Bacon, eggs, sausages and potatoes fried in the drippings – about 50 years ago, that would have been considered a typical Canadian breakfast. Today, just the mention of that same meal would likely bring forth gasps of horror and admonitions to ‘Watch your cholesterol!’
In recent years, Canadians have become much more aware of cholesterol. These days, lipid level testing has become a standard component of medical care and the dangers of too much cholesterol are well known. Yet many people who are warned that they have elevated levels do nothing to bring the problem under control. Much of the reason is because patients with high cholesterol, unlike those who have high blood pressure or blood sugar, tend to feel perfectly well… until a major illness occurs.
“People think if they don’t feel sick, it isn’t an issue. We try to make them aware of the serious long-term risks,” said Nancy Corcoran, Coordinator, Cardiac Patient Education, at William Osler Health Centre’s Medical Risk Management Clinic. The clinic takes a team approach to preventing and treating risk factors associated with abnormal cholesterol levels. The team consists of a registered nurse, registered dietitian, pharmacist, and clerical staff. The program also includes a cardiologist and two endocrinologists.
The clinic operates one day each week at the Osler – Etobicoke (Toronto) and Osler – Peel Memorial (Brampton) hospitals. Patients must be referred by their family doctors or by specialists. Residents in Osler’s third community of Georgetown are generally referred to the Peel Memorial site.
In addition to elevated cholesterol, patients often have additional risk factors such as diabetes, hypertension, obesity, tobacco use or a family history of cardiovascular disease. At the Medical Risk Management Clinic, they receive counselling and support to make changes that lower their risk of heart attack or stroke.
At the first appointment, the patient meets with the nurse and then the dietitian. Those on medication are referred to the pharmacist who reviews the medication regimen and makes suggestions for modification if necessary. Patients learn about what it means to have elevated cholesterol levels and get help with things like menu planning, quitting smoking and starting an exercise program. They can have their questions answered and work with the team to set goals for themselves.
The second visit is usually three months later. The staff monitors the patient’s progress and offer further suggestions. Patients also see either the endocrinologist or the cardiologist at the Etobicoke site. At each session, the staff reviews the patient’s cholesterol test results, blood pressure, body fat/body mass index, and waist measurement. Patients also get educational material to take home. The follow-up continues until patients have reached their target cholesterol level and can maintain a healthy lifestyle on their own.
Kim, a 44 year-old police officer and patient at the clinic, says the regular monitoring keeps her motivated. She has a family history of high cholesterol – her father died at 52 and her daughter was diagnosed with high cholesterol at just 9 years old – and was referred to Osler by her physician. About two years into the program, she has noticed some real improvements in her lipid levels, body weight and blood pressure. “The one-on-one counselling is so individual and so much more meaningful than sitting in a class or reading a book,” she said. “It’s not like a diet or workout regimen, it’s a personalized formula for lifestyle change.”
Some people who have developed unhealthy work, exercise or eating habits over time feel overwhelmed at the notion of changing their lifestyles in a short period. But at the Medical Risk Management Clinic, the approach is realistic and encouraging. The staff work closely with patients to set reasonable goals within achievable timeframes. Bit by bit, those bad habits can be changed.
In these days when family doctors are hard pressed for time, Corcoran finds her patients benefit from the personalized care they get at the Medical Risk Management Clinic. Generally, they leave the program with a much higher awareness of what cholesterol is and how they can manage it. “We try not to scare people,” she said. “Instead we give patients the knowledge and tools to change their risk factors. They learn that they can control their own health to a great extent.”
Kim agrees. “It works…it works for me. I can’t ask for more than that.”