Thursday, March 24, 2016

Change

I'm absolutely fascinated with how people change, how they make lifestyle changes that they can stick with.

In what I do as a cardiologist, motivating people to change is absolutely key.  My goal is to help everyone reduce their risk of cardiovascular disease, whether they've never had a heart problem or they've had bypasses, stents, and heart attacks.

One thing I know, from my own personal life experiences, and from observing my patients -- complete change doesn't happen overnight.  A patient isn't going to leave my office and quit smoking, eat fruits and vegetables, quit eating meat, dairy, and eggs, AND walk an hour a day when these were not prior habits.

My strategy -- I try to focus on the one or two changes that I think will make the most impact on my patient's life.  Some examples, maintaining anonymity of these patients:

--An obese woman in her 50's with diabetes, high blood pressure, heart attack 10 years ago, and a bypass surgery two years ago.  She doesn't exercise, eats a lot of fried meats and white rice, and refuses to eat vegetables because she does not like the taste.  While she clearly has many habits that could improve, I've started by asking her to try new vegetables and incorporate them into her meals, and to walk more.

--A man with atrial fibrillation, sleep apnea, and obesity, who at 6'3" and 270 lbs feels frustrated that he cannot lose weight even though he walks for exercise and tries to make healthy choices at meals.  As it turns out, his meals are mostly at restaurants because his wife is disabled and no longer cooks for them.  We discuss the perils of relying on restaurant food, and he decides he's willing to start cooking for him and his wife, which will hopefully help him burst through his weight loss plateau.

--A man with atrial fibrillation and diabetes, who has successfully lost seven pounds in two months since his initial consultation with me, after eating smaller portions and more fruits and vegetables.  However, he is not exercising because he is afraid to make his heart beat too fast.  After reassuring him that walking for exercise will not be too taxing on his heart, he agrees to start a walking program.

--An obese woman in her 30's sees me because of chest pain that is likely due to reflux.  She has hypertension, is pre-diabetic, and abnormal cholesterol levels.  She exercises by walking on a treadmill or uses an elliptical for 30 minutes a couple of times a week.  She eats a lot of sugary snacks, so we talk about replacing those snacks with fruit, portioned trail mix bags, and Larabars (which are packaged bars made with fruit and nuts and no added sugars or processed ingredients) and eating more meals at home.  The next change for her might be to change the intensity of her workouts to challenge herself more, or to add weights.

We start with making one change successfully, and then move on to the next, with the plan of making these positive changes permanent.

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