The Path to Optimal Wellness

On the Wellness Connection MD  podcast wet strive to present to you practical solutions to your health care concerns.  In this episode we describe a step by step guide to achieving your optimal wellness goals .   Beginning a wellness journey may seem daunting.   Where do I begin?  How can I get from here to there?  Dr. McMinn and Coach Lindsay break it down for you, along with a powerful graphic illustration called Dr. McMinn’s “Arch of Wellness.”  You can find this at McMinnMD.com under the Documents section, or at

https://img1.wsimg.com/blobby/go/62e64053-aa44-44d0-99a1-972bd0a23d2f/downloads/Arch.jpg?ver=1711505564628   

The two legs of the arch represent an empowered patient and an engaged provider working together to achieve  optimal outcomes.   The two legs of the arch meet in middle at the keystone, which ties it all together.  The keystone represents Behavioral Change.  It is the fundamental way that we live our lives that ultimately determines our health status.  As the old saying goes "you can’t keep doing the same thing and expect a different outcome."   It is by attending to the foundations of wellness which we call “lifestyle medicine” that we are able to become the very best version of ourself in mind, body, and spirit.

The patient and the provider each has a crucial role to play when it comes to achieving our goals.   Dr. McMinn and Coach Lindsay along with the “Arch of Wellness” break it down for you step by step.   The details of the path may differ for each person, but the basic steps remain the same.  Depending on where you are on the wellness curve, it may seem daunting to begin, but the sooner you start the better.  Once you've had that heart attack or stroke you can't ake it back. So don't wait till it's too late.  Get started and don’t make it overwhelming. Take your time, and start with the low lying fruit. 

The mantel of empowerment awaits all of us.  It is there for the taking.  As patients each of us must become the “captain of our ship.”  As providers we must become fully engaged in helping each patient achieve his or her optimal wellness goals.  The path for the patient begins with awareness, and proceeds from there. The path for the provider  begins by being a great listener.  Fully hear the patients concerns in a nonjudgmental fashion, and then begin to employ the knowledge and skills that you have learned over the years to partner with the patient  in order to arrive at the best possible course for optimization.

We wish you well on your “Path to Optimal Wellness.”

Transcript

Speaker 1: 0:03

Hello, this is Dr McMahon and welcome to Wellness Connection MD. Maybe you've realized that you have a health challenge going on in your life or, for some reason, you have become aware of the importance of optimal wellness, but you just can't figure out how to get from here to there. It seems overwhelming. Well, if you come to the right place today on the podcast, we're going to outline for you a step-by-step approach, for you and your provider, to help you achieve your wellness goals. So buckle up and let's get going on the path to optimal wellness.

Speaker 2: 0:30

Welcome to the Wellness Connection MD podcast with Dr McMinn and Coach Lindsay, where we bring you the latest up-to-date, evidence-based information on a wide variety of health and wellness topics, along with practical take-home solutions. Dr McMinn is an integrated and functional MD. Thank you podcasts. Visit McMinnMDcom and to stay up to date on the latest topics, be sure to subscribe to our podcast on your favorite podcast player so that you'll be notified when future episodes come out. The discussions contained in this podcast are for educational purposes only and are not intended to diagnose or treat any disease. Please do not apply any of this information without approval from your personal doctor. And now on to the show with Dr McMinn and Coach Lindsey.

Speaker 1: 1:26

Hello and welcome to Wellness Connection MD, the evidence-based podcast on all things wellness. We thank you so much for joining us today. I'm Dr Jim McMinn and I'm here today with our co-host, nurse and certified health coach, ms Lindsey Matthews. Good morning, coach.

Speaker 3: 1:41

Hey, dr Mack, good morning. It's so great to be back on the show with you, dr McMinn, and also all you listeners, thanks for tuning in. As always, we come to you today to bring you honest, commercial-free, unbiased, current, evidence-based, outcomes-oriented information along with practical solutions. So in order to empower you listeners to overcome your health care challenges, to optimize your wellness in mind, body and spirit, and to become that great captain of your ship when it comes to your health and wellness. That's why we're here.

Speaker 1: 2:15

Yeah, coach, for some folks, when they think about where they are with their health and wellness and where they want to be, it can seem somewhat overwhelming to try to get from here to there. Where do you start, oh my gosh, so anyway? Well, today we're going to get back to basics and lay out for you a practical, step-by-step path that you can use, preferably along with your provider, to help you achieve your wellness goals.

Speaker 3: 2:35

But first we have a couple of our housekeeping duties that are very brief we'll take care of here. Our podcast remains commercial-free, so you won't have to be bothered by the annoying and sometimes disingenuous commercials.

Speaker 1: 2:48

However, it does cause us money to produce these podcasts. So think of us like public radio and consider making a contribution to help us keep it coming to you.

Speaker 3: 2:54

And so there's a couple ways that you can do that. First, if you buy nutritional supplements, then consider purchasing physician-grade supplements from our Fullscript dispensary at a 10% discount. You can see that link to Fullscript below in the show notes, or go to mcminnmdcom and the link will also be there at the bottom of the homepage under helpful links. It's simple Just click on the link. They'll guide you through the process. It's a win-win you get the supplements that are high quality at the discount and then you support us for the show and we're grateful, very grateful for that.

Speaker 1: 3:29

And you can also make a contribution directly to the show via credit card or PayPal at the Support the Show link, which is also in the show notes. And please don't forget to subscribe to the show and tell your friends about us and your family about us, so we can keep it growing. And thank you again. So much.

Speaker 3: 3:44

And now Dr Mack, on to the show.

Speaker 1: 3:47

Well, coach, everybody likes stories, so I'm going to tell just a brief true story to set the stage for our topic today.

Speaker 3: 3:53

I'm listening, sounds good.

Speaker 1: 3:55

So one day I was just seeing a new patient in my office and like many of my guy patients, he really didn't want to be there. But his wife loved him and could see his decline and she didn't want to be a young widow with a bunch of kids. So she twisted his arm and made him come in, kicking and screaming the whole way. So I did my usual schtick with him. I took a thorough history, did an exam and I went over all his labs with him and it became abundantly clear to me that he was heading down the road to ruin. As usual, the wife was right.

