Category Archives: Health & Wellness

Lack of nutritional education in PA curriculum

Why aren’t we taught about nutrition?

I was talking to my boyfriend last night who told his doctor about what his diet consists of based on macronutrient (proteins, fats, carbs) amount per day.  His healthcare provider had nothing to say or add.  They were clearly not well versed on the topic.  And I can’t blame them.  It isn’t something we are taught (at least in PA school– I cannot speak for medical school)
BUT WHY are we not taught about the one singular thing that sustains us to live? (well that and hydration) on a very basic level.  Yet, we are teaching medical providers absolutely nothing about it (that I know of at least–someone correct me if I am wrong :).  
What do we learn as first line treatment for EVERYTHING? “diet and lifestyle changes”.  Right?!
Yet, America overall is so very sick. What is causing this and how do we on a small individual level begin taking steps to mitigate this issue? 

1. Set a positive example

I think that a portion of lack of nutritional and lifestyle counseling comes from either lack of personal knowledge or providers who do not follow the advice they would like to provide their patients. 
I’m not suggesting this is always the case or that the majority of health care providers are overweight and know nothing about nutrition. I’m simply suggesting there is a gap. Between what most providers need to know and what knowledge they have.
 
We need to set an example of responsibility for health and wellness in our own lifestyles so that we are comfortable discussing nutrition and exercise with patients. The best boss I have ever had led by example, and it made me want to work harder and be more of a team player.  I know it isn’t exactly the same, but hopefully the concept is appreciated. 

2. Put the patient in control

When anyone is approaching change, they determine where they are ready to begin.  Meet your patient wherever they are in the change process.  Frequently as helpers we seek to “fix” and tell patients how they need to be “fixed”. 
 
I am SO guilty of this!  “do this not that” “avoid this and do this”. 
 
Recently, I have taken on some different language.  
 
“What changes are you willing to make to achieve a healthier lifestyle/weight/etc?”
 
“What are your reasons that are meaningful for you to seek out these changes?
 
“What goals do you have for your health?” 
 
WHAT IS YOUR “WHY”?
 
Talking to a patient about exercising 5 days per week when they do none or maybe they don’t WANT to do that is going to only lead to frustration. 
 
Baby steps.  I love the quote “slow is smooth and smooth is fast”.  Once they are able to make 1 or 2 things they want to make habit and a lifestyle, start suggesting additional small changes.  Small things ADD UP!

3. Seek out knowledge

There is an ABUNDANCE of educational materials and courses on nutrition available out there.  As providers, maybe we have a responsibility to learn some basics (I know don’t we go through enough school).  I am not suggesting we attempt to take on the roll of a clinical dietician or nutritionist. 
 

What is the purpose/function of each macronutrient (protein, fat, carb)? How does each one serve our body and needs in a different way.  We need protein, fats AND CARBS (yes you need those) on a CELLULAR LEVEL. Our cell walls are comprised of all three. Our cells make up our tissues, tissues make up our organs and our organ systems make up our WHOLE BODY.  NOTE: There are variations of needs for each individual based on coexisting disease, goals, desires and basically how you FEEL.  Some people do great eating vegan: good for you.  Some people count macronutrients: good for you.  Not every way of feeding and honoring our bodies works for each person.
 

Learn the basics of some of the major types of nutrition programs (macros, paleo, keto, vegan, vegetarian).  I am definitely victim to pigeon holing myself into IIFYM (if it fits your macros)– because it is what works for me (disclaimer: this does not mean one eats only donuts because “it fits my macros”).  Admittedly, I’ve had a judgemental approach in the past towards other nutritional approaches.  Until I realized we are all not the same round peg going into the same round hole. And as long as your nutrition supports your body and wellness, I’m taking the approach of “good for you!” 
 
Personally, the nutritional approach I follow is IIFYM (if it fits your macros).  Precision nutrition is the certification that my nutrition coach attained and most of the coaches who work for the company.
Excuse my fine dinnerware 😉 
 
PLUG/RECOMMENDATION: if you are interested in learning more about the IIFYM approach visit http://www.workingagainstgravity.com or feel free to message me!  (I love to talk nutrition).  As an active mover– weight lifter, orange theory, crossfit, hiker, runner, etc etc and health care professional I FULLY endorse their approach and coaching.  Their blog also has so much information available for FREE!  Definitely check them out (I get nothing for recommending them!)
DISCLAIMER: I am definitely biased towards this approach because it has worked for me. 🙂
There is also a great deal of information available on podcasts which I have branched out to, and they are FREE!  I encourage you to listen to  nutrition based podcasts and also listen to the ones you may not necessarily agree with. This not only helps gain perspective of a patient or future patient, but also simply because you don’t agree with the entire basis of the program doesn’t mean you can’t take bits and pieces and make them useful 🙂
 
A simple quote that we can ALL live by no matter what nutritional approach you follow is the following:
 
“Eat real food, mostly plants, not too much” -Ben Bergeron
 
I am not advocating veganism or vegetarianism with this concept.
 
