Takahiro Nakajima writes:
The most important thing is that the
health condition of Patient Takahashi does not warrant optimism. But Takahashi
is not willing to understand his condition. So I am going to say to him,
"Mr. Takahashi, unfortunately your health condition is more serious
than your understanding. If you are not going to change your thinking,
you will produce bad results."
Then I must explain his current health condition like this. "Mr. Takahashi,
you say that you frequently experience feelings of weakness and mild pain
in the neck and upper chest areas. Do you know what affects your symptoms?
These symptoms are characteristic of atherosclerosis. As it is, your diagnosis
shows that you have early atherosclerosis. Atherosclerosis means that your
coronary arteries' openings are narrow, so pinching off the supply of blood
to the heart muscle. If the disease becomes worse, your heart, starved
of sufficient blood, begins to die, triggering a myocardial infarction,
or heart attack.
"If you have a heart attack, the situation becomes even more serious,
because the death rate for coronary heart disease (CHD) remains the leading
cause of death for both men and women in 1990, according to a U.S. study.
In Japan, the death rate of CHD is increasing and doctors fear this situation."
Lucky or unlucky, the name of Takahashi's disease is EARLY atherosclerosis.
His symptoms are not so serious for the time being. But his disease could
get worse if he continues his current life style and if he has no medical
treatment. Medical treatment is doctor's work, but Takahashi has a lot
of risk factors. Takahashi must reduce his risk factors. I will persuade
him to reduce his risk factors.
"Mr. Takahashi, you have heard from me about your health condition.
But don't be so pessimistic. Your disease is EARLY CHD so if you change
your daily life, your health condition will improve tremendously. Generally
speaking, CHD's risk factors are smoking, physical inactivity, overweight,
high blood pressure, high blood cholesterol, diabetes and so on. How many
risk factors are applicable to you? You say that you have recently been
diagnosed "hypertensive" and you don't do any exercises, and
you smoke a lot. You have already three risk factors. In addition, you
work too hard. Perhaps you feel much stress. Stress has a very bad influence
on your disease. I know you are a bureau chief in your insurance company,
but you should have more time to relax. Still more, your parents died in
their sixties. Dying at that age is not so long a life now. And your mother
died after heart by-pass surgery complicated by hardening of the arteries.
Your mother's disease is the same as yours. It is one of the risk factors
because you have a similar constitution and, probably, a similar life style."
Now I will explain how to treat his disease from two points of view. Firstly,
I will talk about short term treatment. In the short term perhaps the treatment
centers on a plan for medical treatment not to have heart attack. But it
is impossible to improve his life style at once. Changing habits take a
long time so he must start changing his habits gradually.
"Mr. Takahashi, your treatment in the short term is perhaps mainly
medical treatment. But improving your life style is as important as this.
I think you will have a very hard time because changing habits is very
hard. So don't think that you change your style at once. Take it easy.
You are OK if you can change gradually. For example, reduce your smoking
from two packs a day to one pack a day or change tobacco to low tar and
nicotine. And you must do some exercise, but remember that you mustn't
do a lot of exercise suddenly. You had better walk instead of running in
the beginning. If you say you don't have time to do these things, you must
manage your time to do exercise. For example, you can use stairs instead
of using an elevator, and you can get off one station before the usual
station and walk to your company. You must change your food life. You have
high blood pressure. Hypertension has a big concern with diet. Maybe your
diet contains too much salt. You must reduce your intake of salt."
In the long term, T's life style has to be improved. T has to do more than
reduce risk factors of heart disease. To keep a healthy life is more difficult.
For example, once he improves his life style but then returns to a previous
bad habit, it will be all in vain. To continue in the right direction is
very difficult and it is a big problem.
"Mr. Takahashi, if you can change your life style, you must continue
your new life. To continue is very difficult but I think you can overcome
all the hardship. If you do some exercise, you can start running again.
I know you are a former marathon racer and running long distance makes
your arteries dilate better. And you have to give up smoking finally. Perhaps
it is the hardest change but recently there is a lot of treatments, like
nicotine gum, for giving up smoking. Further, you have to have more rest.
You are a very serious person, so you have to think about these problems
more seriously. You must make yourself at home. I think you can do this,
so please try. If you have a question please come again"
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