Healey on Health

By Gregory J. Healey MD

Humor and entertainment, reflection and inspiration, information and advice are all to be found in the column titled Healey on Health as published in the St. Lawrence Plaindealer. In his weekly column, Dr. Greg Healey has served up a mlange of medical news, health information, personal experience, and good sound advice, all from the perspective of a lifelong small-town family doctor, father, and grandfather. This book is a compilation of his columns as written from 2013 to 2015. With a conversational style and humor drawn from his real-life experiences, Dr. Healey manages to convince the reader that they are sitting in his office, having a casual but meaningful discussion about matters concerning health and everything else. The newspaper column was always meant to help inform and entertain the local community and it is hoped the book will do the same for the extended community. And if you get a chuckle or two out of it along the way, Dr. Healey will be enormously pleased.

• Language: English
• Publisher: Xlibris US
• Release date: Nov 9, 2016
• ISBN: 9781524557874

Gregory J. Healey MD

Greg Healey has been a practicing physician for thirty-eight years in a small-town Canada and upstate New York. He has been, for all of this time, an old-school general practitioner, looking after people from conception to grave. During his professional life, he has also raised a large family and been a vital part of his community. He trained at the University of Toronto Medical School and attended Queen’s University in Kingston, Ontario, for his postgraduate studies. He has been involved for most of his career in the teaching of medical students and residents both in the United States and Canada. He has recently been honored as the NYSARH Rural Health Practioner of the Year. He has also received the President’s Award for Excellence in Teaching at Upstate University Medical School in Syracuse, New York, and his wife, Mary Anne, currently lives in Canton, New York.

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Copyright © 2016 by Gregory J. Healey MD.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

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Rev. date: 11/08/2016

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CONTENTS

Acknowledgments

Dedication

Author’s Preface

You May Be What You Drink

A Doctor’s Opinion

The Gift Of Vitamins

I Hate Cancer

Your Cholesterol

Treating Cholesterol

A Search Within

Dying For Sleep

Regarding Nurses

Regarding Mothers

Preventing Harm From Prevention (Part 1)

Preventing Harm From Prevention (Part 2)

Ticked Off

Sunshine On Our Shoulders

Be A Father Found

Merza, Shmerma

A Hot Flash

Whither Polio

Skitters And Skittles

Sugar: Got You Wanting It

Sugar: The Cereal Killer

Sugar: A Sweet Menace

Outsmarting Stress

Ivy, Oak, Sumac, And Parsnip

Dying To Know

End-Of-Life Care

Taking One For The Team

An Apple A Day

Nidification

An Old Foe Whoops It Up

Lighting It Up

Funny Things Happen Too

Breast Cancer Awareness

Hurting The Ones We Love

Boning Up On Calcium And Vitamin D

Bones Breaking Bad

Bones Breaking Bad 2

Affordable Care Act(Ion)

Affordable Care Action

Holiday Eating

Mental Illness

Children At Play?

It’s Child’s Play Really

Going To Pot

News For Cholesterol

Concussion

Hype About Hypertension

Otc, Not As Easy As Abc

The Power Of Love

Taking Your Breath Away: Asthma

Asthma: Finding Your Breath

Keeping Abreast Of The Times

Sad, So Sad

Nothing Routine About It

Putting Our Best Foot Forward

Not Foolin’

Manly Hormones

Resurrection

Salting Ourselves Away

Confidentially Speaking

Nurses, Mothers, And Bobby Pins

Ticks And Lyme

Weighty Matters

Re Lyme Disease

Attention, Please

Fathers And Families

Headaches

Now Ear This

The Sunshine Vitamin

Beating The Heat

Starving For Care

Chunk-Buttered Potatoes

Dizzy?

Ebola

Our Aching Backs

Managing Back Pain

Shingles

Breaking The Fast

They Are Here

On Love And Violence

Good Clot, Bad Clot

Clots Behaving Badly

Clot Busting

The Brussels Sprout

Kids And Antibiotics

To Treat Or Not To Treat

Thanksgiving

November Forgotten

Christmas Cheer

Baby, It’s Cold Outside

Missed At Christmas

The Sum Of Us

The Sum Of All

Aspirin, Baby

Yes, You Can

Vitamin D, Again

Skin In The Game

Mending Hearts

ACKNOWLEDGMENTS

I wish to thank the staff of Xlibris for their help with this book and with me, the rank amateur. They were all very patient and kind. I need to thank Tammy and Paul and the St. Lawrence Plaindealer for nudging me and encouraging me along the way. I am always grateful to my patients of all these years, both in Smiths Falls, Ontario and Canton, New York. They have taught me a lot and continue to teach me - it is a process. I am proud to thank my family who have supported and inspired me throughout my career and have supplied a lot of the material for these columns – their names were never changed to protect the innocent. And most of all, I must thank my wife, Mary Anne. She is my most inspiring muse, my most effective critic and always my final editor. A man cannot hope for more.

