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 Choosing the right doctor is one of the most important decisions people can make for their health. If you are unsure who to turn to for your general care, experts point out that internal medicine specialists, or internists, specialize in the prevention, diagnosis and treatment of a broad spectrum of illnesses that affect adults through-out their lives, making them the right choice for many adults. Before selecting an internal medicine doctor, it’s helpful to learn a little bit more about their training and specialties. Trained to care for adults, many general internal medicine doctors, or general internists, practice in an office-based setting as primary care physicians for adults, following patients from their teens through their senior years for ongoing medical care. Other general internists spend the majority of their time caring for hospitalized patients in the role of a hospitalist. Due to the broad, intensive nature of core internal medicine training, which requires a three-year residency program after graduating from medical school, general internists aren’t limited to one type of medical problem or organ system, making them especially well-qualified to care for patients with complex conditions or multi-system diseases. “Comprehensive education and training make the internist particularly suited to care for the whole per-son,” says American College of Physicians (ACP) President Dr. Robert M. McLean. “Many patients appreciate the tailored prevention and treatment plans that internists can provide. From the internist’s perspective, we value long-term relationships with patients and working closely with them to pro- vide compassionate, quality care.” While training of general internists does not include pediatrics, obstetrics, or major surgery, patients requiring those services can turn to their general internist for recommendations and referrals. Internal medicine is a wide-ranging field, as many subspecialty areas of medicine require internal medicine training as a foundation, including allergists and immunologists, cardiologists, critical care doctors, endocrinologists, gastroenterologists, geriatricians, hematologists, hepatologists, infectious disease doctors, nephrologists, oncologists, pulmonologists, rheumatologists, and sleep medicine physicians. Training to become an internal medicine subspecialist is both broad and deep, and includes a three-year residency program plus one to three years of fellowship training, depending on the subspecialty. General internists even receive some training in each internal medicine subspecialty during their three-year residency program. To learn more about internal medicine, visit acponline.org, the website of ACP, a membership organization rep-resenting internal medicine doctors, and the largest medical specialty organization in the U.S. “With such in-depth training in the complete care of adults, internal medicine specialists and subspecialists are excellent choices to help patients navigate the increasingly complex world of medical care,” says Dr. McLean, a rheumatologist. “Whether you are healthy or have a chronic illness such as diabetes, cancer or heart disease, an internist can provide comprehensive, coordinated care.” 
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Along with taking your medication as prescribed, some lifestyle habits can help manage your risk and help you live a longer, healthier life like watching what you eat, getting more exercise and managing stress.
Make Healthy Menu Choices A healthy eating plan is a well-rounded diet with plenty of fruits and vegetables (at least 4-5 servings each day). In fact, researchers at the University of Columbia found each daily serving of fruits or vegetables was associated with a 4% lower risk of coronary heart disease and a 5% lower risk of stroke. Other smart choices for your menu include nuts and seeds, whole grains, lean proteins and fish. Limit sweets, sugar-sweetened beverages, saturated fat, trans fat, sodium and fatty or processed meats. Get Moving You likely know exercise is good for you, but an Oxford University study revealed simply swapping 30 minutes of sitting with low-intensity physical activity can reduce your risk of death by 17%. Mortality aside, in its Physical Activity Guidelines for Americans, the U.S. Department of Health and Human Services noted physical activity offers numerous benefits to improve health, including a lower risk of diseases, stronger bones and muscles, improved mental health and cognitive function and lower risk of depression. The greatest impacts come from getting the recommended amount of activity: at least 150 minutes of moderate activity, 75 minutes of vigorous activity or a combination of those activities per week. Be sure to discuss with your doctor which activities may be best for you. If you're having trouble