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Katie Salwei (Host): Thank you for tuning into the Well Within Reach podcast. I am your host Katie Salwei and joining me today is advanced practice provider LaRee Shule. LaRee has been practicing family medicine at Riverside since 1984 and she currently sees patients at our Riverside Healthcare Watseka campus. Thank you for joining me today LaRee.

LaRee Shule APN, FNP (Guest): You're welcome.

Host: Could you tell our audience a little bit about yourself and how you got into medicine?

LaRee:   As far as how I got into medicine, I've been with Riverside, like you said, since 1984. As an advanced practice nurse, I started out first as a nurse on the medical floor then went to critical care, then Cath lab, open heart, neurosurgery. As an advanced practice nurse, then I wanted to do primary care. It always was a goal of mine to take advanced practice or primary care back to the rural environment. I've always been a rural person. I was born and raised in Iroquois county and that’s where I still live. So my husband and I still live in Iroquois County outside of Ashkum. Between Ashkum and Danforth. We’re busy. We have four daughters who we now have seven grandkids. So the weekends are busy with grandkids. So that’s about as much as excitement we have is full time working and full time family.

Host: Well, that’s a good full time. Today we’re gonna talk a little bit about Medicare annual wellness visits, and how to maintain that quality of life after retirement. So let’s start off with what is a Medicare wellness visit.

LaRee:   A Medicare wellness visit is a visit that Medicare will pay for once a year for their members. That visit does not go get charged to their deductible or copay. That visit is not your typical, “We’re gonna address your high blood pressure, your diabetes.” It’s more on focusing on their wellness. We spend some time talking about their cognitive level. Do you think you're slipping? Does family think you're slipping? We spend time talking about what we need to do to keep you healthy. Your diabetes, your mammograms, etcetera. We also spend time on what are the wishes that you want to do in life as you continue to get older? Have you had those conversations with your family?

Then we talk about the different other recommendations that Medicare has because Medicare really does want to keep their members healthy and keep them healthy for as long as they possibly can. So that’s kind of the drift of these visits annually. Those wellness measures then help to keep those members healthy and thriving in their golden years.

Host: Okay. Well healthy, stay healthy on your course is a lot easier than oh I have something wrong and then trying to correct it later. So getting on the right path early or right away is definitely a benefit.

LaRee:   That is correct.

Host: Mkay. So you kind of went through why these visits are so important. I think you had mentioned before is like taking care of yourself. Are there any other benefits to that conversation have with your provider of why these are so important?

LaRee:   There is. Because there's sometimes—There's a questionnaire that we do at first when they first come to that visit. That’s a pen and paper type questionnaire. That opens a door for a lot of conversations that some people who may be very proud will not answer yes or no to some of those questions. It may give us insight into do they need additional services at home? Do we need to get them some help with doing the housework? Do we need to get them services as far as can they navigate safely? Do they need walkers? Do they need canes? So there's a lot of other additional things we can do to keep them independent in their home. Keep them safe, keep them healthy.  

Host: Oh and that’s definitely a good thing. I know it’s hard. Even my parents getting older and you can kind of see the change of, “Oh, I don’t want to lose my independence.” But it’s very important to catch those things in your visit. It’s good that you guys are asking those questions and finding that stuff out. Benefit people for sure. In talking you to before, you found some really interesting statistics and some alarming research about what happens after retirement. Do you want to share some of that?

LaRee:   Yes. When Riverside asked me last year if I would do some community talks on the Medicare wellness and why they're important, I told them yes I would. As any of you know me, I'm a ‘yeah, but.’ So I said okay I will, but I need to know the whys.  So I went out there and did some research and said, “Why are these important?” The first thing I did was I looked at the top 10 causes of death, which those vary from year to year to year. Many of those top 10 causes of death that are still current today are targeted in these wellness visits. So Medicare is really focusing at those common causes of death and wanting to prevent those in keeping you healthier.

Then I went back and said okay. If it’s just after we’re on Medicare, is it real important to the rest of us? So I went back to see who’s dying from these things. That’s when my eyes were really opened. There was some research that I found from the Social Security agency from way back in the 1940s, replicated in the 1950s. The common age where people were dying was aged 65 to 67. Not what I expected to see. If you were lucky enough to retire early, the takeaway for that was you worked yourself so much because you were so ill. Those people were dying at about age 62. So I found that pretty alarming. So then I tried to find newer research.

In 2017—so several years later—AARP repeated similar research. The title of that research, surprisingly, is “Will Retirement Kill You? It Just Might.” We have not changed those outcomes. The people who die from these top 10 things are still the 65/66/67 year old. Those people who retire early are, again, those people who work, work, work, work did not take care of their health, did not do preventative wellness, and unfortunately were already ill. By the time they retired, the illness was so severe that it was taking their life at an early time. So that’s the kind of spin that I do in my practice with all my patients, not including the Medicare wellness and Medicare age, but all my patients. I say that I want you to embrace your wellness. We’re looking at the top 10 causes of death, and we’re going after that now to keep us healthy so that we can impact that research.

Now, my men, they're a tough group to battle. So I kind of have to tell them. If you bought a new car and they told you you have to do three things to make this car last you 15 years, and that’s keep air in the tires, change your oil filter, change your spark plugs. I can guarantee they would do all three of those things every year. So that’s the kind of take away we have to do with these wellness initiatives is make sure we do them every year to try to catch these illnesses before they sneak up on us.

