The Wheels On The Bus Go 'Round And 'Round

I see a lot of illness.  In fact my perspective on health is most likely skewed heavily towards the view that unhealthy lifestyles  lead to illness.

And illness leads to your hospitalization

You see it over and over on my blog.

Is it my perception?

Or is it the reality.

I would tend to lean heavily toward reality.

Our hospital's insulin protocol sheets are probably one of the most widely used protocols in the hospital.  

And that's because a large portion of my practice involves a comorbid diabetes diagnosis.

It never ceases to amaze me that adult onset diabetes (what I call weight related)  is almost entirely avoidable and curable with healthy lifestyle initiatives.  

The pattern of metabolic syndrome, insulin resistance, overt diabetes, hypertension, and to some degree cholesterol status,  are some of the most avoidable chronic illness that ever was.  

They are almost entirely a result of the American effort to remove the word  sweat from our daily vocabulary.

The problem doesn't stop there.  Diabetes care is expensive.  But the sugar ain't going to kill you.  It's all the side effects both microvascular (your capillaries) and macrovascular (your arteries) disease that come with it.

A physician once told me during residency:  We should stop thinking of diabetes as a disorder of glucose metabolism and start thinking of it as a disease of blood vessels.

You see,  it is the havoc that diabetes reeks on blood vessels that causes all the problems as the diabetic ages.

Microvascular:

Blindness

Neuropathy

Renal Failure

Stroke

Cellulitis

Macrovascular

Heart disease

Limb amputations

Renal Artery Stenosis

Stroke

The top two causes of all kidney failure in the United states accounting for over 70% of all chronic kidney disease is diabetes and hypertension.  Kidney failure is expensive,  horribly expensive.

Two of the most preventable and most costly disorders that afflict our obese and expanding waistline population

The side effects of ignoring diabetes is a life of misery.  Growing old with a morbidity and disease burden that would turn most functioning adults into depressed  homebound invalids if they knew what life had in store for them.  

It doesn't have to be that way.

We have a population hell bent on trying to change the laws of nature.  

If you eat yourself silly.  If you smoke yourself silly.  And if you lay around your self silly

You will get out of old age the same kind of effort you put into it.  

A life of illness will be in store for you.

You will likely see me or one of the other soon to be 40,000 hospitalists in the hospital, on an uncomfortable bed with tubes sticking out of you,  meds force fed through a feeding tube,  oxygen tanks wheeled around where ever you go,  a walker if you're lucky,  more likely a wheel chair.

You may suffer a heart attack if the stroke doesn't get you first.

You may suffer a stroke, if the heart attack doesn't get you first.

You may find your 3 trips a week to the kidney dialysis center, at 4 hours a pop,  you may find that this game plan seriously limits your ability to travel the world with your wife.  To go on that cruise you have been promising for the last 20 years.

You may find the oxygen tanks keep you from going too far away from home.  From leaving the house more than a few hours at a time.  From traveling over seas for that Mediterranean dream trip you have always wished for.  

You may find that the nursing home has rules just as if you were a child.

You spend your whole life for others.  Raising your kids.  Earning a living to get your kids through school.  Working two jobs.  

When you finally retire and join the ranks of the other 45 million Medicare and social security recipients on the take,  you expect this phase in your life to be your Golden Years.

Your Me Time.

For those who gave a crap about themselves through the years,  the laws of nature are on your side.  You can expect that for the most part,  nature will keep up it's end of the bargain, allowing you the pleasure of

Growing Old Gracefully.

Or, to put it another way:

Finishing Strong

For those who felt they were above nature's powers,  you can expect to meet me.

And meet me often.  You can expect not to grow old gracefully.

Finishing like a lump.

You can expect a life consumed by medical care, hospital visits, doctors visits.

Jack said it best in the recent movie "The Bucket List"

"The wheels on the bus go 'round and 'round"

The never ending cycle of apathy, obesity and illness has consumed this nation. 

Turning apathy into action is a hard thing to do when the government has created a false net of security for the self imploding self created victims in this country.

When you turn 65, you are given your golden ticket to the leather couch.  You get everything paid for.  You get no personal responsibility component to your health.  Heart attack?  

Sure. My Uncle Sam will pick up the tab.

Need to whack off a leg?  No problem,  I can afford it.  

Your health now becomes the concern of Uncle Sam.  Uncle Sam's main concern is to keep you happy.  Because a happy old person means a happy vote.  

Everyone knows old people vote.  And they vote for whom ever gives them the most money.  The most entitlement.  The old people are a big group.  And as a whole,  they have a ton of skin to throw their weight around. 

Instead of making Mr Old Person take some responsibility for being healthy,  we have decided, as a nation, to make all old people entitled to free benefits, regardless of ability to pay, a guilt free orgy of health care consumption.

Why is it that my elderly smokers can spend $150 a month on cigarettes but according to the AARP can't afford to pay a balance bill arrangement with their doc?

Almost $2000 a year in cigarettes.

Medicare/Medicaid should institute a policy of cotinine testing for all persons on the take.

AND they should allow balance billing for all those in the "high risk" smoking Medicare/Medicaid category.  

Putting some teeth into the entitlement programs by forcing those on the take to entertain the possibility of a financial consequence for their actions would certainly go along way to reducing the FREE=MORE mentality.

You see, in general, those who take care of themselves do not consume health care dollars/resources to the same tune that those who don't.  

In our current system,  we get what we pay for  We get very expensive:

1)Hospitalizations.

2)Proceduralization.

3)Specialist fragmentation.

These are end game health care decisions.  

The other day, I over heard a nurse talking to a specialist about his patient.  It went something like this:

RN:  Good morning doctor.

Doctor:  Good morning

RN:  Are you planning on doing any procedures on Mrs Smith today?

Doctor:  Procedures? Why?  Does she need one?  I'd love to do one.

Multiply that motivation by hundreds of thousands of times a year, where the financial incentive is alive and strong.  You just don't hear that conversation with paracentesis.

It is the care that results from lack of personal responsibility.  Of course this doesn't represent all patients, but generalizing over the entire population,  most hospital admissions,  diseases are the result of  personal responsibility decisions.  

1)Smoking

2)Couch potato

3)Eating too much.

I tell patients every day, over and over again.  You can do more for your health than I could ever do with any medicine.  And you can do it for free.  

I rarely see older folks in the hospital that are 0/3 on these three lifestyle choices.  It is a universal truth that you will have 1/3, 2/3, or 3/3 to be admitted to a hospital.  

There should be a financial reward for those who do give a crap about themselves.  

There should be a tiered Medicare tax while you are working .  Double if you smoke.  And your premiums at age 65 should be quadrupled if you smoke.

They should be cut in 1/2 if you don't smoke, you exercise, and you are not considered obese by all objective standards.

Why should I pay the same as a  smoking couch potato who will consume enourmous resources in due time.

Why is it that I, as a tax payer, should be subsidizing health care costs for a man who clearly has no personal interest in the cost of his care or the health of his body.

In the current system of entitlement where all people and their choices are created equal,  the Wheels on the bus will always go 'round and 'round.