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Off-Topic Preventable chronic disease

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Ray_Levitt

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Certified Instructor
This is intended as a minor rant or exclamation of sorts. Just something I need to get off my chest.

I am an emergency nurse in a hospital in Queens, NY, which is part of NYC. For years now, I have been extremely passionate about primary prevention of chronic disease via healthy lifestyle. In my world, training is a major piece to that puzzle. That's one of the reasons why I decided to obtain my SFI. I recently did so at The Dome in Chicago. It was great to spend 3 days with lots of people who share similar concern for the the maintenance of their own health and that of their clients. It made me forget about my job temporarily. Then, on my first day back to work, the degree of sickness I see on a daily basis smacked me square in the face. It's something I've been aware of since I first started. But it didn't affect me until I spent some time with really healthy people at The Dome.

Of course, there will always be the need for acute care. But most of the patients I have are faced with sickness that could have absolutely been prevented in one way or another. It seems that almost everyone is diabetic, has hypertension, high cholesterol, multiple stents, is obese, smokes. The data show that even dementia is preventable. It's really remarkable how sick people let themselves get without taking even a second's responsibility for the situation. Just yesterday, I had a patient the same age as myself (43) who was morbidly obese. He already lost one leg below the knee to diabetes, and is on his way to losing his other foot, as well as his eyesight. In my head, I'm thinking "DUDE! WHERE IS YOUR OWNERSHIP OF THIS!?!?"

Anyway, I plan to go on to advance practice nursing in the area of primary care. My goal will be to keep people OUT of the emergency room for the same old preventable reasons.
 
Could be many reasons. Time, resources, knowledge, family situation, stress, work, habits, etc. I don't think it's fair to totally blame the patient here.

It's also not totally fair to compare to an SFG event. The amount of people who bay $1200 for a health event is 1/100,000 and likely greater. Many people do reasonable things - eat healthy more often than not, go for daily walks, strength train a bit, find social supports - yet still have high b/w numbers, and may develop a chronic condition.

I'm with you and take my health/fitness very seriously. Some people need a major life event, a proverbial tipping point to change. That tipping point is different for everyone. As with anything, "the teacher will appear when the student is ready".
 
I am an RN myself, I hear you about seeing chronic disease and the frustration it is to deal with people who do not seem to want to help themselves despite all we do to teach them how to. As @wespom9 says, you can only do so much, and you can lead a horse to water, but you can't make them drink as the saying goes.

A person needs to see the change as manageable, starting with just a few baby steps, and worth the effort they put into it, but so often there is not an immediate reward. Amputation or kidney failure seems a long way off to a diabetic with poorly controlled sugars. I am not sure how long ago you did your training, but I recall discussing Maslow's Heierchy of Needs in class and relating it to health and the entire patient/client experience...


Dig a little deeper with that diabetic, and his whole situation, and if he cannot afford adequate food, let alone diabetic supplies, insurance for regular visits to a care provider or able to afford an emergency room visit (I see you are in the USA, I am in a country with universal health care), or has no social circle for support (leading possibly to anxiety and all sorts of other things), therein your problem lies. You only are only seeing the tip of a very big iceberg in that encounter in an emergency room. Primary care needs to spread a wide net, and so much more, right down to the basics of adequate food, water, shelter. Which is a whole other can of worms touching on all sorts of other concepts like laws and government programs, the social safety net and how responsible we are for our fellow man and the concept of a healthy society (in all sorts of ways) leading to the conditions of making it easier to be a healthy individual.
I commend you for wanting to go into the field, it is an area neglected for far too long!
 
I have been extremely passionate about primary prevention of chronic disease via healthy lifestyle. ... most of the patients I have are faced with sickness that could have absolutely been prevented in one way or another.
I am with you 100%. I had a doctor visit today, and he expressed concern for me because I strength train, asking question like, "do you get out of breath or dizzy?" <sigh> I don't mean to sound self-aggrandizing, but if more people took care of themselves like I do, we'd have a lot less chronic disease out there.

-S-
 
There is a book name "Poor nation". I have only read one-fifth of it, but it already makes me think again about all the low-hanging fruit that could make people life better.
 
Could be many reasons. Time, resources, knowledge, family situation, stress, work, habits, etc. I don't think it's fair to totally blame the patient here.

