In the decade that I practice medicine full-time, there were only 2 patients who turned their health around via lifestyle changes in order to get off of medications. I feel like I’ve told this same story 1,000 times because my patients always ask me if they can try to turn their health around and get rid of their diabetes, hypertension, or hyperlipidemia. Managing your health isn’t complicated but requires some drastic changes. Changes which you eventually will get used to but are hard to initiate.
My own small sample size tells me that most individuals aren’t willing to make the necessary sacrifices and lifestyle changes. Maybe they doubt that they can manage their own health themselves. Maybe they don’t have enough support or haven’t gathered the adequate facts.
Healthcare will set the average early retiree back by a lot. Not only will we have to save a lot more but we’ll have less to live off of in retirement. Healthcare in the US isn’t going to get cheaper so here my strategies and anecdotes.
Healthcare is Expensive
If you need to go to the ER or be admitted, healthcare will be expensive. It’s one of the many reasons people want the best health insurance possible. They don’t want to have to pay $5,000 out of pocket.
Fortunately, even the most expensive HDHP’s are now capped at $7k. So you’ll never pay more than $7k in a given year even if you need 100 MRI’s and need to have multiple surgeries and follow-up visits. Unfortunately, you’ll pay a ton out of pocket for the health insurance premium or be indefinitely dependent on your employer to provide it for you as an employment benefit.
But the biggest cost of healthcare isn’t that occasional surgery you’ll need or the ER workup. It’s the chronic disease management – hypertension, diabetes, hyperlipidemia, and psych disorders. That’s why managing your health is as important as managing your investments.
Whatever you do yourself to manage your health will put money directly in your pocket. Most chronic diseases are manageable without medications despite what your doctor says or media reports.
Managing Your Health
Even though I mostly practiced Urgent Care medicine, there were a few primary care patients who didn’t like their PCP’s or just found the UC more convenient. Most of us Urgent Care doctors have such patient followings. They find out when we work and come to us for their primary care management.
D. was such a patient. Nearly 80 and completely healthy all her life. She was diagnosed with DM2 and refused to accept medications, despite an A1C in the double digits. She was slightly overweight but the issue was she was eating really poorly and had a sedentary life after her husband of 52 years passed away.
She figured out that A1C was the way we tracked her DM2 and asked me bluntly whether she can get off the insulin and metformin once the A1C is normal. Of course! Her doctor told her otherwise so she preferred my direction instead.
6 months into the DM2, she dropped all of her excess weight, changed her diet, exercised, and was militant about checking her sugars. A1C dropped down to 5.3. I took her off of her meds. She followed up with me for a few more years and never had any issues.
Common Health Issues
Cancer and MS get the most press but they aren’t the most common healthcare issues that we will experience in our lives.
The common diseases which end up costing us a lot of time any money are:
- type 2 diabetes
- fatty liver
- chronic kidney disease
- back pain
- dental caries
- colon polyps
- hearing loss
- seasonal allergies
Type 2 Diabetes
I won’t start a medical war here but it’s believed that DM2 is a chronic and incurable condition. I don’t agree with that. Instead, it’s the lifestyle which we continue that isn’t compatible with glucose management.
Type 2 diabetics have it hard because you can’t assign each patient a blanket diet and expect them all to fare the same. Some will thrive on fruits while others will have terrible insulin and glucose surges with it.
Weight management, increasing muscle mass, curbing stress, and sleep control are also key to managing DM2. Any such lifestyle changes are nearly impossible for people to adopt because it requires so much work.
Managing your health can save you a lot of money. It’s best to be preventative about the list of medical conditions I mentioned above. Once you are diagnosed with these, it’s a little tougher to manage – or you have to be more drastic about it.
My second case study is Mr. C. who was a successful real estate dude. His main career was mechanical engineering but most of his income was coming from real estate even at an early age. Nearly 70, he was obese, sedentary, depressed, and eventually diagnosed with hypertension.
Next he developed some renal insufficient. Next, a DVT and a small PE. He was on a list of medications longer than my … well, long.
I diagnosed his DVT and we became friends. We hung out outside of work, we had a common interest of classic cars, and he was simply a pleasant person to be around. He made it his mission to taper off his meds.
He got into long-distance cycling. He lost over 50 lbs, put on a lot of muscle, changed his diet for the most part, got rid of a lot of stress by getting rid of some of his real estate, and got back into restoring cars.
He got off warfarin, his BP meds, stopped seeing his nephrologist, and the only medicine he stayed on was a statin because he couldn’t part with bread. He didn’t even take Aspirin.
Managing your health isn’t easy. It’s even harder when you’re a clinician because you cannot think objectively about yourself.
There are a lot of diseases that we can prevent or at least have a good chance of preventing. Most of these diseases are silent and we get glimpses into them when we have the occasional physical.
It’s hard identifying stress or anxiety. What might just seem like a busy day might in fact have been a few subtle panic attacks and underlying anxiety.
That shit adds up. Elevated cortisol levels spike your insulin and change your fat distribution.
Insomnia might just seem being busy with a young child and having to take call. Maybe you’re a night owl and have to wake up early for work.
