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Case Study_Final

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>> Hi and welcome back. Throughout this course, we stress the importance of working in conjunction with medical professionals when supporting clients with gut health issues. There are many things you can do as an Integrative Nutrition Health Coach to help your clients achieve better gut health through primary food and nutrition. Your support and the safe space that you hold for your clients can be healing just in themselves. But when it comes to the medical stuff, evaluating for medical conditions, diagnosing, and prescribing treatments, medications and supplements, we remind you that this is the territory of licensed healthcare professionals. That said, you can make a powerhouse of a team, providing clients with comprehensive care that addresses body, mind, and spirit. But what does this look like? How do you actually go about doing this? We get this question a lot. What makes sense in theory can sometimes be challenging to apply and practice. Where do you draw the line in real life situations? How do you navigate conversations about gut health conditions while staying within your scope of practice and sounding like you have something uniquely beneficial to offer your clients? In this lecture, we'll take you through a case study to bring to life what it might look like to put some of the principles and concepts from this course into action. First, let's meet Laura. Laura was diagnosed with GERD by her doctor two years ago. Heartburn and reflux are daily occurrences for her, which as you can imagine is very frustrating and unpleasant. Her doctor put her on proton pump inhibitors which she took for over a year. At that point, she tried to discontinue them but the pain became unbearable. Laura is very slender and looks tired. She lacks the vibrancy you might expect from someone in their 20s. You notice on her Health History that she's losing weight without trying to. She recently completed her training to become a registered nurse. This profession is very rewarding to her but also very draining. As a medical professional, she's aware of the potential negative effects of long-term use of her medication. She wants to achieve the best level of health possible to give her body a chance to heal itself naturally. To do this, she has turned to nutrition and health coaching. When Laura first comes to you, she's convinced that she has too much stomach acid and that the solution is to get rid of the excess. She asks you for help with this. Now let's say the first thing that pops in your head is the possibility that Laura may actually have two little stomach acid. And if so, she hasn't made the connection that her unexplained weight loss and thin frame might be related to poor nutrient absorption caused by low stomach acid. What do you say? What's okay to do and what isn't? We're not going to just give away all the answers without having you think. So take a moment right now to grab a piece of paper and something to write with. Pause the video for a minute or two and jot down your ideas. So what do you think? There are a variety of ways you could proceed, but first, let's narrow things down by talking about what would not be appropriate here. What you definitely wouldn't want to do is jump to any conclusions and give Laura the idea that she likely has low stomach acid or to assume this and proceed as if she does. You wouldn't want to ignore this possibility either. Just like all doctors are trained to consider all of the possibilities, you too, as a Health Coach, should keep in mind all possible causes. So what to do then? Gather information. Instead of jumping right in with your own ideas, learn more about Laura's history and ask questions. Have any doctor's visits or testing in the past indicated high stomach acid? Why did she feel this is the case? Have any other possibilities been presented by her doctor? Has she received a second opinion? Help clients like Laura feel empowered in their healing journey. Chances are her doctor didn't have an hour to sit and ask in-depth questions. Providing the service is of more value than jumping to a solution during the first session. It's more important to help your clients realize that they are their own best expert and to have them take an active role in thinking critically and putting together clues about their health. Take the time to empower and then educate them on coping strategies. As we say, at IIN, take the long view approach. So now at this point, if Laura hasn't mentioned anything about low stomach acid, you could say something like, "Has your doctor ever suggested the possibility of low stomach acid? You'd need a medical evaluation to determine this, but something to consider is that reflux and heartburn can also be caused by too little stomach acid. Low stomach acid can make it hard to absorb nutrients which can lead to unexplained weight loss. I'm not saying this is what's going on but it may be worth exploring this with your doctor. What do you think?" If Laura wants to explore this possibility, this is where you'd create your first bridge back to her doctor or new medical professional. Encouraging Laura to either set up an appointment with her doctor to explore if she has low stomach acid or suggest that she meet with another medical professional for a second opinion. The bottom line is not to proceed on the basis of your own opinion no matter how spot on it may be. Until she receives any information from the doctor, don't proceed as if she has low stomach acid. So then what do you do now? Give this some thought for a minute or two and then write down your ideas. I'll hang out here until you get back. Pause the video now. Great. What did you come up with? We came up with three ideas over here. I'll share them with you now so you can see if they match up. Then we'll talk about each in detail. Possible next steps with Laura could be to help her naturally manage her heartburn symptoms while the root cause is explored with her doctor, discuss primary food, and inquire about her eating habits. First, let's talk about helping Laura naturally manage her heartburn. This doesn't mean treating Laura's GERD. Generally speaking, doctors treat sickness and Health Coaches inspire better health. Many conditions and symptoms are preventable, meaning