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News & Updates
Throughout the years, I’ve compiled information and advice from experts in the medical field regarding a variety of health care topics. I’ve tried to cover a variety of relevant subjects to help educate you and your loved ones. However, if there’s still something unclear or you have additional questions, please don’t hesitate to let me know.
COVID home treatment - Asymptomatic cases, mild cases of COVID-19
Isolate yourself in a well ventilated room.
Use a triple layer medical mask, discard mask after 8 hours of use or earlier if they become wet or visibly soiled. In the event of a caregiver entering the room, both caregiver and patient may consider using N 95 mask.
Mask should be discarded only after disinfecting it with 1% Sodium Hypochlorite.
Take rest and drink a lot of fluids to maintain adequate hydration.
Follow respiratory etiquettes at all times.
Frequent hand washing with soap and water for at least 40 seconds or clean with alcohol-based sanitizer.
Don’t share personal items with other people in the household.
Ensure cleaning of surfaces in the room that are touched often (tabletops, doorknobs, handles, etc.) with 1% hypochlorite solution.
Monitor temperature daily.
Monitor oxygen saturation with a pulse oximeter daily.
Connect with the treating physician promptly if any deterioration of symptoms is noticed.
Instructions for caregivers:
Mask: The caregiver should wear a triple layer medical mask. N95 mask may be considered when in the same room with the ill person.
Hand hygiene: Hand hygiene must be ensured following contact with ill person or patient’s immediate environment.
Exposure to patient/patient’s environment: Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions. Use disposable gloves while handling the patient. Perform hand hygiene before and after removing gloves.
Alzheimer’s disease is a progressive brain disorder that affects memory, behavior and thinking abilities. It’s the leading cause of dementia, or a decline of cognitive function that interferes with daily activities.
Alzheimer’s is quite common, with a new diagnosis made every 65 seconds in the U.S., and the numbers are on the rise. According to a study published in September 2018 by researchers from the Centers for Disease Control and Prevention (CDC), in 2014 Alzheimer’s and related dementias affected an estimated 5 million Americans age 65 and older, or 1.6 percent of the population. By the year 2060, that number is expected to more than double to 3.3 percent, when it’s predicted that 13.9 million Americans will have the disease.
Symptoms of Alzheimer's typically appear after age 60 and the risk of developing it double every five years after age 65.
Scientists are still learning about the causes of Alzheimer’s, but it involves the buildup of abnormal protein clumps, called “plaques” and “tangles,” in the brain. The exact role of plaques and tangles is still being studied, but experts believe they keep brain cells from communicating with each other and may eventually cause cell death.
Alzheimer's symptoms
Symptoms vary for each person and change as the disease progresses. Early on, you might experience forgetfulness, a shorter attention span and difficulty finishing familiar tasks.
Other early-stage symptoms include:
Concentration problems
The inability to store new information
Planning difficulties
Trouble functioning at work
Some people with early-stage symptoms might be experiencing mild cognitive impairment (MCI). People with MCI have worse memory problems, compared to others their age, but are still able to function in daily life. Just because you have MCI, doesn’t necessarily mean you’ll develop Alzheimer’s—your symptoms may remain the same or get better over time.
As the disease progresses to the moderate or middle-stage, you may:
Forget personal information like your address or phone number
Have a hard time recognizing family and friends
Experience hallucinations or delusions
Wander or get lost more often
Finally, late-stage Alzheimer’s can interfere with basic bodily functions like the ability to walk, swallow or control bowel and bladder habits. This stage normally requires full-time assistance from a caregiver who can help with personal care needs.
Diagnosis and treatment If you experience symptoms like forgetfulness or a shorter attention span, your doctor will start to monitor your cognitive skills over time and regularly ask questions about your behaviors. Since it's difficult to accurately answer those questions by yourself, you should bring a friend or family member with you to appointments. If your cognitive health continues to decline, your doctor will perform medical tests to rule out other conditions. For example, they may take blood or urine samples to check for diabetes or thyroid problems, or send you for an MRI scan to check for other brain conditions.
People with a strong family history of Alzheimer’s disease might be more likely to develop the condition. If you have close relatives with Alzheimer's, let your doctor know so they can begin cognitive testing at the appropriate age.
There's no cure for Alzheimer's currently, but there are medications that can offer symptom relief. The goal of treatment is to maximize your quality of life and give you as much meaningful time with loved ones as possible.