getting motivated, small steps like walking your dog can lead to big changes over time. A scientific statement from the American Heart Association on pets and heart-health showed dog parents are more likely to reach their fitness goals than those without canine companions. Reduce Stress Constant or chronic stress can have real consequences on both emotional and physical health. In fact, research shows chronic stressors like long work hours, financial stress and work-life conflict may be as risky for health as secondhand smoke, according to a report by the Behavior Science and Policy Association. Aside from the direct toll on your body - including elevated risk for heart disease and stroke from high blood pressure, depression or anxiety - stress can lead to unhealthy habits like overeating, physical inactivity and smoking. Exercise is an effective way to keep your body healthy and release stress. You might also consider incorporating meditation and mindfulness practices into your day to allow yourself a few minutes to distance yourself from daily stress. Research compiled by the American Heart Association suggests meditation can reduce blood pressure, improve sleep, support the immune system and increase your ability to process information. Another powerful tool to fight depression, anxiety and poor sleep, according to researchers at the University of California-San Diego, is practicing gratitude or thankfulness. Start by simply writing down three things you're grateful for each day. Learn more about managing your cholesterol and habits to protect your heart health at heart.org/cholesterol. How a Major Health Event Can Reveal Unknown Risks Before his stroke, Lee Stroy, a father of five, considered himself to be a healthy person. "My gauge of being 'healthy' was my ability to wake up in the morning, get to work, take care of my family and live another day to do it again," Stroy said. "That is, until I couldn't." In December 2014, Stroy woke up disoriented and scared after suffering a stroke at just 38 years old. He quickly discovered he had undiagnosed hypertension, diabetes and high cholesterol. "It surprised me to learn there are often no visible symptoms for high cholesterol until a heart or stroke event," Stroy said. "Unfortunately, I was not diligent about my annual check-ups, so my health setbacks provided me with a huge wake-up call." Stroy decided to take control of his health and this marked the beginning of a major lifestyle transformation. The first change was quitting smoking. Next, he began incorporating exercise into his daily routine, initially with simple exercises from occupational therapy. Eventually he worked up to walking several miles a day. Stroy also gradually made changes to his diet and went from being a meat eater to vegan. He also attends regular doctor's visits to keep tabs on his progress. "While it was no easy feat to make such drastic lifestyle changes, they are now second nature," Stroy said. "Don't put off or be afraid to go to the doctor. You could catch something early and be able to make changes that save your life." http://www.svatampabay.com/ http://seniorvoiceamerica.org/ http://seniorvoiceamerica.com/ 813-693-5511  By Mary Gynn - Diabetes Educator
Let me start with the reminder that Diabetes affects 25.8 million people. Those diagnosed are 18.8 million people and undiagnosed total 7.0 mil-lion people. Unfortunately, both Type 1 and Type 2 diabetes are affecting the younger generation, as well, the numbers being a staggering 215,000. (Center for Disease Control and Prevention in Atlantic, GA. www,cdc.com). Prediabetes and diabetes are now officially listed as an epidemic in the US. And, the numbers are growing. An epidemic? This is 2018. Ironically, diabetes was first described in an Egyptian manuscript from 1500 BC and the first cases were described by Indian physicians in 400-500 AD identified as Type 1 and Type 2. Then in 1776, a Dr. Matthew Dobson con-firmed an excess of a kind of sugar in the urine. (Dobson,M. 1776, Medical Observations and Inquiries 5:298-3Is it the 10). And in 1889, it was found that dogs whose pancreas was removed developed all the signs and symptoms of diabetes. So, considering these very early discoveries, why are we dealing today with Diabetes now an epidemic? Shouldn't the disease have been either controlled or eliminated all these years later? Does "It", the epidemic, have some-thing to do with the following questions? I ask: • Is it lack of community health and diabetes education? • Is it the abundance available and consumption of processed foods? • Is it lack of Americans knowing the existence of a gene somewhere in their ancestry that they may have inherited predisposing them to diabetes? Do most Americans have any idea of what a genetic inheritance (aka genome sequence) is? And all the variety of genes we all have predisposing us to health issues? • Is