布朗医生日记
Stop ~,Doc. . . what’s my cholesterol?
Sanford J.Brown(著)
I Take, for example, Fred, a 52-year-old, 350-lb patient who was returning for the results of his exam. I have to say that for the last 10 years, ever since I developed a computer-based wellness approach, giving patients their physical examination results has been especially pleasurable for me. In graphic form, patients see a compilation of data for each year they’ve participated in my HealthTrends program, including all the contributing factors to any disease for which they have a greater-than-average lO-year mortality risk. For example, highrisk diabetic patients see their blood glucose level, weight, and caloric intake flash before their eyes in a montage of graphs. For a computer nut like myself, this program is the sliced bread. Unfortunately, Fred is one of my patients who doesn’t share my enthusiasm.
"Hi, Doc. So, what’s my cholesterol?" Fred asks anxiously.
"Hold on a minute, Fred," I say. "We’ll get to that." I gear up for my presentation. "I need to let you know, first off, that you’ve got greater-than average lO-year mortality risk than your cohort and
increased risk across six disease categories!"
"Uh-huh."
"Yes, for heart disease, stroke, diabetes, emphysema, motorvehicle accident, and suicide." Now, I’m starting to roll. Up come the images- lines connected to dots, signifying systolic and diastolic pressures and driving mileage; bars showing weight, glucose levels, and percentage of seat-belt use; and, of course, cholesterol level.
"Hey, Doc, stop there. What’s my cholesterol?"
"It’s under 200, Fred, but that’s not the whole story. I’ll go into detail with you about that at the end, when I go over your lab results."
"OK, Doc."
I power on, listing for Fred the unfavorable health factors in his life, such as obesity, lack of exercise,frequent depression, and smoking, as well as his poor health practices, including a lack of yearly physicals and the need for a tetanus booster. We discuss his cancer warning signs, such as frequent cough, and the changes he needs to make to add years to his lifequit smoking, lose weight, and wear his seat belt all the time. Next, I explain to Fred his life stress-event score and ways to reduce his stressors. I also mention his 8-year cardiovascular risk and give him an ideal body weight, dovetailing it with the results of his diet analysis. Fred’s exercise prescription is the finishing touch. Throughout my monologue, Fred has remained quiet, respectful, and attentive, but finally he asks, "So what about my cholesterol?"
"We’re almost there, Fred. Just let me give you the results of your physical exam."
After taking a deep breath, I start in with the physical findings. Fred is obese, and his blood pressure is mildly elevated. He has a pendulous abdomen, and I explain to him that he’s a surgical risk for even a simple appendectomy. Fred’s prostate is enlarged, and he has varicose veins. At least his urinalysis and stool slides are fine.
"All right, Fred, now we can discuss your lab results. All of your tests were normal, except for your cholestero1."
"But you said it was under 200, Doc," Fred says while scanning his HealthTrends chart. "It’s not in the red zone, so how can it be abnormal?"
"Well, Fred," I try to explain, "your total cholesterol is not the whole story," although I am earnestly wishing it was. "There are these fractions-the LDL and the HDL. Simply put, Fred, the HDL is the good cholesterol, and the LDL is the bad. Your total cholesterol is only 195. But your HDL fraction is 25 and your LDL is unmeasurable, because your triglycerides are over 300. Your triglycerides need to be below 200 to get an accurate LDL." It’s apparent that I’ve lost Fred, so I backtrack and explain how we measure the HDL but calculate the LDL.
"OK, Doc, so if we get my triglycerides below 200, what should my LDL be?"
Now I really wish the explanation could be simpler.
"Well, Fred, the current wisdom says that depends on how many risk factors you have for heart disease. If you have two or more, it should be less than 130, and if you have less than two, less than 160." Dare I take the plunge and start in with the seven coronary risk factors? Might as well; he already has five: obesity, hypertension, smoking, male sex, and an HDL below 35. The good news is that Fred doesn’t have a family history of coronary disease and hasn’t had a stroke within the past 6 months. The bad news is that drugs won’t help; Fred will have to do the work on his own.
In a convoluted flurry I conclude, "Fred, if you lose weight through dieting and exercise, your triglycerides will go down and your HDL should go up. This should render your LDL measurable. If your HDL goes up over 35, and you stop smoking, and we’re able to control your blood pressure, and if you can lose 150 lb, then you should have no cholesterol problems whatsoever."
"Thanks, Doc," Fred says and he leaves the office, forgetting to take his report with him.
LDL subfractions, anyone?
