Fitness and Finances

Our physical health is impacted by all the aspects of our lives.  One of the most important is how we handle stress.  Worry about finances is one of the leading causes of stress.  The peace of mind that comes from living within one's means is usually more a factor of how we spend rather than on how much we earn.  I have met many people who earn a substantial amount of money and yet still find themselves living above their means.

In recent years we have seen first hand what happens when individuals and nations spend more than they earn.  My son recently told me, "Dad, I'm richer than the U.S. Government."  I thought "how absurd," but then realized that he was absolutely right.  Meager as his savings are, he has not accumulated any debt.

During the great depression, a religious leader taught, "Once in debt, interest is your companion every minute of the day and night; you cannot shun it or slip away from it; you cannot dismiss it; it yields neither to entreaties, demands, or orders; and whenever you get in its way or cross its course or fail to meet its demands, it crushes you." (J. Reuben Clark Jr.).

Now, I am not an expert in financial matters, but having navigated through medical school, I am well aware of the burden of debt.  Once I finished my training, my wife and I focused on paying down our loans instead of accumulating material goods.  It remains one of the best decisions we have made.  We need to make interest work for us, not against us.  It has been said, those who understand interest collect it, those who don't, pay it.

If you find yourself overwhelmed by debt, what is to be done?  First, every expense needs to be evaluated.  If it is not essential, it should be eliminated.  There is no relief until debt has been conquered.  A patient of mine recently told me of volunteering at a local food bank and seeing some people arrive to pick up food in expensive luxury cars, using smart phones.  The car needs to be sold, the phone contract needs to be cancelled.  Write down every expense and track it.  This is just like what I ask my patients to do with their calories.  In fact, we spend an awful lot of money on food.  Make sure that you bag your lunch.  Eating out is a huge expense and can be avoided.  Drink water (see my previous post, "Drink Up").  The amount of money spent on soda, coffee, tea and alcohol is staggering.

Another way to cut expenses is through managing your medications.  Many of them are very expensive.  Sometimes there are alternatives that your insurance plan would cover or that may be generic, which can result in big cost savings.  I know for a fact that your doctor cannot keep track of which medication will be the most cost effective for you.  Look up all of your medications.  If your plan lists cheaper alternatives, write them down and bring the list in to your physician.  At times, there may not be a good alternative and you won't be able to switch due to medical reasons, but I for one, am more than willing to find cheaper alternatives for my patients if it provides the same benefit.  The best way to keep down medication costs is to stay fit and in shape.  Many of my patients would not need all the medications to treat high blood pressure, cholesterol, diabetes, acid reflux, arthritis and even depression if they could get their weight down through diet and exercise.  Our physical health affects our financial health and our financial health certainly impacts our physical health as well.  It is time to be fit.

The Simvastatin Story

This week the FDA released new guidelines in regards to the use of the very common medication, simvastatin, which is used to lower cholesterol and thereby decreasing the risk of heart attack and stroke.  The reason for the guidelines change was due to new information that has been received from their Adverse Event Reporting System.  They found that there was an increased incidence of problems with muscles at the highest dose, 80 mg.  The incidence for this was much higher during the first year that a patient took the drug and was much more so in combination with certain other medications.  The most common are the calcium channel blockers used to control high blood pressure (diltiazem, verapamil).  They recommend that no more than 20 mg of simvastatin be taken in combination with these drugs and 20 mg with a similar medication, amlodipine.

