CHAPTER 2: Health Habits and Health Decisions

Prevention: Easy Choice: Smoking

Smoking greatly increases the chances of dying from cancer, heart, or lung disease.

Patients who quit smoking say that two things often help:1) setting a date to quit; and 2) making a list of what they will do when they want to smoke (chew gum, exercise, etc.). Your doctor can prescribe some medications, like buproprion and nicotine patches, that may help smokers quit. (Patches used for 8 weeks double the quit rate and don't need to be tapered).

Prevention: Easy Choice: Blood Pressure

Have your blood pressure checked at least every two years. When high blood pressure is controlled, the chances for heart attack, kidney problems and stroke go down.

Prevention: Easy Choice: "Quick Killers": Accidents, Homicides, Suicides

Common killers of adults are accidents, murders and suicides.

Smoke and carbon monoxide detectors do save lives.

Seat belts do reduce deaths from car accidents. Helmets reduce head injuries in bicycle and motorcycle accidents but will not protect from fatal neck injuries when speeding.

When following a car, do not tailgate. You should be able to count up to two seconds (very slowly) before you pass the road sign that the car ahead of you just passed. Increase your count to four seconds in bad weather.

Many deaths from car accidents and homicides involve alcohol or drugs. Many people are now smarter about not drinking and driving. But a lot of people still believe that a "legal" blood level of alcohol means that they are not impaired. Alcohol impairs at any level. "Legal" drinkers are more likely to have accidents than non-drinkers.

Most murders are not planned. If you have a gun, keep it locked up and unloaded so it can be used only for hunting and target practice.

Suicide can often be prevented if the person thinking about it can have a good talk with someone they trust as soon as possible. Also, telephone crisis help-lines are available to call in many areas. Anyone with suicidal thoughts should seek counseling as soon as possible.

Prevention: Easy Choice:"Immunizations" - Shots for Safety

Flu shots (immunizations) are now recommended for everyone older than 6 months of age. Pneumonia shots are recommended for older persons, public safety and health workers, people on dialysis or who have have diabetes or diseases of the blood (sickle cell), heart, lung, or liver.

The tetanus shot usually includes the diphtheria vaccine. The immunity for both lasts about 10 years. The side effects of the shot are minor and usually involve only local soreness and a slight fever. During everyday activities (such as doing gardening or outside recreation) the tetanus bacteria can enter a break in the skin and cause infection. It is important to have a booster shot if you have a severe cut or puncture wound.

Measles, mumps and rubella can be prevented through immunizations. Women of childbearing age must be immunized against rubella in order to reduce the risk of serious damage to their baby.

Hepatitis B causes liver disease. Hepatitis immunizations are strongly recommended for most people on dialysis, public safety and health care workers, persons who have injected drugs and men who engage in homosexual behavior. In areas with high rates of hepatitis B immunization of all adults and children is now being recommended.

When planning foreign travel to countries outside of western Europe, you should talk to a doctor or visit your Public Health Department web site. Some immunizations require several shots to be fully effective and you should plan to get them several months ahead of your departure.`www.who.org`_

It is helpful to keep a personal immunization record with the types and dates of shots you have received as well as any side effects or problems that you had.

Prevention: Easy Choice: Eating Well and Exercising

A balanced diet and regular exercise at least three times a week will improve your health. If you are overweight and regularly exercise and change your diet, you can CUT BY ONE HALF YOUR CHANCE FOR HAVING (SUGAR) DIABETES OR HIGH BLOOD PRESSURE! All older adults also benefit by eating about 1200mg of calcium with Vitamin D a day to prevent fractures. However, too much calcium and Vitamin D is generally not recommended.

Prevention: Easy Choice: Alcohol and Drugs

Adults who use alcohol and drugs usually know about some of the risks.

Small amounts of alcohol- particularly red wine- are not harmful and may lower heart disease risks. Higher risks for alcohol problems occur in persons over the age 70 or women who have more than a drink every day; for men below the age of 70, their risk is increased if they drink more than 2 drinks a day.

