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jeudi 12 mars 2015


Today is Wednesday, 11th March 2015
In a tribal Clinic in a corner of the State of Nebraska, the isolation measured by the distance to the nearest café: 30 miles.
After a very pleasant especially healthy lunch prepared by our tribal nutritionist, a patient was ushered into the consulting room. A tall Indian, very neatly combed hair, and well presented, comes in and sits near me. I insist on my patients sitting near me, rather than opposite me, his face or presence obscured by the computer screens.
Unfortunately he suffers from Anxiety attacks for which the psychiatrist had medicated him with a variety of drugs. His wife has a responsible job within the tribal administration, she is also a patient of mine and I had been pleased with the lifestyle changes they were trying to make.
After the usual pleasantries we began a conversation. You look good, I commented, with sincerity, since I detected a shine of good health on his face. We have been trying to change our eating habits. My advice to them has been to avoid heavily processed foods, limit processed foods, and view with skepticism the claims of Pizza Companies and other food pushers. I like to conclude with Michael Pollan’s words: Food does not come through the windows of your car.
Yes I feel good, he said and we continued our conversation a little longer, talking about the improving weather, with possibilities of increasing physical activities. We do not order a lot of investigations, and I try to explain to them the significance of the tests and also interpret the results or consultations of other physicians he might have seen.
I began with the normal eye examination and thus assuring him that his kidneys would also be equally unaffected. HgbA1C a measure of blood sugar excursions had diminished from the last visit, making him and me happy. Fats in his blood have normalized an indirect measure of a better eating pattern. But when I looked at the Cholesterol levels, I was a little disconcerted to see that the so called bad cholesterol was at 180, a level not preferred.
Normally in our patients with Diabetes if they have higher levels of “bad” cholesterol, we prescribe a medication called Statins. Are you taking any statins? I asked him.
There was a moment of silence. He turns an inquisitive face towards me and asks, Does not Statin medications cause Diabetes or make it worse?
I was taken back, for two reasons. We do try to educate our patients and keep them engaged in their own health, but what surprised me was that the paper critically claiming this association was published only on 5th March 2015, less than one week ago. I am fortunate enough to read and have time to read a fair bit of medical literature on a daily basis, and I had discussed this paper with my erudite doctor friend in Miami, who also has time to read medical journals and other articles on a regular, leisurely basis.
Yes, it is true, my friend, Statins can cause Diabetes and make Diabetes worse in those who already have it. I am happy you know that. But I want to explain something. This association of Statin and Diabetes is seen only with powerful statins and at a higher dosage level. The Statin I prescribed for you is a mild Statin and at a lower dosage level.
He was happy at the explanation, and said, if you recommend, I would take it. I told him that in light of current knowledge, it is better to protect his heart since he was younger than 40 years of age.

I was curious; I asked him, where did you read about Statins causing Diabetes? And I was not prepared for the answer. I read it in Facebook a couple of days ago!, he said, with a slightly mischievous laugh,
Here sitting in front of me, this humble Indian, who is afraid to go out into a crowd because of his fear of anxiety attacks, living in a village without a café or shop, is so engaged about what affects his health that he has searched and found the information that he wanted to discuss with me.
I silently wondered how many PAs, Nurse Practitioners or Doctors in the State of Nebraska would have known about this research published less than one week ago? Knowing the reading habits of health care providers in this part of the world, I would guess a small percentage.

A theme during the conversation at Lunch time resonated within me, in our small tribal clinic, we try to engage our patients in their health and educate them in a culturally specific fashion so that they receive the education given.  I was extremely pleased with this patient and complimented him. He got up to leave, he seemed taller than normal and the contented look on his face was my reward for working with the Indians.