Aging: Part 1

I just had a birthday. I turned 32. Each year I think about the same thing now – getting older. It’s about time I write about my journey. So I decided it should be a three-part series of humor, research and enlightenment.

Don’t tread on my ego! Part 1 is a funny story about my thirtieth birthday, that all my close peeps know because I never miss an opportunity to tell of the shock and to get any scrap of affirmation about looking young.  😉

Upon turning 30, I felt an inclination of responsibility. There are certain things a person must now do in life when reaching this ripe age, no? I decided to go to the dermatologist for the first time ever and get a skin check. I got a recommendation for a local, reputable specialist and scheduled.

At the appointment, I did like the doctor’s personality. I explained why I was there – concern over early years of sun damage, new moles, preventing cancer. I was all geared up, swathed in the medical gown, for a thorough inspection.

First blow… The doctor quickly perused. “Hmm, hmm, hmm. Nah, you’re good.” I’m sure I made a disconcerted face because I felt barely observed. She simply said my skin looked fine, and that new moles will continue to appear until well into my forties, so no need to worry. (I guess she was saying she would not take my skin checks seriously, nor would I be at risk for cancer, until after I turn 40???!!!)

I was getting over the laissez-faire assessment and considering, “Cool, no issues. Great news.” When she began with the second blow…

Doctor: “I hope you won’t be upset. And I don’t normally say this, but in your case I feel there is a noticeable need. Or, I wouldn’t say it.

Me: “Okay.”

Doctor: “You have a very expressive face, and that’s awesome. But you also have a very active forehead. It moves a lot, and, unfortunately, that is creating premature wrinkles. See… [hands me a mirror]

Doctor: “Have you ever considered Botox? We do that here.”

Me: “I’m not saying I would never try Botox. But can I just start with a cream or something?”

Doctor: “Yeah, I can write you a prescription. But it really won’t stop the muscles from moving and doing damage, ya know?

Me: “Well, I would like to try that first.”

I left that office baffled and sad. Did she really say I needed Botox? I have a very active forehead? I have premature wrinkles? [sigh] [worry face] [cry]

My husband was incredibly kind to assure me that I was beautiful and look younger than I am and that he lost respect for that doctor and that she was only trying to sell some Botox. My family and friends were equally encouraging. I still got the Retin-A Micro at the drugstore within days.

I cannot even describe fully what an impact this encounter had on me turning 30. I have literally been talking about it for two years. Maybe I’m okay with aging in theory. But maybe I’m not okay with someone saying I look so old I need to inject botulism into my face to stop the deformity and hideousness!

I know. So Silly. I’m laughing now retelling this. (Oh, no, more lines!)

AarikaAging: Part 1
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Chronic Care Management

An estimated 117 million adults have at least one chronic health condition, and an estimated one in every four adults have two or more chronic health conditions. In a questionable healthcare system, mostly focused on treatment instead of prevention, it is not a wonder. Medical providers actually profit short-term by sick patients visiting often. But, frankly, medical providers are also strained with high-demand patient loads, and time and resources do not allow easy tracking. So care has not been very outcomes based – communication post treatment, assessment of disease reversal, etc.

The Centers for Medicare and Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals. Since 2015, Medicare has been reimbursing medical providers for CCM services. Eligible patients are those with two or more chronic conditions expected to last at least 12 months or until death, and that place the patient at significant risk of death, acute decompensation or functional decline.

Examples of chronic conditions include, but are not limited to:

  • Alzheimer’s disease and related dementia
  • Arthritis (osteoarthritis and rheumatoid)
  • Asthma
  • Atrial fibrillation
  • Autism spectrum disorders
  • Cancer
  • Cardiovascular Disease
  • Chronic Obstructive Pulmonary Disease
  • Depression
  • Diabetes
  • Hypertension
  • Infectious diseases such as HIV/AIDS

Wow! Now that I’ve caught you up on the background…

I had the pleasure of helping Doctor for Life launch their Chronic Care Management program, enabling us to create individualized, comprehensive care plans including special education, motivation and follow-up efforts to better patient health outcomes. Medicare covered non face-to-face encounters such as the following, with patients only responsible for a small monthly co-pay:

  • At least 20 minutes per month of chronic care management services
  • Personalized help from a health care professional to create a care plan based on your needs and goals
  • Care coordinated between your doctor, pharmacy, specialists, testing centers, hospitals, and other services
  • Phone check-ins between visits to keep you on track
  • Emergency access to a health care professional, 24 hours a day, 7 days a week
  • Expert help with setting and meeting your health goals
  • Review of medical records and test results
  • Medication refills and management
  • Scheduling same-day appointments

Doctor for Life also decided to offer free group education classes each month – one in Fitness and one in Nutrition. (Yes, you guessed it, I was leading the classes on Fitness. 😉 ) My lessons included:

  • Exercise for the Prevention of Falls / Balance Testing
  • Exercise for Independence / Activities of Daily Living
  • Habits to Improve Health / Lifestyle & Techniques

Participants definitely learned and laughed. (I mean, making them laugh is like my number one goal.) I enjoyed the process too, getting to dig deeper into the perspective of others. I do not have a chronic disease, but I need to understand as much as possible about what that’s like in order to help people.

Health pros must be knowledgeable and empathize. I’m grateful for this opportunity at DFL, and feel the need to share with everyone what some medical providers are doing to improve care and, working together, get patients to their desired health goals.

The outcomes really are positively improving. Recent statistics show that it is worth CMS paying providers because they are saving by lowering benefit payouts to individuals, meaning patients’ care is being routinely controlled instead of having more emergency and extra inpatient or outpatient needs.

If you or someone you know is interested and eligible, please ask your providers accepting Medicare about this level of concierge care.


CMS website >

CMS handout >

Medicare website >

Modern Healthcare article >

AarikaChronic Care Management
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Diabetes Prevention Program

I took this picture the last day of class. I paused on my way out the door, letting the impact of the empty room and happy memories linger for a moment more…

I became a YMCA Diabetes Prevention Program Lifestyle Coach in 2016. Aside from my general agenda for healthy and fit living and my grandfather recently being diagnosed with type 2 diabetes, I was shocked by the staggering statistics of this disease plaguing America.

  • 29.1 million people suffer from diabetes (27% don’t know it)
  • Another 86 million people have prediabetes (90% don’t know it)
  • Without weight loss and moderate physical activity, 15-30% of those with prediabetes will develop type 2 diabetes within 5 years
  • Risk of death for adults with diabetes is 50% higher than for adults without diabetes
  • In 2012, reported total medical costs and lost work and wages for people diagnosed with diabetes was $245 billion
  • Type 2 diabetes is a “lifestyle disease” – which is preventable and should be fought

The YMCA’s program helps adults reduce their risk for developing diabetes by taking steps that will improve their overall health and well-being. Participants qualify for the program by being 18 years of age or older, overweight (BMI of 25 or greater), and diagnosed with prediabetes via a blood test or gestational diabetes. The program is a one-year commitment – meeting as a group weekly for the first 16 sessions, meeting every other week for the next 3 sessions, and meeting monthly for the final 6 sessions. The YDPP emphasizes two primary goals: reducing body weight by 7% and increasing physical activity to 150 minutes per week.

Thanks to the company AFL and their wellness initiatives, I was able to start facilitating a class at their Duncan, SC, campus in December 2016. Some might have questioned beginning our program near the end of the calendar year, but – lemons to lemonade – I was convinced that my participants could learn a tremendous amount in 3 weeks and go into the holidays more prepared than ever.

Day One, we were all a little nervous, I think. But our small group of 4 bonded quickly and proved to be a candid and effective setting.

We powered through Y curriculum. We shared our triumphs and struggles and made action plans. We practiced fitness and nutrition challenges like a week without fried food, pizza or chocolate; cooking a new recipe, buying a piece of gear; and working out with a buddy.