别说了，大夫，我的胆固醇是多少
中国石油天然气集团公司中心医院 周淑新(编译)
令我不解的是无论我怎么做、怎么说，病人就是不注意体检而只关心他们的胆固醇是多少。
比如，我有位52岁、体重350-lb的病人来诊索取检查结果。先声明，10年来，能用电脑向病人讲解体检结果让我倍感欣慰。以图表的形式，使参加健康动向项目的病人可看到年度体检的编辑数据，包括与平均10年死亡风险相比，某些疾病诱因是什么。如向糖尿病高危病人呈现血糖水平、体重和热量混合图表。就像给自己，也要给电脑增添营养，这个项目就像切片面包。不幸的是，Fred不属于能分享我的热情者之一。
“哎，大夫，我的胆固醇是多少？”Fred焦急地问。
“别急，Fred，”我说，“很快就可以知道”，开始了我的演说，“首先，我想你应该知道，与同龄人相比，你平均10年死亡和患6种疾病风险要高。”
“嗯。”
“是这样，包括心脏病、脑卒中、糖尿病、肺气肿、交通事故和自杀。现在就进入了激烈讨论，看点连线图，可了解收缩和舒张压、驾驶英里数；栏内有体重、葡萄糖水平和系安全带的百分数，当然也有胆固醇水平。”
“嘿，大夫，别说了，我的胆固醇是多少？”
“不到200，Fred，但不能说明就没问题了。等仔细看化验室单后，我会详细地和你讨论这个问题。”
“好吧，大夫。”
我开始了讨论，列出Fred生活中的有害风险因素，如肥胖、缺乏运动、频发抑郁情绪而且吸烟、很少就诊，包括做年度体检和应用破伤风增强剂。我们讨论了癌症的警觉症状，如常常咳嗽，需要改变的是放弃吸烟延长生命，减轻体重，开车时要系安全带。接着，还向Fred解释了他的生活应激事件评分，及减少应激源的方法。提出8年患心血管病风险，告诉他理想体重是多少，针对饮食分析结果。最后给出Fred的运动处方。一直都是我在说，Fred很安静、有礼貌、专心地听着，最后他问：“我的胆固醇是多少？”
“马上就可以知道了，Fred，我还是先解释一下你的体检结果。”
我深吸了口气。开始看体检结果。Fred很胖，血压中度升高，腹部下垂，说明具有手术风险性，即便是简单的阑尾手术。Fred前列腺肥大、静脉曲张。至少尿分析和大便涂片还正常。
“好，让我们共同讨论一下实验室检测结果。除了胆固醇所有的检测结果正常。”
“可你说它还不到200呢，大夫，”Fred扫视着他的健康动向表说，“它并没有在红区，为什么说不正常啊？”
“好，Fred，”我来讲一下，“你的总体胆固醇并不能说明整体情况，”虽然我希望如此。“它的组分包括LDL和HDL。简而言之，HDL是好胆固醇，而LDL是坏胆固醇。你的总胆固醇仅为195。而HDL是25，无法检测LDL，因为甘油三酯>300。只有将甘油三酯降至<200，才能得到LDL的精确值。”显然我把Fred给弄糊涂了，所以赶快解释HDL是检测出来的，而LDL是算出来的。
“好，医生，假若我们得到甘油三酯的结果为<200，那么我的LDL是多少？”
看来还需解释得更加通俗一些。
“好，Fred，根据现有的学说解释，要看你有几种患心脏病的风险因素。若>2种，应为<130，若<2种，应为<160。”我能断然解释患冠心病7种风险因素吗？或许可以，他存在5种风险因素：过胖、高血压、吸烟、男性、HDL<35，好在Fred还无冠心病家族史，过去6个月内未发生过脑卒中。但用药也无济于事，这需Fred为自己做点什么了。我随即告诉他“Fred，如果你能控制饮食和运动减轻体重，也能降低甘油三酯，HDL应该上升。这样就会测出你的LDL。如果HDL升至>35、戒烟就能控制血压，如果体重减轻150lb，胆固醇问题就解决了。”
“谢谢，医生, ” Fred说着便离开了诊所，却忘了拿报告结果。
有关LDL的亚组分，有人想知道吗？
【后记】
1988年，Brown就将前瞻医学和健康风险评估(HRAs)模式应用于临床，开展了健康动向项目。Brown利用电脑做健康教育。每个病人栏内都有152项数据，包括体重、血压、每日盐和卡路里摄入量、每周酒精消耗、肝和肾脏功能检测结果，年度应激评分等。体检前病人需完成102项健康风险评估调查问卷，生活应激事件测试和饮食日志，根据体检结果和收集到的信息，对个体10年死亡、伤残和患病风险进行分析并做出健康动向报告。针对报告与病人进行详尽的解释，帮助修正饮食习惯、提出运动处方、告诉病人理想体重是多少、提醒病人开车时要系好安全带。以减少患病、伤残和患病风险，从而维护人们的健康。, 百拇医药
Sanford J.Brown(著)
I Take, for example, Fred, a 52-year-old, 350-lb patient who was returning for the results of his exam. I have to say that for the last 10 years, ever since I developed a computer-based wellness approach, giving patients their physical examination results has been especially pleasurable for me. In graphic form, patients see a compilation of data for each year they’ve participated in my HealthTrends program, including all the contributing factors to any disease for which they have a greater-than-average lO-year mortality risk. For example, highrisk diabetic patients see their blood glucose level, weight, and caloric intake flash before their eyes in a montage of graphs. For a computer nut like myself, this program is the sliced bread. Unfortunately, Fred is one of my patients who doesn’t share my enthusiasm.
