A couple of weeks ago I wrote about my experience of incapacitating back pain while on vacation. Today, I woke up feeling great. My visit to my chiropractor and massage therapist was unusually positive; my muscles were not in spasm and my spinal alignment was pretty good. It is clear that the things I have been doing are finally working.
What I did not write about two weeks ago were the efforts I had been making to manage my back and neck pain prior to its explosion while I was trying to have a good time. Two and a half years ago I fell from my bike and separated my shoulder. Six months after that, the neck pain caused by the fall spurred me to visit the chiropractor. For the last 18 months I have had massage and chiropractic adjustment every two weeks, on average. Our goal is a monthly maintenance schedule to prevent my poor spine from causing the kind of discomfort I experienced last month. Because I was not making the progress I had hoped for and was starting to get depressed about it, two months ago I started yoga classes and two weeks ago I added a Pilates class.
I have made efforts toward fitness for my entire adult life. I have eaten a mostly vegetarian diet since 2005. I have maintained my weight at a healthy level and my BMI (body mass index) is 21.3 (18.5 – 24.9 is considered normal). I have a couple of familial predispositions to heart disease, so I try to keep all the other risk factors down. For the last ten years, I have bicycled pretty regularly, and for most of my life I have been involved in physically active endeavors ranging from dance and aerobics classes to vigorous gardening. Familial tendencies toward depression and other mental health issues, along with my training as a psychologist, have also pressed me toward regular maintenance. My copy of David D. Burns, M.D.’s Feeling Good, the New Mood Therapy and The Feeling Good Handbook are never far away.
The more I think about the health of my nearly 59 year old body, the clearer it is to me that my focus as an individual and our focus as a culture needs to be on good self-care and prevention of illness. For those who work in preventive medicine, my realization would be followed by a big “DUH…of course.” For most of the rest of us ordinary humans, it is easy to give lip service to this notion, but really acting upon it is another matter.
Newspaper reports about the effects of recession on preventive health care abound. Some insurance plans do not cover preventive care, and when money is tight people do not spend on a mammogram or colonoscopy. Those who have lost a job and their health insurance along with it may seek care for acute illnesses, but prevention and care of chronic illnesses often go by the wayside, sometimes resulting in expensive emergency room visits and hospital admissions.
The Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services provides a Guide to Clinical Preventive Services. Screening and Counseling are the two forms that most preventive efforts take. Frequently, education about the disease and self-care for prevention are part of the Counseling. Unfortunately, for many of the illnesses listed there is insufficient evidence to determine the effectiveness of Screening or Counseling in preventing the disorder. The dates on most of these conclusions make it clear to me that it is time for a significant research push in this area; but, Evidence Based Practice will be the topic for another day.
One arena in which prevention has solid research basis and support of the medical community is cardiovascular health. “The American Heart Association believes that basic preventive health care services should be an integral part of an equitable, comprehensive health care plan, accessible to all.” Learning the risk factors of cardiovascular disease and intervening to diminish those factors is a sure way to decrease the likelihood of heart attack in your future. As the AHA indicates, “These are the risk factors we can modify, treat or control:
- tobacco smoke
- high blood cholesterol
- high blood pressure
- physical inactivity
- obesity and overweight
- diabetes mellitus.”
I am not a person who is happy to take a passive role in my life. Sometimes I wind up in that position because of a variety of factors, but the result is never a happy Kathy. I have always been proactive and forward-looking, trying to be prepared for eventualities before they occur. Sometimes I have missed the mark by looking too far ahead, but in the case of health it is never too soon to start taking steps to prolong good health.
Dr. Andrew Weil has long been a favorite of my family. His blending of Eastern and Western ideas in integrative medicine has an intuitive appeal for me. The notion, put forward in his book Healthy Aging, of avoiding many debilitating illnesses by proper diet and exercise and living a long healthy life with a rapid decline at the end seems a no-brainer to me. My health insurance won’t reimburse me for it. Traditional U.S. medicine won’t advocate it until there is significant research supporting it; but I find this active, involved focus on my health much more appealing than passively taking the medicine the doctor orders.
What is your role in your health? Do you see a place for behavioral health providers in prevention and general health care? How should we proceed to make ours a healthier country and each of us healthier individuals?
Please chime in! Let me know what you think.