Speaker 3: 4:27

I've learned, Coach, the hard way from my marriage to Dr Cheryl, that wives are usually right, but please don't tell her I said so, dr Cheryl is full of so much wisdom.

Speaker 1: 4:35

Oh, she is Too much, darn it. But anyway, he was, like many of the folks I had seen in the ER over the years, laying in a gurney having a heart attack, and I know that he too was a heart attack waiting to happen, and sooner than later. So I did my best to convey my concerns to him, but he seemed to be in total denial and wasn't really interested in making any changes to avoid pending disaster. Like a lot of guys, he just wanted to drink beer, eat barbecue, watch football and play golf. So anyway, we went back and forth but at the end of the day I just could not get through to him.

Speaker 1: 5:00

It was very frustrating for me as a provider and I threw every trick in the book at him, but just he wouldn't budge. He just clammed up and insisted on continuing his self-destructive ways. It was almost like a suicidal wish, coach. So I came home from work that night and the interaction with him just lingered with me. I stood over it and it really began to bug me that I wasn't able to get his attention. I kind of felt like I had failed him really Coach him. I kind of felt like I had failed him really, coach, and for some reason I got out a piece of paper and began to brainstorm about how I might break through with such patients in the future, and by the end of the night, I came up with a rough draft of what I now call the Arch of Wellness.

Speaker 1: 5:37

This arch describes a two-legged path to optimal wellness. The two legs represent the patient's path and the provider's path, and these paths meet at the top of the arch where they come together, and that's where you'll find what we call the keystone of the arch, which is behavioral change. At the end of the day, coach, it is behavioral change that then leads to optimal wellness. You can't keep doing the same things and expect a different outcome.

Speaker 3: 6:00

And you also can't just sit there knowing all the things to do but not applying it. So you can see this diagram, listeners, that Dr Whitman is talking about. It's on our website at mcmindmdcom. So go down to the Documents menu at the top of the homepage and scroll down until you get to the Arch of Wellness and if you're at a point like maybe you're driving and listening to this, but if you're not, just go ahead and flip there on your phone, just so you can have an idea for the rest of this podcast of what to do and follow with us as we kind of go through these steps. You're welcome to download the diagram, share it if you wish. I'm a big lover of putting things on my fridge that are important to me. I know my mom still probably has her pyramid of wellness document from seeing you.

Speaker 1: 6:43

And she puts it up there.

Speaker 3: 6:44

Those diagrams are just helpful.

Speaker 1: 6:46

Yeah, my sister has it on her fridge. You know I'm a real visual guy, lindsay, and I guess that's why I came up with this. Sometimes you can have these amorphous thoughts, but when you can see a diagram or a picture of it, it starts to come together. Yes, yes absolutely.

Speaker 3: 7:00

I think it kind of breaks it down and any kind of visual reminders to just clue you back in. So for those of you who can't pull it up for some reason, I'll just do my best to describe it. So it's an arch with two legs, two pieces, and the left arch represents the engaged provider and the right arch is labeled the empowered patient. So, starting at the bottom, we work our way up, both the legs, step by step or stone by stone, and approach the provider and the patient. So this is an approach where the provider and the patient need to take in order to achieve optimal wellness. So this is the arch of wellness.

Speaker 1: 7:41

You know, Coach, those two words engaged and empowered are really important. I really thought a lot about those words because I think one thing we've been trying to always try to empower the patient to be the captain of her ship. And engaged is important as well. The provider has to give a hoot, you know, and come to the room and be invested in trying to do everything he or she can to help that patient. But certainly folks can embark upon this wellness journey on their own, but for those who are able to, we really feel it's helpful to work with a knowledgeable, experienced, caring and engaged provider or health coach like Lindsay to help you improve your odds of achieving your health care and wellness goals.

Speaker 3: 8:35

So, even though there are two parties involved here the patient and the provider the patient is always the captain of the ship. So at the end of the day, it's entirely up to the patient as to whether or not he or she is willing to embark upon this optimal wellness journey. So, for whatever reason, some may find that it is not for them. And at the end of the day, the provider can encourage and guide. But she can't come home with the patient or go grocery shopping with the patient. She can't make the patient exercise, can't control what he or she eats, can't make them go to bed at the right time or get a good, full night's sleep, can't reduce stress, can't get her to take all the supplements. Nothing happens without patient buy-in. So you, the patient, you the patient, got to drink the wellness Kool-Aid. There you go.

Speaker 1: 9:22

Got to do it. You know, Coach, got to drink the wellness Kool-Aid. There you go. Got to do it. You know, Coach, as a provider, I always thought of myself as what I called the humble navigator. I actually sometimes envisioned a ship and there's the captain sitting there, the patient, and I was right beside the captain as the humble navigator.

Speaker 1: 9:36

I like that, Trying to steer away from things like icebergs and storms and to help them sail into clear, open, calm and beautiful waters. But I can only do so much and at the end of the day, the patient either steps up and makes unnecessary changes and reaps the benefits, or she doesn't, and she continues down the path to more badness.

Speaker 3: 9:54

As I mentioned, dr Mack labeled the right leg the empowered patient and, as you said, dr Newman, earlier, historically medicine can be disempowering. The patient goes to the doctor, he receives the orders from the doctor and take this pill and you're expected to follow it, and the last thing that the doctor wants to hear is the patient coming up and saying here's Dr Google's opinion, and what about this and what about that? We just want to make it simple sometimes and just do what I said.

Speaker 1: 10:24

Don't ask questions. Move on to the next patient.

Speaker 3: 10:26

You know, we here on Wellness Connection MD feel that, in order to achieve optimal outcomes, the patient must be empowered in order to be actively engaged in the solution, and engaged in a solution that's long-term too. So at the McMinn Clinic, we used to literally give away hundreds of books in order to educate our patients, to get buy-in, to motivate them a solution that's long-term too. So at the McMinn Clinic, we used to literally give away hundreds of books in order to educate our patients, to get buy-in, to motivate them to take the necessary steps. You'd give them journals, you'd try to involve them in the process.