If you answer yes to any of the following questions, you have, or will probably have, a drinking problem.

• Do you need to drink every day?
• Have you tried to cut back on your drinking and not been able to?
• Do you drink more than 4 drinks in a few hours?
• Have you ever blacked out after drinking?
• Do you ever drink secretly?
• Do you get into fights when you are drunk?
• Do you miss work because you are drunk or hung over, or using other drugs?
• Have you ever been in trouble with the law because you were drunk?
• Do you have problems in relationships with friends or family because of your drinking?

If you have a problem, please talk to a health professional about it. Treatments can be very effective once a person has decided to deal with the problem.

Prevention: Easy Choice: AIDS, Unplanned Pregnancy and Sexual Diseases

AIDS remains a common killer of men aged 25-44. The rates of AIDS has also increased in women. Sexual diseases and unwanted pregnancies are all too frequent problems for both young men and women. Using condoms helps prevent both pregnancy and the spread of diseases. (See Sexual Questions)

Prevention: Easy Choice: Violence in the Home

Violence is not an acceptable way to solve problems. Violence causes violence, abuse leads to more abuse. However, within a family abuse and violence may never be talked about. Just observing violence creates a serious health problem for the children who watch their mothers being beaten by their fathers or their brothers and sisters being beaten.

Violence or abuse by a family member affects the way we feel about ourselves and the way we look at the world. After an attack most people feel anxious. They are worried that it might happen again and that they are powerless to stop it. After even one serious episode of violence, many people will have nightmares, anxiety attacks, or withdraw into themselves.

The long term effects of abuse and violence will cause many people to feel nervous or anxious. Some will have headaches or stomach pains. This is their body's way of showing that they are upset and under a lot of stress. Some become depressed (feel very sad all of the time). Others have panic attacks. They suddenly feel their heart beat fast and they get very shaky. And other people have sudden fears, flashbacks to the events, nightmares, numbing and loss of feeling, reduced interest in usual activities, anger, aggressiveness and difficulty concentrating.

Many may try alcohol or drugs as a way to escape their feelings and to make themselves feel powerful. But this only seems to work for a very short time. They will take more and more drugs and alcohol, but the false feelings of power will weaken and fade away. Adults who have been abused feel badly about themselves, mistrust others, are aggressive and have trouble in their relationships with others. They are more likely to abuse their children.

If you have experienced or witnessed violence and abuse you should seek help. Treatment is available to help you recover from this experience. Talk about it to a licensed mental health counselor, minister or priest, school counselor, or your doctor. You can also call your local domestic violence hotline or "911."

Prevention: Easy Choice: Risks If You Have Hardening of the Arteries or (Sugar) Diabetes

If you have had a heart attack or other forms of hardening of the arteries, you will benefit from:

• Lowering fat (cholesterol) in the blood by losing weight, avoiding fatty foods, exercising and, when necessary, taking prescription medications. Persons with diabetes should be particularly careful about their levels of blood fats.
• Taking a beta blocker pill if you have had a heart attack. Ask your doctor to explain these pills to you if you are not familiar with them.
• Taking a low-dose aspirin a day with your doctor's approval.
• If you have heart failure or diabetes, ask your doctor about a "converting enzyme inhibitor" or spironolactone.

Prevention: Easy Choice: Tests Cervical Cancer and Breast Cancer (for women aged 50 or older)

About 2 of 100 (2%) fifty-year-old women may die of breast cancer by age 80 if her sister and mother did not have breast cancer. The chance is about 4/100 (4%) if her mother or sister had breast cancer and increases even more if they were below age 50 when the cancer was discovered. Modern treatments have reduced these chances for death.

Mammograms (breast X-rays) may also reduce these risks. For women whose mother or sisters have had breast cancer, mammograms should begin at 40. For women without a strong family history of breast cancer, routine mammography every 1-2 years is recommended beginning at least by age 50 and continuing to 80 years of age.

