THE IMPORTANCE OF HAVING A FAMILY DOCTOR

You may remember the HealthNEXT team encouraging you to visit your family doctor after your health assessment each year. This is because we want you to have a medical home (a place where you and your family can receive care for health concerns) and to understand the importance of having a family doctor you know and trust.

A family doctor is a physician that treats the whole person, regardless of age and sex, and practices with a focus on preventive care. A family doctor, also known as a primary care physician (PCP), can care for you when you are sick and well. Not only do they want to help you recover from an illness and feel better, but they also want to keep you from getting sick. They play a key role in preventing disease and helping individuals and families maintain overall health.

Family doctors also assist in coordinating care. For example, if you, your children, or your parents need a preventive screening or need to see a specialist, they will direct and assist you to the appropriate doctor when needed.

A previous post highlighted the significance of having a well visit with your PCP and provided information about what to expect during the visit. Scheduling a well-visit with your PCP is a very important step in making your health a priority. In order to do this, you first need a family doctor! If you do not already have one, you may be asking yourself the following questions:

·         How do I go about finding one?

o   There are a couple approaches you can take. First, you can visit your health insurance provider’s website to search eligible doctors in your zip code. Once you have a list, call around to find out if any are accepting new patients. Second, ask a friend, neighbor, or coworker who their PCP is and find out if they like, trust, and have a good relationship with them. If you receive all positive answers, ask for their name and call! Third, you can ask your plant nurse for a recommendation.

·         What if I don’t like the one I have?

o   Contrary to what many people believe, the quality of care you receive is up to you. If you are not satisfied with your PCP, do not trust them, or do not feel cared for or listened to, do not hesitate to find a new doctor. When life presents a health scare, you need to know that your family doctor will do everything they can to care for you and help you receive the proper treatment.

·         How do I know if they are the right doctor for me?

o   If you are meeting a doctor for the first time, there are a few keys to look out for:

§  Do they take time to introduce themselves and find out who you are?

§  Do they come across kind, caring, and sensitive when asking about your health concerns?

§  Do they make you feel comfortable?

§  Do they make you feel that your health is also a priority to them?

§  In the midst of their busy schedule, do they take the time to answer your questions?

§  Do they review treatment options, alternatives, and potential side effects with you before prescribing medications?

§  Do they discuss wellness and prevention with you during your visit?

·         What should I expect from them?

o   Although most PCPs have a limited amount of time with each patient, you should expect to feel cared for when it is your turn. Your family doctor should discuss your complete family health history with you and provide recommendations on how to live a healthy life and prevent health issues that some of your family members before you may have experienced. They should recommend screenings for particular health problems when you reach the appropriate age. They should treat your acute illnesses and recommend seeing you on a regular basis (annually, biannually, etc.) in order to provide preventive care.

A PCP provides continuity of care. If you make the effort to find a doctor you know and trust, you will not have to start at square one each time you make a visit. Year after year you will have the opportunity to receive optimal care because you have chosen a doctor of good character. A family doctor is someone who knows your personal health history, as well as your family health history, and who follows your health over time to assist you in maintaining a healthy life. During your visits you should feel comfortable and confident in asking questions such as “what does that number mean,” “are there healthy behaviors I can work on in order to avoid blood pressure medication,” or “I’m experiencing certain side effects from my cholesterol medicine. Is there another medication I can try or what can we do differently to treat it?”

Why do I need to have a family doctor if I have a health assessment each year with the HealthNEXT team? SCA offers a unique opportunity to their employees every year in which they can participate in a blood draw and health assessment with a HealthNEXT physician and behaviorist. What the HealthNEXT team provides is different than what your family doctor can provide, making both opportunities great ways to take care of your health and learn about ways to live healthier.

Meeting with the HealthNEXT team allows you to:

·         Have general lab tests performed

·         Ask questions of the physician

·         Learn about screenings and health risks

·         Identify health concerns that need to be discussed and follow-up with by your PCP

·        Receive ongoing coaching from a behaviorist to help you work towards your health-related goals, if you choose

Meeting with your family doctor allows you to:

·         Discuss your family and personal health history in depth

·         Have individualized blood work and other tests based on personal diagnoses and risks

·         Receive medication and treatment for health problems. Your PCP is your prescriber.

