I cannot recommend highly enough the book Outlive by Dr. Peter Attia. The author is a former cancer surgeon who turned from treating sick patients to a life work focusing on extending health spans, not just life spans. Dr. Attai gives us all a blueprint that will hopefully enable individuals to not only have a long life span, but more importantly extend their health span and the rigors of one's life into one's 80's and 90's and beyond. In fact, one of his challenges is to become a centurion and to enter the centurion decathalon, by preparing now for the events he outlines. This is not just tongue in cheek. This is a real strategy.
He explores, using science, the areas of the human biology, medicine, exercise physiology, nutrition, stability, sleep and emotional health.
It is not a how to book, rather his own experiences in which he walks the walk and not just talks the talk. His advice on nutrition will be surprising to all of you.
Dr. Attai characterizes Medicine2.0, which we are all experiencing, is in reality a sick care system. Essentially we seek out healthcare when we suffer illness or when tests done by our physicians indicate an abnormality. Medicine 2.0 has two tools in its toolbox, surgery and medication.
Dr. Attai's approach in Medicine 3.0 is based on a different premise.
He describes the four horsemen of the apocalypse, heart disease, cancer, diabetes and neurogenic disease including dementia.
He presents and provides explicit directions that are all directed to us postponing the horsemen and achieving a long health span. He also discusses Biochemistry, for there is a medication that's currently being explored that may have a profound effect upon increasing our life spans and our health spans.
In the book he makes an analogy between a strategy for a long healthy life to a description that Muhammad Ali gave when he was asked how he won back the heavyweight championship from a seemingly unbeatable opponent. When asked how he did it, Ali explained he won the fight before he walked into the ring. He spent weeks prior strategizing what he would do against the powerful and undefeated champion. He said I won it in the locker room before the fight began.
Dr. Attai believes that we all need a strategy, a very clear and explicit strategy, to achieve the concept of a long health span. I downloaded the book on my phone and using a headset, I took long walks listening to this book which provided me with two outcomes, exercise while I learned.
The last chapter of his book in many ways is the most important. It focuses on his journeys to achieve emotional health. In this chapter Dr. Attai stops being the doctor and becomes the patient. Despite the enormity of his accomplishments and the enormous breadth of his intelligence he was not a happy, peaceful man. His relationships with his wife, his family and his colleagues was contentious and often filled with rage. After a great deal of intervention on the part of his colleagues and friends and his wife he sought out emotional support that would focus on his emotional life span. He shares with great transparency the trauma of his childhood and all the repressed anger and insecurity that drove him. He openly discusses his sense of worthlessness and fear of being a failure. The strategy he uses, both therapeutically and personally, is of enormous value for all of us.
You may want to even read this chapter first, or in my case, listen to it as an audio book. I have found listening is more powerful than reading.
He provides us with clear tools, just like those for our bodies, to transcend emotional challenges and live a long health span as well as a happy life span.
Along sadly different lines, I previously shared with you the concept of low dose CAT scans for anyone who smoked, even decades ago. Now let me update you the outcomes of two patients, one who followed that admonition and one who did not. A dear friend who I advised a year and a half ago to have a low dose CAT scan, even though she stopped smoking 35 years ago and was advised by her two physicians that it was unnecessary, just completed her surgery to remove two malignant tumors in the middle of one of her lungs. Because the tumors were picked up asymptomatically on a scan, there was no evidence of spread to the lymph nodes, no chemotherapy necessary and as far as her physician is concerned she dodged a bullet by being diagnosed prior to a more serious stage of lung cancer.
On the flip side, sadly I just spent time with the husband of a patient who passed away on April 1st. She was diagnosed with lung cancer in March when she couldn't breathe. Despite being under constant medical care for diabetes, no one bothered to do a low dose CAT scan of her lungs, although she had smoked until 25 years ago. When the cancer was diagnosed she only had weeks to live.
I now want to share with you a story with a happy ending that could have been tragic. A new patient who began in my practice two months ago owned her own private business in which she worked hours and found no time to visit a physician for a physical exam. She felt well and saw no reason to seek out medical care. Her relationship with me began because one of her teeth fell out. She had not been to a dentist either for a long period of time.
She was scheduled to see me to begin treatment when I got a call from her that she had suffered a stroke. The happy part of this story is that despite the onset of complete paralysis of the right side of her body, her husband, upon calling 911, was directed to a hospital that had a team capable of retrieving clots quickly. She was in the operating room within 5 hours. The clot was removed. When she woke up all her symptoms had disappeared. Had more time passed or had she gone to a hospital that didn't have the stroke team, she would have been an invalid for the rest of her life.
While in the hospital they discovered she had afibrillation, something she was totally unaware of. The afibrillation allowed a clot to form resulting in her potentially devastating stroke. I have had, unfortunately, a number of patients who were unaware of this condition and did develop strokes that left them debilitated.
Interesting enough, my Apple watch has a feature on it that indicates any irregular heartbeats or afibrillation is discovered. A good friend of mine, a practicing dentist, discovered that he had seven bouts of afibrillation that he was unaware of. When he brought it to his physician's attention he wore a monitor to confirm that he was having episodic afibrillation. This led to a procedure called an ablation that eliminated the afibrillation and hopefully will provide him with a stroke free life.
Now turning to dentistry, I want to reiterate something I've shared in the past. With many years of practice and over 100 patients in their 90's, and 2 passed 100, I have a fairly good sample of dental health and dental disease. But no example is better than my own genetics within my family.
At the age of 40, my parents, as I mentioned before, had 12 teeth between them, my mother having all 12. I lived at the dentist as a child. When I got to dental school many of my teeth required crowns and root canals.
However, the one benefit of becoming a dentist provided to me was, that despite my genetics, I learned how to effectively remove bacteria from my teeth on a daily basis. I shared that with my brother and sister so now at this point, well past the ages of when my parents passed away, the three of us share 80 teeth that would not have been there had I not become a dentist and learned how effectively remove plaque.
The seven minutes a day I spend with a water irrigator and a toothbrush have enabled myself and my siblings maintain a healthy mouth despite being born with a significant genetic proclivity to develop dental disease. I will always consider the education I provide my patients to prevent disease as my greatest contribution to their dental health.
One final note that put a smile on my face recently. Two years ago a 94 year old woman came to my office with her son and daughter. She was missing a number of teeth that affected her smile. They asked whether I would replace these teeth with implants. I was reticent, given her health history and her age. She had survived pancreatic cancer which was diagnosed 8 years prior, and a second cancer which was diagnosed 3 years ago but seemed to be in remission. The surgical procedure and the expense was considerable for a 94 year old individual. The patient, however, insisted and her children supported.
Now, two years later, her daughter was recently in the practice and told me how much her mother is thrilled with her smile. She is constantly looking in the mirror and having the children take pictures of her at every event with a big broad smile.
This reminds me of an admonition I received in graduate school. One of our professors at the time was 72 years old and formerly chairman of the department at Columbia. When discussing a patient someone brought up that the patient was 70 years old and therefore we should consider the patient's age when making a treatment plan. We were all in our late 20's. The professor shared that none of us know how long we are going to live and we should treat people irrespective of their age. Ironically that professor practiced periodontics until the age of 92.
My 96 year old patient reaffirmed the wisdom of my esteemed chairman.
As always I appreciate your feedback.
Dr. Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
May 1, 2023