Health Rules Podcast David Donohue, MD

You very likely have an airway problem.  Most people do.  If you ever had your wisdom teeth removed, that is a sign that you have an underformed jaw.  As a consequence, you likely have a shrunken airway that is prone to closing off when you sleep.  Why is it so common for people to have underformed jaws?  Researchers think that it is because we eat insufficient fiber and roughage as children, and hence do not experience the normal hypertrophy (bulking up) of the jaw bones.  

Our airways are further compromised by chronic inflammation due to pollution and an inflammatory western diet.

When our airway is shrunken, it closes off during sleep.  This leads to a bad night of sleep.  Research tells us that a single bad night of sleep means you are not at your best the next day.  It means your immune system is not functioning at 100%.  It means you are more prone to cancer and heart disease and Alzheimers. 

The tragedy is that when you have an airway problem, you can get a bad night of sleep every night, your entire life!  Such people carry huge increases in chronic diseases like obesity, diabetes, cancer, heart disease, infections, autoimmune disease.  They also feel lousy.  MANY of the people with airway problems suffer from chronic fatigue, headaches, fibromyalgia, jaw pain, allergies, anxiety, depression, and a host of other maladies.  

About 90% of people with airway problems are unaware they have a problem. 

What are signs that YOU may have an airway problem?  

The Signs That You Could Have an Airway Problem

snoring
audible breathing (without snoring)
allergies
insomnia
use of sleeping medicines
night time urination
dry mouth
mouth breathing
nasal congestion
gum disease
headache
fibromyalgia
pain syndromes
musculoskeletal pain (knees, hips, more generalized)
jaw pain
anxiety 
depression
obesity
Atherosclerosis (caused by snoring)
dementia
other chronic diseases

Climate change is now an emergency.  It is no longer about a polar bear floating on a tiny piece of ice.  

It is about flooding, wildfires, crop failures, hurricanes, evacuations.  It’s about forced migration, hunger and food insecurity.  It’s about social isolation of staying indoors for months at a time.  It's also a direct threat to your own health, with head, dehydration, and natural disaster causing more and more death and disability not just in the remote developing world, but here at home as well.  The sirens of the climate emergency are sounding daily.  

In June 2021, before summer has even kicked off, the western US is experiencing its worst drought in over a decade, with new wildfires at a 10-year high.   In Brazil, the Amazon is experiencing its worst drought in 90+ years.

People are getting displaced globally and we have heartbreaking stories of desperation and death as people try to flee areas of food insecurity or military conflict.  In this first half of the 21st century, it is the global poor who will suffer the most from the climate emergency, with financial insecurity, hunger, water scarcity, natural disasters, political unrest, and direct health effects from heat and pollution.  As we enter the second half, even affluence will be no guarantee of security.

Who is most affected by the climate emergency here at home?  It is the most vulnerable people in our communities: children, babies, pregnant women, elderly, poor, undocumented immigrants, and minorities.

Loneliness kills.  People who are lonely have a 1.29 to 2.8 fold increased risk of death in a given year.  The medical group visit is a powerful way to bring groups of patients/clients together, to collectively achieve deeper connection, health education, and healthy skill building.

When done properly, groups can be so powerful that they are beneficial irrespective of the educational material that is presented.  Dr. Jeff Geller coined the term the Group Inclusion Effect, akin to the placebo effect, meaning that the mere inclusion of a person in a group program will create an expected benefit in outcomes, regardless of what the group discusses.

If your goal is to save your patients from the Climate Emergency...
On April 6, 2021, Earth passed 420 parts per million of atmospheric carbon dioxide. This was the halfway point to doubling CO2 relative to preindustrial levels.

Although nothing suddenly shifts at this threshold, it shows just how far we have come. CO2 and other forms of carbon in the atmosphere trap heat. They are like a blanket that covers the Earth, keeping us warm. To double that blanket is to trap double heat trapping. There is a delay in seeing the full effects of rising carbon, so we have already locked in worsening warming and climate change for years to come. Meanwhile humans keep burning...

It turns out the planet is sensitive to even small increases in average temperature. A rise of 1.5 degrees C is bad but a rise of 2 degrees C is much worse. 2 degrees C means large scale flooding, crop failure, wildfires, and the death of nearly all coral reefs. At current rates of emissions, we are on a path to see 3-5 degrees C rise by 2100. This level of warming is predicted to cause a massive shift in what part of the world is habitable.

Particularly concerning is the idea of tipping points. The more warming we get, the more polar melting, which causes release of more carbon trapped in Siberian permafrost and also less reflected sunlight (because of less ice and snow). Both of those things lead to more warming, which leads to more melting. And so on, and so on. Those are 2 powerful and worrying vicious cycles that may have already begun.

Climate change causes a host of health problems. Both heat and elevated CO2 levels in the air have been both found to impair our ability to think. Altered weather patterns cause flooding or drought, crop failure, and food insecurity. Wildfires have already increased dramatically, and are predicted to increase multi-fold more as we see more warming. Rising sea level and sinking of the US East coast (due to melting Greenland, which occupies the same tectonic plate) means flooding of coastal cities. Overall, people who are poorer will suffer terribly, but we will all suffer as this century unfolds.

