I’ve never quite understood why some patients are compelled to lie about their healthcare. Even with television shows like CSI, some patients will look us right in the eye and flat out lie about which foods they are or are not eating, or about their vitamin regimen (or lack thereof.) Of course, the real story lies within their veins.
“I haven’t been feeling well lately. I am always exhausted. It is all that I can do to get out of bed every morning,” said the patient.
“Well, let’s take a look at your recent labs,” I said. Flipping through the pages, I frowned. Where are my damn glasses? Oh there they are - on my head. Duh. “Let me guess - you ate a carbohydrate-heavy meal the night before these labs were drawn?”
The patient looked up in surprise. “Uh, no…why do you say that?”
Pointing at her labs, I say, “Do you see here? Your sugars were bottomed out when these fasting labs were drawn. That tells me that, the night before, you ate a LOT of carbs which caused your blood sugar to first spike, then plummet. Are you sure that you didn’t have carbohydrates? Because if you really didn’t, then I’ll have to send you out for a lot of really expensive blood tests.”
Okay, I lied. So sue me.
The patient started squirming. “Well, we had friends in town and we went for Italian,” she finally confessed. “I’m sorry, I just didn’t want you to yell at me.”
It was my turn to be surprised. “Yell at you? A, I don’t yell. Second, if you want to do things that are against your surgery’s protocol and sabotage not only your weight loss but your health, that is your business. We have a lot of other patients who actually want our help to make healthy changes.” I paused for a beat of five. “So - moving on. How are you doing with your vitamins?”
The patient started to launch into what was probably another lie, then thought better of it. “You know from the lab work, don’t you?” she asked tentatively.
I chuckled. “Yes, I do. I can see that you are taking your multivitamins and calcium, but your iron is very, very bad. Tell me about that.”
“Well, since I cannot take iron with calcium, I oftentimes forget to take it. What’s going on?” she asked.
I pulled my stool around to her chair. “See this? This is your hematocrit level. Hematocrit is a blood test that measures the number and size of your red blood cells. It gives a percentage of red blood cells found in whole blood. We always order it as part of a complete blood count. Normal results vary, but in general the normal range for females is between 36.1 and 44.3 percent,” I said.
She asked, “So what is my number?”
“Eight percent.”
“Eight percent?!” she shrieked.
“Eight percent,” I repeated. “Normally, a low hematocrit may be due to conditions such as anemia, blood loss, bone marrow failure, destruction of red blood cells, leukemia, malnutrition or specific diet deficiencies, multiple myeloma, and rheumatoid arthritis. Based on your results, it is likely due to anemia. We are going to have to put you on a special iron super-multivitamin that has vitamin C and B-12 to aid in iron absorption, plus intrinsic factor, also for absorption. You’ll need to take it three times a day for ninety days. This is not an overnight or over-the-counter fix.”
“Three times a day? That’s a lot of iron! I’ll be constipated for weeks!” she howled.
I took off my glasses. “Months, actually. I recommend that you start taking it with a stool softener, and be sure to take both with a full glass of water.” I leaned in for effect. “This is what happens when complete and utter inaction on your part brings your body dangerously close to injury. Did you know that severe anemia can cause severe health problems such as strokes?”
She almost passed out at that pronouncement.
Look, folks. We don’t tell you to take prescribed vitamins because we have nothing better to do. As a bariatric post-op, you chose to rearrange your gut and, to keep your body working normally, promised to replace the vitamins and minerals that you either or not ingesting in the first place or absorbing. We had weight loss surgery to lead healthier, longer lives. What’s the point of having surgery if you are going to create new, harmful issues for yourself?
One more rant for the road.
To the pharmaceutical rep who shook my hand today and almost broke it. Hey, doofus! WTF? Do you see these? They are called boobs. I know that you know I have them because you kept trying to look down my shirt this afternoon. Anyway, having them means that I am a girl. So ease up - you don’t have to crush my hand when you shake it!