Eat real food. 
 
What does this mean? If it is on a shelf or has an expiration date > 2 weeks– its not real food. 
 
Mostly Plants.
 
Micronutrients are SO important and vital to maintaining health and wellness.  There are micro’s that you can only get from a diet that is rich in veggies! Magnesium, zinc, vitamins, etc etc.  Don’t get me wrong I love my steak once in a while, dairy and ALL sources of protein (if you don’t, that is ok, too!)
 
Not too much.
 
This means something different for everyone.  For most of our patients this can be simplified to prevent being overwhelmed:
 
1/2 your plate is veggies
1/4 lean protein
1/4 starch/carbohydrate
1-2 thumb size of healthy fat (nut butter, avocado, egg yolk, etc). 
 
I think if we can all follow those 3 principles and relay them to our patients we might instill some wellness! 
Example of what I bring to work to eat during a day 🙂

4. Encourage wellness instead of treating illness 

I listen to a podcast called “Pursuing Health” By crossfit games athlete and now medical doctor, Julie Foucher.  On one episode, she discussed where medicine is heading and I LOVE that she said that we are gearing more towards KEEPING PATIENTS WELL instead of treating illness. Instead of incentives for how many patients we see it will be based on quality and wellness. 
 
The problem with this: you can give patients all the information and tools, but if they don’t do the work– will we be getting “dinged” for their illness?  
 
I see both sides. I want to promote wellness, but we cannot FORCE people. I’m interested to see where this is going.  Also, definitely check out Julie’s podcast!  She was the first CF athlete I cheered for and love seeing what she is doing!

5. Advocate change

This is more of a MACRO (as in large) concept.  I would love to hear if people actually THINK nutrition needs to be incorporated and on what level into PA (and/or medical) school curriculum.  Are there people out there who encountered nutrition as part of their pre-req’s or in PA/Med school?  I’d love to hear experience and/or opinions about this!  (Especially because I know I tend to be really biased about wellness/nutrition/exercise 🙂

On the Obesity Epidemic and What People Don’t Want to Hear.

No one is going to like me for this article. Physicians, PA’s, NP’s, patients… basically all of America is going to hate me.
But, sometimes we need to hear things we don’t like. 
I’d like to start by saying that in America we are constantly bombarded with all types of consumption and choices.  Society at large has us set up to fail– to over consume in terms of nutrition and finances– and pretty much anything else. 
We are not set up to succeed in our health or wellness, which continues to spiral out of control through generations.  I read a statistic (several times) stating 80% of America is either obese or overweight.  I can’t remember the source; but, I started to pay attention to my patients and the general population at large and I mean– it seems pretty accurate.
Fast food, advertisements, portion sizes… hell even the size of our utensils are grossly enlarged to skew our perception of what we “SHOULD” (trigger word) be consuming and how much of it.
The number of subconscious decisions we make in a day regarding the food we choose to consume and what we spend our money on is basically innumerable.
We live in a society that values quantity and quickness over quality and mindfulness.  My response to this is: THIS NEEDS TO CHANGE.  It is not something that is going to change on a macro level.  It starts with each individual and spreads.
Now, here is the part no one is going to like.  We are all responsible for this. 
HOW?
Will power and responsibility is a thing.  We are all individually responsible for how we treat our bodies, minds and souls.  The nutrition and lifestyle we choose fits into all of these categories. Simply because society does not set us up to succeed does not give us an out to be obese, lazy and victims of our circumstance. 
We all have the power to make better choices.  Do it.
Health care providers: QUIT skipping the difficult conversations.  Patients need to hear that they are obese and what they are doing to their bodies by not honoring them with healthy choices. I’m not suggesting we start bombarding people with “hey you know how overweight you are? do something”. What I am suggesting is that we start having difficult conversations and lead by example. 
Is it difficult to sit in front of someone and tell them “you need to lose weight” and have that conversation?  Yes.  I do it 5-10 times per day.  No joke.
If you are skipping over the conversation you are part of the problem and not the solution. 
Modern western medicine teaches us in school to treat illness.  What I have learned in my time on earth and three years as a medical provider is that you have to learn to teach you patients to honor wellness.  That well-being is not a pill, it is not an overnight solution or a crash diet or diet pills (I simply tell people “no” when they ask for them).
Teach your patients wellness.  If you don’t know what this means I encourage you to learn. Learn and practice what it means to live a life of mindfulness and wellness.  Develop an understanding of proper nutrition– unfortunately we are NOT taught this in school and it is something I have learned through nutrition coaching.
SHAMLESS PLUG: If you are interested in a life overhaul that starts with honoring your body with nutrition visit Working Against Gravity at: https://www.workingagainstgravity.com/

