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Tuesday, May 14, 2013
Doctors often admonish their patients to make lifestyle changes that will help their health: stop smoking, eat better, exercise more and lose weight.
If patients don’t make progress on these challenging goals, doctors may get frustrated and scold patients. Then they prescribe pills to lower cholesterol, control blood sugar or reduce blood pressure.
Patients also feel frustrated. Making big changes can be extremely difficult. People get defensive when they are scolded and may give up.
Albert Einstein supposedly said, “Insanity is doing the same thing over and over again, but expecting different results.” We know doctors are not crazy, but the pattern of reprimanding and prescribing is repeated over and over.
As any parent who has ever tried to nag a child into keeping his room neat knows, scolding doesn’t work very well. A new approach, known as motivational interviewing, is gathering momentum in medicine.
Those who have been trained in its use learn to collaborate with patients. They find out what goals the patient is setting or is willing to set, and then help the patient figure out how to reach them. This may mean tackling baby steps or finding rewards that are meaningful to the patient.
Behavioral economist Dan Ariely, Ph.D., tells in his book “Predictably Irrational” of being prescribed a medication that had horrible side effects. It was essential for treating a very serious viral infection.
He was supposed to take it three times a week. Because he loves movies, on treatment days he would rent a movie, set up everything for comfortable watching and then take the medicine. By the time he began to experience the fever, headaches, nausea and vomiting, he had already enjoyed much of the movie and was able to look forward to the next movie hit. He was the only patient in the study who managed to take every dose as the physicians recommended.
Ariely explains his strategy, “Planning my evening in this way helped my brain associate the injection more closely with the movie than with the fever, chills and vomiting, and thus, I was able to continue the treatment.”
As you might guess, rewards need to be individually tailored. Goals also need to be personalized. Rather than being told “You must lose 50 pounds,” the person decides what goal has meaning for her. She and the doctor, nurse or health coach figure out together what steps she needs to take to reach it. Then the coach uses nonjudgmental encouragement to follow up at each step. This adds the dimension of accountability, critical in maintaining progress.
Physicians often complain that patients stop taking their medicine. Sometimes they don’t even fill the initial prescription, suggesting that patient and physician were not on the same page about the benefits and risks of the drug. Doctor visits may be too short for the doctor to ask the patient what he thinks about the medicine.
In a different approach, the patient’s concerns about drug side effects could provide an incentive for him to change his diet and exercise patterns. The goal would be to reach an acceptable blood pressure, for example, without medication.
Being congratulated instead of scolded would be a welcome change for many patients.
Q: I happened across a study showing that low-sodium diets don’t offer benefits to people who aren’t otherwise at risk for heart disease.
I realized that I’ve been religiously following a low-sodium diet for years, since it was advised for the general population. I’ve completely lost my taste for salt and avoid it whenever possible, but I am not at risk for heart disease.
I wondered what would happen if I changed. So just for the heck of it, I began adding some sea salt to my food. (Sea salt tastes really good.) After a while, I noticed something odd. Whereas I had suffered screamingly painful leg cramps at night for years (as long as I had been avoiding salt), they disappeared. Coincidence? I think not.
A: Sodium has long been vilified by public health officials. An eight-year study in the Journal of the American Medical Association (May 4, 2011) showed, however, that people consuming the least sodium in their diets had the highest mortality.
Another study found that low intake of sodium was linked to an increase in stress hormones (adrenaline, renin and aldosterone), which might have a negative impact on cardiovascular health (American Journal of Hypertension, January 2012).
Those who are salt-sensitive or have heart disease may indeed benefit from a low-salt diet. Someone like you, though, may discover that too little sodium can sometimes have negative consequences.
Many readers report that pickle juice or yellow mustard, both high in sodium, can help relieve muscle cramps.
Q: I was misdiagnosed for five years, and it nearly cost me my life. I was eventually told I had Parkinson’s disease and was referred to a neurologist.
During the neurological exam, I was asked if I had ever had a thyroid test. A simple blood test that I had never been given would have shown that I suffered with a hyperactive thyroid. It was out of control, and all my internal organs were seriously affected.
The endocrinologist called in consultants, and all agreed it was a miracle I was still alive. They had never seen a case as severe as mine. My heart was racing at 180 beats a minute, and no one had detected it.
My all-over shaking was visible. I could not sign my name, and they had a hard time doing scans because I had difficulty keeping still. I was terrified at the diagnosis, but I learned to take control of my health by asking lots of questions and looking things up.
A: An overactive thyroid gland is a serious health threat. It is shocking that it took five years to diagnose your condition, which responds to medication, radioactive iodine or surgery.
We are sending you our Guide to Thyroid Hormones with detailed information about symptoms, testing and treatment.
Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. T-4, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Untreated hyperthyroidism can lead to weakened bones and heart disease.
Q: What food do I need to eat for deficiency of potassium?
A: Here is a list of potassium-rich foods: artichokes, apricots, asparagus, avocado, bananas, beets, bell peppers, blackberries, broccoli, Brussels sprouts, cabbage, cantaloupe, carrots, cauliflower, chard, mushrooms, nectarines, oranges, potatoes, squash, sweet potatoes and tomatoes.
“The People’s Pharmacy with Joe and Terry Graedon” airs Saturday at 7 a.m. on WVTF (89.1 FM) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7 FM). Joe and Teresa Graedon’s column runs in Tuesday’s Extra.
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