Spot on my man. I see the same trends in the PT clinic regarding both orthopedic and general deconditioning scenarios. The Ernest Hemingway quote comes to mind when he asked how he went bankrupt- “Gradually, then all of the sudden.”
The signs are there for your health, but you have to 1. Know what to look for 2. Actually look 3. Act accordingly.
Thank you for elevating the conversation to treatment prior to crisis!
Would love your thoughts about women and heart disease and how to prevent the dismissive treatment that so often greets women presenting with the same symptoms.
I'm sorry to hear this Susan. I think you highlight a problem of Medicine 2.0 that particularly hits home with women who develop disease later than men. I think my best strategy is to empower everyone with the knowledge to accurately assess and advocate for themselves should they ever be dismissed in their concerns about symptoms or their health. In general, I think healthcare is too symptom driven and that moving earlier to focus on preventive and cardiometabolic health focus is the best strategy. I'm open ears for other strategies. Thanks for the insightful comment. Jake
Yes, I really think most of the basic testing can be low cost and high value. I think where we have missed the mark is not tracking and trending the results which action items: ApoB/LDL is now here, let’s improve x: diet//exercise/sleep and aim for 10-20% improvement by time point y. If no improvement start next intervention. This is where treadmill or bike test can be used as well in the same fashion. Actionable targets with a reassessment far outweigh general advice.
Really, really good message. I especially liked your comment "failure of imagination". I have a big sign over the door in my resident's workroom (al la Ted Lasso) that says "BE CURIOUS".
Dr. Rogers - thanks for sharing this amazing message. I loved the message from Ted Lasso and i love it even more now coming from you. BE curious and let’s change our patients trajectories!
Love this, Dr. Kelly! The guidelines talk about how to objectively interpret patient data, but most of the time, personal trends tell us the story of what is happening to a patient.
This really hits home for me. The trajectery concept is so important, most people wait until they've crossed that threshold before taking action. I had a family member who kept putting off labs becuase everything seemed fine, until it wasn't. Your triangle framework makes it easy to understand where to focus prevention efforts. The point about signals vs diagnoses is something more doctors need to get.
I really appreciate the supportive comment. This solidifies my goal to create a visual framework that allows all of us to easily remember and focus on the key pillaras of cardiometabolic health. Let's move our health focus upstream. Together!
Thanks for this. I’ll share it with the younger people who are important to me. I’m 75, so maybe too late, I already have 7 stents, (3 a month ago) and a super high calcium score. With LDL-c consistently in the mid 40’s for years, and 10 months on a vegan diet thru the Ornish program not solving my problem, I’m convinced it’s metabolic syndrome that’s driving my plaque growth. I’ve asked to be put on one of the GLP-1 drugs (tirzepatide) multiple times in the last year, no agreement. Im not obese, a1c is 5.0. But I’ve got 5 out of 5 signs of MetS. I’m planning on insisting on Ze-bound next month at my appt and if I don’t get it, I’ll go to Noom or Ro. Thanks for the validation, it helps..
Ken - I didn't know how to respond (like or not) but THANK you so much for sharing. I'm impressed by your amazing diet and ability to get your LDL-c into the mid 40s. Unfortunately, LDL-c/ApoB are just one piece (an important one) of the puzzle. I agree that metabolic resistance and syndrome absolutely contribute to atherosclerosis and other chronic diseases. Ken, please DM me and I'll see what I can do to help you.
If you are writing this for regular people, you need to explain or elaborate some of the factual statements. Medical shorthand or jargon cannot be understood by us. Keep trying,
Cheryl - thank you for this thoughtful, informative feedback. I will work hard to limit (eliminate?) my shorthand and explain my thoughts as well as medical details more clearly. Thank you for reading & commenting! Jake
Patients are not doctors, therefore they follow what their primary care physician says most the time. Sadly many of those doctors are ignoring everything that can be done to prevent MI or stroke ahead of time. Really is frustrating. I have to do my own labs outside of the doctors office because their refusal to order ApoB, Litle a, even A1C. It is unbelievable. But thanks for open my eyes. We the people need to be our own advocate.
This is the main reason I’m writing; I want to share all the tools for everyone to have the knowledge in front of them to make the best decisions for themselves. I’ve been thinking and writing about this medical desert between age 18-40 plus where we wait for something to happen rather than seek out early signals. Let’s share the knowledge and tools to help everyone get healthier, earlier.
Spot on my man. I see the same trends in the PT clinic regarding both orthopedic and general deconditioning scenarios. The Ernest Hemingway quote comes to mind when he asked how he went bankrupt- “Gradually, then all of the sudden.”
