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. Helping patients make healthier choices is a major focus for Deborah Koehn, MD, a primary care physician at VCU Health at Stony Point. Many of her patients have diabetes or prediabetes, high cholesterol, high blood pressure or a mixture of all three. The underlying reason for each of these conditions more often than not is the same — overweight.
Dr. Koehn spends a lot of time educating her patients about eating healthy meals. Together with her patients, she develops a plan that meets their health needs and sets reasonable, achievable goals for weight loss.
On the surface, eating healthy sounds simple, but Dr. Koehn realizes it's usually easier said than done. “It’s behavior change, and behavior changes are harder than people think.”
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.
Healthy eating is just as important while dining out, Dr. Koehn says. Look at restaurant menus before you decide where to dine. If the restaurant makes it available, check the nutrition information too.
Some eating plans, such as those for diabetic patients, affect the whole family. Sarah Meyers, a physician assistant at Bon Secours Canal Crossing Internal Medicine, urges patients to bring their families to diabetes education classes.
It’s usually not feasible for everyone in the household to eat different meals, so it’s important for family members to understand the role of food in the disease and to get on board with the diet change. Plus, if unhealthy eating is the cause for the disease, everyone at home is at risk.
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. Many food makers package food and drinks in large sizes to sell more of their product. For example, 20 years ago, the typical bagel was three inches in diameter and 140 calories. Today’s bagels are often six 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. Dr. Koehn teaches patients how to 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, Meyers often recommends joining a gym and working with a personal trainer.
But for others, a membership is nothing more than a donation to the gym. Going to a health club isn’t for everyone, Meyers says. 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, Meyers says. Start at 10 minutes three times a week and add time when it gets too easy.
Sometimes, starting out small is the most healthy 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.
Dr. Koehn recommends that people use some sort of tool — be it a FitBit, a smart phone app or a pedometer — to measure how far they’re walking and to gauge their progress as they work toward reaching their 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.
Think of diet and exercise as medicine, Dr. Koehn urges.
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, Meyers says. 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, say both Meyers and Dr. Koehn. They can offer tips to keep up your momentum when you hit a roadblock.
For example, you’re able to reach 4,000 steps a day, but your goal is 10,000. It’s OK to send your doctor or nurse a quick message asking for advice on how to increase your steps. When emailing, a short, direct message is best, Dr. Koehn says.
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 McDonalds, a cholesterol-lowering statin drug might be your best choice, Meyers says.
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 slip visit won't fall through the cracks.
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.
Dr. Koehn often recommends counseling to overweight patients who are unable to change their eating habits. “So many people have dysfunctional relationships with food,” she says. “A lot of that comes from emotional issues.” Counseling can help people figure out what is blocking them from healthy eating.
It’s important to find a counselor who is right for you, Dr. Koehn says. She suggests calling counselors on a referral list (often provided by your physician), explaining the basics of your issue and deciding 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. Dr. Koehn recommends meditative yoga — not hot yoga, which focuses more on the workout and sweating. The typical yoga studio has lessons for beginners, and staff members can help you decide what type of yoga is best for you.
Dr. Koehn often encourages adolescents who are struggling with anxiety to try meditative yoga. It gives 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 the 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. People don’t understand what it does to treat their condition or they don’t understand the doctor’s instructions. Sometimes people can’t afford their prescription medication or the drug causes an unpleasant side effect.
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 them right away. They don’t want you to wait until your condition gets worse to find out there is a problem with your medication.
If a medication is too expensive, your doctor often might be able to prescribe a less-expensive option. Some pharmaceutical makers offer free or discounted drug programs.
If you’re experiencing side effects, your doctor can find a different drug that will work better for you. If you hear a troubling rumor about the medication, your doctor or nurse can talk it over with you. “But I can’t help if I don’t know there is a problem,” Meyers says.
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
Deborah Koehn, MD with VCU Health at Stony Point
Sarah Meyers, PA-C with Bon Secours Canal Crossing Internal Medicine