A frequent question I get from patients is to define the term “fasting” as it relates to bloodwork.  The most common reason why your physician wants you to fast before bloodwork is to check your cholesterol (also referred to as lipids, HDL/LDL, triglycerides) and blood sugar to test for diabetes. Most annual bloodwork for healthy individuals will include these among other tests, so if you only get bloodwork once yearly, it will likely need to be done under these conditions.

Generally, the fast is for 8 hours.  In other words, as long as you don’t eat anything after midnight the night before and you skip breakfast, you should be ok.  Continue to take most of your usual medications in the morning (thyroid pills, blood pressure medications, stomach acid lowering medications, vitamins).  However, if you are on diabetes medication, check with your physician about which medications you should  hold off on taking, these are usually the medications that say “take with food” (e.g. short-acting insulin).

Can you drink water during the “fast”?  Yes, you can and should drink moderate amounts of water, as this does not affect the cholesterol and sugar tests.  Your doctor may also want a urine sample and having a full bladder is always helpful.   I would advise against coffee or tea  as most people unconsciously add sugar and milk to them.  I often tell my patients to bring their morning cup of coffee/tea to the lab testing site, so they can have it immediately after the blood draw.  It is also wise to bring a snack like a bagel, piece of fruit, or snack bar so that you can fuel your body before you head to work.

What if you forgot and ate a donut?  I would generally advise to hold off on the bloodwork until you are able to fast again.  Perhaps you could put a post-it on your fridge and bathroom mirror to remind yourself next time.  If you are absolutely unable to squeeze another trip to the lab in your busy schedule, I would just get it done that day, but be sure to let the person drawing your blood know that you didn’t fast.  Don’t worry, you won’t be punished for telling the truth, they will just make a note of it on the lab requisition.  When you discuss the results with your physician, let him/her know as well.  If the cholesterol results are normal, I wouldn’t worry because that means your cholesterol was normal despite the donut.  However, if there were abnormalities, I would consider repeating them with true fasting conditions.

On a side note, here’s a trick to minimize bruising afterwards.  After the needle is removed, hold pressure tightly with gauze over the area and raise your arm above your head for about 2 full minutes.  You may look silly, but the bruising will be lessened.  To get better veins for the phlebotomist, do arm exercises like bicep curls the day before, and  allow your arm to hang down at your side for at least 5 minutes before the blood is drawn.

Guest Author: Beth Tansey Peller, RN, BS, CWC®

Change is Hard!

Making sustainable changes in habits that support our health can be challenging. We all know people who lose weight on a diet and then gain it all back, more than once. Or, start an exercise routine, and then stop going to the gym, running, or whatever they were doing. Say they want to get their blood pressure down, or maybe their cholesterol. Swear that they will give up junk food, soda, or something else. But they can’t stick with it. Maybe you have even been one of those people. A Certified Health or Wellness Coach can support your journey, but you can put the process to work for yourself.

The key to making changes that you can live with is to be strategic. Start with the end in mind. Create a vision of who you want to be, how your health with be different then, and how you will feel. Imagine that you are already there…

Ask yourself some questions

• What will your energy level be like in the future?
• How will your clothes fit?
• What kind of exercise will you enjoy doing?
• What kinds of food choices will you be making?
• What will your doctor say about your blood work?

And, don’t forget why you are doing this. What is the motivator that will keep you on this path to better health when life gets in the way?

What could work for you?

Build Your Confidence

Think about what’s possible─talking into account the realities and demands of your life, your schedule, your personality─within 3 months or so. Losing 10 or 15 pounds? Getting a regular exercise routine in place? (One that actually works for you.) Making healthier food choices, like fruit instead of cookies, a baked potato instead of French fries? Taking a few minutes each day to do something relaxing or enjoyable instead of getting too stressed?

Think about what strengths you have to help you get there. Are you organized? A good planner? Have a lot of determination? Good at using your creativity to come up with ideas that could work?

SMART Goals Make all the Difference

After you’ve thought it through, think about what your first small, doable step will be. Choose a goal that’s really important to you, yet small enough to achieve. Turn it into a SMART goal for the coming week. One that’s Specific, Measureable, Action-based, Realistic, and on a Timeline, so that when you get to the end of that week, you will be able to gauge how well it worked for you.

Here’s an example: I will choose salad with dressing on the side for lunch instead of my usual sandwich with chips on Monday, Tuesday, and Thursday next week.