It's also not totally fair to compare to an SFG event. The amount of people who bay $1200 for a health event is 1/100,000 and likely greater. Many people do reasonable things - eat healthy more often than not, go for daily walks, strength train a bit, find social supports - yet still have high b/w numbers, and may develop a chronic condition.

I'm with you and take my health/fitness very seriously. Some people need a major life event, a proverbial tipping point to change. That tipping point is different for everyone. As with anything, "the teacher will appear when the student is ready".
You are correct. There are LAYERS of reasons for the patterns I mentioned. But these do not absolve one of their responsibility for their health.
 
I am an RN myself, I hear you about seeing chronic disease and the frustration it is to deal with people who do not seem to want to help themselves despite all we do to teach them how to. As @wespom9 says, you can only do so much, and you can lead a horse to water, but you can't make them drink as the saying goes.

A person needs to see the change as manageable, starting with just a few baby steps, and worth the effort they put into it, but so often there is not an immediate reward. Amputation or kidney failure seems a long way off to a diabetic with poorly controlled sugars. I am not sure how long ago you did your training, but I recall discussing Maslow's Heierchy of Needs in class and relating it to health and the entire patient/client experience...


Dig a little deeper with that diabetic, and his whole situation, and if he cannot afford adequate food, let alone diabetic supplies, insurance for regular visits to a care provider or able to afford an emergency room visit (I see you are in the USA, I am in a country with universal health care), or has no social circle for support (leading possibly to anxiety and all sorts of other things), therein your problem lies. You only are only seeing the tip of a very big iceberg in that encounter in an emergency room. Primary care needs to spread a wide net, and so much more, right down to the basics of adequate food, water, shelter. Which is a whole other can of worms touching on all sorts of other concepts like laws and government programs, the social safety net and how responsible we are for our fellow man and the concept of a healthy society (in all sorts of ways) leading to the conditions of making it easier to be a healthy individual.
I commend you for wanting to go into the field, it is an area neglected for far too long!
Definitely familiar with Maslow. And your points are 100% valid with respect to it. But most of my patients are way up there on the hierarchy! They almost always have iPhones, etc! There are way too many related factors that contribute to the poor health we see. All we can do is pick a manageable goal and reach for it.
 
There is a book name "Poor nation". I have only read one-fifth of it, but it already makes me think again about all the low-hanging fruit that could make people life better.
When the RIGHT choice becomes the EASY choice, we all win. The problem is that currently, the WRONG choices are often the easiest choices.
 
Definitely familiar with Maslow. And your points are 100% valid with respect to it. But most of my patients are way up there on the hierarchy! They almost always have iPhones, etc! There are way too many related factors that contribute to the poor health we see. All we can do is pick a manageable goal and reach for it.

When the RIGHT choice becomes the EASY choice, we all win. The problem is that currently, the WRONG choices are often the easiest choices.
Wrong choices are often the easiest choices, that is true...we need to change the environment and circumstances. One only needs to read books like Atomic Habits by James Clear (setting oneself up for success) about making a successful environment for easier habits leading to better health.

Ultimately, people are entitled to autonomy in their health choices (provided they are in their full faculties and it is a fully informed choice regarding pros and cons of course).....that is where health care providers experience the proverbial beating one's head against the wall/only being able to inform and counsel so much :(
 
To be totally honest... I’m not surprised at all when I see people that have let themselves get so unhealthy. I think what surprises me is people like I see here who have actually taken responsibility and learned to discipline themselves. That’s the real anomaly. People willing to take ownership of their life and make changes.

My wife is a nurse and sees some real bummers. I have a lot of empathy for people which these problems though. A lot of them seem like decent people that just had a sh*t hand from the start.

I had a good job, great friends and was very strong, fit and active... I mean I was running a dept at Whole Foods and opening new stores, working on movies and tv... tons of well paying side gigs too... Couple wrong turns and a few years later I was a homeless heroin and crack addict. I get how this stuff happens to people. It creeps in and these lows you hit just become the new normal.

Some people just never got the right software uploaded to make good decisions. Some people have everything going perfectly and just due to life being life they get cut down and can’t seem to recover from it easily. Some people are just like hardwired to self sabotage and self destruct it seems like.

