:: to the teeth ::   thoughts on social justice, medicine, race, hope and beats
"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::
"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Sunday, April 24, 2005
Patient Stories from the Topahkal
47yo male with newly diagnosed diabetes mellitis. Married, no children. Initial lab workup revealed a significant dyslipidemia (triglycerides 880, cholesterol 306) and a fairly strong case of diabetes (hgb A1C 10.8, mean blood sugar level 268). Initial approach was to start the patient on a standard dose of Gemfibrozil to control his severe hypertriglyceridemia, Glipizide to control his sugar, and a baby aspirin daily to minimize cardiac risks. This is fairly routine medical care. Some folks will also start their patients on Statin drugs to control the high cholesterol and maybe choose a different diabetes pill. I'm not a fan of statins in the first year or two of a treating people with diabetes or dyslipidemia. While some data indicates these drugs have a benefit there are real issues of compliance past a few months and a focus on pills instead of nutrition.
The patient understood that the medications were being started to stabilize his illness and improve his symptoms. We talked about using the medications for 6-12 months while he made lifestyle changes that would optimize his health, using food and exercise as medicine. There was no promise made about stopping the drugs, his body would decide that, but it was our goal. We spent about an hour talking about dietary changes, the role of sugar as a poison for the pancreas and other organs, the utility of certain foods and herbs. We also talked about the patients fears of the diagnosis of diabetes.
He left terrified (I later learned) but with some clear steps he could take and easy access back to the office if any questions arose. About two months later I received some labs by fax and I was flabbergasted. It took me about five minutes to realize what I was seeing. This man's triglycerides were now 80, not 880. His cholesterol was 140, not 306. His hgb A1C was 7.3, not 10.8. His mean sugar was 140, not 268. I called the patient and asked him to come in and see me to review the labs. I was fairly certain that the Gemfibrozil could not have accomplished such a significant change and I wanted to know what happened.
Turns out that he had stopped the Gemfibrozil after a month and had cut his dose of Glipizide down to half a pill because of side effects. Almost all of the lab changes were due to dietary and exercise changes. He had incorporated flax seeds into his diet, as well as oatmeal (not instant) each morning. He had cut out all lard, fat and white flour products as well as almost all sugar products. He was still eating meat but in balance with alot more vegetables. He was exercising every other day for at least 20 minutes.
And he felt great! He also looked great. all his symptoms of diabetes and fatigue were gone. I stopped his Glipizide and we'll check his blood levels again in 2-3 months to ensure that this wasn't a fluke and that his diabetes is controlled with diet and exercise alone.
This man earned his independence from the medical system by taking the challenge of creating his own health. He recreated his relationship to food and physical exercise with minimal consultation. The total cost of this transformation was under $100.00 for the doctor visit, the labs and the intial medications. The folks who calculate the GNP won't be happy but you can't please everyone anyways... 2 months.
A Reality Check is in Order - I've been a student of medicine now for almost 10 years and have rarely seen this kind of transformation happen. I tell this story not to set some standard but to to share the possibilities with folks. As providers, it gets easy to become discourged or pessimistic during our training or on the job when so many patients are unable to care for or invest in themselves. There are many real issues that contribute to this reality. In any healing process there are at least two participants. The person who is healing him or herself and the person who is facilitating that process. My personal challenge now is to explore the relationship between how we build our health systems, what our clinics look and feel like, and how our attitudes as providers INFLUENCE the POSSIBLE for our patients.
posted by andru | 4/24/2005 08:53:00 AM | |
Beautiful case study - wish there were more people like him who do take the initiative to take control of their health and not just rely on the medical system (and it is a flawed system) to take care of him - in this case using diet and nutrition and exercise and I'm sure having a positive frame of mind doesn't hurt...we definitely need to take steps in taking charge of our health and I hope this story/case is not going to be just an isolated one. congratulations
# posted by : 4/25/2005 6:50 PM
Hi, it is liz from http://lizditz.typepad.com I don't speak or read Spanish, really. I have a question -- is there a good, practical "how to manage diabetes with diet" booklet in Spanish?
# posted by : 5/10/2005 1:14 AM
So often patients want a magic bullet pill -- one that doesn't require any work on their part.