Speaker 1: 10:55

Yeah, and the other leg of the arch represents the engaged provider. The provider needs to enter into the encounter prepared and willing to do whatever he or she can do to help that patient achieve their goals. Unfortunately, the way things are going in modern medicine, most providers these days work for the man in a corporate medical structure and the main focus of which is to make a profit. These providers are often under the gun to see more and more patients in order to increase revenues. They also have to spend more time on the electronic medical record, so their time is even more limited. Also, sadly, most doctors have been brainwashed into taking a drug-focused perspective. They have learned very little about important lifestyle medicine therapies like nutrition. And I'm not saying this to bash my medical colleagues, lindsay, it's just the honest truth. Most doctors will admit it. It's just the way it is. Coach, but in this model we are promoting, the provider has to be totally prepared and engaged to optimize the outcome for the patient.

Speaker 3: 11:49

Yes, and you know, I think so much too with our providers today is that our whole system, our whole setup, what we've bought into as providers and patients, is broken, you know. So it's also like this global cultural problem of how we approach things in general and like as patients. So many of us patients come in just with this consumeristic mindset. And we're not willing to, you know. We just put it all in the provider's lap instead, and so there's this, you know, yeah, so it's a system failure.

Speaker 3: 12:28

So those are the two legs of our arch empowered patient and engaged provider. So let's break this down by first working our way up the patient's path to optimal wellness. Let's take it kind of stone by stone. So the very first step or stone on the path is awareness. At some point the patient has to exit the denial mode and we got to wake up and realize that there is a problem, or at least that they're not where they want to be as far as achieving their wellness goals.

Speaker 1: 12:55

In the case of the train wreck patient that I mentioned above, the awareness began with me carefully communicating to him the accumulating risk factors that would most likely result in a significant bad outcome for him in the not too distant future. I also assured him that if we got busy and made the necessary changes, that he could potentially avoid the pending disaster. People often take their health for granted, coach, until they have that stroke or their heart attack, but by then it's too late. Once you've had that heart attack or stroke, you can't take it back. I think that my conversation with him was the first time he had really heard it in such honest terms, but I made sure he got the message. At that moment he did achieve awareness, which is the all-important first step on the path to optimal wellness, but unfortunately he was not willing to take the next step, which is intention. In other words, he finally saw the gravity of the situation but was not willing to do anything about it. He chose to stay in denial mode, much to the disappointment of me and of his wife.

Speaker 3: 13:51

As Dr Mack mentioned, the next step for the empowered patient is intention. This means that after you recognize the problem, now you have to be ready to actually do something about it. But unfortunately, there are many people who are aware that they have a problem, but they have no intention of making the necessary changes to address the issue. No-transcript personalized plan that allows you the opportunity to move forward to better health and wellness.

Speaker 1: 14:47

Once you have that plan, the next step is action based on your plan. The best plan in the world won't work if it just sits on the shelf and collects dust. You've got to get the inertia to move forward and the discipline to keep going with the plan.

Speaker 3: 15:00

The next step for the patient is then monitoring. It helps to track your progress with the plan and how you feel certainly matters, and it's also helpful if you can track measurables so, like the weight's coming off, inflammation score is coming down, blood sugar or blood pressure normalizes. So if you see those measurables, if you can see that things are improving, then that will encourage you to continue to stick with the plan. On the other hand, if things are not improving, then you may want to tweak and work with your provider to adjust the plan in order to better move things in the right direction.

Speaker 1: 15:35

You know, coach, again, I'm kind of a visual guy. So, for instance, with a lot of people with weight issues, I would encourage them to make a graph that you put on the refrigerator, right, so you can see it every day, and on the up and down axis you can have your weight and on the horizontal axis you put time, like once a week, and so you see that weight coming down and, oh my gosh, it's really reinforcing. You give yourself a pat on the back and it makes you want to stick to it and try even harder. So yeah, I'm a big believer in monitoring, measurables and, ultimately, charting and graphing.

Speaker 3: 16:05

And I know you would also like when patients would come in. You had a checklist initially of you know, these are all the things, you know fatigue and you'd list it on each appointment visit and so you could go back to the very first visit and say are you still having fatigue?

Speaker 1: 16:20

Are you? Still having headache I'd only had that, but I rated it on a scale of one to five.

Speaker 3: 16:25

Yes.

Speaker 1: 16:25

And you had like zero little bit moderate, severe, extreme. And so when they came in and they had the extreme problem and now it's a two, then that tells me, because sometimes they come in and say, well, how are you doing? Oh, I'm not any better, well, let's go through this. And you go one by one by this. Oh, and everything's improved, Say well, here we go.

Speaker 3: 16:43

You actually are better, because you won't forget what it was like Everything.

Speaker 1: 16:47

Yeah, they forget how bad they were really, quite frankly, exactly.

Speaker 3: 16:50

I loved that you provided that tool, so that was so good. Yeah, exactly, I loved that you provided that tool.

Speaker 1: 16:54

Yeah, yeah, so that was so good, yeah right. The last step before we get to the keystone of the ARCH is accountability. The patient has to hold himself responsible for sticking with the program. If he gets off track, he needs to cowboy up and get back on the program and, as I said earlier, the doctor can't come home with you and control what you put in your mouth or can't crack the whip to make you exercise every day. So it's up to the patient to be accountable to do the right thing.

Speaker 3: 17:19

And so before we get to the punchline, which is the keystone step that holds the arch together, let's switch over to the provider side of the arch and look at the steps that the engaged provider should take in order to help the patient achieve their optimal wellness goals. The provider's very first step is to be a good listener. There is an old saying in medicine which goes like this listen to the patient and he will tell you what's wrong with him. So many times in medicine we count on expensive, fancy tests to come up with a diagnosis, when instead, if the provider will just listen to the patient and connect the dots, then the provider will usually know what's going on with the patient without all the costly tests.