If you have allergies, you’re not alone. More than 50 million Americans have allergies, making them the sixth most common cause of chronic illness. But it’s not enough to know that you’re one of millions who suffer. To treat allergies more effectively, you first need to know what is causing your allergic reactions. Allergy tests are quick and painless ways to find out. Find out how allergy tests are done before you head to the appointment.
What allergies and allergy tests are
Allergies are the immune system’s response to certain triggers, called allergens. There are a few types of allergies: seasonal allergies like pollen and some types of mold; perennial allergies, which are commonly caused by dust mites, and cat or dog hair; and food allergies. Wheat, eggs, milk, peanuts, tree nuts, soy, fish and shellfish are the most common sources for food allergies, but any food can be an allergen.
If you want to know your specific allergens, you’ll need an allergy test. What are allergy tests? There are two types: skin tests and blood tests. “Both are equally valid and very good at detecting allergies, and, overall, are considered comparable tests,” says Christopher Webber, MD, an allergist with Sky Ridge Medical Center in Lone Tree, Colorado.
How are allergy tests done?
Though both tests are simple and accurate, the blood test is more convenient. According to Dr. Webber, a blood test can be done in your primary care doctor’s office at any time of the day, doesn’t require an empty stomach and you don’t need to stop taking allergy medications. The drawback is that the test results take longer to process. You’ll receive them within a week, says Webber.
A skin test must be done at an allergist’s office, according to Weber, and you can’t take antihistamines for five to seven days before the test—but you’ll have results in about 20 minutes. Webber explains what an allergy test is like: An allergist will rub pieces of plastic that have been dipped in various allergens—foods, pet dander, or pollen from different trees, grasses, and weeds—on your back.
Does allergy testing hurt?
A positive skin test will cause a hive or welt that lasts for about 20 minutes. It doesn’t hurt, says Webber. “It is usually very fast, sometimes feels like a small poke that is barely noticeable, does not cause bleeding, and is tolerated at all ages,” he says. “But it does itch. Everyone is worried about the hurt, but forgets the itch.”
False negatives and false positives
Webber says that there are two situations that could cause either a false negative or a false positive in an allergy test, and it’s an allergist’s job to interpret the results of the test. About one in four people with seasonal allergy symptoms don’t actually have allergies; instead, they have irritant rhinitis, also called nonallergic rhinitis, which has many of the same symptoms as allergies but the immune system is not involved. Triggers include cigarette smoke, strong smells, dust and air pollution, according to Weber. An allergy test could come up negative, but that doesn’t mean a person doesn’t have symptoms, he says.
On the other hand, testing for food allergies can sometimes cause a false positive. That means there’s an immune system response to the allergen, but there are no symptoms. “The test correctly measures the presence of an allergy antibody, but an allergy is the presence of allergy antibody plus symptoms,” Webber says. “Having a positive test does not, by itself, mean you have an allergy.”
What you can do about allergies
Once you’ve received your test results and you know what’s causing your allergic reactions, how do you manage your allergies? For food allergies, simply avoid the allergen and keep an EpiPen ready in case you come in contact with it.
For seasonal allergies, the first step is tracking the pollen count, so you know when to expect symptoms. When the pollen count is moderate to high, Webber says:
Keep your house windows closed so pollen doesn’t get in.
Shower at night, so pollen doesn’t move from your hair to your pillow while you sleep.
Exercise inside instead of outside.
Webber also recommends changing your air filters every one to three months. Don’t bother with an expensive “allergy-free” filter. Getting cheap ones and changing them often usually yields better results.
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Influenza, aka the flu, can cause painful headaches, body aches and lack of energy, but for some, the virus can be more dangerous, even life-threatening. The flu and related flu complications claimed an estimated 80,000 lives during the 2017-2018 season, according to the Centers for Disease Control and Prevention (CDC). Between 2010 and 2014, the death toll reached anywhere from 12,000 to 56,000 a year.
“The flu is a respiratory illness caused by the influenza virus," says Matthew Tincher, MD, an emergency medicine specialist with TriStar Horizon Medical Center in Dickson, Tennessee.
