Care For Your Mental and Physical Health in Tandem
It felt good (not literally) to get my mammogram done last week.
Whenever I’m put in the patient role, I am reminded: 1) how very vulnerable we are as humans, 2) that prioritizing my health (mental and physical) is always worthwhile; and 3) how luxurious it can be to sit in a calm, quiet, WiFi-less waiting room—despite an upcoming boob crush.
Simple pleasures!
During the pandemic, many of us have sidelined—or flatly avoided—doctor’s appointments for medical, psychological, and logistical reasons. We’re well aware that seeing anyone indoors, even a physician, carries risk during a pandemic. Many people who dodged doctors well before the pandemic have found good cover for delaying care. Others with anticipatory anxiety about medical testing (because of actual, perceived, or anticipated bad news) have had a double struggle during COVID. Indeed for most of my patients who’ve had breast cancer, a mammogram is hardly a pleasure.
(Technical note: be sure to wait TWO WEEKS after the COVID vaccine to get your mammogram. The natural lymph node activation from the vaccine can skew breast imaging, so waiting two weeks will avoid unnecessary anxiety.)
And finally for so many of us, self-care is last on the list when we’re working more, sleeping less, and shepherding kids to and from Zoom school. Who has time to prep for a colonoscopy not to mention put dinner on the table?
But we need to remember that taking care of our underlying health is critical. It’s also the best way to protect ourselves from COVID-19.
My best advice today?
CHECK IN WITH YOUR PRIMARY CARE DOCTOR.
Schedule your physical. Take care of yourself like you do everyone else. Here are a few pointers:
1. Be safe.
With eleven months of accumulated knowledge about COVID risk mitigation, most doctors know how to protect their patients. But if you feel unsure, you should call to inquire about the office’s safety protocols. Are they screening patients for COVID risk before any in-person visit? Is the waiting room well-ventilated and set up for distancing? Is the face-to-face visit with your doctor appropriately brief—with most of your conversation done via telemedicine? A doctor’s appointment can look very different these days. In my office, for example, a (mostly) virtual physical consists of laboratory testing followed immediately by a five-minute masked face-to-face physical exam with me, followed a few days later by a videoconference to review test results and the patient’s “whole” health. Note that other medical visits will look different depending on the service and level of risk—all of which are worth discussing with your primary care doctor.
2. Check for avoidance thoughts and behaviors.
During their check-up, patients commonly admit to me their reluctance to be there. “I wanted to ______ (lose weight/have my colonoscopy/schedule my mammogram) before I came in to see you.” Shame, fear, and worry about weight gain, a missed mammogram, or pending test results, for example, can easily override rational thought. “It’s not you—it’s me,” my patient said to me last week as she hopped on the scale with her eyes closed. Indeed, my job is to help people through hard times—mental and physical—without judgment.
3. Make a list.
This appointment is for you. Scan yourself from head to toe, and write down all the things that have been bothering you. Think of all your COVID questions. From back pain to sleeplessness to your brother’s recent heart attack, your primary care doctor needs to know it all.
4. Go through your list.
Once you are with your doctor (either in-person or virtual), be sure to review any and all medical conditions and concerns. Go over your medications, drug allergies, and your preventative health maintenance (cancer screenings, vaccinations, appointments with specialists). Ask your questions. Clarify your COVID risk. Discuss the COVID vaccine.
5. Address more than just your test results.
Health is more than just the absence of disease. Even people with normal test results have room for improvement. How could you live better, smarter, happier? In other words, your data matters, but it matters most when it’s put in context.
Be honest. Talk about your nutrition, alcohol use, sleep hygiene, stress, and your mental health. For example, our relationship to food informs what we eat. I can help someone drop their cholesterol levels when I understand what they eat and their late-night stress eating.
Similarly when discussing exercise, it’s important to consider pain, old injuries, and any physical or psychological barrier to getting regular movement. Most people know that exercise is good for everything from diabetes to dementia. It’s important we address what’s holding you back.
And last, our everyday habits inform our moods, anxieties, and relationships to work, family, and each other. These matter, too, when it’s clear that our emotional health affects how we feel every day and directly inform health outcomes.
Just last month, my friend Erin Michos, MD, Director of Women’s Cardiovascular Health at Johns Hopkins School of Medicine, co-authored a new scientific statement from the American Heart Association summarizing evidence of the biological, behavioral and psychological links between mental health and heart disease.
BONUS: Next month, I get to interview Dr. Michos on this very topic! Details are coming soon.
6. Leave with a plan.
Whether it’s seeing a registered dietician to abandon poor eating habits and eat more intuitively; meeting with a therapist to discuss grief, loss, parenting, or stress management; or vowing to gradually re-engage in exercise after an injury—or too much time on Zoom, remember that health is more than just seeing your doctor once a year. It’s about your everyday habits, how you cope with stress and how you take care of your body and mind. Structure and support are essential for effecting change, and setting goals with your doctor can provide a springboard for a healthier future.
7. Schedule a follow-up appointment.
Time and trust are the commodities in healthcare. If you need more time with your doctor to cover everything head to toe, do what you can to schedule it. Telemedicine has expanded our services, improved accessibility, and can enhance the patient-doctor relationship. Particularly during a pandemic, evidence-based, data-driven medical advice tailored to your unique health issues has never been more important. You deserve it!
P.S. (and a preview of Thursdays’ content): CONTINUE TO FIGHT FEAR WITH FACTS.
Many of you are naturally concerned about the new variants, particularly now that the B.1.17 and B.1.351 variants were Washington, DC, on February 11, 2021. I will address this topic in more depth later in the week and on tonight’s Facebook live, but my best advice for TODAY is to watch this YouTube video with Dr. Monica Gandhi at UCSF explaining why we don’t need to worry so much about the variants (at 30:22 minutes). She goes on to provide evidence-based hope for our future with specific answers to many of your FAQs about how we can alter behavior after vaccination.
P.S. Join me and Dr. Ackerly TONIGHT on Facebook live to answer your questions about all of the above.