DISCLAIMER: I do not receive financial incentives or anything by promoting them.  But by being a part of their group I did develop mindfulness and a nutritional habit that honors my body and wellness. My life changed because of the choice I made to work with WAG (working against gravity). 

I encourage all of my colleagues, future colleagues, physicians, nurses— or whoever you are— start with yourself.  If you transform yourself and learn, you have the capacity to help and transform another.  This change will not occur overnight;  but, I encourage everyone to be a part of change on a small scale so that changes at large can occur in the future ❤

America Has No Idea What They’re Eating.

I recently started working 1:1 with a nutrition coach.  I’ve always been a healthy eater.  Recently,  I’ve cut out sugar and focused more on healthy foods and timing of nutrition.  When I felt I had done all I could on my own I hired a coach for a few months.

Now I’ve weighed some foods before and eyeballed even more.  Let me tell you the first time you weigh or measure peanut butter or almond butter you question everything you ever thought you knew.  And then you cry just a little inside and out.

I look at the portion sizes people take in and scream and die on the inside.  People literally have no idea what they are eating.  In turn, their kids also are not learning what they are eating.

One of the women on the facebook page for the nutrition program I follow (Working Against Gravity) posed a question if other Moms in the group worried about what their kids though about them weighing and measuring their food.

At first I was like eeehhh good point.  Then I thought a bit deeper.  I thought to myself “This is a great teaching opportunity!”

Kids take in so much from their parents. Food, eating habits, nutrition and wellness are no different. I figure it this way, parents who weigh and measure their food can potentially cause the same harm or good as the parents who quadruple the dosing for their children.  It is all about the perspective.

The way I look at it is for parents who are healthy and weigh and measure food, they can teach their children about what is necessary in order to properly fuel their bodies and grow up healthy. Teach them what veggies, healthy protein and carbohydrates are and what they do for their bodies and mind.

Not teaching children about healthy portion sizes and food can have just as much if not more a detriment than showing them that it matter.  It results in kids growing up not being able to identify what broccoli or cauliflower is, or eating 16oz of pasta when a serving is 1/2 to one cup, eating 10oz of steak or chicken when 2oz gives you 15 grams of protein.  10oz of meat= 75g protein.  CRAZY!  My daily requirement on any day whether it is a rest day or I’m in the gym being active for 2-3 hours is 120g.

Like I said, people have NO idea what they are eating. As long as we as adults have no idea what we are eating– we pass that same message on to the next generation.  I guess my final statement is that we shouldn’t shy away from teaching kids about healthy eating.  If they don’t learn to form healthy habits, it will likely result in unhealthy habits and behaviors.

Healthcare Culture: Everything Hurts and I’m Dying

There are a lot of issues being discussed in healthcare today.  One point I don’t hear a lot about, but see everyday comes directly from our patients mouths.  They come in to clinic with the mindset of “everything hurts and I’m dying”.  What this means is that if they have a headache they think and know that they have a brain bleed and they need and MRI.  If their child has a cough they definitely need an antibiotic.  They woke up sick this morning or have an ache in their shoulder x1 day: everything hurts and I’m dying.  

The undertone of this statement that they don’t directly say: And you BETTER do something– better yet– what I think you need to do. 

Now, let me be clear it isn’t that I’m not empathic to patients who are feeling ill or in pain.  However, there is this culture out there that extreme measures, investigations and treatments need to be taken if you have a headache.  Are there the small percent of people who do need these measures? ABSOLUTELY.  That is why we do history and physical exams to weed these people out and send them for these tests.  