it because the majority of Americans are addicted to sugar and sugar is present in practically all our food? And, why is sugar in all of our food? • Is it the growing numbers of people who don't want to adapt a healthy life-style either early on or when diagnosed with a blood test they have prediabetes? • Is it because people aren't aware of their predisposition to the disease and have no knowledge of the metabolic syndrome? • Is it because Americans who if they do have some pre-diabetes symptoms just want a quick-fix pill to avoid facing reality and say nothing to or deny any symptoms to their physician? • Is it due to the insidious development of overweight and/or the obesity epidemic? • Is it in anyway connected to the in-activity or a "sitting" population in to-day's America? • Is it connected to stress in our lives in today's stressful world that we do nothing about? • Is it the multitude of pills or insulin pre-diabetics and diabetics ingest and inject and think they are the "cure"? • Is it the lack of diabetics not knowing how to self-manage their own dis-ease resulting in permanent sugar control? • Is it pre-diabetics and diabetics have no desire to self-manage or fearful of taking control of their disease? In my years of being a registered nurse and diabetes educator, I could go on and on identifying the multitude of questions. They help me arrange my diabetes self-management education programs and discuss your answers to the above questions. Your answers assist my effort to understanding why we now have a diabetes epidemic. Mary Gynn, RN, MSN/MS, MPH, CDE http://seniorvoiceamerica.org/ http://www.svatampabay.com/ http://seniorvoiceamerica.com/ http://www.getsva.com/ 813-693-5511  Teaching For Health Series,
PREDIABETES By Mary Gynn, RN, BSN, MSN/MS, MPH, Diabetes Educator WHAT IS PREDIABETES? Prediabetes is a condition that can lead to Type 2 diabetes and heart disease. When you have prediabe-tes, your blood glucose (sugar) levels are higher than normal, but not high enough to be diagnosed as diabetes. Diabetes can lead to many health problems and chronic complications, so it’s very important to prevent diabetes in the first place. “Prediabetes is a red flag letting you know that you are at high risk for problems,” said Dr. Samuel Klein, of the Washington School of Medicine in St. Louis, Mo. “Approximately 86 million Americans, one in three, are estimated to have a blood glucose level that is higher than normal but not high enough for the diagnosis of diabetes.” Without lifestyle changes to improve health, 15-30 percent of people with pre-diabetes will develop Type 2 diabetes within five years, per the CDC. PRE-DIABETES RISK FACTORS: - HbA1c between 5.7-6.4 percent, per Dr. Ralph DeFronzo of the University of Texas Health Science Center in San Antonio • Age 45 or older • African American, Hispanic / Latino, American Indian, Asian American, or Pacific Islander • Have a parent, brother, or sister with diabetes • Overweight • Physically inactive • High blood pre sure (140/90 Hg or higher) or taking medication for high blood pressure • Low HDL cholesterol (35mg/dL or lower) and/or high triglycerides (higher than 250mg/dL • A woman who had diabetes during pregnancy • Diagnosed with Polycystic Ovary Syndrome (PCOS REVERSING PRE-DIABETES: • Cut back on calories and saturated fat (read labels) • Lose weight • Increase your daily physical activity • Get in touch with a Diabetes Educator who has studied diabetes and can support your life-style changes and work with you on a personal level. They give the time that the doctor does not have. The knowledgeable people in the endocrine “community” can play an important role in keeping you from getting diabetes. If you are overweight, losing 5-10 percent of your total weight is very helpful. So, if you weigh 200 lbs., the goal would be to lose 10-20 pounds. It can be done gradually, and you can avoid getting diagnosed with “full-blown” diabetes. The less there is of your body and body fat, the easier it is for your pancreas’s beta cells to produce insulin. You don’t have to make big changes. Small steps can lead to big results, especially eating less and moving more. Walking at least 30 minutes a day, five days a week and eating less fat and calories can lead to big results. Start counting your calorie intake today. Start each dinner with a salad of leafy greens. Salad provides nutrients and fills you up. Start with switching from regular soda to no-calorie water and eating fewer high-calories foods (read the labels). Start to make the gradual changes to keep diabetes away. Please remember: “Prediabetes is a red flag. Education is key to diabetes prevention.” Mary Gynn, RN, is a certified diabetes educator and facilitates diabetes http://seniorvoiceamerica.org/ http://www.svatampabay.com/ http://www.getsva.com/ 813-693-5511 |
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