Dangerous Dan’s Dangerous Dan’s Road To RecoveryRoad To Recovery

By: Dan Zukiwsky, Keri By: Dan Zukiwsky, Keri Gerlach, Will Inkley, Jayme Gerlach, Will Inkley, Jayme

Kelly, and Will DechertKelly, and Will Dechert

Lifestyle ScheduleLifestyle ScheduleMonMon TuesTues WedsWeds ThurThur

ssFriFri SatSat SunSun

InterviewInterview PhysicianPhysician pedorthistpedorthist Golf Golf scheduled scheduled (No CART)(No CART)

Family Family recreation recreation dayday

-Lifestyle -Lifestyle meeting #1meeting #1

MonMon TuesTues WedWedss

ThurThurss

FriFri SatSat SunSun

Abrupt QuitAbrupt Quit

Introduction Introduction of patchof patch

PhysioPhysio

Scheduled Scheduled Relapse Relapse (morning (morning coffee coffee break)break)

Hypnosis Hypnosis sessionsession

lifestyle lifestyle counseling counseling #2#2

-learn self -learn self observationobservation

-Learn self--Learn self-efficacyefficacy

Golf Golf scheduled scheduled (No CART)(No CART)

Family Family recreation recreation dayday

Client Objectives/GoalsClient Objectives/Goals

Initial goal of 10 % decrease in body weight (20 lbs)Initial goal of 10 % decrease in body weight (20 lbs) Implement a smoking cessation programImplement a smoking cessation program Lower Blood pressure (Diastolic)Lower Blood pressure (Diastolic) Lower Cholesterol (LDL)Lower Cholesterol (LDL) Implement small incremental nutritional changes Implement small incremental nutritional changes

(Lower protein and fat, add substantial amount of (Lower protein and fat, add substantial amount of carbs and vegetables etc.carbs and vegetables etc.

Decrease red meat intakeDecrease red meat intake Reduce stress overall through management Reduce stress overall through management

techniquestechniques Decrease symptoms in shoulder and backDecrease symptoms in shoulder and back

Behavioral Prescription-Behavioral Prescription-SmokingSmoking

Smoking CessationSmoking Cessation Self Evaluation of tobacco cravingsSelf Evaluation of tobacco cravings Recall interview info (BP, cholesterol)Recall interview info (BP, cholesterol) Approach: Approach:

Counseling in conjuction with a 24 hour Counseling in conjuction with a 24 hour transdermal patchtransdermal patch

Smoking FactsSmoking Facts Five stages of smoking: Preparation, initiationFive stages of smoking: Preparation, initiation, ,

habitualhabitual, stopping, and resuming (Snyder 1989), stopping, and resuming (Snyder 1989) Smoking can play a central role in the control of Smoking can play a central role in the control of

emotions: anxiety, boredom, stress depression may emotions: anxiety, boredom, stress depression may cue smoking.cue smoking.

Cravings can be triggered by external stimuli: Cravings can be triggered by external stimuli: seeing others smoke, drinking a cup of coffeeseeing others smoke, drinking a cup of coffee

Acute withdrawal symptoms occur 7-10 days after Acute withdrawal symptoms occur 7-10 days after quitting. These include headache, heightened quitting. These include headache, heightened anxiety, irritability, ability to concentrate, and anxiety, irritability, ability to concentrate, and fatigue.fatigue.

Nicotine symptoms occur long after it has been Nicotine symptoms occur long after it has been used by the body. So will experience cravings used by the body. So will experience cravings

Within min after smoking nicotine levels fall in the Within min after smoking nicotine levels fall in the blood = more cravingblood = more craving

Behavioral Prescription-Behavioral Prescription-SmokingSmoking

Refer to Hypnotic Specialist (decreases Refer to Hypnotic Specialist (decreases relapse when used with counseling)relapse when used with counseling)

80 % relapse without counseling80 % relapse without counseling

Potholes Along The RoadPotholes Along The RoadFrequent causes of potholes/slip-upFrequent causes of potholes/slip-up Eating (coffee)Eating (coffee) Times of stressTimes of stress AlcoholAlcohol Social SituationsSocial Situations BoredomBoredom When you feel good (Sex) or bad (No sex)When you feel good (Sex) or bad (No sex) Food substitutionFood substitution

POTHOLES ARE OK, EVERYONE EXPERIENCES THEM!!!!!POTHOLES ARE OK, EVERYONE EXPERIENCES THEM!!!!!