Immunizations for the prevention of cervical cancer in young women are now available. They seem to work very well. Pap tests for cervical cancer are generally recommended every three years (after two normal tests, one year apart). Younger women with multiple sex partners or sexual diseases should have a pap test more often and also a test for chlamydia. Women over age 65 need them less frequently and not at all if all previous tests have been normal.

Prevention: Easy Choice: Tests for Bowel Cancer

Experts in all countries recommend testing for bowel cancer in all adults aged 50 years or older. However there is disagreement about the best method for testing (looking with a scope or doing tests for blood in the bowel movement).

Prevention: Easy Choice: Preventable Accidents: The "Little Things"

To place preventable accidents in perspective, consider these causes of death in the United States. Compared to about 40,000 motor vehicle related deaths in 1994, there were 14,000 deaths from falls, almost 10,000 deaths from poisoning and 8,000 deaths from drowning or fire. (In addition, about 8,000 deaths are related to the use of aspirin, Motrin (ibuprofen), Naprosyn (naproxen) and related medications. See Common Medical Conditions and Medications).

Accidents seldom "just happen" and many can be prevented. Because accidental injuries occur more often in later life and result in more serious injuries, attention to safety is especially important for older people.

Protect yourself and your loved ones! Check for harmful things at home, at work and during recreation.

At home are:

• Stairways and halls well lit?
• Loose rugs and extension cords in the way?
• Handrails sturdy and 30 inches higher than stairs?
• Medicines and poisons locked or out of reach?
• Outside steps, ramps and walkways repaired?
• Water heaters set so that water will not scald skin?
• Smoke and carbon monoxide detectors in working order?
• Emergency exits planned and quick and easy to unlock?

At work:

• Your protective gear (hearing protection, work boots, work gloves, safety glasses) worn? Your masks worn to protect from dust and chemicals?
• Your chairs, keyboard and desk set so that your forearms, wrists and hands are in a straight line?
• Lifting is done with your legs by squatting with your back straight, knees bent and weight held closely to your body?
• Hand truck or assistance is used for heavy weights? (More than 40 pounds for women and 80 pounds for men.)

At play:

• Most busy adults do not spend much time worrying about protecting their eyes, ears, or mouth from harm. Take care! Damage is usually permanent and very disabling.
• Sun damage to the skin continues to cause an increase in skin cancers and wrinkles.
• Many people do not wear life vests when boating or protective clothing when around ticks that may carry Lyme Disease.

Falls are the most common cause of fatal injury in older people. If you are an older adult, the following "little things" can make a big difference to prevent falls.

• Have vision tested regularly and properly corrected.
• Make sure that medicines are labeled with large print. Both illness and the side effects of medicines increase the risk of falls. Use egg cartons or special containers to lay out pills correctly.
• Limit your intake of alcohol. Even a little alcohol can disturb already impaired balance and reflexes.
• Use a cane, walking stick, or walker to help maintain balance on uneven or unfamiliar ground or if you sometimes feel dizzy. Use special caution when walking outdoors on wet and icy pavement. Have a grab bar installed in your bathroom if you are the least bit unsteady.
• Wear high-collared shoes that have rubber soles and low heels. Avoid wearing only socks or smooth - soled slippers on stairs and waxed floors. They make it very easy to slip.
• Approximately 5% of adults have a lot of problems feeling dizzy. If you feel dizzy, use caution in getting up too quickly after eating, or lying down or resting. Low blood pressure may cause dizziness at these times.
• Make sure that the nighttime temperature in your home is no lower than 60°F. Prolonged exposure to cold temperatures may cause body temperatures to drop, leading to falls. Most older people cannot tolerate cold as well as younger people.
• Maintain a regular program of exercise. Regular physical activity improves strength and muscle tone. This will help you move more easily and keep your joints, tendons and ligaments more flexible. Many older people enjoy walking and swimming. Mild weight bearing activities seem to reduce bone loss due to osteoporosis.
• Balance training (for example, Tai Chi) can also reduce the risk for falls.

