Preventative Medicine For Paramedic - Case Study Example

Preventative medicine: case study of the Health sciences and medicine of the August 16, Case Study Suzy is a 46 yearold woman who runs her own business. She has come to see you because she is feeling stressed by her commitments at work and home. She is married with two children aged 16 and 22 years. She smokes a packet of cigarettes per day and admits to drinking a bottle of wine at night to relax. She gets annoyed when her husband tells her to cut down on drinking. She has tried quitting smoking before but she found she got too "highly strung" and went back to smoking. She doesnt exercise because of the lack of time. Introduction The patient is a 46 year old woman complaining that she is ‘feeling stressed’. She believes that her stress has originated from being overwhelmed with work and family-related commitments and responsibilities. Patient’s profile is that of a career woman who runs her own business and also manages a family with two children, one of whom is a teenager, and a husband. In order to relax and to cope with stress, Suzy has resorted to smoking and alcohol. So far as exercise is concerned, she doesn’t have any time for it because of her busy lifestyle. She probably realizes the importance and necessity of quitting smoking and had tried it earlier but was unable to give up the habit. Suzy’s scenario is typically representative of other working women of this age group, who develop risk factors such as smoking, alcohol abuse, physical inactivity, stress and anxiety, which makes them prone to lifestyle-related disorders like hypertension, cardiovascular diseases, stroke, diabetes, cancer and psychological illnesses like depression. Lifestyle management and health promotion are the most commonly used approaches and aims of preventive and integrative medicine interventions in patients like Suzy (Kligler & Lee, 2004). What are the immediate issues you would consider? The patient complains that she feels stress. Thus, it appears to be the most immediate issue. Patient is stressful because of multiple commitments at her home and workplace. It may also be contributed by a feeling of not being able to give up addiction to smoking and alcohol despite being urged by family members. Inability to balance work and family commitments may have resulted in conflicts at workplace and in the family, and this discord can be a significant cause of stress. Indeed, lack of control and strain at job are important external stressors (Ward, Jones, & Phillips, 2003). However, stress seldom occurs in isolation. Physical exhaustion often coexists with psychological or nervous exhaustion. Also, physiological systems are activated in the presence of stressors, and many biological markers associated with these activations have been associated with health implications (Ward, Jones, & Phillips, 2003; Brady & Sonne, 1999). Psychosocial stress has also been clearly linked with cardiovascular disease (von Känel, 2012). Therefore, Suzy’s physical, mental and emotional health needs to be examined before she can be offered any advice regarding her state of wellness. The concept of integrative medicine is applicable to this case. Rather than just prescribing ‘drugs’ to treat the symptoms, which present the surface of the problem, a combined approach that includes modification of the risk factors, dietary modification, incorporation of physical activity, nutraceuticals and mind body techniques is used to achieve holistic health. What are the preventive issues to consider? Straker (2012) emphasised the importance of giving priority to prevention of diseases. He enumerates and explains five lifestyle risk factors responsible for many disease states that are currently prevalent, and much can be gained from modifying these factors (Straker, 2012). Smoking, alcohol intake and physical inactivity are some of these behaviours that Suzy needs to address. She can prevent conditions like cardiovascular disease, stroke, diabetes and its related complications, cancers, osteoporosis and depression. The evidence-based practices that have been recommended for prevention of chronic lifestyle-related diseases are smoking cessation, optimization of nutrition, normalisation of weight, optimal physical activity, stress reduction, optimal sleep and cessation of substance abuse, which is alcohol in this case (Dean, 2009). How would you assess her? Comprehensive assessment of Suzy’s health includes eliciting the medical history, physical and psychological examination and investigations. It is essential to screen for modifiable risk factors such as hypertension, dyslipidemia and diabetes, so the early treatment can be initiated (Whitley, Main, McGloin, & Hanratty, 2011). A complete medical history consists of chief presenting complaints, history related to major systems of the body such as respiratory, cardiac and gastrointestinal system, effort tolerance, and easy fatigability. Family history and dietary history can help assess the risk of chronic diseases. Physical examination pertains to major systems as well as general physical examination of pallor, blood