·         Have visits on a regular basis in order to monitor or address specific health concerns, such as high blood pressure, diabetes, etc.

·        Obtain referrals/suggestions for screenings and specialists

Take advantage of both opportunities! After the heath assessment each year, share your lab results with your family doctor and discuss with him/her what you learned and perhaps what you are working on, individually or with your behaviorist/health coach. Ask for further recommendations and receive answers to your questions.

Keep an eye on the blog for an upcoming post on relevant questions to discuss with your PCP.

WHAT TO DRINK

When I talk with people at SCA health assessments about cutting back on soda (pop) and other sweetened beverages, I am often asked “What should I drink?”  My first answer, of course, is water.  As you are trying to cut back on other drinks, you may want to try alternating each drink of your current beverage with a bottle or glass of water.  For those who have difficulty drinking plain water, here are some other ideas of healthy beverages.

WATER

Try adding flavors to water or seltzer water that do not contain sugar or artificial sweeteners.  Most powdered products that add flavor to water contain sugar and/or artificial sweeteners.  Instead, add a squirt of lemon or lime juice.  You can even get fancy by putting some fresh fruit (orange, berries, melon, cucumber, or mint leaves in a pitcher of water.  The water will absorb the flavor.  For convenience, you can buy Hint Water, which is already infused with flavors. 

I also recommend “water essence” made by soda stream that has no sugar or artificial sweeteners.  It can be added to water or seltzer water. 

TEA OR COFFEE

If your blood pressure is high or if you have trouble sleeping, be careful about consuming too much caffeine.  If you drink coffee or tea (hot or iced), try to stick with decaffeinated or limit the amount.  Coffee has more caffeine than black tea.  Green tea has less than black tea.  Herbal tea (such as chamomile, mint, or fruit tea) has no caffeine.

Both coffee and tea are high in antioxidants and can be beneficial for health.  What usually makes them unhealthy is what people add to them.  Limit the sugar or artificial sweeteners in coffee or tea.  Powdered creamer is made with trans fats, so try adding skim milk, lowfat milk or milk alternatives (soy, almond, rice, etc).

If you buy bottled iced tea, try unsweetened or look for one with less sugar, such as some of the flavors made by Honest Tea.  

VEGETABLE JUICE

Fruit juices are high in sugar, but vegetable juices (such as V8) can be a good source of nutrients.  Choose low sodium varieties or try making your own with a juice machine.  If you do drink fruit juice, try to mix it with water to reduce the sugar and calorie content.  Citrus and dark berry juices (with no sugar added) are the highest in nutrients.

GREEN DRINK

If you think you might not be getting enough fruits and vegetables, you may want to supplement your diet with a “green drink.”  This could be a powder that you add to juice or milk.  You can also make a green smoothie in a blender with a combination of fruits and vegetables.  Here is an entertaining video with examples of nutrient-packed (and very tasty) green smoothie. (Note: some contain other colored vegetables and are not actually green!)

FRUIT SMOOTHIES

Be careful of store or restaurant smoothies, which can be high in added sugar, artificial sweeteners, and/or calories.  Try smoothies that are made from just fresh (or frozen) fruit, water or milk, and ice.  The fiber in the fresh fruit slows digestion and creates less of a spike in your blood sugar than fruit juice.  If you have diabetes, talk with your family doctor about how much fruit should be included in your diet.

MILK AND MILK ALTERNATIVES

Fat-free (skim) milk is a good source of protein.  The fat in other types of milk can raise your cholesterol and triglycerides.  If you don’t like milk or have lactose intolerance, try milk alternatives, such as soy or almond milk.  Soy and almond milk have the same nutrient found in soybeans and almonds.

Whatever you are drinking, it is important to stay hydrated.  Determine your unique hydration needs. Remember that many healthy beverages still have calories, which should be considered if you are trying to lose weight.  If you have suggestions or questions about healthy beverages, leave us a comment below!