they're caused by poor diet and lifestyle. The role of an Integrative Nutrition Health Coach as part of a treatment team is to help clients improve their life choices. This in turn may help improve a client's symptoms if they're at the root of the issue or exacerbating the condition. But this is different than treating a medical condition which is something only a medical professional is trained to do. Makes sense? As we cover elsewhere in this course, certain foods and aspects of lifestyle can trigger heartburn for some people. Helping Laura to eliminate episodes of heartburn triggered by factors within her control will help her start to feel better. So one thing you could do would be to educate Laura about common triggered foods. You could even give her handout to take home with a list of acidic foods and beverages that may aggravate reflux. Keeping in mind that Laura is bio-individual, you'd next want to help her apply this information. A good starting point would be to ask her if she can identify offhand any foods, drinks, or situations that seem to trigger her reflux. Does she typically try to avoid these or does she continue to consume in spite of the consequences? It's easy to assume that clients aren't putting themselves in situations that result in suffering. But you'd be surprised to know for example how many clients refuse to part with their coffee or wine despite the heartburn it brings. You may find that Laura's symptoms of GERD are being exacerbated by habits she's struggling to break. What her doctor may only have time to write off as noncompliance is an area where you could step in and provide much needed support to improve compliance. The next step in the process might look like helping Laura identify trigger foods she's not aware of. Over the next few weeks, between sessions, you could ask her to keep food journal to record what she eats and how she feels afterwards in terms of her heartburn and reflux. Or you could approach it this way. Every time Laura experiences an episode, ask her to write down in a journal what preceded it. What did she eat and drink last and in what context? Was she stressed? Wearing restrictive clothing? Did she quickly devour a large portion of food? Playing detective can reveal some powerful clues. When possible offenders surface, you can suggest that Laura try temporarily crowding out those foods or doing an elimination diet. Just remember, it's not appropriate to suggest that a client adapt a diet that entirely eliminates a food group. You wouldn't want to tell a client like Laura to stop eating all dairy or all grains, for example. In a case of any major dietary changes, you'd want to tell Laura to first consult with her doctor and to consider meeting with a nutritionist to make sure she's getting all of her nutritional needs met in the absence of a major food group. Now since you can't force your clients to meet with a nutritionist or a doctor and you can't go there with them, students often ask how you enforce this. Short answer is that you can't. You can't tell your clients what to do. But you can make it more likely that they'll follow through. A great way to do this is to develop a list of reputable traditional and alternative healthcare providers that you can refer your clients to when these moments come up. A client who walks out with a name, telephone number, or website written on a postage or stored in their phone is more likely to follow through. And here is a bonus for you. If you put yourself out there and establish connections with these medical professionals, you can create a referral system where they send their patients your way too. Everybody wins. Okay, back to Laura. Let's imagine that you go through these steps with her. She pinpoints that her reflux is often worst in the morning and late afternoon. Looking at her food journal together, you notice a corresponding pattern. She often grabs a bottle of orange juice from the hospital's vending machine on the day she has no time to eat breakfast. And most afternoons, she has some chocolate for energy boost to get her through her last few hours at work. Coincidence? You'd challenge Laura to crowd out the OJ and the Chocolate for a week to find out. You also leave Laura with one recommendation to try putting an extra pillow under her head when she sleeps elevating it about six inches from the mattress. So far, other than the suggestion, you provide a little bit of education and guided Laura through self-exploration, but you haven't given her any medical advice or made any direct suggestions, yet she's already starting to become more aware of her body and noticing that she feels better. Awesome. All right, now let's talk about the second direction you could have taken in your work with Laura. Focus in on primary food. This is the cornerstone of health coaching and you should be constantly weaving this into your work with clients regardless of what brought them to you. You could have chosen not to talk about heartburn or trigger foods or anything on the topic just yet. Maybe you simply have taken the time on getting to know Laura more and learning what's going on in all areas of her life. At any point, in the coaching process, it can be beneficial to focus in on primary food. So let's say you spend some time asking Laura questions about her life. Right away, it becomes apparent that her lifestyle and stress levels are affecting her health and well-being. She works long shifts at the hospital with little time to catch her breath. Most say, she's running from patient to patient. She often eats lunch standing up or forgets to eat. She realizes that this may have to do with why she's losing weight despite eating large dinners. Laura points out her lack of muscle tone lamenting that when she was in school, she made time to work out but never has time anymore since starting her residency. You discover that she misses exercise and feels weak. You point out that she hasn't said much about her husband who she has only mentioned once or twice. She explains that her marriage is strange because he's a young doctor completing his residency in another state. Living apart makes her feel lonely and it's compounded by the fact that their schedules rarely line up so they seldom speak to each other. When you ask what else is stressful in her life, she reveals that her cat has diabetes and requires frequent