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Have a regular relationship with a health care provider

Let me issue a friendly warning to those productive individuYour health care provider should be somebody with whom you are comfortable talking about any aspect of your life which can have impact on your health--which is to say, almost anything. Sometimes, especially in an age when the shifting alliances of health plans force us to find new providers, it is difficult to keep the same doctor or nurse practitioner for a long time. Still, it is worth the effort to find somebody you can connect with enough to trust, because that trust is what you rely on.

One lesson in this is, despite the difficulties and expense, it is a great idea to have the first visit to a new provider be for a routine checkup or a get-acquainted session. The first time a new doctor or nurse lays eyes on you, you should ideally not have a 101-degree temperature and feel generally as though you have been found on the floor of a bus station bathroom.

There are some things to look for in a provider's office that should let you know if it is a well-run operation from a patient comfort point of view. Does the doctor or nurse talk to you before an examination, or when you meet for the first time are you already wearing one of those fashion-statement-for-exhibitionists gowns? On the medical history questionnaire, does it ask "Are you married?" or does it ask "With whom do you live?"--the latter is a more precise question medically and a more sensitive question for people who have a significant other to whom they are not married.

And finally, the gut question: are you comfortable with this person? This has nothing to do with clinical skill, knowledge, or even whether somebody is a nice person or not. Sometimes personalities click and sometimes they don't, and your health care provider should be someone you click with.

Know your cholesterol level

Cholesterol is a white waxy fat. Yuck, you think. Well, the truth is, every cell in your body needs cholesterol to function, so it's wrong to think that life would be better if we could just get rid of cholesterol.

But, the level of cholesterol in your blood may have a profound influence on your health, and that's why it's good to know.

Cholesterol has two main components, usually abbreviated as HDL and LDL. HDL is "good" cholesterol--it actually removes plaque from artery walls. LDL is the wears-black-leather-and-hangs-around-on-street-corners cholesterol, and builds up on artery walls, which can cause all kinds of problems, such as heart attack and stroke.

There are two main things you should know about cholesterol--the ratio between total cholesterol and HDL (it should be less than 4.5) and the LDL level, which should be lower than 130 milligrams.

But look--you don't need to know all this stuff. All you need to know is that it's important for you and your health care provider to look at these levels and make changes, such as weight loss, diet change, or cholesterol-lowering drugs, if need be.

Know your body mass index

The body mass index is a measurement of body fat based on your height and weight. It provides a pretty good quick snapshot of where you stand in relation to where you should be from a health point of view. It has some limitations, most obviously for people who have a muscular build it may overestimate body fat. But it's a good number to know and a good way to measure progress on an exercise and/or weight loss effort.

But here's one caution before you go plugging in the numbers to do the calculation--longtime Vanderbilt School of Nursing nurse practitioner Anne Moore says that almost nobody is exactly right about either their weight or height. Get on some accurate scales and do a careful measurement of your height, or the number you get for the ultra-sophisticated high-tech body mass index calculator (see the Resources section) will be wrong and, therefore, useless.

Have your blood pressure checked regularly, and know what to do with the information.

You can have a health care provider do this. You can drop by the Health Plus offices in Memorial Gym and have this done. There are machines at drug stores and supermarkets, and there are handy home blood pressure devices, including wristwatch versions. It may be that no health information is easier to come by than your blood pressure.

Quick primer: blood pressure is literally the measurement of the highest pressure attained by the blood when the heart pumps it into the arteries (the top number, systolic) and the lowest pressure to which the pressure drops at the bottom of the cardiac cycle (the bottom number, diastolic).

While low blood pressure troubles some people and can cause, for example, fainting spells, high blood pressure is the usual concern; it is defined as a measurement above 140/90. But that measurement doesn't mean you have a disease, because high blood pressure isn't a disease--it's a risk factor for disease. Among the problems known to be caused by high blood pressure are heart attack, stroke, renal failure, and heart failure, all as a result of the atherosclerosis caused by high blood pressure.

High blood pressure itself usually has no symptoms, so there are literally millions of people walking around with this major risk factor for nasty disease who have no idea. Which is why, to come full circle, you should have it checked or check it yourself, a couple of times a year.

