April 7, 2024 • 50 mins
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.”
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hello, this is Dr McMahon and welcome to Wellness
Connection MD.
Maybe you've realized that youhave a health challenge going on
in your life or, for somereason, you have become aware of
the importance of optimalwellness, but you just can't
figure out how to get from hereto there.
It seems overwhelming.
Well, if you come to the rightplace today on the podcast,
we're going to outline for you astep-by-step approach, for you
and your provider, to help youachieve your wellness goals.
(00:24):
So buckle up and let's getgoing on the path to optimal
wellness.
Speaker 2 (00:30):
Welcome to the Wellness Connection MD podcast
with Dr McMinn and Coach Lindsay, where we bring you the latest
up-to-date, evidence-basedinformation on a wide variety of
health and wellness topics,along with practical take-home
solutions.
Dr McMinn is an integrated andfunctional MD.
Thank you podcasts.
Visit McMinnMDcom and to stayup to date on the latest topics,
(00:51):
be sure to subscribe to ourpodcast on your favorite podcast
player so that you'll benotified when future episodes
come out.
The discussions contained inthis podcast are for educational
(01:13):
purposes only and are notintended to diagnose or treat
any disease.
Please do not apply any of thisinformation without approval
from your personal doctor.
And now on to the show with DrMcMinn and Coach Lindsey.
Speaker 1 (01:26):
Hello and welcome to Wellness Connection MD, the
evidence-based podcast on allthings wellness.
We thank you so much forjoining us today.
I'm Dr Jim McMinn and I'm heretoday with our co-host, nurse
and certified health coach, msLindsey Matthews.
Good morning, coach.
Speaker 3 (01:41):
Hey, dr Mack, good morning.
It's so great to be back on theshow with you, dr McMinn, and
also all you listeners, thanksfor tuning in.
As always, we come to you todayto bring you honest,
commercial-free, unbiased,current, evidence-based,
outcomes-oriented informationalong with practical solutions.
So in order to empower youlisteners to overcome your
(02:03):
health care challenges, tooptimize your wellness in mind,
body and spirit, and to becomethat great captain of your ship
when it comes to your health andwellness.
That's why we're here.
Speaker 1 (02:15):
Yeah, coach, for some folks, when they think about
where they are with their healthand wellness and where they
want to be, it can seem somewhatoverwhelming to try to get from
here to there.
Where do you start, oh my gosh,so anyway?
Well, today we're going to getback to basics and lay out for
you a practical, step-by-steppath that you can use,
preferably along with yourprovider, to help you achieve
your wellness goals.
Speaker 3 (02:35):
But first we have a couple of our housekeeping
duties that are very brief we'lltake care of here.
Our podcast remainscommercial-free, so you won't
have to be bothered by theannoying and sometimes
disingenuous commercials.
Speaker 1 (02:48):
However, it does cause us money to produce these
podcasts.
So think of us like publicradio and consider making a
contribution to help us keep itcoming to you.
Speaker 3 (02:54):
And so there's a couple ways that you can do that
.
First, if you buy nutritionalsupplements, then consider
purchasing physician-gradesupplements from our Fullscript
dispensary at a 10% discount.
You can see that link toFullscript below in the show
notes, or go to mcminnmdcom andthe link will also be there at
the bottom of the homepage underhelpful links.
(03:17):
It's simple Just click on thelink.
They'll guide you through theprocess.
It's a win-win you get thesupplements that are high
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Speaker 1 (03:29):
And you can also make a contribution directly to the
show via credit card or PayPalat the Support the Show link,
which is also in the show notes.
And please don't forget tosubscribe to the show and tell
your friends about us and yourfamily about us, so we can keep
it growing.
And thank you again.
So much.
Speaker 3 (03:44):
And now Dr Mack, on to the show.
Speaker 1 (03:47):
Well, coach, everybody likes stories, so I'm
going to tell just a brief truestory to set the stage for our
topic today.
Speaker 3 (03:53):
I'm listening, sounds good.
Speaker 1 (03:55):
So one day I was just seeing a new patient in my
office and like many of my guypatients, he really didn't want
to be there.
But his wife loved him andcould see his decline and she
didn't want to be a young widowwith a bunch of kids.
So she twisted his arm and madehim come in, kicking and
screaming the whole way.
So I did my usual schtick withhim.
I took a thorough history, didan exam and I went over all his
labs with him and it becameabundantly clear to me that he
(04:16):
was heading down the road toruin.
As usual, the wife was right.
Speaker 3 (04:27):
I've learned, Coach, the hard way from my marriage to
Dr Cheryl, that wives areusually right, but please don't
tell her I said so, dr Cheryl isfull of so much wisdom.
Speaker 1 (04:35):
Oh, she is Too much, darn it.
But anyway, he was, like manyof the folks I had seen in the
ER over the years, laying in agurney having a heart attack,
and I know that he too was aheart attack waiting to happen,
and sooner than later.
So I did my best to convey myconcerns to him, but he seemed
to be in total denial and wasn'treally interested in making any
changes to avoid pendingdisaster.
Like a lot of guys, he justwanted to drink beer, eat
barbecue, watch football andplay golf.
So anyway, we went back andforth but at the end of the day
(04:58):
I just could not get through tohim.
It was very frustrating for meas a provider and I threw every
trick in the book at him, butjust he wouldn't budge.
He just clammed up and insistedon continuing his
self-destructive ways.
It was almost like a suicidalwish, coach.
So I came home from work thatnight and the interaction with
him just lingered with me.
I stood over it and it reallybegan to bug me that I wasn't
(05:18):
able to get his attention.
I kind of felt like I hadfailed him really Coach him.
I kind of felt like I hadfailed him really, coach, and
for some reason I got out apiece of paper and began to
brainstorm about how I mightbreak through with such patients
in the future, and by the endof the night, I came up with a
rough draft of what I now callthe Arch of Wellness.
This arch describes a two-leggedpath to optimal wellness.
(05:40):
The two legs represent thepatient's path and the
provider's path, and these pathsmeet at the top of the arch
where they come together, andthat'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 samethings and expect a different
outcome.
Speaker 3 (06:00):
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 atmcmindmdcom.
So go down to the Documentsmenu at the top of the homepage
and scroll down until you get tothe Arch of Wellness and if
you're at a point like maybeyou're driving and listening to
(06:21):
this, but if you're not, just goahead and flip there on your
phone, just so you can have anidea for the rest of this
podcast of what to do and followwith us as we kind of go
through these steps.
You're welcome to download thediagram, share it if you wish.
I'm a big lover of puttingthings on my fridge that are
important to me.
I know my mom still probablyhas her pyramid of wellness
document from seeing you.
Speaker 1 (06:43):
And she puts it up there.
Speaker 3 (06:44):
Those diagrams are just helpful.
Speaker 1 (06:46):
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 theseamorphous thoughts, but when you
can see a diagram or a pictureof it, it starts to come
together.
Yes, yes absolutely.
Speaker 3 (07:00):
I think it kind of breaks it down and any kind of
visual reminders to just clueyou back in.
So for those of you who can'tpull 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 providerand the right arch is labeled
(07:22):
the empowered patient.
So, starting at the bottom, wework 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 wherethe provider and the patient
need to take in order to achieveoptimal wellness.
So this is the arch of wellness.
Speaker 1 (07:41):
You know, Coach, those two words engaged and
empowered are really important.
I really thought a lot aboutthose words because I think one
thing we've been trying toalways try to empower the
patient to be the captain of hership.
And engaged is important aswell.
(08:11):
The provider has to give a hoot, you know, and come to the room
and be invested in trying to doeverything he or she can to
help that patient.
But certainly folks can embarkupon this wellness journey on
their own, but for those who areable to, we really feel it's
helpful to work with aknowledgeable, experienced,
caring and engaged provider orhealth coach like Lindsay to
(08:32):
help you improve your odds ofachieving your health care and
wellness goals.
Speaker 3 (08:35):
So, even though there are two parties involved here
the patient and the provider thepatient is always the captain
of the ship.
So at the end of the day, it'sentirely up to the patient as to
whether or not he or she iswilling to embark upon this
optimal wellness journey.
So, for whatever reason, somemay find that it is not for them
(08:56):
.
And at the end of the day, theprovider can encourage and guide
.
But she can't come home withthe patient or go grocery
shopping with the patient.
She can't make the patientexercise, can't control what he
or she eats, can't make them goto 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 patientbuy-in.
(09:18):
So you, the patient, you thepatient, got to drink the
wellness Kool-Aid.
There you go.
Speaker 1 (09:22):
Got to do it.
You know, Coach, got to drinkthe 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 humblenavigator.
I actually sometimes envisioneda ship and there's the captain
sitting there, the patient, andI was right beside the captain
as the humble navigator.
I like that, Trying to steeraway from things like icebergs
and storms and to help them sailinto clear, open, calm and
(09:44):
beautiful waters.
But I can only do so much andat the end of the day, the
patient either steps up andmakes unnecessary changes and
reaps the benefits, or shedoesn't, and she continues down
the path to more badness.
Speaker 3 (09:54):
As I mentioned, dr Mack labeled the right leg the
empowered patient and, as yousaid, dr Newman, earlier,
historically medicine can bedisempowering.
The patient goes to the doctor,he receives the orders from the
doctor and take this pill andyou're expected to follow it,
and the last thing that thedoctor wants to hear is the
patient coming up and sayinghere's Dr Google's opinion, and
(10:17):
what about this and what aboutthat?
We just want to make it simplesometimes 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 optimaloutcomes, the patient must be
empowered in order to beactively engaged in the solution
, and engaged in a solutionthat's long-term too.
So at the McMinn Clinic, weused to literally give away
hundreds of books in order toeducate our patients, to get
buy-in, to motivate them asolution that's long-term too.
So at the McMinn Clinic, weused to literally give away
hundreds of books in order toeducate our patients, to get
(10:47):
buy-in, to motivate them to takethe necessary steps.
You'd give them journals, you'dtry 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 enterinto the encounter prepared and
willing to do whatever he or shecan do to help that patient
achieve their goals.
Unfortunately, the way thingsare going in modern medicine,
most providers these days workfor the man in a corporate
medical structure and the mainfocus of which is to make a
profit.
