The Questions Patients May Be Afraid to Ask
The questions we have about our health are a window into deeper contemplations. Failing to uncover the deeper question leads to a lot of unnecessary treatments.
Welcome to the Healthy Aging Newsletter, a free publication translating trustworthy medical research into simple habits to age well, free of chronic disease. I’m Dr. Ashori, a family medicine doctor turned health coach.
Is keto good for weight loss?
The keto concept as we know it now didn’t exist a few years ago. Someone contemplating their health and weight may see it as a tool to get to their ideal weight.
The underlying question or concern my patient has: “Why am I so focused on dropping pounds right now?”
We know what it takes to lose weight - by no means an easy task. Hardly any reputable physician, nutritionist, exercise physiologist, personal trainer, or epidemiologist will disagree on what it takes to lose weight.
Fear-Inducing Headlines
From journalists to AI to me writing here on Substack, we are all trying to capture the attention of an audience, for various reasons. When we read about microplastics, cancer, keto, or Vit D, we perk up because there is an underlying fear that writers are targeting which we haven’t yet coped with.
On the extreme, imagine you had no real fear of dying. You certainly wouldn’t want to go immediately or leave your family and loved ones but you have a more holistic view of living and dying. When you read about microplastics at first you might perk up but then drop back down to your baseline without getting riled up by the noise of yet another cancer-causing product.
Do plastics cause cancer?
They are really asking … “Why am I so afraid of cancer?”
Let’s talk about cancer. For all the lifeyears lived by human beings, it’s certainly not that common. But the idea of wasting away from cancer in a hospital bed is such an unpleasant thought.
If we didn’t believe that cancer = suffering we might not care much if plastics cause cancer. Or we would consider how harmful plastics are compared to driving without a seatbelt or having a loaded, unsecured gun in the house. Some call this perspective. Some call it overrationalization.
Should I do more aerobic or resistance training?
“Does working harder keep me from getting sick?”
Is suffering necessary to achieve better health? What’s health? We know that social media and Western medicine have already defined what health should be but is that what your personal definition is?
How do you enjoy spending your time? If you did do more aerobic vs resistance training, how much difference would it make?
Would aspirin help me not get colon cancer?
“What can I do to not die from the same cancer my beloved dad died of?”
The pain and hurt we carry often dictates our decisions in life. Sometimes we’ve dealt well with these experience and they are tucked away nicely. Other times they are so messy, raw, they drive most of our decisions and actions.
Why is it that I believe that I’ll get colon cancer? Have I really dealt with my emotions about my dad? How do I remember him without thinking about cancer or that if he did things differently, he wouldn’t have gotten cancer?
Of course, after processing all of this information, a time comes when we can ask, What’s an effective and sustainable strategy to minimize my risk of colon cancer, if I am at higher risk for it?
Can a statin help me prevent a heart attack?
“I’m terrified of suffering a heart attack, what can I do to prevent it?”
Fear is often not the best health motivator. It leads to desperate and disparate actions which leave us feeling emotionally drained and physically exhausted.
“I might get a heart attack one day and I want to do everything necessary to not feel ‘regrets’, so I’ll create my living will and make sure my family and loved ones are cared for.”
Often a patient doesn’t want these conversations with their doctor. I totally understand that. But unfortunately despite trillions of dollars spent on studying and dispensing statins, we still aren’t exactly sure who will and won’t get a heart attack or stroke when taking it.
How do I know if I’m in zone 2 or getting enough of it?
“Exercise feels meaningless to me, how do I stop doing it if I don’t like it or find joy in it?”
When you’re active enough, you’ll naturally get a healthy dose of zone 2 training. Of course, your body may not care much whether you’re in zone 2, 3, or 1.5. And you’ll perhaps jump enough into zone 5 to please Dr. Peter Attia.
Movement, being outdoors, feeling your joints, getting the delightful high of a fast heart rate, feeling your breath deep in your abdomen, and feeling your muscles flex, relax, that could be the beauty of exercise. For others, it’s knitting or painting.
My blood pressure was 166/98 - what do I do?
“How can I detach myself from this damn blood pressure cuff that’s running my life?”
As human beings we use numbers to communicate important concepts. Almost always, they are far less meaningful than they seem. Especially in clinical medicine, differentiating anxiety induced hypertension from real hypertension is so complicated.
And if we leave clinical protocols to their own, eventually only a blood pressure of 90/58 is acceptable. Everyone else would be considered diseased. But do you feel diseased? What are you afraid of and how much control do you feel you have over your overall life and living?
With that dilemma confronted, there is often a relinquishing of control. In that space, my patients can then decide if they even care about their blood pressure or maybe they want to assess their real risk of any major heart related disease before taking any action.
What investigational drugs can I try to treat my advanced pancreatic cancer?
“I’m not ready to die - I can’t face the idea of not being around anymore.”
It’s human nature to be hopeful and look for solution even if they seem quite unlikely. Some can navigate this space elegantly and for the rest of us it’s going to be messy and unnerving.
Coping with death, dying, and suffering rarely happens in the last few months of lives. It’s instead something we have to cultivate now, when we’re healthy. We are all dying and that’s what supposedly makes life so beautiful. What Western medicine’s technology can guarantee us is that you don’t have to suffer during that process.
Do I need fish oil for my cardiovascular health?
“I hate myself for not doing what I think I should to be healthier. I don’t want to get a heart attack - what else can I do?”
The degree of love you have for yourself trumps any love you can have or show for others. If you can’t hold space for yourself it’s hard to do it for others. But when you finally accept all your perceived shortcomings and don’t think you need to be praised for your successes, there opens this space of love that’s so easy to bestow on others.
For some, relinquishing judgement, hate, control, and constant admonishment allows for space to love ourselves. The first thing that disappears is then trying to change ourselves. Acceptance. In this space we can now really consider what’s important to us - is it the beer and cigarettes we have with friends or the hours spent in the gym and supplement isles?