The signs are there for your health, but you have to 1. Know what to look for 2. Actually look 3. Act accordingly.
Thank you for elevating the conversation to treatment prior to crisis!
Let’s keep educating, teaching and treating!
Would love your thoughts about women and heart disease and how to prevent the dismissive treatment that so often greets women presenting with the same symptoms.
I'm sorry to hear this Susan. I think you highlight a problem of Medicine 2.0 that particularly hits home with women who develop disease later than men. I think my best strategy is to empower everyone with the knowledge to accurately assess and advocate for themselves should they ever be dismissed in their concerns about symptoms or their health. In general, I think healthcare is too symptom driven and that moving earlier to focus on preventive and cardiometabolic health focus is the best strategy. I'm open ears for other strategies. Thanks for the insightful comment. Jake
All very low cost, unsphisticated but it does the job.
Yes, I really think most of the basic testing can be low cost and high value. I think where we have missed the mark is not tracking and trending the results which action items: ApoB/LDL is now here, let’s improve x: diet//exercise/sleep and aim for 10-20% improvement by time point y. If no improvement start next intervention. This is where treadmill or bike test can be used as well in the same fashion. Actionable targets with a reassessment far outweigh general advice.
Really, really good message. I especially liked your comment "failure of imagination". I have a big sign over the door in my resident's workroom (al la Ted Lasso) that says "BE CURIOUS".
Thank you for your inspirational messages.
Dr. Rogers - thanks for sharing this amazing message. I loved the message from Ted Lasso and i love it even more now coming from you. BE curious and let’s change our patients trajectories!
Love this, Dr. Kelly! The guidelines talk about how to objectively interpret patient data, but most of the time, personal trends tell us the story of what is happening to a patient.
We have to change the message and move from snapshots to timelines so that we can improve our trajectory! Onward!
Onward. 💪
This really hits home for me. The trajectery concept is so important, most people wait until they've crossed that threshold before taking action. I had a family member who kept putting off labs becuase everything seemed fine, until it wasn't. Your triangle framework makes it easy to understand where to focus prevention efforts. The point about signals vs diagnoses is something more doctors need to get.
I really appreciate the supportive comment. This solidifies my goal to create a visual framework that allows all of us to easily remember and focus on the key pillaras of cardiometabolic health. Let's move our health focus upstream. Together!
Thanks for this. I’ll share it with the younger people who are important to me. I’m 75, so maybe too late, I already have 7 stents, (3 a month ago) and a super high calcium score. With LDL-c consistently in the mid 40’s for years, and 10 months on a vegan diet thru the Ornish program not solving my problem, I’m convinced it’s metabolic syndrome that’s driving my plaque growth. I’ve asked to be put on one of the GLP-1 drugs (tirzepatide) multiple times in the last year, no agreement. Im not obese, a1c is 5.0. But I’ve got 5 out of 5 signs of MetS. I’m planning on insisting on Ze-bound next month at my appt and if I don’t get it, I’ll go to Noom or Ro. Thanks for the validation, it helps..
Ken - I didn't know how to respond (like or not) but THANK you so much for sharing. I'm impressed by your amazing diet and ability to get your LDL-c into the mid 40s. Unfortunately, LDL-c/ApoB are just one piece (an important one) of the puzzle. I agree that metabolic resistance and syndrome absolutely contribute to atherosclerosis and other chronic diseases. Ken, please DM me and I'll see what I can do to help you.
DM sent. Thank you
I’ll check it out and respond. I love to help in any way I can.
If you are writing this for regular people, you need to explain or elaborate some of the factual statements. Medical shorthand or jargon cannot be understood by us. Keep trying,
Cheryl - thank you for this thoughtful, informative feedback. I will work hard to limit (eliminate?) my shorthand and explain my thoughts as well as medical details more clearly. Thank you for reading & commenting! Jake
This is a great mission for you.
Love these articles,
G
Gordo - this means a lot. Thanks helping me shape my focus.
Excellent writing, much appreciated!
Thanks for reading and commenting Thomas!
Patients are not doctors, therefore they follow what their primary care physician says most the time. Sadly many of those doctors are ignoring everything that can be done to prevent MI or stroke ahead of time. Really is frustrating. I have to do my own labs outside of the doctors office because their refusal to order ApoB, Litle a, even A1C. It is unbelievable. But thanks for open my eyes. We the people need to be our own advocate.
This is the main reason I’m writing; I want to share all the tools for everyone to have the knowledge in front of them to make the best decisions for themselves. I’ve been thinking and writing about this medical desert between age 18-40 plus where we wait for something to happen rather than seek out early signals. Let’s share the knowledge and tools to help everyone get healthier, earlier.