Why does this matter? What is this causing in medicine? Cost. Waiting room lines. The emergency department being used for non-emergencies (sorry people this was not created for you to get a pregnancy test free or score some morphine for back pain– it was meant for people with asthma exacerbation, CHF, PNA amongst so many others). 

How does this effect providers? We also have to act like someone who thinks they are dying are dying.  If we don’t they’re not satisfied. Re-assuring patients has become the most difficulty part of my job.  We all know when we have this person in front of us.  I always make sure to do a full physical exam.  I talk them through it saying “your ears are clear–no infections, airway is patent– tonsils are not enlarged, no lymph node enlargement, lungs sound great, your neurological exam is completely normal, vital signs completely within normal limits—– etc etc”.  But for some people they just aren’t satisfied.   

What else are we to do?  Patients who push for further intervention, I tell them I cannot treat an infection that is not there or worry about signs or symptoms that you do not have.  I tell them this is good news.  

My question is where are we going wrong? It seems like more and more people are lacking basic concepts about colds, headaches and belly aches.  I do my best to educate my patients.  Viral bronchitis is a BIG one.  I tell them 98% of bronchitis is caused by a virus. The cough can last 3-4 weeks even after you begin feeling better.  I state “Scary symptoms that you DO need to be concerned about are persistent fever or coughing up blood streaked sputum.” I ask them EVERY TIME “do you have any questions”.  I usually ask this twice. Yet somehow there are still people who come back a week later cause they have a dry lingering cough?  

Would love to hear thoughts from students on rotation and practicing providers with how you best handle these situations.  As well as suggestions.  May this serve as a reminder to always educate your patients as much as possible!

The Hierarchy of Medicine & Minding The Gap

Medical careers have always had somewhat of a tough, rough and tumble appeal.  It’s difficult to get accepted, get through school, residency, fellowships, boards, etc etc. We’re all these type A, rise-and-grind people. Whatever your particular career may hold, whether you are a nurse, doctor, PA, NP, Pharmacist.  The culture of medicine is BRUTAL and our jobs are difficult enough, so I pose the question: why are we making it more difficult on each other?

Who remembers being a PA/RN/Medical Student and being terrified of Residents or Attendings?  Allow me to raise my hand first. I cannot help but think how backwards this is.  Think about it, we are in a field that most people would say they enter to “help people”.  That is what we write in our personal statements and tell admissions committees I guarantee it. So, if we are truly in the business of helping people and “working as a team” why am I getting yelled at for calling an on call Fellow Physician at 2am? Why do I hear providers yelling at nurses? Confession: I’ve done this. Second confession/further information: Don’t page me “Pt has a fever.  Please advise” when they already have Tylenol ordered. (If I had a dollar…)

Ok, anyways I’m getting off track. When did medicine become a culture of “I’m higher up than you so I can yell at you/treat you like crap?” Back to that 2am call to a Fellow Physician: If you do not want to be woken up, don’t be a GI doctor– it will require call. Second, since when did I have to apologize for waking someone up because I have a patient that truly needs you to get your ass up and come in and do something?  You chose this, you wanted to pursue this career and help patients.  Get up. Put on your shoes and get your ass to the hospital. No, I didn’t say this– but I thought about it.

Perhaps the greater question is: Does this behavior and interactions harms patient care?  Especially in a hospital setting at teaching institutions where environments can be quite cut throat and hostile.  Residents fighting for cases, PA’s trying not to get their ass chewed out by fellows and attendings, providers getting pissed at nurses, nurses getting pissed at CNA’s. etc etc.

Like I said, have I been guilty of being an asshole when I’m dead tired and can’t handle another trivial request? Yep, sure have. Am I proud of this? No.

Listen, the reality about medicine is that you deal with people all day and it gets rough and sometimes you lose your shit.  (I hope I’m not alone here) Have I let this realization alter me for the better?  Sure have.

I’ve been reading a lot of Brene Brown’s work lately.  In one of her books (I think it was “Daring Greatly”) she talks about how you are not who you say you are or who you want to be.  You are only what you do.  The difference between this, she refers to as “minding the gap”. The space between who you are/what you actually do and who you want to be/what you actually do. 

Everyday I look at my fridge where I have a dry erase board that says “Mind The Gap”. And I think about the person I want to be in the present and how I want to become better every day.  Am I perfect? Hell no.  Am I trying? Hell yes.