But we will teach you methods that will help you get over themBut we will teach you methods that will help you get over them-Positive outlook-Positive outlook- No self blame- No self blame-Relaxation-Relaxation-Hypnosis-Hypnosis-Self efficacy-Self efficacy-Self Observation-Self Observation-Understanding Coping strategies-Understanding Coping strategies

Potholes ContinuedPotholes Continued

Pothole is basically a high risk smoking Pothole is basically a high risk smoking situation and an inadequate coping situation and an inadequate coping response.response.

2 approaches2 approaches Motivation to avoidMotivation to avoid Coping skills to maintain avoidanceCoping skills to maintain avoidance

Strategies include aversion, and self Strategies include aversion, and self controlcontrol

Stress ManagementStress Management Self Evaluation of stressSelf Evaluation of stress Excess stress may contribute to the development Excess stress may contribute to the development

of Cardiovascular diseaseof Cardiovascular disease Breathing ExercisesBreathing Exercises StretchingStretching WalkingWalking Progressive relaxationProgressive relaxation Go to relaxing spot when at work on lunchGo to relaxing spot when at work on lunch Alcohol, caffeine, sugar, fats, and tobacco all put Alcohol, caffeine, sugar, fats, and tobacco all put

a strain on your ability to cope with stress.a strain on your ability to cope with stress. ExerciseExercise FishingFishing

MonMon TuesTues WedsWeds ThurThurss

FriFri SatSat SunSun

InterviewInterview PhysicianPhysician pedorthistpedorthist Golf Golf scheduled scheduled (No CART)(No CART)

Family Family recreation recreation dayday

-Lifestyle -Lifestyle meeting #1meeting #1

MonMon TuesTues WedWedss

ThurThurss

FriFri SatSat SunSun

Abrupt QuitAbrupt Quit

Introduction Introduction of patchof patch

PhysioPhysio

Scheduled Scheduled Relapse Relapse (morning (morning coffee coffee break)break)

Hypnosis Hypnosis sessionsession

lifestyle lifestyle counselling counselling #2#2

-learn self -learn self observationobservation

-Learn self--Learn self-efficacyefficacy

Golf Golf scheduled scheduled (No CART)(No CART)

Family Family recreation recreation dayday

Lifestyle ScheduleLifestyle Schedule

Second Lifestyle SessionSecond Lifestyle Session

Check up on smoking cessationCheck up on smoking cessation Recap cravingsRecap cravings Initial response to hypnosis Initial response to hypnosis

treatmenttreatment Recap of physioRecap of physio

Behavioral Prescription- Behavioral Prescription- SmokingSmoking

Family Intervention SessionFamily Intervention Session Interactive processInteractive process Recap discussion of smoking facts and Recap discussion of smoking facts and

consequences of smoking on family consequences of smoking on family Schedule family intervention per Schedule family intervention per

unscheduled relapseunscheduled relapse

Family Counseling Family Counseling InterventionIntervention

Benefits of quitting smoking include: Benefits of quitting smoking include: easier breathingeasier breathing Improved taste and smellImproved taste and smell More energyMore energy More refreshing sleepMore refreshing sleep Monitary savings (you could save $1400 dollars Monitary savings (you could save $1400 dollars

annually and go and a vacation)annually and go and a vacation) Pride of accomplishmentPride of accomplishment Personal satisfactionPersonal satisfaction

Family Counseling Family Counseling ContinuedContinued

Additional Benefits related to family members:Additional Benefits related to family members: Children decreased exposure to smoking Children decreased exposure to smoking

toxinstoxins Asthma symptoms will decreaseAsthma symptoms will decrease Cardiovascular disease etc. associated with Cardiovascular disease etc. associated with

smoking. Genetic predisposition towards smoking. Genetic predisposition towards health related problems (CVD). Decreased health related problems (CVD). Decreased risk if smoking decreased.risk if smoking decreased.

Decreased Second hand smoke risk. Decreased Second hand smoke risk. Problem because smoke is unfiltered, Problem because smoke is unfiltered, greater risk associated with this type of greater risk associated with this type of smoke.smoke.

