Thursday, February 22, 2018

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The Bridge to Better Health Starts With Primary Care – Part III

Written by  Geri Aston

Primary care physicians are our partners on the road to good health. They urge us to get our vaccinations and preventive health screenings. They’re the ones reminding us to eat healthy and exercise.  

But sometimes it’s easier to get on and stay on the path to good health when we have company on the journey. Then once we’ve adopted a healthy lifestyle, we can set a good example for others and perhaps inspire them to join us.

This article, the third in a yearlong OurHealth Richmond series about primary care, focuses on “sharing your care.” With the advice of local primary care physicians, we’ll provide ideas for how you can work healthy practices into your daily life and possibly motivate others to do the same. 

Setting your sites on eating right

“One of the most important aspects of a healthy lifestyle is eating right”, says Daphne Bryan, MD, a family physician at Bon Secours Bermuda Crossroads Primary Care in Chester. Dr. Bryan recommends that patients avoid eating white starchy foods and sweets on a daily basis. Some examples of foods to steer away from are breads, white rice, crackers, chips, cakes, candies and cookies.

People should have at least seven servings of fruit and vegetables each day. To fit that into your eating plan, try eating two types of vegetables at lunch and at dinner and have fruit for snacks, Dr. Bryan suggests. Another tip is to avoid eating foods with more than one major ingredient. “Meats, fish, fruit and vegetables only have one ingredient; however, Oreos have a lot more than one,” she says.

To make healthy eating easier, patients can try cooking larger portions and putting single portions in containers for lunch the next day or freezing them for quick dinner another day, Dr. Bryan adds.

Bon Secours has weight-loss resources for employees and the community, Dr. Bryan says. It has two board-certified bariatric medicine specialists in the Richmond area and three in Hampton Roads. These physicians are trained to help with total wellness.
Dr. Bryan assists patients with weight loss by coaching them in making important lifestyle changes and using medication for appetite suppression when needed.

“Sometimes it’s not the addition of medicine that is needed for weight loss, but instead removing medications that cause weight gain,” she says. “I will soon be adding a more aggressive approach to weight loss called the “New Directions” program. These programs are available to employees, as well as our patients at large.”

Once you’ve adopted healthy eating habits, it can be fun encourage the same in others. “You could make a healthy, tasty meal for a friend or family member and then ask that person to help make the menu for the next time,” says Megan Lemay, MD, a primary care physician and assistant professor of medicine in general internal medicine at Virginia Commonwealth University, Richmond.

Exercising for the body and mind

Getting enough physical activity is just as important as eating right. The recommended amount of exercise for the average adult is at least 150 minutes a week of moderate activity. As a rule of thumb, moderate activity means exercise you can do while carrying on a conversation without losing your breath.

Exercise helps to improve conditions, such as hypertension, diabetes, anxiety and depression, Dr. Bryan notes. She suggests that anyone who has been sedentary and is planning to start exercising talk to his or her primary care doctor about a safe way to get started.

Walking is one of the best exercises. It’s free and is good for people in any age group. Walking is just one option, though. Find something you like to do that doesn’t involve sitting.

Dr. Bryan suggests joining a local gym. Facilities with indoor pools are particularly helpful for people who have arthritis or other disabilities that make exercise painful because water takes away the pressure on the joints.

Exercise not only helps people feel better physically, but mentally, too. “It’s a great way to manage stress”, Dr. Bryan says. She also suggests trying yoga and studying relaxation techniques. There are many helpful sources online that teach meditation.

Making exercise social, not just for your own health and enjoyment, but to motivate others who might need an extra nudge.

“You could think about inviting that family member on a walk, hike, or swim and letting them decide the next outdoor activity to enjoy,” Dr. Lemay says. “It's motivating to feel that you have some control over the healthy changes in your life.”

For people with children, family activities help you physically and mentally while you model healthy behavior for your kids. Walking, biking or hiking together encourages healthy habits that can last for a lifetime.

Aging doesn’t change the recommended activity level of 150 minutes a week. Elderly people benefit physically and mentally from exercise also. The intensity of activity might be lower though, and sometimes disability gets in the way.

Share Your Care When it Comes to Traditional Screenings

Cancer screenings

Once you reach age 50, doctors recommend several cancer screenings. If you have a family history of early cancers, your physician might suggest screening before 50. Getting recommended screenings is one way to set a good example for others, says Megan Lemay, MD, a primary care physician and assistant professor of medicine in general internal medicine at Virginia Commonwealth University, Richmond.

“Many of my patients are more willing to undergo screening when a spouse or friend has had a good experience,” she says. “If you've recently had a mammogram, pap smear, colonoscopy, or another screening test that went better than expected or discovered something before it turned into a cancer, I would definitely share that with your friends and family. You never know if your friend or relative's test could truly save their lives.”

Breast cancer (Women)

40-49: Discuss with your doctor or nurse.
50-64: Starting at age 50, get screened every two years.
65 and older: Get screened every two years through age 74. Age 75 and older, ask your doctor or nurse if you need to be screened.