 

I Don’t Have Time VS. It’s Not a Priority.

I cannot emphasize how much “I don’t have time” correlates to “It’s not a priority.”  I challenge everyone to take the phrase “I don’t have time” and replace it with “It’s not a priority”.  I guarantee you that it will be eye-opening.    

Quite frequently I have individuals who talk to me about my workout regimen and my food prep and I’m amazed at their ability to find reasons as to why I am able to do the things I am able to do for my health and how those reasons correlate to why they absolutely cannot.  
The most recent incident occurred as someone proceeded to tell me that I have time to workout because “I’m not responsible for other people”. Translation: I don’t have a husband or children.  First, I believe this is an excuse.  Do individuals who have families have a time management and priority challenge: yes. Do individuals like me have a priority challenge?  YES. Everyone’s time management challenges are unique to them.  I feel as though others have attempted to make me feel that because I don’t have a family, my priorities and check lists of things to complete are somehow easier to accomplish or not as important as those with families/husbands/wives.  I proceeded to tell this person that I work full-time. I run a side business and a website.  I have a dog that is a priority and I make sure she has food prepared and gets a walk 6 days a week. I spend a lot of time on the website/blog and other projects I’m working on collaborating with other professionals.  I also spend a decent amount of time reading about medicine and investing into my career. 
Everyday I wake up at 4:45am. I go to the gym participate in group crossfit class 5-6 days per week and 3 days a week I do extra individualized programming.  I’m either out of the gym by 6:30 or 7:30am on days that I work depending on my programming.  I go home walk my pup and listen to my HIPPO education RAP, shower/get ready/pack lunch(already prepped for week)/eat breakfast. Any extra time is dedicated to editing statements or working on the website OR a special project I’m working on with National Physician Assistant Eduction (its secret for now 😉  I arrive at work at 9am.  9am.  By the time I get to work I’ve done more with my day than most people do with 12 hours.  Currently I work in an urgent care.  This morning in 3 hours and 15 minutes I have seen 11 patients and written most of this blog.  Any down time at work I spend editing, reading medicine or responding to emails. 
We all have priority challenges.  We filter massive amounts of information, people and tasks daily and we decide consciously and unconsciously what we prioritize.  You are what you do, not who you say you are or what you say you will do. 
We all have the same 24 hours in the day, it’s all about finding ways to maximize every minute and hour afforded to you. 
I challenge everyone who reads this article– for ONE WEEK: Replace “I don’t have time” with “It’s not a priority” and I guarantee you will learn a great deal about yourself.  

Sugar and Sleep

I’ve always been a relatively healthy eater in my adult life.  This of course was after a long phase in high school of eating Entenmann’s chocolate donuts for breakfast and sometimes lunch (seriously ask my best friend Melanie I ate them for basically 50% of my meals). I’ve also always been very active and athletic.  However, I’ve never really followed a particular way of eating…paleo, zone, etc.  I’ve just always kind of followed what I called a strict 85-90% clean and 10-15% stuff I wanted.

Recently a lot of my friends have tried out the Renaissance Periodization Diet.  They’ve all made tremendous gains on their lifts and tell me they feel amazing–not to mention they’ve cut their body fat percent and leaned out.  So–I decided to give this it a try, I bought the templates for my weight and gender.

I’ve been doing it only about a week and a half and I decided to have some cake at dinner and “cheat”(I have a serious sweet tooth) I immediately felt awful.  What was more troubling to me was that when I woke up the next morning I felt like I had a hangover.  I had slept a solid 9 hours and only woke up once because of my dog barking. I couldn’t believe how great I had been feeling when I woke up on the RP diet and how shitty I felt this morning when I woke up. I’ve always been a good sleeper–head hits pillow I’m out.  I’m blessed in this respect I realize.

I’m wondering if anyone else out there has had this experience when they strictly cleaned up their diet that sugar made them feel like shit?  I’ve heard people talk about it and how when they then have sugar their body is basically rejecting it.  I’ve honestly always kind of thought “yea ok whatever”.  But now I’m wondering if there is something to it?

 

Exercise Hating

While I was on vacation, one morning I woke up and I was scrolling through Facebook (as many of us do). I saw that some girl I went to high school with was mentioned in the comment of an article about how CrossFit is basically the devil and worst thing ever created.  As someone who has been crossfitting since before the reebok endorsement I’ve listened to my fair share of “Crossfit Hate”.