Speaker 1: 18:03

I just posted a blog Coach called Listening the Most Powerful Tool in Medicine, and you can check that out at mcminnmdcom under the heading Wellness MD blog in the menu at the top of the homepage, but I'll also put a link to that in the show notes for you Also. For many diagnoses such as chronic fatigue syndrome, fibromyalgia, dysautonomia, that kind of stuff, just to name a few, there really are no good tests for these diseases. So the only way to come up with a diagnosis and a plan is through detailed listening and connecting the dots.

Speaker 3: 18:32

It's also important that the practice and the provider provide a welcoming and non-judgmental atmosphere of trust where the patient feels comfortable coming in, talking about his or her problems, knowing that they'll be taken seriously and that you're not going to be judged either. It's important that you can come in and share things.

Speaker 1: 18:52

You know, Lindsay, I always hate to wash our dirty laundry in the medical field, but I think we're too quick to judge people for so many reasons, and I think sometimes, for instance, somebody comes in with things that there's no good test for, like chronic fatigue or whatever. We think they're malingering or drug-seeking or hypochondriac or whatever you know attention-seeking, and so we got to. That's one thing I learned in the ER You've got to leave your judgment outside the room, and I think that, yeah, certainly there are people who are there to some alternate agenda, but for the most part, your default should be to trust a patient.

Speaker 3: 19:30

Yes, most people are in a vulnerable place when they come before a provider, and I think that also is something that we, as medical professors need to remember. Like this person is vulnerable, they're exposing all of their troubles and problems, or they're in the hospital setting. Nobody wants to be there, nobody wants to have to deal with these things, but there they are.

Speaker 1: 19:49

But finally, on the subject of listening, coach, I know I'm kind of old school, but I just don't buy it, coach, I know I'm kind of old school, but I just don't buy it that a doctor can be looking at the computer screen and be typing in the medical record and listening intently to the patient at the same time. The practice just destroys the chemistry between the provider and the patient and I've been on the receiving end of this when I went to see my doctor and I felt that it was very off-putting. She had her back to me the whole time. There was no eye contact, very little attention to body language and I really didn't get the feeling she heard a word I said, coach, it was really kind of frustrating for me. And also most EMR programs are constantly flogging the provider to fill in certain boxes in order to boost coding and billing. So the provider is actively thinking about responding to the EMR prompts and she's not fully engaged in listening to the patient.

Speaker 3: 20:36

Right, you know, unfortunately we kind of experienced this, my husband and I, when Tyler got really sick several years ago with dysautonomia. We went to all of the providers and you know some were truly, truly kind and caring people, but we just, at the end of the day, we didn't truly feel heard and because there wasn't clear-cut answers for what was going on with Tyler. He didn't fit in the algorithms of the problems that they were used to. It was just his problems kind of got dismissed. This is just anxiety, you're just stressed Like here's literally here's some anxiety medicine, and there was so much more going on with him with dysautonomia than just that, and so they didn't really get how sick he was and so it was just that was really hard that we didn't feel like we were taken seriously or really understood, or really just that there was a space for us to receive care.

Speaker 3: 21:34

you know, then at the end of the day it kind of builds this sense of like distrust.

Speaker 1: 21:38

Right, correct, right, but unfortunately, coach, I think this happens too often. I wish that medical students had a mandatory class on listening and asking the right questions, and I think it's really becoming a lost art this whole listening thing, and yet it's our most powerful tool in getting to the right diagnosis and to coming up with a good treatment plan. I remember when I was in the ER, it seemed like the best doctors did the fewest tests. They took a good history, a medical history, and they did a good exam and they kind of knew what was going on at that point. They didn't need to rely on a bunch of fancy tests. On the other hand, the doctors who were less secure in their clinical skills order more needless labs and x-rays, and the ER was always backed up and the patients waited forever to get these test results to come back when these doctors were on duty.

Speaker 1: 22:24

So for you providers out there, history, history, history. Listen intently to your patients, connect the dots, and your basic, as I said above, your basic default should always be to trust the patient and to take them seriously. And one more thing, coach when I was before I retired all those years at McMinn Clinic, during the patient visit, I learned to take these cryptic shorthand notes, and I could do this without ever looking away from the patient. I always maintained eye contact so that I could see the facial expressions and read the body language, but then at the end of the visit, I always typed the patient a note, which is actually a letter, and in the first paragraph I summarized their complaints. And by doing this, the patient always knew that they had been listened to and I had heard everything, and they really seemed to appreciate this confirmation that they had been heard.

Speaker 3: 23:10

And I think that speaks to just that side of us of needing to be as a human. We need to feel understood and I think there's a healing that comes from the provider just through that.

Speaker 1: 23:23

Another advantage of that Coach is that when you do that and you go over that letter with them, if you got it wrong, then that was their chance to tell you.

Speaker 3: 23:32

Yes, right.

Speaker 1: 23:33

Yes, because I said at that point they said no, no, no, doctor, that's not quite what I said or what I meant, but that way you know you both agree that here's what we're dealing with, here are the issues, and so I think it really helped. As you remember, coach, I wrote thousands of letters over the years. Oh yes, every single patient, every visit wrote a letter to them.

Speaker 3: 23:51

Yeah, I loved that.

Speaker 1: 23:53

Yeah.

Speaker 3: 23:54

And you know, I think, the other thing too when they can see the summary of their complaints, it helps with that intention step of seeing, oh wow, that's a lot written out. I am now fully aware of all the things that I've just kind of been shuffling around and dealing with in my life.

Speaker 3: 24:11

And now let me form a better intention to move forward. So I think that really helps them on those beginning steps of the arch in becoming that empowered patient. But the next step for the engaged provider is to do that just old-fashioned physical exam. This is another cornerstone of clinical medicine that can tell you a lot about what's going on. However, along with listening, this too seems to be becoming a thing of the past. I believe that it is often an expectation on the patient that the provider examines him or her. I have heard it repeated many times from the patient about other providers. He never examined me, he never even touched me, he didn't listen to me, like with a stethoscope. Besides gathering data, I do think that there is consideration to be given to the power of touch, done in an appropriate and, of course, professional manner to the comfort of the patient and to further establish that connection between the provider and the patient. There's that relationship there.

