Smart Phrases And Workups – Counseling

COVID DC Instructions	
As advised by the Centers for Disease Control and Prevention (CDC), you should quarantine in your home and limit contact with others to avoid spreading the virus. You should quarantine for *** days from symptom onset (end date ***).

Stay home except to go to the doctor. Do not go to work, school, or public areas except for getting medical are.  If you have an upcoming doctor appointment, call the office and notify them that you tested positive for COVID-19 on ***

You should not share dishes, drinking glasses, cups, utensils, towels, toothpaste, or bedding with others in your home.  After using these items, wash thoroughly with soap and water. Clean and disinfect all "high-touch" surfaces and laundry.  High touch surfaces include counters, tabletops, doorknobs, toilets, phones, keyboards, tablets, bedside tables.
Clean your hands often with soap and water for at least 20 seconds. Avoid touching your eyes/nose/mouth with unwashed hands. Cover your mouth and nose when you cough or sneeze.

You should wear a facemask around others and in accordance with CDC guidelines.

People you live with should self-isolate for 14 days from your last contact with them (end date ***)
CIRRHOSIS	
Healthy tips with cirrhosis:
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- check with your doctor that you are up-to-date on pneumonia, hepatitis A, hepatitis B, and influenza vaccines

- you should be screened for liver cancer every 6 months with an ultrasound of your abdomen

- ask your doctor about screening for Vitamin D deficiency

- avoid alcohol and NSAIDS (ibuprofen, Advil, Motrin)

- avoid opioid medications (Norco, oxycodone), benzodiazepines (Xanax), and raw shellfish

- eat a healthy diet high in protein
DERM	
Dermatology Education
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Recommend applying SPF 30 or higher every couple of hours while outside. Skin cancer results from chronic sun exposure so it is important to use sun protection and sunscreen. Any ulcer/pimple that doesn't heal in 2-3 weeks should be evaluated

Skin cancer surveillance relies on the A,B,C,D,E's (asymmetry, irregular borders, multiple colors, diameter >6 mm, evolution in size/shape/color). Any new lesions should be documented with photograph with a ruler for scale
DIABETES	
Diabetes
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You can prevent or delay diabetes by losing weight, increasing exercise to 30 minutes per day at least 5 days  per week, and eating healthy.

Normal blood sugar is 80-120.

Recommend a diet with decreased sugars and grains such as white bread, rice, tortillas, pasta, and sugary drinks. Try increasing nonstarchy vegetables, fiber, and protein. Eat regular, balanced meals to avoid large fluctuations in your blood sugar.

It is important to take your medications as prescribed to prevent serious health complications such as blindness, kidney failure, heart disease, stroke, loss of toes/feet/legs.

Check out cdc.gov/diabetes for more information
HEART FAILURE	
Heart Failure
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Take all of your medications every day. Your heart failure medication plan is designed to keep your heart as healthy and strong as possible.

Weigh yourself every day. A change in your weight can be a sign that your heart failure is not as well controlled as it needs to be. Keep a record of your daily weights.

At each appointment, ask what your current dry weight is

If your weight increases by 2 pounds in a day, take an extra dose of furosemide (water pill)

Call your heart failure provider if your weight increases or decreases 5 pounds in a week

Eat a low salt diet to prevent extra water weight. Limit your fluid intake to 2L per day

Exercise 30-45 minutes for 5 days per week

Call your provider if you experience new or worsening heart failure symptoms.  These include: unexplained change in weight, swelling in stomach or legs, shortness of breath that is new or more often, dizziness, chest discomfort with activity, fast or irregular heartbeat, tiredness/weakness
SLEEP HYGIENE	
Healthy sleep is essential for physical and mental health. Here are some tips to optimize healthy sleep:
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- Avoid caffeine after 1 pm. Avoid large meals after 8 pm.  Avoid alcohol and nicotine 4-6 hours before bedtime as they prevent deep sleep.

- Have fixed times at which you wake up and go to sleep every day to minimize disruptions in sleep rhythm.

- Keep your nighttime routine consistent to reinforce in your mind that it's bedtime.

- Budget 30 minutes to wind down with things that calm you such as soft music, light stretching, reading, paced breathing, meditation. Unplug from electronics as they will stimulate your mind when it should be winding down.

- Dim lights and avoid blue light. Bright lights inhibit the body from producing the hormone melatonin to help with sleep.

- Regular exercise will make it easier to sleep at night.

- Keep naps 20-30 mins in the early afternoon.

- Restrict in-bed activity - try to avoid using electronics or working in bed.

- Make your room as dark as possible with thick curtains/blinds or eye mask. Make your room as quiet as possible and if noisy, try a white noise machine or fan.
TELEHEALTH	
Due to the national coronavirus outbreak, this visit was conducted under newly released CMS guidelines allowing the use of audio/visual communication via technology to remotely evaluate patients. Patient was at home and provider was in the office. Consent was obtained from the patient allowing for remote evaluation with the understanding that a complete evaluation is not possible and thereby some signs or symptoms may be missed. Patient agreed to the telehealth appointment with complete understanding of the limitations. The patient was instructed to call the PCP or head to the ED if they developed any cough, sustained fever or other constitutional symptoms.
WEIGHT LOSS	
Weight loss tips:
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- Focus on portion control. Only a quarter of the plate should be carbs. The other quarter should be protein. The other half should be vegetables with some fruit on the side. You can have one serving of dairy on the side. Refer to ChooseMyPlate.gov. Other options include meal replacements such as Jenny Craig, Weight Watchers, SmartOne, or Lean Cuisine. Your daily calorie goal should be to reduce to 1200-1300 calories a day

- Try intermittent fasting The 16/8 method: Also called the Leangains protocol, it involves skipping breakfast and restricting your daily eating period to 8 hours, such as 11 am - 7 pm. Then you fast for 16 hours in between.

- I recommend the Mediterranean diet for weight loss and overall cardiovascular health

- The largest source of excess calories is from liquid calories. Examples are soda, alcohol, juice, milk. Try and reduce and eventually eliminate these. Instead try to drink at least 2-2.5 liters or 67-84oz of water a day.

- Try to limit carbohydrate intake. Examples are white rice, potatoes, pasta, bread, french fries, chips. These have a high glycemic index which means they will make your blood sugar high quickly and also plummet quickly. This drop will make you hungry again more quickly.

- Decrease desserts. Try snacking on microwaved frozen peas before your dinner to limit your hunger, or as a snack if you are craving desserts.

- Increase servings of vegetables and fruits. Goal is 6-7 servings a day

- Besides diet modifications, try to exercise 30 minutes daily at least 5 times a week. You can try walking, swimming, or even biking. Your step goal should be around 8000 a day.

- Try downloading Noom -- an app that helps with counseling to reduce appetite