pressure, weight, body mass index (BMI) and etc. Blood investigations include blood glucose levels, lipid profile; and depending upon the presence of other signs and symptoms, further investigations such as ECG, spirometry and etc. may be carried out. Psychological assessment is required to gain an insight into the cause of her increased stress levels and of substance abuse as a means to cope with it. What benefits could she gain from changing her lifestyle? According to Dean (2012), changing the lifestyle is the most powerful tool to become healthy again. Current guidelines advise giving up smoking altogether and limiting alcohol consumption to less than two standard drinks per day (Straker, 2012). Suzy currently smokes one pack per day, and this pattern of smoking in women of her age group has been found to be associated with an increased risk of osteoporosis (Brook, Balka, & Zhang, 2012). Smoking status has also been independently linked to increased arterial thickness, which is a marker of atherosclerosis, hypertension and cardiovascular disease (Giudice et al., 2012). Also, it’s a well known fact that smoking causes various malignancies, especially oral and lung cancers. Giving up smoking will decrease all these risks for Suzy. Alcohol abuse can result from stress and can result in stress and psychological illnesses, liver diseases and cancer (Brady & Sonne, 1999; Testino, 2011). Physical activity will increase her stamina and fitness levels and allow her to work more efficiently. Thus, changing her lifestyle practices, Suzy will achieve numerous benefits. What options are there for improving her general health? For Suzy, along with lifestyle modification, many options to improve her general health exist. She needs to modify her diet by including more servings of fruits and vegetables, akin to palaeolithic diet, and cut down on modern, processed, salt, calorie and fat laden foods. She can instead include substances and supplements referred to as nutraceuticals, which have positive and antioxidant effects on body metabolism. Examples include natural products like green tea, garlic, flax seeds, soy products, omega fatty acids (fish oil), flavanoids, ginseng, and supplements like lycopene, whey protein, minerals like zinc, magnesium and calcium, and vitamins such as B complex, C, D and E in appropriate dosages (Houston, 2010). For a healthcare provider it is important to recommend a product that is evidence-based and suitable for the patient (Zelig & Radler, 2012). Mind body therapies like Yoga, pranayama and meditation can be used for stress management (Kjellgren et al., 2007). How would you go about working with her to implement those changes? (Give examples of what you might do and how you would deal with possible responses). The most important thing that needs to be understood by Suzy and me is that lifestyle factors are a part of ingrained behaviour, and changing them requires patience, persistence and plenty of motivation (Britt, Hudson, & Blampied, 2004). Merely giving advice about incorporating changes in the lifestyle has not been found to be very effective. Instead, encouraged is a more patient-centered approach such as motivational interviewing, wherein the patient is encouraged to talk and discuss his or her current behaviours and level of satisfaction (Britt, Hudson, & Blampied, 2004). Suzy needs counselling and support to be able to bring these changes in her lifestyle and adopt them permanently. Group support for quitting smoking and alcohol, pharmacotherapy (nicotine replacement therapy), and follow up are additional tools which can aid in inculcating low risk behaviours in Suzy. Also, spousal support and that of children is required. Suzy needs to identify her work priorities and home priorities and discuss them with her family members. Issues such as financial goals, work prioritisation and delegation, division and help for household work, time management, and meal practices need to be addressed, and this may lead to a restructuring of her commitments and to a less stressful work profile. Mind body therapy can be suggested for the reduction of stress (Wolsko, Eisenberg, Davis, & Phillips, 2004). Yoga and meditation are one type of this therapy, and recently their most common indication has been found to be stress management (Penman, Cohen, Stevens, & Jackson, 2012). Practical examples of these changes include encouraging her to adopt healthy habits and act as a model for her children. Questionnaires are given to assess her responses to the questions dealing with lifestyle choices, and patient’s progress can be evaluated on repeat assessment. Suzy is asked to formulate her diet plans as are culturally relevant and suitable for her lifestyle and are yet healthy. She is suggested to prepare salads and low fat food. She can substitute wine with milk or non alcoholic beverages. She attends psychosocial support groups to quit smoking and reduce alcohol consumption and seeks medical help for pharmacological support. As relapses should be expected initially, the stressors for relapses are to be identified and methods developed to deal with them. For fun, she is motivated to