Sunday, October 5, 2008

Focus on Diabetes

Diabetes is a lifestyle disease. That means it can be caused or made worse by poor choices -- a high-calorie, high-sugar diet and a sedentary lifestyle, for instance.
The Fauquier Times-Democrat newspaper was good enough to publish several stories highlighting the disease and the tools Fauquier Health provides to battle it. In case you missed them, here are the stories.

Managing diabetes: Hard work, but worth it

About a year ago, in July of 2007, Warrenton resident Jim Smyth realized that he hadn’t been feeling well. He said, “I was really tired, didn’t feel like myself. I felt like I had a minor case of the flu. I have traveled a lot internationally for years, so I figured that’s why I was feeling run down.”

He had no idea how ill he really was.

Dr. Michael Lin of Warrenton diagnosed Smyth with Type 2 Diabetes, which runs in his family. “It turned out I was really sick, and had been for a while. I just didn’t know it,” said Smyth.

He was put on medication, and tried to get a handle on his blood sugar. “I started exercising at home, but I didn’t really know what I was doing. I was undisciplined, and there was no accountability.

“I am pretty busy. I work for an international publishing company, in business development, and have customers all over the world. By 8 a.m., I’m already way behind, because the rest of the world has been up and doing business for hours. When I was first diagnosed, I kept thinking I could continue the way I had been and just make a few changes in diet and exercise.”

By December, Smyth saw that his self-help efforts were not working. On his doctor’s suggestion, Smyth joined Fauquier Health’s LIFE Center, a medically based fitness center. “I started because I had to. At first I did it to live longer, but now I do it to feel better. And it really works.”

That was 9 months -- and 36 pounds – ago.

Smyth joined Fauquier Health’s Diabetes Management class and was surprised. He said, “I’m very well-educated. I read everything on diabetes when I got my diagnosis. But I took the pre-test they gave in the class and failed. The class gave me a chance to talk with experts and discuss how the disease affects my body and how I could make real changes.”

Smyth met for one-on-one sessions with diabetes educators Aren Dodge and Dottie Williams at the LIFE Center. “They provided a combination of expertise and genuine caring that is unlike anything I’ve seen anywhere else,” said Smyth.

The individual classes were followed by four group classes. Dodge reported, “Jim is great. He’s our cheerleader. He comes to classes and speaks to others about his experiences and provides encouragement.”

Nutrition is a main focus of the Diabetes Management classes. Smyth said, “It’s not easy, but I have no choice. If I want to eat junk food, I’m going to feel bad.

“Dottie is always checking on me. ‘How’s your blood sugar today? What did you eat yesterday?’ It’s great to have someone to discuss things with. They teach you how to eat the right amount at every meal. The support is terrific.”

Regular exercise is another important component of diabetes management. Smyth said, “I can’t say enough about the LIFE Center. People don’t know how lucky we are to have this kind of facility right here in our small town. I come in and work out for 30-45 minutes, six days a week whenever I’m not out of town. Once I’m here, I don’t want to leave.
“I have people here who ask me how I’m doing. It’s a little extra incentive. If I don’t come, next time they want to know, ‘Where were you?’

Smyth continues to get help and motivation from Williams and Dodge, as well as exercise physiologist Sara Freeman. “Sara developed a plan for me and I follow her directions. I never get bored. There are lots of different things to try. I’m not great at stretching, so Amy (Moore, another exercise physiologist) showed me what’s good for me. I’ve done water exercise classes with John Ferguson and that was great, a lot of fun.”

“It’s hard work, but I get real benefits--benefits that let me enjoy every day more. I am very grateful for the care and support I get from the LIFE Center team.”

Smyth has made astonishing progress in a short time. The last time his blood sugar was tested, his numbers were the same as a person without diabetes. “I feel really good. It has happened very quickly. My doctor was amazed.

“The real benefit has been to the quality of my everyday life. I wake up every day feeling better. I can’t control the disease, but I can control how it affects me.”

New endocrinologist debuts in Warrenton

Nearly one in ten American adults has diabetes and, if present trends continue, one third of Americans born today will develop diabetes in their lifetime. These staggering statistics are from the American Diabetes Association.

Because diabetes is now being referred to as an “epidemic,” Fauquier Health has recruited a diabetes specialist to be part of its newly created Fauquier Health Endocrinology. Endocrinologist Dr. Deepak Kashyap is delighted to be in Fauquier. “I see this as a tremendous opportunity to provide vital specialty care in diabetes and other endocrine diseases.”

