Your Golden Years, Your Golden Challenge: A Practicing Physician's Prescription for Preventative Health Care from Midlife to Retirement and Beyond

Copyright 2004 Herman Schmid.

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ISBN:

978-1-4120-3573-6 (sc)

ISBN:

978-1-4122-2715-5 (e)

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CONTENTS

Preface

1. Introduction

Have you reached that midway point of your life?

Will there be golden years for all?

Whom shall we credit for extending life during the last century?

Are you looking forward to your retirement?

Why blame an aging population for our national health problems?

Are national health problems as negative as reported?

Have you made changes in your life style?

2. Retirement

The do’s and don’ts

Have you and your partner planned ahead?

What are the important factors for your retirement?

Let us discussion each of these points in more detail.

3. Your Golden Years

Are you planning for those golden years ahead?

Do the statistics for life expectancy work in your favor?

Is there meaning to those golden years?

Do you have a hidden child hiding in you?

What influences the amount of resuscitative medical care?

4. Your Golden Challenge

Will you accept a golden challenge?

Are some seniors resistant to a golden challenge?

Is your preventive care as important as care for your car?

Are your golden years a good investment?

Are you motivated to take the first steps?

What will be your inspiration to start a preventive health plan?

5. Preventive Care

Do you wish you had been born in those good old days?

Can we define preventive care?

What are the seven stepwise levels of preventive care?

Can we define quality of life?

Will our mental state influence our perception of quality of life?

Are you in control of your future health and longivity?

6. Step 1 – Exercise

Weight management or exercise, which is most important?

How does the musculoskeletal system maintain mobility?

Does aging alter the musculoskeletal system?

Has treatment of musculoskeletal disorders changed?

What exercises can counter musculosketal aging?

Why not start your exercise program today?

7. Step 2 – Weight Management

Do americans have a national weight problem?

Are you one of the overweight americans?

What prevents americans from losing weight?

Do you know the composition of the foods you eat?

What do we mean by an appetite center in our brain?

What regulates the amount of sugar entering our cells?

Are diet programs based on nutritional knowledge?

Will control of the appetite center affect weight loss?

Will food shopping and cooking habits effect your weight?

Will the choice of foods affect your weight?

8. Step 3 – Your Health Evaluation

That physical exam, still the same?

Why fix it, if not broken?

Should everyone have the same tests and exams?

What is a functional illness?

Are all health evaluations the same?

9. Preventive Care: Step 4 – Non-Prescription Agents

Are over the counter and non - prescription agents effective?

1. Agents recommended for senior patients.

2. Drugs released from prescription status.

3. Supplements based on observational and anecdotal reports to be effective.

4. Agents that do not contribute to improved health and not recommended.

Are supplemental agents worth the risk?

10. Step 5 – The Medical Approach

What four underlying disorders are major risk factors for the chronic diseases?

1. Hypertension (high blood pressure).

2. Dyslipidemia (abnormal blood lipids).

3. Diabetes (elevated blood sugar)

4. Over weight (obesity)

What are the medical approachs to the six major causes of death?

1. Coronary artery disease

2. Cancer

3. Chronic lung diseases

4. Stroke

5. Diabetes

6. Accidents

7. The remaining causes of death—a variety of diseases

Do you keep your medical appointments?

11. Step 6 – The Surgical Approach

When do you call surgical treatment preventive?

Why are some patients hesitant to accept surgery?

Is there a role for the medical provider when surgery is refused?

What surgical procedures may qualify as preventive?

12. Step 70 – Preventive– Preventive Care.

Why not consider preventive, preventive care?

How were the medical norms determined?

Is there a medical basis for the preventive, preventive approach?

Has preventive, preventive care been used in the past?

13. Great Sex After Fifty And Beyond

Will sex be important to your retirement?

Why is a woman, a women, and a man, a man?

What happens at female and male menopause?

Foreplay- is there a role for great sex after fifty?

