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Health resolutions
Dr Asheesh Mehta Internal Medicine Specialist January 03, 2018
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The New Year is the time for resolutions and health related resolutions are usually at the top of the list. Stopping smoking or other types of tobacco use should be the first resolution for all users.  The WHO estimates that tobacco is directly responsible for about 6 million deaths each year and about 890,000 of these deaths occur in nonsmokers exposed to second-hand smoke. The misery caused by tobacco is much greater than is accounted for by the number of deaths as a far larger number of people suffer diverse health problems including chronic bronchitis, emphysema, stroke, heart disease, various types of cancers, etc. Tobacco is extremely addictive and there is no easy way of giving it up. A firm intention to do so is a must and the new year is an opportune time to make this resolution. Making tobacco products costlier has been a successful strategy in other parts of the world and hopefully the already implemented increase in prices here will also serve as a disincentive to smokers. Aids such as nicotine gum and patches as well as prescription tablets like varenicline (Chantix from Pfizer) are of significant help in improving success rate but without a resolute will the result will be failure or an early relapse. Support from family and friends improves success in giving up smoking.

For people without known chronic illnesses a worthwhile resolution would be to undergo a health screening. The type of screening warranted depends on the age and sex as well as general health status and family history of illnesses. Diabetes, hypertension and obesity are prevalent in epidemic proportions in the Gulf in both citizens and expatriates. These conditions are interrelated in the sense that obesity and lack of exercise predispose to both diabetes and hypertension and all four of these are major risk factors for heart disease. Smoking, elevated levels of serum cholesterol and triglycerides and stress are other major modifiable risk factors for heart disease while age, race, sex and family history are nonmodifiable risk factors. Heart disease continues to enjoy the decidedly dubious distinction of being the leading cause of death and hence the concentration on screening for its risk factors. It is well known that a significant proportion of diabetics are not aware that they suffer from this illness and for hypertension the number of so-called silent cases is even higher. In fact hypertension is often described as the classical silent killer. Regarding high cholesterol and triglyceride levels in blood, these cause no direct symptoms and are only detectable by a blood test. Screening for diabetes and raised cholesterol and triglycerides along with blood pressure measurement is very much worthwhile in all adults. Negative testing results are to be hoped for but should not make one complacent. Repeat testing is desirable at at regular intervals, the interval depending on the findings at initial evaluation and also the presence of obesity, any symptoms, family history, etc. Abnormal results need rectification measures in one’s lifestyle and possibly also long-term medication. Treating these diseases at an early stage prevents or delays complications to a large extent.

Weight and exercise generally figure in health resolutions of most people. Maintaining one’s weight within desirable limits is a challenge for most of us. Ample availability of food, sedentary lifestyle with very little physical activity and lack of time have a compounded effect on weight
Other health screening which should be part of the resolution needs to include breast cancer screening in women and for prostate cancer in older men. Breast cancer continues to be the commonest cancer (barring skin cancer) in women and often affects quite young women. Treatment of early stages of breast cancer is highly rewarding with excellent cure rates. These cure rates are not too bad even in more advanced cases. Self-examination, clinical examination, ultrasound and mammography are the more commonly utilized screening methods. Prostate cancer is extremely common in older men. Fortunately, most such cancers remain within the prostate gland and do not cause clinical symptoms. Even the minority that do spread locally or to distant sites however constitute a fairly large number of individuals and hence the need to screen all older men. Blood tests such as PSA, a rectal examination and ultrasound evaluation are the usual screening methods employed. Cancer colon is common in Caucasians and is also being seen with increasing frequency in other races, possibly due to changes in diet and lifestyle. A new year resolution to screen for this cancer is also a good idea. Stool test for occult blood, rectal examination, specific blood tests and colonoscopy are the screening tests of use for colon cancer screening.

Weight and exercise generally figure in health resolutions of most people. Maintaining one’s weight within desirable limits is a challenge for most of us. Ample availability of food, sedentary lifestyle with very little physical activity and lack of time have a compounded effect on weight. Food choices are also part of the problem. Colas, fruit juices, desserts, french fries all contribute. Nuts too, though otherwise healthy, are very fattening. The resolution to control or lose weight needs to be implemented with a well planned strategy. Keeping expectations reasonable is most important to avoid disappointment and abandonment of the endeavour. Weight loss of 1 to 2 Kg per month over a period of a few months is achievable by most people provided they are able to adhere to their plan. Larger losses are often achieved by really overweight people in much shorter times but they also tend to gain the weight back at the same speed. A gradual loss over a longer time is generally easier to sustain. Most of the weight loss will be achieved by diet control rather than by exercise. Eating small frequent meals is found to be more efficacious in reducing weight rather than skipping meals. Different types of dietary regimens work for different individuals and one needs to persevere with what gives one results provided it is not leading to nutritional deficiency or other complications. A high protein diet with carbohydrates restricted to a minimum is quite popular. Any diet needs to include adequate quantities of fresh vegetables and fruits. People with preexisting illnesses such as diabetes and hypertension need to obtain clearance from their physicians before going on excessively strenuous diets. When making the resolution to go on a diet one needs to understand that it may need to be undertaken for quite long periods if sustainable results are to be achieved.

Regular exercise is another important resolution for the new year. Ideally a combination of aerobic and anaerobic exercises should be undertaken. Aerobic exercises such as walking, jogging, swimming, cycling are particularly beneficial in protecting the heart. 20 to 30 minutes of this type of exercise should be carried out at least 5 days a week. Weight-bearing exercises too are important to maintain muscle mass and to tone them up. They also help in keeping bones healthy and improve posture. These exercises should be carried out at least twice a week. It is common sense for previously sedentary individuals to start with exercises gradually so as to build up stamina and also avoid injuries. Warming up before exercises is recommended as is wearing suitable footwear and clothing. Ensuring adequate hydration during physical activities is also important. Again, individuals with preexisting illnesses need clearance from their doctors. Diabetics in particular need to take care to avoid injuries, especially those to the feet such as shoe-bites. Thus, for ideal results a combination of both types of exercises is advisable.

The final health resolution that rounds off the list is to try and reduce stress or at least to manage it better. Unfortunately, stress is part of our lives and most of us are not able to keep it under adequate control. There are no easy solutions but dedicating adequate time for oneself and trying to maintain a balance in one’s life are most important. Adequate time for oneself is about getting enough sleep, enough time for one’s interests and hobbies and for physical exercise. Keeping in contact with one’s family and friends is also important. This does require time and also effort. It is often difficult to dedicate enough time for oneself when one is working long hours and spending too much time commuting and everyone has their own constraints. An analysis of how one spends time through the day is really worthwhile. The television, the computer and the smartphone probably account for too much of what one spends free time on. A balance in allocation of free time may allow one to have a better life and also reduce stress.

Most new year resolutions are soon broken but maybe it is time to adhere to resolutions this year and enjoy a healthier and surely happier life.
 

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