Host: So glad that you're on top of that. It’s nice to…Even now, going to my primary care thinking of I don’t want you to have this down the road. So let’s look at this now. Let’s improve this now. It’s like well yeah. I don’t want that to happen to me. I want to make sure that I'm as healthy as can be. I've got little kids. Then you're thinking, I mean you’ve got grandkids. These people that are retiring, you want them to enjoy their life not have some unexpected illness or an illness that might could have been prevented. So yeah. Definitely taking advantage of these programs or these visits is definitely important.

LaRee:   Now Riverside too, even for their employees, has a reach program that they do for their employees where we do annual lab work. Historically I always sat down with my patients and also the employee patients and we talk about cholesterol: the good, the bad, the ugly. Riverside has now kind of embraced that as well too. Once you know hey, if I can get my good higher, that’s a great thing. Oh, my bad is too high. I've got to get that down. What can I do about that? You kind of totally change how you're looking at food, how you're looking at exercise. So just to have somebody tell you your cholesterol is good is not all you need to hear. You need to be empowered to say, “Okay, but what's my good, what's my bad, what's my ugly?” You need to know all of them so that you own your health.

Host: Yeah, definitely. Seeing the numbers makes a difference. Then seeing the improvement when you are working towards is definitely helpful as well. So in addition to these Medicare wellness visits, what else can patients do to stay healthy?

LaRee:   Patients always can stay active. Using their joints, getting up, getting movement is going to help hopefully delay the development of arthritis. Hopefully prevent the development of spondylosis or the spine getting stiff and not wanting to move, or spinal stenosis. So we want them to stay active. We want them to keep their balance, keep their core muscles tight so that they don’t trip and fall. At these Medicare wellness visits, one of the things that is discussed is home safety. One of the number one causes of trauma to the senior citizens is trips in the home. So we want them to get rid of the rugs. We want them to get rid of the flowing bed skirts, flowing bedspreads, the flowing curtains so that they don’t trip and fall. So staying active is important. Eating three times a day—not once because they can only afford it or they're not hungry enough—but eating three times a day, incorporating protein into their diet.

We spend some time in the office too talking about a lot of times, especially if they’ve lost a loved one and they're home alone. “Oh I'm not too hungry. I'm just going to eat once a day.” That meal might be cheese and crackers because that’s all they're hungry for. You have to talk about well, your body’s going to start burning your muscle then for protein and that’s gonna lead to weakness. We also talk about sleep health. If you don’t sleep well, the daytime is not gonna be a god time. That can lead to daytime fatigue, making them want to trip, fall. So it all kind of plays together. Staying hydrated, staying active, eating well, sleeping well.

Host: It definitely sounds like something…I mean rather than more of a visit type thing, it’s more of a conversation to figure those things out kind of. Kind of get the start of it to see where I can start to help you in this area. Maybe here’s something you didn’t think about before. Maybe we should look at this. Like getting rid of those rugs or those flowing curtains that could be posing a risk to you. As much as they look great, we want to make sure you're safe type of thing.

LaRee:   Most recently I had a patient who kind of chuckled. She said, “Well, I don’t have any rugs in my home, but I recently tripped on a rug in a restaurant.” She kind of giggled. She did not get hurt, but she said, “Guess what? The rug’s not there anymore.” I said that’s a great thing.

Host: Yeah. Something you don’t really think about until it’s brought up. You're like oh. I wouldn’t have thought about it that way, but it’s definitely something you want to watch for. So if somebody’s interesting in looking more into this or scheduling their annual wellness visit, what should they do?

LaRee:   All they have to do is call their provider and they can make their annual wellness or just discuss it with their physician or their advanced practice provider or their physician’s assistant, whoever they see annually for their wellness. What I'm trying to do is anything we get that appointment and we do that; I then schedule them for their next routine appointment. I also ask the front staff to schedule them a year out for their wellness so that it’s kind of just like that dental appointment. I was here in October. I better come next October so it just gets routine and it’s on the books. As we age, some of the things that apply to us at these appointments kind of changes because the guidelines change with aging.

Host: Yeah. So if you're looking or interested in finding out more or you want to schedule, go ahead and talk to your provider. Go ahead and give their office a call. There's also going to be more information on Riverside’s website at riversidehealthcare.org. So LaRee, is there anything else that we may have missed that we want to make sure our audience knows about?

LaRee:   I think I still just want to challenge everybody to just embrace your health. And even though when you look at those causes of death, even like the top two, are heart disease and cancer and you think I don’t have that, just purely knowing your cholesterol, you’ve now decreased those. Doing your colonoscopies as recommended by your providers, you’ve decreased those. Doing your mammogram, you’ve decreased those. Doing your pap smears, you’ve decreased those. So you're gonna kind of put that 66/65/67 year old data, we’re gonna push that out and push it out. So just keep embracing your health, follow along, do what we know we need to do to make sure we don’t have any of these things, and live a long healthy life.

Host: I like what you said. Embrace your health. So make sure you embrace your health and talk to your primary care provider. They're there to help you. They care about and they want you to live a long healthy life. Thank you so much for joining us LaRee. Thank you for tuning in to the well within reach podcast.