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Watch What you Eat or it will Come Back to Bite you



Robert woke up and went to the gym as he did every morning. He was an attractive guy by most people's standards. Well-manicured and the image of fitness. You could see his muscles from a mile away. While I would love to say that we met at the gym, that is not how we met. We met because he was experiencing "the worst headache of his life and blurred vision". As a new graduate nurse in the Emergency Room, I came into contact with people that experienced health crises for various reasons. Some of my patients had a chronic diagnosis and did not follow their medication regimens for many reasons, but this encounter stuck with me. This 40-something-year-old man, to the naked eye, would be the image of health and fitness, was my patient in a bay where everyone around him would wish to be in his shape. What led to him being my patient in the area where the sickest patients were on that day?

Robert's wife arrived and was as attractive as he was. They were a good-looking couple. She had medications for him to treat high blood pressure. I noticed that the seals to the medication bottles were intact. Before her arrival, I couldn't figure out why his blood pressure readings were coming back so high. He was experiencing a hypertensive crisis. Each time the blood pressure machine would attempt to measure his blood pressure, alarms would sound off, 200/160, 220/140, 210/120. We measured the blood pressure on both arms, the numbers never decreased. After identifying his medications, I knew that he had high blood pressure. Why didn't he tell us? Why wasn't he taking his medications? As the hours passed, I became more familiar with the patient and his wife. I learned from his wife that he has struggled with the diagnosis since receiving it two years prior and has never consistently taken his medications because he blamed them for the issues he began to experience with erectile dysfunction. This was a learning experience for me because while in school, the image of the patient with high blood pressure and cholesterol never had the appearance of this patient. I quickly began to appreciate the necessity of understanding my patient's familial history, dietary intake, and willingness to adhere to their recommended treatments. Two of the contributing factors to this Robert's situation were his hesitancy toward taking his prescribed medications and his diet. Robert knew the changes that would need to happen to maintain his health while having high blood pressure. He wrongly assumed that exercise alone would cure high blood pressure. This notion was the furthest from the truth and dangerous. The blood pressure readings I measured while treating him, I had seen with patients I had treated that were actively having a stroke. The fear I experienced while treating him was one of the scariest parts for me. He was largely unaware of the level of risk he was posing to himself. I found this table in an article that Harvard Medical Published in their Focus on Nutrition series: Nutrition 101 Good eating for good health

"Your goals

For most people, TLC stands for tender loving care. For doctors, it stands for the Therapeutic Lifestyle Changes diet. The TLC diet provides sound goals for most Americans.

The TLC DietTotal calories Adjusted in conjunction with exercise to attain or maintain healthy body weight. (Your doctor or a nutritionist can help you figure out how many calories you should be taking in.)

Total fat 25% - 35% of total calories

Saturated fat Less than 7% of total calories

Polyunsaturated fat Up to 10% of total calories

Monounsaturated fat Up to 20% of total calories

Cholesterol Less than 200 mg a day

Protein About 15% of total calories

Fiber The Institute of Medicine recommends:

  • men 50 years and younger get 38 grams per day

  • women 50 and younger get 25 grams per day

  • men over 50 get 30 grams per day

  • women over 50 get 21 grams per day"

(Harvard Medical School, 2018)

I tell this story and chose to share the text from the Focus on the Nutrition series to stress the balance of diet, exercise, and transparent communication with your health care provider team.

Reference:

Harvard Medical School. (2018). Nutrition 101: Good eating for good health [web log]. unknown.

Author:

Alita-Geri Carter, MSN, RN, CPNP-PC

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