This article, the second in a yearlong OurHealth series about primary care, will focus on your part of the patient-physician partnership.
Although you can’t change your age, gender or genetics, you can change the lifestyle choices that affect your health. Diet has an important role in the treatment of many chronic conditions, such as diabetes, obesity, kidney failure, hypertension and heart disease, says Roy Habib, MD, a primary care physician at LewisGale Physicians in Salem.
Dr. Habib makes an effort to discuss diet with his patients at office visits. He makes simple recommendations that patients can understand and try to follow. In general, he recommends eating foods low in salt, fat and carbohydrates. A Mediterranean diet high in vegetables, whole grains, fruits and nuts, and that replaces butter with olive oil and adds herbs for flavor, is becoming a proven healthy choice.
For patients with diabetes, it is important to stick to a low-carbohydrate diet, eat regularly and avoid skipping meals, Dr. Habib says. For heart failure, liver cirrhosis and kidney disease, it is crucial to avoid excessive fluids and restrict salt intake.
Eating healthy starts before going to the grocery store. It means planning healthy meals in advance, shopping often enough to have nutritious options on hand and reprioritizing your grocery budget.
Dr. Habib avoids complicated diet regiments because the more difficult a meal plan is, the more likely patients are to be overwhelmed and ignore their doctor’s instructions.
Henry Burgess, MD, a family medicine doctor at LewisGale Physicians’ Daleville office, takes the same approach. “The best way to make changes that will last is to make small changes in diet and exercise gradually over time so that each feels easier to stick to and make a habit of,” he says.
What does a healthy meal look like?
The Healthy Eating Plate, developed by Harvard University, shows people what a healthy meal looks like. The U.S. Department of Agriculture has a similar tool, called MyPlate www.choosemyplate.gov. The American Diabetes Association offers Create Your Plate www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/?loc=ff-slabnav to help people control their blood sugar. You can ask your primary care provider whether one of these meal plans or a different one is right for you.
Preventing portion distortion
The type of food on your plate is important, but so is the amount. Did you know that portion sizes in America have increased over time? Many restaurants serve oversized portions, sometimes big enough for two people, and food makers package food and drinks in large sizes to sell more of their product. For example, 20 years ago, the typical bagel was 3 inches in diameter and 140 calories. Today’s bagels are often 6 inches and 350 calories.
As portions have grown, so have Americans’ waistlines. If you’re trying not to overeat when you’re at a restaurant, how can you tell how much is the right amount when you don’t carry measuring spoons or cups?
It turns out you have a portable measuring tool at hand, literally. People can use their hands to estimate serving sizes to avoid overeating at home and at restaurants.
Get up and go
Diet alone isn’t enough to achieve a healthy weight. The other half of the equation is exercise. Many people think of going to the gym when they think exercise. For people who can afford it and are motivated, joining a gym and working with a personal trainer can be a good option.
But for others, a membership is nothing more than a donation to the gym. Going to a health club isn’t for everyone. If that’s the case with you, the most important thing is to find an activity you like to do because you’re more likely to stick with it.
It’s okay to start out small and add time when it gets too easy. In fact sometimes starting out small is the healthiest approach. Taking up running or an organized sport you haven’t played for years could result in an injury because your muscles aren’t conditioned for it.
Walking is a great alternative. It doesn’t stress the joints and it’s free. A commonly heard goal is 10,000 steps a day, but that’s not an official government health recommendation. The Centers for Disease Control and Prevention says typical adults should get two hours and 30 minutes of moderate intensity aerobic activity — such as brisk walking — every week, and they should perform muscle-strengthening activities two or more days a week.
A fitness tool — be it a FitBit, a smart phone app or a pedometer — can help you measure how much you’re walking and to gauge your progress as you work toward reaching your goal over time.
Obese people have to take special care when starting their physician-recommended exercise routine because the extra weight puts pressure on their joints. Exercising in a pool is often the best option because it’s easier on the joints.
People who don’t like water or are shy about putting on a bathing suit can still safely add to their activities. Even getting up and moving about during TV breaks helps. You can gradually add more activity as time goes on.
Honesty and action
An individualized eating and exercise plan can keep chronic conditions like diabetes, high blood pressure and high cholesterol in check without medication or with a lower dose.
Your plan will only be successful if you’re honest with your physician at the outset and as you work toward your goals. Be frank about how much exercise you get, what you eat and what your weaknesses are. If your only exercise is to walk to the mailbox and back, that’s what you should tell your doctor. Truthful information will help your physician determine what your first activity goals should be.
Some patients are very motivated to change their habits, while others find it a struggle. Some patients falter, don’t let their doctor know and give up.
If you have a hard time meeting your goals, your primary care provider would much rather you reach out to them for help than give up. They can offer tips to keep up your momentum when you hit a roadblock.
If you really are unable to change your behavior, you have to be honest about that too. If you have high cholesterol but keep eating at McDonald's, a cholesterol-lowering statin drug might be your best choice.
When you’re exercising and changing your eating habits because of a chronic illness, your doctor will make plans for follow-up visits. It’s important to keep those appointments so your physician can make sure your plan is working and make needed changes if it’s not.
If it’s possible, make your next appointment before you leave your primary care provider's office. That way, your follow-up visit won't slip through the cracks.
Jefferson Internal Medicine Associates in Roanoke keeps a “bump list.” Any patient who cancels or misses an appointment is placed on this list so the office can call them to reschedule their missed appointment. “We explain to our patients that their health and well-being is very important to us,” says Anne Jaeger, MD.
Vaccines aren’t just for kids
Most people remember getting vaccine shots when they were kids. You might even have your old vaccine booklet from when you were a child. But the need for immunization doesn’t end with childhood.
