Four Doors Apart
As I knocked and walked in to his darkened hospital room, it took a moment to make out the curled up form of a man lying in that hospital bed. The blanket was taut around him, pulled up to even cover his face.
As he sensed my presence, he pulled the blanket down. I introduced myself, and verified his identity, and broke the ice like I typically do by asking how he, his appetite and his food were all getting along.
I knew some of his history from reading his chart. I had read the results of the last panel of laboratory values. I knew what medications he was being given.
But the lab value of particular interest was the HGB1Ac. A blood test that indicates the general level of control of diabetes over the last three months. In his chart, it was flagged as “greater than 14” which means it was off the chart. A number of 6 or below is desirable. The higher the number, the higher the blood sugars have been in a chronic state.
The principle of the test works the same way that a baker or cook in the kitchen makes a fine, golden crust on a baked cake or hash browned potatoes. It is the chemical reaction between sugar (glucose) and protein. A non-reversible reaction that permanently changes the protein (specifically an amino acid making up the protein). In the kitchen we call it the “browning reaction.” Makes that desirable caramelized look on the surface of starchy foods. The chemists call it the Maillard Reaction. What drives it in the kitchen is heat. What drives it in the body is concentration. And that high blood sugar concentration forces the reaction between the sugar and the amino acids in proteins to change, become damaged, become non-functional. It happens in the micro-arteries of the eye, the kidney, the extremities, the heart . . . the precursors to the horrible complications of diabetes. Red blood cells last about 90 days. That high sugar concentration attaches to a specific marker in red blood cells, hence the hemoglobin A1C test is an indicator of diabetes management over the last 90 days.
The patient was in his early 40’s.
The H&P (history and physical) provided a brief synopsis of his disease process.
Horrible.
And a litany of his total non-compliance with medication or life-style issues surrounding his condition. And yes, a history of alcohol abuse.
The man was frightened. He had been admitted through the emergency room with blood sugars in the 800 range. He had been in metabolic acidosis. He was sick. Very sick.
I asked him about his diet history. It didn’t surprise me at all. One meal a day. Fast food. High fat, high sodium, low fiber. Cheap, quick, and easy. The constant drinking of sugared, caffeinated beverages. For just a few pennies more, you can really up-size. A chain smoker. A job, when he did work, that was sedentary.
We talked some more about what he knew about diabetes management. Virtually nothing. He had never been instructed on how to check his blood sugars. For some reason, he had been on oral hypoglycemic agents only and not insulin . . . and hadn’t taken that. He had no functional knowledge whatsoever about nutrition, the role of carbohydrate, the difference between complex and simple carbohydrates with respect to their effect on blood sugars. Food was anything he could get going through the drive-thru and consume before he hit the center lane of traffic again.
But now he was frightened. And quite willing to listen. And his education would take several sessions. He was worried about how he was going to get education with no insurance. And the other little complications that a for-profit-insurance-based-health-care system forces on all we citizens.
I did my best to reassure him that we would work with him while he was still in the hospital. And I alerted the Certified Diabetes Educator on the hospital staff of his plight.
We talked some more about how diabetes can be managed. Lots and lots of people do it. From little kids to grandparents. That it is something that he could learn and do . . . if he wanted to.
Still frightened when I left, but with a degree of hope.
Four doors down the hall.
I knocked on the door, and received a rousing “Come in.”
And sitting in the chair, ready to leave as soon as his ride showed up, was a youthful-looking man that I knew from his chart was well into his 80’s.
His new pacemaker had been installed, and he was a tickin’ and ready to go.
His diet order had been “Cardiac Diet” and so I wanted to briefly assess his knowledge of just what that meant.
And wow! Did I get a lecture on his prudent cardiac diet eating practices! This guy was a poster boy for the American Heart Association!
And it showed.
With that pacemaker, he would out-live me!
We talked of the hiking trail in Longview, TX that I had just discovered. He was down to walking it now, ‘cause he was afraid he might fall on his bike.
But his walking, his snacking on almonds, his near vegetarian diet, his avoidance of processed foods with a passion, his drinking of only water . . . he was a living, breathing practitioner of wellness.
And I had to tell him my story of how to go shopping. Of how the big grocery stores are laid out. Of how to tackle that corpulent pit of compulsion. When you enter, stick to the outside walls. That is where you will find the least processed foods. Closer to the way that Mother Nature made them. Start in the bakery with the whole grain bread. Not just that “wheat bread,” but the real stuff. That multigrain European-like artisan bread. Then move into the dairy section for the low fat/fat free stuff. And if you dare, try soy milk. Look for the cholesterol-free egg substitute products. If you must have eggs, look for those eggs from chickens feed omega-3 fatty acids. Then in the meat section . . . small amounts. Use meat as a condiment. Pick the low fat. The skinless. Fresh. Not processed. Then head for the produce section. Go crazy there. Pick something of every color you see. And then. Take one little side trip down the aisle where they sell the brown rice, whole grain pasta and the peas, beans, lentils and that good stuff. You can pick up some canned tomato sauces if you like.
Then get the heck out of there!!
The rest of the store will just do ya’ in.
He laughed and laughed!
And that new ticker was doin’ its thing.
And I did something I shouldn’t have done, for I knew it would bring sadness to his face.