As far as the metabolic conditions... I mean after I got clean I ballooned up to around 220 at my heaviest and I felt like I could NEVER get back into shape. I can only imagine if I went to 250 or 300 or suffered some kind of real health issue. Or was on a terrible food budget. Or only had a dollar general nearby to buy groceries where the “healthy” options are like low-fat microwave burritos. I don’t know if I would have had any motivation after hitting a certain point. I feel for them. The info these people get from their doctors and tv shows is probably WACK too. But these are “trusted” sources.

My wife tells me some of the stuff these doctors tell people and it’s just... Wonky. Real “switch to whole wheat bread instead of white. Eat a variety of colored food” kind of advice. Cmon man. Who is that gonna help? I think at a certain point of metabolic derangement most people would almost need a mentor or real support group (or forum) to help you get to the other side. Not just advice. It’s hard to muster up the discipline to make long lasting changes. Even when they’re incremental. A lot of people my wife sees doing home health care don’t even have a computer or cell phone. Or a library in walking distance. Their info is limited.

I think ULTIMATELY, clearly YOU are responsible for yourself but at the same time it’s not like everything we’re exposed to (or not exposed to) doesn’t factor in to how our lives unfold. Especially when what most people get is probably bad intel. I mean I’d like to think I’m a fairly intelligent/rational/reasonable person but I STILL have to put post it notes on my mirror and meditate daily just to like remind myself to have compassion for other people, stick to my diet, get my training in and stuff that you wouldn’t think you’d need daily reminders of to live a not-so-self-destructive life.
 
Could be many reasons. Time, resources, knowledge, family situation, stress, work, habits, etc. I don't think it's fair to totally blame the patient here.
The amount of misinformation out there about weight loss and health is mind boggling. The amount of well intended, but misdirected information probably more so. I can't blame anyone that is trying but misinformed or misguided as it is incredibly easy to be in that state.
 
Not in the US but here in Scotland, the life expectancy of a bloke in an area of Glasgow is 54. The neighbouring area is the average, upper 70s/low 80s. Needless to say the former is socially deprived.

It's easy to pin chronic health problems to personal responsibility. Whilst there is an element of that to any and all behaviour, it is wealth and health inequalities that enable choice and opportunity.
The tipping point is here and now....pandemic.

The pandemic has fully exposed what has been known for a long time and largely ignored.....wealth and health inequalities. Poverty. Chronic stress. The impact on health is enormous.

Of course, not always. A comfortably affluent person is not immune from disease but having the resources to address their well being with opportunities we all take for granted sure helps.
 
We are 50+ years into knowing definitively that smoking kills yet many people continue to smoke. And socio-economic status figures prominently in rates of smoking yet many poor people never smoke and others give up in a timely fashion. To increase the complexity, in poor households, even amongst siblings, we find a spectrum of heavy smokers to never smokers. In the meantime, millionaires with PhDs die of lung cancer having smoked and not eaten their vegetables. As always, people's choices can confound any assumptions made about them
 
I think its important to note that if you are health care worker in a clinical setting you're gong to see people in bad shape all the time - just like LE will be dealing with a lot of criminals compared to the general population.

The people in my own life who are not in good shape tend to fall into two categories - those who neglect their health because they never had the tools or the education to do a proper job of it and don't think they are in bad enough shape to stress. This is most of them.

Some of them have a bad accident or other acute health issue that puts them on pain killers, steroids, anti-depressants or other medication that makes it (on top of what other clinical issues they might have) very difficult to stay motivated and have metabolism function normally.

Let's face it, without injecting too much doom and gloom into the conversation, the human race is not on a very optimistic trajectory - suicides are up, addictions are up, mental health crisis episodes are increasing from elementary school on up. What could have been a dress rehearsal for mankind cooperatively dealing with a true global crisis (of which there are plenty on the horizon) has degenerated into squabbling, hoarding, greed and indifference.

Advertising, social media, entertainment and in some cases our political leadership encourage us to behave almost infantile in our emotional state. If you find yourself in a place where taking care of yourself is instinctive you should be thankful, spread the message it is not all that difficult to attain and is worth the effort. Have compassion for those that have been wrecked on the rocks of this modern life - "there but for the grace of God..."
 
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To be totally honest... I’m not surprised at all when I see people that have let themselves get so unhealthy. I think what surprises me is people like I see here who have actually taken responsibility and learned to discipline themselves. That’s the real anomaly. People willing to take ownership of their life and make changes.

