Preventive Medicine: Addiction, mental health, bone heath and more

 

#PreventiveMedicine

Some other things to ponder:

A large portion of preventive care is commonplace knowledge that most of us are aware of but don’t always follow. In reality these are more effective than more sophisticated measures in preventing illness.

Harmful effects of Substance Abuse:

Human beings are supposedly most intelligent of the species on this planet. Yet their intelligence takes a nose dive when it comes into contact with substances like tobacco, alcohol, opioids. Animals don’t have the means to procure such self destructive things and are fortunate in that sense.

Tobacco:

 Smoking or chewing tobacco is directly responsible for a significant number of cancers and cardiovascular disease. When I went for the wari last month I was stunned to see the number of tobacco stalls by the road. Each stall had such large number of chewable tobacco products on sale and no dearth of buyers. Even more shocking was the discovery that a single can of chewable tobacco is equivalent of 5 packs of cigarettes!! The incidence and prevalence of tobacco related cancers, especially oral cancers, is, not surprisingly, very high in India. The tobacco industry must be really having a ball with such a large rural population that can be targeted and lured into becoming life long customers. The more sophisticated urban folks find style in smoking cigarettes and those still higher up the social ladder get access to imported cigars. In the USA younger population these days is into electronic cigarettes termed vaping. The product may be different but the essential ingredient remains nicotine. Cancers of the tongue, mouth, pharynx, larynx, esophagus, stomach, colon, pancreas, urinary bladder, kidneys are all linked to tobacco use. Vaping, in addition, sends many users to the intensive care unit with acute pulmonary disease and is a cause of high mortality in young people.

Are all these tobacco related illnesses and deaths preventable? 

100%.

 Number one enemy is one’s own mind. Number two enemy are the industries that thrive on human weakness. Personal profits are valued more than social responsibility.

Alcohol:

 Alcohol is known to cause liver disease and liver cancer. The damage is dose dependent. Besides the extreme damage caused by long term heavy drinking, there is collateral damage with negligence in work and social responsibilities, strained relationships, dysfunctional family life including domestic violence, divorces, nutritional deprivation, drunken driving and resultant motor vehicle accidents and deaths, hospitalization for acute intoxication, neuropathy and financial draining. Kids of alcoholics remain highly vulnerable to becoming alcoholics. 

Most alcoholics, from the people I have known closely, I find them to be in denial about their problem. Some of them were so bright in academics and seemingly the most cultured people in the heyday that it is shocking and heartbreaking to see what has become of them today. The devil has completely knocked off their senses with an easy weapon. Alcohol.

There is a lot of help available if these people decide to give a fight to come off the habit. But very few get that insight. And sometimes it is too late when they do. I try to make my patients aware that once the liver is damaged the only treatment to save them is a liver transplant and that is not easily available. They need to awaken early to gain back control of their lives.

Opioid crisis in developed nations is a raging epidemic. Medical prescribers need vigilance and conscience when using their authority. Tough love is many times needed to prevent your patient from going into a downward spiral. Drug related deaths from overdose as well as (drug related)violence are a major problem in many countries.

Besides opiods, young and old people fall into the habit of recreational use of marijuana( cannabis/ ganja) , amphetamines, and many other substances. 

With all above substance use problems, family is the one that becomes miserable and comes begging the doctors for help. But we can only help someone who wants help. We unfortunately are quite helpless if the person with the addiction is not motivated to quit. We try repeated counseling with the hopes of making a difference. Results are more often disappointing than not.

What I feel most bad about is to see the rare privilege for spiritual enlightenment in a human birth being squandered away in such a reckless manner.

Besides the ones mentioned above there are some other things one must stay away from to preserve good health.

There are carcinogens in smoked foods, in MSG/ aji no moto used in oriental cooking, also in the caramel coloring used in colas, and many more. 

