Aviva Massihesraelian
Case Study– Calandra James
Immunizations:
1) She should receive the flu shot (IIV or RIV), as it is flu season (not the live one since she is over 50 years old.)
2) She should also receive the Tdap booster if she has not received it yet (should be given every 10 years.)
3) She should receive the Zoster vaccination if she has not yet received it- either 2 doses of the recombinant (RZV) or 1 dose of the live (ZVL) vaccine.
4) She should receive the Pneumonia vaccine if she has not yet received it (PCV13 followed by PPSV23 at least one year later)
Screenings (according to the USPSTF):
- She should have a mammogram if she has not had one within the past 2 years, since she is part of the age group that should be receiving biennial screening- woman between age of 45 and 74. (She should not receive a pap smear/ any testing for cervical cancer since she is over 65.)
- She should be screened for lung cancer with a low dose CT scan, since she is a smoker with over a 30 year pack history, who quit less than 15 years ago (she has a 40 year pack history and quit 5 years ago).
- She should be screened for colon cancer since she is between 50 and 75 years old. She can be screened using any of the various screening methods (no gold standard), but the colonoscopy is the most commonly used screening method. Other options include a sigmoidoscopy, CT colonoscopy, or stool tests (FOBT, FIT, or stool DNA tests.)
- She should be screened for abnormal glucose and diabetes by measuring hemoglobin A1C since she is overweight and has a family history of diabetes (so at increased risk.)
- She should be screened for Hepatitis C using a blood test because she was born between 1945 and 1965.
- She should be screened for osteoporosis using a bone density test since she is a woman over the age of 65.
- She should be screened for lipid disorders by measuring her total cholesterol and her LDL cholesterol, because she is a woman over 45 years old.
- She should also be screened for alcohol abuse, tobacco use, hypertension, obesity, and depression, with questionnaires/ specific questions asked by the practitioner.
Injury Prevention:
Traffic Safety- she should wear a seatbelt when driving, minimize distractions, and should not engage in reckless driving. She should also wear a helmet when riding a bicycle.
Water Safety- she should only swim in designated areas and areas that are close to shore. She should enter the water feet first, and know the depth of the water as well as location of underwater hazards before jumping or diving. This is particularly relevant since she mentioned going swimming at the beach.
Firearm Safety- Though she did not mention this, if she does keep a firearm in the home, the unloaded gun and ammunition should be kept in separate locked cabinets.
Sports Safety- Though she did not mention this, if she plays any sports, she should use appropriate protective equipment when playing sports and engage in proper physical conditioning before playing sports.
Diet:
Her current diet is mainly balanced and healthy, but she clearly is not happy eating this way, and it is stressing her out and making her too miserable. The goal would be to find a diet that is still healthy but is more enjoyable for her, so that she can stick to it better. Her BMI is in the overweight category (25.8), but not obese, and she has a high waist circumference. Another aspect to keep in mind is that though she is not herself diabetic, she has a family history of diabetes, so she should keep that in mind and be conscious of her sugar intake.
She mentioned that she does not really cook much, but cooking often results in healthier food than grocery bought food, and home cooked food is often more satisfying, so I would suggest taking on cooking simple foods, at least once in a while. Cooking is time consuming, but now that she is retiring, hopefully she will have some more free time and can use some of it to start cooking occasionally.
For breakfast, she usually has egg whites on whole wheat toast which is very healthy and sounds tasteful. But she could change it up so she does not get bored of the same thing every day- some other healthy options include fat free/ low sugar yogurt (potentially with fruit or granola) and sugar free/ low sugar oatmeal. She should be conscious of not ingesting too much sugar because she might be at increased risk for high glucose due to her family history of diabetes.
For lunch, yogurt and fruit are a good option but they might not be completely filling or satisfying. Peanut butter has healthy fat but it is still very caloric, and she could eat something else instead that includes that many calories and might be more satisfying. A good option for lunch might be a salad with various proteins, such as fat free cottage cheese, or nuts/ beans/ chickpeas which are very filling. She can then eat the fruit as a snack during the day.
