The Natural Way...

I know, I know... I'm long over-due for a post from my Internal Med rotation here in sunny San Diego... But with all the outdoor sun and fun in San Diego, who has time to blog?!
The rotation has been great. Once again, with a week left, I find myself stunned that it's time to move again already. The past 5 weeks have been a great learning experience. The constant exposure to patients with chronic disease and med-lists miles long, has made me better at sight-recognizing generic drugs names - and for that alone- I am eternally grateful to this rotation - or WILL be greatful come PANCE time...
The majority of my patients here are geriatric... of course this means everything from 50 year olds with a touch of hyperlipidemia, to 90 year olds with multiple cardiac events, cancers come and gone, and long-term disease processes like MS, Diabetes or Parkinson's. It's been so interesting just on an observational stand point, of what one 70 year old patient looks like compared to another 70 year old patient... you can tell the miles on the tires on all these folks. Some people come in, and before I go in the room I read up on the chart and see 63 yo Female- history of diabetes, frequent UTI's, maternal history of breast cancer, in for labs and med refills... got it... Go into the room and I think "Good god you look like CRAP!" (of course I only say this in my little Meghan head - not out loud.) I use my Mom for a barometer of how old/young/ healthy people are... and maybe this isn't such a good idea because a) she's Saint Eileen and the nicest and most positive/ level-headed person in the whole entire world and b) my Mumsey is hot-to-trott, kicks butt in her daily Turbokick/ Zumba classes, eats healthy and really DOES stop at that ONE 5 oz. glass-of-wine-3-4 days-per-week rule... the perfect blend of health and does NOTTTTTTTT look like she's hitting the 6-0 mark... but some of these other people, I just think... dude, you've got 8 years to go til you're my Mom's age and you look like death munchin' on a cracker and and you'll be lucky if you MAKE it to 60...
It's sad the patients that you see in for just acute disease/pain management - when you know there's a much bigger domino falling earlier upstream (preventable!) and yet causing every other problem they have. I used to think people don't know better... but now IIIII know better... people KNOW what's good for them and what they should and shouldn't do, and the problem is 98% of the time, they choose not to do the right thing... that as a medical professional is so frustrating. You see people who are walking heart attack/stroke risks and yet can't be bothered to walk around the block for 30 minutes a day or the diabetic that can't pass up the free bagels and cookies brought into the office lunch room EVERYDAY, and yet they're A1C is 13 and they're heading to blindness and amputations... uggggg small changes would make a BIG difference.
The other thing I hear from my elderly patients a lot, is the OTHER end of the spectrum... in the form of the popular phrase "Oh I don't like to take anything..." Well, as my preceptor puts it "The goal is not to get to the end without ever being on any medication, it's to MAKE it to the end in as best shape as possible, and the medicines are the vehicle to get you there..." I cannot count how many times I see patients asking for just 3 MORE months to get their cholesterol/ blood pressure/ sugars on track "Don't put me on medicine" they plead, "I'm taking natural supplements only: Red Yeast Rice, Fish Oil, and Saw Palmentto..." What people who are supposed "naturalists" don't realize is that all these 'natural' compounds are DRUGS! I've told many a patient on this rotation "Hey, arsenic is 'natural'... and it'll kill ya faster than the simple hydrochlorathizide I want to give you ever will..."
In fact, you see this "natural" trend all over the place. In healthy and unhealthy individuals, sporty people, and old crippled grandma's... it doesn't matter. They seem to think if its not a Rx'd 'drug' it's some how better or safer. This could not be farther from the truth. Every drug - asprin, flinstone chewables, vicodin - has risks and benefits. What makes the 'natural' or 'herbal' substances more evil than the big-drug-company products they supposedly replace is that NO ONE regulates them. The FDA puts every rx'd drug through a stringent testing, human trial, clinical trial and approval process to prove it is safe, does what it says it'll do, with minimal & acceptable side-effects and interactions. The formulation must be standardized, and the ingredigents specifically listed and verified for every pill produced. No one does this for the "Women's Urinary Health" or "Men's Vitality Prostate Herbal" formulas you buy at healthfood stores or GNC... the manufactures of such products are bound by NOTHING to ensure one pill, batch or ingredient supplier is the same, consistant or reliable from one bottle to the next. And in terms of knowing what you're exactly taking... because they are un-regulated- they can get by with listings of ingredients as vague as "propritary blend... 10g"... go ahead... check a label on such a product you might already have in your own home or next time you're pursuing GNC or Whole Foods. Propritary blend could mean anything from 10% Cinnamon/ 30 % Beet Root/ 50% Apple Cider Vinegar/ 10% Dandilion root to your grandmothers sugar cookie recipe...
And the bottom line is- whether you pop an herbal "heart health" pill from Vitamin World, or an over-the-counter Tylenol PM, your LIVER has to process whatever we put into it. So your vital organ is doing work (and sometimes taking a beating) whether you THINK it's natural or an evil drug...
But try explaining this to a patient... oye vey! Thanks for letting me vent here... my apologies for the rant...
Anywho, time is winding down here and I definitely will be leaving with the overwhelming majority of my encounters being with nice, sweet (albeit really sick :( ) grandmas and grandpas. I love the oldies... they are so cute, and part of that endearment is how set in their ways they are. They'll tell ya straight up "I have a vermouth martini every night since college..." (Patient, 91)... I love it. Clearly, that must be the 'natural' way to good health and long life.
Live long and prosper... on to the next location and adventure next week... stay tuned.
xoxo
Mego