The worldwide burning of fossil fuels also releases toxins and pollutants (like particulates, ozone, sulfur dioxide, nitrogen dioxide, mercury, arsenic, chromium) on a massive scale, damaging our land, water, and air. PM2.5 is a name for very small particulates in the atmosphere. PM2.5 is known to cause significant health problems when we breathe them. We can measure the increase in deaths from lung disease but also heart attacks and early death.

To solve the climate crisis, the planet needs behavior change on a massive scale. Enter the physician. Most of the remedies to the climate crisis increase the health of our patients. Healthy behaviors can be a win-win for the patient, their loved ones, and for the environment. Switching from animal based nutrition to plant based nutrition is a particularly effective change we can make to achieve better health and significantly lower our footprint. Red meat in particular is extremely damaging to our planet, accounting for the lion’s share of carbon emissions and rainforest destruction. We physicians can also help patients adopt behaviors that will protect them in the short term from the immediate health effects of climate change.

While we physicians can accomplish a lot by just advocating with our patients, we need to reach outside of our medical practice as well. Your community may not believe a climate scientist but many are more willing to take scientific information from a doctor.

Cardiovascular disease or CVD refers to diseases of the blood vessels to the heart (heart attack, CHF), brain (stroke, TIA), or other organs (peripheral artery disease, aortic aneurysms).  CVD is usually due to accumulation of cholesterol plaque and inflammation. The most common cause of death from CVD is from heart disease, and we sometimes use the terms heart disease and CVD interchangeably.

CVD claims the lives of 1 in 3 women in the United States and globally.  That is more deaths than from all forms of cancer combined.

CVD doesn’t happen all of a sudden. It starts young in life, with fatty streaks depositing in children who eat Western style foods.  It is usually without symptoms until later in life.  But when kids develop obesity, elevated lipids, or diabetes, it is a sign that heart disease is in process.

Sometimes CVD first shows itself during pregnancy, when early CVD can manifest with preterm birth, miscarriage, or still birth.  Some conditions during or shortly after pregnancy are harbingers for greater risk of future CVD: gestational diabetes, hypertension, preeclampsia.  Pregnancy can be thought of as an early stress test of your heart, and any of these signs can signify likely early CVD.

What causes CVD?  The main causes  of CVD in women and men are high blood lipids and cholesterol, high blood pressure, diabetes and high blood glucose, obesity, inflammation, and toxins like tobacco.  Your genes play a role and if you have a lot of CVD in your close relatives, you may have extra risk yourself.  

Most people are not aware that you can change your genetics!  Health lifestyle behaviors can literally turn on healthier genes and turn off unhealthy genes.  

Fortunately, CVD can be prevented and even reversed at almost any stage of a girl's or woman's life.  How can I do that you ask?

So this episode is heavily rooted in the field of healthcare delivery science. Our topic is patient safety.

It is a super important topic! Some think 3rd leading cause of death. Now that is regarded as probably hyperbole. But everyone agrees, it is a very big problem and causes far more adverse outcomes and yes deaths than many other industries.

We are SUPER privileged to have a real world expert in the field of patient safety as our guest, Dr. Jennifer Myers.

Dr. Myers is Professor of Clinical Medicine
Director, Center for Health Care Improvement and Patient Safety (CHIPS), University of Pennsylvania, Philadelphia, PA, a fellow in the American College of Physicians. and a Fellow in Hospital Medicine in the Society for Hospital Medicine.

So here’s the deal.
When you receive health care, there is risk. Almost everything we do in healthcare carries pretty significant possibility of error or imperfect care. Some have attempted to quantify the impact of error in medicine. The common finding is that it’s a very big problem. In the hospital, errors happen about 3% of the time, and they are deadly about 6% to 13% of the time. AHRQ estimates that 1 in 8 Medicare patients in the United States experience medical error in a given hospitalization. In an outpatient setting, recommended treatments are followed only 55% of the time.
There is a newish field of medicine to the rescue it is called patient safety. Organizations like CampaignZero and government bodies like AHRQ have identified some best practices to minimize medical error and maximize quality of care.
The recurring theme is to take an active role. Communicate, a lot. Ask questions, question decisions, track events. Don't assume your health care team has seen your results or correctly acted on them.
It can feel frighterning to ask questions but it is essential to keeping yourself safe. Healthcare providers need to make a welcoming environment, and some do this better than others.
There is another kind of error that is seldom discussed or researched. It is failure to enact what is possible through behavior change. In many ways, the modern healthcare system is a hammer that looks to all of our health problems as nails that need hammering with tests, medications, and procedures. Lifestyle medicine practitioners observe that modern traditional healthcare systematically omits discussions on how profoundly beneficial behavior change can be, when done right.

So I hope that in this discussion, Dr. Jennifer Myers and I are able give you some tools that can help you engage with it safely.