The doctor looked at his patient and then, with a somber look on his face, turned to her husband and said, "Kiss your wife a lot because she is going to be dead within five years."

The Patient

Rita and Paul Lindsey met while they were both in the Navy, assigned to the Labor and Delivery Ward at Naval Hospital Millington, Tennessee. They have been married for 34 years.

"We do everything together," Rita said. "We're inseparable."

Rita served as a hospital corpsman, racking up 12 years of active and Reserve duty. She isn't a novice to health care, but as the years passed after leaving the military, her sedentary lifestyle, food choices and unwillingness to take her medications as prescribed were taking their toll on her health.

"I grew up in Alabama," Rita said. "The food I was raised on was mostly fried and unhealthy. Even when we cook vegetables in the south, we add in some bacon or bacon grease for flavor."

She also smoked more than two packs of cigarettes a day.

Rita had a great job with the Department of Defense, working equal employment opportunity (EEO) issues. She was busy, successful and living a fulfilling life, going to church, spending time with her husband, visiting with her three children and five granddaughters ... life was good.

"I knew I had diabetes; I knew I was overweight," Rita said. "I knew my blood pressure was too high, but for the most part, I was too busy to be sick and I was feeling okay, so I didn't give it much thought."

But then, a series of medical issues changed her life in ways she couldn't even begin to comprehend.

The Patient's Husband

Rita's husband Paul retired from the Navy as a chief hospital corpsman. He also knew about proper diet and nutrition and the benefits of exercise. And like Rita, decades after his retirement and years of a poor diet and little exercise, his past had caught up with him.

"I had my first heart attack in 2005," Paul said. "Since then, I had another heart attack and four stents placed in my heart. And then the stroke hit me in 2015."

The stroke required Paul to undergo months of extensive rehabilitation, and Rita was with him the entire time.

"I prayed about what I needed to do," Rita said. "Do I leave my job even though I'm not retirement-eligible because of my age? My husband needs me."

Rita approached Paul about the possibility of leaving work. He too had been praying over their situation and they decided although they would miss Rita's income, life was too short for them not to spend as much time together as possible.

Rita left her job to care for Paul. At the time, she was also taking care of one of her daughters who was having health problems as well.

"Seeing my daughter through her health issues and taking care of Paul, I finally realized if I didn't start taking care of myself, who was going to take care of them?" Rita said. "So, in July of last year after Paul recovered, and being told by my pulmonologist that my COPD (chronic obstructive pulmonary disease) had gone from mild to moderate, I quit smoking cold turkey."

The transition had begun.

The Nurse

Marilyn Green is Naval Health Clinic Cherry Point's (NHCCP) diabetic coordinator.

"I keep track of all the diabetic patients assigned to our clinic," Green said. "I reach out to these patients at least every six months. I call them my 'club members.' I provide them with education about diabetes and work with them to ensure they are using their testing equipment properly, keeping up with their medications, getting their lab work done when scheduled and encouraging them to exercise."

"Marilyn is awesome," Rita said. "She is extremely persistent. She would call me regularly and ask me if I'm testing and letting me know when it was time to get my labs done."

Marilyn had been working with Rita for several years, but during that time, Rita had not been very reliable when it came to taking her medications and getting her testing done on time. But Green wasn't having any of Rita's excuses. The calls kept coming, Rita kept ignoring them and Marilyn would call again.

"Finally, one day Marilyn called me and I decided that I would go and get my blood work done," Rita said. "And so, during the last few weeks of 2015, I went and had the labs pulled and found out my A1C (a blood test that provides information about a person's average levels of blood glucose over the past three months) was 9.1. Not very good."

But, once again, instead of taking action, life rolled on ... until April 8.

"I will never forget that date," Rita said. "I had been feeling bad for some time. I was functioning because I had to. I was getting severe migraines, but I ignored them as I was still putting my family first. It was becoming so bad my vision was actually getting blurry."

She went in for her blood work and a visit with her primary care manager (PCM). Only this time, the visit became deadly serious.

The Doctor

"He's given up on me," Rita said to her husband in the car on the way home.

Rita was surprised. She liked her primary care doctor, Lt. Michael Fedewa.

"He's such a compassionate doctor," she said. "He listens to me and doesn't make me feel bad about not trying harder."

But Fedewa's compassion had given way to the fact that his patient was probably going to die sooner rather than later if she didn't do something to reverse the deadly course she was on.

"Your A1C is now 11.7," Fedewa told Rita. "You have a history of high blood pressure and your triglycerides are so high, we have to conduct a special test to get an LDL (low-density lipoprotein value)."

Then Fedewa turned to Paul and said, "Kiss your wife a lot because she is going to be dead within five years."

Rita looked into Fedewa's face and saw nothing but compassion and concern. Somehow, what he said was finally reaching her when nothing else had up to this point.

Fedewa mentioned he wanted to put Rita on a drug called Bydureon (Exenatide), an injectable diabetes medicine that helps control blood sugar levels. But, because Rita had such a long history of being non-compliant when it came to taking her medicines and modifying her diet, Fedewa told Rita she would probably do better if he referred her to an endocrinologist in town.

"That's when I thought he had given up on me," Rita said.

Rita and Paul stopped by to see Marilyn on their way out of the clinic and told her what had just transpired.

"I don't want to die," Rita told Marilyn. "I have my husband, I have my children and grandchildren, and my church ... life is too wonderful to cut it short."

Marilyn, sensing that Rita was ready to make a change, saw her opening and suggested Rita see Lt. Cmdr. Carol Ellsworth, NHCCP's Medical Home Port Department head who is also a certified diabetes educator and family nurse practitioner. She also suggested Rita see the clinic's dietician to learn more about healthy eating.