Don’t be fooled, this is not an article in defense of Crossfit; (I refuse to go there) however, a statement in support of health, wellness and fitness.  Everyone is entitled to their opinion and to choose whatever fitness regimen/program that works for them.  Before I was a PA, I was a personal trainer and I’ve always supported the idea that you cannot force someone into fitness if it is something they despise.  Everyone needs to find something that is enjoyable for them. If you don’t enjoy it, you won’t sustain it.  By nature we are not creatures who do things that we outright hate and make us miserable.  (I’m not talking about subliminal crap like abuse and why we pick our spouses–talk for another day and website).   Fitness, health and wellness is absolutely no different.

Instead of absolutely bashing each other for what we choose to do for exercise, here is a crazy idea: why don’t we support each other?  I know, its novel–but perhaps more of us might think about giving it a try.  There are a lot of fitness regimens and types of exercise out there I despise.  I’m no yogi (although I go once in a while to get my flex and Namaste on) and if I tried to golf I’m certain I would wrap a club around a tree with frustration–I’m clearly meant to lift heavy weight for time with that mentality.  I used to run–a lot and hate it now.  But I love CrossFit and swimming (ok and the occasional run). I know a lot of people who have discovered healthy lifestyles through Pure Barre, Yoga, running, biking, triathlon’s, etc. Who am I to tell them what they do is stupid?  Um, no one.  In fact, it makes me ecstatic that more people are finding methodologies that lead them to a healthier lifestyle.  I recently read Amy Poehler’s “Yes Please” and she said something amazing.  We all spend a lot of time critiquing others and she decided that her motto would be “Good for her, not for me”.  Rock on girlfriend, I couldn’t agree more.  Just because it isn’t for you doesn’t mean it doesn’t influence a ton of people in a positive manner.

Yes, Crossfit can be dangerous.  So can every other sportAlso, 712 people died from accidents with hammers last year, so apparently hammers are dangerous as well. There are bad apples in every bag and not everyone who coaches or participates in Crossfit is safe.  My point is this to the girl who wrote that article and anyone else who hates on whatever form of fitness others choose to engage in: Support others and whatever makes them happy and healthier.

Remember: “Good for her, not for me”.  (this saying can also apply to men by changing the gender 🙂 )

“Being Healthy is Expensive”

This is a statement I hear ALL of the time.  It is also one of the things that frustrates me to no end.  As someone that does CrossFit, I’m faced with people continually saying “Yea, but its just SO expensive”.  We hear it all of the time “Eating healthy costs more”. Then you have gym memberships, Yoga, Barre, Running, CrossFit, Orange Theory, etc, etc.

My open argument to people who support the overarching theme of “It’s too expensive to be healthy” gather around the following questions:

  1. How much is the handbag you are currently carrying and how many of them do you own? How many pairs of designer boots or jeans do you have in your closet?
  2. How many times have you stopped at Starbucks or “refilled” your Starbucks app this month (by the way I have a Starbucks app and the minimal refill is $25 dolla dolla bills)
  3. How much money have you spent on booze this month? Its expensive to drink alcohol.  If you went out for two drinks 4 times this month you would have approximately spent 58$ (this is assuming 6$ drinks with tip and that you didn’t eat anything)
  4. How much do you spend weekly on dining out?
  5. So, eating healthy and exercising has potential increasing costs.  I hear you.  But, please tell me how much a year your diabetes or heart disease is costing you–please. Doctors appointments, medications, meeting your full deductible, etc.
  6. What about indirect costs.  For example, basically if you are on one chronic medication it raises your premium for life insurance.  Or the complications from diabetes or heart disease including expensive surgeries, chronic wounds and hospitalizations.

I hear the fundamental principal that eating healthy does truly cost more–up front.  The costs in the end I truly think are more astronomical.  Also, I’m not saying you have to go out and get a personal trainer or a CrossFit membership for $150/month.  Last time I checked the road is available and free to walk on. Globo gyms as I call them offer memberships as low at $19 dollars a month.  Thats like 4 Starbucks drinks.

My point is this: Yes, upfront costs can be obnoxious and you would rather buy another pair of boots.  I get it, I like boots too.  However, it’s planning for retirement.  The  more you work ahead the better your life and health with be in the long run!

 

 

 

 

False Sense of Health?

