Even though we are part of Texas Children’s Hospital, at the Texas Adult Congenital Heart Center (TACH Center) we see adult patients every day. Our patients, like many adults, face the challenge of changing habits and modifying their lifestyles.
As a physician assistant, I embrace my responsibility not only as a health care provider, but also a health educator. For example, I look for opportunities to empower each patient to take responsibility of his or her health plan. I stress that we need to be partners in this process; we are equal partners with equal, though different, responsibilities. This arrangement makes sense to patients, and they outwardly embrace it.
In terms of exercise, many patients learned as children to limit physical activity because of their heart condition. They viewed exercise as “dangerous.” Unfortunately, now as adults, some misunderstand the relationship between their congenital heart disease (CHD) and physical activity – they are often afraid of physical exercise. So they become sedentary. As a result, they struggle with complications of their pediatric heart surgery and other conditions that will lead them to early cardiovascular disease such as high blood pressure, obesity, high cholesterol and diabetes.
How this relates to my recommendations about one aspect of their wellness plan – exercise – is interesting. The idea that they can manage things related to their health is foreign to many of my patients. Some continue to rely on what they learned from their parents and what their physicians told them to do which was not to over exert themselves. Now I am telling them to trust their judgment and take more responsibility for their health. I see myself as their cheerleader to encourage them to form new habits!
My passion for fitness, nutrition and overall well living drives me to connect to patients and educate them not on
ly about their congenital heart disease, but also about the general heart healthy habits that they must practice as adults. This is an important point, since 85% of patients with congenital heart disease reach adulthood and there are 1.3 million adults with congenital heart disease in the United States. Although some of our patients do require exercise restrictions, most are encouraged to engage in some physical activity. In terms of diet, I provide resources to illustrate the benefits of heart healthy diets as it relates to quality and longevity of life. My patients definitely understand these concepts, and I feel we both leave the visit on the same page. We become partners to break poor lifestyle habits.
I ask myself: Why can’t I convince all my patients, for whom exercise and healthy food choices could significantly change their lives, that any form of movement is better than none? That the heart healthy diet has been proven to help reduce risk for acquired heart disease? My patients don’t lack desire, determination, family support or knowledge. And they all have my fierce support and encouragement! What am I doing wrong? Is something missing in my delivery of the “facts” about the relationship between exercise/food and health?
I wish it were so simple. But we know now that there is another huge factor at play in the delivery of information to our patients and their subsequent behavioral change: the brain! Recent popular books on the brain – Change Your Brain, Change Your Life and The Power of Habit – are helping us to understand that the human brain is literally a barrier to change. These analyses show that when we try to do things differently, our brains say, “No, No, No!”
But the analyses, however, also emphasize that one thing helps to break down that barrier: suffering. Another thing – repetition – helps develop a new habit. Still another – support from those at home and in the medical community – helps sustain it. This information helps me understand that at times I am fighting with what I can’t see – someone’s brain – and not the suffering person in front of me who can’t grasp what I am saying and put it into use. That makes me more empathetic and offers me a chance to discuss the true barrier: habit.
I encourage all parents and adult patients to form good habits and to consult with us to understand the limits and benefits of exercise and nutrition in the daily health regimen. Unlike children, who are dependent upon others to create and monitor their health regimes, our adult patients need to develop confidence in their own abilities to change habits and manage their health outside of a medical setting. Good habits, started early with encouragement from me and other staff members, are an essential way for us to form a solid partnership leading to responsible long term health decisions!