Alexa Fleckenstein M.D.

Sometimes a patient is desperate for a diagnosis: If she has been going from doctor to doctor, and has been told uncountable times that nothing is wrong, it's all in her head - she might be relieved if she finally gets told she has "chronic fatigue." At least, now she can deal with it. Sometimes a diagnosis can save a life: If your belly hurts, and the diagnosis is “appendicitis”, a surgeon will operate on you, and your life is saved in all likelihood. When my son, a few years ago, had high fever, stiff neck and the worst headaches of his life, only the diagnosis of a physician turned the course of the disease around. The physician thought it likely was a tick-borne disease and probably tularemia: With the right antibiotic, my son recovered quickly. Sometimes a diagnosis is just and word: Say, your doctor tells you that you have hypertension - high blood pressure. That doesn’t help you much. It helps the doctor to know what pill to prescribe you – for the rest of your days. Now you are a patient. High blood pressure is a typical modern-day stress disease. Only about five percent of people who are diagnosed with high blood pressure, have an underlying medical condition. The rest – ninety-five percent! – have a wrong lifestyle. But interestingly, the diagnosis doesn’t tell you that there might be a difference – or that something else than a pill might help you. If you have an especially astute doctor, he will tell you that you have “essential hypertension”, “essential” here meaning no real reason he knows of. With other words, the diagnosis is a medical throwing up his arms in the air, declaring nothing can be done. Except for a few pills, of course. You have stress because your boss is unreasonable, or your spouse is the nagging kind, or your gambling debts are threatening to destroy your family life – again, you might not be able to do much. On the other hand, you might be starting thinking about what can be done. Getting more sleep every night? Eating more vegetables? Going into therapy? Returning to school, training for another line of work? Divorcing your spouse, or going to marriage counseling together? Enrolling in a course of ballroom dancing together? Changing jobs? Taking up tennis to get a handle on your stress and work some of the anger off physically? No – you have a diagnosis, and now you get a pill. That’s all. Your doctor didn’t even tell you to drink more water, I bet. You were probably told to go easy on salt. That is nice advice – if you were also told that most processed and restaurant foods contain too much salt, even your breakfast cereals and the “nutritional” bar. And that the salt problem is really big in black people but less of an issue in Caucasian people. Chances are that your doctor also gives you a diagnosis of too high cholesterol – hypercholesterolemia. That’s another pill, right away. Your doctor didn’t tell you that high blood pressure and high cholesterol aren’t two different diseases. They are one bad lifestyle. More often than not they go together. And, oh, now you got diabetes! Your sugars are too high and this new diabetes really needs good management. Your doctor might even give you a new name for the three diseases above: Syndrome X. He will wiggle his head in concern, because having all three makes it really dangerous. One has to be treated extra-extra carefully – with many pills. Some (or all) of those pills have side effects. Liver failure, depression, impotence, muscle inflammation, fatigue, upset stomach, and so on – which will require more pills and more monitoring. None of the pills will buy you real health – glowing, sweaty, happy health as you might experience when you play a round of pick-up Frisbee or swim in the ocean. I am not saying here you should throw away all the pills your doctor gave you. I am just saying you should strive for health, not for diagnoses and an assortment of pills, so that, one by one – and with the supervision of your physician – you might be able to drop the pills. What is the difference between this diagnosis and that diagnosis? My son’s illness had nothing to do with lifestyle, and all to do with a nasty bug. Most diseases like high blood pressure, diabetes, high blood fats, and many cases of depression, arthritis and cancer have a whole lot to do with lifestyle. If you break a bone, only a good cast will help mending it – and good food will speed up the healing process. Once you have a cancer, of course, a bit of lifestyle change is not enough to save your life – you need surgery, radiation, chemotherapy. Once the cancer is diagnosed, eating more fresh vegetables and going for a daily walk in sunlight might help you recover – but better would have been you would have started on a healthy path many years ago. The uncomfortable truth is: Health does not come out of a pill bottle. And a diagnosis is just a name. What you do with your life counts for your health.