Simvastatin 80 mg pill

You may ask, if there are serious risks to taking this medication, why wasn't it just pulled off of the market?  The reason is that for many people the risk of not taking the medication is higher than the risk of taking it.  In the last twenty five years, the incidence of heart disease has decreased dramatically.  Most researchers feel that it is due to the beneficial effects of the statin medications.  Their effects on the liver and on muscle tissue is well known.  When it is watched for and monitored, the medication is safe.  Simvastatin in particular is useful because it is the only statin on the market that is both potent and available in a generic form.  In my opnion, lovastatin and fluvastatin have more incidence of muscle pains.  Pravastatin is quite safe, has fewer muscle problems but is not very potent.  Basically, three options remain: Crestor, Lipitor and Vytorin.  Crestor and Lipitor will both be quite a bit more expensive.  The incidence of muscle problems is likely to be lower but the potential still exists.  Vytorin is simvastatin, together with a medication called ezetimide (Zetia).  It works by blocking the absorption of cholesterol in the intestines.  It shows great reductions in cholesterol levels but there is some debate over whether that translates into fewer cardiovascular events (heart attacks).

Where does this leave you?  It depends on your individual situation.  Step one is to estimate your cardiovascular risk.  If you have known vascular disease (atherosclerosis-partial blockage in any of your arteries), it is imperative that your LDL, bad cholesterol, be less than 100 mg/dl.  This is unlikely to be achieved by diet alone. A statin drug has the best data in regards to lowering your future risk.  If you have diabetes you fall into that same risk category.  If neither of the two are present, go to the Framingham Risk Calculator (click here) and if your risk is above 10%, you should be on a statin.   If it is lower you need to ask yourself if you are truly doing everything you can in regards to diet and exercise to ensure that you remain healthy.   Healthy living is preferable to medications any day of the week as long as the proper levels are attained.

If you need to take a statin medication, the good news is that if you have been taking simvastatin at 40 mg or less and are doing well on it, there is no concern about staying on that dose.  If you take 80 mg of simvastatin or you are also taking any of the medications that interact with it, you should discuss this with your physician.  For a detailed summary from the FDA and a list of all medications that can interact with simvastatin (click here).  If you have any questions, feel free to ask in the comments.  I'll be happy to respond.  Remember, these medications are there only to assist your own efforts in eating right and getting plenty of exercise.  They do not take their place.  Let's just simply be healthy!

Walking on The High Wire

Have you ever seen the person at the circus that walks on the tightrope?  The amazing ones can even ride a bike across while balancing balls, plates, boxes and other items.  It requires inner strength and great balance.  Similarly, our physical health can only be maximized if we are in balance in all the areas of our life.  If one area is neglected, it will affect the others.  I believe that we must be aware and nurture our health not only physically, but also, mentally, emotionally, financially and spiritually.  Let me touch on each of these, going in to more depth in future posts.

Mental Health:
We think of our youth as the years of our education but that is when it begins, not when it ends.  Keeping our brain active is important to maintain alertness, awareness and to ward off problems with our memory.  As our population ages we are seeing more and more of our family and friends develop dementia.  The scientific community has looked at all sorts of drugs and even herbal remedies to aid the brain.  None have been shown to be very significant.  However, one study in particular caught my eye.  Those patients who exercised their brain (puzzles, games, speaking a foreign language, playing a musical instrument) had a seven fold decreased risk of developing Alzheimer's Dementia than those who did not.  In addition, those who are stimulated to learn and grow mentally are more apt to read this blog and other sources of health.  Information is power.  In regards to your health, it is the power to make healthy choices and meaningful changes.

Emotional Health:
Our emotional state has a huge bearing on our physical health.  The stress from strained relationships can produce anxiety which is not just mental, but biochemical.  When we are under stress, signals from our brain are sent to the adrenal gland which is stimulated to produce epinephrine (adrenaline).  This courses through the blood stream, causing all sorts of effects.  Most noticeably are those of the heart, making it speed up, contract harder and even causing skipped beats or extra beats.  We can feel sweaty, dizzy and lightheaded.  It takes up so much energy, that it leaves us tired and exhausted.  Our immune system is taxed and we are left more vulnerable to colds and infections.  Often, patients will come in and tell me all of their physical symptoms and complaints but no one wants to admit that it could be caused by emotional stress.  It is much easier to be given a pill than to be told to work on improving relationships.  I recently saw a woman who has had many complaints over the last year.  She is currently doing relatively well and we have developed a strong enough relationship and understanding that I felt that I needed to discuss her family stresses in more detail.  I told her, "I fear that the stress of your relationship with your husband is having adverse consequences on your health."  Tearfully, she acknowledged that she felt trapped in the relationship and didn't even like going home after work.  We talked of ways to get help for them both, and though I certainly didn't solve any of her problems, she left with an understanding of how that stress was affecting her health and is now better able to focus her energies on the cause rather than on the symptoms.