I haven’t talked much about my personal life or what I do in my spare time. I like to lift heavy shit for time. AKA CrossFit.  I’m really into being healthy and personal betterment, whether it is intellectual, physical or whatever.  I was a personal trainer for a while before PA school, I’ve ran 10+ half marathons, I did one triathlon and played sports virtually all of my life.  You get it–it’s important to me.
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Being a health care provider can be somewhat frustrating at times for anyone who is health conscious.  Most of the people I see and treat are super sick.  They take 10-20 medications daily, have no idea what medications they are taking or purpose they serve. Most of you have probably experienced it on some level. I remember being super impressed with a 93 year old patient I had who could tell me when his last echocardiogram was and his ejection fraction.  I may have high fived him, he pretty much rocked.
I think the overall state of our health is rapidly declining. I also think patients do not have a clear understanding of what is occurring with their health. Seriously though–as a Nation we are in bad health. Why is this happening? I believe there are innumerable reasons and road blocks.  Some of which I am going to venture to explore today.  All of the reasons are too complex to mention in one post-I’m sure I will touch on a lot of them as time goes on, as for now, I’ll leave it to what I believe are the massive red flags.
I can’t help but wonder if a false sense health and wellness is being created.  What are the forces behind this potential false sense of health and wellness? Driving forces include health care providers, sensitivity and political correctness, the new average/normal health state of society, as well as screening tests and advanced technology inadvertently reassuring bad habits.
A substantial number of patients with chronic conditions that we know and treat are not improving.  In fact from my experience it can be the opposite.  Their diseases are getting more concerning, hemoglobin A1c’s are rising, ejection fractions are dropping and the number on the scale is going up.  Consistently on my rotations I watched providers ignore the BMI, edit out “obesity” on patients discharge summary or simply just add medications or increase insulin regimen without talking to the patient about what was going on or why it was happening. Patients begin seeing medication as getting rid of their illness as opposed to masking it.
imagePeople no longer think they are diabetic because they take insulin, or that they don’t have high blood pressure because they take metoprolol.  Instead of having important, difficult conversations with patients about their weight and other various aspects of declining health We slap medicine on it to fix the numbers. But, is the quality of life of our patients improving?
Now, let’s be clear I’m not shaming medical providers.  However, suggesting that we do have a small part in perpetuating the epidemic of illness. That small part entails not succumbing to a ridiculous level of political correctness that we neglect to broach difficult conversations with our patients.  We need to talk to our them about difficult topics and make sure explain that just because they are taking a medication doesn’t mean they don’t have a disease.  I know we are all short on time it’s hard to cram all this stuff into a 15 minute appointment.  What I do ask and suggest is that we don’t see it and brush it to the side because it’s “taboo” to help your patients hold themselves accountable.  Talk to that patient who has put on 15 pounds since their last appointment.  Tell the new patient who has a BMI > 40 that their weight is adversely effecting them, and if it hasn’t yet it will–warn them of the adverse effects. Heart disease, diabetes, stroke, joint ailments/chronic pain–all of which can lead to more damaging and expensive side effects.
Sick is the new standard.  Yea, kind of like orange is the new black.  Whether or not any of us want to admit it we are a culture that for most of us–we follow a general range of societal norms.  What is average is normal, and the more people who are a certain way the more normal it is therefore the more accepted.  When things are “acceptable” there is no sense of urgency to do anything to change.  Meaning that because having multiple chronic diseases have become the norm, it is becoming very acceptable to simply just life with these diseases.
Diabetes. According to the CDC in 2002 5.5 million people had diabetes.  In 2014 22 million people were estimated to be afflicted with the disease. The cost for diabetes direct and indirectly in 2012 was 245 BILLION dollars.  That absolutely blew my mind.  I asked my colleagues this same question and their responses were not even close.  Their guesses included 2 and 3 MILLION dollars.
Obesity. An estimated 34.9% aka 78.6 million adults are reported to be obese.  Ready for the cost annually?  147 BILLION in 2008.  Again yes, BILLION. We wonder why our country is in a ridiculous amount of debt—–a post for a whole other day.  The CDC reports that the medical costs for obese individuals are 1,429 higher per year than a person with a BMI WNL.  Anyways, this is not supposed to be about cost.
Heart disease. Kills 610,000 individuals annually.  Coronary Artery Disease (CAD)–which I swear every patient I admit has–kills 370,00 0 each year (for the love of god people take your Lipitor I don’t care if your muscles hurt–kidding kidding). Again, the modifiable risk factors that have the possibility of having a positive impact on patient morbidity and mortality if addressed are numerous.