I mentioned a little bit about four doors down.
The Refectory Manager
As he sensed my presence, he pulled the blanket down. I introduced myself, and verified his identity, and broke the ice like I typically do by asking how he, his appetite and his food were all getting along.
I knew some of his history from reading his chart. I had read the results of the last panel of laboratory values. I knew what medications he was being given.
But the lab value of particular interest was the HGB1Ac. A blood test that indicates the general level of control of diabetes over the last three months. In his chart, it was flagged as “greater than 14” which means it was off the chart. A number of 6 or below is desirable. The higher the number, the higher the blood sugars have been in a chronic state.
The principle of the test works the same way that a baker or cook in the kitchen makes a fine, golden crust on a baked cake or hash browned potatoes. It is the chemical reaction between sugar (glucose) and protein. A non-reversible reaction that permanently changes the protein (specifically an amino acid making up the protein). In the kitchen we call it the “browning reaction.” Makes that desirable caramelized look on the surface of starchy foods. The chemists call it the Maillard Reaction. What drives it in the kitchen is heat. What drives it in the body is concentration. And that high blood sugar concentration forces the reaction between the sugar and the amino acids in proteins to change, become damaged, become non-functional. It happens in the micro-arteries of the eye, the kidney, the extremities, the heart . . . the precursors to the horrible complications of diabetes. Red blood cells last about 90 days. That high sugar concentration attaches to a specific marker in red blood cells, hence the hemoglobin A1C test is an indicator of diabetes management over the last 90 days.
The patient was in his early 40’s.
The H&P (history and physical) provided a brief synopsis of his disease process.
Horrible.
And a litany of his total non-compliance with medication or life-style issues surrounding his condition. And yes, a history of alcohol abuse.
The man was frightened. He had been admitted through the emergency room with blood sugars in the 800 range. He had been in metabolic acidosis. He was sick. Very sick.
I asked him about his diet history. It didn’t surprise me at all. One meal a day. Fast food. High fat, high sodium, low fiber. Cheap, quick, and easy. The constant drinking of sugared, caffeinated beverages. For just a few pennies more, you can really up-size. A chain smoker. A job, when he did work, that was sedentary.
We talked some more about what he knew about diabetes management. Virtually nothing. He had never been instructed on how to check his blood sugars. For some reason, he had been on oral hypoglycemic agents only and not insulin . . . and hadn’t taken that. He had no functional knowledge whatsoever about nutrition, the role of carbohydrate, the difference between complex and simple carbohydrates with respect to their effect on blood sugars. Food was anything he could get going through the drive-thru and consume before he hit the center lane of traffic again.
But now he was frightened. And quite willing to listen. And his education would take several sessions. He was worried about how he was going to get education with no insurance. And the other little complications that a for-profit-insurance-based-health-care system forces on all we citizens.
I did my best to reassure him that we would work with him while he was still in the hospital. And I alerted the Certified Diabetes Educator on the hospital staff of his plight.
We talked some more about how diabetes can be managed. Lots and lots of people do it. From little kids to grandparents. That it is something that he could learn and do . . . if he wanted to.
Still frightened when I left, but with a degree of hope.
Four doors down the hall.
I knocked on the door, and received a rousing “Come in.”
And sitting in the chair, ready to leave as soon as his ride showed up, was a youthful-looking man that I knew from his chart was well into his 80’s.
His new pacemaker had been installed, and he was a tickin’ and ready to go.
His diet order had been “Cardiac Diet” and so I wanted to briefly assess his knowledge of just what that meant.
And wow! Did I get a lecture on his prudent cardiac diet eating practices! This guy was a poster boy for the American Heart Association!
And it showed.
With that pacemaker, he would out-live me!
We talked of the hiking trail in Longview, TX that I had just discovered. He was down to walking it now, ‘cause he was afraid he might fall on his bike.
But his walking, his snacking on almonds, his near vegetarian diet, his avoidance of processed foods with a passion, his drinking of only water . . . he was a living, breathing practitioner of wellness.
And I had to tell him my story of how to go shopping. Of how the big grocery stores are laid out. Of how to tackle that corpulent pit of compulsion. When you enter, stick to the outside walls. That is where you will find the least processed foods. Closer to the way that Mother Nature made them. Start in the bakery with the whole grain bread. Not just that “wheat bread,” but the real stuff. That multigrain European-like artisan bread. Then move into the dairy section for the low fat/fat free stuff. And if you dare, try soy milk. Look for the cholesterol-free egg substitute products. If you must have eggs, look for those eggs from chickens feed omega-3 fatty acids. Then in the meat section . . . small amounts. Use meat as a condiment. Pick the low fat. The skinless. Fresh. Not processed. Then head for the produce section. Go crazy there. Pick something of every color you see. And then. Take one little side trip down the aisle where they sell the brown rice, whole grain pasta and the peas, beans, lentils and that good stuff. You can pick up some canned tomato sauces if you like.
Then get the heck out of there!!
The rest of the store will just do ya’ in.
He laughed and laughed!
And that new ticker was doin’ its thing.
And I did something I shouldn’t have done, for I knew it would bring sadness to his face.
I mentioned a little bit about four doors down.
The Refectory Manager
posted by The Refectory Manager | 11:16 PM
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