Knowledge is power
This post is inspired by a recent patient I cared for last week. Due to HIPAA, this will remain anonymous and will be used only for educational purposes. There will be photos in this post, but they are mine.
The patient I cared for was diagnosed with acute pancreatitis, most often due to either gallbladder disease/obstruction or excessive alcohol consumption. Uncommonly, their diagnosis was caused by hypertriglyceridemia or high triglyceride levels in the blood. These levels exceeded 2,000 when normal is anything below 150. Without deep details about the patient, the first line of treatment was a continuous insulin drip. I had never heard of this in my 11 years as a nurse, so I was excited to have this patient as a learning opportunity. But I did not leave work to come home and not dig deeper about this and why it happens, so my learning continued. It is fair to say that I now have a better understanding of a few things: 1. What insulin does in the body, as there are more things involved other than just lowering blood glucose 2. How triglycerides become increased and spoiler, it’s not fat 3. How triglycerides cause pancreatitis, and 4. The treatments for pancreatitis caused by hypertriglyceridemia.
The patient and I discussed their understanding of why they were in the hospital. I jump on any opportunity I have to assess what people understand about their health. While I appreciate critical care medicine and all we have at our disposal in the hospital, our patients cannot have daily or sometimes every 4-hour lab draws and continuous intravenous infusions of medications that help them. They only have what they know and understand or how to get answers to their questions. In other words, knowledge is power for them. With this conversation, I could deduce that they had a fundamental understanding of how they arrived at this healthcare crisis but had not been informed of how triglycerides were the cause. Their healthcare provider focused not on them as a whole person or empowering them with enough knowledge to learn how to live healthier. Medications are sometimes unavoidable, but if people ask questions and truly learn about how their bodies react to certain foods, they can change or even eliminate drugs from their lives. We agreed that asking more questions was something they would do in the future.
This sparked my thought that many people do not know their lab results or their meaning. To add insult to injury, they do not know how their lifestyle affects lab results.
March 2012 Lipid panel
In 2012, I was 33 years old and five months away from graduating from the LPN program. I had a basic understanding of what health markers I should be watching and what they meant, not from a physician but from my educational journey in school. Over the years, I have had the opportunity to keep an eye on my lab work with more scrutiny after working in long-term care, trauma, and critical care. Now, I am pursuing my nurse practitioner education in primary care, and it is even more evident how there is a severe knowledge deficit across the lifespan of patients. Caring for this patient motivated me to learn more about the triglyceride/insulin connection, and even reason through how my own labs have changed over the years.
June 2023 lipid panel
At 43 years old, my labs show a most notable difference in triglycerides. A lightbulb went off in my head. Even though I am older, my blood tests are better. But why? 5 months ago, I stopped drinking alcohol and began taking a GLP-1 agonist medication. Was it just those two things that have helped me over the years? No. It is a sum of all my efforts to achieve a healthier lifestyle. This type of inner dialogue has to be a part of our lives. Many patients rarely take responsibility for their health and struggles. The victim mentality fuels this. But if you can stop, think, learn, and understand how we are never a victim of our circumstances, you will be empowered with enough knowledge to end this cycle. While genetics are not modifiable, there are many ways to keep track of and improve our health based on who we are as individuals.
After a long conversation with my patient, we both agreed they have the inner strength and motivation to change how they see food and how they can reverse their circumstance. It is an infrequent occurrence when a patient admits that they are the problem, and even though it is easy to blame their doctor for not teaching them about their triglyceride levels, it is up to them to ask. Encouraging patients to ask to see their lab work, keep copies, do research, and ask questions is the only way they can take control of their health. They are who they live with and know themselves better than anyone else. Always remember knowledge is power.