Tougher Choices: Using a Balance Sheet for "Tough Decisions"

These decisions are tough because you have to balance some possible good things (benefits) against some possible bad things (harms). Each patient may use different ways to make the choice. Some will say that for them, a possible harm is more important while others think the possible benefits are more important than the harms. Make yourself a list of the good and bad effects of a test or treatment and see which is more important for you. Use this Table as an example.

But before you spend to much time making a balance sheet, do make sure you are doing something about risks to your health that always have a large impact on your health---smoking (no real cost to quit), diet (no real cost to change) and blood pressure control (if diet does not work there are lots of inexpensive, very effective treatments).

Other Tougher Choices: Hormone Replacement for Menopausal Women

Low dose estrogen hormone replacement is effective and seems quite safe when taken for a few years to reduce hot flashes. Longer-term use will reduce the risk for weak bones but it will slightly increase the risk for uterus (womb) and breast cancers. Adding progesterone to reduce the uterus cancer risk adds other risks such as a higher risk for blood clots, breast cancer and heart disease.

More information on this topic is found in Women's Health.

Other Tougher Choices: Alternative and Complementary Medicine

Because medicine and surgery treatment do not cure all problems, patients often try other approaches such as chiropractic, nutrition and herbal therapy, high dose vitamins, acupuncture, massage and meditation. Many clinicians will refer some patients to these "alternative" or "complementary" approaches. In general, you should feel most comfortable testing an alternative approach when there is something you can measure or feel (such as pain). If you keep a diary of your measures and feelings when taking or not taking the treatment, you will be able to determine if it is working. Be particularly cautious about treatments you have to use for more than a few weeks. Try to figure out the costs and benefits of the new approach.

What about herbs and plant supplements? Most are not regulated and they may contain impurities that might harm you. Most are not proved to work. The table lists common herbal supplements.

-aloe vera - psoriasis, constipation -black cohash** - hot flashes in women -chamomile - stomach and bowel -chaste tree - premenstrual pain -echinacea** - colds and flu -ephedra* - weight loss -feverfew - migraine headaches -garlic*,** - hardening of arteries, high cholesterol -ginger - motion sickness, weight loss -ginko*,** - hardening of the arteries, depression, memory -ginseng* - tiredness -guarana - tiredness, weight loss -green tea - bowel cancer -hawthorne - heart trouble -horse chestnut* - vein problems -kava - anxiety -milk thistle*,** - liver disease -mistletoe* - cancer -peppermint - stomach and bowel -primrose oil - premenstrual pain, skin problems** -saw palmetto*,** - urinary difficulty in men -soy proteins - hot flashes in women** -St. John's Wort* - mild depression -valerian - anxiety, trouble sleeping

(* known to cause problems with other medications or alone; ** recent scientific studies show little effect)

Studies show that a non-plant supplement glucosamine has some effect in arthritis and that zinc somewhat reduces the symptoms of colds when taken early. The benefit are unclear for these other non-plant supplements: DHEA, coenzyme q10 and chromium.

Other Tougher Choices: Self-Testing and Commercial Screening

• On the internet and in your drug store. You can now have many important tests done without visiting a doctor's office: strep throat, blood pressure, HIV, pregnancy, blood in stool, total cholesterol and illegal drugs. As the availability of home health, internet and "shopping center" tests and screening clinics grow, you need to be sure that you have thought through their benefits and harms.
• At times you may be offered by phone or mail a chance to participate in a screening for your health. You may be offered some good tests (such as a blood pressure or eye test) and questionable tests (such as a test for calcium in your arteries, a total body scan, or a DNA profile). Be very careful you have made a "balance sheet" BEFORE you have any of these tests done.