Speaker 1: 25:07

You know, Coach, I can't tell you how many times just a simple physical exam has helped me as a provider to make the right diagnosis. Let me tell you just a quick story to illustrate the point. I had a 40-something-year-old lady who came to see me one day. I'd been seeing her for quite a while and I asked her how she's doing. She said, oh, I'm fine, doctor, Just a little bit of constipation. And that really wasn't her main complaint or really the reason why she was there. But with every patient I had just a quick exam. I did, and this takes two minutes and so I felt her belly and I said, hmm, this doesn't feel like constipation to me. Let's get a quick ultrasound. So we did and we found that she had an early ovarian mass.

Speaker 1: 25:45

I remember that and I remember her telling me the story about that. And so we caught it so early because of that two minute exam that she got it cut out. She never had to do any chemo, any radiation. It's been at least 10 years ago and she's still cancer-free from a cancer that's usually deadly all due to a two-minute physical exam. I'm just saying, coach, we rely so much on fancy CAT scans, mri stuff like that, but just examining the patient is still so important.

Speaker 3: 26:13

Yes, well, you know. I'll give you another example, dr Whitman. Just from my times of working in the hospital, I recall a patient that me, as the nurse, I had to escalate their care because the patient was tachypneic, meaning they were breathing fast. But when they were transferred to the ICU setting they just hooked him up to the monitor and the monitor did not pick up those respirations, but the my stethoscope did.

Speaker 1: 26:38

Yep, there you go.

Speaker 3: 26:39

And because you know if a patient's breathing really shallow, you're not going to pick that up. But so you know it's just monitors and computers and machines.

Speaker 1: 26:51

They're not humans you know they can't pick up all of those subtleties. They don't do not take the place of clinical judgment. Yes, right, yes. So there we go.

Speaker 3: 26:56

Yes, so the next step for the engaged provider is testing. This is where we gather more data, if needed.

Speaker 1: 27:02

If needed.

Speaker 3: 27:04

So sometimes the diagnosis is right there in front of us, plain and clear, and no further tests are needed, and actually it is our opinion that overall providers probably do too much testing. Unfortunately, there has been an explosion in the number of lab tests that providers can do and I think sometimes that's part of like it's patient driven in some ways Like people want more data, more information, more, more more.

Speaker 1: 27:28

Plus there's money in it. You go to a conference and some testing company is there and say, oh, do this fancy test. And they have a beautiful display and a good-looking lady who's pushing it Right yeah. So some former high-heeled ex-nurse, so anyway. So doctors buy into it and they do these tests, but it really doesn't change outcomes. Right and a lot of times these tests have not been validated.

Speaker 3: 27:53

Right.

Speaker 1: 27:54

Right.

Speaker 3: 27:55

And then they can be really expensive. It runs up the cost for the patient. So we should do the tests that we need. Tests can be a helpful tool. They're in our toolbox, but we don't want to over-test either.

Speaker 1: 28:08

And sometimes these tests uncover things I call incidentalomas, which, as the name implies, it's an incidental finding that has nothing to do with why the patient came to see you, and are usually insignificant and irrelevant. These findings can send you down rabbit holes, muddying up the clinical picture, costing the patient even more money, and usually result in no benefit to the patient. One fundamental tenet that I always adopted over the years was to never do a test if it's not going to change the outcome for the patient. As you know, coach, we did a lot of work with gut health, and when I first started with my gut health focus, I ordered a lot of functional testing, but I eventually realized, after doing a lot of it, that the answer was always the same. It's kind of crazy.

Speaker 1: 28:48

Not enough diversity, yeah it was always that the microbiome was screwed up.

Speaker 3: 28:52

Yes, exactly, but.

Speaker 1: 28:53

I finally realized that usually based on history, we knew that the microbiome was screwed up before we ever did $400 tests, so why do the test? It's a waste of money. Just fix the microbiome.

Speaker 3: 29:04

Right, right, right. So now that the engaged provider has gathered the information by listening physical exam tests, the next step is to put together a customized treatment plan for the patient. Since, as the providers, we tend to take a functional and integrative approach, we try to connect the dots and take this ground-up root cause approach in our treatment plan. So, for instance, a patient comes in with itchy skin but based on our clinical assessment, we're pretty sure that there's that gut-skin connection. So in this case, our plan would also include a gut health program, whereas traditional medical approach would be to prescribe some antihistamine drugs, even perhaps some steroids, along with some topical salves. Most of these patients had seen the dermatologist before they got to us and the traditional approach just had not worked. They had a bunch of salves there in the medicine cabinet.

Speaker 3: 30:00

You know a bunch of those medicine bottles, but we often saw miracle cures with many of these same patients. With this root cause functional approach.

Speaker 1: 30:09

Right In that particular situation. Coach, we did a whole podcast on the gut skin connection, which I think was quite good.

Speaker 1: 30:14

If you don't mind me saying so myself, I might want to go back and take a listen to that, but patients often came in with many complaints. For instance, a very common scenario would be that at the same time they had fatigue, muscle aches, brain fog, can't sleep, aches all over, no libido, and it's all at once. And so I mean you could spend a whole visit just on any one of those. So one therapeutic approach would be to work on these one at a time, and it may be helpful to check in with the patient and ask her how aggressive would you like for me to be? If she wants to take a go-slow approach, then you might want to go one at a time and start working on the things that are most important to her, and then you can circle back around and take them one by one until they're all addressed.

Speaker 1: 30:56

However, let's go back to our veterinarian, dr Cheryl's pronouncement that dogs can have tics and fleas at the same time. So when the patient has all these various complaints, their problems could be totally separate things like tics and fleas. Or I have found in many instances you can connect the dots to a common denominator. More often than not that has to do with things like gut health, since there is a what I call a gut everything connection. So if the patient was up for it and wanted to be more aggressive and get to a better place quicker, then my default was to usually treat all these things at once with a functional root cause approach, and usually this did the trick and the patient came back and everything was better. And, quite frankly, as a provider, it was pretty amazing for me to see this.