Managing your health means managing your circumstances. It means managing people around you who could potentially add to your stress. It means having to care more about yourself than others – at least at first.
I’m not impressed by the mother who tells me that she has no time to herself because she’s running around after her kids and husband all day. No matter how nobly she phrases it, she isn’t a martyr because her health problems will be the burden of her family one day and sadly our nation’s.
It’s too raw to call it selfish but that’s the hard part of managing your health and being a parent.
Anxiety and stress probably adds more to hypertension and diabetes than we can prove. But it’s also what we eat. It might be the protein fetish that we have as Americans. As a vegan, I’m always asked whether I’m worried about not getting enough protein. I’m 6′ and 175 lbs and not deficient of muscle.
Marketing has done a lot to push protein but ignorance is no longer justifiable in 2018 when information is free.
Managing my own Health
Over the years I’ve had a few health issues, nothing major so far. I’ve had back pain, lactose intolerance, IBS, bouts of anxiety, depression in medical school, perioral dermatitis, multiple dental caries, recurrent episcleritis, peritonsilar abscesses, and hypertension.
You would think I’m a mess but these all popped up at different times and I’ve figured out the cause to most and was fortunately able to change my lifestyle to remedy them.
I don’t take medications. In the past 7 years I’ve only take 1.5 pills of HCTZ at the behest of a fellow doctor which was unnecessary.
I share this with my readers because many of us medical professionals live similar lifestyles. Most of us eat on the run, try to be active, and have a great deal of stress.
I developed hypertension in medical school. Stress was the biggest culprit and insomnia didn’t help.
For the past 2 years my blood pressure started creeping back up. I wasn’t stressed anymore. I was sleeping really well but I was drinking more alcohol with friends and eating more processed foods.
Over the past few months I decided to cut out alcohol and salt. I started a more cardio-focused routine to excrete more salt, and I avoided long sedentary periods which I’m prone to when I sit down to write.
My BP started creeping into the 170/120 range and for a while I never had a reading below 145/95. So I gave in, decided to try HCTZ. I took it for 1.5 days and, for the first time, I had a reading of 128/84. But I felt terrible – nauseated and gassy and a lot of mucus production.
Lifestyle Changes for Hypertension
My weight was never an issue but like most vegans, I was eating a lot of processed stuff. That’s one of the reasons I try to steer my patients away from being vegan and adopt a whole plant-based diet.
After just 1 week of making a few simple but drastic changes, I have consistent readings in the 100/60 range. No more random headaches, no more feeling fatigued, and less sinus congestion (?).
- no added salt
- low impact cardio for 1 hour a day
- no alcohol
- no processed foods
- daily meditating
Health Care Cost of Hypertension
For a busy medical professional the time lost visiting their doctors is far worse than the dollar costs of managing hypertension. Sadly, in the US we don’t respect our patient’s time and we let them wait and wait just to see a doctor. Then wait for medications, then wait for labs, and wait for a follow-up appointment.
But the financial costs add up as well. There are copays for visits, copays for labs, copays for medications, and paying for a blood pressure cuff which set me back 50 euros here in Spain.
The worst part of having your hypertension managed allopathically is relying on the US healthcare system. This means you’ll likely spend more to get the better insurance. You’ll get used to your overworked primary care doctor and will switch insurances to make sure you retain her services.
You routinely will have to go see your doctor for refills, electrolyte and Cr checks, lipid panels, and probably have to adjust your medication dosage or class a few times until your BP is properly managed.
BP meds are prone to side effects from causing hyperglycemia to bronchospasms, ED, depression, urolithiasis, gout, neuropathy, and nephropathy.
False Sense of Security
Far worse than all these is the false sense of security such medications give patients. They assume that because they are on prescription medication their health should be fine. They settle into this drug-managed lifestyle without realizing that they are heading down a path of the HTN/DM2/HL trifecta.
They are taking medications to control their BP but aren’t making any other lifestyle changes and so it’s likely that HL is right around the corner. And they aren’t adjusting their diets even though their bodies are screaming to do so. And so, next comes DM2, followed by colon diverticula, sleep apnea, daytime somnolence, decrease energy, ED, and atherosclerosis.
I want to enjoy my time and my health in retirement. Some diseases aren’t preventable nor manageable by lifestyle changes but the majority are. I believe life is more enjoyable when you are actively managing your health rather than outsourcing it to clinicians who are trained in prescribing rather than disease management.
Healthcare Costs in Retirement
This all ties back to finances – at least on my blog. If I can do my part to stay healthier then I have to spend less money on health care. That means I need to save less for retirement. Which means I don’t have to work as hard and as long.
Because the average American suffers the consequences of a stressful lifestyle later in life, they will spend the majority of their healthcare dollars during their retirement years – their non-income years.
I don’t care to rely on an expensive health insurance plan or drug prescription plan. I don’t want to spend my time remembering to take a medication, dealing with side effects, visiting doctors, having my blood drawn, or fighting the pharmacy for a refill.
A bland meal of chickpeas and zucchini may not be right for everyone. But it’s my tradeoff for getting out of the practice of full-time medicine and retiring early.