Symptoms can vary from mild to severe, but the sickness is different than the common cold, he adds. Cold and flu are caused by different viruses and accompanied by varying symptoms. Fever, body aches and weakness are common with the flu, but not as much with a cold. Usual cold symptoms include sneezing, stuffy nose and sore throat, all which come on gradually.
Anyone can catch the flu, but some populations are more likely to have adverse reactions. Find out who is at the highest risk and which symptoms may warrant emergency care.
Who is most at risk for flu complications?
Children: Because their immune systems are weaker, children under the age of 5—and especially those under age 2—are vulnerable to dangerous influenza complications. Since 2010, between 7,000 and 26,000 children younger than 5 were hospitalized for issues related to the flu each year, according to the CDC.
Pregnant women: Pregnancy alters the immune system, heart and lungs, which can mean getting the flu during pregnancy puts expectant mothers at a higher risk for severe symptoms and flu complications like pneumonia.
“Your physiology, blood pressure, blood flow and heart rate are all different during pregnancy, because the baby is taking up a lot of your blood flow and nutrients,” Tincher says.
This sensitivity lasts up to two weeks after giving birth. The flu can also cause problems for a developing baby, including premature delivery and fetal brain, spine and spinal cord defects. Getting a flu shot during pregnancy can provide some protection after the baby is born, before he or she is old enough to be immunized.
Adults 65 and older: As we age, our immune systems become frail. The CDC estimates between 70 percent and 85 percent of flu-related deaths occur in seniors over 65. The elderly make up 54 percent to 70 percent of seasonal flu hospitalizations.
“Their immune systems are not fully active, so it’s easier for them to pick up the virus,” Tincher says.
People with medical conditions: The flu weakens your body and can make existing health problems worse. For this reason, people with conditions like asthma and diabetes may have a harder time managing symptoms while they're under the weather. One example: Infections like the flu make it harder for people with diabetes to control blood sugar levels.
Influenza can also increase your heart attack risk, according to a January 2018 New England Journal of Medicine study. Results suggest adults were six times more likely to have a heart attack within a week of a flu diagnosis than one year before or after the sickness. About half of adults hospitalized during the 2017-2018 flu season had cardiovascular disease.
People with these conditions are also at greater risk for flu-related complications:
Chronic lung diseases, like chronic obstructive pulmonary disease and cystic fibrosis
Liver and kidney disorders
Neurological conditions, like epilepsy and cerebral palsy
Blood disorders, like sickle cell disease
Diseases or medications that weaken your immune system, like cancer, HIV or steroids
Severe obesity—body mass index of 40 or greater
If you experience flu-like symptoms and have any of these medical conditions, talk to your healthcare provider (HCP) about getting the proper treatment.
When is emergency care necessary?
Flu symptoms typically come on suddenly within one to four days of exposure to the virus. The illness can last anywhere from a few days to two weeks. Common symptoms include a cough, chills, headaches, fatigue, muscle aches and sore throat. Not everyone with the flu will have a fever, but most do.
Some people will develop flu complications, however, like pneumonia, sepsis, sinus or ear infections and bronchitis. Both pneumonia and sepsis can be life-threatening, and need prompt medical treatment.
However most cases of influenza are mild and can be managed at home, without the help of a health professional, although some symptoms could signal the need for treatment. Adults should contact a HCP immediately for symptoms like:
Difficulty breathing or shortness of breath
Severe or persistent vomiting
Chest or belly pain or pressure
Sudden dizziness
Confusion
Dehydration
Symptoms that get better, then return with fever and a worsened cough
"Not everybody with the flu needs to come to the emergency department," Tincher says. "The vast majority of healthy adults and children can get treatment for the flu in their doctor’s office." Can't get an appointment? Visit your local urgent care facility.
In infants and children, watch for trouble breathing, a fever accompanied by a rash, lack of tears when crying or skin that is bluish in color. “Children with the flu may show a decreased level of activity, a fever, rapid breathing or coughing,” says Tincher. If your young one has any of these symptoms, it could be a sign of a flu complication or severe illness, he adds.
“A healthy child should be active, smiling and playful,” Tincher says. If your child isn't interactive or is acting fussy and you think it could be due to the flu, he recommends heading to the emergency room.
What's the best way to prevent the flu?
