BLOG: My patients, my heroes — saving Nancy’s liver
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“My patients, my heroes” is a special series in my blog that I dedicate to my patients. It launched in May with the story of my patient, Melissa, titled “Beating the Odds.”
I believe that every patient whom I have encountered over the years has a special story that goes beyond the boundaries of the regular doctor-patient clinic visit; beyond the boundaries of EMR clicks, templates, macros and box-checking. These stories are not usually included in routine clinic notes. These stories of my patients have been happy, sad, hilarious or just routine life happenings. In every patient visit, I try to leave time to let patients tell their stories in parallel with telling the details about their medical problems — and I have trained myself and have learned to listen tentatively. My fellows often would express how incredible it was that I would remember every patient’s story as soon as the fellow begins presenting his or her patient’s case.
This post is about Nancy.
Nancy is a patient who established endocrinology care with me in the summer of 2007. She has diabetes and other endocrine and medical problems. She is a retired professor of arts, from Lansing Community College in Michigan.
Nancy had obesity, which complicates her diabetes management. She had insulin resistance; I had prescribed large amounts of insulin to maintain blood glucose and HbA1c goals.
One day, several years ago, her labs showed elevated liver enzymes. Nancy underwent liver imaging, which showed fatty liver, so-called non-alcoholic fatty liver disease, or NAFLD or hepatic steatosis.
Nancy had read that there is concern about NAFLD causing progression to liver cirrhosis.
This was a wake-up call for her. She did not want to lose her liver.
She knew what the problem was and how to fix it: her weight.
She began cutting carbohydrate consumption and lost significant weight. Together we were able to stop her insulin completely. Her blood glucose and HbA1c have remained at or close to goal since, though she would go, now and then, into medical stressors that would require small amounts of insulin.
Unfortunately, Nancy was diagnosed with metastatic breast cancer a few years ago. She is still undergoing intermittent treatment and continuous surveillance, is doing well overall, and her spirits remain very high.
Nancy is a gifted artist. The image below (Figure) is a mural painting by Nancy dedicated to women in the military. She was invited to produce the painting as a large mural at the VA Medical Center in Syracuse, New York.
More information about Nancy’s mural is available on the official website of the VA Long Beach Healthcare System.
Nancy presented me a poster of the mural that I hung in my office. She also presented me a small postcard collection of a selection of her artwork that I keep in my album archives.
I am proud to be Nancy’s doctor.
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