In terms of other snacks, vegetables are a good idea but she might not want to eat that if she has a salad for lunch. But pita chips are not such a great option because they include refined grains and do not include many beneficial nutrients. An alternative option to pita chips could be whole wheat crackers or nuts (if she does not have them in her salad), as these are more filling and satisfying and provide nutrients that are beneficial to the diet. (She should be cautious if she has nuts not to have too many because they have small serving sizes and are high calorie.)
For dinner she usually has a salad with some sort of protein. Food that could be more satisfying with a similar amount of calories could be steamed/ grilled vegetables with fish or grilled chicken. Steaming vegetables such as broccoli or string beans provides a hot dinner which is healthy and tasty!
She mentioned that her current diet is “joyless” and she spends a lot of time trying to “stave off hunger.” If she is interested in considering a diet plan, a diet plan that might work for her could be the low-carb diet. This diet emphasizes low carbohydrate intake and increased intake of protein and fat. Protein is useful at helping a person feel full and fat makes food taste better, thereby improving satisfaction. This diet is also shown to help people lose more weight, which is a goal of hers. Her current diet does not seem to include many carbs anyway, so if she is a bit more cautious about carbohydrate intake (maybe skipping the piece of toast in the morning or not eating pita chips/ any type of carb for snack), she can increase her intake of fat and protein, and solve her issues of “joyless” meals and constant hunger.
Another potential option for her, if she is willing to go a completely different route, would be a meal replacement plan. Since she mentioned that she spends way too much time trying to keep her calories in check, a meal replacement plan would solve her problem by offering her foods to eat so she does not have to think about it so much. Many of these plans include hot foods and different options to choose from, so maybe it can make her diet more exciting and encourage her to stay on it.
Exercise:
She stated that she engages in lots of different forms of exercise, such as walking, swimming, riding a bike, and using weights and resistance bands. She also stated that she spends time trying to exercise enough to reach a calorie deficit, so I am assuming she is getting an appropriate amount of exercise. I would just reinforce that according to CDC guidelines, she should be getting about 150 minutes per week of moderate intensity exercise or 75 minutes a week of vigorous intensity exercise. Since she is getting older, I would recommend the moderate exercise so as to prevent any potential exercise-related injuries. 150 minutes a week of moderate intensity exercise could include bike riding, swimming, and walking, which are activities she typically engages in already. Riding a bike to do errands is a great idea, and taking brisk walks with her partner, sons, or just to relax is a great way to stay active and incorporate movement into everything she does. Since she currently only swims in season, and depending on where she lives it might also be hard to take walks or bike ride when it gets cold, I would recommend considering signing up for a gym that includes bikes and an indoor swimming pool during the months when she cannot partake in these activities outside. In addition, as per CDC guidelines, she should also be engaging in muscle strengthening activities at least twice a week. This can be done using the free weights and resistance bands she has at home, and can be done for as little as ten minutes at a time.
Though moderate exercise will help her stay healthy and maintain her weight, if she wants to lose weight through exercise she might be more successful by engaging in more vigorous exercise. This could be done with the same activities she is currently engaging in, if she increases the intensity a bit. She can swim laps, ride bikes on hilly terrain or faster than ten miles per hour, and race walk or jog instead of taking brisk walks. This is up to her and her preferences- both moderate and vigorous intensity exercise will help keep her healthy and lower her risk of various health problems, including cardiovascular disease (and the more the better- if she exercises for more than 150 minutes per week, that is great too and can decrease her risk even further!)
Harm Reduction:
Nutritional harm reduction- she should choose healthier options if she ever goes out to eat (though based on the diet she describes, she probably already does anyway.)
Brief Interventions:
I do not believe she needs any brief interventions. She no longer smokes or drinks alcohol, she does not engage in substance use, and her BMI does not fall under the category of obese.
Sources:
file:///Users/avivamass/Downloads/Adult.Vaccination.Schedule.2019%20(1).pdf
file:///Users/avivamass/Downloads/Principles%20of%20Screening%20(1).pdf
file:///Users/avivamass/Downloads/PreventiveHealthCareSchedule2018%20(3).pdf
file:///Users/avivamass/Downloads/Wadden%20-%20Lifestyle%20Modification%20for%20Obesity%20(1).pdf
PPTs intro
Writing an Exercise Rx Powerpoint
Nutrition Powerpoint