The CDC recommends the flu vaccine, either the injectable vaccine or nasal spray depending on your age and health profile, for anyone 6 months and older. Children under the age of 8 who have not been vaccinated before should receive two doses of the vaccine at least 28 days apart. If you're feeling under the weather or have an allergy to the vaccine or any of its ingredients, speak with your HCP before getting immunized. If necessary, your HCP can reschedule your vaccination appointment once your cold is gone and provide you with other tips for staying virus-free.
Research suggests vaccination typically reduces your flu risk by 40 percent to 60 percent, though its effectiveness varies year-to-year. Even if the inoculation doesn't prevent the flu, it can reduce severity of symptoms and protect against dangerous flu complications.
Flu outbreaks typically peak between December and February, but cases can occur as early as October and as late as May. The CDC recommends getting the flu vaccine before the end of October, but even vaccinations given in January or later can help safeguard against sickness.
You should know however, that the nasal spray is not recommended for anyone under two years of age, over 49 years old, immunocompromised or between the ages of 2 to 17 who take aspirin-containing medications. Expectant mothers should not receive the nasal spray, but the standard flu shot is safe despite misconceptions.
A high-dose vaccine is also available for adults older than 65, and research suggests it is more effective in preventing flu in elderly adults than the standard flu shot.
Vaccines protect more than just the people who are vaccinated; they prevent transmission to those who aren't. This is especially important for infants and people with conditions that restrict their ability to get the flu shot. For "herd" immunity to be effective, a certain percentage of the community must get vaccinated. The more people get the flu shot, the greater protection we have against the flu.
The flu shot is just the first step in preventing winter illnesses. Tincher also recommends staying away from sick people when you can. Other infection-reducing steps include:
Washing your hands regularly with soap and water for at least 20 seconds
Avoiding touching your nose, eyes and mouth
Routinely disinfecting objects and surfaces in your home, office and classroom
Managing stress with techniques like physical activity or calling a friend
Getting enough sleep—7 to 9 hours a night
Eating a healthy, well-balanced diet
Help keep others flu-free by staying home for at least 24 hours after your fever subsides and covering your mouth when you cough or sneeze.
Understanding Chest Pain (Angina Pectoris)
What is angina pectoris?
Angina is temporary pain or discomfort in the chest that occurs when not enough oxygen-carrying blood reaches your heart muscle. The term "angina" means pain, while "pectoris" refers to the chest.
Angina symptoms vary. Sometimes it feels like heartburn, similar to what you may feel after eating a heavy meal. If you feel this pain regularly, it may be a symptom of heart disease.
What causes angina?
Angina is most often a sign that you have heart disease, specifically a blockage of one or more of the main blood vessels supplying the heart muscle, known as the coronary arteries. Women may have blockages in the very small arteries that branch out from the coronary arteries.
Angina is the most typical symptom of heart disease. In the United States, approximately 10 million people suffer from angina. An angina attack occurs when the blocked vessel prevents adequate blood flow, or when there is a spasm of the vessel leading to decreased blood flow to the heart muscle. Spasm often occurs at rest and typically happens overnight.
Does angina cause or worsen a heart condition?
Usually, angina does not cause any heart damage. Angina is more like a warning signal, and it can mean you're at greater risk of having a heart attack. Whether you're hiking uphill, having a heated argument with your partner, or digesting a five-course gourmet meal, angina is your heart's way of telling you that you're making it work too hard and that it is not getting enough blood and oxygen.
What are the symptoms of angina?
Although they vary from person to person, these are the typical symptoms:
A sharp or dull pain, tightness, pressure, squeezing or burning sensation in the chest
Pain in your arms, neck, jaw, shoulder or back, accompanying chest discomfort (these symptoms often occur during physical exertion, emotional stress or eating)
Tingling, aching or numbness in the elbows, arms or wrists (especially your left arm)
Shortness of breath
Perspiration
Nausea
Fatigue
Anxiety
Dizziness
Angina symptoms in women can include feeling out of breath, nausea, vomiting, abdominal pain or stabbing chest pain.
How is angina diagnosed?
Your healthcare provider (HCP) can determine if you have angina by looking at your symptoms and having you perform a stress test, which usually means walking on a treadmill.
You'll be hooked up to an electrocardiogram (EKG), which measures the electrical activity of the heart before, during and after the stress test. Your blood pressure will also be monitored throughout. Characteristic changes occur on the EKG if heart disease is present.