Stroke.  800,000 hospitalizations in 1989 and that number is now up over a million.  Cost per year in 2008: 18.8 billion.
I have simply highlighted several diseases that were easy access on CDC and that I know from clinical practice are incredibly common.  The sad part about these diseases is that there are more modifiable risk factors as opposed to non-modifiable.  Physical inactivity, obesity, smoking, medication compliance (one could argue if this is truly “modifiable” or not).
My point is that the numbers of chronic diseases are rising at a ridiculous rate.  I would venture to guess that if you combined the category of overweight and obese individuals together they would comprise >50% of the population. I’m also willing to bet that >80% of hospitalized patients are either overweight or obese.  I can’t remember the last time I palpated an abdomen of normal size.  The madness needs to stop.  People need to get off the merry-go-round.  Providers need to start having difficult conversations.  Patients need to start having accountability and the iron armor of political correctness needs to be sloughed off.  I’m not saying bully people with chronic diseases.  I’m simply suggesting we attempt to become catalysts for change instead of simply allowing our patients to accept poor health standards.
So, we are now led to the point where we have all of these chronic diseases that have quite the laundry list of potential negative effects.  What do we do? Create a screening tool, which has positives and negatives.
Smoking for example. Smoking kills.  We all know this, there’s this thing called the surgeon general warning.  Because of this, in the health care field we have (and by we I mean the powers that be—The USPTF) decided that we should “preventatively screen” individuals 55-80 who have a minimum of a 30 pack year smoking history or have quit within the past 15 years. What we are doing for them is giving them a one time dose of low radiation CT scan to screen for lung cancer.  There are results that can be found on the USPTF website if you want more information on the study USPTF LDCT Lung CA Screening.  There are various additional  links on this page you can click to read more about the screening and evidence to support  this standard of care.
imageNow, my initial response was–what a great idea we can catch cancer early, less money spent on chemo, radiation and maybe show patients that yes–smoking does kill.  However, there was an article published in a recent article of JAAPA suggesting that perhaps we are giving smokers a false sense of “it is ok to smoke” because so few of these tests are turning out to be positive.  Meaning patients with a significant smoking history has the test completed and it comes back negative–what this translates to for a patient is this: ” Oh, well I smoke but I had my screening done and everything is ok so I guess I can continue to smoke”.  There is question being raised if we are have created a phenomenon of false security. FYI the USPTF is reporting that there is clinical significance to benefit patients from performing he LDCT.
On a related note, we have a lot of different sophisticated measuresimage these days that can track out calories, what we eat, how much energy we exert, etc.  I’ve developed this notion in my head and I’m not sure who else shares this proposition with me, that devices such as fit bits also contribute to a false sense of health.
DISCLAIMER: I know very little to nothing about these devices.  My extent of knowledge on them is that they electronically can track your steps, you can set up step goals, face off against your friends to see who does the most steps and that some of them claim to be a let o track sleep activity.  Here is my beef.  Say your step goal is 5,000 for the day and your work in a hospital. It’s very likely that you are able to get those 5,000 or more steps in your 8, 10 or 12 hour day.  However, taking this many steps throughout the duration of time previously mentioned is not the same as someone who goes out and continually moves/exercises for 30-45 minutes.  The person who gets their steps or activity in through 8-12 hours does not sustain an elevated heart rate to produce the same cardiovascular and metabolic benefits as someone who continually goes for runs, swims or does Crossfit, etc.
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I’m not suggesting take the elevator everywhere and that walking wherever and whenever you can to keep moving is a bad thing.  My point is that I don’t think it suffices to count for working out and I think a lot of people who use these devices can tend to be of the mindset that “oh I don’t need to go to th. gym/run/swim/Zumba or whatever it is you do because I walked 5,000 steps today”. I just cannot buy into this mindset and I think a lot of people do.
Why is this important? Less activity leads to more people being over weight and obese.  Obesity puts more people at risk for multiple chronic diseases, diseases which are leading to the acceptance of our current state of health as a nation.  We need to start with ourselves as providers by doing our best to institute change and provide support to our patients. In return hope that our patients are able to accept some sense of self responsibility, realize a change needs to be made and begin to take steps toward better health outcomes one person at a time.
I would love to hear what others think, drop a comment and let me know what you think!!