The Lucky Years of Old Age

On making individualized health decisions….

Here’s the common refrain for staying healthy in old age:

  • Exercise for at least 30 minutes and preferably 60 minutes, both cardio, and strength, on a daily basis.
  • Eat plenty of fruits and vegetables.
  • Lose weight.
  • Move around more; less sitting and more standing.
  • Maintain good posture.
  • Stay positive and do not let stress get the best of you.
  • Monitor you blood pressure and glucose every day (and anything else you can track).
  • Talk it all out with your doctor at the next visit and be proactive about health and well-being.
  • Stay mentally challenged.
  • Find that place where you want to spend the rest of your days in peace and harmony.

Did I forget anything?

The refrain is a baseline for enacting permanent change in lifestyle habits that have formed over decades. Follow these mandates or grow old ungracefully. Not following these mandates simply increases the odds of becoming a burden. You don’t want to be confined to a miserable existence. It’s obvious that a healthy path will make you more alert and active—as well as a much happier and vibrant person overall.

This is the kind of conversation I have with myself all the time now that I have started collecting social security. It’s rather pathetic, this daily pep talk. Some days it works better than others. Today, for instance, I was up early, went for a vigorous walk, had a bowl of berries with walnuts for breakfast, took my glucose and blood pressure numbers and, while elevated, they were not all that bad.  Took a shower, got comfortable and really enjoyed reading for about an hour before getting to the real work.

If I can religiously do this kind of day for one week straight without the least bit of cheating, then I can do it for another week and another until it becomes a habit (more on habits and deep work in later posts).

For some help, I suggest reading The Lucky Years: How to Thrive in the Brave New World of Healthby David B. Agus, M.D., internationally recognized professor of medicine and CBS News medical correspondent

After reading this book twice over the course of one month, I changed my work, diet, and exercise habits, along with my overall thinking about aging. Thank you, Dr. Agus.

I’m not saying that reading this book will have the same kind of influence on you, but I do strongly believe that reading this book can only have a positive impact on how you will perceive and monitor your aging self.

Here’s the main premise: We are alive during a time when medical advances are taking shape that enable us to live very high quality, healthy lives into our 90s, as long as we follow some relatively simple rules and guidelines and become highly proactive monitors of our individual health issues and challenges.

And, yes, you could still die young even if you do take this healthy pathway. There are no guarantees, and everyone ages differently. Some of us are susceptible to disease regardless of our healthy habits. Simple math, however, shows that your odds increase the likelihood of living a high quality existence into your 90s if you rigorously and religiously practice good health.

As Agus noted in an interview I watched some time ago on the Charlie Rose show, “we are not going to live until 130 or 140 because there is general engineering failure in the body, and I do not think we are at that point where we can re-engineer the whole body.” He added, however, that “in the short run. . . we’ll live quality years until our 90s or 100.”

Agus presents a variety of modern health and medicine developments, based on Big Data and plenty of new health-related technologies, that will enable the continued growth of the so-called “Lucky Years,” including: precision/personalized medicine practices, proteomics, gene editing, immunotherapy, inflammation measurement, stem cell research, advanced cancer therapies, 3-D printing of organs, and much more.

Information Literacy and Doctor Relationships
It’s extremely difficult, however, to wade through the enormous amount of information about good health and aging without getting lost. “Now that we live in an era of abundant information and data, we need to develop a survival instinct that’s deft at navigating through the rapidly changing flow of information, some of it good, some of it not so good,” Agus explains in his book. He mentions that deciphering the good from the bad information requires that we also honor and identify our bodies as complex organisms. Each of us has our “own unique nuances, patterns, preferences, and needs. And there is no right answer in health decisions,” Agus writes.

Now, in my mind, that is an extraordinarily sensible and simple way to look at your health.  To repeat for greater emphasis: “There is no right answer in health decisions.”

So, the marching orders are to pay very close attention to what’s happening in your body and mind and be aware that your particular, individualized way of medicating and treating your body healthfully, or not, might be a worthwhile path to embark on. In other words, you do not always have to follow your doctor’s suggestions regarding medications and lifestyle changes.