These providers are often underthe gun to see more and more
(11:16):
patients in order to increaserevenues.
They also have to spend moretime on the electronic medical
record, so their time is evenmore limited.
Also, sadly, most doctors havebeen brainwashed into taking a
drug-focused perspective.
They have learned very littleabout important lifestyle
medicine therapies likenutrition.
And I'm not saying this to bashmy medical colleagues, lindsay,
(11:36):
it's just the honest truth.
Most doctors will admit it.
It's just the way it is.
Coach, but in this model we arepromoting, the provider has to
be totally prepared and engagedto 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 ourwhole system, our whole setup,
what we've bought into asproviders and patients, is
broken, you know.
So it's also like this globalcultural problem of how we
approach things in general andlike as patients.
So many of us patients come injust with this consumeristic
(12:12):
mindset.
And we're not willing to, youknow.
We just put it all in theprovider's lap instead, and so
there's this, you know, yeah, soit's a system failure.
So those are the two legs of ourarch empowered patient and
engaged provider.
So let's break this down byfirst working our way up the
(12:34):
patient's path to optimalwellness.
Let's take it kind of stone bystone.
So the very first step or stoneon the path is awareness.
At some point the patient hasto exit the denial mode and we
got to wake up and realize thatthere is a problem, or at least
that they're not where they wantto 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 awarenessbegan with me carefully
communicating to him theaccumulating risk factors that
would most likely result in asignificant bad outcome for him
in the not too distant future.
I also assured him that if wegot busy and made the necessary
changes, that he couldpotentially avoid the pending
disaster.
People often take their healthfor granted, coach, until they
(13:17):
have that stroke or their heartattack, but by then it's too
late.
Once you've had that heartattack or stroke, you can't take
it back.
I think that my conversationwith him was the first time he
had really heard it in suchhonest terms, but I made sure he
got the message.
At that moment he did achieveawareness, which is the
all-important first step on thepath to optimal wellness, but
unfortunately he was not willingto take the next step, which is
(13:39):
intention.
In other words, he finally sawthe gravity of the situation but
was not willing to do anythingabout 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 yourecognize the problem, now you
have to be ready to actually dosomething about it.
But unfortunately, there aremany people who are aware that
they have a problem, but theyhave no intention of making the
necessary changes to address theissue.
No-transcript personalized planthat allows you the opportunity
(14:44):
to move forward to betterhealth 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 worldwon't work if it just sits on
the shelf and collects dust.
You've got to get the inertiato move forward and the
discipline to keep going withthe plan.
Speaker 3 (15:00):
The next step for the patient is then monitoring.
It helps to track your progresswith the plan and how you feel
certainly matters, and it's alsohelpful if you can track
measurables so, like theweight's coming off,
inflammation score is comingdown, blood sugar or blood
pressure normalizes.
So if you see those measurables, if you can see that things are
(15:21):
improving, then that willencourage you to continue to
stick with the plan.
On the other hand, if thingsare not improving, then you may
want to tweak and work with yourprovider to adjust the plan in
order to better move things inthe right direction.
Speaker 1 (15:35):
You know, coach, again, I'm kind of a visual guy.
So, for instance, with a lot ofpeople with weight issues, I
would encourage them to make agraph that you put on the
refrigerator, right, so you cansee it every day, and on the up
and down axis you can have yourweight and on the horizontal
axis you put time, like once aweek, and so you see that weight
coming down and, oh my gosh,it's really reinforcing.
You give yourself a pat on theback and it makes you want to
(15:57):
stick to it and try even harder.
So yeah, I'm a big believer inmonitoring, measurables and,
ultimately, charting andgraphing.
Speaker 3 (16:05):
And I know you would also like when patients would
come in.
You had a checklist initiallyof you know, these are all the
things, you know fatigue andyou'd list it on each
appointment visit and so youcould go back to the very first
visit and say are you stillhaving fatigue?
Speaker 1 (16:20):
Are you?
Still having headache I'd onlyhad 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 andthey had the extreme problem and
now it's a two, then that tellsme, because sometimes they come
in and say, well, how are youdoing?
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 youprovided that tool.
Speaker 1 (16:54):
Yeah, yeah, so that was so good, yeah right.
The last step before we get tothe keystone of the ARCH is
accountability.
The patient has to hold himselfresponsible for sticking with
the program.
If he gets off track, he needsto 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 inyour mouth or can't crack the
whip to make you exercise everyday.
(17:14):
So it's up to the patient to beaccountable to do the right
thing.
Speaker 3 (17:19):
And so before we get to the punchline, which is the
keystone step that holds thearch together, let's switch over
to the provider side of thearch and look at the steps that
the engaged provider should takein order to help the patient
achieve their optimal wellnessgoals.
The provider's very first stepis to be a good listener.
There is an old saying inmedicine which goes like this
(17:41):
listen to the patient and hewill tell you what's wrong with
him.
So many times in medicine wecount on expensive, fancy tests
to come up with a diagnosis,when instead, if the provider
will just listen to the patientand connect the dots, then the
provider will usually knowwhat'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, andyou can check that out at
mcminnmdcom under the headingWellness MD blog in the menu at
the top of the homepage, butI'll also put a link to that in
the show notes for you Also.
For many diagnoses such aschronic fatigue syndrome,
fibromyalgia, dysautonomia, thatkind of stuff, just to name a
few, there really are no goodtests for these diseases.
(18:25):
So the only way to come up witha diagnosis and a plan is
through detailed listening andconnecting the dots.
Speaker 3 (18:32):
It's also important that the practice and the
provider provide a welcoming andnon-judgmental atmosphere of
trust where the patient feelscomfortable coming in, talking
about his or her problems,knowing that they'll be taken
seriously and that you're notgoing to be judged either.
It's important that you cancome 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 withthings that there's no good
test for, like chronic fatigueor whatever.
We think they're malingering ordrug-seeking or hypochondriac
(19:12):
or whatever you knowattention-seeking, and so we got
to.
That's one thing I learned inthe ER You've got to leave your
judgment outside the room, and Ithink that, yeah, certainly
there are people who are thereto some alternate agenda, but
for the most part, your defaultshould be to trust a patient.
Speaker 3 (19:30):
Yes, most people are in a vulnerable place when they
come before a provider, and Ithink that also is something
that we, as medical professorsneed to remember.
Like this person is vulnerable,they're exposing all of their
troubles and problems, orthey're in the hospital setting.
Nobody wants to be there,nobody wants to have to deal
with these things, but therethey are.
Speaker 1 (19:49):
But finally, on the subject of listening, coach, I
know I'm kind of old school, butI just don't buy it, coach, I
know I'm kind of old school, butI just don't buy it that a
doctor can be looking at thecomputer screen and be typing in
the medical record andlistening intently to the
patient at the same time.
The practice just destroys thechemistry between the provider
and the patient and I've been onthe receiving end of this when
I went to see my doctor and Ifelt that it was very
(20:09):
off-putting.
She had her back to me thewhole time.
There was no eye contact, verylittle attention to body
language and I really didn't getthe feeling she heard a word I
said, coach, it was really kindof frustrating for me.
And also most EMR programs areconstantly flogging the provider
to fill in certain boxes inorder to boost coding and
billing.
So the provider is activelythinking about responding to the
(20:29):
EMR prompts and she's not fullyengaged in listening to the
patient.
Speaker 3 (20:36):
Right, you know, unfortunately we kind of
experienced this, my husband andI, when Tyler got really sick
several years ago withdysautonomia.
We went to all of the providersand you know some were truly,
truly kind and caring people,but we just, at the end of the
day, we didn't truly feel heardand because there wasn't
(20:57):
clear-cut answers for what wasgoing on with Tyler.
He didn't fit in the algorithmsof the problems that they were
used to.
It was just his problems kindof got dismissed.
This is just anxiety, you'rejust stressed Like here's
literally here's some anxietymedicine, and there was so much
more going on with him withdysautonomia than just that, and
(21:17):
so they didn't really get howsick he was and so it was just
that was really hard that wedidn't feel like we were taken
seriously or really understood,or really just that there was a
space for us to receive care.
you know, then at the end of theday 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 studentshad a mandatory class on
listening and asking the rightquestions, and I think it's
really becoming a lost art thiswhole listening thing, and yet
it's our most powerful tool ingetting to the right diagnosis
and to coming up with a goodtreatment plan.
I remember when I was in the ER, it seemed like the best
(22:01):
doctors did the fewest tests.
They took a good history, amedical history, and they did a
good exam and they kind of knewwhat was going on at that point.
They didn't need to rely on abunch of fancy tests.
On the other hand, the doctorswho were less secure in their
clinical skills order moreneedless labs and x-rays, and
the ER was always backed up andthe patients waited forever to
get these test results to comeback when these doctors were on
(22:23):
duty.
So for you providers out there,history, history, history.
Listen intently to yourpatients, connect the dots, and
your basic, as I said above,your basic default should always
be to trust the patient and totake them seriously.
And one more thing, coach whenI was before I retired all those
years at McMinn Clinic, duringthe patient visit, I learned to
(22:44):
take these cryptic shorthandnotes, and I could do this
without ever looking away fromthe patient.
I always maintained eye contactso that I could see the facial
expressions and read the bodylanguage, but then at the end of
the visit, I always typed thepatient a note, which is
actually a letter, and in thefirst paragraph I summarized
(23:04):
their complaints.
And by doing this, the patientalways knew that they had been
listened to and I had heardeverything, and they really
seemed to appreciate thisconfirmation 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 andI think there's a healing that
comes from the provider justthrough that.
Speaker 1 (23:23):
Another advantage of that Coach is that when you do
that and you go over that letterwith them, if you got it wrong,
then that was their chance totell 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 quitewhat I said or what I meant, but
that way you know you bothagree that here's what we're
dealing with, here are theissues, and so I think it really
helped.
As you remember, coach, I wrotethousands 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 theircomplaints, it helps with that
intention step of seeing, oh wow, that's a lot written out.
I am now fully aware of all thethings that I've just kind of
been shuffling around anddealing with in my life.
And now let me form a betterintention to move forward.
(24:14):
So I think that really helpsthem on those beginning steps of
the arch in becoming thatempowered patient.
But the next step for theengaged provider is to do that
just old-fashioned physical exam.