DEDICATION

This book is dedicated to my mother Donna Healey 1932-1981.

I know you see us Mom but I sure wish we could see you.

AUTHOR’S PREFACE

A few years back, one of my patients, Tammy Beaudin, asked me if I would write a little piece for a magazine she worked for here in northern New York. She thought I would be good at giving some short but pithy answers to some common questions people might have for doctors. She offered no pay, just the usual fame and glory. I did the piece and she thought it was cute and asked me if I wanted to write a little medical column for our local weekly, the St. Lawrence Plaindealer. I agreed.

They asked for four columns to be submitted as a start and I think they expected me to keep abreast by being four columns ahead at all times. They clearly didn’t know much about doctors. After those first four columns were printed over the next four weeks, I rushed to make the deadline for the fifth and then have usually rushed for the deadline ever since.

I have enjoyed doing these columns. I feel like I am talking to you all better than at any other time. Certainly, the conversations in my office are far more pointed and personal, and often about hockey or politics. But the conversation I get to have with all of you through my column is exceptional for me. You might think it isn’t much of a conversation since I do all the talking, but it is still a conversation. Your side of it is a collective of everything that you all tell me about, all of the time. And my side is what I think is the best thing to tell you - at this time anyway.

I try very hard to make sure that anything I have said to you in these columns is as scientifically accurate as possible. And of course, much of what I say is opinion, an educated guess really. But it is absolutely the most honest thing I can say. I have presented my columns in this book in the order that they have appeared in our newspaper with the date they were written. Medical knowledge and opinion changes considerably over time and the dates are important for future readers’ consideration. These columns represent my general view on things and should not be used as direct medical advice. It goes without saying that you should get your medical advice directly from your own doctor, hopefully she knows you well and certainly she knows you better than I do.

Physicians, most of us, live our profession. You call us Doctor, our friends might drop it down to Doc, and although we may be fathers and wives, daughters and coaches, friends and teammates, we are always doctors. This is o.k. with us, we signed up for it. But it does set us apart from you a bit and can make us feel a little lonely at times.

When I write these columns (or stories) for you, it makes me feel part of you all. Because I do think about all of you, all the time. I want you all to do well, feel good, be happy and, of course, be very healthy. I imagine you all reading these humble offerings, maybe learning something new or just getting a chuckle. I hope that reading them will cause some reflection on your own lives, maybe inspiring you to change your outlook or behavior. Maybe they will encourage you – as they do me - to reaffirm your commitment to your loved ones, your community, and yourself.

My medical license says that I am Gregory J. Healey M.D. but I prefer Doc, or just Greg. I was the one who was good in math and chemistry and bad at hockey, was helpful with the yearbook but was no threat on the dance floor. I said I would be your doctor and I have been your doctor, for a long time now. And I love you all for letting me be that. I hope that as you read this book you will receive it as a very sincere thank you note from me.

I feel less lonely already.

Our society has a drinking problem. I’m not talking about alcohol here, although another day I will. I’m talking about water or more specifically, the lack of water in our diet. People are not suffering from dehydration, far from it; our fluid consumption is fine. We just don’t drink water anymore. (And when we do, we pay too much for it.)

Children complain that water doesn’t taste like anything, having been raised since infancy on a steady diet of milk, juice, soda, and just about anything else they ask for. Adults often pay two dollars or more for a bottle of water (making it more expensive than milk) but still prefer flavoring in their vitamin water or diet drinks. After putting Equal in their coffee, they will then promptly drink eight or ten teaspoons of sugar naturally present in their glass of orange juice. (Anyone remember juice glasses?)