Speaker 3: 31:38

It was also very gratifying for me and for the patient Right. And so once the provider comes up with this plan, then it's time to move on to the next step, which is to educate the patient as to what's going on. The patient wants to know, and the patient has a right to know what's going on.

Speaker 1: 31:52

You know, many patients have never heard of things like dysautonomia or autoimmune disease. Right, and they have a right to understand what's going on with their bodies, and so we need to step up and explain their conditions to them in terms they can understand. It also helps to go over their labs and other tests line by line so they can feel confident we're on the right track. Some books, some handouts, diagrams can also be helpful for patient education.

Speaker 3: 32:18

And after we do all of this, then the provider's next step is to motivate the patient to get going with the program, to stick with the program, and some people are sick and tired of being sick and tired and they can't wait to get going. However, for others it can be challenging to get them moving. It may seem overwhelming, since we're sometimes asking them to make some really fundamental changes to their way of life. It's not like just simply, you know, here's another pill to take in the morning. Just as an example, we've seen patients go gluten-free and see amazing benefits their chronic headaches are gone, their skin itching gets better and on and on, they have better energy, etc. But for someone who has eaten gluten products all their life and they're used to going to the grocery store and these are the things they get every time it may seem daunting to really give it up and to get started with that gluten-free program.

Speaker 1: 33:04

They have no idea how to do it. And that's why I'm a huge believer in things like health coaches and nutritionists and I was so blessed to have you and Nurse Laurel and Jennifer at the clinic and you guys were wonderful with things like motivational interviewing and help get patients on board with the program and holding them accountable. You definitely changed so many lives, lindsay, and I know the patients were very grateful for that and many of them could not have done it without you.

Speaker 3: 33:29

Well, thank you, Dr Reitman, and you know my dad used to coach basketball, and I like to use the analogy of two young basketball players who are just starting to learn how to shoot free throws. With one player, you could say go work on your free throws, I'll come back and check on you in six weeks. And then for the other one, you can have this program with detailed instructions, like a plan for becoming the greatest free throw shooter and a coach who would work with them every day to help them achieve those goals. And at the end of the allotted time, I'm pretty confident that the player with the plan and the coach will almost always outperform the player who just tried to DIY it.

Speaker 1: 34:06

By the way, I'm so sorry about Kentucky.

Speaker 3: 34:11

Rubbing it in with the listeners.

Speaker 1: 34:13

We're just getting over the NCAA playoffs here. Kentucky just ran into a hot team.

Speaker 3: 34:18

Oh my gosh yeah but hey, look at Bama there I know, I know, I know, but anyway, and now you had to rub it in while y'all were listening.

Speaker 1: 34:27

Yeah, yeah, yeah, yeah so, but likewise with a healthcare treatment plan, which can be sometimes quite complicated, the patient with the health coach will often find it easier to get going and will be better prepared to stick with the program and ultimately will have better clinical outcomes than the patient without the health coach.

Speaker 3: 34:44

And now, drum roll, dr Mack we finally get to the punchline. This is where the two legs of the arch meet in the middle to create that keystone. This is the step that makes the whole thing come together and work. The important step is called behavioral change.

Speaker 1: 35:01

There you go.

Speaker 3: 35:02

There's an old saying that goes something like this Don't continue to do the same thing and expect a different outcome. To get that different outcome, you got to change things.

Speaker 1: 35:11

It's like the definition of insanity is to keep doing the same thing over and over again and expect new results so we're going to try to be sane here and, as the term behavioral change implies, this step may require fundamental changes in the way we live our lives. This overlaps with the concept of lifestyle medicine. We did a great podcast on that, which is number 34. And on the podcast I called lifestyle medicine the most powerful medicine on earth, and you might want to go back and check that one out. I think it's a good one. Again, if you don't mind me saying so myself.

Speaker 3: 35:42

Certainly, there is a time and a place in medicine for drugs and surgery, and we're thankful for them. But for the vast majority of our patients, behavioral change is the key, and this can be very difficult to do, but at the end of the day, this is the surest way to optimal wellness for most patients and for our society as a whole, especially with our skyrocketing rates of chronic diseases that are also increasing our health care costs. So our current trajectory is not sustainable.

Speaker 1: 36:13

You know, coach, I don't know if you've seen the price tag on some of these new drugs. I mean, when you watch TV, you see commercial after commercial for these expensive like, especially, autoimmune drugs. Oh my gosh, they cost a fortune. And so we're just going to end up bankrupting our healthcare system if we don't change the fundamental way we practice and we live our lives. So one of the things we talk about most in this lifestyle discussion is diet, is nutrition, and I've seen dietary changes work miracles with patients, but they're difficult and especially here down south where we live.

Speaker 1: 36:48

The good old southern diet is predominantly kind of a high-fat diet and we have the right to be proud of our southern food heritage. It's wonderful high-fat diet and we have the right to be proud of our Southern food heritage. It's wonderful. Some of our most common meals include biscuits and gravy, fried chicken, fried green tomatoes, fried just about anything. Oh yeah, anything we can fry Oreos. That's right. Fry Oreos Right.

Speaker 1: 37:12

The world's best barbecue, and we all wash it down with a gallon of Milo sweet tea and I mean sweet tea and take a couple pieces of pecan pie along with some homemade Nella ice cream sweet tea, and take a couple pieces of pecan pie along with some homemade vanilla ice cream.

Speaker 3: 37:19

I like your Southern accent coming out there with your Boston fast talk.

Speaker 1: 37:27

That's right, it's just great going down coach.

Speaker 3: 37:28

My mouth's watering just thinking about it, I know. However, solid science tells us that, along with these tasty Southern treats, we in the South also lead the nation in obesity, hypertension, diabetes, and we have the shortest lifespan in the nation. In fact, six out of the top seven states for diabetes are right here, right here in the heart of Dixie Mississippi, louisiana, alabama, georgia, texas and South Carolina.

