What is chronic disease management and preventive medicine?

St. Joseph’s/Candler Primary Care Physician Dr. Tia Bingham explains how you can control chronic, common conditions such as type 2 diabetes or hypertension after you’ve been diagnosed

When certain people are diagnosed with a chronic disease, such as high blood pressure or type 2 diabetes, it can be really scary and feel like the end of the world.

Others may almost ignore the diagnosis, especially if they are younger and don’t experience symptoms. (Hypertension especially can be asymptomatic.)

Dr. Tia Bingham, a family medicine doctor with St. Joseph’s/Candler Primary Care in Pooler, doesn’t want her patients to react either way.

“Blood pressure is not going to kill you over-night. Diabetes is not something that is going to cause a stroke or heart attack or amputation after one day,” she says. “It can slowly over time cause damage, so getting these things under control – yes, even in your 30s, 40s, 50s – is important so everyone can live a long, healthy, happy life.”

Dr. Bingham calls this chronic disease management. It’s taking actions while you are living with a chronic disease to manage the condition and hopefully prevent long-term organ damage.

“If you wait until you have a heart attack or stroke or amputation or blindness, that can severely interfere with your quality of life,” she says.

For all her patients, Dr. Bingham recommends regular check-ups with their primary care physician, along with recommended vaccines and screenings such as colonoscopies and mammograms.

If you are diagnosed with high blood pressure, she recommends three main things:

1. If you are overweight (a BMI over 25), for every 10 pounds you lose, you can lower that top number by about eight. Weight is strongly correlated with high blood pressure, Dr. Bingham says.
2. Cut salt from your diet. That too can lower that top number. She encourages her patients to look into the D.A.S.H. diet. 
3. Get at least 150 minutes of cardiovascular exercise throughout the week. That’s not just taking the stairs at the office, but getting your heart rate up and keeping it up for 30 minutes. That is a great non-pharmacologic way to lower your blood pressure, Dr. Bingham says.

High blood pressure treatment can start with those lifestyle changes, but Dr. Bingham cautions there also may come a point when medication is needed. She uses herself as an example. Dr. Bingham tells her patients about her experience having high blood pressure, even as a young, thoughtfully healthy woman. When she was diagnosed eight years ago, she started regularly exercising and made diet adjustments, but it still came to a point where she needed medication.

“It’s easy for me to take medication for blood pressure because I see people after they’ve had a heart attack or stroke; I’ve seen the devastation, and I know I don’t want that for myself. Just like I don’t want that for you,” Dr. Bingham says. “My goal is to get them exactly on the medications they need; nothing more, nothing less.”

Chronic disease management for type 2 diabetes is a little more complicated because our body’s handle insulin differently, and there’s a heredity component as well. What Dr. Bingham does recommend to her patients with diabetes is a combination of exercise, diet and medication use.

She encourages her diabetic patients to cut down on carbs and increase lean proteins and non-starchy vegetables. They don’t spike your sugar and keep you fuller longer, she says.

Dr. Bingham also recommends 150 minutes of cardiovascular exercise each week, and if you are prescribed medications, to take as directed. Those medications can not only help control your blood sugar, but also can help prevent long-term damage to certain organs in your body. 

And for every single patient, Dr. Bingham encourages you to quit smoking if you are a smoker.

“This is what I love about primary care, people respond differently to how you talk to them. Some people want a doctor who is going to be like stop doing this, don’t do that,” Dr. Bingham says. “But most people do not respond well to, ‘You must stop smoking; you must lose weight.’ As a primary care doctor, it’s always my goal to figure out how you are going to respond to what I’m trying to help you to do.”

She does this through motivational interviewing, which is asking a lot of questions but a certain way. Instead of saying, you need to quit smoking, she’ll ask, ‘Why do you smoke?’ ‘Is there anything you can do besides smoking on your break from work, or can you chew gum in the car instead of smoking?’

“I think there are a lot of different ways to get someone to care about their health, if you ask the right questions,” Dr. Bingham says. “It may not be what people expect, but just to get them thinking about their health and hopefully in a better space.”

Preventative medicine

Beyond chronic disease management, Dr. Bingham discusses preventative measures with her patients. These measures include screening for cancer and other asymptomatic chronic disease states.

“The point of cancer screenings is picking up on cancer before you become symptomatic,” she advises. “Often times, if you wait until you have symptoms of colon cancer – such as weight loss, rectal bleeding or changes in your bowel habits – by the time a cancer is found, it has already spread to other parts of your body and is much more difficult to treat.”

She also advises that there have been some updates in current cancer screening guidelines. For example, in individuals who do not have family history of colon cancer, it was previously recommended to start colon cancer screening at age 50. Now the guidelines recommend screening to start at age 45, “and sometimes younger if you have a strong family history” Dr Bingham adds.

Related Article: Six frequently asked questions about colonoscopies

Dr. Bingham also recommends lung cancer screenings for people 50 to 80 years old who have a long history of smoking. Low dose CT scans are used to pick up small nodules that may appear concerning.  If a CT scan picks up an area of concern, the patient can much more quickly get into the specialist so they can be treated promptly.

Related Article: Lung Cancer Screening: From never hearing of it to finding his cancer

As for women’s health, Dr Bingham says, “About one in eight women will get breast cancer, and most cases are spontaneous. By that I mean that there is no family history.”

She recommends annual mammograms in women starting at age 40 years old.

Looking for a primary care doctor in the region? Find one near you today.