Really Good Advice

We doctors are full of all kinds of really good advice.  Sometimes you've got to wonder, though, if we ever listen to what comes out of our mouths.  I read this little pearl of advice a couple weeks ago while I was vacationing in the cold, snowy mountains of northern Utah.

It comes from the December 4th, 2011, edition of that venerable publication Parade Magazine (hey, don't knock it—I've been a faithful reader since I was 12) in an article called "Take Our Winter Skin Quiz."  In addition to gleaning highly educational tidbits about the use of sunscreen in the winter (answer: highly encouraged, unless you live in Nome, Alaska) and how much lip balm to apply (only small amounts of a glycerin- or shea butter-based product), I also saw this paragraph about the hazards of hot water on your epidermis:

True or False? The steam from a hot shower is good for your skin.
Answer: FALSE. "Hot baths and showers have a stripping effect on skin by wearing away natural oils," says Dr. Jeannette Graf, a New York dermatologist.  Instead, take a lukewarm shower or bath and limit your tub time to five minutes.

Rrriiiggghhhttt.  A lukewarm bath for 5 minutes.  Now, I'm not sure what part of New York Dr. Graf lives in (perhaps a suburb of San Diego?) but here in Omaha we have winters that would make the Snow Miser cringe with frostbite.  Just to walk to the mailbox requires putting on more layers than Lady Gaga in a butcher shop.

Personally, the only way I'd be able to sit in a lukewarm bath is if I had a fully charged Swedish sauna standing by.  After about 8 seconds sitting in a tepid basin I’d be ready to ditch my natural oils for a skin-blistering deluge of hot water.  Did no one on the editorial staff of my beloved Parade bother to apply the "common sense" filter to that little gem of medical advice?

Dermatologists—the same killjoys responsible for the ever-escalating sunblock arms race—sure have the ability to take the fun out of just about anything, but they're not the only offenders.

Heart doctors love to preach the virtues of an ascetic diet.  Stay away from the red meat, eat lots of chicken and fish, fill up on fresh vegetables and fruits, and eschew heavy desserts, they say.  But attend a banquet at a fancy steakhouse with a room full of cardiologists and you'll see that what is preached is not always what is practiced.  Not a lot of takers for the grilled chicken breast and limp vegetables—we'll take the surf-n-turf combo all around, if you please.  It seems that every time I'm at a restaurant I run into at least one of my patients who cowers sheepishly when he realizes he's been busted indulging in a feast of lethal red meat.  It doesn't seem to occur to him, as he sees me wipe the barbecue sauce from the corner of my mouth, that I wasn't there for the steamed broccoli.

And fish!  How many servings of fish are we supposed to be consuming every week?  I don't know anyone outside of sushi chefs and pelicans that can ingest the volume of seafood recommended in health magazines.  And don't even get me started on the whole 8-glasses-of-water-a-day thing.  How are our kidneys supposed to handle that much water—we’d have no room left for our daily Mountain Dews and Latte Grandes?

How many times have you read articles about the importance of 8 hours of uninterrupted sleep?  Sure, it's really good advice, but in my experience most people who fail to achieve the requisite slumber don't do it by choice.  Insomnia, prostate enlargement, work demands, and crying babies are variables that we don't have much control over.  Medical professionals who incessantly repeat the mantra about optimal sleep live under the assumption that people with bags under their eyes forego the full 8 hours out of rebellious willfulness.

Just about now my hypocrisy alarm begins to sound.  That’s the little red light and siren I’ve affixed to my computer monitor that alerts me whenever I start to drift into preaching out of both sides of my mouth.  When it comes to dispensing doctrinal advice about what you should and shouldn’t be doing with your life, I’m about as bad an offender as they come.  Over the past 3 years I’ve published an encyclopedia’s worth of thou-shalt-nots.  If you were to read my entire literary output you’d be convinced I think you should run a marathon every day and eat nothing but celery and handfuls of cholesterol pills.

Am I really the best person to be telling you to ignore your doctor’s (and Parade Magazine’s) recommendations?  I don’t really know.  I do, however, have plenty of experience with people ignoring my advice.  I have an older patient with a long history of stable coronary disease who smokes like a chimney.  When I first met him I gave him my obligatory tobacco cessation lecture.  He listened patiently as I extolled the merits of tossing the Marlboros, then told me his own story.  He had lost his wife to cancer, his only son to an industrial accident, suffers crippling arthritis, and is dealing with prostate cancer.  His greatest joy in life—after everything has been taken away—is to wake up in the morning and light up a cigarette.

I never said another word to him about it.

I dispense advice because people pay me to.  If you as a patient want to know how to live longest and healthiest, do exactly as your doctors say.  Sometimes, though, that well-intended advice collides with what brings you joy and makes life worth living.

Life is more than just stretching out the maximum number of years spent on this planet.  When you find that you’re making yourself miserable trying to do everything you hear from Dr. Oz, Oprah, Parade Magazine, Women’s Health, Good Housekeeping and me, just take some time for yourself and ignore all of our really good advice.

And, above all, go take a long, hot bath.