Digestive Health Newsletter

Here’s to Your Health: A SMART Strategy for Keeping Your New Year’s Resolutions

Alan V. Safdi, MD

Volume 18, 
January 01, 2010

by Alan V. Safdi, MD

Alan V. Safdi, MD, FACG, is the Director of Gastroenterology at Deaconess Hospital, where he has served on the hospital’s Executive Committee. Dr. Safdi has also served as the President, Treasurer, and Secretary for the Southwest Ohio Digestive Disease Society. He, along with Dr. Michael Safdi, was instrumental in starting the Consultants for Clinical Research in Cincinnati. His group has published a number of articles in the American Journal of Medicine, the American Journal of Gastroenterology, the Annals of Internal Medicine, and a variety of other prominent medical journals.

Table of Contents

Introduction

Do you make New Year’s resolutions to control your inflammatory bowel disease (IBD), but find them difficult to keep? If so, you’re not alone. Many people who make resolutions each year find it hard to keep their resolutions over the long haul. However, the fact that you make New Year’s resolutions gives you an advantage over people who don’t. People who resolve to change are much more likely to make lasting positive changes, compared to people who don’t resolve to change.

When making your resolutions, it’s helpful to put them in writing. Writing them down will force you to think them through carefully. Resolutions should answer the following questions:

 

  • What are my goals?”
  • Where am I likely to get tripped up?”
  • How will I increase my chances of success?”
  • Why am I making these resolutions?”

 

Include as much detail as possible in your answers to these questions, and use wording that will make it obvious whether or not you have met your goal.

Because we know that good intentions alone are not enough, it is important to also have a strategy in place. Having a strategy that helps you change your behavior is proven to increase your chance of success. This year try making SMART resolutions: Specific, Measurable, Achievable, Relevant, and Time-Specific.

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What are SMART resolutions?

Is your goal specific?

It’s important to be specific about how you will achieve your goal. “I will remember to take my medication” is not as specific as “I will use a medication diary to help me remember to take my medication at the same time(s) each day.” Taking your medication as prescribed is the single most important way to decrease your risk of an IBD relapse. For example, a study of people with ulcerative colitis found that 89% of those who took their medication as prescribed remained symptom-free one year later, as compared to 39% of those who did not take their medication. In other words, if you take your medication as prescribed, you are five times more likely to stay in remission. And staying in remission not only means you’ll feel better – it also saves on the healthcare costs related to a relapse.

Is your goal measurable?

Spell out how you will measure your progress. If you can’t measure it, how will you assess your success? For example, if you want to lose 20 pounds, a measurable goal would be to lose two pounds each week. Measuring little successes will keep you motivated to achieve your goal.

Is your goal achievable?

If your goal is too difficult, you will have trouble achieving it and become discouraged and frustrated. If your goal is too easy, you will not feel the necessary motivation to make changes. Your goal should be a challenge, but not too far out of reach. If you have an “all or nothing” mentality, you are likely to feel deprived and return to your old habits. For example: “Chocolate triggers my IBD, so I will never eat it again” vs. “I will not eat chocolate more than once a month.”

Is your goal relevant?

Consider your current situation, including your resources and available time. Is your resolution one you truly want to accomplish? Is it realistic to set a goal of running a marathon before the end of the year or, given your circumstances, is it more likely that you will find the time and energy to walk for 45 minutes, four times each week? It’s also important to set goals for yourself, not to impress others.

Is your goal time-sensitive?

Make sure your resolution includes a deadline for achieving your goal. A time-bound goal gives you a clear, precise target to work toward. For example: “I will schedule an appointment for my annual exam and any routine screening (e.g., colonoscopy) by March.”

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How to keep your goals on track?

Once you’ve clarified your goals, it’s important to develop an action plan. As the expression goes: If you fail to plan, plan to fail. An important step while planning involves predicting potential obstacles and setbacks to achieving your goal and having a strategy in place for dealing with them. For instance, if you know that remembering to take your medication is more difficult when you’re not having a flare-up, make using the medication diary a daily priority. In fact, it might be helpful to link taking your medication to other things you do every day, like brushing your teeth or eating your lunch.

Other strategies for remembering your medication include using pill boxes to organize daily doses, keeping your medication visible (on the counter instead of in a drawer), and using electronics to your advantage. Consider programming your watch, cell phone, or computer to remind you when it’s time for your medication.

Go public

Don’t keep your resolutions a secret. People who go public with their resolutions set themselves up for success. Share them with friends and family who are likely to support your efforts. Ideally, find a friend with a similar goal, so you can help motivate each other.