This is another cornerstone ofclinical medicine that can tell
you a lot about what's going on.
However, along with listening,this too seems to be becoming a
(24:37):
thing of the past.
I believe that it is often anexpectation on the patient that
the provider examines him or her.
I have heard it repeated manytimes from the patient about
other providers.
He never examined me, he nevereven touched me, he didn't
listen to me, like with astethoscope.
Besides gathering data, I dothink that there is
consideration to be given to thepower of touch, done in an
(24:59):
appropriate and, of course,professional manner to the
comfort of the patient and tofurther establish that
connection between the providerand 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 hashelped me as a provider to make
the right diagnosis.
Let me tell you just a quickstory to illustrate the point.
I had a 40-something-year-oldlady who came to see me one day.
I'd been seeing her for quite awhile 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 maincomplaint or really the reason
why she was there.
But with every patient I hadjust a quick exam.
(25:30):
I did, and this takes twominutes and so I felt her belly
and I said, hmm, this doesn'tfeel like constipation to me.
Let's get a quick ultrasound.
So we did and we found that shehad an early ovarian mass.
I remember that and I rememberher telling me the story about
that.
And so we caught it so earlybecause of that two minute exam
(25:53):
that she got it cut out.
She never had to do any chemo,any radiation.
It's been at least 10 years agoand she's still cancer-free
from a cancer that's usuallydeadly all due to a two-minute
physical exam.
I'm just saying, coach, we relyso much on fancy CAT scans, mri
stuff like that, but justexamining 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 workingin the hospital, I recall a
patient that me, as the nurse, Ihad to escalate their care
because the patient wastachypneic, meaning they were
breathing fast.
But when they were transferredto the ICU setting they just
hooked him up to the monitor andthe monitor did not pick up
(26:35):
those respirations, but the mystethoscope 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 topick that up.
But so you know it's justmonitors 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 theplace 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 moredata, 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 opinionthat overall providers probably
do too much testing.
Unfortunately, there has beenan explosion in the number of
lab tests that providers can doand I think sometimes that's
part of like it's patient drivenin some ways Like people want
(27:26):
more data, more information,more, more more.
Speaker 1 (27:28):
Plus there's money in it.
You go to a conference and sometesting company is there and
say, oh, do this fancy test.
And they have a beautifuldisplay and a good-looking lady
who's pushing it Right yeah.
So some former high-heeledex-nurse, so anyway.
So doctors buy into it and theydo these tests, but it really
doesn't change outcomes.
Right and a lot of times thesetests 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 thepatient.
So we should do the tests thatwe need.
Tests can be a helpful tool.
They're in our toolbox, but wedon't want to over-test either.
Speaker 1 (28:08):
And sometimes these tests uncover things I call
incidentalomas, which, as thename implies, it's an incidental
finding that has nothing to dowith why the patient came to see
you, and are usuallyinsignificant and irrelevant.
These findings can send youdown rabbit holes, muddying up
the clinical picture, costingthe patient even more money, and
usually result in no benefit tothe patient.
One fundamental tenet that Ialways adopted over the years
(28:31):
was to never do a test if it'snot going to change the outcome
for the patient.
As you know, coach, we did alot of work with gut health, and
when I first started with mygut health focus, I ordered a
lot of functional testing, but Ieventually realized, after
doing a lot of it, that theanswer was always the same.
It's kind of crazy.
Not enough diversity, yeah itwas always that the microbiome
(28:51):
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 wasscrewed 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 engagedprovider has gathered the
information by listeningphysical exam tests, the next
step is to put together acustomized treatment plan for
the patient.
Since, as the providers, wetend to take a functional and
integrative approach, we try toconnect the dots and take this
ground-up root cause approach inour treatment plan.
(29:26):
So, for instance, a patientcomes 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 wouldalso include a gut health
program, whereas traditionalmedical approach would be to
prescribe some antihistaminedrugs, even perhaps some
(29:47):
steroids, along with sometopical salves.
Most of these patients had seenthe dermatologist before they
got to us and the traditionalapproach just had not worked.
They had a bunch of salvesthere in the medicine cabinet.
You know a bunch of thosemedicine bottles, but we often
saw miracle cures with many ofthese same patients.
With this root cause functionalapproach.
Speaker 1 (30:09):
Right In that particular situation.
Coach, we did a whole podcaston the gut skin connection,
which I think was quite good.
If you don't mind me saying somyself, I might want to go back
and take a listen to that, butpatients often came in with many
complaints.
For instance, a very commonscenario 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.
(30:30):
And so I mean you could spend awhole visit just on any one of
those.
So one therapeutic approachwould be to work on these one at
a time, and it may be helpfulto check in with the patient and
ask her how aggressive wouldyou like for me to be?
If she wants to take a go-slowapproach, then you might want to
go one at a time and startworking on the things that are
most important to her, and thenyou can circle back around and
(30:51):
take them one by one untilthey're all addressed.
However, let's go back to ourveterinarian, dr Cheryl's
pronouncement that dogs can havetics and fleas at the same time
.
So when the patient has allthese various complaints, their
problems could be totallyseparate things like tics and
fleas.
Or I have found in manyinstances you can connect the
dots to a common denominator.
More often than not that has todo with things like gut health,
(31:14):
since there is a what I call agut everything connection.
So if the patient was up for itand wanted to be more
aggressive and get to a betterplace quicker, then my default
was to usually treat all thesethings at once with a functional
root cause approach, andusually this did the trick and
the patient came back andeverything was better.
And, quite frankly, as aprovider, it was pretty amazing
(31:37):
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 comesup 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, andthe 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 orautoimmune disease.
Right, and they have a right tounderstand what's going on with
their bodies, and so we need tostep up and explain their
conditions to them in terms theycan understand.
It also helps to go over theirlabs and other tests line by
line so they can feel confidentwe'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 thepatient to get going with the
program, to stick with theprogram, and some people are
sick and tired of being sick andtired and they can't wait to
get going.
However, for others it can bechallenging to get them moving.
It may seem overwhelming, sincewe're sometimes asking them to
make some really fundamentalchanges to their way of life.
(32:38):
It's not like just simply, youknow, here's another pill to
take in the morning.
Just as an example, we've seenpatients go gluten-free and see
amazing benefits their chronicheadaches are gone, their skin
itching gets better and on andon, they have better energy, etc
.
But for someone who has eatengluten products all their life
and they're used to going to thegrocery store and these are the
things they get every time itmay seem daunting to really give
(33:02):
it up and to get started withthat gluten-free program.
Speaker 1 (33:04):
They have no idea how to do it.
And that's why I'm a hugebeliever in things like health
coaches and nutritionists and Iwas so blessed to have you and
Nurse Laurel and Jennifer at theclinic and you guys were
wonderful with things likemotivational interviewing and
help get patients on board withthe program and holding them
accountable.
You definitely changed so manylives, lindsay, and I know the
(33:24):
patients were very grateful forthat 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 Ilike to use the analogy of two
young basketball players who arejust starting to learn how to
shoot free throws.
With one player, you could saygo work on your free throws,
I'll come back and check on youin six weeks.
And then for the other one, youcan have this program with
detailed instructions, like aplan for becoming the greatest
(33:51):
free throw shooter and a coachwho would work with them every
day to help them achieve thosegoals.
And at the end of the allottedtime, I'm pretty confident that
the player with the plan and thecoach will almost always
outperform the player who justtried 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 hotteam.
Speaker 3 (34:18):
Oh my gosh yeah but hey, look at Bama there I know,
I know, I know, but anyway, andnow 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, whichcan be sometimes quite
complicated, the patient withthe health coach will often find
it easier to get going and willbe better prepared to stick
with the program and ultimatelywill have better clinical
outcomes than the patientwithout 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 ofthe arch meet in the middle to
create that keystone.
This is the step that makes thewhole thing come together and
work.
The important step is calledbehavioral 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 samething 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 overand over again and expect new
results so we're going to try tobe sane here and, as the term
behavioral change implies, thisstep may require fundamental
changes in the way we live ourlives.
This overlaps with the conceptof lifestyle medicine.
We did a great podcast on that,which is number 34.
(35:32):
And on the podcast I calledlifestyle medicine the most
powerful medicine on earth, andyou might want to go back and
check that one out.
I think it's a good one.
Again, if you don't mind mesaying so myself.
Speaker 3 (35:42):
Certainly, there is a time and a place in medicine
for drugs and surgery, and we'rethankful for them.
But for the vast majority ofour patients, behavioral change
is the key, and this can be verydifficult to do, but at the end
of the day, this is the surestway to optimal wellness for most
(36:02):
patients and for our society asa whole, especially with our
skyrocketing rates of chronicdiseases that are also
increasing our health care costs.
So our current trajectory isnot sustainable.
Speaker 1 (36:13):
You know, coach, I don't know if you've seen the
price tag on some of these newdrugs.
I mean, when you watch TV, yousee commercial after commercial
for these expensive like,especially, autoimmune drugs.
Oh my gosh, they cost a fortune.
And so we're just going to endup bankrupting our healthcare
system if we don't change thefundamental way we practice and
we live our lives.
So one of the things we talkabout most in this lifestyle
(36:35):
discussion is diet, is nutrition, and I've seen dietary changes
work miracles with patients, butthey're difficult and
especially here down south wherewe live.
The good old southern diet ispredominantly kind of a high-fat
diet and we have the right tobe proud of our southern food
heritage.
It's wonderful high-fat dietand we have the right to be
(36:56):
proud of our Southern foodheritage.
It's wonderful.
Some of our most common mealsinclude biscuits and gravy,
fried chicken, fried greentomatoes, fried just about
anything.
Oh yeah, anything we can fryOreos.
That's right.
Fry Oreos Right.
The world's best barbecue, andwe all wash it down with a
gallon of Milo sweet tea and Imean sweet tea and take a couple
pieces of pecan pie along withsome homemade Nella ice cream
(37:17):
sweet tea, and take a couplepieces 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 usthat, along with these tasty
Southern treats, we in the Southalso lead the nation in obesity
, hypertension, diabetes, and wehave the shortest lifespan in
the nation.
