Tuesday, February 20, 2018

RNRVFebMar2018 IpadIphoneCLICK HERE
for the
current digital
version of

Featured Stories

The Bridge to Better Health Starts With Primary Care – Part IV - Inspire Your Care

Written by  Geri Aston

Getting on the road to good health is often easier than staying on it. Today, many people have — or are at risk of developing — common chronic conditions such as diabetes, high blood pressure or heart disease. Oftentimes, those health concerns prompt them to visit a primary care physician.

That’s a great first step. Primary care doctors work with their patients to develop a plan of action specific to each patient's health needs and goals.  

Those patients often start out eager to make the lifestyle changes — like losing weight or exercising — that are necessary to prevent or combat most chronic conditions.

But as the months go by, many formerly motivated individuals begin to lose steam. Sometimes they fall back into old, unhealthy habits. And sometimes people don’t see the results they expected, so they throw up their hands and quit trying. Regardless of why people falter, their primary care physician can help get them back on track.

This article, the fourth in a yearlong OurHealth series about primary care, focuses on “inspiring your care.” In it, primary care physicians offer ideas on how to overcome the obstacles that might sidetrack people on their path to better health.

Reach for a helping hand

If it’s been months since your last appointment with your primary care physician and you’ve lost the momentum to stick with your health behavior goals, it’s worth it to schedule a follow-up appointment.

“Start by talking to your doctor,” says William D. Thomas, DO, a family physician with LewisGale Physicians in Christiansburg. “Then you two, together, can decide the best plan forward based on your expectations and goals, with the confidence of knowing you are making sound medical decisions.”

Dr. Thomas helps struggling patients prioritize their health care goals by medical importance so they can address their most important issues first.

He also educates patients about their health conditions. “I find a lot of patients are interested but not informed about their health conditions,” Dr. Thomas says. Having good information helps to get patients interested in their health and invested in their care.

“As long as I can educate them enough to make informed decisions, I work hard to allow them the autonomy to be the drivers of their healthcare,” Dr. Thomas says.

In addition to reaching out to your primary care physician, support from family and friends can help you stay motivated.

Regularly connecting with one or more friends who are also working to improve their health can increase the likelihood of you reaching your health goals, notes Mark Greenawald, MD, a family physician at Carilion Clinic Family Medicine in Roanoke.

Creating a “safe zone”

Obesity already carries an emotional weight. “Many obese people feel ostracized by society and judged by those who don’t even know them as someone who has no self-control or who takes more than their share,” says Brian Dickens, DO, a family physician at Academic Primary Care Associates in Blacksburg. “When weight trends upward, patients often come in feeling frustrated, ashamed and in despair.

Successful weight management takes organization, establishment of habit changes and resilience. "We can live without tobacco, alcohol or drugs, but we all must eat,” Dr. Dickens says.

People are known to bite off more than they can chew, so to speak, by overestimating what they can accomplish when they first set their health behavior goals. Many get discouraged when they don’t see the change they wanted or it doesn't happen fast enough.

When patients are struggling, Dr. Dickens analyzes their habits with them, looks for trends and plans small changes to right the ship. Then doctor and patient schedule a follow-up appointment to gauge progress and troubleshoot as needed.

One important thing Dr. Dickens does at the outset is to create a “safe zone” for his patients. “Yes, I hold my patients accountable for their health, but they’re not going through it alone,” Dr. Dickens says. “I try to make sure they understand I’m their advocate.”

Calorie and exercise combo

Patients should know that they’ve got a lot of company in their quest to lose weight, says Carolyn Clark, MD, a primary care physician with Physicians Associates of Virginia in Roanoke. “At any given time, approximately two-thirds of the U.S. population is trying to maintain or lose weight.”

Sometimes even when a person improves their eating and exercise habits, they still have trouble losing weight. “As with most complex problems, finding the solution is no less challenging,” Dr. Clark says.

According to Dr. Clark, strategies that decrease energy intake (fewer calories eaten) have a greater potential for causing weight loss than those strategies that increase energy out (exercise). “This is not to be interpreted that exercise is not important but to highlight the fact that diet trumps exercise,” she says.

Increasing physical activity is particularly helpful for long-term maintenance of weight loss. “The diet will get you there, and the exercise will keep you there,” Dr. Clark says.

To successfully keep weight off in the long run, people have to embrace a complete, long-term lifestyle change that encompasses a calorie-controlled eating style, exercise and behavior modification, Dr. Clark explains. “It takes a great deal of introspection and self-control to accomplish and maintain these goals.”

Characteristics of people who are most likely to succeed include weight loss of more than 4.4 pounds in four weeks, frequent and regular attendance at a weight loss program and the person’s belief that his or her weight can be controlled, Dr. Clark says.

Keep tabs on yourself

Life can be chaotic, so tracking results — positive and negative — is an essential part of your care plan, says Mark Greenawald, MD, a family physician at Carilion Clinic Family Medicine in Roanoke. This is particularly the case when a patient has a chronic condition, such as diabetes or high blood pressure.

Not only does tracking your results allow you to better understand your health and become more actively involved with your care, but it also helps inform your physician of your progress between appointments.

Tracking blood pressure levels often helps patients better manage their condition, Dr. Greenawald says. Research has shown that multiple home measurements more accurately reflect overall blood pressure control than a single measurement at your physician's office, he notes.

There are many effective ways to monitor your health and track your progress. It can be as simple as a paper tracking system or computer flow chart to something more sophisticated, such as a fitness app or an activity-tracking device.

“Daily attention can provide motivation, increase your awareness and help provide the nudge that is often needed when trying to change a health behavior,” Dr. Greenawald says.

The mental and physical health connection

Many people consider their mental health to be separate from their physical health, but that’s not the case, doctors say. Taking care of your mental health is part of a healthy lifestyle.

It is important for patients to let their primary care physician know when anxiety or depression is interfering with their ability to work, enjoy relationships or enjoy life.

Chronic illnesses can cause mental health issues, such as anxiety or depression, or worsen them. For example, people with diabetes are at higher risk for depression because the difficulty of managing diabetes can be stressful and lead to depression.

On the flip side, a mental health problem can make a person less motivated to exercise, eat right or take their medicine, which can lead to or worsen a chronic illness. Physical and mental health problems can feed off each other. A person depressed about a diabetes diagnosis might lose the motivation to manage the disease, which would make both the disease and the depression worse.

As with all other attempts to adopt a healthier lifestyle, people shouldn’t become discouraged and give up if their efforts to improve their mental health don’t work as quickly as expected, doctors say.

Many mental health prescription medications don’t take full effect for several weeks or months. Additional treatments that usually involve some mix of individual psychotherapy, group psychotherapy, exercise and diet or lifestyle changes are often necessary for a person to notice improvement. These interventions can provide enough support during the treatment process to help prevent those making health behavior changes from becoming discouraged.

Next in our series

Part V of OurHealth magazine's six-part series, "The Bridge to Better Health Starts With Primary Care," examines ways you can track your efforts to ensure you're on the right path. The ability to measure your care will make it easier to see your success. Be on the lookout for Part V in the October/November issue!


Expert sources:
Carolyn Clark, MD, a primary care physician with Physicians Associates of Virginia, P.C. in Roanoke.
Brian Dickens, DO, a family physician at Academic Primary Care Associates in Blacksburg.
William D Thomas, DO, a family physician with LewisGale Physicians in Christiansburg.
Mark Greenawald, MD, a family physician at Carilion Clinic Family Medicine in Roanoke.