Wednesday, March 21, 2018

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The Bridge to Better Health Starts with Primary Care: Part V - Measure Your Care

Written by  Geri Aston


Improving your health requires lasting lifestyle changes that affect the way you eat, your activity level, your mindset and your interactions with your doctor. 

Oftentimes the plan includes losing weight because overweight and obesity play a major role in many chronic conditions — high blood pressure, heart disease, diabetes, arthritis and sleep disorders, for example. The temptation is to measure your success by your weight. But the scale is just one measuring tool, and it doesn’t capture the full impact of the lifestyle changes you’ve made.

This article, the fifth in a yearlong OurHealth series about primary care, examines other ways to keep tabs on your progress toward better health.

“Raid” the fridge

Storm your fridge and pantry — not to grab a snack, but to check their contents.

Primary care providers we have interviewed for this OurHealth series have recommended that people move away from foods made in a factory, sweets, sugary beverages and junk food. Instead, they have suggested that people eat more fresh foods, especially vegetables and fruit. If money is tight, frozen vegetables and fruits can be good, less-expensive alternatives.

Is your fridge stocked with fresh items? Are there plenty of vegetables and fruits? If so, you’re on the right track. If not, it’s time to re-evaluate your buying choices.

Doctors also recommend that people shop for simple foods with real ingredients.

Read the labels on the food in your cupboard or pantry. Do the items have just one or only a few ingredients that you don’t recognize? Are they low in sugar, salt and saturated fat and contain no trans fat? If you answered "yes," it’s a sign you’re eating right.

Or is your pantry full of chips, sweets and other products with long lists of unrecognizable ingredients and high doses of sugar, salt, and saturated or trans fat? If you answered "yes," you need to shop healthier.

Put pep in your step

Keeping physically active is part of a healthy lifestyle. The health improvement plan you developed with your doctor likely includes some goals for being more active.

One way to measure success is to monitor how much physical activity you weave into your day or week. The Centers for Disease Control and Prevention says typical adults should get two and a half hours of moderate activity a week and perform muscle strengthening activities two or more days a week. Moderate activity means exercise you could do while carrying on a conversation without getting out of breath, like brisk walking.

Tracking the amount of activity you get is just one measure, though. It’s also helpful to evaluate the effect your activity has had on the way you feel and on your endurance. If your goal was to improve your fitness by walking, are you feeling more energetic? Are you able to walk farther than before? Do you breathe easier while you walk? The same measures apply to jogging.

Maybe your increased activity level has given you the ability to do something you weren’t in shape to do before, like taking an aerobics class, walking the golf course instead of riding a cart or chasing after your grandchildren in the park. These would all be positive signs of a healthier you.

Minding your mind

Improving your health isn’t a neck-down endeavor. Positive mental health is part of the whole picture.

Research shows that exercise can help reduce anxiety and improve mood. Sunshine and exercise boost the level of serotonin, a chemical your body produces that is important for healthy brain function. Exercising with friends or family is good for your physical and mental health because socializing eases anxiety and depression.

If you’re nine months into your health improvement plan, it’s time to take stock of its impact on your mental health. Are you feeling more motivated, happier or less stressed now than you were before?

Sometimes a mental health problem can block efforts to improve your physical health. Depression can make a person unmotivated to exercise, eat right or take their medications. That can lead to a chronic illness or worsen an existing one. An underlying mental health issue could be the reason for a physical problem such as obesity.

When mental health symptoms affect your ability to work or to enjoy relationships or your life, doctors recommend getting help from a mental health professional. If that’s the case with you, have you made an appointment yet? If you have, are you continuing to keep your appointments? If you were prescribed mental health medications, are they working? (Many medicines for mental health don’t take full effect for several weeks or months.)

If you answered "yes" to these questions, it’s a good indication that you’re on the way toward better mental health. If you answered "no," it’s time to check in with your doctor to figure out what’s going on so you can come up with solutions.

Better labs and less medicine

People with chronic diseases often need to get regular lab tests. The results help you and your doctor measure whether your lifestyle changes and medication are working.

At nine months into your health improvement plan, have your lab results improved? If you’re diabetic, is your blood sugar in better control? If you’ve got high blood pressure or high cholesterol, are those numbers coming down?

If so, keep up the good work. If not, it’s time to contact your physician. Primary care physicians interviewed for this series urge their patients to call their office when they’re having trouble sticking with a health improvement plan. More often than not, doctors can suggest solutions. But doctors can’t help if they don’t know there is a problem.