The problem is that while we need the water in our fluids, we don’t need the sugar, the chemicals, or the calories. Anyone over ninety pounds needs at least ten cups of fluid (water) daily—more if they are very active—to keep their system flushed and their kidneys happy. Ten cups of good clean drinking water has no calories at all. Ten cups of orange juice is 1,300 calories of sugar; Pepsi, 1,000 calories of sugar; apple juice, 1,100 calories of sugar; and 1 percent milk, 1,100 calories of sugar, fat, and protein. Most of us don’t need more than about two thousand total calories daily, so you can see that it is easy to get over half those calories just meeting our fluid requirements if we continue to avoid water and substitute with other fluids. And the water is free!

So have your coffee or tea; a teaspoon of sugar won’t hurt. Drink some juice; out of a four-ounce juice glass please. Have a glass of milk each day, especially you children. But please relegate soda to the status of alcohol—special occasions only. Go ahead and put a water filter on your tap if you don’t trust your municipality. But please drink water, lots and lots of water.

There is an old saying that you can ask two doctors and get three opinions. The truth is you can probably ask one doctor on most days and get three different opinions if you let him or her talk long enough. As a doctor, I am paid to give opinions every day. There remains a frustratingly lower level of certainty in those opinions than I would like, which is why they are still, after all, just opinions and why two differing opinions may have equal merit.

This is true in almost all walks of life, but doctors generally do—and always should—acknowledge this uncertainty. I believe the more certain a person is of his/her opinion, the less likely that person is to more closely approach the truth in the long run. However, an opinion must be developed so that a decision can be made.

Let me tell you how—or perhaps why—I come to an opinion; this seems only fair if I expect you to have any interest in my opinion. A physician’s opinion should be based on training, experience, and current scientific knowledge. My training as a medical doctor began with two years of university science courses before four years of medical school and then two years of residency in family medicine. But my training never really ends. I do about one hundred twenty hours per year of continuing medical education; I’m not exaggerating. My experience is thirty-eight years of small-town general practice, including hospital practice, emergency medicine, obstetrics and neonates, geriatrics and pediatrics. I have had the privilege of caring for people from pre-birth to death covering the spectrum from happy, well baby visits to tending terrible injuries, treating dire illness, and managing end-of-life care. I have delivered babies to the babies I delivered, and I have watched too many of my dearest patients breathe their last.

I have been fortunate to be a teacher of medicine with Queen’s University in Kingston, Ontario, and Upstate University in Syracuse, New York, giving me the opportunity to mentor—they might call it torture—young physicians. And as all teachers will admit, I have been taught by my students.

Like most of my colleagues, I live my profession, never really off duty, dragging my loved ones along for the ride. I read—a lot—every day, but the science that informs my opinion is incomplete and constantly evolving. On the other hand, the consequences of my opinion are immediate and often permanent. While I have to live with my mistakes, my patients may not; a little pressure there.

Opinions are abundant. Your brother, your hairdresser, your aunt Edna, and your secretary’s aunt Edna can and will have opinions. But my opinion, in matters of medical, is my life’s work, constantly changing and, therefore, destined to be imperfect and incomplete but always, I hope, the best one that I can form at this moment. Take it or leave it.

Vitamins are enthralling little bits of magic in our food. We are told that they are miraculous in their power to harm us if absent or to save us if in abundance. They are the key to good nutrition and long disease-free life. They are every mother’s dream, a way to discharge her onerous responsibilities for the health of her children while convenient, simple, and scientifically proven. Pop-Tarts followed by a Flintstone, problem solved. They are a godsend for those of us who have, with various excuses, forsaken healthy lifestyles and need a trick solution—a way out of the mess our health is going to be in if we don’t start eating right and exercising more. Really? Nope.

Like most things too good to be true, the benefits of vitamin and nutritional supplements generally aren’t true either. Supplements are overhyped, expensive, and usually unnecessary, sometimes dangerous. We spend a ridiculous amount on them each year with no evidence for their merit.

Occasionally, vitamin supplements are beneficial. For instance, women who are planning to conceive and carry a child should probably take vitamin B supplements to avoid spina bifida, hydrocephaly, and possibly other neurological disorders. This belief is coming under further scrutiny however after a recent study showed higher levels of serum folic acid in mothers whose children went on to exhibit autism.

Vitamin C, studied to death, has shown no health benefits when taken in doses beyond the amount available in many foods, such as one potato, one tomato, or a small amount of orange juice each day. (We don’t store vitamin C very much, so the extra you take each day ends up in your urine.)

Vitamin E has clearly shown actual harm when taken by adults to reduce their risk of heart disease and yet is frequently on the list of supplements my patients have decided to take.