Then, gauge how confident you are that you will actually achieve this goal. On a scale of 1 (not going to happen) to 10 (I am totally sure I will do this), a 7 is usually enough to result in success. If it’s lower, what one more thing could you do to be sure it will happen? Maybe a reminder in your Smartphone, a friend to share that healthier lunch with you, or picking up premade salads to bring to work.

Celebrate Your Success!

Health behavior change can be hard, but it can be done. Over time, through some experimentation to find what you can comfortably do on a regular basis, the SMART changes you make will become sustainable. To paraphrase Sheryl Crow, “A change will do you good.” For you, there will be no going back. These changes will stick.

Guest Author: Ellen Davis, NP, DNP

Stress is defined as a psychological and physiological response to events that upset our personal balance in some way. It is categorized into 2 types- good stress (eustress) and bad stress (distress). Examples of good stress include the birth of a child, moving into a new home, getting married. Instances of bad stress are more easily identified. Some examples include losing one’s job, a death in the family, and divorce.

What is the stress response?

The stress response is the body’s response to the stressful event. It occurs in three stages. Stage 1 is the “Fight or Flight” or alarm stage. This is the body’s initial adrenalin response. Stage 2 is the resistance stage, when the body is still alert and aware, but starting to relax. The rush of adrenalin is gone. Stage 3 is exhaustion, when the body finally returns to baseline, and needs time to recover. One may notice the need for additional sleep during this stage, to allow the body to repair itself.

What are the physical effects of stress?

Stress causes the release of many hormones into the circulatory system. These include adrenalin, cortisol (a natural steroid), and many others. These hormones act in varying ways, but lead to increased blood pressure, increased cholesterol, increased development of atherosclerosis (clogged arteries), and a decreased immune response.

What are some ways I can better deal with stress?

There are many techniques used to help us deal with stress. A few suggestions include:

• Leaving work at work
• Taking a vacation or a stay-cation
• Listening to music
• Reading a good book
• Engage in some sort of physical exercise daily
• Laugh as often as possible
• Visit with friends
• Eat a balanced, healthy diet that is low in fat and salt
• Get at least 7-8 hours of sleep at night
• Find a way to play daily- why do kids get to have all the fun?
• Meditate
• Don’t dwell on the past- look to the future
• Think positive thoughts, and tell yourself positive things daily (Every day, in every way, I am making better food choices, and becoming healthier.)

If stress is severe, one may need to obtain counseling to work through the issues.

Fruits are not all created equal.  The current guidelines for most people suggest 5 servings of fruits and vegetables per day.  Does this mean you can eat 5 bananas each day?  I highly disagree.  First, an average sized banana contains 105 calories.  If you eat 5 of them, that is over 500 calories.  To put that into perspective, a can of Coke is 140 calories.  If you go by a 2000 calorie diet for the average person, 5 bananas would mean 1/4 of your daily calories!  Though you are getting a lot of potassium (which can be bad with certain medical conditions and medications), you are getting less valuable nutrients for your caloric cost.

What should you eat instead?  If you look at fruits, a medium wedge of cantaloupe has 23 calories.  One cup of nectarines (about 2 small size) is 63 calories.  By incorporating various other fruits you are getting a whole plethora of vitamins and minerals that are important to good health.

Vegetable-wise, there are many more, as in general most vegetables are not sweet.  Take your pick of celery (19 cal per cup), lettuce (8 cal per cup), cucumber (16 cal per cup), and carrots (52 cal per cup).

Be creative with your vegetables.  If you are used to chips and dip while watching sports on TV, change the chips to slices of cucumber.  While the dip may still be loaded in fat and calories, I guarantee you would not be able to eat as many cucumber slices to equal the amount of calories in a handful of chips.  (FYI 14 tortilla chips = 110 calories=150 slices of cucumber!)

At the moment, the U.S. is facing a large shortage of physicians to accomodate the needs of its growing population.  Most doctors’ offices are scheduling patients in 10 or 15 minute intervals.  However, this does not account for patients whose problems are more complex and may require more time than allotted.  This commonly causes the doctor to run over into his/her next appointment.  It is inevitable that waiting time is increasing and patients are getting more frustrated.

I often advise my patients to schedule their appointment for the first slot in the day.  There will be no patients before and they will be seen with minimal waiting.  In addition, if the doctor needs fasting bloodwork, that can be accomplished on that visit.  Another ideal time would be after the physician’s lunch break.  In my years of practicing medicine, I am always surprised at how few people take advantage of these times.

Cancellations are very likely in any physician’s office.  Check with the receptionist to see the likelihood of taking a cancelled appointment, but of course be polite about it.  Always bring something to read or do in the case you have to wait.  We all have mail to sort or emails to write to make the time go by.