It’s also important to keep follow-up appointments and get the lab tests your doctor suggests. Life is busy, but you have to make time for your health.

A reduction in the amount of medication you need to take can also serve as a measure of your success. Maybe because you’re eating better and exercising, you’ve gotten healthy enough for your doctor to lower the dose of your blood pressure medicine. Or perhaps your healthier lifestyle means you’re reaching less often for the pain relievers in your medicine cabinet.

Positive results like these count whether you’ve lost weight or not.

Don’t give up

What if you don’t see the results you hoped for when you started on your health improvement plan? Doctors say you shouldn’t give up or beat yourself up over it. Talk to your physician about your concerns to get advice on how to achieve the change you want.

If any of your results are negative, you can use them as motivation to improve. Every day is a new day to make good health choices.

Getting your zzz’s

Getting a good night's sleep does more than keep you feeling refreshed. According to the National Heart, Lung, and Blood Institute, it plays an important role in your physical and mental health.

In the extreme, the damage from not getting enough sleep can occur in an instant, such as a car crash, the National Institutes of Health notes. Meanwhile, the National Highway Traffic Safety Administration estimates that 83,000 crashes annually between 2005 and 2009 were related to drowsy driving.

Over time, the lack of sleep can hurt your health in a number of ways, NHLBI says. Sleep is involved in the healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure and stroke.

Sleep helps maintain a healthy balance of important hormones, including the ones that make you feel hungry or full. Lack of sleep makes you feel hungrier and increases your risk for obesity. Sleep also affects the hormone that controls your blood glucose (sugar) level. Sleep deficiency results in a higher than normal blood sugar level, which over time can increase the risk for diabetes.

Your immune system relies on sleep to stay healthy. Ongoing sleep deficiency can change the way your immune system responds, for example, by making it more difficult to fight common infections.

Sleep also helps your brain work properly, NHLBI says. During sleep your brain is preparing for the next day — it's when your brain forms new pathways to help you learn and remember information. If you don’t get enough sleep, you may have trouble making decisions, solving problems, controlling your emotions and behavior and coping with change. Sleep deficiency also has been linked to depression and suicide.

How do you know if you’re getting enough sleep? Last year, the National Sleep Foundation came out with the following recommendations for healthy amounts of sleep.

Age         Recommended     May be appropriate         Not recommended
18-25      7-9 hours             6 hours; 10-11 hours      <6 hours or >11 hours
26-64      7-9 hours             6 hours; 10 hours           <6 hours or >10 hours
65+        7-8 hours             5-6 hours; 9 hours          <5 hours or >9 hours
[end sidebar]

The lowdown on checkups for adults

Regular checkups are important even for people who feel well. They give your doctor a chance to screen for diseases, determine if you’re at risk for future medical problems and update vaccinations. Checkups also help you maintain a relationship with your doctor so he or she can better help you when you are ill.

But how often do you need a checkup? Here are some recommendations.

Eye exam

  • 18-39 = Every 2 years if you have a vision problem, more often if recommended by your eye doctor
  • 40-54 = Every 2-4 years
  • 55-64 = Every 1-3 years
  • 65+ = Every 1-2 years

Dental exam

Adults 1-2 times per year for an exam and cleaning. Your dentist will decide if you need more frequent visits.

Physical/wellness visit

There’s no rule of thumb about when to get a physical. It depends on how healthy you are in addition to your age.

  • <30 = If you’re healthy — don’t smoke, have no disease risk factors (including being overweight) and don’t take prescription medications — get a checkup every 2-3 years. Others should ask their doctors how often they need a physical.
  • 30-40 = Healthy individuals should get a physical every other year.
  • 50+ = Annual physicals are recommended.

Next in our series

Part VI of OurHealth magazine's six-part series, “The Bridge to Better Health Starts With Primary Care,” examines ways you can celebrate the rewards realized from taking good care of yourself. Be on the lookout for Part VI in the December issue!


“Why Is Sleep Important?” National Heart, Lung, and Blood Institute,
“Research on Drowsy Driving,” National Highway Traffic Safety Administration,
“How Much Sleep Do We Really Need,” National Sleep Foundation,
“Physical Exam Frequency,” MedLinePlus, National Institutes of Health, National Library of Medicine,
“Should you get an annual physical?” DukeHealth,