In fact, six out of the topseven states for diabetes are
(37:49):
right here, right here in theheart 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 theleast exercise and, coach, when
you add it all up, thescientists all agree that it's
not a coincidence that there's ahuge overlap between the
Southern diet and lifestyle andthese unwanted conditions like
obesity, diabetes, hypertensionand ultimately, premature death.
In fact, you know, Coach, Ithink in some clinics around
(38:19):
Alabama it's the exception ifyou 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 tothe 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 sugarnumber on your lab report.
It's amputations, blindness,heart problems, kidney failure,
neuropathy, increased rates ofcancer and dementia.
And likewise, hypertension isnot just blood pressure rating.
It also has those similarnegative consequences I just
(38:57):
listed.
So that sweet tea and friedfood may taste good going down,
but it's got a big price tag andthe long-term consequence of
chronically always eating thosethings in is a life of prolonged
illness, misery and evenpremature death.
So it's serious.
I mean, it's just, it'sprofound.
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 hada big family get together, you
know, and at that get together.
We eat a lot of food, which iswonderful, it tastes so good.
But if I ate like that on aregular basis, oh my gosh, I'd
be big as a barn.
So anyway, so I practice, andme and my wife Cheryl, we
(39:40):
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 eatpretty healthy.
We try to focus on just a wholefood diet.
That's our emphasis.
But you know, we every now andthen go out and blow it out and,
like the holidays come along,we have a family get together
and there's that homemade icecream or whatever.
Speaker 3 (40:03):
And I think those things are healing and healthy
for us.
On that emotional, like weconnect over food, we connect
over these things.
But to your point, I think it'sthat ratio, that 90-10, that
80-20, but truly living thatratio 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 expectingperfection.
But there are some people.
If they veer off the path atall, they pay heavy consequences
.
I'm thinking of a wonderfulyoung girl who came to see me
one time with a juvenilerheumatoid arthritis and it was
practically crippling for herand I got her on a program and
one of the biggest things we didwas change her diet and it was
(40:45):
a miracle cure, coach.
It was just amazing.
But she told me if she slippedand ate food she wasn't supposed
to, she could feel it rightaway.
So I do think that some peoplejust can't have any wiggle room.
But from the medical point ofview, we have pills for diabetes
, pills for blood pressure andeven now we have pills in
(41:07):
surgery for obesity, but nothingcomes anywhere near close to
behavioral change to improveoutcomes for these patients.
And it's never too late tostart.
But the sooner you start withchanging your behavior in the
direction of a healthy lifestyle, then the greater your odds of
avoiding disease and achievingoptimal wellness.
And as I said earlier, onceyou've had that stroke you can't
take it back.
(41:27):
It's too late.
So the sooner you change thebetter.
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 ofcollateral damage.
There's collateral benefit tothis because you know you might
change your diet to improve yourdiabetes, but that's also going
to improve your heart diseaseand your dementia and this and
that and the other.
So there's so much benefit fromit.
Speaker 3 (42:00):
There are also many other conditions besides the
common diseases that we'vementioned that really benefit
from lifestyle changes, and thebiggest example to that is just
I've mentioned him many times onthe show my husband Tyler.
The thing that has helped himthe most with his dysautonomia
was not drugs or surgery, it waslifestyle change, especially
dietary changes, and you know wetalked about that on that
podcast we did a long time agoon the dysautonomia.
(42:20):
If anyone wants to search that,you can, and then we'll circle
around and do another one one ofthese days with more updates on
his journey but reallyimproving his gut health and
making those dietary changes.
And this is coming from anutritionist.
He graduated with his degree innutrition, but we still had to
make changes.
We thought we were doing theright things, but we really made
dietary changes and improvedhis gut health and that
(42:42):
dramatically changed histrajectory and helped his
dysautonomia yeah, and thatpoints out also that the best
diet for each patient is verypersonalized.
Speaker 1 (42:53):
You know, the diet that works for me may not be the
diet for tyler, and so he hadto find out the diet that worked
for him.
And so I just read a reallygood book by a guy named Peter
Addy, a real popular authorthese days.
It's called Outlive.
In the book he talks about theconcept of healthspan as opposed
to lifespan.
So lifespan is how long youlive, but healthspan is the
(43:18):
concept of maintaining fullfunction and a high quality of
life as nearly as possible rightto the end of life.
It's not a new concept.
It appears to have been firstdiscussed back in the 1980s.
But Dr Adia does a really nicejob discussing it in his book,
and so I highly recommend it.
I'll list his book in thereferences at mcminnmdcom.
Speaker 3 (43:31):
Wouldn't it be nice to live to a ripe old age with
your physical, mental andemotional capacities optimized.
Then you play a round of tennisone day, or go for a nice walk
in nature, and then you die inyour sleep that night.
Oh, that'd be great, wouldn't it, leslie yeah that just sounds
like a nice way to go versus themore common scenario where we
have this prolonged gradualdecline and you have kind of
(43:53):
just a lot of physical sufferingor misery on the way and you
spend the last 10 years in anursing home stuck there more or
less alone, away from yourfamily, not doing the things
that you love.
The people in these scenariosmay have the exact same lifespan
, but the first patient has amuch 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 mosteffectively promoted a robust
health span.
I would have thought it wasdiet, quite frankly, coach, but
Dr Addy made a really compellingcase for exercise being number
one.
And, by the way, the book doescome in audible as well.
(44:32):
So if you want to just listento it instead of reading it,
that works also.
But so let me wrap this up bygoing back to the arch of
wellness and summarizing.
The take-home message is thatthe keystone at the top of the
arch is behavioral change.
It is the day-to-day attentionto the fundamental way that we
live our lives over time thattranslates into our best chance
of living a long, happy,fulfilling, meaningful, healthy
(44:54):
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 thegraphic, the patient must put on
the mantle of the empoweredpatient and the provider must be
totally engaged in doingwhatever needs to be done to
help that patient achieve theirbest outcome.
The Arch of Wellness graphicoutlines that steps that the
engaged provider and theempowered patient need to take
(45:17):
in order to get to that keystoneof behavioral change and that
leads to optimal wellness.
So we are not denying thatbehavioral change can be
difficult.
People are resistant and havethe right to be.
But that's why effectivecommunication, behavioral
interviewing, education,motivation and coaching are key
(45:37):
elements to this program.
But at the end of the day, eventhe engaged provider can only do
so much.
The patient either gets onboard or they don't.
They come to the fork in theroad and they can take the wrong
fork, continuing theirunhealthy ways.
Pay the consequences down theroad, or they can take the right
fork.
Consequences down the road, orthey can take the right fork.
(45:59):
Engage in the behavioral change, Take the path outlined in the
arch of wellness and, step bystep, 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 thepodcast that your health is your
greatest blessing in life.
Instead of taking it forgranted, we need to be
incredibly grateful for it,cherish it and nurture it as
best we can.
And let's face it, youth coversup for a lot, but as we get
older, stuff happens.
I vividly remember a lovelypatient of mine who was from New
(46:25):
Orleans and, by the way, ifyou've never been to New Orleans
, you've got to go.
It has more character and soulthan any city I can think of in
America.
However, the folks in NewOrleans do know how to party.
Folks in New Orleans do knowhow 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 getout of New Orleans and away from
the New Orleans lifestyle forher health and that most of her
friends who still live therewere pretty decrepit in their
(46:45):
50s.
They drank and smoked andpartied and ate their way into
badness at a relatively youngage.
But they had a good timegetting there.
But also good for my friendthat she saw the light and she's
now incredibly healthy andvibrant as she approaches 70.
Speaker 3 (47:05):
I think that illustrates so much about to
just surrounding yourself withthe things that are going to
propel you forward, so at somepoint a person's light bulb of
awareness has to turn on.
Then the patient needs to drinkthe Kool-Aid get with the
program.
The good news is that it canusually be a gradual transition.
You don't have to do everythingat once, and I would really
suggest that most people willnot be successful trying to do
everything at once.
Pick that low-lying fruit first, the things that are most
(47:28):
important to your health, theeasiest to do, and go after
those first, and then, little bylittle, keep moving in the
right direction.
Plan things like restorativesleep, stress reduction, healthy
eating and exercise into yourday 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 bitof a guidepost to help you get
started with those.
In closing, we on the podcastwill continue to be engaged
providers, at least as best wecan do via a podcast, and we
hope that you will take on therole of being the empowered
patient.
Together, and with the help ofyour provider, we can reach the
keystone of the arch and createthe behavioral change that will
(48:04):
help you achieve your optimalwellness.
Speaker 3 (48:06):
That'll about do it for this episode of the Wellness
Connection MD.
Thank you so much for joiningus.
We hope that you're able toglean something from what we've
shared and that it was helpfulto you.
Speaker 1 (48:17):
And don't be afraid to reach out to us.
You can check us out atmcmindmdcom, where you can find
the McMind MD blog, and pleasehelp the podcast grow by telling
your friends and family aboutus.
Speaker 3 (48:28):
And take a moment to rate us on iTunes.
The reviews really help us getthe word out.
Speaker 1 (48:37):
And you can email me at drmcmind at yahoocom.
You can also find me atMcMinnMD on Facebook, Instagram,
Twitter and LinkedIn.
And now, Coach Lindsey, pleaseleave 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 histhings I know we talk about Dr
Sherrill's phrases, so this isone of my dad's and he said how
do you eat?
He said moose.
I think most people say how doyou eat an elephant, but my dad
would always say moose and he'dsay 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 stepat a time and go back, pick that
like Dr McMinn said, the lowestlying fruit or another way of
looking at it would be theweakest link in your chain you
know what's that thing and pickthat one thing and put it on the
arch of wellness and put itright there at the bottom on the
(49:27):
empowered patient side, andjust okay, I'm starting at that
bottom and move forward likeCandyland.
One step to the next and moveforward to that behavioral
change.
Speaker 1 (49:37):
Yeah, you know, I remember I used the phrase
low-lying fruit one time with apatient 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 picka low-lying apple, or you can
get out your ladder or climb tothe 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 thatgive you the most value, that
are the easiest, and that couldbe something as simple as
reducing the sugar in your lifeand going for a walk after
(50:07):
dinner, or something like that.
And then from there you getmore 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 betterand better, you want to do more
.
Yes, and so, anyway, well, thatshould 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 .