Vitamin D supplementation, while showing enough promise that I recommend it, has still not been shown through study to improve our health if we take extra D to raise our levels.

Vitamin deficiency, very rare in modern society, can be devastating, but vitamin excess can be harmful as well. We just aren’t that smart yet about nutrition to pick and choose the vitamins we should take.

I think we should use the vitamins that nature gave us. We may choose to give these vitamins names or letters like A, C, D, or CoQ10, but nature knows them as vegetables and fruits and nuts and eggs. They come with no labels and no wrapping, but nonetheless, they are a gift from God to you.

We all hate cancer, which means we are afraid of it—we doctors as much or more than most. Overall, it is the second leading cause of death after cardiovascular disease and is the leading cause of untimely death, striking down people of all ages.

Causes of cancer can be divided into three broad categories: genetics, food and environment, and smoking; the latter alone accounts for about a third of all cancer deaths. Our treatment of cancer improves every year, but preventing it in the first place is, of course, always better.

Sometimes, but not always, finding it early with Pap smears, colonoscopy, or mammography makes a big difference. As a consumer of health care, you can help with the prevention of cancer generally and with the early detection of certain cancers.

Genetics are hard to change, but we are getting better at predicting risk of cancer based on genetics and taking steps based on that information. Family history is important, and your doctor needs to be updated as to changes in your family history so the genetic information can be applied to your care.

You do control most of the food you eat and many aspects of your environment. Eat less fat; carcinogens can accumulate in the fat of animals, so eat less animal fat and avoid greasy foods generally. Other foods may prevent cancer; these mostly include vegetables, some fruits, and nuts as well. Avoid direct sunlight; use protection if you cannot. Clean your home, but don’t try to sterilize it. Soap and water and elbow grease are the only chemicals safe for your home.

When outdoors, stay away from pesticides and herbicides; they kill insects and plants for a reason. A green dandelion-free lawn is not worth lymphoma. If you are a food producer and have to use these chemicals, then use them with every safety precaution available for you and your family.

You should not allow smoking in your home; second-hand smoke increases lung cancer risk eight times above the norm. If you personally still smoke, then for heaven’s sake, stop! This is getting ridiculous. Why cigarettes are still legally sold in 2013 will be very puzzling to future historians.

See your doctor for scheduled visits for prevention. (This is not necessarily annually; it depends on your age and history.) Your doctor will recommend the appropriate preventive screening tests and procedures based on the best evidence to date.

Last, while cancer is terrifying, please try to keep all risks proportionate in your decision making. Driving by a nuclear reactor every day is not remotely as dangerous as driving by it without your seat belt on.

Cholesterol is confusing to patients and health care providers alike. The medical community has unwittingly furthered the confusion and deepened the mystery, leaving people unsure what to do.

People with high cholesterol have more cardiovascular disease. We’ve known this since the late sixties, prompting all sorts of public announcements and recommendations which, once they were put out there, were very hard to change. High cholesterol increases the risk of heart disease but more for some of us and less or not at all for others. There is also a difference between HDL or good cholesterol and LDL or bad cholesterol.

High LDL is associated with more plaque in our arteries, whereas high HDL seems to protect us from plaque buildup. Most of the cholesterol we measure in the blood is made by ourselves, and only a small proportion comes from our food. Almost all the cholesterol in our blood is in lipoproteins, little particles that carry fat around in our blood. The balance of these lipoproteins in their various sizes is what we measure when we measure your cholesterol.

Good cholesterol is related to the number of smaller lipoproteins that we think carry fat from fat cells to the liver for use. Bad cholesterol is indicative of more large lipoproteins, carrying fat to the fat cells to be stored. If we eat a lot of food we don’t need, our liver makes fat out of the excess food and produces cholesterol-containing lipoproteins to carry the excess to our fat cells, creating a lot of bad cholesterol in our blood. For people under stress, people with certain genes or diabetics, this response to excess food is even worse.

On the other hand, exercise, eating less, and losing weight will result in lower levels of these bad lipoproteins and higher levels of the good lipoproteins. Alcohol raises the levels of good cholesterol, and this may be the reason that modest drinkers have less cardiovascular disease than nondrinkers. (It only takes one drink a day to achieve this modest benefit; any more than that and now you’re just drinkin’.)