Especially for men

Testosterone- do you have enough?

Viagra or cialis, which is best?

Are other technics available for a firm erection?

What can be done when medical treatments fail?

Especially for women

Menopause-why be concerned?

Why has estrogen replacement been minimized today?

Why estrogen replacement is a yes, progesterone is a no!

Is there another hormone to stimulate sexual desire?

14. The Final Question - Where Do You Go From Here?

Have you accepted your golden challenge?

Is there a role for public health agencies in preventive care?

Can community wide prventive care programs be developed now?

What are the main points of this book?

Do my patients and i have a final question?

DEDICATION

IN GRATITUDE:

TO OUR TEACHERS WHO HAVE SHARED THEIR KNOWLEDGE AND MEDICAL SKILLS WITH MY WIFE, A NURSE PRACTITIONER, AND WITH ME, A PHYSICIAN, AND TO OUR PATIENTS WHO OVER THE YEARS HAVE ALLOWED US TO SHARE IN THEIR LIFE’S JOURNEY.

IN APPRECIATION:

TO MY WIFE FOR EDITING THIS BOOK AND FOR HER COMPANIONSHIP OVER SIXTY YEARS OF MARRIAGE.

IN MEMORY:

OF OUR SON KARL J. SCHMID, WHO DIED AT AGE THIRTY SIX DURING A SPORT EVENT AND WHO LIVES DAILY IN OUR HEARTS AND MINDS.

PREFACE

Medicine has changed significantly over the past 50 years. Drug companies, medical centers, and the government, through research, have developed diagnostic methods and treatments that have increased life expectancy of the American population to an average of 78 years. Our federal and state governments now provide the majority of care to our aging population through Medicare and Medicaid insurance programs. Insurance companies, Medicare and Medicaid have accepted the increased costs of these improved diagnostic methods and treatments by extending benefits for both outpatient and inpatient care. Hospitals, in addition to their traditional role of providing beds for ill patients, have provided the diagnostic equipment and facilities necessary for the lifesaving advances of specialty medicine.

The role of the physician also has changed dramatically over the past years to meet the needs of an aging population. Prior to the middle of the last century medical care was primarily episodic. Patients did not see their doctor until they were acutely ill. Now, the advances in medical knowledge of disease processes and the availability of improved diagnostic methods and treatments have focused medical practice on the prevention of disease. In other words, before the occurrence of a heart attack, stroke, diabetes, and even cancer, there are detectable underlying disorders which, when discovered and treated early, can prevent life limiting disease. Doctors have learned that the underlying disorders and diseases associated with aging do not usually start in older age, but often are present by middle age and younger. Then, changes in life style, and early treatment will be most effective in preventing later morbidity and mortality.

This book is written to inform the reader of the major preventive health recommendations now practiced by the medical community. The material in this book has been influenced by my personal experiences as a practicing physician as well as by my prior years as a teacher and researcher in the area of cardiovascular diseases. From my patients, I have learned that they will accept both changes in life style, as well as necessary treatments, when they better understand the underlying medical reasons for these recommendations. With this approach in mind, I trust that this book will provide sufficient medical information for the reader to embrace a golden challenge of preventive health care to know and to fully enjoy the rewarding golden years ahead.

My readers have asked why there is not a bibliography for this book. This would be almost impossible because each statement in this book relates to the present basis for most practicing doctor’s medical approaches and decisions when treating patients. Each statement is backed by multiple basic and clinical scientific investigations published in many medical journals. Such a bibliography would require a book of much larger size. More information concerning the scientific and clinical details for the information in this book can be explored in more detail at Google and other Internet sources.

CHAPTER 1

INTRODUCTION

HAVE YOU REACHED THAT MIDWAY POINT OF YOUR LIFE?

