The tail spin - part 2
We're talking about our two patients, Janet and Sharon who are at a turning point in their lives. That turning point is called the tail spin. The tail spin is where they make poor health care choices that result in a loss of their vitality and health. Let's take a look at the similarities and differences between their cases.
1. Occupation - Both of these patients work hard. They stand for long periods of time and have done so for many years. Their incomes are meager compared to the amount of time that they work. Why? They may have been poor students or come from a less than supportive household. In most cases, they're perpetuating a socio-economic status we'd call poverty.
2. Obesity - It's expensive to eat fresh fruits and vegetables. The availability of inexpensive, highly processed foods makes obesity so common. Simply put, when you're trying to stretch a dollar, you'll be eating cereal and pasta. Obesity is contributing to loading on their joints, especially their hips and knees, resulting in early onset osteoarthritis.
3. Hypertension - Although not all hypertension is caused by obesity, it's a known fact that if you loose your weight you'll go off of your blood pressure medication. Over time, hypertension will result in damage to the heart and kidneys.
4. Diabetes - It's also a well known fact that obesity contributes to diabetes. Although not all cases of diabetes are due to obesity, the relationship is undisputable. In a study that tracked obese diabetic patients who underwent bariatric surgery, 83% of all obese, diabetic patients went off of all of the diabetes medication follow successful weight loss with bariatric surgery.
5. Socio-economic status - What was it like for these two patients growing up? Did they have supportive families or were their parents too busy trying to survive hard economic times? In Janet's case, she's got her work cut out for her. Her husband is unemployed and her son is sponging off of her with no contribution to the family overhead. To make tough choices, like the choices you need to make in a health care tail spin, how does a person do so without a supportive family? How do they have the capacity to improve themselves when they are unfamiliar with the concept of self improvement?
1. Social - Where Janet has no support at home, Sharon is embarking on a new life and may very well be open to new ideas. Sharon's recent mastectomy has given her a chance to take a good look at her mortality and her divorce has freed her from previous ties that may have kept her life 'as-is'. Janet's support system is virtually non-existent. Her husband and son have come to depend on her and that's all she knows.
2. Income - As the sole provider for her family, Janet cannot take time for herself. And when she does, she's just plain tired. There's no room in her life for exercise. Sharon on the other hand may be open to exercise but also trying new things that she's never before considered like yoga, hiking or dancing. She's going to be open to an active lifestyle.
In my next blog post, let's see how the conversations with Janet and Sharon went. Were they able to pull out of the tailspin?
Jeffrey A. Oster, DPM