SOMETIMES BETTER TO LEAVE IT ALONE

Part of my new job as a nurse practitioner is discussing treatment plans and overall health conditions with the resident’s family members. Most of them want to be kept up-to-date on their loved ones health status, if there were any changes, and what will be the treatment plan. Contacting them too much is not a bad thing and is highly recommended to keep everybody happy. I believe this to be a good thing as well as giving me a good opportunity to educate. Part of the nursing philosophy is treating the patient holistically and to educate them on their health. Even after much patience on my part when attempting to educate a family member I get to the point when I realize – just leave it alone.

Several months ago one of my patients had routine labs drawn which included a lipid panel. After the results came back the NP before me found his triglycerides were over 300. He was placed on gemfibrozil and another lipid panel was ordered to be drawn in three months. That is about the time I came into the picture.

After being on gemfibrozil it reduced his triglycerides to within normal range. His HDL was still a little low but it was decided to keep him on gemfibrozil and re-check another lipid panel in another three months. I saw his wife wheeling her husband down the hallway towards me. The reason why he is in the nursing home is because he had a stroke which left him unable to care for himself. This is the conversation I had with her about her husband’s recent lipid panel.

“Hi. We met a week ago. I am the NP that will be taking care of your husband,” I said.

“Oh yes. How are you today? What do you think of my hat?” she asked as she held up her multi-color straw hat. In Phoenix wearing a hat was not a bad thing because of how hot it got in the summer months.

“It is very pretty. It looks good on you,” I replied. She did look good in the hat.

“Thank you,” she said.

“I wanted to talk to you about your husband’s cholesterol. We just got his last lab results back and it has improved…” I told her as she interrupted me.

“Yes. I know his triglycerides were way up. You know it’s because this place feeds him potatoes. They are so high in carbs. No wonder why they were so high,” she said. I noticed she had a small cooler sitting on her husband’s lap. I would ask about that later. I wondered if she had a copy of Atkins at home.

“The potatoes probably did not bring his triglycerides up that high. It could be genetics and sometimes we don’t have any control over it,” I responded.

“No. It is what this place feeds him. You know they fed him sugar-free pie? When I found out I told them he should eat fruit. What is wrong with these people?” she said in a frustrated voice although she still smiled with her multi-colored hat in her hand. Her husband was watching her as we talked about his triglycerides.

“The pie was probably a nice treat for him. I am sure they don’t feed it to him all of the time,” I responded.

“But they give him potatoes. That is what brought his cholesterol up. I wish they would feed him different,” she said.

I talked to her for several more minutes before realizing the conversation was going to go nowhere.

“Well, his HDL is still a little low and we will re-check his labs again in a few months. We will keep him on his medication,” I told her.  

“Okay,” she smiled as she wheeled her husband down the hall with the little cooler in his lap.

“What is in the cooler?” I asked out of curiosity.

“Oh, that is his fudge ice cream bar. He likes them so I bring them to him almost everyday,” she smiled.

“Oh that is nice. I bet he likes those on these hot days,” I said trying to contain myself. I knew it was better to leave things alone and not pursue it any further. Maybe in the future I would approach the diet and cholesterol talk again. But for this day it was better to leave it alone. I watched as she wheeled her husband down the hallway so he could eat his fudge ice cream bar.