To have a good cholesterol profile in your blood, you should eat less food generally, especially fats and carbs, and try to maintain a reasonable weight. Avoid saturated fats in particular, but you can have a little butter on your roll. Eat four eggs a week; they are good for you. Exercise every day, a thirty-minute brisk walk is fine. If you like alcohol, then one drink a day won’t hurt and may help, but more than two drinks a day is not recommended.

The same lifestyle changes required to optimize your cholesterol will also lower your cancer risk and reduce the likelihood of diabetes and obesity. It’s all good. If knowing your cholesterol level would be a motivator, then go get it measured by your doctor. Sometimes we may need to intervene and do even more to treat your cholesterol; more on that next time.

You had your cholesterol measured, and it is high. This puts you in a higher risk group for premature heart disease and stroke. What now? As discussed in the last article, the ratio of good (HDL) to bad (LDL) cholesterol is important, and the lifestyle changes are a no-brainer, just a hard-to-doer.

As with most things in medicine, there are drugs—many, many drugs. Some are cheap, some expensive. Whether or not they should have side effects, they will have side effects. You will hate taking them, you will forget to take them, and you will be sitting in front of your television writing down the 1-800 number to talk to a lawyer about your drug. Yet despite all this negativity around pharmaceuticals, it is my opinion that certain among you should take these drugs.

Having high serum cholesterol is a major risk factor for heart disease. If you already have heart disease or stroke or peripheral vascular disease, then your risk is already 100 percent, and you should take a statin class drug. If you cannot tolerate a statin class drug, or if you cannot get your LDL cholesterol below your target number (discuss your target number with your physician), then add or take another cholesterol-lowering agent. The evidence for this advice is overwhelming and repeated in multiple studies. The plaque inside your arteries may actually shrink over time if your get your cholesterol low enough!

If you have type 2 diabetes, you really need to keep your LDLc down. Statistics indicates that your risk of heart disease by simply being diabetic is the same as someone who has already had a heart attack! It is recommended that you take a statin and keep your LDLc below 70 mg/dL.

If you are a smoker, you should quit smoking. Even if you don’t want to or can’t seem to quit smoking, you should at least try to get your LDLc below 70 mg/dL.

If you have high blood pressure, you should endeavor to get both the blood pressure and your cholesterol down to optimal levels.

If you have no heart disease and you are not diabetic, should you take meds for high cholesterol when the lifestyle changes don’t work? One tool I use to help decide is the ten-year CVD risk calculator developed from the Framingham study data. (Google it.) This includes smoking, age, sex, blood pressure, and cholesterol numbers and estimates the risk of you having an event in the next ten years. It does not allow for family history, which I think is an important consideration, but it is a good starting point for discussion. You are the one taking the drug, and you take the risk, so it is your call. But I think having some kind of risk estimate is vital to your decision.

Treating your cholesterol lowers your relative risk for heart disease. If your risk is only 1 percent and by taking a drug daily for ten years, your risk drops to 0.6 percent, then I would have to treat two hundred fifty people like you for ten years to prevent one cardiovascular event. If your risk is 15 percent and we can lower it to 9 percent, then it might be more worthwhile to treat.

Ultimately it has to be your call as to whether or not you take medication to lower your cholesterol. And this decision should be made after careful consultation with your own physician. I think the drugs are safe and effective, but everyone is different in their response, and we have to be flexible. There are more options for treatment coming down the pipe, and there will be more information forthcoming as well about the benefits of therapy.

There’s the one about the surgeon who, discouraged by high malpractice insurance, decided to become an auto mechanic instead. He took the course at his local community college and then did the final exam. When he received his final grade of 150 percent, he went to his instructor for an explanation. Well, you took the engine apart perfectly, and that’s 50 percent of the grade, and then you put it together perfectly, and that’s another 50 percent. So the surgeon asked what the extra 50 percent was for, and the instructor replied, We never had anybody to do it all through the tailpipe!

Endoscopic procedures have revolutionized medicine in the last thirty years, making old procedures safer, cheaper, and more effective. We have new procedures, before almost inconceivable, to investigate illness, repair damaged parts, and prevent cancer deaths. Colonoscopy has now become the preferred screening test for colorectal cancer. Even the Canadians, with a deserved reputation for rationing care, make colonoscopy widely available and have determined it to be the cheapest and most effective way of saving years of life that would otherwise be lost to colorectal cancer.

Screening colonoscopy should be done at age fifty