Reward yourself

Celebrate your successes, even small ones. Treat yourself to something you enjoy that doesn’t interfere with your goal. If you have kept up with your exercise program for six weeks, treat yourself to a massage or some other reward. When you lose 10 pounds, treat yourself to a new shirt or pair of pants.

Be flexible

While it’s important to have clear goals, it’s equally important to periodically reevaluate your resolution and plans. Sometimes it’s necessary to tweak or modify your original goals. Perhaps your goals were too lofty and unrealistic. Or maybe you’ve learned something about yourself along the way that gives you more insight into your best shot at success. Making adjustments isn’t evidence that you have failed; in fact, quite the opposite. It shows that you have the insight and determination to continue on the path you have started down, with a few minor changes that will increase your chances of success down the road.

Persistence pays off. According to research, only 40% of people achieve their resolution on their first try. The rest try several times. In fact, for 17% of people who make New Year’s resolutions, it takes more than six attempts before they finally succeed.

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Conclusion

Because the holidays are typically times of indulgence and busy schedules, many people look forward to a new start in January, when they are eager to make positive changes in their lives. But remember that there is nothing magical about January 1. In a study focusing on health-related resolutions, only 65% of subjects made their resolutions between December 28 and New Year’s Day. The rest made resolutions as early as May and as late as the end of January. It’s never too late, especially when you have a chronic disease like IBD. Sticking with your resolutions and attaining your goals is well within reach, now that you are equipped with a SMART strategy.

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Important Safety Information about AZASAN

WARNING: Chronic immunosuppression with this purine antimetabolite increases risk of neoplasia in humans. Physicians using this drug should be very familiar with this risk as well as with the mutagenic potential to both men and women and with possible hematologic toxicities. See WARNINGS section in complete Prescribing Information.

AZASAN® (azathioprine tablets) 75/100 mg is indicated as an adjunct for the prevention of rejection in renal homotransplantations, and also for the management of active rheumatoid arthritis to reduce signs and symptoms.The most commonly reported side effects associated with AZASAN therapy are leukopenia and/or thrombocytopenia, secondary infections, neoplasia, nausea, vomiting, diarrhea, fever, myalgias, skin rashes, and hepatotoxicity. AZASAN therapy should be given cautiously when used concomitantly with allopurinol, ACE inhibitors, and other agents affecting myelopoiesis. AZASAN is contraindicated in pregnant and lactating women and in patients who have shown hypersensitivity to this product.

Consult with your physician to see if this product is right for you.

Complete Prescribing Information for AZASAN, including BOXED WARNINGpdf

Important Safety Information about METOZOLV® ODT

WARNING: TARDIVE DYSKINESIA

See full prescribing information for complete boxed warning.

Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with the duration of treatment and the total cumulative dose.

Metoclopramide therapy should be discontinued in patients who develop signs or symptoms of tardive dyskinesia. There is no known treatment for tardive dyskinesia. In some patients, symptoms may lessen or resolve after metoclopramide treatment is stopped.

Treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia.

METOZOLV® ODT (metoclopramide HCl) is indicated as short-term (4 to 12 weeks) therapy for adults with symptomatic, documented gastroesophageal reflux disease (GERD) who fail to respond to conventional therapy and for the relief of symptoms associated with acute and recurrent diabetic gastroparesis (diabetic gastric stasis) in adults. Therapy should not exceed 12 weeks in duration. Take on an empty stomach up to four times daily, at least 30 minutes before eating and at bedtime.

METOZOLV ODT is contraindicated in patients with intestinal obstruction, hemorrhage, or perforation; pheochromocytoma; known sensitivity or intolerance to metoclopramide; epilepsy; or are receiving concomitant medications with extrapyramidal reactions.

Extrapyramidal symptoms (EPS), manifested primarily as acute dystonic reactions, occur in approximately 1 in 500 patients treated with the usual adult dosages of 30 to 40 mg/day of metoclopramide. These usually are seen during the first 24 to 48 hours of treatment with metoclopramide, occur more frequently in pediatric patients and adult patients less than 30 years of age and are even more frequent at higher doses.

Drug-induced Parkinsonism can occur during metoclopramide therapy, more commonly within the first 6 months after beginning treatment, but also after longer periods. Patients with a history of Parkinson’s disease should be given metoclopramide cautiously, if at all, since such patients can experience exacerbation of Parkinsonian symptoms when taking metoclopramide.

There have been rare reports of an uncommon but potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) associated with metoclopramide. Clinical manifestations of NMS include hyperthermia, muscle rigidity, altered consciousness, and evidence of autonomic instability. The management of NMS should include immediate discontinuation of metoclopramide and other drugs not essential to concurrent therapy.

Depression associated with metoclopramide use has occurred in patients with and without a history of depression. For those patients with a prior history of depression, metoclopramide should only be given if the expected benefits outweigh the potential risks.