We had “lapse” but not “relapse.” We had birthdays, weddings, travel, bad weather, office deadlines and so many other life events – that, under other circumstances, may have held us back. But we learned.

We actually looked forward to seeing each other. The “power of the group” was valued and motivational. They definitely had a coach who cared. And I had participants who would get REAL. That’s how we managed our year together.

I would be remiss to not say that as of December 2017, all 4 people did prevent diabetes!

So, to Angie, the HR lead who championed YDPP, and to John, Rich, Candice and Tammy, the hard-working, fun-loving folks I am grateful to know…

“Go forth and be successful!”


AarikaDiabetes Prevention Program
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Behavior Change Revolution

I was listening to a podcast from Freakonomics Radio entitled “How to Launch a Behavior-Change Revolution.” It relates entirely to my everyday struggle as a health and fitness professional, and covers an underlying issue for client success in Healthy Weight Lifestyle Programs at Doctor for Life.

Behavior change is a big ask. Experts understanding thinking and decision-making is tough. The average person understanding his or her own influences and patterns is tougher. And that person actively choosing to change and diligently fulfilling that path is the toughest of all. I say to clients all the time, “Knowing what to do and actually doing it are two different things.”

The podcast representatives state that human nature is to “repeatedly make decisions that undermine their own wellbeing” and that “people rarely behave as rationally as economic models predict.” They believe that studying and trying to implement behavior change is the most worthwhile pursuit for any scientist, that it is wise to help people make better decisions for themselves and for society. I agree.

With the staggering and growing statistics in obesity and chronic disease, particularly a lifestyle-related disease like Type II Diabetes, I do not doubt that the general public is ignorant to the fact that all these per-day and per-meal unhealthy decisions add up. Of course, it is much more convenient to eat a fast food cheeseburger today than to worry about how that affects many tomorrows and premature death.

This podcast focuses on a group of researchers, a dream team, coming together to work on the Behavior Change for Good Initiative. Their mission is to determine best practices in three realms – number one being Health (smoking cessation, healthy eating, increasing exercise, reducing alcohol consumption). They are partnering with large organizations for participation and funding of real-world experiments, helping scientists discover insights that could address the pressing social problem of self-destructive humans and establish long-lasting behavior change.

The Behavior Change Revolution has been happening for decades – in academia for a while, and creeping into government policy shops and commercial firms more recently. But it is hardly mainstream yet. Institutional and societal change, when it happens at all, usually happens slowly and with a lot of pushback. So this team’s ambition is quite lofty (and time-consuming, and expensive).

Will it take a nudge? Will it take expanding or shrinking choice sets? Will it take redesigning how incentives in given situations are set up, via smart algorithms or old-fashioned human touch? The ultimate goal is to help people get satisfaction they’ll need in the short-term and outcomes they’ll want in the long-term.

< As written for Doctor for Life >
AarikaBehavior Change Revolution
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Cancer & Excess Weight

A recent Internal Medicine News article covered an October report from the Centers for Disease Control and Prevention citing that “being overweight or obese significantly increased the risk of developing at least 13 types of cancer.”

The study compared statistics between 2005 and 2014, showing that obesity-related cancers* increased by 7%. They found that 40% of nearly 1.6 million of all cancer diagnoses were people with overweight- or obesity-related cancers. The rates were more pronounced in older people (50-74 years of age) and women (possibly because of female-specific cancers). Although, during that same time period, incidences of cancers unrelated to body weight decreased by 13%. [*Excluding colorectal cancer.]

CDC Director Brenda Fitzgerald, MD…

“A majority of American adults weigh more than recommended – and being overweight or obese puts people at higher risk for a number of cancers – so these findings are a cause for concern. By getting to and keeping a healthy weight, we all can play a role in cancer prevention.”

Doctor for Life bridges the gap to fight overweight and obesity and chronic disease. Our Healthy Weight Lifestyle approach helps mitigate these negative statistics with screening and prevention. Our lead physician is board certified in both Internal Medicine and Obesity Medicine.

