduled a stress test for me the next day.

The next day I had the stress test with an accompanying echocardiogram.  The echocardiogram shows how the different portions of the heart are functioning under the stress of exercise.  As I was exercising that left shoulder discomfort began and persisted throughout the rest of the test.  My cardiologist was there the whole time and said the EKG (elctrocardiograph) portion of the test looked good, but he had some questions about what the echocardiogram was showing.  He was going to speak with one of his partners about it.  He wanted me to get dressed and would see me in the exam room.  I changed back to street clothes, and went to an exam room.  There the nurse checked my blood pressure and found it to be a bit low, so she had me lay down.  My doctor soon came in and said he wanted to do a cardiac catheterization that day to determine why one of the walls of the heart was not moving normally.  (When your coronary arteries are blocked, certain areas of the heart wall don’t get enough oxygen-carrying blood and will move abnormally.)  Of course I agreed, but wanted him tell my wife, Mary.  She soon joined us, and as he started to tell her, everything went black and I had a cardiac arrest.

They made three attempts at electrical defibrillation before finally bringing me back with the fourth. The first thing I remember is a nurse lifting the oxygen mask from my face and asking, “Are you back with us?”  I guess I still had my sense of humor because I replied, “I didn’t know I had left.”  Everyone was relieved and all the staff involved with my resuscitation laughed.  Mary, who was waiting in the hall, heard the laughter and started to breathe a little easier.

My point in relating my experience was to show how even a doctor who deals with these signs and symptoms every day with his patients can be in denial about his own situation. If not for my finally facing my symptoms objectively and the good fortune of having the cardiac arrest in the absolutely best place, I probably would not be writing these words.  It’s better to be overly cautious about new or worsening symptoms.  Let your doctor assess them, because they can deteriorate in an instant.

In future posts I’ll share more of my experiences with the health care system.   I’ll talk about surviving two hospitalizations and making lifestyle changes to prevent another heart attack.  In the next one I’ll give some pointers about how to handle new and worsening symptoms.

For Your Health – Dr. Bob