Your Own Root Cause Analysis

A Root Cause Analysis is a problem-solving method to determine a primary cause of a causal chain which can lead to operating events.

For our purpose, we will define your Root Cause as current aspects of your behavior which impact your health. The more brutally honest you are with yourself, the greater opportunity you will have to induce meaningful change in your own life. The next questions are an overview to help you determine your own root cause of disease processes. These questions are simply an overview and may not be as in-depth as required for your own individual situation.

#1) How healthy are your parents and your siblings?
Your family tree is part of your genetic heritage. As you the share the DNA of your family, if you partake in the same environment and share similar behavioral activities, there is a fair likelihood that you will share similar health care-related events. Looking at organisms to which you are most similar can give you a clue as to a potential causal chain of events which may impact your own future health.

#2) Do you smoke?
This does not have a follow-up question, such as “If so, how much?” Smoking, according to the Centers for Disease Control, is the leading cause of preventable death in America. Smoking is so noxious to individual and public health that the only true treatment for this addiction is cessation.

#3) Are you obese? Are you overweight?
Obesity is defined by the Body Mass Index (BMI), a determination created by Belgian statistician Adolphe Quetelet in the 1800s. It came to fame from the work of the epidemiologist Ancel Keys in 1972 and has become used to determine obesity rates for different societies and countries by the World Health Organization. You can also use an online calculator from the National Heart Lung and Blood Institute. Some fault the BMI because it does not take into account several factors such as visceral adiposity (the belly fat around the organs) or total body fat percentage, but it has been studied and used for so many years, it is helpful to identify one’s own BMI. It is often surprising to realize how little weight is required to be obese or overweight. For instance, a 5 foot 8 inch individual is considered obese with a weight of 197 lbs, and overweight at a weight of 165 lbs.

#4) Do you have hypertension, and/or elevated cholesterol?
The Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure is a committee which determines blood pressure guidelines. Their latest (JNC 8) was just released in December, 2013 but primarily focused on treatment guidelines for specific blood pressure readings. The prior report, the JNC 7 which was released 10 years earlier in 2003, had the following guidelines.

Normal: <120 systolic (top number) AND < 80 diastolic (bottom number) Prehypertension: 120-139 systolic OR 80-89 diastolic
Stage 1 Hypertension: 140-159 systolic OR 90-99 diastolic
Stage 2 Hypertension: >160 systolic OR > 100 diastolic

Regarding cholesterol results, there are various recommendations on cholesterol lowering medications, yet studies have consistently shown that often the lower the total cholesterol and bad cholesterol (LDL), the lower the risk of cardiovascular disease. As a corollary, an elevated good cholesterol (HDL) can reduce the risk of heart disease. However, merely taking medications to raise the good cholesterol has not shown cardiac protection. Rather, it appears to be much more cardio protective if one can raise the good cholesterol with exercise and activity. A low cholesterol diet to also decrease the total cholesterol and LDL cholesterol also seems to be a good choice for cardio protection.

#5) Do you have heart disease?
Have you had a heart attack, angina (chest pain related to heart disease), a heart rhythm problem or an enlarged heart? The greatest risk factor for a future heart disease is a personal history of a prior cardiac event. In short, if you have had a heart attack, you have a much higher risk of developing future heart disease. For instance, Bill Clinton had coronary artery bypass surgery at age 57 (2004) but then had cardiac stent placements at age 63 (2010).

#6) Do you have diabetes?
Diabetes is most commonly diagnosed by two fasting blood sugars of 126 or greater. However, a normal fasting blood sugar is less than 100. Diabetes is considered a “cardiovascular event equivalent”, meaning that the risk of having a heart attack is similar to the risk of a person that already had a heart attack. If one knows one’s cholesterol, blood pressure, and blood sugar numbers, a very informative calculator has been created by the American Heart Association to allow individuals to obtain their 10 year risk of heart disease. I advise you to play around with the numbers on this calculator. Notice if a 45-year-old man has a healthy body mass index of 23 and has good cholesterol numbers and a good blood pressure, the risk of heart disease may only be 1-2%, but if that individual has diabetes, the risk jumps to > 20%.

#7) Do you have cancer? Or are you at increased risk of cancer?
For nearly all cancers, life expectancy is increased if one catches it an earlier stage. However, I view cancer as a process and the best treatment, if possible, is to avoid its creation in our bodies if at all possible. Knowing the risk factors for various cancers, as well as informed knowledge about appropriate screening tests, can be beneficial. MD Andersen has some nice online calculators to determine survivability of breast, colorectal, esophageal and pancreatic cancers.

#8) Are you sedentary?
The Sedentary Behavior Research Network (did you even know there was such an organization?) defines sedentary behavior as “any waking activity characterized by an energy expenditure ≤ 1.5 metabolic equivalents and a sitting or reclining posture” Without a commitment to activity, it is possible for many of us to exist as sedentary individuals throughout our work and home life. With normal activity, an individual usually walks around 4000-6000 steps a day. It requires a commitment to obtain 10,000 steps a day, which is the amount recommended by many public health agencies. However, more studies are also coming to light stating that the intensity of exercise may also play a role as well. For instance, running may equal 250 to 300 steps a minute.

#9) Are you depressed or stressed?
Depression is commonly based on questions associated with sadness, lack of initiative, excessive feelings of guilt, decreased energy, decreased concentration, change of appetite, and feelings of suicidality. If symptoms are overwhelming, one should seek professional help immediately, but often many of us can harbor simmering feelings of depression. Further, it is not only depression or stress, but the way we react to these feelings (such as overeating, smoking or excessive rumination and sedentary behavior) which can lead to future disease states.

Now, write a short descriptive statement of yourself. Such as, “I am a 44-year-old male non-smoker with a BMI in the obese range. I am sedentary. I do not know if I have high blood pressure and I am not aware of my cholesterol. My mother, who smoked, had a heart attack at 61 and is still living and my father is 75 in fair health on no major medications (but he does not see a physician regularly). Maybe I’m a little depressed.”

Or

“I am a 50-year-old female smoker with a BMI in the normal range. My cholesterol is slightly elevated by my last physical exam and my blood pressure would place me in the prehypertensive range. My father died at the age of 76 (he smoked and had emphysema) and my mother is alive at the age of 80 and is in good health (she stopped smoking at the age of 60). I don’t consider myself depressed. Based on a Framingham Risk Factor calculation, my risk for cardiovascular disease in the next 10 years is 6%.”

A basic root cause of medical illness in both examples is different. While obesity is probably the greatest concern for the 44-year-old male in the former example, in the latter example her smoking is the most likely cause of her ill health.

Now, after identifying the individual behavior, it is best to go a step further. Why is the 44-year-old male overweight? Does he eat at night? Is it stress eating? Does he exercise enough? Why doesn’t he know his cholesterol and blood pressure? Does he live in a state of fog of his overall health? If a root cause of the primary ill health can be identified, action can be taken at both the psychological and physical level to effect change. Asking the deeper questions about why we participate in an unhealthy activity may unlock a psychological answer to help implement the physical changes which are required.

Regardless, once the undesirable activity is targeted, it can help to take some time to research or develop a SYSTEM for behavioral change for yourself. The key point here is to invest in a SYSTEM for change -- using something consistently -- a video, a coach, a book, a youtube, whatever works and whatever makes you accountable to effect this change. I view both health and disease not as static events but as processes. We want to move from disease progression to health progression. Lastly, aspects which can help develop effective systems are often stronger if we have knowledge about the benefits of change. That is why the next few postings will go into detail regarding the earlier questions.