Hello, this is Dr McMahon and welcome to Wellness
Connection MD.
Maybe you've realized that youhave a health challenge going on
in your life or, for somereason, you have become aware of
the importance of optimalwellness, but you just can't
figure out how to get from hereto there.
It seems overwhelming.
Well, if you come to the rightplace today on the podcast,
we're going to outline for you astep-by-step approach, for you
and your provider, to help youachieve your wellness goals.
(00:24):
So buckle up and let's getgoing on the path to optimal
wellness.
Speaker 2 (00:30):
Welcome to the Wellness Connection MD podcast
with Dr McMinn and Coach Lindsay, where we bring you the latest
up-to-date, evidence-basedinformation on a wide variety of
health and wellness topics,along with practical take-home
solutions.
Dr McMinn is an integrated andfunctional MD.
Thank you podcasts.
Visit McMinnMDcom and to stayup to date on the latest topics,
(00:51):
be sure to subscribe to ourpodcast on your favorite podcast
player so that you'll benotified when future episodes
come out.
The discussions contained inthis podcast are for educational
(01:13):
purposes only and are notintended to diagnose or treat
any disease.
Please do not apply any of thisinformation without approval
from your personal doctor.
And now on to the show with DrMcMinn and Coach Lindsey.
Speaker 1 (01:26):
Hello and welcome to Wellness Connection MD, the
evidence-based podcast on allthings wellness.
We thank you so much forjoining us today.
I'm Dr Jim McMinn and I'm heretoday with our co-host, nurse
and certified health coach, msLindsey Matthews.
Good morning, coach.
Speaker 3 (01:41):
Hey, dr Mack, good morning.
It's so great to be back on theshow with you, dr McMinn, and
also all you listeners, thanksfor tuning in.
As always, we come to you todayto bring you honest,
commercial-free, unbiased,current, evidence-based,
outcomes-oriented informationalong with practical solutions.
So in order to empower youlisteners to overcome your
(02:03):
health care challenges, tooptimize your wellness in mind,
body and spirit, and to becomethat great captain of your ship
when it comes to your health andwellness.
That's why we're here.
Speaker 1 (02:15):
Yeah, coach, for some folks, when they think about
where they are with their healthand wellness and where they
want to be, it can seem somewhatoverwhelming to try to get from
here to there.
Where do you start, oh my gosh,so anyway?
Well, today we're going to getback to basics and lay out for
you a practical, step-by-steppath that you can use,
preferably along with yourprovider, to help you achieve
your wellness goals.
Speaker 3 (02:35):
But first we have a couple of our housekeeping
duties that are very brief we'lltake care of here.
Our podcast remainscommercial-free, so you won't
have to be bothered by theannoying and sometimes
disingenuous commercials.
Speaker 1 (02:48):
However, it does cause us money to produce these
podcasts.
So think of us like publicradio and consider making a
contribution to help us keep itcoming to you.
Speaker 3 (02:54):
And so there's a couple ways that you can do that
.
First, if you buy nutritionalsupplements, then consider
purchasing physician-gradesupplements from our Fullscript
dispensary at a 10% discount.
You can see that link toFullscript below in the show
notes, or go to mcminnmdcom andthe link will also be there at
the bottom of the homepage underhelpful links.
(03:17):
It's simple Just click on thelink.
They'll guide you through theprocess.
It's a win-win you get thesupplements that are high
quality at the discount and thenyou support us for the show and
we're grateful, very gratefulfor that.
Speaker 1 (03:29):
And you can also make a contribution directly to the
show via credit card or PayPalat the Support the Show link,
which is also in the show notes.
And please don't forget tosubscribe to the show and tell
your friends about us and yourfamily about us, so we can keep
it growing.
And thank you again.
So much.
Speaker 3 (03:44):
And now Dr Mack, on to the show.
Speaker 1 (03:47):
Well, coach, everybody likes stories, so I'm
going to tell just a brief truestory to set the stage for our
topic today.
Speaker 3 (03:53):
I'm listening, sounds good.
Speaker 1 (03:55):
So one day I was just seeing a new patient in my
office and like many of my guypatients, he really didn't want
to be there.
But his wife loved him andcould see his decline and she
didn't want to be a young widowwith a bunch of kids.
So she twisted his arm and madehim come in, kicking and
screaming the whole way.
So I did my usual schtick withhim.
I took a thorough history, didan exam and I went over all his
labs with him and it becameabundantly clear to me that he
(04:16):
was heading down the road toruin.
As usual, the wife was right.
Speaker 3 (04:27):
I've learned, Coach, the hard way from my marriage to
Dr Cheryl, that wives areusually right, but please don't
tell her I said so, dr Cheryl isfull of so much wisdom.
Speaker 1 (04:35):
Oh, she is Too much, darn it.
But anyway, he was, like manyof the folks I had seen in the
ER over the years, laying in agurney having a heart attack,
and I know that he too was aheart attack waiting to happen,
and sooner than later.
So I did my best to convey myconcerns to him, but he seemed
to be in total denial and wasn'treally interested in making any
changes to avoid pendingdisaster.
Like a lot of guys, he justwanted to drink beer, eat
barbecue, watch football andplay golf.
So anyway, we went back andforth but at the end of the day
(04:58):
I just could not get through tohim.
It was very frustrating for meas a provider and I threw every
trick in the book at him, butjust he wouldn't budge.
He just clammed up and insistedon continuing his
self-destructive ways.
It was almost like a suicidalwish, coach.
So I came home from work thatnight and the interaction with
him just lingered with me.
I stood over it and it reallybegan to bug me that I wasn't
(05:18):
able to get his attention.
I kind of felt like I hadfailed him really Coach him.
I kind of felt like I hadfailed him really, coach, and
for some reason I got out apiece of paper and began to
brainstorm about how I mightbreak through with such patients
in the future, and by the endof the night, I came up with a
rough draft of what I now callthe Arch of Wellness.
This arch describes a two-leggedpath to optimal wellness.
(05:40):
The two legs represent thepatient's path and the
provider's path, and these pathsmeet at the top of the arch
where they come together, andthat'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 samethings and expect a different
outcome.
Speaker 3 (06:00):
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 atmcmindmdcom.
So go down to the Documentsmenu at the top of the homepage
and scroll down until you get tothe Arch of Wellness and if
you're at a point like maybeyou're driving and listening to
(06:21):
this, but if you're not, just goahead and flip there on your
phone, just so you can have anidea for the rest of this
podcast of what to do and followwith us as we kind of go
through these steps.
You're welcome to download thediagram, share it if you wish.
I'm a big lover of puttingthings on my fridge that are
important to me.
I know my mom still probablyhas her pyramid of wellness
document from seeing you.
Speaker 1 (06:43):
And she puts it up there.
Speaker 3 (06:44):
Those diagrams are just helpful.
Speaker 1 (06:46):
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 theseamorphous thoughts, but when you
can see a diagram or a pictureof it, it starts to come
together.
Yes, yes absolutely.
Speaker 3 (07:00):
I think it kind of breaks it down and any kind of
visual reminders to just clueyou back in.
So for those of you who can'tpull 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 providerand the right arch is labeled
(07:22):
the empowered patient.
So, starting at the bottom, wework 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 wherethe provider and the patient
need to take in order to achieveoptimal wellness.
So this is the arch of wellness.
Speaker 1 (07:41):
You know, Coach, those two words engaged and
empowered are really important.
I really thought a lot aboutthose words because I think one
thing we've been trying toalways try to empower the
patient to be the captain of hership.
And engaged is important aswell.
(08:11):
The provider has to give a hoot, you know, and come to the room
and be invested in trying to doeverything he or she can to
help that patient.
But certainly folks can embarkupon this wellness journey on
their own, but for those who areable to, we really feel it's
helpful to work with aknowledgeable, experienced,
caring and engaged provider orhealth coach like Lindsay to
(08:32):
help you improve your odds ofachieving your health care and
wellness goals.
Speaker 3 (08:35):
So, even though there are two parties involved here
the patient and the provider thepatient is always the captain
of the ship.
So at the end of the day, it'sentirely up to the patient as to
whether or not he or she iswilling to embark upon this
optimal wellness journey.
So, for whatever reason, somemay find that it is not for them
(08:56):
.
And at the end of the day, theprovider can encourage and guide
.
But she can't come home withthe patient or go grocery
shopping with the patient.
She can't make the patientexercise, can't control what he
or she eats, can't make them goto 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 patientbuy-in.
(09:18):
So you, the patient, you thepatient, got to drink the
wellness Kool-Aid.
There you go.
Speaker 1 (09:22):
Got to do it.
You know, Coach, got to drinkthe 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 humblenavigator.
I actually sometimes envisioneda ship and there's the captain
sitting there, the patient, andI was right beside the captain
as the humble navigator.
I like that, Trying to steeraway from things like icebergs
and storms and to help them sailinto clear, open, calm and
(09:44):
beautiful waters.
But I can only do so much andat the end of the day, the
patient either steps up andmakes unnecessary changes and
reaps the benefits, or shedoesn't, and she continues down
the path to more badness.
Speaker 3 (09:54):
As I mentioned, dr Mack labeled the right leg the
empowered patient and, as yousaid, dr Newman, earlier,
historically medicine can bedisempowering.
The patient goes to the doctor,he receives the orders from the
doctor and take this pill andyou're expected to follow it,
and the last thing that thedoctor wants to hear is the
patient coming up and sayinghere's Dr Google's opinion, and
(10:17):
what about this and what aboutthat?
We just want to make it simplesometimes 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 optimaloutcomes, the patient must be
empowered in order to beactively engaged in the solution
, and engaged in a solutionthat's long-term too.
So at the McMinn Clinic, weused to literally give away
hundreds of books in order toeducate our patients, to get
buy-in, to motivate them asolution that's long-term too.
So at the McMinn Clinic, weused to literally give away
hundreds of books in order toeducate our patients, to get
(10:47):
buy-in, to motivate them to takethe necessary steps.
You'd give them journals, you'dtry 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 enterinto the encounter prepared and
willing to do whatever he or shecan do to help that patient
achieve their goals.
Unfortunately, the way thingsare going in modern medicine,
most providers these days workfor the man in a corporate
medical structure and the mainfocus of which is to make a
profit.
