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Wednesday, November 12, 2014

Advice to the Young!

Zita's cautionary tale dated 30/10/14 meant for the younger generation brought to my mind a few other instances of patients who suffered strokes or myocardial infarcts where there were no identifiable risk factors other than stress, according to our current state of knowledge. Other colleagues in our batch are sure to have encountered similar instances.
As we all know, our current knowledge is as little as a drop in the mighty ocean- and there may be a multitude of other factors that play their roles in these events, which may be unravelled in the future.

There was a time in the past when no one even spoke about lipid profiles!
ND in one of his recent comments on this blog wrote about destiny- which I thought was interesting and opens another dimension to all this.

Even though we don't "know it all" nor ever will-it is good to be able to impart the little we know to our younger generation. As medical practitioners, whatever our chosen fields, we have spent most of our lives advising people on how to maintain good health. I wonder however, whether we have been successful in convincing our own young on maintaining good health. Personally, I cannot boast success.

My daughter,being a responsible medical professional has no need for my advise anyway and takes care of herself of her own accord. My son (non medical) on the other hand seems to believe he is indestructible, and any caution is quickly thrown to the wind.

Apart from mountain climbing while there are "severe weather" warnings in place, boiling eggs in volcanic craters, swimming in Malawi, bungy jumping, diving with head colds, motor bike/car racing, hot air ballooning etc etc, he cannot be persuaded to see a doctor, even though he has overshot the recommended age for commencement of cardiovascular disease risk assessment (CVDRA) for those from the Indian subcontinent in New Zealand. This is in spite of a family history of premature coronary heart disease(CHD).

His argument - "I see  doctors all the time - I don't need to see any more" and  "It won't be the family history or the lipids,but stressing about them that will kill"!
His favourite foods continue to be "fatty pork" and "fatty duck"!

Knowing it is bad practice to medically manage one's own family, I have made innumerable attempts to get him registered with a medical practice, but failed.

Of course I must admit - being widely read even on health and medical matters, he has some reasonable counter-arguments to some of our practices. For example "statins have been prescribed only in the last 15-17 years -Who is to predict the problems when it is taken by a 35 year old for another 40 years?"
(Updates on statin prescribing already call for monitoring of new problems which are being recognized)
Further, our past practices with HRT, vitamins A,C,E,Folate in CHD, more recently the changed recommendations for calcium intake, and even the ever changing recommendations regarding the simple issue of egg consumption, make him understandably sceptical.

A few weeks ago, to impress on him again the importance of having a CVDRA and an independent opinion on his state of health, I began to cite the case of a young man of 39 yrs who recently passed away in his sleep and was only discovered when workmates went to his residence to see why he wasn't at work.
Quick came the response-"that was a nice and easy way to go"
My reasoning that it wouldn't have been easy, and that he would have been in pain as the paramedics smelt Wintogeno that he had rubbed on his chest even as they walked into his house,met with
"WINTOGENO! Cutting edge treatment for a heart attack! Good stuff for the Lancet!"
I couldn't get him to be serious and my attempts to continue were interrupted in quick succession with:
"good excuse not to go to work"
"Did he report 'dead in bed'? Would have saved his mates the run- around looking for him"
(all this not in disrespect for the unknown deceased, but his usual way of dismissing any advice)
My cautionary tale got nowhere! None of them ever do !

Of course they are from mum (cook, cleaner, laundress, general "dog's body"!)

Of what consequence an MBBS or any of 3 Fellowships that usually follow my name!

Hope my colleagues have been more successful in cautioning their own young.

Rohini

Addendum

The 39 year old described above was under enormous stress from a failing business. I do not know whether he had other risk factors  but 39 years is a very young age to die of a myocardial infarct in any case.
Stress is undoubtedly a killer.
Destiny ND? who's to know!

7 comments:

  1. Rohini, your son must be a bundle of energy, zest and optimism! Part of the problem with preventive advice is when it is inconsistent. When experts disagree, it is not easy for the lay person. I know that advice can change with new discoveries and advances and reviews, as it must. But when you read about various opinions on coconut oil, eggs, polyunsaturates, statin problems etc, it is no wonder that confusion is created. To me a few things seem totally reasonable with the current state of evidence. I am convinced that Blood Pressure levels, Lipid profile, strong family history, Diabetes, body weight and exercise levels matter. I am also convinced that if your lipid profile is "unsatisfactory" in spite of dietary and exercise measures, then the advantages of Statins outweigh the disadvantages. As for Destiny, belief in destiny (as a kind of fixed programmed future), is a self-fulfilling prophecy If you don't take preventive advice, then it is your destiny to suffer consequences and if you do take advice, it is your destiny to be rewarded! My own view of destiny is that we all have likelihoods or tendencies to proceed in a certain direction but byour actions, we can influence and change the.course in many instances. For example, if you are Hypertensive, have a strong family history of IHD and Diabetes, you are obese and physically inactive your "destiny" could be a life of sad unwanted cardiovascular events but you can change this "destiny" by taking corrective action, To me, belief in a life path "set in stone" and predetermined is not only hard to accept but has huge negative connotations. It is like the student who says, "I am not going to study for this exam, if I am destined to fail, I will fail however hard I study!" To imagine that from the moment you are born, to the moment you die, your case history is already written in great and immutable detail is defeatist and has absolutely no scientific evidence to back it. When you plan any journey (life is the biggest one you will ever do!), it seems wise to take sensible precautions where necessary and preventive health advice is just that. Anyway, that is my view!

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    1. Thankyou speedy - I do agree with your views .

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    2. I agree with you as well as ND that we need to take whatever precautions are necessary and do what needs doing . At the same time I believe we are not in total and absolute control of our lives whatever we may do. ie destiny.

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  2. Just to clarify what I said about destiny here is an exact copy: "Remember and stick to what you have to do to lead a healthy life but don't dwell on it too much and be obsessive. Let it be a habit and not a millstone round your neck. Remember also the awesome force of destiny can always surprise you. Meanwhile be happy and content with what you have."
    ND

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  3. ND. Can't agree with you more on your quote - obsession is never a good thing as are any type of millstone, in whatever guise they come!

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  4. Rohini
    The problem about kids you mention is due to our Asian values. We must learn to let go like in the West. I tend to say my bit and let them take it or leave it.
    ND

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  5. Thankyou ND .It is a good strategy -

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