Dr. David's Blog

Stress management – like exercise, eating right, or navigating the health system – is a serious and challenging component of health promotion. It takes work and is a skill that can be learned.  After years of therapy and then passing that information along to my patients, I’ve found that there are key steps that can help anyone achieve greater peace.

1. Passion! (again)

With stress management, it all comes back to passion. Tackle life with passion. Throw love and energy into everything you do.

2. Put yourself first.

Be honest with yourself – and others – about what you need. Give yourself the leeway to be first once in a while.

3. Be kind to your body and seek health.

Your health is precious and nothing is more important than taking care of yourself. A healthy body is going to be much more prepared to handle stress.

4. Don’t take yourself too seriously and learn to laugh.

Anyone who has the capacity to laugh at himself and see humor in any situation is bound to be a more peaceful and relaxed person.

5. Be kind – to yourself and others.

Developing healthy interpersonal relationships is a huge component of living a stress-free life. But, remember, it begins with you. Be kind to yourself and you can learn to be kind to others as well.

6. Learn to say no.

Remember, the greater the responsibility the more important it is to not take everything on yourself. Numerous studies have shown that the most successful people are not that busy.

7. Don’t let the little things get to you.

It’s amazing how often we get upset over the smallest of things. Remember what is important and put your challenges into perspective.

8. Learn how to handle conflict.

When you find yourself in a challenging situation, take a moment to breathe and try to find the core reason for your conflict. It’s often not what’s on the surface.

9. Learn to forgive.

Forgiveness plays a major role in promoting health and assuring a long and independent life. It rids you of resentment, hostility, and negative thoughts that can eat away at you.

10. Maintain your boundaries between work and home.

Nothing is worse than coming home after a stressful day and letting your work issues affect your home life.

11. Recognize what stresses you out.

We all have certain triggers that can send us off. Find out what your trigger is and try to address it. Each time you feel that thing happen – whatever it is – stop and breathe. Try to relax and approach the situation anew.

12. Stop. Breathe. Seek peace.

Learning to unwind and seek true and inner peace will save your life. Whenever you find yourself stressed or revved up, stop and breathe. Notice your breath. Find peace in this present moment. Doing so will bring you back, calm you down, and provide a little extra room to be honest.

1. 1. People who strongly believe in a higher power live longer, are less likely to become ill and have a better quality of life.
2. 2. Those with a serious illness respond to treatment better, are more likely to recover and have a better attitude if the believe completely that god is on their side.
3. 3. There is no evidence that praying for someone (intercessory prayer) improves outcomes of illness. However those who believe in divine intervention respond better to those who are ill.
4. 4. God does not favor one religion over the other. If you are a faithful Moslem, Buddhist, Hindu, Jew or Christian your quality of life, health is better and your life expectancy longer.
5. 5. Members of faiths that promote a healthy life style (no drinking, no cavorting, better diet) live the longest but not necessarily the best.
6. 6. During an illness your doctor or pastor can be a greater healer if they discuss issues of faith with their patient. Most physicians are embarrassed to do this viewing discussing religion as an invasion of privacy. In the appropriate setting we always ask our patients “Is religion important in your life”. If the answer is yes we emphasize the strong link between faith and health.
7. 7. It is spirituality more than anything else that determines our link with faith. In other words we must practice the core tenets that characterize every individual. You must be a truly good, honest and ethical human being.
8. 8. Faith demands that you be a loving human being. Love thy neighbor and thy god is the centerpiece of every faith. St. Paul said “ In the end there are only three things of important – Love, Faith and Hope and of these the most important is Love.”
9. 9. Giving is an important element of faith. Volunteer 14 hours a week and live 5 years longer. And charity and care of the needy is a measure of your faith. Giving money to a good cause is an insurance policy to a longer life. The more you give the longer you life.

10. Last but not least is the Capacity to Forgive. Don’t bear a grudge, don’t threaten to get even, ask for forgiveness and forgive those who have done something particularly egregious to you. Faith is all about the capacity to forgive. Only be forgiving a serious emotional or physical injury will we ba able to receive the peace and strength needed to continue. 

Many ask for the natural remedy to treat constipation that was developed by my good friend and colleague Dr. Jerry Malott. Use this recipe to improve your heart health and to make you “As smooth as silk!”

Mix equal parts of:

Sunflower seeds

Sesame Seeds

Flax seeds

Take one or two teaspoons daily in cereal, salads, yoghurt or just plain neat. Eat them whole or you can grind them in a coffee grinder

With each passing decade Americans are getting fatter. We define weight by the body mass index (BMI), calculated by your weight over your height squared. A BMI above 32 indicates obesity, between 22 and 30 defines overweight and less than 19 is too thin. Overweight but not obese individuals live the longest. However they do not live the best as with advancing age are far more prone to cancer, diabetes, hypertension, heart disease and osteoarthritis.