Sleep:

Just like we discussed regarding exercise, one must have a regular routine for sleep. Try having a fixed time for bed and wake up. Important chemicals in the brain are restored during deep sleep. Therefore allowing such restful sleep is important to replenish the reserves so the brain functions optimally during the day. Avoiding loud noises or music, TV, disturbing discussions before sleep time allows to prepare for the night. Similarly avoiding caffeine late in the evening can facilitate sleeping on time.

Lack of sleep has shown to cause early heart disease.

Stress:

Stress too when severe and/or persistent is shown to lead to heart disease and deaths. 

Stress acts by release of excess body steroids. It can lead to diabetes, high blood pressure and strokes. Stress also makes people vulnerable to addictions. 

Develop your own effective ways to handle day to day stress whether by cultivating a hobby or listening to soothing music or meditation. Choose the company of the wise. 

Cultivate a mental culture of positive thinking. Any thought that is uncharitable does not help you, ever! So don’t give it shelter in the prime real estate of your mind! 

Depression and anxiety are a major problem everywhere. Yet most people are either not aware of the symptoms or simply in denial and refuse to seek help. It is a painful situation to live with these conditions. It affects interpersonal relationships, work performance and often gets complicated with substance abuse. 

There are social taboos regarding taking medications for mental health disorders. I tell patients that mind is just one organ like other organs and mental health disorders are illnesses like diabetes or high blood pressure. There is nothing to feel ashamed about if you need to take medication for depression, anxiety or other mental illnesses. It is nobody else’s business to know and you don’t have to get on the roof to announce it to the world. But it is important that you commit to taking the medication as per your Dr’s advice if you want to improve. 

The ultimate disaster arising from sudden or untreated and cumulative stress/depression / anxiety is taking one’s own life.

Suicide Prevention is an important part of Preventive Care and sadly overlooked. Watch your loved ones for subtle signs of depression. If they become withdrawn or overtly and uncharacteristically gregarious, they are sleeping too much or too little, they are inattentive, irritable or frequently missing work and assignments, turning to alcohol. Many times crying or appearing melancholic may not be the signs on the surface. Talk to mental health professionals if you suspect something is off. 

Bone Health :

Falls and Fractures are another set of neglected issues for which preventive measures can make a huge difference.  

Taking calcium and vitamin D supplements after the age of 50, and moderate weight bearing exercises help maintain bone health. 

It is a good idea to get a bone density scan 5 years after hitting menopause. Then every 3-5 years if it is normal. If it shows osteoporosis your doctor can discuss with you regarding additional medication that can help make the bones stronger.

As discussed under hydration, sodas contain phosphoric acid which is the fizz you see in them. This ingredient is particularly bad for your bones. One more reason to not indulge in sodas too frequently.

Elderly people tend to have weak bones. That in addition to frailty, balance and mobility issues and poor vision create high risk for falls and fractures. A nasty hip fracture can take away whatever independence they have. It’s really no fun. To avoid these mishaps always encourage them to use mobility devices like canes or walkers, minimize clutter in their surroundings, avoid loose wires or curled carpets, diligently mop up slippery floors, encourage non skid footwear, insist that they turn on the lights at night before using the bathroom. Install railings on stairs and in showers and toilets to hold on to. Don’t get up or turn too fast. Small things take you a long way to keep in good health. 

In this series on preventive medicine you were presented five separate posts. If you found these useful save these for future reference and share with your friends. Made a check list of things discussed and see what you are missing or what you can implement easily. Focus on two priorities at a time. Then if you are comfortable add more goals.

Cancer screening recommendations can change with time but most other things remain relevant at all times. Invest your time, thought, energy, effort and a small amount of resources towards prevention and the returns will be big in the future. 

The agenda for preventive care can be summed up in this Sanskrit verse:

Sarvepi Sukhinah Santu

Sarve Santu Niramayaha

Sarve Bhadrani Paschyantu

Ma kaschit dukkha bha bhavet 

May all be happy

May all be healthy 

May all experience auspiciousness and prosperity at all levels 

May suffering and sorrows stay away from all 🙏🏼🙏🏼

Saree is a tussar Bhujodi in dusky shades of yellow and lavender.