These providers are often underthe gun to see more and more
(11:16):
patients in order to increaserevenues.
They also have to spend moretime on the electronic medical
record, so their time is evenmore limited.
Also, sadly, most doctors havebeen brainwashed into taking a
drug-focused perspective.
They have learned very littleabout important lifestyle
medicine therapies likenutrition.
And I'm not saying this to bashmy medical colleagues, lindsay,
(11:36):
it's just the honest truth.
Most doctors will admit it.
It's just the way it is.
Coach, but in this model we arepromoting, the provider has to
be totally prepared and engagedto 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 ourwhole system, our whole setup,
what we've bought into asproviders and patients, is
broken, you know.
So it's also like this globalcultural problem of how we
approach things in general andlike as patients.
So many of us patients come injust with this consumeristic
(12:12):
mindset.
And we're not willing to, youknow.
We just put it all in theprovider's lap instead, and so
there's this, you know, yeah, soit's a system failure.
So those are the two legs of ourarch empowered patient and
engaged provider.
So let's break this down byfirst working our way up the
(12:34):
patient's path to optimalwellness.
Let's take it kind of stone bystone.
So the very first step or stoneon the path is awareness.
At some point the patient hasto exit the denial mode and we
got to wake up and realize thatthere is a problem, or at least
that they're not where they wantto 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 awarenessbegan with me carefully
communicating to him theaccumulating risk factors that
would most likely result in asignificant bad outcome for him
in the not too distant future.
I also assured him that if wegot busy and made the necessary
changes, that he couldpotentially avoid the pending
disaster.
People often take their healthfor granted, coach, until they
(13:17):
have that stroke or their heartattack, but by then it's too
late.
Once you've had that heartattack or stroke, you can't take
it back.
I think that my conversationwith him was the first time he
had really heard it in suchhonest terms, but I made sure he
got the message.
At that moment he did achieveawareness, which is the
all-important first step on thepath to optimal wellness, but
unfortunately he was not willingto take the next step, which is
(13:39):
intention.
In other words, he finally sawthe gravity of the situation but
was not willing to do anythingabout 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 yourecognize the problem, now you
have to be ready to actually dosomething about it.
But unfortunately, there aremany people who are aware that
they have a problem, but theyhave no intention of making the
necessary changes to address theissue.
No-transcript personalized planthat allows you the opportunity
(14:44):
to move forward to betterhealth 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 worldwon't work if it just sits on
the shelf and collects dust.
You've got to get the inertiato move forward and the
discipline to keep going withthe plan.
Speaker 3 (15:00):
The next step for the patient is then monitoring.
It helps to track your progresswith the plan and how you feel
certainly matters, and it's alsohelpful if you can track
measurables so, like theweight's coming off,
inflammation score is comingdown, blood sugar or blood
pressure normalizes.
So if you see those measurables, if you can see that things are
(15:21):
improving, then that willencourage you to continue to
stick with the plan.
On the other hand, if thingsare not improving, then you may
want to tweak and work with yourprovider to adjust the plan in
order to better move things inthe right direction.
Speaker 1 (15:35):
You know, coach, again, I'm kind of a visual guy.
So, for instance, with a lot ofpeople with weight issues, I
would encourage them to make agraph that you put on the
refrigerator, right, so you cansee it every day, and on the up
and down axis you can have yourweight and on the horizontal
axis you put time, like once aweek, and so you see that weight
coming down and, oh my gosh,it's really reinforcing.
You give yourself a pat on theback and it makes you want to
(15:57):
stick to it and try even harder.
So yeah, I'm a big believer inmonitoring, measurables and,
ultimately, charting andgraphing.
Speaker 3 (16:05):
And I know you would also like when patients would
come in.
You had a checklist initiallyof you know, these are all the
things, you know fatigue andyou'd list it on each
appointment visit and so youcould go back to the very first
visit and say are you stillhaving fatigue?
Speaker 1 (16:20):
Are you?
Still having headache I'd onlyhad 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 andthey had the extreme problem and
now it's a two, then that tellsme, because sometimes they come
in and say, well, how are youdoing?
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 youprovided that tool.
Speaker 1 (16:54):
Yeah, yeah, so that was so good, yeah right.
The last step before we get tothe keystone of the ARCH is
accountability.
The patient has to hold himselfresponsible for sticking with
the program.
If he gets off track, he needsto 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 inyour mouth or can't crack the
whip to make you exercise everyday.
(17:14):
So it's up to the patient to beaccountable to do the right
thing.
Speaker 3 (17:19):
And so before we get to the punchline, which is the
keystone step that holds thearch together, let's switch over
to the provider side of thearch and look at the steps that
the engaged provider should takein order to help the patient
achieve their optimal wellnessgoals.
The provider's very first stepis to be a good listener.
There is an old saying inmedicine which goes like this
(17:41):
listen to the patient and hewill tell you what's wrong with
him.
So many times in medicine wecount on expensive, fancy tests
to come up with a diagnosis,when instead, if the provider
will just listen to the patientand connect the dots, then the
provider will usually knowwhat'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, andyou can check that out at
mcminnmdcom under the headingWellness MD blog in the menu at
the top of the homepage, butI'll also put a link to that in
the show notes for you Also.
For many diagnoses such aschronic fatigue syndrome,
fibromyalgia, dysautonomia, thatkind of stuff, just to name a
few, there really are no goodtests for these diseases.
(18:25):
So the only way to come up witha diagnosis and a plan is
through detailed listening andconnecting the dots.
Speaker 3 (18:32):
It's also important that the practice and the
provider provide a welcoming andnon-judgmental atmosphere of
trust where the patient feelscomfortable coming in, talking
about his or her problems,knowing that they'll be taken
seriously and that you're notgoing to be judged either.
It's important that you cancome 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 withthings that there's no good
test for, like chronic fatigueor whatever.
We think they're malingering ordrug-seeking or hypochondriac
(19:12):
or whatever you knowattention-seeking, and so we got
to.
That's one thing I learned inthe ER You've got to leave your
judgment outside the room, and Ithink that, yeah, certainly
there are people who are thereto some alternate agenda, but
for the most part, your defaultshould be to trust a patient.
Speaker 3 (19:30):
Yes, most people are in a vulnerable place when they
come before a provider, and Ithink that also is something
that we, as medical professorsneed to remember.
Like this person is vulnerable,they're exposing all of their
troubles and problems, orthey're in the hospital setting.
Nobody wants to be there,nobody wants to have to deal
with these things, but therethey are.
Speaker 1 (19:49):
But finally, on the subject of listening, coach, I
know I'm kind of old school, butI just don't buy it, coach, I
know I'm kind of old school, butI just don't buy it that a
doctor can be looking at thecomputer screen and be typing in
the medical record andlistening intently to the
patient at the same time.
The practice just destroys thechemistry between the provider
and the patient and I've been onthe receiving end of this when
I went to see my doctor and Ifelt that it was very
(20:09):
off-putting.
She had her back to me thewhole time.
There was no eye contact, verylittle attention to body
language and I really didn't getthe feeling she heard a word I
said, coach, it was really kindof frustrating for me.
And also most EMR programs areconstantly flogging the provider
to fill in certain boxes inorder to boost coding and
billing.
So the provider is activelythinking about responding to the
(20:29):
EMR prompts and she's not fullyengaged in listening to the
patient.
Speaker 3 (20:36):
Right, you know, unfortunately we kind of
experienced this, my husband andI, when Tyler got really sick
several years ago withdysautonomia.
We went to all of the providersand you know some were truly,
truly kind and caring people,but we just, at the end of the
day, we didn't truly feel heardand because there wasn't
(20:57):
clear-cut answers for what wasgoing on with Tyler.
He didn't fit in the algorithmsof the problems that they were
used to.
It was just his problems kindof got dismissed.
This is just anxiety, you'rejust stressed Like here's
literally here's some anxietymedicine, and there was so much
more going on with him withdysautonomia than just that, and
(21:17):
so they didn't really get howsick he was and so it was just
that was really hard that wedidn't feel like we were taken
seriously or really understood,or really just that there was a
space for us to receive care.
you know, then at the end of theday 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 studentshad a mandatory class on
listening and asking the rightquestions, and I think it's
really becoming a lost art thiswhole listening thing, and yet
it's our most powerful tool ingetting to the right diagnosis
and to coming up with a goodtreatment plan.
I remember when I was in the ER, it seemed like the best
(22:01):
doctors did the fewest tests.
They took a good history, amedical history, and they did a
good exam and they kind of knewwhat was going on at that point.
They didn't need to rely on abunch of fancy tests.
On the other hand, the doctorswho were less secure in their
clinical skills order moreneedless labs and x-rays, and
the ER was always backed up andthe patients waited forever to
get these test results to comeback when these doctors were on
(22:23):
duty.
So for you providers out there,history, history, history.
Listen intently to yourpatients, connect the dots, and
your basic, as I said above,your basic default should always
be to trust the patient and totake them seriously.
And one more thing, coach whenI was before I retired all those
years at McMinn Clinic, duringthe patient visit, I learned to
(22:44):
take these cryptic shorthandnotes, and I could do this
without ever looking away fromthe patient.
I always maintained eye contactso that I could see the facial
expressions and read the bodylanguage, but then at the end of
the visit, I always typed thepatient a note, which is
actually a letter, and in thefirst paragraph I summarized
(23:04):
their complaints.
And by doing this, the patientalways knew that they had been
listened to and I had heardeverything, and they really
seemed to appreciate thisconfirmation 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 andI think there's a healing that
comes from the provider justthrough that.
Speaker 1 (23:23):
Another advantage of that Coach is that when you do
that and you go over that letterwith them, if you got it wrong,
then that was their chance totell 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 quitewhat I said or what I meant, but
that way you know you bothagree that here's what we're
dealing with, here are theissues, and so I think it really
helped.
As you remember, coach, I wrotethousands 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 theircomplaints, it helps with that
intention step of seeing, oh wow, that's a lot written out.
I am now fully aware of all thethings that I've just kind of
been shuffling around anddealing with in my life.
And now let me form a betterintention to move forward.
(24:14):
So I think that really helpsthem on those beginning steps of
the arch in becoming thatempowered patient.