Nutrition Info and HabitsNutrition Info and Habits

Recap physician findings Recap physician findings Exam should take place at least once a yearExam should take place at least once a year

Eating habits (frequency) (5 likert Eating habits (frequency) (5 likert scales for food groups)scales for food groups)

Cholesterol level (LDL) 130 mg/dlCholesterol level (LDL) 130 mg/dl Eggs and butter have most cholesterolEggs and butter have most cholesterol Increase risk for heart diseaseIncrease risk for heart disease

Nutrition ModificationNutrition Modification Acidic foods such as oranges, grapefruit, lemons, limes, etc Acidic foods such as oranges, grapefruit, lemons, limes, etc

will help lower the pH balance in your blood and help will help lower the pH balance in your blood and help decrease nicotine cravings.decrease nicotine cravings.

Reduction of red meat (allow once per week on day of Reduction of red meat (allow once per week on day of choice)= decreases LDLchoice)= decreases LDL

Substitute fish, chicken, turkey for red meat= Increase Substitute fish, chicken, turkey for red meat= Increase HDL, especially fish which have omega 3 unsaturated fatty HDL, especially fish which have omega 3 unsaturated fatty acidsacids

Include at least one (moderation) serving of fruits and Include at least one (moderation) serving of fruits and vegetables per meal (broccoli, cauliflower, asparagus, vegetables per meal (broccoli, cauliflower, asparagus, zucchini, sweet potatoes). Are all high in vitaminszucchini, sweet potatoes). Are all high in vitamins

Eat fruit for dessertEat fruit for dessert Choose healthy snacks (handful of almonds, dried fruits)Choose healthy snacks (handful of almonds, dried fruits) Prepare meals for family during the week. Increase Prepare meals for family during the week. Increase

frequency of cooking. Try family preparation of foods.frequency of cooking. Try family preparation of foods. Include glass of red wine with dinner (1 glass per day) = Include glass of red wine with dinner (1 glass per day) =

helps cardiovascular health through cholesterolhelps cardiovascular health through cholesterol

Nutrition Modification Nutrition Modification Con’tCon’t

Prepare lunch for work, no take-out (Peanut butter Prepare lunch for work, no take-out (Peanut butter and jelly on whole wheat bread)and jelly on whole wheat bread)

During breaks at work consume water ( at least 1-1.5 During breaks at work consume water ( at least 1-1.5 litres per day) (Nalgene good)litres per day) (Nalgene good)

Decrease alcohol consumption, substitute light beer Decrease alcohol consumption, substitute light beer Decrease coffee intake to two cups per day Decrease coffee intake to two cups per day

(moderation)(moderation) Foods high in Vitamin B-6 which increase metabolism- Foods high in Vitamin B-6 which increase metabolism-

split peas, banana, chicken, beans, and advocado. Do split peas, banana, chicken, beans, and advocado. Do not overcooknot overcook

Reduction of portion size slowly (Serving size), and Reduction of portion size slowly (Serving size), and increase vegetable integrationincrease vegetable integration

How do you think you could decrease fat through How do you think you could decrease fat through cooking methods?cooking methods?

Cooking TipsCooking Tips

Cooking tips: Bake, broil, steam, Cooking tips: Bake, broil, steam, grillgrill

Bake fries instead of fryingBake fries instead of frying Invest in an indoor grillInvest in an indoor grill Use sweet potatoes instead of white Use sweet potatoes instead of white

potatoes. They have Vitamin B and potatoes. They have Vitamin B and FibreFibre

Physical PrescriptionPhysical Prescription

No cart for golfingNo cart for golfing 10 % weight loss goal (20 lbs). 10 % weight loss goal (20 lbs).

Minimum of 10 wks, about 2 lbs a Minimum of 10 wks, about 2 lbs a week.week.

Incorporate family walks (one to two Incorporate family walks (one to two walks per week, 30 minutes walks per week, 30 minutes minimum)minimum)

Slow integration of winter activities, Slow integration of winter activities, core strength and aquatic activities.core strength and aquatic activities.

Physical PrescriptionPhysical Prescription

MonMon TuesTues WedsWeds ThurThurss

FriFri SatSat SunSun

WalkWalk WalkWalk Scheduled Scheduled golfgolf

Scheduled Scheduled fishingfishing

Take home information for Dan: acidic foods, Canadas food guide, goals and objectives, etc.