The Centers for Disease Control and Prevention recommends that adults get an annual flu vaccine, periodic booster shots for some diseases and a pneumonia vaccination at age 65. Most adults who are 49 and younger can get the flu vaccine in a nasal mist instead of a shot.
Almost everyone experiences times in their life when they’re anxious or depressed. It’s important to let your primary care provider know when it happens to you. Your physician can help you determine whether your feelings are normal or a sign of a mental health problem.
If you are having a mental health problem, your doctor will likely refer you to a counselor who can help you work through it. Counselors also teach coping skills that you can use through your life.
Overweight patients who are unable to change their eating habits can often benefit from counseling that helps them figure out what is blocking them from healthy eating.
It’s important to find a counselor who is right for you. Ask you doctor for a referral list and then call a few counselors on the list, explain the basics of your issue and decide whether that person will be a good fit for you based on your conversation.
In many communities there aren’t enough counselors to meet demand, so you might experience a wait for an appointment. That’s why it’s important to call counselors without delay.
Exercise also helps to relieve mental health problems. Sunshine and exercise boost the level of serotonin — a chemical produced by your body that is important for brain function.
Yoga can be a particularly good exercise option. The typical yoga studio has lessons for beginners, and staff members can help you decide what type of yoga is best for you. For adolescents who are struggling with anxiety, meditative yoga can give them a tool besides medication that they can use to cope with stress.
Sometimes counseling and exercise aren’t enough, and medication is needed. Primary care doctors handle prescribing for common mental health problems. For serious mental health disorders, the doctor will usually refer the patient to a psychiatrist.
Most mental health medications take up to six weeks to take full effect. The doctor will typically schedule a follow-up appointment a month or two after prescribing the medication to make sure it’s working.
Mental health: Know the warning signs
Trying to tell the difference between normal feelings, especially in times of stress or loss, and what might be signs of a mental illness can be hard. Tell your doctor if you are experiencing any of these common signs of mental illness in adults and adolescents.
• Excessive worrying or fear.
• Feeling excessively sad or low.
• Confused thinking or problems concentrating and learning.
• Extreme mood changes, including uncontrollable “highs” or feelings of euphoria.
• Prolonged or strong feelings of irritability or anger.
• Avoiding friends and social activities.
• Difficulties understanding or relating to other people.
• Changes in sleep habits or feeling tired and low energy.
• Changes in eating habits, such as increased hunger or lack of appetite.
• Changes in sex drive.
• Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don't exist in objective reality).
• Inability to perceive changes in one’s own feelings, behavior or personality.
• Abuse of substances like alcohol or drugs.
• Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing aches and pains).
• Thinking about suicide.
• Inability to carry out daily activities or handle daily problems and stress.
• An intense fear of weight gain or concern with appearance (mostly in adolescents).
Credit: National Alliance on Mental Illness
Take your meds
By some estimates, more than half of all prescription drugs either aren’t taken at all or aren’t taken according to the doctor’s instructions. The result is that a lot of people are in poorer health than they should be, and some even die.
There are lots of reasons why people don’t take medicine. “Sometimes a patient is concerned about possible side effects, skeptical of a medication’s importance or simply unsure of why they were prescribed the medicine in the first place,” says Anthony Stavola, MD, vice chair of Carilion Clinic’s Department of Family and Community Medicine in Roanoke. “I find that taking the time to educate and inform is the best way to remedy any confusion or concern.”
Sometimes people can’t afford their prescription medication. A less expensive generic option is often available, Stavola notes, so it’s important to let the doctor know if medication cost is a problem for you. Many Carilion Clinic primary care locations are certified patient-centered medical homes with care coordinators and a consulting pharmacist who can help patients find affordable options, he adds.
Medical Home: a patient centered approach to primary care in which you find an entire care team dedicated to you, and focused on prevention and wellness. Led by your physician, your care team works with you to achieve your healthcare goals.
Regardless of the reason, your primary care doctor wants to know if you’re not taking your medication, why you're not taking it and if you’re confused about how to take it. Tell him right away. Your doctor doesn’t want you to wait until your condition gets worse to find out there is a problem with your medication.
If your medication isn’t working, your can adjust your dose or change the medication all together if it’s causing side effects, Dr. Jaeger says.
If you hear a troubling rumor about the medication, your doctor or nurse can talk it over with you.
10 questions to be “medicine smart”
Patient who understand their medications are more likely to take them. Here are 10 questions you can ask your doctor or nurse to get the information you need to use medicines appropriately.
1. What is the name of the medicine and what is it for? Is this the brand name or the generic name?
2. Is a generic version of this medicine available?
3. How and when do I take it — and for how long?
4. What foods, drinks, other medicines, dietary supplements or activities should I avoid while taking this medicine?
5. When should I expect the medicine to begin to work, and how will I know if it is working? Are there any laboratory tests required with this medicine?
6. Are there any side effects, what are they and what do I do if they occur?
7. Will this medicine work safely with the other prescription and nonprescription medicines I am taking? Will it work safely with any dietary or herbal supplements I am taking?
8. Do I need to get a refill? When?
9. How should I store this medicine?
10. Is there any written information available about the medicine?
Credit: National Council on Patient Information and Education
Centers for Disease Control and Prevention – www.cdc.gov
National Alliance on Mental Health – www.nami.org
National Council on Patient Information and Education – www.talkaboutrx.org
National Heart, Lung, and Blood Institute – www.nhlbi.nih.gov
Henry Burgess, MD, with LewisGale Physicians in Daleville
Roy Habib, MD, with LewisGale Physicians in Salem
Anne Jaeger, MD, with Jefferson Internal Medicine Associates in Roanoke
Anthony Stavola, MD, with the Carilion Clinic Department of Family and Community Medicine, Roanoke