COLORECTAL CANCER PREVENTION

March is the month to be aware of and to prevent colorectal cancer, also known as cancer of the colon or rectum. According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer-related deaths in the United States. Fortunately, early diagnosis can often lead to a complete cure.

Colorectal cancer affects men and women of all racial and ethnic groups, and is most often found in people aged 50 years or older. It is the 3^rd most common cancer for both men and women in the U.S.

There is no single cause of colorectal cancer. Most cases begin as benign (non-cancerous) polyps, which slowly develop into cancer over time.

Risk factors for colorectal cancer include:

·         Being age 50 or older

·         Having inflammatory bowel disease

·         Personal or family history of colorectal cancer or polyps

·         African American or of Eastern European descent

·         A diet high in red and/or processed meats

·         A sedentary lifestyle

·         A low-fruit and low-vegetable diet

·         A low-fiber and high-fat diet

·         Overweight or obesity

·         Drinking alcohol regularly

·         Tobacco use

·         A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome)

Symptoms of colorectal cancer include:

·         Blood in or on your stool (bowel movement)

·         Stomach pain, aches, or cramps that don’t go away

·         Losing weight without explanation

Colorectal polyps and cancer often don’t cause symptoms, especially early on. That is why regular screening is so important. Furthermore, these symptoms may be caused by other health issues and not colorectal polyps or cancer. If you are experiencing any of these symptoms or risk factors for colorectal cancer, talk to your doctor about your risk and need for screening, as well as a thorough exam.

If everyone aged 50 or older had regular screening tests, as many as 60% of deaths from colorectal cancer could be prevented. Screening is used to find pre-cancerous polyps (abnormal growths) in the colon so they can be removed before they turn into cancer. Screening also helps to find colorectal cancer at an early stage, when treatment is most effective and successful. Screening is recommended to all adults beginning at age 50. Men and women who are experiencing symptoms or who have a family history of colorectal cancer should talk to their doctors about being screened before age 50.

Screening options for colorectal cancer include:

·         Stool test – Upon obtaining a stool sample, tests are run to detect any blood (seen or unseen) that may be present in your stool. This option is recommended once a year unless otherwise specified by your doctor.

·         Flexible sigmoidoscopy* – During this exam, the doctor inserts a short, thin, flexible, lighted tube into the rectum to check for polyps or cancer inside the rectum and lower third of the colon. This option is recommended every 5 years unless otherwise specified by your doctor.

·         Colonoscopy* – This screening test is considered the gold standard of all screening tests for colorectal cancer. It is similar to the flexible sigmoidoscopy, except a longer tube is used to inspect the entire colon, which can be up to 5-6 feet long. During this exam the doctor can find and remove most polyps and some cancers. Colonoscopy is also used as a follow-up test if anything unusual is found during one of the other screening tests. This option is recommended every 10 years unless otherwise specified by your doctor. Reasons for more frequent colonoscopies could be the presence of polyps, family history, or related symptoms.

*Special preparation is required 24 hours prior to these screening tools to cleanse the colon in order for the doctor to accurately inspect the colon. Fortunately, the methods of preparation have evolved over the past several years and now come in many different flavors of liquid, and also include a pill form to ease the process.

Prevention is key!

Living a healthy lifestyle could help to prevent colorectal cancer, as well as many other cancers and health problems. This includes getting regular physical activity, eating a healthy diet rich in fruits, vegetables, and fiber and low in fat, limiting alcohol consumption, and avoiding tobacco. Furthermore, discuss your family history and personal health with your doctor at your regular well visit. And remember to be screened for colorectal cancer at age 50 or when recommended by your doctor to help prevent or detect early colorectal cancer. During the rest of the month of March, make it a point to put your health first by talking with your doctor. Also, share this information with friends and loved ones and join the fight again colorectal cancer.

DRINKING RESPONSIBLY

For many people, alcohol is part of how we mark special occasions, share good times with loved ones, celebrate holidays, and enjoy leisure time.  When enjoyed responsibly, drinking alcohol can carry some benefits for physical and mental health.  However, alcohol also carries some health risks.  If you drink alcohol, it is important to understand both the risks and benefits.

