“Live a healthy life, then die quickly at 90”

19 Jan

by Carolyn Thomas     @HeartSisters

woman funny oldYou’d hardly expect a physician who spends his life trying to cure cancer to suddenly shift gears and suggest that maybe, just maybe, we should “stop trying”. But it turns out that New Jersey oncologist Dr. James Salwitz agrees with a review of data published in the September 2012 issue of Lancet Oncology, entitled “First Do No Harm: Counting the Cost of Chasing Drug Efficacy.” *

An accompanying Lancet editorial suggests that during the 10 years between 2000 and 2010, “many new cancer drugs produced marginal extensions in survival and simultaneously increased risk of treatment-associated death and side effects.”  This compelled Dr. Salwitz to write:   

“A hundred years ago, the medical model was one of acute disease and trauma.  The major events that threatened life were infection such as syphilis and TB, childbirth and accidents.  Chronic illness was rare because we did not live long enough, as the average lifespan in 1900 was 47 years.  Medical science therefore focused on measures to prevent and treat infections, make birth safer, and treat injury.  This resulted in the rapid rise in life span to 70 years by 1950.

“Then the model of illness changed to that of extended diseases such as heart disease, dementia, diabetes and cancer, and research focused not on preventing these illnesses but on treating the effect of these maladies. 

“It is a chronic illness approach where large numbers of patients spend the last years of their lives debilitated while receiving increasingly toxic and expensive therapy to draw out functionally limited lives. This has increased survival only six or seven more years.

“The alternative model proposed is a modification of the present life-disease cycle, which, instead of focusing on deterioration in the last years of life, targets the prevention of disease during healthy youth. 

“The concept is to achieve high functioning illness-free life for the longest possible time and then have the cycle complete with a short end-of-life acute phase focusing on quality.  

“In other words: live a healthy life to, say, 90 – and then die quickly. Theoretically, this would produce a net longer lifespan and a higher functioning level with less suffering.”

I don’t know about the rest of you, but I’m drawn to this care model.  As a person living with a chronic and progressive illness, however, I suspect that, as Dr. Salwitz realistically predicts, I will continue to be “debilitated while receiving increasingly toxic and expensive therapy” in order to draw out my  “functionally limited” life.  Depressing, right?  (See also: “Live to 100? No Thanks!”)

Recently, one of my readers contacted me and mentioned that, like me, she was living with ongoing coronary microvascular disease after successfully surviving her own “widow maker heart attack “ – and that was 12 years ago.  Immediately picturing the prospect of years more of these ongoing bouts of crushing exhaustion and debilitating chest pain, my surprising and unbidden gut reaction:

“12 years!?!  TWELVE YEARS?!?!?!  I can’t face 12 more years of this!”

The overpowering sense of what those who study Post Traumatic Stress Disorder (PTSD) call a “foreshortened future” may seem shocking to non-patients. Don’t get me wrong, my heart sisters: I’m not considering doing anything to speed up my inevitable departure from this earth.

But having watched others spend years dying on the installment plan in longterm care beds, bleakly incapacitated and helpless, I can tell you flat out that this scenario is not for me.  I’ve already instructed my loved ones to bring in a nice big pillow for my face should that ever become my own reality. (And I also hastened to warn them that the pillow does not come out just because they find me annoying in the meantime . . .)

So what hope do those living with debilitating chronic illness have between now and that pillow-over-the-face time? 

For many of us – no matter what our specific diagnosis may be – it’s a one-day-at-a-time regimen of taking our meds, fitting in exercise, healthy meal-planning, resting when we need to, juggling medical appointments and learning to appreciate each glorious sunrise for as many sunrises as we have left.

But for those people (many of whom are our health care providers) who have never walked in our hospital booties, this day-to-day regimen is hard to appreciate, as I wrote here in Healthy Privilege: When You Just Can’t Imagine Being Sick.

This is also what Dr. Victor Montori and his team at Mayo Clinic describe as the “burden of treatment” – a largely-ignored reality for millions of us who sometimes find that the relentless “work” of being a patient can exceed our capacity to cope.  Their recommendation? Minimally Disruptive Medicine – a unique perspective, as they wrote in the British Medical Journal:**

“The strategies we have developed to manage chronic disease have created a growing burden for patients. This treatment burden induces poor adherence, wasted resources, and poor outcomes. Against this background, we call for minimally disruptive medicine that seeks to tailor treatment regimens to the realities of the daily lives of patients.”