Financial Health:
Living within our means provides a peace of mind that is priceless.  If we stay out of debt, we will not have to wonder if we need to choose to pay the mortgage or for a prescription.  Financial worries can be all consuming and cause the same stresses and health consequences as outlined in the preceding paragraph.  I realize that we all have different circumstances and some are left to struggle financially due to no fault of their own.  However, most of us can manage our resources better than we currently do.  We don't often think of how that impacts our health, but it most certainly does.  From a more global perspective, it has been shown that the best way to improve the health of a nation is not to pour more money into health care but to work on eliminating poverty.  We are much more able to take care of our physical health when we don't have to spend all of our energy on providing the very basic necessities of life.  Getting as much education as possible opens the doors of opportunity and ties in to our mental health as stated above.  Better jobs often have better health care benefits as well.

Spiritual Health:
The belief in a higher power, though not universal, is certainly pervasive in our world.  It brings hope to the depressed and provides an individual with a feeling of purpose in life.  Religious texts, such as the Bible, are full of examples of the power of faith to heal and to be healed.  When a loved one has passed away, those who have a strong religious connection often have stronger support groups and cope better.  As a physician, I have found great strength in being able to acknowledge a patient's belief and to support them as they may struggle with a serious illness.  I feel I can better help them cope with their disease by understanding their beliefs. There have been scientific studies showing the actual merit of prayer.  In fact, I pray for my patient's doctor each and every day.

All of these areas are important and must be balanced to achieve optimal physical health.  Each of us may have more work to do in one area than another.  When you are on the high wire of health, remember to keep all your burdens balanced!

Good Rays or Bad?

One of the key elements to our health is maintaining balance.  Just about anything, taken to an extreme can have bad consequences.  It is important to utilize one of our greatest, but often neglected, God given gifts: common sense.  No where is this better exemplified than in how we deal with sun exposure.

We have learned that excess sun causes skin cancer.  In the form of melanoma, it can be a rapidly progressive, deadly disease.  The medical community has gotten the word out.  Stay out of the sun.  Use sunscreen.  Protect yourself.  This is all true.

Now, shutting yourself inside all day and avoiding the sun's rays at any cost is not necessarily a good thing.  When the sun is out we all feel a little better.  Just as it awakens our plants and helps them to grow, it has been shown to decrease our propensity to depression and lift our moods.

There is one are of our health that the sun is essential to our metabolism.  It has to do with calcium.  Calcium keeps our bones strong.  It triggers our muscles to contract.  Without it, our heart could not pump.  It is very tightly regulated in our blood stream.  One of the ways in which this happens is through Vitamin D.  There are several sources of vitamin D in our diet but the active form which helps us absorb calcium, is formed through an enzyme that requires sunlight through the skin.  Without vitamin D our body does not function well.  I am finding in my own practice of medicine many, many people who have low Vitamin D levels.  When I was in medical school, I was taught to consider Vitamin D deficiency in mostly older patients with thin bones who never get outside.  We now live in a society where we go all day long without being outside.  Instead of walking or biking to work, we drive.  We sit all day long in buildings whether at work or at school.  When we arrive home, we rush to the computer to talk to our friends on facebook or write on our blogs!  We need more sun.

Sun exposure is bad, you say.  In excess, of course it is.  Just 10-15 minutes of sun exposure, three days a week is sufficient to maintain adequate levels of vitamin D.  Grab a hat, wear your sun screen but get outside and enjoy those rays.  Remember, keep everything in balance.