Speaker 1: 37:57

And, aside from diet, many of these states also are the states where we get the least exercise and, coach, when you add it all up, the scientists all agree that it's not a coincidence that there's a huge overlap between the Southern diet and lifestyle and these unwanted conditions like obesity, diabetes, hypertension and ultimately, premature death. In fact, you know, Coach, I think in some clinics around Alabama it's the exception if you don't have obesity, hypertension or diabetes.

Speaker 3: 38:25

Yes.

Speaker 1: 38:26

The box is pre-checked.

Speaker 3: 38:27

Yes, right, yeah. So yeah, you have to add it to the history you have to uncheck the box if you don't have them.

Speaker 1: 38:33

It's crazy.

Speaker 3: 38:35

Let's pause for just a moment to recognize that diabetes is not just a sugar number on your lab report. It's amputations, blindness, heart problems, kidney failure, neuropathy, increased rates of cancer and dementia. And likewise, hypertension is not just blood pressure rating. It also has those similar negative consequences I just listed. So that sweet tea and fried food may taste good going down, but it's got a big price tag and the long-term consequence of chronically always eating those things in is a life of prolonged illness, misery and even premature death. So it's serious. I mean, it's just, it's profound. Now I have a. It's just it's profound.

Speaker 1: 39:18

Now I have a confession, coach, we're recording this podcast. Right after Easter holiday had a big family get together, you know, and at that get together. We eat a lot of food, which is wonderful, it tastes so good. But if I ate like that on a regular basis, oh my gosh, I'd be big as a barn. So anyway, so I practice, and me and my wife Cheryl, we practice. I guess what do we call? Sometimes the 80-20 rule, sometimes it's the 70-30 rule.

Speaker 3: 39:45

Yes.

Speaker 1: 39:48

Most of the time and I'm so blessed that Cheryl is such a great cook is we eat pretty healthy. We try to focus on just a whole food diet. That's our emphasis. But you know, we every now and then go out and blow it out and, like the holidays come along, we have a family get together and there's that homemade ice cream or whatever.

Speaker 3: 40:03

And I think those things are healing and healthy for us. On that emotional, like we connect over food, we connect over these things. But to your point, I think it's that ratio, that 90-10, that 80-20, but truly living that ratio and not sneaking into the 50-50 category of things.

Speaker 1: 40:24

Yeah, yeah, I guess one thing I'm trying to point out is we're not expecting perfection.

Speaker 1: 40:27

But there are some people. If they veer off the path at all, they pay heavy consequences. I'm thinking of a wonderful young girl who came to see me one time with a juvenile rheumatoid arthritis and it was practically crippling for her and I got her on a program and one of the biggest things we did was change her diet and it was a miracle cure, coach. It was just amazing. But she told me if she slipped and ate food she wasn't supposed to, she could feel it right away. So I do think that some people just can't have any wiggle room.

Speaker 1: 41:01

But from the medical point of view, we have pills for diabetes, pills for blood pressure and even now we have pills in surgery for obesity, but nothing comes anywhere near close to behavioral change to improve outcomes for these patients. And it's never too late to start. But the sooner you start with changing your behavior in the direction of a healthy lifestyle, then the greater your odds of avoiding disease and achieving optimal wellness. And as I said earlier, once you've had that stroke you can't take it back. It's too late. So the sooner you change the better.

Speaker 3: 41:30

Yes, and behavioral change does not have any side effects too.

Speaker 1: 41:34

There we go does not have any side effects to it. There we go.

Speaker 3: 41:37

So it's first line you know it's our first choice, because there is no harm with it.

Speaker 1: 41:43

Well, I don't think there's. We talk about the concept of collateral damage. There's collateral benefit to this because you know you might change your diet to improve your diabetes, but that's also going to improve your heart disease and your dementia and this and that and the other. So there's so much benefit from it.

Speaker 3: 42:00

There are also many other conditions besides the common diseases that we've mentioned that really benefit from lifestyle changes, and the biggest example to that is just I've mentioned him many times on the show my husband Tyler. The thing that has helped him the most with his dysautonomia was not drugs or surgery, it was lifestyle change, especially dietary changes, and you know we talked about that on that podcast we did a long time ago on the dysautonomia. If anyone wants to search that, you can, and then we'll circle around and do another one one of these days with more updates on his journey but really improving his gut health and making those dietary changes.

Speaker 3: 42:30

And this is coming from a nutritionist. He graduated with his degree in nutrition, but we still had to make changes. We thought we were doing the right things, but we really made dietary changes and improved his gut health and that dramatically changed his trajectory and helped his dysautonomia yeah, and that points out also that the best diet for each patient is very personalized.

Speaker 1: 42:53

You know, the diet that works for me may not be the diet for tyler, and so he had to find out the diet that worked for him. And so I just read a really good book by a guy named Peter Addy, a real popular author these days. It's called Outlive. In the book he talks about the concept of healthspan as opposed to lifespan. So lifespan is how long you live, but healthspan is the concept of maintaining full function and a high quality of life as nearly as possible right to the end of life. It's not a new concept. It appears to have been first discussed back in the 1980s. But Dr Adia does a really nice job discussing it in his book, and so I highly recommend it. I'll list his book in the references at mcminnmdcom.

Speaker 3: 43:31

Wouldn't it be nice to live to a ripe old age with your physical, mental and emotional capacities optimized. Then you play a round of tennis one day, or go for a nice walk in nature, and then you die in your sleep that night.

Speaker 3: 43:43

Oh, that'd be great, wouldn't it, leslie yeah that just sounds like a nice way to go versus the more common scenario where we have this prolonged gradual decline and you have kind of just a lot of physical suffering or misery on the way and you spend the last 10 years in a nursing home stuck there more or less alone, away from your family, not doing the things that you love. The people in these scenarios may have the exact same lifespan, but the first patient has a much better health span.