But because a stress test is meant for screening, you may need other tests, such as a nuclear scan or an angiogram. In an angiogram, a dye is injected into your blood and an X-ray is taken of the heart and its blood vessels.
How is angina treated?
The usual medication for an attack of angina is nitroglycerin placed under the tongue. It helps dilate blood vessels so more blood can reach the heart. Nitroglycerin is also available in pill or patch form to prevent symptoms. To note: Anyone taking nitroglycerin should avoid using Viagra (sildenafil), because a serious drop in blood pressure could result.
After you've undergone a full evaluation, your physician may prescribe other medications, such as beta blockers and calcium channel blockers, which can help prevent angina as well. Your doctor may also want you to take aspirin regularly, which reduces the ability of blood to clot. This allows blood to flow more easily through narrowed arteries.
You may also benefit from learning stress-reduction techniques such as meditation or relaxation exercises. Check your local community center for classes or workshop listings or explore online options.
What should I do if I'm having an angina attack?
Most people who have been diagnosed with angina are prescribed nitroglycerin tablets. You should always have them with you or nearby. Keep them in several places at home and work.
Sit down and rest, if you're not already sitting, and put one tablet under your tongue to dissolve. Nitroglycerin can cause dizziness, so it's important to take it sitting down and to get up slowly once you feel better.
The American Heart Association recommends taking one nitroglycerin tablet. If the pain has not improved or has worsened after five minutes, call 911 immediately for an ambulance in case you are having a heart attack. Once you are in contact with emergency services, you may be instructed to repeat the dose of nitroglycerin up to two more times in five-minute intervals.
How do I know whether I'm experiencing angina or a heart attack?
It's easy to mistake an angina attack for a heart attack. They both tend to start with chest pain. Both can be marked by pain, numbness or tingling in the neck, shoulders, arms and jaw. The difference is that with the most common form of angina, rest and medication relieve the symptoms in two or three minutes.
If you are having a heart attack, the pain will not go away and it may become more intense. Although angina can cause chest pain and discomfort, heart attack pain is generally more severe.
Women often experience heart attacks differently than men and may have symptoms unrelated to chest pain such as shortness of breath, nausea, sweating, dizziness or unusual fatigue. If you ever feel these symptoms or what could be described as "an elephant sitting on your chest," call 911—they are signs of a heart attack.
Does medication always help ease an angina attack?
Medication helps if you have stable angina, the most common sort. But if you've been diagnosed with unstable angina, symptoms are different than your usual pattern of angina and might signal a heart attack. Medication often doesn't help resolve unstable angina.
Unstable angina usually lasts longer than a few minutes and often occurs when you're not exerting yourself. If you have unstable angina, you need to discuss with your doctor how to monitor your condition and when you should consider symptoms an emergency.
Knowing the pattern of your angina attacks should help you identify a true emergency, especially if there are changes in duration, cause or intensity.
If I have angina, what do I have to do to take care of myself?
Your doctor will advise you on how much you can do based on the results of your tests. A supervised exercise program for heart patients can be extremely helpful, but you may need to modify your activities so you don't overtax yourself.
If a big, rich meal sets off an angina attack, try smaller portions. If walking quickly causes symptoms, slow your pace. In very cold or windy weather, you'll probably have to bundle up and cover your head and face. Your doctor may even tell you to put a nitroglycerin tablet under your tongue before stepping outside. And if you've had a heart attack already, your doctor may prescribe a low dose of aspirin every day to prevent another one.
If you have heart trouble, you'll be healthier if follow these guidelines:
Control high blood pressure, diabetes and high cholesterol levels.
Maintain a low-fat, low-sodium diet.
If you smoke, quit.
Reduce or stop your alcohol consumption.
If you're overweight, try to drop a few pounds.
Exercise for 30 minutes at least 5 days a week, unless your doctor forbids it.
Heart disease is generally treated with medication. In some cases, however, people have successfully reversed heart disease by exercising, following a strict, plant-based low-fat diet recommended by their doctors and making other lifestyle changes.
Sources:
National Heart, Lung, Blood Institute. “Angina.” 2010.
American Heart Association. “Angina pectoris.” 2010.
Ohio State University Medical Center. Health for Life. “Nitroglycerin Sublingual.”
American Heart Association. “Heart Attack and Angina Statistics.” 2007.
“ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction-Executive Summary.” ACC/AHA Practice Guidelines. Circulation. 2004;110:588-636 Accessed 21 Nov 2008.