The big caveat is that not obeying your doctor’s suggestions, particularly if you know he is a smart doctor (they are not all smart), must be thoroughly backed by your own research into your complex self and then discussed with the best doctor you can find for your individual tastes.

Find the Right Doctor
In brief, you have two choices: One is to obey your doctor and simply not question anything he/she advises and go on your merry way; or secondly, you can be extraordinarily proactive and attentive to how your complex self works and very possibly not take your doctor’s advice. You can and should continue to have a strong relationship with your doctor, in which you discuss your health, and where your doctor honors your decision and works around your decisions.

This is not an easy task, and it takes a relatively long time—at least it has for me.  Many doctors do not want to have this kind of relationship with their patients because, for one, visits become a lot longer with patients like you instead of patients who simply nod their heads in acceptance or ask only a few questions. Many physician offices are packed with patients (at least they are where I live) and do not even take new patients, or, if they do, it takes a minimum of three months to get an appointment.

Physicians want to have a full schedule of numerous patients in order to earn what they think is a decent income for all the hard work and financial investment they put into learning their craft. (I’m sure there are also doctors who load up their schedules for purely altruistic reasons as well.) They load up their schedules to a point where quickly attending to one patient after another becomes a daily routine.

There is also the issue of HMOs and other health systems imposing rules and regulations, especially on what medications to prescribe, that have negative effects on the patient/doctor relationship. Nonetheless, if you are the kind of patient who upsets such doctor-office routines, things can prove to be awkward, with your doctor not paying close enough attention to what you have to say. Or, perhaps you have a difficult time accurately explaining your complex self and need a good amount of back and forth with your doctor before your true needs and desires are made clear.

So, the smart thing to do is find a doctor who listens and follows your lead, and one who does not get frustrated or angry with you if you do not strictly follow his advice. Trying to find such a doctor could take years, and the insurance companies do not make it any easier for you to accomplish a doctor change.

The Problem with Changing Doctors and Medical Records
Many insurance plans do not cover evaluating a doctor before placing him/her into your primary care physician slot. Additionally, when changing to a new doctor, the paperwork and transference of records is not always accurate, or your records become truly confusing and have big breaks in time where records are missing. The best way to get around the evaluation part when searching for a new doctor is to simply make an appointment with a doctor that interests you and pay out-of-pocket cash – that is, if the doctor’s office allows that (and you can afford it) – some do not.

Unfortunately, getting around the medical records problem is often insurmountable. Many doctor offices simply are not properly equipped to handle the accurate recording and transfer of medical records, but they are getting better at it.

Bottom line, there is no simple way to get around such challenges—more often than not when you go with the system, your records wind up all over the place and become completely disorganized, especially if you have changed insurance plans and have had several doctor changes.  You ultimately wind up presenting your new doctor with misinformation, which leads to misdiagnoses, which leads to poor overall health.

All this really means is that you need to take on health issues on your own time in a very proactive, dedicated, routine manner and learn how to effectively record and communicate your complex self to your doctor.  It sucks, but it’s important. Your life depends on it.

Take the Two-Week Challenge
You can start along this pathway by taking Agus’s “two-week challenge,” explained in chapter five of The Lucky Years.  This is where you basically keep your weight under control, manage stress better, make physical activity a regular habit, be more attuned to what your body is telling you and act accordingly, and stop procrastinating on important tests and early-detection screenings, Agus writes. All this falls under three lessons, he adds: record your bodies features, measure yourself, and automate your life. The book then presents a good number of tasks and schedules to follow over 14 days that I will not get into except to say that all or any part of this will help you get on a solid and better health path.

Another tool that can help comes from Agus’s previous book, The End of Illness, where he points his readers to a worthy “personal health inventory” questionnaire you can complete in order to get a very good idea about the true nature of your complex self (see http://davidagus.com/resources/). Not only will this questionnaire make you confront yourself more directly from a health and well-being perspective, it is also a great starting point for sharing with your doctor.

In short, combining the two-week challenge with the personal health inventory tool can be of great benefit for your physical and mental health.

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