Surprisingly, Rita agreed.

When Rita and Paul got to their car to drive home, Rita began crying.

"No one has ever told me I was going to die," Rita told Paul. "This is my wake up call."

Rita and Paul went home and decided to go for a walk -- the first of many. When they got home from their walk, they threw out all the junk food.

The Family Nurse Practitioner

"By the time Rita and Paul came to see me a few days later, they were already well on their way to making the changes they needed to get healthy," Ellsworth said. "They both had been struggling with diabetes for a number of years, so they knew the basics, but I still went over the risks of the disease with them and the possible negative outcomes if the disease is not treated appropriately. They were both highly motivated for change."

Ellsworth explained to the couple the way ahead was through small changes.

"People need to start with small, attainable goals," Ellsworth said. "If you need to lose 50 pounds, make a goal to lose five. After you lose those five pounds, you will have achieved your goal and started building a foundation of success to obtain future goals.

"It's not magic," Ellsworth continued. "Managing diabetes takes proper diet, exercise and taking your medications as prescribed. It also takes a lot of motivation and in this case, the fact Rita and Paul are working together as a team is making all the difference. But, if you're not at the point as a patient where you're ready to listen and hear this information, chances are you won't be as successful. Patients have to be ready to make this lifestyle change."

Fedewa agrees.

"Our success rates are so much better when both family members sign on to improve their lifestyles," Fedewa said. "Not only is it a team effort on the part of the health care providers, it's a team effort within the patient's home."

The Dietician

"The Lindseys were extremely motivated and already making the appropriate lifestyle changes when they came to see me," NHCCP Registered Dietician Michelle Amber said. "Now they were looking for validation that the changes they were making were the correct ones."

Amber provided the Lindseys with the five rules they would need to live by in order to be successful -- No sugary beverages, eat 3-4 times daily, eat carbohydrates with protein, portion control, and finally, walk after every meal or increasing physical activity.

Amber also provided the Lindseys with a "My Plate" diagram, a placemat which shows how much of each food category is recommended.

"We have the My Plate on our dinner table at home," Paul said. "It's a great reminder of what our portions should look like and puts the emphasis on the vegetables and whole grains."

"It's extremely important to realize that Rita's and Paul's success isn't due to a diet," Amber said. "They didn't approach this as a diet or a temporary plan to lose weight. They needed and adopted a lifestyle change in the way they live, and it's working well for them.

"People often ask me about some of the diet plans advertised on television," Amber continued. "They're very popular especially for people like Rita and Paul, 'empty nesters' who often find it easier to pick something up for dinner on the way home. But many of these plans provide food that is extremely processed and consumers still have to buy their own vegetables and fruits, which should be the majority of everyone's diet. So not only are these plans expensive, it's healthier for people to shop and prepare their own meals at home."

The Future

Rita is now down from 226 to 185 lbs. with an ultimate goal of 140 lbs. Paul is down from 226 to 185 lbs. with the goal of getting down to 170 lbs. Although this might seem like a lot of weight loss in a few months, both Rita and Paul are being closely monitored by their physicians. And along with the weight loss comes other benefits. Their blood work is improving, where before their numbers were off the chart. They feel better. They have more energy, more stamina and they even look healthier.

They exercise almost daily by walking two miles or riding their bicycles for six miles. And they still eat out on occasion, still have a cheat day where they will indulge in one of their favorite foods -- fried mushrooms or a small ice cream cone.

"I think one of the keys to our success is the fact that out medical team wanted to stay involved with us and follow up with us," Rita said. "I feel as if they truly wanted to see Paul and me succeed, which in turn, gave us the extra motivation we needed."

"At NHCCP, we enable our staff to provide the highest levels of health care to more than 30,000 Marines and Sailors, their families and retirees," NHCCP Commanding Officer Capt. Angela Nimmo, said. "The Lindseys are receiving the kind of care we strive to provide every patient walking through our doors. They are just one example of the excellent service and care the talented group of health care professionals at NHCCP provide our beneficiaries every day.

"As Navy Medicine continues to move towards patient-centric care, and as we align with the Navy Surgeon General's mission of 'Keeping the Navy and Marine Corps family ready, healthy and on the job,' the NHCCP staff will continue to find innovative ways to care of our patients," Nimmo added.

No journey would be complete without a minor obstacle or two to overcome. Rita's knees are aching and surgery is pending.

"I'm going to have to figure a way to keep exercising," Rita said. "But my health care team tells me that as important as exercise is, diet is more important and I'll just have to modify my food intake while I'm rehabilitating.

"I am forever grateful to Ms. Green, Ms. Amber, Lt. Fedewa, and Lt. Cmdr. Ellsworth for helping us on this journey, and most of all to my wonderful husband who is always at my side," Rita added. "Paul and I keep a picture of us we took last year on our refrigerator with a caption, 'Do you want to return to this size?' So every time we go to the refrigerator or the pantry, we look at it. And now we're looking forward to many more years with our grandbabies."

***

Named after Medal of Honor recipient, Pharmacist's Mate 2nd Class William D. Halyburton, the Naval Health Clinic Cherry Point provides high-quality patient care to more than 33,000 active-duty members and Department of Defense beneficiaries. In addition to outpatient surgical services, NHCCP offers Medical Home Port (including family care and pediatrics), dermatology, internal medicine, orthopedics, physical therapy, mental health, pharmacy services, preventive medicine, aviation medicine and radiology to include MRIs.

For more information, visit http://www.navy.mil, http://www.facebook.com/usnavy, or http://www.twitter.com/usnavy.

For more news from Naval Health Clinic Cherry Point , visit www.navy.mil/.