Cervical cancer (Women)

18-39: Get a Pap test every three years if you are 21 or older and have a cervix. If you are 30 or older, you can get a Pap test and human papillomavirus (HPV)* test together every five years.
40-49: Get a Pap test and HPV test together every five years if you have a cervix.
50-64: Get a Pap test and HPV test together every five years if you have a cervix.
65 and older: Ask your doctor or nurse if you need to get a Pap test.

Colorectal cancer (Men and women)

40-49: You might be screened if you have a strong family history of colon cancer or polyps or if you have risk factors, such as a history of inflammatory bowel disease or polyps.
50-64: Starting at age 50, get screened for colorectal cancer. Talk to your doctor or nurse about which screening test is best for you and how often you need it.
65 and older: Get screened for colorectal cancer through age 75.

Lung cancer (Men and women)

50-64: Starting at age 55, get an annual screening if you have a 30 pack-year smoking history* and currently smoke or have quit within the past 15 years
65 and older: Get screened through age 80.

Prostate cancer (Men)

50-64: Men should discuss prostate cancer screening with their doctor starting at age 50, or younger for African-American men and those with a family history of prostate cancer in a close relative younger than age 65. Prostate examinations are no longer routinely done on men with no symptoms.
65 and older: Talk with your doctor about prostate cancer screening.

Source: National Institutes of Health,

*Smoking history pack-year – A way to measure the amount a person has smoked over a long period of time. It is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. For example, one pack-year is equal to smoking one pack per day for one year, or two packs per day for half a year.

Dig into your health roots

Knowing your family history and sharing it with other family members enables you and your family to be proactive about making lifestyle choices that could affect whether some illnesses with a hereditary component develop.

“Family members share genes, lifestyles and environments that may influence health and risk of chronic disease”, says John Strazzullo, MD, a family physician at Patient First in Richmond. Having a family member with a chronic disease or serious condition, such as cancer, high blood pressure, diabetes, or heart disease, may mean you have increased risk of developing that disease, too.

“If your doctor understands your family history, he or she is better able have a discussion with you about lifestyle choices and appropriate screening tests”, Dr. Strazzullo says. This discussion might help you make any needed changes that could lessen your chance of developing a chronic illness and encourage you to get appropriate testing in order to detect a cancer at an early, curable stage.

“It can also aid the physician in detecting an inheritable disease before a patient suffers health problems due to the condition,” Dr. Strazzullo says. For example, thrombophilia, an increased tendency to form dangerous blood clots that can break loose and lodge in your lungs, can be inherited, he notes.

A complete family history is important for all family members, even if they are not biologically related, Dr. Strazzullo says. That’s because family members often share social and environmental exposures that may influence health risks, such as poor diet, smoking, or exposure to toxins, such a lead in drinking water.

Dr. Strazzullo offers these tips for compiling a useful family health history record:

  • Talk to family members about health history and update the record from time to time.
  • Record the names of your close relatives from both sides of the family for three generations (parents, siblings, grandparents, aunts, uncles, nieces and nephews).
  • List all diseases and conditions the individual is diagnosed with and age at diagnosis.
  • Include the age and cause of death of deceased family members.

Get some shut-eye

Adequate sleep is an essential, but often overlooked, part of a healthy lifestyle. Everyone needs at least seven hours of “good” sleep a night, says Daphne Bryan, MD, a family physician at Bon Secours Bermuda Crossroads Primary Care in Chester.

“I say ‘good’ sleep because if a person has sleep apnea, although they are sleeping, they are not getting proper oxygen while they sleep,” she says. “This is linked to many health conditions. To name a few: obesity, hypertension and frequent headaches.”

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and feel tired even after a full night's sleep, according to the Mayo Clinic in Rochester, Minn. If you think you might have sleep apnea, the Mayo Clinic recommends you see your doctor. Treatment can ease your symptoms and may help prevent other problems.

Modeling healthy choices

Living a healthy lifestyle involves more than going to the doctor, taking your medicine and exercising. Everyday choices impact our health, and making good choices can inspire friends and loved ones to do the same.

Driving safely: You can set a good example by wearing your seatbelt, not texting or talking on the phone while driving and not drinking and driving.

Limiting screen time: Balancing screen time with time outside is not just good for kids, but also for adults. If you are asking your tween to limit video games, you shouldn’t be stuck on your iPad.

Not smoking: Studies show that children whose parents smoke are more likely to take up the habit. Primary care doctors can help smokers who want to quit. Nicotine replacement products such as lozenges, gum, patches and inhalers make it easier. Your success might encourage others. If you’re a smoker and you quit, it might just be contagious.


Expert sources
~ Daphne Bryan, MD, is a family physician at Bon Secours Bermuda Crossroads Primary Care in Chester.
~ Megan Lemay, MD, is a primary care physician and assistant professor of medicine in general internal medicine at Virginia Commonwealth University, Richmond.
~ John Strazzullo, MD, is a family physician at Patient First in Richmond.