But the next step for theengaged provider is to do that
just old-fashioned physical exam.
This is another cornerstone ofclinical medicine that can tell
you a lot about what's going on.
However, along with listening,this too seems to be becoming a
(24:37):
thing of the past.
I believe that it is often anexpectation on the patient that
the provider examines him or her.
I have heard it repeated manytimes from the patient about
other providers.
He never examined me, he nevereven touched me, he didn't
listen to me, like with astethoscope.
Besides gathering data, I dothink that there is
consideration to be given to thepower of touch, done in an
(24:59):
appropriate and, of course,professional manner to the
comfort of the patient and tofurther establish that
connection between the providerand 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 hashelped me as a provider to make
the right diagnosis.
Let me tell you just a quickstory to illustrate the point.
I had a 40-something-year-oldlady who came to see me one day.
I'd been seeing her for quite awhile 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 maincomplaint or really the reason
why she was there.
But with every patient I hadjust a quick exam.
(25:30):
I did, and this takes twominutes and so I felt her belly
and I said, hmm, this doesn'tfeel like constipation to me.
Let's get a quick ultrasound.
So we did and we found that shehad an early ovarian mass.
I remember that and I rememberher telling me the story about
that.
And so we caught it so earlybecause of that two minute exam
(25:53):
that she got it cut out.
She never had to do any chemo,any radiation.
It's been at least 10 years agoand she's still cancer-free
from a cancer that's usuallydeadly all due to a two-minute
physical exam.
I'm just saying, coach, we relyso much on fancy CAT scans, mri
stuff like that, but justexamining 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 workingin the hospital, I recall a
patient that me, as the nurse, Ihad to escalate their care
because the patient wastachypneic, meaning they were
breathing fast.
But when they were transferredto the ICU setting they just
hooked him up to the monitor andthe monitor did not pick up
(26:35):
those respirations, but the mystethoscope 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 topick that up.
But so you know it's justmonitors 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 theplace 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 moredata, 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 opinionthat overall providers probably
do too much testing.
Unfortunately, there has beenan explosion in the number of
lab tests that providers can doand I think sometimes that's
part of like it's patient drivenin some ways Like people want
(27:26):
more data, more information,more, more more.
Speaker 1 (27:28):
Plus there's money in it.
You go to a conference and sometesting company is there and
say, oh, do this fancy test.
And they have a beautifuldisplay and a good-looking lady
who's pushing it Right yeah.
So some former high-heeledex-nurse, so anyway.
So doctors buy into it and theydo these tests, but it really
doesn't change outcomes.
Right and a lot of times thesetests 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 thepatient.
So we should do the tests thatwe need.
Tests can be a helpful tool.
They're in our toolbox, but wedon't want to over-test either.
Speaker 1 (28:08):
And sometimes these tests uncover things I call
incidentalomas, which, as thename implies, it's an incidental
finding that has nothing to dowith why the patient came to see
you, and are usuallyinsignificant and irrelevant.
These findings can send youdown rabbit holes, muddying up
the clinical picture, costingthe patient even more money, and
usually result in no benefit tothe patient.
One fundamental tenet that Ialways adopted over the years
(28:31):
was to never do a test if it'snot going to change the outcome
for the patient.
As you know, coach, we did alot of work with gut health, and
when I first started with mygut health focus, I ordered a
lot of functional testing, but Ieventually realized, after
doing a lot of it, that theanswer was always the same.
It's kind of crazy.
Not enough diversity, yeah itwas always that the microbiome
(28:51):
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 wasscrewed 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 engagedprovider has gathered the
information by listeningphysical exam tests, the next
step is to put together acustomized treatment plan for
the patient.
Since, as the providers, wetend to take a functional and
integrative approach, we try toconnect the dots and take this
ground-up root cause approach inour treatment plan.
(29:26):
So, for instance, a patientcomes 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 wouldalso include a gut health
program, whereas traditionalmedical approach would be to
prescribe some antihistaminedrugs, even perhaps some
(29:47):
steroids, along with sometopical salves.
Most of these patients had seenthe dermatologist before they
got to us and the traditionalapproach just had not worked.
They had a bunch of salvesthere in the medicine cabinet.
You know a bunch of thosemedicine bottles, but we often
saw miracle cures with many ofthese same patients.
With this root cause functionalapproach.
Speaker 1 (30:09):
Right In that particular situation.
Coach, we did a whole podcaston the gut skin connection,
which I think was quite good.
If you don't mind me saying somyself, I might want to go back
and take a listen to that, butpatients often came in with many
complaints.
For instance, a very commonscenario 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.
(30:30):
And so I mean you could spend awhole visit just on any one of
those.
So one therapeutic approachwould be to work on these one at
a time, and it may be helpfulto check in with the patient and
ask her how aggressive wouldyou like for me to be?
If she wants to take a go-slowapproach, then you might want to
go one at a time and startworking on the things that are
most important to her, and thenyou can circle back around and
(30:51):
take them one by one untilthey're all addressed.
However, let's go back to ourveterinarian, dr Cheryl's
pronouncement that dogs can havetics and fleas at the same time
.
So when the patient has allthese various complaints, their
problems could be totallyseparate things like tics and
fleas.
Or I have found in manyinstances you can connect the
dots to a common denominator.
More often than not that has todo with things like gut health,
(31:14):
since there is a what I call agut everything connection.
So if the patient was up for itand wanted to be more
aggressive and get to a betterplace quicker, then my default
was to usually treat all thesethings at once with a functional
root cause approach, andusually this did the trick and
the patient came back andeverything was better.
And, quite frankly, as aprovider, it was pretty amazing
(31:37):
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 comesup 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, andthe 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 orautoimmune disease.
Right, and they have a right tounderstand what's going on with
their bodies, and so we need tostep up and explain their
conditions to them in terms theycan understand.
It also helps to go over theirlabs and other tests line by
line so they can feel confidentwe'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 thepatient to get going with the
program, to stick with theprogram, and some people are
sick and tired of being sick andtired and they can't wait to
get going.
However, for others it can bechallenging to get them moving.
It may seem overwhelming, sincewe're sometimes asking them to
make some really fundamentalchanges to their way of life.
(32:38):
It's not like just simply, youknow, here's another pill to
take in the morning.
Just as an example, we've seenpatients go gluten-free and see
amazing benefits their chronicheadaches are gone, their skin
itching gets better and on andon, they have better energy, etc
.
But for someone who has eatengluten products all their life
and they're used to going to thegrocery store and these are the
things they get every time itmay seem daunting to really give
(33:02):
it up and to get started withthat gluten-free program.
Speaker 1 (33:04):
They have no idea how to do it.
And that's why I'm a hugebeliever in things like health
coaches and nutritionists and Iwas so blessed to have you and
Nurse Laurel and Jennifer at theclinic and you guys were
wonderful with things likemotivational interviewing and
help get patients on board withthe program and holding them
accountable.
You definitely changed so manylives, lindsay, and I know the
(33:24):
patients were very grateful forthat 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 Ilike to use the analogy of two
young basketball players who arejust starting to learn how to
shoot free throws.
With one player, you could saygo work on your free throws,
I'll come back and check on youin six weeks.
And then for the other one, youcan have this program with
detailed instructions, like aplan for becoming the greatest
(33:51):
free throw shooter and a coachwho would work with them every
day to help them achieve thosegoals.
And at the end of the allottedtime, I'm pretty confident that
the player with the plan and thecoach will almost always
outperform the player who justtried 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 hotteam.
Speaker 3 (34:18):
Oh my gosh yeah but hey, look at Bama there I know,
I know, I know, but anyway, andnow 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, whichcan be sometimes quite
complicated, the patient withthe health coach will often find
it easier to get going and willbe better prepared to stick
with the program and ultimatelywill have better clinical
outcomes than the patientwithout 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 ofthe arch meet in the middle to
create that keystone.
This is the step that makes thewhole thing come together and
work.
The important step is calledbehavioral 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 samething 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 overand over again and expect new
results so we're going to try tobe sane here and, as the term
behavioral change implies, thisstep may require fundamental
changes in the way we live ourlives.
This overlaps with the conceptof lifestyle medicine.
We did a great podcast on that,which is number 34.
(35:32):
And on the podcast I calledlifestyle medicine the most
powerful medicine on earth, andyou might want to go back and
check that one out.
I think it's a good one.
Again, if you don't mind mesaying so myself.
Speaker 3 (35:42):
Certainly, there is a time and a place in medicine
for drugs and surgery, and we'rethankful for them.
But for the vast majority ofour patients, behavioral change
is the key, and this can be verydifficult to do, but at the end
of the day, this is the surestway to optimal wellness for most
(36:02):
patients and for our society asa whole, especially with our
skyrocketing rates of chronicdiseases that are also
increasing our health care costs.
So our current trajectory isnot sustainable.
Speaker 1 (36:13):
You know, coach, I don't know if you've seen the
price tag on some of these newdrugs.
I mean, when you watch TV, yousee commercial after commercial
for these expensive like,especially, autoimmune drugs.
Oh my gosh, they cost a fortune.
And so we're just going to endup bankrupting our healthcare
system if we don't change thefundamental way we practice and
we live our lives.
So one of the things we talkabout most in this lifestyle
(36:35):
discussion is diet, is nutrition, and I've seen dietary changes
work miracles with patients, butthey're difficult and
especially here down south wherewe live.
The good old southern diet ispredominantly kind of a high-fat
diet and we have the right tobe proud of our southern food
heritage.
It's wonderful high-fat dietand we have the right to be
(36:56):
proud of our Southern foodheritage.
It's wonderful.
Some of our most common mealsinclude biscuits and gravy,
fried chicken, fried greentomatoes, fried just about
anything.
Oh yeah, anything we can fryOreos.
That's right.
Fry Oreos Right.
The world's best barbecue, andwe all wash it down with a
gallon of Milo sweet tea and Imean sweet tea and take a couple
pieces of pecan pie along withsome homemade Nella ice cream
(37:17):
sweet tea, and take a couplepieces 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 usthat, along with these tasty
Southern treats, we in the Southalso lead the nation in obesity
, hypertension, diabetes, and wehave the shortest lifespan in
the nation.
