Posts Tagged ‘ECG’


The Elusive Strict Diet

March 14, 2012

Photo by techwithtodd, via Flickr

By Amy M. Collins, associate editor

Several days ago, we linked on our Facebook page to an abstract of a JAMA article that found that women hospitalized for myocardial infarction were more likely than men to present without chest pain. A few days later, my 59-year-old mother was told by her general practitioner that her ECG had shown an electric “blip” that could be due to scarring from an unnoticed heart attack. My mother—always too lax about these things (unlike her hypochondriac daughter)—calmly told me she always has random chest pains and it could have happened at any time.

A visit to the cardiologist a few days later eased our fears. She hadn’t had a heart attack, but was diagnosed with right bundle branch block and has to undergo further testing. With high C-reactive protein levels, elevated cholesterol, and a history of heart disease in the family, one can’t be too careful. A stress test and cardiac ultrasound have been ordered.

In discussing her cholesterol level, which had increased since my mother’s last wellness exam, the cardiologist suggested she start taking statins. Not keen on medication, and worried by recent reports of adverse effects from these drugs, she said she’d rather only start with that if there were no other options. His suggestion was to maybe try some over-the-counter products to lower the cholesterol, mentioning that there were products that acted liked sponges to absorb cholesterol, but not offering anything specific.

My mother’s general practitioner followed up by letter, giving her a three-month window to try to bring  the cholesterol levels down by following a “strict diet,” with no further information on what that entails or what she could do to accomplish this. Exercise was not mentioned at all.

Today my mother asked me what she should eat to make her cholesterol go down. (She thinks that, as an editor at AJN, I naturally have all the answers!) Already thin and following a low-fat diet, she says she doesn’t know where to start. She also admitted to consulting WebMD to find out what she could do.

Resorting to searching online for answers, to me, raises a huge red flag that communication between provider and patient had broken down somewhere, or wasn’t sufficient. Surely this can’t be the best answer. A phone call and discussion or at least an information pamphlet seems warranted.

I guess we can’t expect physicians to be nutritionists and personal trainers, but it seems strange and all too familiar that the first line of defense always appears to be medication, without a mention of specific lifestyle changes that are within our control (treating the disease instead of possibly preventing it). Read the rest of this entry ?



March 4, 2011

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

by doortoriver, via Flickr

Dusk is near, and I’m standing in the woods under a gunmetal sky, watching the snow begin to fall. I can’t get my last patient out of my head.

The struggles the man had faced were obvious. A gauze dressing was wrapped around his head, concealing the bullet wound he’d inflicted, and his skinny arms were scattered with small scars and open wounds, many of them infected. He wasn’t young, but it felt like he was.  Something about a coma
. . . the lines and wrinkles disappear from the face. He almost looked asleep.

But there was no peace here.

Breathing was all that he had; there were no other reflexes. Scant life left and no hope. There would be no organ donation. His family signed the forms to withdraw care and said goodbye.  He was left alone, breathing.

It didn’t take long for the tracings of his ECG to become irregular, the angles wider and more erratic. I rushed into his room (no one should die alone!) just in time to see him exhale with a loud and raspy sigh. I stepped toward him and put my hand on his shoulder, thinking that I’d just seen this man’s last breath, and that he was gone. So many thoughts went through my head at once; that my hand on his shoulder was wasted . . . too little, too late; that our care had been futile; and that the loss of this man was an epic failure. We came in at the end of the game, and this failure was larger than medicine.

I was shocked when one last rasp of breath escaped him and a drop of something icy cold and wet hit my arm.  I pulled my hand back with a shiver. Such a stupid thing to do, to stand right in front of the open mouth of a dying man.

A dead man.

I’m standing in the cold, and it’s beginning to snow harder. The further I look through the static of falling snow, the less I can see; the horizon blurs softly into shades of gray. It’s so quiet.

I’m struck by the sound the snowflakes make as they tap against the dead leaves that cling to trees. Cold like ice, yet they sizzle.

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