"Hi, Doc. So, what’s my cholesterol?" Fred asks anxiously.
"Hold on a minute, Fred," I say. "We’ll get to that." I gear up for my presentation. "I need to let you know, first off, that you’ve got greater-than average lO-year mortality risk than your cohort and
increased risk across six disease categories!"
"Uh-huh."
"Yes, for heart disease, stroke, diabetes, emphysema, motorvehicle accident, and suicide." Now, I’m starting to roll. Up come the images- lines connected to dots, signifying systolic and diastolic pressures and driving mileage; bars showing weight, glucose levels, and percentage of seat-belt use; and, of course, cholesterol level.
"Hey, Doc, stop there. What’s my cholesterol?"
"It’s under 200, Fred, but that’s not the whole story. I’ll go into detail with you about that at the end, when I go over your lab results."
"OK, Doc."
I power on, listing for Fred the unfavorable health factors in his life, such as obesity, lack of exercise,frequent depression, and smoking, as well as his poor health practices, including a lack of yearly physicals and the need for a tetanus booster. We discuss his cancer warning signs, such as frequent cough, and the changes he needs to make to add years to his lifequit smoking, lose weight, and wear his seat belt all the time. Next, I explain to Fred his life stress-event score and ways to reduce his stressors. I also mention his 8-year cardiovascular risk and give him an ideal body weight, dovetailing it with the results of his diet analysis. Fred’s exercise prescription is the finishing touch. Throughout my monologue, Fred has remained quiet, respectful, and attentive, but finally he asks, "So what about my cholesterol?"
"We’re almost there, Fred. Just let me give you the results of your physical exam."
After taking a deep breath, I start in with the physical findings. Fred is obese, and his blood pressure is mildly elevated. He has a pendulous abdomen, and I explain to him that he’s a surgical risk for even a simple appendectomy. Fred’s prostate is enlarged, and he has varicose veins. At least his urinalysis and stool slides are fine.
"All right, Fred, now we can discuss your lab results. All of your tests were normal, except for your cholestero1."
"But you said it was under 200, Doc," Fred says while scanning his HealthTrends chart. "It’s not in the red zone, so how can it be abnormal?"
"Well, Fred," I try to explain, "your total cholesterol is not the whole story," although I am earnestly wishing it was. "There are these fractions-the LDL and the HDL. Simply put, Fred, the HDL is the good cholesterol, and the LDL is the bad. Your total cholesterol is only 195. But your HDL fraction is 25 and your LDL is unmeasurable, because your triglycerides are over 300. Your triglycerides need to be below 200 to get an accurate LDL." It’s apparent that I’ve lost Fred, so I backtrack and explain how we measure the HDL but calculate the LDL.
"OK, Doc, so if we get my triglycerides below 200, what should my LDL be?"
Now I really wish the explanation could be simpler.
"Well, Fred, the current wisdom says that depends on how many risk factors you have for heart disease. If you have two or more, it should be less than 130, and if you have less than two, less than 160." Dare I take the plunge and start in with the seven coronary risk factors? Might as well; he already has five: obesity, hypertension, smoking, male sex, and an HDL below 35. The good news is that Fred doesn’t have a family history of coronary disease and hasn’t had a stroke within the past 6 months. The bad news is that drugs won’t help; Fred will have to do the work on his own.
In a convoluted flurry I conclude, "Fred, if you lose weight through dieting and exercise, your triglycerides will go down and your HDL should go up. This should render your LDL measurable. If your HDL goes up over 35, and you stop smoking, and we’re able to control your blood pressure, and if you can lose 150 lb, then you should have no cholesterol problems whatsoever."
"Thanks, Doc," Fred says and he leaves the office, forgetting to take his report with him.
LDL subfractions, anyone?