Speaker 1: 44:12

Yeah, one particular thing I found interesting in Dr Addy's book exercise, not diet, is by far the number one aspect of lifestyle medicines that most effectively promoted a robust health span. I would have thought it was diet, quite frankly, coach, but Dr Addy made a really compelling case for exercise being number one. And, by the way, the book does come in audible as well. So if you want to just listen to it instead of reading it, that works also. But so let me wrap this up by going back to the arch of wellness and summarizing. The take-home message is that the keystone at the top of the arch is behavioral change. It is the day-to-day attention to the fundamental way that we live our lives over time that translates into our best chance of living a long, happy, fulfilling, meaningful, healthy life in mind, body and spirit.

Speaker 3: 44:56

Happy, fulfilling, meaningful healthy life in mind, body and spirit. And, as you can see from the graphic, the patient must put on the mantle of the empowered patient and the provider must be totally engaged in doing whatever needs to be done to help that patient achieve their best outcome. The Arch of Wellness graphic outlines that steps that the engaged provider and the empowered patient need to take in order to get to that keystone of behavioral change and that leads to optimal wellness. So we are not denying that behavioral change can be difficult. People are resistant and have the right to be. But that's why effective communication, behavioral interviewing, education, motivation and coaching are key elements to this program.

Speaker 3: 45:39

But at the end of the day, even the engaged provider can only do so much. The patient either gets on board or they don't. They come to the fork in the road and they can take the wrong fork, continuing their unhealthy ways. Pay the consequences down the road, or they can take the right fork. Consequences down the road, or they can take the right fork. Engage in the behavioral change, Take the path outlined in the arch of wellness and, step by step, head towards optimizing their wellness.

Speaker 1: 46:03

So the mantle of the empowered patient is right there in front of you for the taking. I've said many times on the podcast that your health is your greatest blessing in life. Instead of taking it for granted, we need to be incredibly grateful for it, cherish it and nurture it as best we can. And let's face it, youth covers up for a lot, but as we get older, stuff happens. I vividly remember a lovely patient of mine who was from New Orleans and, by the way, if you've never been to New Orleans, you've got to go. It has more character and soul than any city I can think of in America.

Speaker 1: 46:31

However, the folks in New Orleans do know how to party. Folks in New Orleans do know how to party and it's not just a now and then. For them, it's a way of life. My friend said she had to get out of New Orleans and away from the New Orleans lifestyle for her health and that most of her friends who still live there were pretty decrepit in their 50s. They drank and smoked and partied and ate their way into badness at a relatively young age. But they had a good time getting there. But also good for my friend that she saw the light and she's now incredibly healthy and vibrant as she approaches 70.

Speaker 3: 47:05

I think that illustrates so much about to just surrounding yourself with the things that are going to propel you forward, so at some point a person's light bulb of awareness has to turn on. Then the patient needs to drink the Kool-Aid get with the program. The good news is that it can usually be a gradual transition. You don't have to do everything at once, and I would really suggest that most people will not be successful trying to do everything at once. Pick that low-lying fruit first, the things that are most important to your health, the easiest to do, and go after those first, and then, little by little, keep moving in the right direction. Plan things like restorative sleep, stress reduction, healthy eating and exercise into your day from the get-go.

Speaker 1: 47:42

And I think we have podcasts on just about all those things we just mentioned. So that could be a little bit of a guidepost to help you get started with those. In closing, we on the podcast will continue to be engaged providers, at least as best we can do via a podcast, and we hope that you will take on the role of being the empowered patient. Together, and with the help of your provider, we can reach the keystone of the arch and create the behavioral change that will help you achieve your optimal wellness.

Speaker 3: 48:06

That'll about do it for this episode of the Wellness Connection MD. Thank you so much for joining us. We hope that you're able to glean something from what we've shared and that it was helpful to you.

Speaker 1: 48:17

And don't be afraid to reach out to us. You can check us out at mcmindmdcom, where you can find the McMind MD blog, and please help the podcast grow by telling your friends and family about us.

Speaker 3: 48:28

And take a moment to rate us on iTunes. The reviews really help us get the word out.

Speaker 1: 48:37

And you can email me at drmcmind at yahoocom. You can also find me at McMinnMD on Facebook, Instagram, Twitter and LinkedIn. And now, Coach Lindsey, please leave us with a. Coach Lindsey, pearl of wisdom.

Speaker 3: 48:47

You know I mentioned earlier that my dad's a basketball coach and one of his things I know we talk about Dr Sherrill's phrases, so this is one of my dad's and he said how do you eat? He said moose. I think most people say how do you eat an elephant, but my dad would always say moose and he'd say one bite at a time.

Speaker 1: 49:04

There we go.

Speaker 3: 49:06

So if you feel like you're in a lose-lose situation, you feel overwhelmed. We're going to start one step at a time and go back, pick that like Dr McMinn said, the lowest lying fruit or another way of looking at it would be the weakest link in your chain you know what's that thing and pick that one thing and put it on the arch of wellness and put it right there at the bottom on the empowered patient side, and just okay, I'm starting at that bottom and move forward like Candyland.

Speaker 3: 49:33

One step to the next and move forward to that behavioral change.

Speaker 1: 49:37

Yeah, you know, I remember I used the phrase low-lying fruit one time with a patient and they didn't really know what I was talking about, so I don't want to insult anybody's intelligence here.

Speaker 3: 49:44

But let me just explain that for a minute, all right.

Speaker 1: 49:46

So if you come across an apple tree, you can stand there and just reach up and pick a low-lying apple, or you can get out your ladder or climb to the top of the tree and pick the highest apple. Right which one's easier? The low-lying apple. It tastes just as good. So just to do the things that give you the most value, that are the easiest, and that could be something as simple as reducing the sugar in your life and going for a walk after dinner, or something like that. And then from there you get more aggressive and you keep moving up the chain.

Speaker 3: 50:12

And it snowballs. It has an energy of itself.

Speaker 1: 50:17

Once you get started, there's inertia. Once you feel better and better and better, you want to do more. Yes, and so, anyway, well, that should wrap it up, and thank you so much for listening. We really appreciate it. This is Dr McMinn.

Speaker 3: 50:26

And this is Coach Lindsay.

Speaker 1: 50:27

Take care and be well.