My wife is a nurse and sees some real bummers. I have a lot of empathy for people which these problems though. A lot of them seem like decent people that just had a sh*t hand from the start.

I had a good job, great friends and was very strong, fit and active... I mean I was running a dept at Whole Foods and opening new stores, working on movies and tv... tons of well paying side gigs too... Couple wrong turns and a few years later I was a homeless heroin and crack addict. I get how this stuff happens to people. It creeps in and these lows you hit just become the new normal.

Some people just never got the right software uploaded to make good decisions. Some people have everything going perfectly and just due to life being life they get cut down and can’t seem to recover from it easily. Some people are just like hardwired to self sabotage and self destruct it seems like.

As far as the metabolic conditions... I mean after I got clean I ballooned up to around 220 at my heaviest and I felt like I could NEVER get back into shape. I can only imagine if I went to 250 or 300 or suffered some kind of real health issue. Or was on a terrible food budget. Or only had a dollar general nearby to buy groceries where the “healthy” options are like low-fat microwave burritos. I don’t know if I would have had any motivation after hitting a certain point. I feel for them. The info these people get from their doctors and tv shows is probably WACK too. But these are “trusted” sources.

My wife tells me some of the stuff these doctors tell people and it’s just... Wonky. Real “switch to whole wheat bread instead of white. Eat a variety of colored food” kind of advice. Cmon man. Who is that gonna help? I think at a certain point of metabolic derangement most people would almost need a mentor or real support group (or forum) to help you get to the other side. Not just advice. It’s hard to muster up the discipline to make long lasting changes. Even when they’re incremental. A lot of people my wife sees doing home health care don’t even have a computer or cell phone. Or a library in walking distance. Their info is limited.

I think ULTIMATELY, clearly YOU are responsible for yourself but at the same time it’s not like everything we’re exposed to (or not exposed to) doesn’t factor in to how our lives unfold. Especially when what most people get is probably bad intel. I mean I’d like to think I’m a fairly intelligent/rational/reasonable person but I STILL have to put post it notes on my mirror and meditate daily just to like remind myself to have compassion for other people, stick to my diet, get my training in and stuff that you wouldn’t think you’d need daily reminders of to live a not-so-self-destructive life.
You make an excellent point when you referred to the poor advice given by doctors. Beyond a broad list of "dos and don'ts," preventable chronic diseases require constant effort in order to remain free of the complications of the disease. As such, the current model of care ("take 2 and call me in the morning.") doesn't fit. The patient needs continuous support and checking in. The model in which care is delivered needs to be disrupted.
 
I'd like to point out that my T1 Diabetes is not preventable, T2 is even though there's a lot of debate about this thing.

Sorry but I don't like to see the term "Diabetes" alone :)

Totally agree with the rest
Very fair point. Let me qualify my initial statements by saying that the complications from diabetes are preventable. And yes, that data do show that T2DM is preventable. In many cases, it can be reversed. In nursing school, we are told that DKA is most commonly seen in Type 1 diabetics. But in my experience, I see more type twos, whose diabetes is so uncontrolled that they go into DKA.
 
I think its important to note that if you are health care worker in a clinical setting you're gong to see people in bad shape all the time - just like LE will be dealing with a lot of criminals compared to the general population.

The people in my own life who are not in good shape tend to fall into two categories - those who neglect their health because they never had the tools or the education to do a proper job of it and don't think they are in bad enough shape to stress. This is most of them.

Some of them have a bad accident or other acute health issue that puts them on pain killers, steroids, anti-depressants or other medication that makes it (on top of what other clinical issues they might have) very difficult to stay motivated and have metabolism function normally.

Let's face it, without injecting too much doom and gloom into the conversation, the human race is not on a very optimistic trajectory - suicides are up, addictions are up, mental health crisis episodes are increasing from elementary school on up. What could have been a dress rehearsal for mankind cooperatively dealing with a true global crisis (of which there are plenty on the horizon) has degenerated into squabbling, hoarding, greed and indifference.

Advertising, social media, entertainment and in some cases our political leadership encourage us to behave almost infantile in our emotional state. If you find yourself in a place where taking care of yourself is instinctive you should be thankful, spread the message it is not all that difficult to attain and is worth the effort. Have compassion for those that have been wrecked on the rocks of this modern life - "there but for the grace of God..."
Very well put.
 
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