Stages of Change: Pre-contemplation

We're going to begin a 5 week series on change. Each week we will look at a different stage of change, examples, ways to initiate change, what each stage looks like, and what progress you can expect.

This first week is: Pre-contemplation.

Oftentimes you feel hopeless and helpless. You resist change. Smart Recovery in New England describes pre-contemplation as, "It isn't that we can't see the solution. It's that we can't see the problem".

Think of a drug addict or alcoholic. Often they are playing the blame game, deny responsibility, avoid, and create distance. They blame anyone and everything; traffic, their boss, family problems, genetics, lack of income, lack of time, lack of access, etc.

The bottom line is that EVERYONE can have an excuse. Most people can use their childhood, their family, job, spouse, genetics as an excuse. How long will you play the victim? Doesn't it sap your energy? Buck up, buttercup, and take the reins!

The people who are successful are those who accept their lot in life and persevere. They make lemonade out of lemons.

If you feel like you're fat because your mom was fat and your dad was fat, then you will continue in your cycle. Instead, take responsibility. Change YOUR diet. Change YOUR lifestyle. Focus on YOU.

Take some time to do an inventory of your current situation and ask the why questions.

Two examples could be:

I don't have enough money to make my bills. Why? Because I have too much credit card debt. Why? Because I charged too much when I was in college. Why? Because I never learned how to manage my money. BOOM! Ok, so you need to learn how to manage money.

I weight 100lbs more than I should. Why? Because I eat too much. Why? Because I eat all the time. Why? Because I eat when I feel stressed. Why? Because I learned to cope with my feelings by eating. Why? Because somewhere along the way, I was traumatized and never dealt with it. Why? I didn't feel safe. Why? I felt ignored and abandoned. Boom! We can deal with this!

If we can find the cause, we can find a solution.

This is pre-contemplation. Being mindful and aware enough to identify an issue. Acknowledging the issue is next week: contemplation!

 

 

 

 

Body, mind, spirit, soul

The totality of a human.

There's a scene in Breaking Bad where Walt (Bryan Cranston) is breaking down the chemicals in the human body. As the scene progress we find out that hydrogen, oxygen, carbon, nitrogen, calcium, iron, sodium, and phosphorus account for 99.888042% of body composition. Gretchen surmises that that must be everything. Walt isn't so convinced. There must be something more!

"There's got to be more to a human being than that", he states.
"What about the soul?", Gretchen questions. What about the soul?

If, indeed, the soul comprises 0.111958% of our make up, we rely upon it much more than 0.111968% of the time!

How do we maintain the balance? How do we keep the soul in sync with the body and mind and spirit?

My friend Kevin at Rebooted Body has a great saying: Do What You Love Today. His application is more towards movement, but lets apply it to everything!

If you enjoy running, this achieves nourishing the body through exercise. It probably gives you a chance to think and relieve stress which feeds the mind, spirit, and soul!

For some people, it can be a long walk, a chat with a friend, a nap, swimming, yoga, pilates, painting, getting a manicure, cycling, hiking, reading, driving, cleaning.

In my experience, if you're doing something active, this feeds your body and enables negative energy to be removed and replaced with peace, calmness, tranquility. I suggest my patients to walk 20 minutes a day, 3 days a week. Totally doable. The effects of this are grand. In a study by a professor at Cal State Long Beach, his participants rated better health, energy, overall mood, happiness, and self esteem. Simply by walking. An easy fix to many troubles. In a not-so-eloquent way, the energy you are using to be mad or annoyed or worrying about something is released physically during the activity. Not all of it and not every time, but it will be significantly improved.

“Above all, do not lose your desire to walk. Everyday, I walk myself into a state of well-being & walk away from every illness. I have walked myself into my best thoughts, and I know of no thought so burdensome that one cannot walk away from it. But by sitting still, & the more one sits still, the closer one comes to feeling ill. Thus if one just keeps on walking, everything will be all right.”
― Søren Kierkegaard

Visit Prep 2.0

I remembered something very important after I wrote last weeks article. A reason why limiting the visit to 2-3 issues is so important and why some patients may struggle with this concept.

When I see a patient who has multiple problems; pain, unresolved issues, incomplete referrals, medication requests, it very often is a sign of depression.

Please hear what I'm saying without becoming defensive. Patients who have multiple concerns, keep me in the room longer than normal, cannot complete one sentence about one topic without moving onto another issue, are often crying or near tears, connect all of their problems that often include other people, and who request multiple medications (to address all their concerns), are usually depressed. Not always and not everyone, but often and usually.

As a provider, I listen to the patient, try to help them diagnose these concerns and when the concerns keep coming and multiplying, it finally hits me. I ask them if they think they could be depressed and they usually say yes.

Depression exacerbates symptoms. It makes pain feel more intense, it creates anxiety which can mimic a heart attack (chest pain, shortness of breath, palpitations), feels overwhelming, creates anger within a normal medical visit.