HEALTH BENEFITS ASSOCIATED WITH ALCOHOL CONSUMPTION

Light to moderate alcohol consumption carries some possibility of health benefits, especially for the heart.  This is defined as no more than one drink per day for women, two drinks per day for men.  The image below demonstrates what could be counted as one drink. 

While drinking alcohol is not necessary for health and may not benefit everyone, this amount of alcohol might:

·         Reduce your risk of developing heart disease

·         Reduce your risk of dying of a heart attack

·         Possibly reduce your risk of strokes

·         Lower your risk of gallstones

HEALTH RISKS ASSOCIATED WITH ALCOHOL CONSUMPTION

It is important to balance the possible benefits of light-moderate alcohol consumption with the health risks of too much alcohol.  For some individuals, even a light-moderate amount of alcohol could increase risk.  This image demonstrates a few of the health problems that may be associated with drinking alcohol:



Not mentioned above is the risk for those who are diabetic or at risk for diabetes.  Alcohol is immediately converted into sugar.  It will raise blood sugar levels, which can be dangerous for diabetics and can increase the chance of becoming diabetic.  Triglycerides are affected by many factors, but they are most sensitive to changes in alcohol consumption.  If you are trying to lower your triglycerides, consider cutting back on alcohol.  Heavy drinking by young adults has also been linked with osteoporosis and bone fractures later in life, because it pulls calcium away from the bones.

Anyone who is pregnant should discuss the risks of alcohol consumption with their prenatal care provider.  Alcohol use during pregnancy is associated with fetal alcohol syndrome, which can be fatal.  You can learn more at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001909/. 

Alcohol consumption by breastfeeding mothers should also be discussed with an OB/GYN or pediatrician. 

IMPAIRED JUDGEMENT

Alcohol should not be consumed in excess if you will be working, driving, operating machinery, engaging in risky sports (rock climbing, sky diving, etc.) or must be responsible for children.  Alcoholic beverages should not be combined with energy drinks including caffeine and other stimulants (taurine, ginseng, etc).  When combined, individuals cannot properly judge how impaired they are, and are more likely to drink excessively, drive while drunk, and make other dangerous choices.  Blood alcohol levels of those consuming such mixed beverages (ie. vodka and Red Bull) are generally more than twice as high as those drinking alcohol alone.



ALCOHOL DEPENDANCE

If you suspect that you might be drinking too much alcohol, or if you wonder whether your relationship with alcohol is unhealthy, there are two sets of questions you might want to consider.  These are known as the CAGE and the AUDIT.  They can be found on this website. http://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htm.  If you answer “yes” to two or more questions on the CAGE, move on to take the AUDIT.  If you would like assistance with quitting or reducing your alcohol use, contact your Employee Assistance Program (EAP).

ALCOHOL AND MOOD

Some people drink alcohol when they are feeling low, in order to “drown their sorrows.”  Others may drink alcohol to relax after a stressful day.  While alcohol can alter mood, it should not be seen as a long-term solution to stress, anxiety or depression.  Alcohol also does not assist with sleep problems.  It may help you to fall asleep, but results in poor quality (less restorative) sleep.  If you are struggling with any of these concerns, your EAP can help.

DRINK RESPONSIBLY

If alcohol will be a part of your leisure time or any special events this season, be sure to drink responsibly.  That means determining safe limits and sticking to them so that you can enjoy alcohol without letting it take control of you.



VITAMIN D!

Vitamin D is very important to our bodies and helps us to maintain normal blood levels of calcium and phosphorous.  It aids in calcium absorption, helping to form and maintain strong bones, which decreases risk for fractures and osteoporosis as we age.  Recent research also suggests that Vitamin D may provide protection from many other physical and mental health conditions.

HOW TO GET IT

Vitamin D is found in some dietary sources, such as fish, eggs, fortified milk, and cod liver oil, but the primary source of vitamin D is sunlight.  When exposed to ultraviolet B (UVB) rays, the D3 form of the vitamin is created in the skin.