Irrespective of weight what we eat determines how long we live and the diseases that occur in late life. Even at the ideal weight or below you have dietary habits that predisposes them to hypertension, heart disease, cancer and even Alzheimer’s. It follows that no matter your weight you must develop a better relationship with food. Start with these these basic steps:

1. Change how you eat
Recognize your motives for eating. Are you even hungry? How do you hope to feel after your meal? Developing a healthy relationship with food often means changing lifelong habits. Second, slow down. A key element of developing a healthy relationship with food is actually noticing that you ate! Stop rushing through meals. Stop eating “on the run.” Enjoy every bite of food that passes your lips. Pay attention to it! Chew slowly and notice how it tastes and feels.
Regulate portion size. In the last twenty years, portion sizes for the average American meal have grown exponentially. Clearly, portion size is important. But portions is not about depriving yourself of food, it is about giving your body the amount of food it needs to feel satisfied.
2. Educate yourself about food
Once you have started to change how you eat, you can begin the process of changing what you eat. Remember diets fail and the best diet by far is the don’t diet diet. This is easy to follow and may be summarized as follows:
Eat the right fats. A fat free diet is unhealthy and may promote weight gain. The right fats are monounsaturated olive or canola oil that should be used to saute and omega three fatty acids obtained in fatty fish, a handful of nuts or avocadoes. In moderation these foods are good for you.
Eat the right protein. Simply put this is lean meat and fatty fish.
Eat as much fruit and vegetables as you want. Whole fruits are better than juices, consumer sugar rich fruits (oranges, grapes) in moderation and you can’t have too much salad or vegetables such as broccoli, zucchini or squash
Watch the carbohydrates. Too much sugar and starch leads to weight gain, diabetes and an array of ills. Avoid empty calories such as sodas and candy. No more than two servings of starch with each meal (bread, pasta, beans, rice, potato) . Portion sizes should be no more than two thirds the size of your fist.
Avoid supplements. The best way to get nutrients is from the diet. Too much Vitamin C, D, and E for example can cause more harm than good. Everyone should assure adequate calcium and vitamin D intake either from dairy products or as a pill twice or three times daily with meals. Over aged 70 a multivitamin without iron and 1000 microgram B12 tablet should also be taken
3. Maintain the same weight.
It is better to be overweight (pleasantly plump) than losing weight on a diet and gaining it back with a vengeance. Find your stable weight and stick with it. Learn to be happy with what you weigh and the way you look. In the long term this will improve self esteem, confidence and promote health.

Add exercise to this simple plan and a lifetime guarantee of a healthier and longer life is possible

With each passing decade Americans are getting fatter. We define weight by the body mass index (BMI), calculated by your weight over your height squared. A BMI above 32 indicates obesity, between 22 and 30 defines overweight and less than 19 is too thin. Overweight but not obese individuals live the longest. However they do not live the best as with advancing age are far more prone to cancer, diabetes, hypertension, heart disease and osteoarthritis.

Irrespective of weight what we eat determines how long we live and the diseases that occur in late life. Even at the ideal weight or below you have dietary habits that predisposes them to hypertension, heart disease, cancer and even Alzheimer’s. It follows that no matter your weight you must develop a better relationship with food. Start with these these basic steps:

1. Change how you eat
Recognize your motives for eating. Are you even hungry? How do you hope to feel after your meal? Developing a healthy relationship with food often means changing lifelong habits. Second, slow down. A key element of developing a healthy relationship with food is actually noticing that you ate! Stop rushing through meals. Stop eating “on the run.” Enjoy every bite of food that passes your lips. Pay attention to it! Chew slowly and notice how it tastes and feels.
Regulate portion size. In the last twenty years, portion sizes for the average American meal have grown exponentially. Clearly, portion size is important. But portions is not about depriving yourself of food, it is about giving your body the amount of food it needs to feel satisfied.
2. Educate yourself about food
Once you have started to change how you eat, you can begin the process of changing what you eat. Remember diets fail and the best diet by far is the don’t diet diet. This is easy to follow and may be summarized as follows:
Eat the right fats. A fat free diet is unhealthy and may promote weight gain. The right fats are monounsaturated olive or canola oil that should be used to saute and omega three fatty acids obtained in fatty fish, a handful of nuts or avocadoes. In moderation these foods are good for you.
Eat the right protein. Simply put this is lean meat and fatty fish.
Eat as much fruit and vegetables as you want. Whole fruits are better than juices, consumer sugar rich fruits (oranges, grapes) in moderation and you can’t have too much salad or vegetables such as broccoli, zucchini or squash
Watch the carbohydrates. Too much sugar and starch leads to weight gain, diabetes and an array of ills. Avoid empty calories such as sodas and candy. No more than two servings of starch with each meal (bread, pasta, beans, rice, potato) . Portion sizes should be no more than two thirds the size of your fist.
Avoid supplements. The best way to get nutrients is from the diet. Too much Vitamin C, D, and E for example can cause more harm than good. Everyone should assure adequate calcium and vitamin D intake either from dairy products or as a pill twice or three times daily with meals. Over aged 70 a multivitamin without iron and 1000 microgram B12 tablet should also be taken
3. Maintain the same weight.
It is better to be overweight (pleasantly plump) than losing weight on a diet and gaining it back with a vengeance. Find your stable weight and stick with it. Learn to be happy with what you weigh and the way you look. In the long term this will improve self esteem, confidence and promote health.