别说了，大夫，我的胆固醇是多少
中国石油天然气集团公司中心医院 周淑新(编译)
令我不解的是无论我怎么做、怎么说，病人就是不注意体检而只关心他们的胆固醇是多少。
比如，我有位52岁、体重350-lb的病人来诊索取检查结果。先声明，10年来，能用电脑向病人讲解体检结果让我倍感欣慰。以图表的形式，使参加健康动向项目的病人可看到年度体检的编辑数据，包括与平均10年死亡风险相比，某些疾病诱因是什么。如向糖尿病高危病人呈现血糖水平、体重和热量混合图表。就像给自己，也要给电脑增添营养，这个项目就像切片面包。不幸的是，Fred不属于能分享我的热情者之一。
“哎，大夫，我的胆固醇是多少？”Fred焦急地问。
“别急，Fred，”我说，“很快就可以知道”，开始了我的演说，“首先，我想你应该知道，与同龄人相比，你平均10年死亡和患6种疾病风险要高。”
“嗯。”
“是这样，包括心脏病、脑卒中、糖尿病、肺气肿、交通事故和自杀。现在就进入了激烈讨论，看点连线图，可了解收缩和舒张压、驾驶英里数；栏内有体重、葡萄糖水平和系安全带的百分数，当然也有胆固醇水平。”
“嘿，大夫，别说了，我的胆固醇是多少？”
“不到200，Fred，但不能说明就没问题了。等仔细看化验室单后，我会详细地和你讨论这个问题。”
“好吧，大夫。”
我开始了讨论，列出Fred生活中的有害风险因素，如肥胖、缺乏运动、频发抑郁情绪而且吸烟、很少就诊，包括做年度体检和应用破伤风增强剂。我们讨论了癌症的警觉症状，如常常咳嗽，需要改变的是放弃吸烟延长生命，减轻体重，开车时要系安全带。接着，还向Fred解释了他的生活应激事件评分，及减少应激源的方法。提出8年患心血管病风险，告诉他理想体重是多少，针对饮食分析结果。最后给出Fred的运动处方。一直都是我在说，Fred很安静、有礼貌、专心地听着，最后他问：“我的胆固醇是多少？”
“马上就可以知道了，Fred，我还是先解释一下你的体检结果。”
我深吸了口气。开始看体检结果。Fred很胖，血压中度升高，腹部下垂，说明具有手术风险性，即便是简单的阑尾手术。Fred前列腺肥大、静脉曲张。至少尿分析和大便涂片还正常。
“好，让我们共同讨论一下实验室检测结果。除了胆固醇所有的检测结果正常。”
“可你说它还不到200呢，大夫，”Fred扫视着他的健康动向表说，“它并没有在红区，为什么说不正常啊？”
“好，Fred，”我来讲一下，“你的总体胆固醇并不能说明整体情况，”虽然我希望如此。“它的组分包括LDL和HDL。简而言之，HDL是好胆固醇，而LDL是坏胆固醇。你的总胆固醇仅为195。而HDL是25，无法检测LDL，因为甘油三酯>300。只有将甘油三酯降至<200，才能得到LDL的精确值。”显然我把Fred给弄糊涂了，所以赶快解释HDL是检测出来的，而LDL是算出来的。
“好，医生，假若我们得到甘油三酯的结果为<200，那么我的LDL是多少？”
看来还需解释得更加通俗一些。
“好，Fred，根据现有的学说解释，要看你有几种患心脏病的风险因素。若>2种，应为<130，若<2种，应为<160。”我能断然解释患冠心病7种风险因素吗？或许可以，他存在5种风险因素：过胖、高血压、吸烟、男性、HDL<35，好在Fred还无冠心病家族史，过去6个月内未发生过脑卒中。但用药也无济于事，这需Fred为自己做点什么了。我随即告诉他“Fred，如果你能控制饮食和运动减轻体重，也能降低甘油三酯，HDL应该上升。这样就会测出你的LDL。如果HDL升至>35、戒烟就能控制血压，如果体重减轻150lb，胆固醇问题就解决了。”
“谢谢，医生, ” Fred说着便离开了诊所，却忘了拿报告结果。
有关LDL的亚组分，有人想知道吗？
【后记】
1988年，Brown就将前瞻医学和健康风险评估(HRAs)模式应用于临床，开展了健康动向项目。Brown利用电脑做健康教育。每个病人栏内都有152项数据，包括体重、血压、每日盐和卡路里摄入量、每周酒精消耗、肝和肾脏功能检测结果，年度应激评分等。体检前病人需完成102项健康风险评估调查问卷，生活应激事件测试和饮食日志，根据体检结果和收集到的信息，对个体10年死亡、伤残和患病风险进行分析并做出健康动向报告。针对报告与病人进行详尽的解释，帮助修正饮食习惯、提出运动处方、告诉病人理想体重是多少、提醒病人开车时要系好安全带。以减少患病、伤残和患病风险，从而维护人们的健康。, 百拇医药