While we’re waiting for Minimally Disruptive Medicine to transform chronic disease care for us, what does this mean in terms of our own day to day lives? It may simply mean deliberately incorporating more positive options into each day, and far fewer stressful ones. It means refusing to say YES when we mean NO.

Or, as Maya Angelou once said:

“Do the best you can do until you know better. Then when you know better, do better.”

But as Dr. Salwitz seems to be saying, shouldn’t all of us be doing this before we get sick?

Why do so many of us resolve to live well only after a catastrophic diagnosis like heart attack or cancer strikes us down?

Maybe, just maybe, if enough of us exercised and ate right and learned how to say NO more often, we could in fact “produce a net longer lifespan and a higher functioning level with less suffering.” 

The brutal reality is, however, that very few people decide early on in life that a higher-functioning longer lifespan is what they’re going to focus on – in much the same way that most 20-somethings don’t have a retirement plan in place.

More appealing decisions in the here-and-now include eating too much of the wrong kinds of unhealthy (but oh-so-tempting!) foods, not exercising every day, poor sleep  and stress management strategies, smoking or drinking too much, bragging about how “crazy busy” we are, and making other short-sighted lifestyle choices based on immediate gratification – not longterm health goals.

When I was at Mayo Clinic attending the WomenHeart Science & Leadership Symposium For Women With Heart Disease in 2008, I met many otherwise-healthy heart attack survivors who were triathletes, vegans, Buddhist meditators, and everybody in between. The sad truth is that even being what might be considered a health nut is in reality no absolute guarantee of warding off catastrophic health crises down the road. But we do have plenty of scientific evidence that things like not smoking, mindful eating, maintaining a healthy weight, better stress and sleep management, and daily exercise, for example, are promising ways to beat the odds.

And what if . . . ?  What if we decided to follow the wise advice of Dr. Salwitz now, and encourage those we love to do it, too?

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*  “First Do No Harm: Counting the Cost of Chasing Drug Efficacy.” The Lancet Oncology, Volume 13, Issue 9, Page 849, September 2012.
** “We Need Minimally Disruptive Medicine.” BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b2803. 2009;339:b2803

See also:

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Q:  Why does it take a catastrophic health crisis to get us to improve our lifestyles?

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8 Responses to ““Live a healthy life, then die quickly at 90””

  1. Ray's Mom January 20, 2013 at 3:49 pm #

    First doctors and scientist work to extend the life of humans; then they work just as hard to end the life saving medical inventions and shorten the life of humans. I am all for natural death, but I have seen way too much of hastening death in recent time.

    Like

  2. Kathleen January 19, 2013 at 1:31 pm #

    I’m with you on quality over quantity. And, of course, how much good, really, is any given treatment or practice going to do?

    It’s been over 30 years since radical cancer treatments when I was 21. Glad for every one of these years I may or may not have had with less – they threw everything they had and there was no control group. Long-term effects of those treatments have been undermining my health ever since, but that quality of life balance is still positive.

    For 2 years a neighbor suffered miserably through various treatments for pancreatic cancer and life extension, if any at all, was marginal.

    On the other hand, an aunt in her 80s, who had always been very active, opted not to treat her lung cancer at all. She traveled, enjoyed her family and visitors, and regaled us with stories as long as she could. The moment her balance shifted, she opted for hospice and palliative care, and died not long after.

    At this stage of my life, Aunt M’s choice looks pretty good to me.

    Liked by 1 person

    • Carolyn Thomas January 19, 2013 at 1:46 pm #

      Hi Kathleen,
      So glad that your cancer treatment/quality of life balance is still positive all these years later! And you were 21 when diagnosed – not in your 80s like your aunt. It’s all about the tradeoffs – as your Aunt M so beautifully demonstrated – isn’t it?

      My nightmare is that I’ll suddenly wake up one morning and find that, insidiously, my quality of life has slowly declined to the point where I’m propped in my wheelchair, wearing diapers and staring blankly at the aquarium for hours on end, having entirely forgotten to remind my family about that big pillow!!

      Like

      • Kathleen January 20, 2013 at 11:47 am #

        My nightmare too, though to have a clear mind while unable to afford appropriate care is a worse one.

        Liked by 1 person

  3. CuriositytotheMax January 19, 2013 at 7:52 am #

    Great jem of a post! mmmmmm . . .

    Your most ardent jewel thief,
    jJ

    Liked by 1 person

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