As I entered the exam room of my first patient of the day, I noticed he had some papers in his hand and didn’t look all that happy to see me. As I sat down and asked what was going on, he handed over the laboratory report received from his work physical. “I’ve been put on notice about my cholesterol” he stated flatly. “I suppose you are going to put me on medication for it?” he asked. His numbers showed triglycerides in the 600’s and total cholesterol greater than 280. Generally, we look for your cholesterol panel to be: Cholesterol less than 200, Triglycerides less than 150, LDL (L for lousy) cholesterol less than 100, and HDL (H for healthy) greater than 40.
It is interesting to me that throughout my nursing career and nurse practitioner training, it is usually assumed that high cholesterol means cholesterol medication. This could not be further from the truth. In fact, cholesterol medications are not the first line of treatment I prescribe. I’d rather stay away from medication side effects, dosing issues, medication combinations or other issues related to using medications until the last resort.
With February being heart health awareness, I would like to take the opportunity to encourage people to take a moment to think about this. Just for a moment, close your eyes, still your mind, take a minute to listen to your breath as it fills your chest and leaves your body, and just pay attention to the heart beating in your chest. You may feel it in your neck veins or hear it faintly in the background.
The heart is an amazing organ that physically works around the clock to help maintain the basic balance within the body, is a powerful mind/emotion/body chakra, and is how life starts and stops all within one beat. Pretty incredible really….
Statistics show that “Heart disease is the leading cause of death for men and women in the United States. Every year, 1 in 4 deaths are caused by heart disease” per the U.S. Department of Health and Human Services (2018). But heart disease is not as simple as calories or cholesterol. Did you know that both the World Health Organization and the Centers for Disease Control and Prevention both list things like air quality as contributors to heart attacks and strokes? “The World Health Organization estimates that air pollution causes more than 3 million deaths each year.2 Air pollution may cause up to 200,000 early deaths each year in the United States” (CDC, 2017).
My answer to my patient was one of a starting conversation about his overall health status. Questions about his diet patterns/habits, sleep quality, exercise/activities, stress management, home and work-lives, and his definitions of what health and wellness was to him. Our conversation revealed: a) he doesn’t ever take the physical labs in a fasting state as he should, b) he has been eating at McDonalds for breakfast frequently as he travels for work in rural NV, c) he is not a person that will exercise or change things such as the amount of alcohol he drinks, d) feels that he can make a small adjustment to his diet to get the numbers back to last year’s levels. Just this little bit of information helps me to understand his willingness to change, how to encourage him to make small changes, and give him lead on the plan of action. I don’t under-estimate the importance of family and know that his very active girlfriend can be of some benefit for his treatment. By the end of the visit, we had a plan of action as well as defined boundaries of when medication may be considered. Had I attempted to push my values and beliefs of what he should do or immediately prescribed medications, he would have resisted making any changes in his life, would have questionable medication compliance, and I would have lost the opportunity to know more about his definitions and values of what his health and wellness are.
Overall, my message to you is this. If you have problems with your cholesterol being high, have a conversation with your healthcare provider. The truth is there are most likely things you can do to decrease the numbers and put off going on medications. I am posting my references and some resources for you. Should you have any questions or would like to make an appointment, please give me a call.