In one study in hypertensive patients, intravenously administered metoclopramide was shown to release catecholamines; hence, caution should be exercised when metoclopramide is used in patients with hypertension. Any rapid rise in blood pressure associated with METOZOLV ODT use should result in immediate cessation of metoclopramide use in those patients.

Since metoclopramide produces a transient increase in plasma aldosterone, patients with cirrhosis or congestive heart failure may be at risk of developing fluid retention and volume overload. If these side effects occur at any time in any patients during metoclopramide therapy, the drug should be discontinued.

Adverse reactions, especially those involving the nervous system, may occur after stopping the use of METOZOLV ODT.

In clinical studies, the most frequently reported adverse events (≥2% occurrence) were headache, nausea, fatigue, somnolence, and vomiting.

Complete Prescribing Information for METOZOLV ODT, including BOXED WARNING pdf

Important Safety Information about OSMOPREP

WARNINGS

There have been rare, but serious reports of acute phosphate nephropathy in patients who received oral sodium phosphate products for colon cleansing prior to colonoscopy. Some cases have resulted in permanent impairment of renal function and some patients required long–term dialysis. While some cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using medicines that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and possibly nonsteroidal anti–inflammatory drugs [NSAIDs]).

It is important to use the dose and dosing regimen as recommended (PM/AM split dose).

OSMOPREP® (sodium phosphate monobasic monohydrate, USP, and sodium phosphate dibasic anhydrous, USP) Tablets are indicated for cleansing of the colon as a preparation for colonoscopy in adults 18 years of age or older. Considerable caution should be advised before OSMOPREP is used in patients with severe renal insufficiency, congestive heart failure, ascites, unstable angina, gastric retention, ileus, severe chronic constipation, bowel perforation, toxic megacolon, gastric bypass or stapling surgery, or hypomotility syndrome. Use with caution in patients with impaired renal function, patients with a history of seizures or at higher risk of seizure, patients with higher risk of cardiac arrhythmias, known or suspected electrolyte disturbances (such as dehydration), or people taking drugs that affect electrolyte levels. Patients with electrolyte abnormalities such as hypernatremia, hyperphosphatemia, hypokalemia, or hypocalcemia should have their electrolytes corrected before treatment with OSMOPREP.

OSMOPREP is contraindicated in patients with a known allergy or hypersensitivity to sodium phosphate salts or any of its ingredients, and in patients with biopsy–proven acute phosphate nephropathy. In clinical trials, the most commonly reported adverse reactions (reporting frequency >3%) were abdominal bloating, nausea, abdominal pain, and vomiting. It is recommended that patients receiving OSMOPREP be advised to adequately hydrate before, during, and after the use of OsmoPrep.

For complete Prescribing Information for OSMOPREP including BOXED WARNING.pdf

Important Safety Information about VISICOL

WARNINGS

There have been rare, but serious reports of acute phosphate nephropathy in patients who received oral sodium phosphate products for colon cleansing prior to colonoscopy. Some cases have resulted in permanent impairment of renal function and some patients required long-term dialysis. While some cases have occurred in patients without identifiable risk factors, patients at increased risk of acute phosphate nephropathy may include those with increased age, hypovolemia, increased bowel transit time (such as bowel obstruction), active colitis, or baseline kidney disease, and those using medicines that affect renal perfusion or function (such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and possibly nonsteroidal anti-inflammatory drugs [NSAIDs]).

It is important to use the dose and dosing regimen as recommended (PM/AM split dose).

VISICOL® (sodium phosphate monobasic monohydrate, USP, and sodium phosphate dibasic anhydrous, USP) Tablets are indicated for cleansing of the colon as a preparation for colonoscopy in adults 18 years of age or older. VISICOL is not to be used in patients with congestive heart failure, ascites, unstable angina pectoris, gastric retention, ileus or acute obstruction or pseudo-obstruction, severe chronic constipation, bowel perforation, acute colitis, toxic megacolon, or hypomotility syndrome. Use with caution in patients with impaired renal function, pre-existing electrolyte disturbances, or people taking drugs that affect electrolyte levels. VISICOL is contraindicated in patients with a known allergy or hypersensitivity to sodium phosphate salts or any of its ingredients. In clinical trials, the most commonly observed (≥1%) adverse reactions occurring with use of VISICOL were generally transient and self-limited and included nausea, vomiting, abdominal bloating, abdominal pain, dizziness and headache.

Consult with your physician to see if this product is right for you.

Complete Prescribing Information for VISICOL, including BOXED WARNING pdf

The information contained on this page is intended for US patients, healthcare professionals, and pharmacists only.

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