In fact, six out of the topseven states for diabetes are
(37:49):
right here, right here in theheart 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 theleast exercise and, coach, when
you add it all up, thescientists all agree that it's
not a coincidence that there's ahuge overlap between the
Southern diet and lifestyle andthese unwanted conditions like
obesity, diabetes, hypertensionand ultimately, premature death.
In fact, you know, Coach, Ithink in some clinics around
(38:19):
Alabama it's the exception ifyou 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 tothe 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 sugarnumber on your lab report.
It's amputations, blindness,heart problems, kidney failure,
neuropathy, increased rates ofcancer and dementia.
And likewise, hypertension isnot just blood pressure rating.
It also has those similarnegative consequences I just
(38:57):
listed.
So that sweet tea and friedfood may taste good going down,
but it's got a big price tag andthe long-term consequence of
chronically always eating thosethings in is a life of prolonged
illness, misery and evenpremature death.
So it's serious.
I mean, it's just, it'sprofound.
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 hada big family get together, you
know, and at that get together.
We eat a lot of food, which iswonderful, it tastes so good.
But if I ate like that on aregular basis, oh my gosh, I'd
be big as a barn.
So anyway, so I practice, andme and my wife Cheryl, we
(39:40):
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 eatpretty healthy.
We try to focus on just a wholefood diet.
That's our emphasis.
But you know, we every now andthen go out and blow it out and,
like the holidays come along,we have a family get together
and there's that homemade icecream or whatever.
Speaker 3 (40:03):
And I think those things are healing and healthy
for us.
On that emotional, like weconnect over food, we connect
over these things.
But to your point, I think it'sthat ratio, that 90-10, that
80-20, but truly living thatratio 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 expectingperfection.
But there are some people.
If they veer off the path atall, they pay heavy consequences
.
I'm thinking of a wonderfulyoung girl who came to see me
one time with a juvenilerheumatoid arthritis and it was
practically crippling for herand I got her on a program and
one of the biggest things we didwas change her diet and it was
(40:45):
a miracle cure, coach.
It was just amazing.
But she told me if she slippedand ate food she wasn't supposed
to, she could feel it rightaway.
So I do think that some peoplejust can't have any wiggle room.
But from the medical point ofview, we have pills for diabetes
, pills for blood pressure andeven now we have pills in
(41:07):
surgery for obesity, but nothingcomes anywhere near close to
behavioral change to improveoutcomes for these patients.
And it's never too late tostart.
But the sooner you start withchanging your behavior in the
direction of a healthy lifestyle, then the greater your odds of
avoiding disease and achievingoptimal wellness.
And as I said earlier, onceyou've had that stroke you can't
take it back.
(41:27):
It's too late.
So the sooner you change thebetter.
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 ofcollateral damage.
There's collateral benefit tothis because you know you might
change your diet to improve yourdiabetes, but that's also going
to improve your heart diseaseand your dementia and this and
that and the other.
So there's so much benefit fromit.
Speaker 3 (42:00):
There are also many other conditions besides the
common diseases that we'vementioned that really benefit
from lifestyle changes, and thebiggest example to that is just
I've mentioned him many times onthe show my husband Tyler.
The thing that has helped himthe most with his dysautonomia
was not drugs or surgery, it waslifestyle change, especially
dietary changes, and you know wetalked about that on that
podcast we did a long time agoon the dysautonomia.
(42:20):
If anyone wants to search that,you can, and then we'll circle
around and do another one one ofthese days with more updates on
his journey but reallyimproving his gut health and
making those dietary changes.
And this is coming from anutritionist.
He graduated with his degree innutrition, but we still had to
make changes.
We thought we were doing theright things, but we really made
dietary changes and improvedhis gut health and that
(42:42):
dramatically changed histrajectory and helped his
dysautonomia yeah, and thatpoints out also that the best
diet for each patient is verypersonalized.
Speaker 1 (42:53):
You know, the diet that works for me may not be the
diet for tyler, and so he hadto find out the diet that worked
for him.
And so I just read a reallygood book by a guy named Peter
Addy, a real popular authorthese days.
It's called Outlive.
In the book he talks about theconcept of healthspan as opposed
to lifespan.
So lifespan is how long youlive, but healthspan is the
(43:18):
concept of maintaining fullfunction and a high quality of
life as nearly as possible rightto the end of life.
It's not a new concept.
It appears to have been firstdiscussed back in the 1980s.
But Dr Adia does a really nicejob discussing it in his book,
and so I highly recommend it.
I'll list his book in thereferences at mcminnmdcom.
Speaker 3 (43:31):
Wouldn't it be nice to live to a ripe old age with
your physical, mental andemotional capacities optimized.
Then you play a round of tennisone day, or go for a nice walk
in nature, and then you die inyour sleep that night.
Oh, that'd be great, wouldn't it, leslie yeah that just sounds
like a nice way to go versus themore common scenario where we
have this prolonged gradualdecline and you have kind of
(43:53):
just a lot of physical sufferingor misery on the way and you
spend the last 10 years in anursing home stuck there more or
less alone, away from yourfamily, not doing the things
that you love.
The people in these scenariosmay have the exact same lifespan
, but the first patient has amuch 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 mosteffectively promoted a robust
health span.
I would have thought it wasdiet, quite frankly, coach, but
Dr Addy made a really compellingcase for exercise being number
one.
And, by the way, the book doescome in audible as well.
(44:32):
So if you want to just listento it instead of reading it,
that works also.
But so let me wrap this up bygoing back to the arch of
wellness and summarizing.
The take-home message is thatthe keystone at the top of the
arch is behavioral change.
It is the day-to-day attentionto the fundamental way that we
live our lives over time thattranslates into our best chance
of living a long, happy,fulfilling, meaningful, healthy
(44:54):
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 thegraphic, the patient must put on
the mantle of the empoweredpatient and the provider must be
totally engaged in doingwhatever needs to be done to
help that patient achieve theirbest outcome.
The Arch of Wellness graphicoutlines that steps that the
engaged provider and theempowered patient need to take
(45:17):
in order to get to that keystoneof behavioral change and that
leads to optimal wellness.
So we are not denying thatbehavioral change can be
difficult.
People are resistant and havethe right to be.
But that's why effectivecommunication, behavioral
interviewing, education,motivation and coaching are key
(45:37):
elements to this program.
But at the end of the day, eventhe engaged provider can only do
so much.
The patient either gets onboard or they don't.
They come to the fork in theroad and they can take the wrong
fork, continuing theirunhealthy ways.
Pay the consequences down theroad, or they can take the right
fork.
Consequences down the road, orthey can take the right fork.
(45:59):
Engage in the behavioral change, Take the path outlined in the
arch of wellness and, step bystep, 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 thepodcast that your health is your
greatest blessing in life.
Instead of taking it forgranted, we need to be
incredibly grateful for it,cherish it and nurture it as
best we can.
And let's face it, youth coversup for a lot, but as we get
older, stuff happens.
I vividly remember a lovelypatient of mine who was from New
(46:25):
Orleans and, by the way, ifyou've never been to New Orleans
, you've got to go.
It has more character and soulthan any city I can think of in
America.
However, the folks in NewOrleans do know how to party.
Folks in New Orleans do knowhow 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 getout of New Orleans and away from
the New Orleans lifestyle forher health and that most of her
friends who still live therewere pretty decrepit in their
(46:45):
50s.
They drank and smoked andpartied and ate their way into
badness at a relatively youngage.
But they had a good timegetting there.
But also good for my friendthat she saw the light and she's
now incredibly healthy andvibrant as she approaches 70.
Speaker 3 (47:05):
I think that illustrates so much about to
just surrounding yourself withthe things that are going to
propel you forward, so at somepoint a person's light bulb of
awareness has to turn on.
Then the patient needs to drinkthe Kool-Aid get with the
program.
The good news is that it canusually be a gradual transition.
You don't have to do everythingat once, and I would really
suggest that most people willnot be successful trying to do
everything at once.
Pick that low-lying fruit first, the things that are most
(47:28):
important to your health, theeasiest to do, and go after
those first, and then, little bylittle, keep moving in the
right direction.
Plan things like restorativesleep, stress reduction, healthy
eating and exercise into yourday 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 bitof a guidepost to help you get
started with those.
In closing, we on the podcastwill continue to be engaged
providers, at least as best wecan do via a podcast, and we
hope that you will take on therole of being the empowered
patient.
Together, and with the help ofyour provider, we can reach the
keystone of the arch and createthe behavioral change that will
(48:04):
help you achieve your optimalwellness.
Speaker 3 (48:06):
That'll about do it for this episode of the Wellness
Connection MD.
Thank you so much for joiningus.
We hope that you're able toglean something from what we've
shared and that it was helpfulto you.
Speaker 1 (48:17):
And don't be afraid to reach out to us.
You can check us out atmcmindmdcom, where you can find
the McMind MD blog, and pleasehelp the podcast grow by telling
your friends and family aboutus.
Speaker 3 (48:28):
And take a moment to rate us on iTunes.
The reviews really help us getthe word out.
Speaker 1 (48:37):
And you can email me at drmcmind at yahoocom.
You can also find me atMcMinnMD on Facebook, Instagram,
Twitter and LinkedIn.
And now, Coach Lindsey, pleaseleave 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 histhings I know we talk about Dr
Sherrill's phrases, so this isone of my dad's and he said how
do you eat?
He said moose.
I think most people say how doyou eat an elephant, but my dad
would always say moose and he'dsay 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 stepat a time and go back, pick that
like Dr McMinn said, the lowestlying fruit or another way of
looking at it would be theweakest link in your chain you
know what's that thing and pickthat one thing and put it on the
arch of wellness and put itright there at the bottom on the
(49:27):
empowered patient side, andjust okay, I'm starting at that
bottom and move forward likeCandyland.
One step to the next and moveforward to that behavioral
change.
Speaker 1 (49:37):
Yeah, you know, I remember I used the phrase
low-lying fruit one time with apatient 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 picka low-lying apple, or you can
get out your ladder or climb tothe 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 thatgive you the most value, that
are the easiest, and that couldbe something as simple as
reducing the sugar in your lifeand going for a walk after
(50:07):
dinner, or something like that.
And then from there you getmore 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 betterand better, you want to do more
.
Yes, and so, anyway, well, thatshould 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 .
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