Mayo Clinic. “Heart disease in women: Understand symptoms and risk factors.” January 2009.
Mayo Clinic. “Angina.” June 2009.
American Academy of Family Physicians. “Angina and Heart Disease.” November 2006.
Managing diabetes requires care, commitment and planning. With your diagnosis, it’s helpful to develop an action plan that is specific to you.
To develop this plan, you’ll work with your healthcare provider to decide which goals are best for you and how you’ll reach them. Here are some tips to get you started.
Be S.M.A.R.T.
To manage your diabetes in the way that’s best for you, you’ll need to set some personal goals. The American Diabetes Association suggests conceiving them as “S.M.A.R.T.”:
Specific: Decide exactly what you want to achieve and how that will look. For example, you might say, “I will walk 4,000 steps (about 2 miles) every other evening on a route I map through my neighborhood.”
Measurable: Find a way to measure your progress so that you’ll know when you’ve hit your goal. Try, “I will use a smartphone app to track my steps and the days I walk.”
Attainable: Make sure you have what you need to achieve your goal. If some element is missing, figure out how you’ll acquire it. In other words, “I will use the health app that comes with my smartphone or download another app that tracks steps. I’ll also buy good, supportive walking shoes.”
Realistic: Your goal needs to be something you know you can achieve, and you need to feel a commitment to it, not just an obligation. That could translate to a statement like, “Committing to exercise as a lifestyle change is important to me, and this plan will help me achieve that change.”
Time-specific: No open windows here. Set a realistic timeline or deadline for yourself for meeting your goal. As in, “By the end of the first week, I will have walked 12,000 steps.”
What kinds of goals should you include?
The key areas for goal setting to manage your diabetes and blood sugar levels are:
Healthy eating
Regular physical activity
Medication adherence
Checking blood sugar
Developing problem-solving plans
Reducing risks associated with having diabetes
Mental health (coping with your diagnosis and its management)
These seven areas of management are what the American Association of Diabetes Educators (AADE) calls the AADE7 Self-Care Behaviors.
Talk with your healthcare provider about appropriate aims in each of these areas. Everyone’s needs will differ, and your plan should put the “personal” in personalized management.
Remember not to overlook the mental health, or coping, aspects of your plan. Getting a diabetes diagnosis can be unsettling or even shocking, so be sure to include goals related to maintaining a healthy outlook and getting support when you need it.
And you don’t need to set big goals for each of these. You can create small steps and short-term targets (for example, “Eat two servings of vegetables every day this week”), re-evaluating how your plan worked for you as you reach each deadline.
A special case: illness
The best-laid plans can go off the rails when illness strikes, and your diabetes management plan isn’t immune to this possibility.
Of course, you do have some control over your wellness and you should do your best to stay current with screenings and preventive care that are recommended for your age, health history and sex. These steps can include regular blood pressure checks, screening for breast and colon cancer and ensuring that your vaccinations are up to date.
But even the most careful attention to such details can’t completely protect you from diseases like the common cold. That’s why you’ll need a plan B for sick days when viral or other illness strikes. This kind of planning falls under the “problem-solving” area of your management plan. You can’t predict every situation that arises, but you can establish in advance what you’ll do if your health or other areas hit an unexpected curve.
A sick-day plan might involve more frequent blood glucose checks, a commitment to keep up food intake, increased liquid intake (sugar-free) and notes about what should trigger a call to your clinician. As with all parts of your management plan, the sick-day steps should be developed in coordination with your doctor.
Evaluating your success
Each time you reach a deadline, it’s a good idea to pause and look back at cases where you met your goal—or fell a little short. If you came up short, look at the factors that interfered with your progress and see what you can do to reduce those obstacles for your next steps. Talk to your clinician about ideas for adjusting a goal or minimizing obstacles.
These moments of self-evaluation are also your time to establish your next set of goals, in partnership with your doctor.
You’ll also need to commit to reproducing your earlier successes. The process of managing diabetes is an ongoing one. Maintaining the beneficial changes you make in your lifestyle is key, and refreshing your goals as you assess your progress can help.
Lastly, don’t forget to reward yourself for meeting your goals. Include in your plan some small but special indulgences for achieving your aims, such as a long, quiet bath or a nice (healthy) dinner out.