It happened before you knew it! You celebrated your fortieth birthday and couldn’t escape from the fact that you had reached that dreaded midway point in your life. Perhaps, you celebrated your fiftieth, and suddenly the term senior citizen took on a new meaning as you received unsolicited packets of information from the AARP (American Association of Retired Persons) welcoming you to join their increasing ranks and participate in the multitude of programs available to seniors. Possibly, conversations with family and friends have drifted recently toward the topics of high blood pressure, cholesterol, heart disease, and that dreaded word cancer. Have you noticed an increase in your waistline, and an added effort to climb those familiar stairs or neighborhood hill? Do you find yourself taking quick glances at the newspaper’s obituary column, taking solace in finding that many of those listed have lived well into their eighties and nineties? Does it frighten you to see that several had died in their forties or fifties? Did you then look further to see if they died from an accident rather than a disease? Well, welcome to the last half of your life. Your golden years await you.

WILL THERE BE GOLDEN YEARS FOR ALL?

Your golden years can be golden indeed. Life expectancy has increased dramatically in the last century from slightly less than 50 years at the year 1900, to the present average of 78 years for the American citizen. This breaks down to 76 years for American males and almost 80 years for females. These figures, unfortunately, are slightly lower for minorities, and significantly lower for the developing nations of the world. A recent television program about Afghanistan reported the average life expectancy at less than fifty years, similar to ours a century ago. Before you sit back, however, and take comfort in the knowledge that our life span has increased by more than 25 years during the past century, you must remember that these values represent an average for the entire population and predict little about your individual chance for survival. More importantly, these statistics predict little about your future quality of life should you live beyond these averages.

A most important question that must be asked by each of us as we approach the midway point in our life, and certainly for those nearing retirement is, How did those living beyond life expectancy, especially those reaching ninety or one hundred years of age, get there? Was it inheriting good genes conducive to a long life, living a healthier life style based on preventive medical care, or just good luck? Perhaps, a combination of all three!

The above question is not easily answered for us individually, since we are each unique in our genetic inheritance and life styles. Furthermore, each of us experiences different environments and stresses. Despite rapid advances in genetic knowledge, the probability of altering our genetic inheritance by medical means appears very unlikely for our present senior age group. However, preventive changes in life style and medical treatments are available now that will influence many of the risk factors and disabling disorders that contribute to an earlier death. Medical scientists predict that an early start of such preventive programs may increase the average life expectancy by another four to five years within the next few decades.

WHOM SHALL WE CREDIT FOR EXTENDING LIFE DURING THE LAST CENTURY?

At the start of this new century we have indeed entered a new era for our lives. Now, the majority of us can look forward to 20 or 30 years beyond retirement. How did this change come about? I’m certain it was not from living a healthier life style than our parents, who worked harder physically, ate higher fiber fresh foods, and remained lean and fit throughout life. Now, we work less, eat more processed fatty foods, and watch television for hours. Despite these negative influences a significant advance in life expectancy did occur.

Much of the credit for this advance must be given to the pharmaceutical and medical research that started during the early part of the last century. The discovery of sulfa and penicillin in the 1930’s were followed by many other potent drugs and vaccines. A dedicated public health program must be credited for the rapid application of these discoveries to the general public. These continued advances resulted in methods for the prevention of diseases and life prolonging medical treatments, in contrast to the limitations of surgery that could only remove the diseased tissue.

The earlier successes of medical research stimulated the growth of many philanthropic organizations devoted to the support of medical research, such as the American Heart Association and the American Cancer Society. Such organizations were funded generously by citizens appreciative of the successful control of infectious diseases. The success of the philanthropic organizations and the pharmaceutical industry in discovering newer treatments stimulated the Congress of the United States, in 1948, to form the National Institutes of Health. The Institutes were charged to support research at the Institute’s national center in Bethesda, Maryland, and to support research and training at medical centers in the United States as well as foreign countries. Congress has continued to fund these Institutes, which now number 27 Institutes. Support by congress has increased yearly and totals over 30 billion today. The National Center for Complementary and Alternative medicine was formed by