Dr. Cheryl Sarmiento…

“Even though the effects of unhealthy weight on diabetes, cardiovascular disease, mortality and other health outcomes are widely known, there is less awareness that unhealthy weight gain is associated with increased risk of certain cancers. There are opportunities for Clinical Intervention, and at DFL, we have all the available tools with services and programs to fight these dreadful diseases.”

< As written for Doctor for Life >
AarikaCancer & Excess Weight
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Taken Aback

Recovery seems to be a neglected theme in a world of fitness. We cannot fault trainers too much, as their job is usually to correct a situation by adding activity to someone’s life because the lack of it has led to health and size issues. Yet, what about the clients, or trainers themselves, who are too active? Here lies my personal struggle and confession of late.

I have always been athletic and very physically capable. I did not realize until recently what it feels like to be limited, and the toll it would take on my psyche.

In January, I began to notice a recurrence of back pain, mostly surrounding my right shoulder blade. I spent a few months rotating through the following routine… Exercise. Pain. Aleve. Stretch. Ice. Discomfort. Exercise. Pain. Etcetera. Sometimes the pain was striking like a knife. Sometimes it was dull and achy. It would go away for a day or two. Unfortunately, that only prolonged me not seeking help sooner.

In April, leading up to my wedding, I finally decided to nix the “walk it off” mentality that had been engrained in me since childhood sports and see a highly recommended physical therapist.

A part of me was relieved to discover that I really did have a limitation on my right side, mobility problems with my first rib, pectoralis major, shoulder capsule and upper trapezius. I was not crazy or a hypochondriac. The pain was real. And, it made sense that the back was not the cause. The back, being very strong, and the body, being amazingly coordinated, was working overtime to assist the other muscles dysfunctioning. I was taken aback by back takin’ a beating!

With my therapist, I realized that my right shoulder had been chronically abused. Basically, I had been over-using and under-resting it. That’s definitely harder for me to bear than if I had some standout injury to point to as the source of my ailment.

For one, we worked together on movements to improve range and lessen pain and discomfort, in weekly sessions and assignments on my own. Foam rolling, down-and-back motions, engaging the lower back and tennis ball massages were all huge. The biggest goals were to not stress it with exercise and to rest long and often.

For two, aware of this ride side domination, I began thoroughly contemplating my regular daily activities. Unhappy to admit, I found that I was doing just about everything with my right arm – carrying my backpack, scrubbing dishes, using a computer mouse, weeding the garden, brushing my teeth. I also found that my sleeping positions rounded out the right shoulder, like sleeping on my right side a lot or when sleeping on the left still curling the right shoulder around hugging a pillow.

For the sake of recovery, in the last two months, I have not done any lifting or pressing. I have only officially worked out three days per week. I have laid on the couch in the evenings strapped up with ice packs.

I feel held hostage, and I hate that I didn’t notice all the small things building up. I am deflated by my condition and see my physique and power declining. Maybe no one else even pays attention. But I have to manage feelings of frustration and inadequacy. Now, I want to turn it into a learning opportunity.

Opposite of many, I want to be active so badly. However, my willpower challenge is not giving in to that desire and taking the time off my body needs. Like what I ask of clients, this means I have to adapt and behave differently for a stint. I have to recognize what’s best for me and do that, not just do what I am inclined to. In all fairness, it also means I would benefit from a lifestyle adjustment, balancing out my ratio of work to breaks more.

Going through this bind helps me closer understand my clients’ limitations. A hardship helps me relate to the hurdles they face when making behavior changes, how tough it can be to do something unusual. I can empathize and tell testimony.

It also pushes me to promote that lost theme of recovery, how important it is as a part of the cycle, especially for beginners or life-changers. Because an injury, illness or fatigue – all brought on by over-activity – will be the first thing to shred motivation and keep that person from the gym.

So as you are killing it with resistance training, cardio endurance, group exercise classes, hunkered at your desk, lugging your kids around or doing domestic chores, remember the two types of recovery – the very normal short-term period you take between activity bouts that keeps you from having to take the very excruciating long-term period you may find yourself in while climbing out of a hole you created by depleting your systems.