insulin shots. To put it mildly, Laura is stressed. She knows her stress is a problem but sees much of it as unavoidable. What would you do with this information? If you're thinking about helping Laura crowd out her stress with primary food, you're on the right track. We explain throughout this course how the gut is negatively impacted by stress. Stress in our lives is a sign of imbalance, which is best addressed by tuning into primary food. An improved sense of well-being goes beyond just minimizing stressors. It also involves creating more joy and contentment. By helping Laura figure out what she needs more of in her life, it will help crowd out the stress and improve the way she feels. So you ask Laura what's missing in her life, what does she need more of, what could she benefit from having less of. You discover not surprisingly that Laura wants more time for herself to feel better taken care of and to get back to exercising. You help her map out a schedule and find a few small but significant ways to incorporate self-care. With clients like Laura who can't fathom devoting even more time out of their hectic day to commit to things, just starting with something as simple as five deep breaths on the way to and from work can create a shift. It's not very realistic for Laura to jump right back into working out an hour a day. But carving out 10 minutes in the morning to do a Tabata video chances are that something that could stick. As Laura starts making herself a priority tending to her needs and what makes her happy, it'll create an overall increased sense of well-being. This won't make her GERD go away but it may help her symptoms feel more manageable and get her body in better shape to heal itself. Lastly, let's talk about the third path you could have taken with Laura, inquiring about her eating habits. How we eat is just as important as what we eat. This is something often overlooked by doctors and nutritionists. Does Laura eat with distractions? She shares that she eats standing up at the hospital while looking over charts. What about dinner? She admits that she eats in front of the TV and that she does this because it makes her feel less lonely without her husband there. What do you do? Telling Laura she should shut off the TV while eating may help with her heartburn but it's not going to address her loneliness. A good way to proceed might be by looking at ways that Laura can feel less lonely while still being mindful and present during dinner. You could also ask Laura if she's eating before bedtime. She says she isn't, but then again she eats a substantially large dinner when she gets home around 8:00pm or 9:00pm because she's so hungry. Bringing her attention to this, she realizes she goes to bed with a feeling of heaviness that's often uncomfortable. She's attributed it to GERD, but until she tracked her behaviors, she hadn't made the connection that she was worsening her symptoms with her eating patterns. So with this approach, your focus with Laura becomes about how she can make it a priority to eat breakfast and lunch so that she doesn't come home starving and eating a huge dinner to compensate. She says she likes smoothies. So you help her create a routine for making green smoothies in the morning to provide easy to digest nutrients for her body. She says that she can't take a proper lunch break, so you start small. By making sure she at least has food on hand that she can easily grab and remember to eat. Help Laura create a list of quick and easy snacks and small meals to stock up on that she can bring to the hospital like nuts, fruit, cheese, yogurt, and soup. Encourage her to take snack breaks and to put reminders on her phone. Also, have her commit to putting down the charts and sitting down while she eats, even if it's for five minutes. By helping Laura tune into triggers, crowding out stress with primary food, and paying attention to how she eats her food, you can help her make some significant progress without treading near diagnosis or treatment. Her doctor will treat her GERD while you help her to become healthier and happier overall. Can you see how this type of work perfectly complements that of doctors in helping individuals? When you feel comfortable helping to create a dialogue between your clients and their doctors, you can help them ask questions and look into potentially helpful supplements and treatments. For example, it wouldn't be appropriate to prescribe that Laura start taking digestive bitters before every meal to rev up her digestion. But you could describe what they do and tell her to ask her doctor about them. If a client wonders why they can't just go out and buy a supplement or herb, remind them of their bio-individuality. Everyone responds to things differently. In the event that Laura does in fact have high stomach acid, the bitters would aggravate her condition. There's a lot of trial and error on the path to wellness, but we should try to eliminate unnecessary guesswork when it may cause more harm than good. Clients like Laura will make progress step by step. There's no quick fix. Help your clients prime their bodies for healing by teaching them to listen to their inner wisdom, while seeking out all necessary medical treatment to complement your support. Integrative Nutrition Health Coaches can work wonders for prevention, but sickness always requires the appropriate interventions. Staying in a safe spot when it comes to scope of practice keeps your clients safe. Always keep their best interests in mind. In this lecture, we focus on our client Laura and one condition GERD. Can you see how these guidelines are interchangeable? There's no one formula for how to work with clients, but there are general principles and themes for how you can work safely and effectively with clients who have medical conditions and see other treatment providers. Did you find this case study to be helpful? I encourage you to share your own favorite case studies in your Facebook group and compare notes. Just be sure to keep names anonymous. See you soon.

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Duration: 19 minutes and 39 seconds
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Language: English
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Posted by: integrativenutrition on Jun 28, 2018

Case Study_Final

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