Patients often report knowing exactly what lifestyle changes they need to make for improved health, but find their good intentions all too often give way to entrenched behaviours and lifelong habits. Physicians, meanwhile, struggle with the time intensity involved in lifestyle counselling, wondering what more they can do to bridge the gap between what’s agreed to in the clinical setting . . . and what actually transpires after the patient leaves the office.
For Steve Potter, bad news from his family physician landed him in the care of an in-clinic multidisciplinary team, all ready the moment Steve decided to take the plunge info lifestyle change. His results? A 50% drop in both triglycerides and LDL with just a 10% loss of body weight. Here is the story of a “remarkable” improvement for one Edmonton Southside PCN patient.
Steve Potter knew exactly what dietitian Loreen Wales would say about his lifestyle. He was so sure, in fact, that weeks before his first nutritional assessment, Steve did the unthinkable: he set his alarm for 5:30 a.m., climbed onto the dusty treadmill in his basement and exercised for 30 minutes. It was so out of character that to this day, Steve can’t believe he actually did it.
Or that he’d get up and do it again the next day.
That fateful morning was nearly 18 months ago – a time when Steve could not imagine adding one more minute to the daily treadmill agony. Today, Steve is running five days a week, lifting weights in the evening, and still marvelling at the inches he’s lost . . . and the life he got back.
“Yeah, it was really easy to ignore my diabetes back then,” admits Steve. “I could just take a couple of pills and everything would be okay – the pills would fix things.” Soon, though, he was on “all the meds my doctor was comfortable putting me on” and his triglyceride levels continued to rise. After three consecutive quarterly increases, Steve knew the party was over. “Once the pills were no longer doing what they were supposed to do, I realized I needed to take this seriously,” he recalls. “I really needed that triglyceride scare as the push to get me started.”
Steve’s family physician, Dr. Oliver Seifert, hears this story all the time, saying 90% of patients fall into the same trap. No matter how much time he spends counselling diabetic and hypercholesteremic patients about morbidity and risk factors, Seifert says few patients have the resolve to take action on their own. “All too often it seems easier to let the drugs do the work. In the worst case scenario, it’s a really good scare or a more serious event, like a stroke or a heart attack that brings home the message.”
Steve’s scary moment landed him an appointment with a registered dietitian – a health professional he admits he never would have seen on his own. But the free, no-obligation appointment with Loreen Wales was one of the many extra supports available to him as a patient of the Edmonton Southside Primary Care Network, thanks to a provincial funding initiative aimed at improving access to primary care services. A doctor’s referral was all Steve needed to meet with a dietitian for the first time in his life.
If first impressions count for anything, Steve was clearly not ready for much of Loreen’s advice. “Honestly, I thought she was crazy at first,” he laughs. “She told me to lose weight by eating more.” Steve soon learned Loreen meant eating more of the right foods, more often, and in smaller portions. Loreen suggested more fruits and vegetables, only to find Steve never liked vegetables as a kid and rarely ate them either in childhood or into his adult years. And fruit wasn’t on the menu much either.
Loreen’s veggie plan met with defiance. “I have never eaten a salad in my life and I’m not starting now.” But Steve did agree to one small concession: instead of the bag of potato chips he consumed daily as an accompaniment to his lunch sandwich, instead he would eat some carrots. Just a few.
“First carrots. Then red pepper.”
And now?
Pause.
“Yes, I will even eat a salad.”
Steve and Loreen, along with nurse educator Kate Miner, became a health partnership team, offering a degree of patient support and accessibility that Dr. Seifert could never achieve on his own with a practice of 1,500 – 1,600 patients. “It is a profound advantage to have professionals right in the clinic who can help patients stay on top of their diet and exercise, do regular blood glucose monitoring, and keep a close eye on these indicators,” he insists. “It means I can remain involved, yet focus on issues that are more urgent and complex. And I am just down the hall if the team needs to pop in with a question or a concern.”
Kate Miner says education, follow-up and monitoring are critical aspects of patient self-management, yet they are often neglected due to the time intensity of the work. “Unlike physicians, nurse educators have the time to be focused exclusively on teaching,” she explains. “As I get to know each person as an individual, and how the disease impacts their life, I can start bringing it all home for patients. That’s when we really start to accomplish things.”
Steve agrees, praising the health care team for helping him learn so much about his own eating and lifestyle habits. “Loreen had me do a food log for a month and I was surprised at how much I ate out (at restaurants),” he explains. While Steve thought a chicken focaccia sandwich was ‘eating well,’ Loreen pointed out that he was consuming half of his daily calories in just one meal. Within three months of initiating exercise and dietary changes, Steve’s triglyceride levels dropped to 1.72 from 3.62 mmol/L. The accompanying drop in LDL over 18 months, to 1.98 from 4.36 mmol/L, is nothing short of remarkable, says Dr. Seifert. Steve also reduced his waistline by 15 cm and gained overall strength and tone – all this with just nine kilograms in weight loss, or 10% of his body weight.
These days, Steve eats out just twice a week, down from the five or six meals he used to eat in restaurants and fast food outlets every week. He tries to eat at least two servings of vegetables and three servings of fruit a day – not a perfect diet, but “night and day” compared to the way he used to eat.
In retrospect, Steve says the lifestyle changes weren’t nearly as difficult as he was afraid they’d be. “The hardest thing was just making myself do it. Setting my alarm for 5 a.m. . . . digging up the motivation to actually get out of bed . . . eating a few carrots . . . a lot of it is mental. You have to keep pushing yourself.” Steve also credits the persistence of Loreen, whom he considers a personal trainer of sorts. “She kept wanting more from me. She was very tough, but fair. And she made me realize that you can’t eat at 40 the same way you did at 20.”
Dr. Seifert believes the PCN’s patient support programs – accessible, just-in-time and customized to individual needs – are a critical starting point. The rest, he says, is up to patients. “It boils down to this: we can offer all the programs patients need, and try to make the system more perfect and more comprehensive, but there is one factor we have little influence over, and that is whether patients are motivated to do what they need to do.”
For those who choose to participate, the results can be astonishing. “Patients who put in the kind of effort that Steve put in are doing exceptionally well,” says Seifert. “We have individuals participating to varying degrees of intensity and diligence and I would say 90% are seeing positive results.”
And to think it all started with a scare, a few carrots and a dusty old treadmill.