Add exercise to this simple plan and a lifetime guarantee of a healthier and longer life is possible

1. Make sure that you have regular medical checkups. After aged 50 have a complete physical at least annually and over the age of 65 more frequent visits may be needed. Remember early detection and prevention of disease is far better than treating a current disease
2. Identify a primary physician that you relate to and trust. A willingness to communicate with you is very important. The more faith you have in your primary care physician the more confident you can be that your care will be ideal.
3. Understand what is involved in the annual physical examination. Write down all of your concerns ahead of time. Most doctors do not spend sufficient time to do it right.
4. Make sure that unnecessary screening tests are not done. Easy to understand recommendations are available from the United States Preventative Health Care Task Force and the American Society of Family Medicine. Remember do not do things that are of no value and that my find problems that should not be identified as all they do is lead to more tests.
5. If problems are identified, make sure you understand the nature of the problem and learn as much as you can about it either from written materials or from the internet. Everyone should become computer literate. If you don’t use a computer consider learning, if not rest assured that those close to you can and provide all the information you need to understand the problem.
6. Make sure you are involved in treatment decisions. Understand that physicians usually prescribe the most expensive treatments, do too many tests and perform procedures that are of no proven value and may cause more harm than good.
7. If you are over the age of 75 its best to always take someone with you to the doctor. Consultations are confusing and often the patient hears only what he or she wants to.
8. Remember that if you are older too many cooks spoil the broth. Too many physicians leads to excessive medication use, a higher risk of side effects and fragmented care. Let you primary care doctor coordinate your care and let him refer you to a specialist when needed.
9. If a serious diagnosis is made make sure that the following issues are answered:
   1. Please provide me with information about my illness.
   2. Will the treatment that you recommend prolong my life?
   3. Will the treatment improve my quality of life?
   4. What are the chances the treatment will be successful?
   5. Are there alternative, less invasive treatments?
   6. Where is the sound scientific evidence that shows what you say is indeed true?
10. Should you become seriously ill make sure that your wishes are known.
    1. Make sure you discuss your wishes with your entire family
    2. Make sure you have advanced directives and a living well.
    3. Identify a loved one who has your durable power of attorney who will make decisions for you if you are unable to do for yourself.

I am in New York about to be on the Mike Huckabee show discussing health care reform. It seems to me that no one is getting it right. As a geriatrician I have taken care of thousands of older people who have ranged from being very healthy to severely ill. From them I have developed insights into our health care system and believe me there is much that is wrong and little that is right. Here are some concerns and my answers.

1. Too many Americans are Uninsured. This is the only aspect of our health care system that is currently being addressed. And sadly no one is willing to come up with a solution. I wish you all luck but the answer is everyone must have access to affordable health care.
2. The Graying of America. 72 million baby boomers are marching toward old age. 65% of all health care dollars are consumed by those over the age of 65. And in the next 20 years the percent of the population over the age of 85 will more than double. The solution. America must accept that the cost of health care will increase. More insured and more older persons means hat no matter how hard we try we cannot cut costs enough to provide quality health care to all.
3. Health care costs are increasing much more than the rate of inflation. Every year this is happening and it must be controlled. The solution. We cannot keep cutting payments to doctors and hospitals. Physicians refuse to accept Medicare and hospitals do not have the funds to provide quality care. We must change the way we pay for health care. Will discuss this below.
4. We have a serious manpower problem. There are too many specialist and too few primary care physicians. We recognize that there is a shortage of physicians so we are increase the number of medical students but most are electing to enter unneeded specialty care that pays well for procedures. The solution. We must require that more medical students enter primary care. This can be accomplished by decreasing the number of positions for training specialists and by making the career of primary care more rewarding.
5. We focus to much on acute care and at least half or all health care costs are spent on unnecessary, expensive and unproven care. The evidence is compelling we do too many tests, perform too many procedures and prescribe the most expensive care. The Solution. We must only practice medicine that is based on sound scientific evidence of benefit. We must stop paying physicians as much for procedures. Currently the more you do the more you get paid. As a patient we must become educated and involved in health care decisions. Do not believe everything your doctor tells you. Ask important questions. Make sure you understand the diagnosis. Ask of the treatment will prolong your life. Ask if it will improve your quality of life. Ask what are the risks and side effects. Ask if there are alternative less risky procedures that are just as effective. And ask for the scientific evidence that what your doctor is telling you is indeed true.
6. Do not fear health care reform. The vitriolic and aggressive opposition to health care reform is not productive. The solution. Without reform quality of our health will continue to decline. Rationing will only be an option if we not reform the system. If we practice more of the right health care and less of the wrong, if we become empowered and responsible for our own health and work on preventing disease there will be more than sufficient money to care for all of our needs while assuring a prosperous future for ourselves, our children and grandchildren