SIGNS OF DEFICIENCY

Most people in the US do not meet the recommended levels of Vitamin D, which have been increasing every few years as more research develops.  Less extreme deficiency is often undetected because the symptoms can be confused with other conditions.  These symptoms may include fatigue, body aches and pains, unsteady balance, depressive symptoms or other changes in mood.  Less common is extreme Vitamin D deficiency, which can lead to severe muscle and bone weakness in adults and bone deformity in children.  Without enough Vitamin D, our bodies cannot absorb enough calcium needed to keep bones strong.

Aside from bone and muscle problems, Vitamin D deficiency has also been associated with brain function issues, kidney disease, respiratory concerns, diabetes, some cancers, gastrointestinal problems, autoimmune diseases, hypertension and heart disease.

SUN EXPOSURE

When thinking about sun exposure, it is important to balance Vitamin D concerns with the risks, including skin cancer, sunburn and skin poisoning.  Darker skin pigments offer more protection from skin damage, but are less efficient at synthesizing vitamin D.  Therefore, individuals with dark skin and people who use daily sunscreen are at greater risk for vitamin D deficiency. 

People who spend most of their time indoors or covered with clothing are also at higher risk for deficiency.  This may include infants, housebound elderly or disabled, anyone with a condition or using medication that requires limiting sun exposure, anyone who wears religious coverings, as well as those living north of the line from Baltimore to San Francisco.  Elderly persons, in addition to having less sun exposure, may be less efficient in making Vitamin D through their skin.  People with obesity and some digestive diseases may have trouble absorbing Vitamin D.

UV RAYS

The UV index is a system to tell people the strength of UV rays each day.  We make the most Vitamin D in our skin when the UV index is greater than 3.  During summer months and in warmer climates, enough Vitamin D can be created with 10-15 minutes of sun exposure, twice a week, on the face, hands and arms (without sunscreen).  You can check your local UV index daily at http://www.epa.gov/sunwise/uvindex.html.  BE CAREFUL to avoid exposure on days when the UV index is 6 or above.  Exposure to the sun for extended periods of time is dangerous, so use the UV index to help you avoid unsafe sun exposure.

If your body cannot produce enough vitamin D because of insufficient sunlight exposure, you will need to obtain it from foods and/or supplements.  Experts now suggest that people with risk of vitamin D deficiency should consume 1000 IU of vitamin D each day.  Those who are already deficient may need higher doses to achieve an increase in the bloodstream.  It’s very important to talk to your doctor about your risk for vitamin D deficiency before beginning any supplements. He /she will help you determine what your body requires.  If you have children, their pediatrician may have specific recommendations regarding Vitamin D. 

The threshold for safe vitamin D levels is very high, and the body will not create an unsafe amount from sun exposure.  However, it is important not to take in too much through food or supplements.  This can cause the intestines to absorb too much calcium, which may lead to calcium deposits in the heart and lungs, confusion and disorientation, kidney problems, nausea, vomiting, constipation, poor appetite and muscle weakness.

NUTRITION

In climates where Vitamin D cannot be sufficiently absorbed from sun exposure, the diet is often high in oily fish, which are also good for heart health.  Again, it is important to balance the benefits of vitamin D with the risk of too much mercury (especially pregnant women).  To learn more about which fish are low in mercury, go to: http://www.nrdc.org/health/effects/mercury/guide.asp.  Some foods are fortified with vitamin D, including breakfast cereals, oil spreads (ie. Smart Balance), dairy products*, milk alternatives (soy, almond, rice) and some orange juice.

SUMMARY

If you are concerned about your Vitamin D level, here are 3 ways to increase it:

- safe and adequate sun exposure

- a diet with vitamin D rich or fortified foods

- supplements

Be sure to speak with your doctor before taking steps to address your risk of deficiency.

*All forms of milk contain the same amount of Vitamin D supplementation.  Skim or fat-free milk is the best choice for heart health and contains as much Vitamin D as whole milk, which is sometimes confusingly called “Vitamin D Milk.”