Travels with Headcase

"Stan's other Baby"

My patient Stan is at increased risk for Atherosclerosis.  This concerns me, as Atherosclerosis is one of the top fatal health conditions in America. He’s 55 years old, an avid car nut and family man.  He’s also a-pack-a-day since age 15 smoker and loves high fat greasy food (i.e. Polynesian BBQ, marinated Tri-tip, Jamaican Jerked Chicken…hello cholesterol!)

“So it’s been a while since you’ve come in…tell me how you’ve been doing.”

“Well JD, I don’t feel so well.  Whenever I walk my legs ache after about half an hour, and I have to rest to get the pain to subside.  I also get dizzy spells, and I have to sit down for those, too – and you know how much I love to sit – he he.” Smirked Stan.  I know he’s joking with me; he’s an active guy, always busy doing something.

“Tell me about your baby.”

“Miranda? Why she’s all growed up – I’m proud of her. You know, she’s going to school at Northwestern,” he says, sniffing back a tear.

“You must be proud Stan, you’re practically crying.”

“I am. I’m just sad thinking about ALL that money I’m gonna’ drop at Northwestern U.”

“Stan, that’s great, but I’m actually asking about your other baby in the parking lot there,” I said pointing to the late model Chevy in the parking lot.

His eyes light up. Suddenly, Stan’s a teenager again; eyebrows lifted and a smile draped across his face. “Oh! Oh Sheryl? Well, she’s running just fine.”

Stan’s other ‘baby’, the one he refers to as Sheryl, is his car.  A restored classic, 1967 Chevrolet Chevelle SS: mint condition, leather bucket seats, 4-speed, posi-traction rear, stock color GM gold flake.  It has the works.  Stan reworked the engine, 396 big block bored out to a 12:1 compression ratio – it’s a moderate but “street-legal racecar”.  Stan told me that with slick tires, it runs in the low 12’s on the drag strip.  Pretty damn good for a grandpa car.  I wanted Stan to think about that engine before I told him about his own internal engine – his heart and vasculature (i.e. arteries and veins) are clogged up by his 40 years of smoking and a fatty, greasy, grilled-animal-diet.  We’re going to have to discuss his numbers.

Me: “So Stan – I want to talk about your tests, but first, I want to ask you about your car’s engine – what happens to your engine if you use 20W-50 oil during the summer? Then say you neglected to change your oil, so it’s up to over 8,500 miles with the same heavyweight oil?  Let’s also say you haven’t had a radiator flush in 10,000 miles.  Tell me about the condition of that 396 c.i. engine out there under those conditions – just hypothetically, of course…”

Stan: “Well that particular oil is already real thick, so by now it would be sludgy – I’d get poor performance, the car would lurch and would accelerate more slowly, wouldn’t go nearly as fast as it could with lighter, thinner oil like 5W-30.  Old heavy oil is not efficient, not good at taking heat out of the engine, doesn’t circulate well…so it will overheat.  Might even clog up the valves, too.  Regarding that radiator, there’s a calcification that occurs on the inside of the engine block, the radiator tubing and radiator hoses if you don’t flush out that ol’ antifreeze.  Why, that might lead to a blocked radiator hose, which could stretch it out and blow a hole right through the wall of the hose.”

Me: “Alright Stan, your description of the engine is very much like what’s happening with your own heart and plumbing.  What’s happening is your blood is getting thicker; it’s not healthy, it’s like that heavy oil and thickened antifreeze fluids you described.  Looking at your INR-blood tests, and the other symptoms that brought you in today, we can see that you are at risk for getting a blood clot, which could blow a hole through one of your own pipes – the trouble is, that could cripple or kill you!  We need to make that blood thinner using a drug.  You’ve been using Aspirin, and that has helped, but we need to switch you to something more powerful, like Warfarin, commonly called Coumadin. Once you start taking this medicine, please stop taking the Aspirin; otherwise you might have problems with bleeding.  You also need to make significant diet changes – less salt, more vegetables, and get a walk in every day.  Smoking?  That’s gotta’ go.  It’s made a bad problem even worse.  If you want to be alive long enough to see your grandkids grow up, and be able to do more than watch them from your living room window, sitting in a wheelchair hooked to a respirator, you must stop smoking.”  I knew this last image of his inactivity would arrest his attention, knowing how active he is with his family.

“We have several options and even some drugs that can help wean you off the cigs for good, Stan.  Let’s start talking about that, as medicine can help you, but stopping smoking will really improve your health!”

Sources:

Lehne , Richard A., PhD (2007). Pharmacology for Nursing Care. Sixth Ed. USA: Saunders Elsevier Publ., St. Louis, MO.