High blood pressure can usually be controlled by a combination of smoking cessation, diet, exercise, and medication. There's no magic bullet, but there are a number of steps to take to bring blood pressure down, and the steps are well worth it because--well, read that list again of potential diseases.

The first step is knowledge, and that knowledge is easy to get. Walk over to Health Plus and shout, "Hit me with the digits!"

Have your blood sugar checked annually

Diabetes is a very serious illness that many people have without knowing they have it. Over time, it can lead to serious complications, such as blindness and amputation of limbs.

And it is so easy to test for. A couple of minutes, and you can have some information that can help you live a longer and better life if it turns out you have diabetes.

Get a regular colon exam after age 50

Colon cancer is one of the most common cancers in the United States--only breast cancer and lung cancer are more common among the life-threatening malignancies--and is relatively easy to detect and easy to stop in its tracks when caught early enough.

People at the age of 50 or older should be checked for colon cancer regularly, as should people whose medical or family history place them at increased risk.

The simplest and most often used test for colon cancer is the fecal occult blood test, which looks for blood in bowel movements. Since not all precancerous polyps bleed and some things that are not life threatening, such as hemorrhoids, do bleed, this test is not perfect, but it is a quick and broad assessment tool that can point to problems.

Sigmoidoscopy is an examination of the lower part of the bowel, which is where most colon cancer begins, and this test is often recommended for people who are 50 or older.

But the most accurate screening exam is the colonoscopy, which examines the entire large intestine for polyps, and, at the same time, allows for their painless removal. A flexible tube with a light and camera is inserted into the rectum and a doctor can see the entire surface of the bowel. Since a polyp may take many years to develop into a deadly cancer, the exam in most people needs to be done only every 10 years.

Have a living will and durable power of attorney for health care

A living will tells your loved ones and your health care providers what you would like done regarding your care if you are unable to communicate such decisions for yourself. A durable power of attorney for health care designates who you would like to make decisions for you if you are unable to do so.

Preparing both of these takes very little time, allows you to make these important decisions for yourself, and can save your loved ones much anguish later.

Use antibiotics when appropriate.Don't use them when they're not.

Antibiotic resistance is increasing and is genuinely alarming the infectious disease and public health communities. Both patients and physicians have become enraptured with the effectiveness of antibiotic therapy. It's clear that parents often demand antibiotics for the treatment of their children's viral infections.

The problem is, antibiotics don't work against viral infections. And the dangerous consequence of that overuse is that strains of bacteria against which no antibiotic works may evolve. Treating some patients who have one of these strains of antibiotic-resistant bacteria is like going into a time machine back to the pre-antibiotic era. The danger is that, if more restraint isn't shown, that situation may also be a time machine look into a chilling, post-antibiotic future.




Every time you sneeze the wind velocity generated in your nose is up to 100 miles per hour--more than hurricane force.

Among the recently rejected slogans for a national advertising campaign explaining the lifesaving advantages of a colon exam: "Get your butt to the doctor."

From around 3500 B.C.--before any of the Bible was written, to put things in context--there was writing on clay tablets in Sumer detailing that people suffered stomach upset. And Sumerian physicians, probably by a process of trial-and-error that you don't want to think about too closely, settled on a combination of milk, peppermint leaves, and carbonates as a remedy. The concept was that alkaline substances work to neutralize stomach acid--which is pretty much the concept that Tums and Rolaids and their like still operate on.


VUMC staff and faculty can see a Vanderbilt doctor within 48 hours for any acute or chronic problem through the V-FAM program. Call 343-8863 for an appointment with an available Internal Medicine or other physician. You may not get to see your own doctor, but somebody will see you--and the plan is open to immediate family members, too.

To find a quick calculator of body mass index, go to the Web site of the National Institutes of Health's National Heart, Lung, and Blood Institute. There you'll find the calculator at http://

Model living wills and durable power of attorney for health care forms are available from the Office of Patient Affairs, between the VUH lobby and the elevators and the Admitting Office just off the lobby of VUH. A model living will can also be downloaded from the VUMC Web site at edu/ethics/living.pdf.

Some screenings, such as cholesterol and blood pressure, are available from many medical and nursing clinics at and affiliated with VUMC, and also at Health Plus as part of a comprehensive wellness assessment. The Health Plus phone number is 343-8943.







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