Dr. Kashyap said that his role is to de-burden primary care doctors by focusing on intense diabetes education and treatment. “Your primary care doctor may be treating you for arthritis, high blood pressure, and other medical conditions as well. I am able to focus my time with patients addressing their questions and working with them to improve their understanding of diabetes.”

Dr. Kashyap is board certified in internal medicine and endocrinology and is a certified diabetes educator. He explained, “This is an additional certification in teaching patients how to manage their diabetes – reviewing the roles of nutrition and physical activity, educating patients about the pathophysiology, individualizing treatment goals and providing coping skills.”

A study by the National Institutes of Health revealed that about one-third of people who have diabetes don’t even know they have it. Dr. Kashyap said, “By the time most diabetics are diagnosed, the beta cells (insulin-producing cells) of the pancreas have been damaged so much that only 50 percent of them remain functional. And each year, another 3-5 percent of these cells fail. Newer drugs such as Byetta (a twice-daily injection) or Januvia (a once-daily pill) could possibly prevent further pancreas failure.

“I have a lot of experience with these newer therapies. Byetta, for instance, can have the added benefit of decreasing the appetite for easier weight loss. Because excess weight is a contributor to diabetes, this is an important benefit.”
Dr. Kashyap added, “I am trained in the use of insulin pumps, which can be used in place of insulin shots. Pumps release the medication automatically, and there are fewer needle sticks.”

But diabetes treatment is not all about medication. Diabetes is a “lifestyle disease,” caused and exacerbated by poor diet and inactivity as well as genetics.

Dr. Kashyap said, “I spend a lot of time with my patients talking about meal plans and exercise habits. It can be difficult to convince patients of the long-term benefits of these changes because sometimes serious diabetic complications may take several decades to develop. Many adult diabetics don’t even have the most common symptoms: fatigue, increased thirst, frequent urination and blurry vision.”

About half of those diagnosed with diabetes decide to change their lifestyle.

“If we catch diabetes early, and significant lifestyle changes are made, in some cases it can even be reversed. But I must have the patient’s participation. My job is to empower people to make the changes they need to make. If you have diabetes, you have to live with it, but I’m here to help you with that.”

Fauquier Health Endocrinology
550 Hospital Drive (at Fauquier Health Medical Center on Hospital Hill)
Warrenton, VA 20186
Main number: 540.316.5940
Main Fax line: 540.316.5941

Special Programs for Diabetics

Diabetes and You
What: Dr. Deepak Kashyap, a board certified physician in Endocrinology and Internal Medicine, will discuss diabetes prevention. Find out who is at risk for diabetes; the signs and symptoms of diabetes; how diabetes develops, and what changes you can make to reduce your risk of diabetes and protect your health.
When: Thursday, November 13, at 7 p.m.
Where: Sycamore Room B at Fauquier Hospital
Information: Registration required. Call 540.316.3588.

Self-Management Training
Classes on diabetes self-management are offered at Fauquier Health’s L.I.F.E. Center in Warrenton.
Participants learn the basics of managing diabetes, including nutrition, monitoring, problem solving, activity goals, stress and complication prevention. A free glucometer, test strips and lancets are given out, and those who enroll are signed up for a free L.I.F.E. Center membership while they are enrolled in the class.
The self-management sessions, which require a doctor’s referral, include two one-hour, one-on-one classes with diabetes educators Aren Dodge and Dottie Williams. Eight hours of group classes follow, offered weekends, evenings or day times.
The classes are covered by Medicare and most insurance plans. More information is available by calling the L.I.F.E. Center at 540.316.2652.

Diabetes Support Group
The Fauquier Health L.I.F.E. Center hosts a free Fauquier Diabetes Support Group on the second Thursday of every other month. The group will meet from 6-7 p.m. in Studio 1 on November 13 and January 8, 2009.
The group will be for anyone in the community with any type of diabetes, as well as his or her support person.

More information is available by calling the L.I.F.E. Center at 540.316.2652.

Diabetes Program at the Free Clinic
In addition to its regular health clinic, the Fauquier Free Clinic has a diabetic specialty clinic that meets once a month by appointment. Three doctors participate in the special program: Dr. Michael Ackerman, Dr. Bill Simpson and Dr. Kevin McCarthy.
The patients benefit from extra attention, shorter wait times, group classes about diabetes management, and seeing the same volunteer physician each time they come.
Operating since 2003, the diabetes clinic serves about 35 patients, mostly those who can benefit from additional education about their disease, or who have had a particularly difficult time controlling their blood sugars.

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