Fortunately at my clinic, my office is right next door to Behavioral Health. I am able to ask for a consult and right then and there the patient can be assessed for suicidal ideation or intent and scheduled for a counseling session or group therapy. I offer medication and supportive services.

Aside from the obvious medical issues most patients I encounter have (DM, HTN, obesity), depression and its friend, anxiety, are the next most common health issues.

If you think you are struggling with depression, please come talk to your provider. Please find a counselor. The work is hard, but the rewards are beautiful.

Below is a copy of a depression questionnaire we use to screen for depression. In our office, if you score 10 or more, we offer Behavioral Health services.

Visit prep

Last week I mentioned being prepared for your visit and what that entails. I also mentioned writing down your top 2-3 concerns. Today, I will explain why is this important.

If you are young and mostly healthy, you shouldn't have too many health concerns. It's still important to connect with your PCP annually; think PAP, mammo, colorectal screenings, HTN monitoring, etc. Because you're "healthy" (meaning you do not take medication regularly or have any chronic diseases; HTN, DM), seeing your PCP annually is usually fine. This allows the relationship to stay open and connected, it updates your medical history (Did you have a baby? Mother with new HTN diagnosis?), gives us a chance to update your labs and notice any trends, and allows us to offer routine screenings. If you have a cough/cold/stomach bug, it's always a good idea to check-in. We can keep the relationship current make sure it isn't developing into something more serious.

The reason why I recommend 2-3 issues/visit is this: You get 20 minutes with me, lets spend that time focused deeply on a few issues rather than skim across 5-6 things. Here's an example: a patient comes in and wants to discuss globus (feeling of something stuck in the throat), acid reflux, and decreased hearing in the right ear. Issue 1 and 2 are possibly connected and are possible easy fixes. Issue 3 is possibly due to impacted ear wax and is a quick ear lavage away from perfect hearing! If a patient comes in and says they have nausea and vomiting for 1 week, bloody stool x2 weeks, chest pain, shortness of breath, leg pain, and allergies, I am not going to address all of these issues. 1) this patient has too many issues to be safely addressed at one visit. 2) the chest pain and SOB are more concerning and need to be evaluated. 3) this patient possibly has chronic diseases they are unaware of and need more time and attention.

Patient number 2 will be evaluated and then scheduled for a follow up. There are simply too many issues and not enough time to address them adequately. It's ok to have several problems! When it rains, it pours! Healthcare is no different! Give us a chance to help you and provide great care by giving us time to explore reasons for the problem.

Now is a good time for my disclaimer.

I am a Nurse Practitioner; licensed by the State of California. The content on this site is strictly for informational purposes only. There is no medical advice and nothing posted should be construed that way. The information posted does not imply consent between you and I as a patient-provider relationship. Please find a local, trained healthcare provider for their medical advice and treatment. If you have health issues, please make an appointment with a licensed healthcare provider in your area and consult them. Additionally, you agree that you shall not make any health or medically related decisions based on any information you obtain from this site. Please, do your due diligence and consult with a health care provider before engaging in diets, exercises, or other changes to your physical being that may have an impact on your health and medications. The opinions stated are mine, unless otherwise indicated, and should not be construed as direct medical advice for yourself, sister, brother, mother, aunt, cousin, BFF, sisters friends grandmas dog.

:)

How do I become The Total Patient?

You can do it! My BFF and I love Bitmoji. I'll see if I can add the 'Rosie the Riveter' bitmoji...

Taking control is the first step to being the best patient you can be!

 

 

5 Tips for being the best Total Patient
 

1. Be prepared- Be on time, write down your questions (2-3 max; we'll discuss this later), bring ALL current medications. When the medical assistant asks why you're here, tell them! I do a lot of preparation for the visit based on what you tell the MA, so be honest and thorough!

2. Be open to conversation- It is very difficult to converse with a patient who says, "IDK, YOU'RE the doctor, you tell me". We are discussing YOUR health!

3. Be involved- If we make a lab appointment, keep it! If we make a referral, go to that appointment! If you have a question, call us! If you are struggling with your blood pressure or glucose, come see us and bring a journal or log! Anything you can do to support your condition will make our jobs infinitely easier and this means more time with us!

4. Take responsibility for yourself- You know you should change your diet, you know you should walk more. DO IT! Make these small, manageable changes. We can encourage you, but you have to put some effort in, too!

5. Don't be a stranger- The best part is developing a relationship. If I see you every quarter (4x/year) I remember your face, I can pull up previous visits and see what we discussed, see where we're going, what we need to do. If I see you once a year, it's much more difficult. And, I will spend a lot of time catching up on preventative medicine.

You're well on your way to being the best Total Patient and the best You! I sound like Dr. Oz....yikes!