participate in physical activities and sports with friends and family or take long walks and spend time with family. These are some examples of numerous changes which are brought about gradually, at a pace comfortable for the patient but significant enough to improve her health. Role of paramedics or emergency care practitioners in the scenario of preventive medicine for health promotion of the patients has been recently described by Armstrong, Akroyd & Burke (2012). They have rightly commented that this role needs to be defined more clearly, and that paramedics are an additional resource to nurses and general practitioners when it comes to dispensing advice about health and well being. Paramedics can act as a vital link between the patient seeking advice for a positive health change and the health care team. Working at the community level, they can gather data, spread awareness about the risk factors and refer those requiring treatment to higher centres, akin to community health workers (Whitley, Main, McGloin, & Hanratty, 2011). At patient level, such as the present case, continual support, personal interaction and follow up are required. Conclusion Suzy is afflicted with risk behaviours such as stress, smoking, alcohol abuse and physical inactivity. These behaviours are making her prone to various diseases. Preventative medicine interventions are aimed at modifying her lifestyle so that Suzy can improve her current and future health status and general wellbeing. Paramedics can play an important role in the context of preventative medicine. However, this role needs to be researched and defined further. References Armstrong, A., Akroyd, K. V., & Burke, L. (2012). The role of the emergency care practitioner in the provision of health advice and health promotion to patients within the UK National Health Service. Journal of Interprofessional Care, 26, 64–65. doi: 10.3109/13561820.2011.609625. Brady, K. T., & Sonne, S. C. (1999). The role of stress in alcohol use, alcoholism treatment, and relapse. Alcohol Research & Health, 23(4), 263-271. Retrieved from http://pubs.niaaa.nih.gov/publications/arh23-4/263-271.pdf Britt, E., Hudson, S. M., & Blampied, N. M. (2004). Motivational interviewing in health settings: a review. Patient Education and Counselling, 53, 147–155. doi: 10.1016/S0738-3991(03)00141-1 Brook, J. S., Balka, E. B., & Zhang, C. (2012). The smoking patterns of women in their forties: their relationship to later osteoporosis. Psychological Reports, 110(2), 351 362. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368498/pdf/nihms359117.pdf Dean, E. (2009). Physical therapy in the 21st century (Part II): Evidence-based practice within the context of evidence-informed practice. Physiotherapy Theory and Practice, 25(5–6), 354–368. doi: 10.1080/09593980902813416 Giudice, R., Izzo, R., Manzi, M. V., Pagnano, G., Santoro, M., Rao, M. A. E.,… Trimarco, V. (2012). Lifestyle-related risk factors, smoking status and cardiovascular disease. High Blood Press & Cardiovascular Prevention, 19(2), 85-92. Houston, M. C. (2010). The role of cellular micronutrient analysis, nutraceuticals, vitamins, antioxidants and minerals in the prevention and treatment of hypertension and cardiovascular disease. Therapeutic Advances in Cardiovascular Disease, 4, 165. doi: 10.1177/1753944710368205 Kligler, B., & Lee, R. (2004). Integrative medicine: principles for practice. New York: McGraw-Hill. Kjellgren, A., Bood, S. A., Axelsson, K., Norlander, T., & Saatcioglu, F. (2007). Wellness through a comprehensive Yogic breathing program – A controlled pilot trial. BMC Complementary and Alternative Medicine, 7, 43 doi: 10.1186/1472-6882-7-43 Penman, S., Cohen, M., Stevens, P., & Jackson, S. (2012). Yoga in Australia: Results of a national survey. International Journal of Yoga, 5(2), 92–101. doi:  10.4103/0973 6131.98217. Straker, L. (2012). Prevention needs to be a priority. Journal of Physiotherapy, 58, 5-7. Testino, G. (2011). The burden of cancer attributable to alcohol consumption. Maedica (Buchar), 6(4), 313–320. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391950/pdf/maed-06-313.pdf von Känel, R. (2012). Psychosocial stress and cardiovascular risk – current opinion. Swiss Medical Weekly, 142, w13502. doi: 10.4414/smw.2012.13502 Ward, A. M. V., Jones, A., & Phillips, D.I.W. (2003). Stress, disease and joined-up science. Quarterly Journal of Medicine, 96(7), 463. doi:10.1093/qjmed/hcg084 Whitley, E. M., Main, D. S., McGloin, J., & Hanratty, R. (2011). Reaching individuals at risk for cardiovascular disease through community outreach in Colorado. Preventive Medicine, 52, 84–86. doi:10.1016/j.ypmed.2010.10.005 Wolsko, P. M., Eisenberg, D. M., Davis, R. B., & Phillips, R.S. (2004). Use of mind-body medical therapies: results of a national survey. Journal of General Internal Medicine, 19(1), 43-50. doi:  10.1111/j.1525-1497.2004.21019.x Zelig, R., & Radler, D. R. (2012). Understanding the properties of common dietary supplements: clinical implications for healthcare practitioners. Nutrition in Clinical Practice, published ahead of print online on 8 August 2012. doi: 10.1177/0884533612446198 Read More