Continuing with rehabilitation then, June is my month of recovery. I am human. I have goals and a plan as well. It will not be easy. But I will be focused these next few weeks. I will get better. It matters that much.

New rotation… Warm up. Exercise. Cool down and stretch. Still ice and massage if necessary. Listen to the body. Get enough rest in between. Then exercise again!

P.S. Thank you, Premier Physical Therapy.  🙂

AarikaTaken Aback
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Give Us Our Daily Water

“According to most of the literature, a safe general recommendation for daily fluid intake is about 3 liters of fluid (or 12 cups) each day. Since 1 liter (4 cups) comes from our food, this means that 2 liters (8 cups) comes from purposeful fluid intake (in other words, drinking).”

This is Precision Nutrition on Water and Fluid Balance. I read this and guffawed a bit. For me it presents a new way of looking at how much water a person should be drinking daily. Most could recite to you that they should be getting eight glasses of water a day. Here are the issues…

1) I have heard (and recited) that drinking “eight glasses” of water is ideal per day. Key word is glasses. How much is in a glass, you ask? Well, depends on the size of the glass. Could be eight ounces, 12 ounces, 16 ounces, etc. A person may have an eight-, 12- or 16-ounce glass but may not fill it up all the way.

2) We hear the number “eight” all the time. (That is technically meant to be “cups,” although you have all been referenced “glasses” before.) I understand that organizations and companies need to simplify messaging. But with no one ever hearing that the recommended total amount for fluid intake in a day is actually 12 cups (four cups of water being gained from food intake), we think eight is the only goal.

3) Four cups of our daily fluid are supposed to be taken in via food. No one knows this because the focus is always on the number eight. And, I consider that for water to be ascertained, we must also be eating the right foods. I’m sure the average Jane does not get close to four cups per day of fluid from eating canned, frozen, boxed, processed crap.

So… Revelation! The way I educate on hydration has forever changed. I will now be stating solidly 12 cups of fluid as the recommendation per day – four from nutritious food and eight from drinking water. Precise words matter. A whole picture matters. Relativity matters.

AarikaGive Us Our Daily Water
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D Deficiency

I woke up this morning and opened all the curtains and blinds in my house. I’m working from home today so I feel that this act is worth it, versus me throwing back the sashes on a normal day only to have to close them again when I leave the house an hour later. Cost-benefit analysis at its core… I’m aiming to get as much sunlight as I can these days because I recently found out that I am vitamin D deficient.

I visited my OB-GYN for an annual physical about two weeks ago, and she asked when I last had a cholesterol test. Probably in elementary school when it was offered through some free program, I said. She raised an eyebrow and then sent me down the hall to meet with a technician to draw blood. It was a relatively painless experience until I got the results – not enough vitamin D, and now you must take a daily supplement for the next year. Goo!

This hurt me. I am very conscious of vitamin D as an important nutrient to the body. I researched, wrote the script and hosted a health and wellness talk show interview segment with a medical specialist on that exact subject once. I exit my office most days at lunch to eat outside and then sit in my car to read with the windows down to get natural light and fresh air. I do constant yard work on my 1.12 acres. I run and play sports outside. I intake proper things like fish, milk, eggs and cheese. How am I vitamin D deficient?

I know it’s possible. The test doesn’t lie. And thankfully, I am only mild on the scale and taking over-the-counter D when I could have wound up with a prescription. I’ll do the healthy thing – eat good food sources, soak up rays, take my medicine.

But this diagnosis bothers me for another reason. If I am failing in the Vitamin D department, then how many others out there are affected? Seriously, I try my best to live a healthy lifestyle. So how are the couch potatoes and office drones doing? They are likely all sitting around weak and brittle boned.

This is apparently a big problem, among many other health-related issues in our society. I’m now a victim and speaking out. Ha! One more soapbox for me to stand on, you loafers.

Get tested, and if found deficient, shovel those fruit gummies.

AarikaD Deficiency
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