Lifestyle advice: Would you follow advice

25 September 2014

ANDY McLACHLAN – Scotsman, cardiology NP and past-consumer of deep-fried pizza and hamburgers the size of your head – recently got lectured by an after-hours pharmacist while picking up his type 2 diabetes medication.

As a reformed character with great blood sugar, cholesterol, a BMI of 24 (and only succumbing to the occasional pink iced bun) McLachlan suggests sensitivity is needed for when and how health professionals’ offer lifestyle advice to patients.

I would love to be able to run, feel the wind in my (thinning) hair and lope gracefully past the meandering masses.

However wishing is not enough and despite trying it many times, I end up looking like a fish out of water, flapping about and gasping for breath. Bits of my body that were never meant to meet, flop and slap together, reminding me of my constant struggle for a modest BMI.

Once I ran about 3 km nonstop and the next day was so sore I could barely get out of my bed. Luckily I do manage to eat very well, almost professionally. I come from a family of great eaters and am afflicted with Scottish good looks, a love for loud rock‘n’roll and underdogs; and diabetes.

In my early twenties as a young student nurse I was skinny. I didn’t do any exercise except doing meaningless tasks on the ward: “You boy… test that week-old urine with these out-of-date reagent strips, then write it on this bit of paper that I’m going to then throw immediately in the bin” “Yes, Sister”.

I lived on a diet of potato scones (a Scottish delicacy), alcohol, deep-fried pizza (another Scottish delicacy) and lollies. I knew it wasn’t a healthy diet but thought I’ll deal with the consequences when they arise.

In my thirties I moved to the USA and lived on a supersized version of the diet I consumed in my twenties. I ate hamburgers the size of your head for breakfast, all-you-can-eat chicken wings for lunch and pizza the size of picnic tables for dinner; all washed down with tasteless American beer. Vegetables, and even fruit, were an oddity to my taste buds.

The nurses I worked with were incredible fun, friendly and mostly enormous; they ate copiously and drank bathtub-sized buckets of Coke throughout the night shift. In the morning, when we had finished eating a month’s worth of calories in one night, we would all go for breakfast via the House of Pancakes or Taco Bell or Denny’s and load up on more sugar, fat and/or salt-laden treats. I was getting bigger and bigger...another wafer-thin mint?

The penny drops

As I moved through adulthood into my acute cardiology career I knew I needed to smarten up - the evidence was right in front of me every shift. I was overweight and wheezy.

I started to walk every day and realised cream cakes and doughnuts for lunch may not be the healthiest option. I started playing soccer again in my early forties, walked a few half-marathons and gave up some of my dietary infidelities (not all); but the damage was done.

One night I saw my wife looking at me kind of strangely.“What are you doing?”

At that point I had my head under the tap and was furiously gulping down litres of beautiful, ice-cold water. “I’M SO THIRSTY,” I replied.

“What’s wrong with you…you’ve lost a lot of weight…Oh my God…do you think it’s cancer?”

The bizarre thing is – there I was working as a CVD nurse specialist seeing people just like me every day – but it took til then for the penny to drop.

My blood glucose was 32 and I was quickly diagnosed with diabetes. I was started on some medication and given some motivational advice from my GP – God bless him – about a diabetic who nearly killed himself by over-eating plums. That piece of advice, and his obvious concern, are the only bits of that initial review that stick in my mind. I still can’t look at plums without a touch of dread.

When I came out of my first major encounter with New Zealand healthcare, with my newly-diagnosed diabetic label on, I was feeling stunned. But with my Scottish stiff upper lip (slightly trembling) and the support of my family…I got on with it.

Diabetes is a big deal but I mostly do all the right things, though I struggle fitting regular exercise into my life, and still constantly battle demons in my head whenever I see an iced bun (the pink ones, don’t know why). “JUST EAT IT, EAT THEM ALL” my brain screams at me and sometimes you know what…I do.

“You’re no oil painting yourself!”

Over the years I have had some interesting encounters with the healthcare machine. Mostly good I hasten to add and my current GP is excellent and attentive, though interestingly I rarely see a practice nurse.

My regular pharmacist is also a delight but one day recently I ran out of pills (busy life…it happens) and had gone to a weekend GP who charged me a small fortune and sent me to the pharmacy next door.

I knew I was in trouble when the pharmacist, who I had never seen before, glanced at the script then looked over her glasses at me and snarled, in a rather menacing, initially quiet but slowly rising voice: “Why did you run out of your pills?”

I think I actually stammered as I started explaining my obvious character flaws to this perfect stranger in her busy shop. “You need to exercise more and CUT OUT ALL SUGAR,” she further snarled. And – while she resisted the urge to say fatty at the end – I knew that was what she was thinking. I just stood there transfixed like a rabbit on the motorway.

As she readied my prescription I knew more was to come on my dietary indiscretion and slovenly ways. She flashed me a disapproving look as she handed me the pills, holding onto the bag so I couldn’t just run off. Oh NO! Out of the corner of my eye I saw my kids about to enter the shop…holding enormous ice creams.

I knew that would be the end for me, not only am I a “bad diabetic” but I’m inflicting my evil ways on these young innocents. I made my excuses and hurriedly left leaving her grasping at air, and with her mouth open ready to deliver some parenting advice.

I had the urge to shout, “you’re no oil painting yourself, Mrs” as I barrelled out the door, sweeping my kids up along the way. But I resisted - much too polite for that.

And while I enjoy a good lecture as much as the next guy – my cholesterol is wonderful, HbA1c in the early 50s, BMI 24, BP 110/60 and I’m exercising more than I have ever done in my life. Even my retinas are perfect. I wondered what this woman wanted from me…not my regular business, obviously.

Telling people off really doesn’t work

That experience got me thinking about what is the best approach to discussing lifestyle changes with people, who is best placed to offer support, and what situations work best.

Maybe we should wear a badge with something like: “Lifestyle change…I can help, ask me how?”

I’m not perfect but I know now that discussing change with people takes some planning, relationship-building, tact, careful enquiry and real empathy. A recent study showed that people who were told bluntly they were fat by their health professional actually gained more weight than people who were treated with some level of respect.

Telling people off, really doesn’t work. I wonder if I met the “me” I was pre-diabetes (think Back to the Future… it could happen) would I listen to the sort of claptrap I was spouting back then, probably not.

I’m not suggesting we all need to have a disease before we can help people, in fact I know some of my lifestyle beliefs would be irrelevant for anyone else, but they work for me.

I like the approach of simply asking people what they already know before trying to teach them how to suck eggs. You may find they know more about themselves, than you…

And sadly, I still can’t run