CASE STUDY: ALEXI BURR
| Health Promotion and Injury Prevention |
| Immunizations |
| Influenza inactivated (IIV), Influenza Recombinant (RIV), or Live Attenuated Influenza Virus (LAIV), one dose annually. Due to recent pregnancy, patient is likely up to date on Tdap/Td booster Childhood vaccines with HPV are up to date |
| Screenings as per USPSTF |
| Alcohol misuse Depression Hypertension Obesity Tobacco Use and Cessation HIV Infection Intimate Partner Violence—indicated because Alexi is a child-bearing woman Cervical cancer screening—a PAP smear with Co-Testing HPV BRCA gene screening—family history of breast cancer in both maternal grandmother and aunt |
| Injury Prevention for Patient |
| Traffic Safety |
| Injury Prevention for Patient with Children |
| Burn Prevention Fall Prevention Choking Prevention Drowning Prevention Safe Sleep Environment Poison Prevention CPR for Infants and Children Firearm Safety |
| https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html https://pediatrics.aappublications.org/content/94/4/566 |
| Diet |
| Dietary/Health Issues |
| Normal BMI of 19.5 Rapidly lost 20 pounds as result of ulcerative proctitis Lack of consistency in meals History of anorexia |
| Dietary Modifications |
| Ulcerative Proctitis: Depending on the proctitis, high fiber foods could help soften stool and prevent constipation, but they could also cause problems depending on individual – Avoid caffeine, fructose/ high-fructose corn syrup, lactose, and sugar alcohols – Supplement or eat foods high in omega-3 fatty acids, probiotics, and vitamins C and E Past Recovery from Anorexia: Reduce stressors that may cause a return to disordered eating behaviors |
| Plan |
| Alexi already places an emphasis on fruits and vegetables in her diet with little red meat and no fried foods. This is important, as plant sources will provide fiber that can help ulcerative proctitis symptoms as well as provide necessary vitamins and nutrients. I would recommend she continues to incorporate fruits and vegetables wherever possible, with a variety of colors. If some peels of plant sources seem to bother her, it’s easy to remove the peels. Breakfast: For her typical breakfast of toast with almond butter, I would just recommend she look for breads with whole grains or bran that will be high in fiber. Lunch: She should continue to try to eat salads or other plant-based meals for her lunches, but perhaps try meal prepping so that she doesn’t have to worry about making her lunch or snacks every single day of the week, but rather one allotted timeframe for them. It’s important for Alexi to make sure she’s finding time to eat, especially with the busy things going on in her life, because it will continue to promote healthy eating habits rather than disordered eating. If she doesn’t have time to get a salad, having a supply of meal replacement bars or shakes in her office will give her a lunch option that’s quick and easy and will make sure she is eating. Snacks: Having a bag of nuts or seeds in purse will help make sure she has a snack when she’s on the go and will provide Omega 3 fatty acids that may help her ulcerative proctitis. There are also small plain yogurt cups that are easy to throw in a bag or in the car, and the probiotics may help the proctitis as well. Be aware that many yogurts have a lot of added sugar, so look for a plain or Greek yogurt with low sugar. Dinner: If dinner is a really busy time, it’s okay if there’s not always time for someone to cook a homemade meal. When getting food, either from a restaurant or the supermarket, focus on things with fruits and vegetables and some sort of protein source. If there are days when a “not so unhealthy chain” is the only feasible option, just try to limit your portion sizes as needed and focus on a balanced meal. Avoid: continue to avoid fried foods, as well as caffeine, high fructose corn syrup, lactose, sugar alcohols, and any other foods that may cause flare-ups. |
| https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/eating-diet-nutrition https://www.crohnscolitisfoundation.org/diet-and-nutrition/what-should-i-eat https://www.nationaleatingdisorders.org/learn/general-information/recovery |
| Exercise |
| Current Activity vs. Guidelines |
| Current Activity: Feels active because of busy schedule and two kids Walks from one end of campus to another Stands while lecturing but may sit for extended periods as well Guidelines: A minimum of 150 minutes per week of moderate intensity exercise or 75 minutes per week of vigorous intensity exercise Muscle strengthening activities that involve all major muscle groups 2x per week Limit extended periods of sitting |
| Exercise Plan |
| Alexi is likely not getting enough exercise to meet the current guidelines. She seems to be active but does not quite meet the 150 minutes/ week goal. In order to do this, she can slowly start to increase the amount she is exercising, adding a little her and a little there. She could also increase her walking from a light walk to a brisk walk. She has a busy schedule already, so it’s best to incorporate physical activity wherever possible. Walking from one end of campus to another is a great way to be active during the day, especially if she makes sure she is walking at a brisk pace. Perhaps if she has a couple extra minutes between lectures, she could add a little more distance to that walk to increase the minutes of walking she is doing each day. To increase the total amount of exercise each week, maybe she could walk with her kids to the park, or even walk around the block with them. Whatever activities she can do with her family while still being physically active are a great way to get in a little exercise. Additionally, perhaps during her long sitting periods of the day, she can take a couple minute break to either walk around the office area or do some small muscle strengthening exercises. For example, squats are an exercise that don’t require a lot of space and can be done fairly quickly. Another option would be to have a set of small weights near her desk or near where she works during the day to just use when she has a couple of spare minutes to get a little more muscle strengthening in. To promote overall physical activity, it’s also important to look for ways to increase activity wherever possible, even when extremely simple. For example, taking the stairs instead of an elevator or escalator. Parking at the back of a parking lot just to get a little bit more walking in could also help. |
| https://www.cdc.gov/physicalactivity/basics/pa-health/ https://health.gov/paguidelines/second-edition/ https://www.cdc.gov/physicalactivity/downloads/pa_examples.pdf |
| Harm Reduction |
| Current Actions |
| Fast Food Currently chooses “not so unhealthy chains” rather than choosing a clearly unhealthy chain for dinner Designated Drivers Recognizes she has too much to drink and isn’t safe to drive, so asks colleagues to drive her home |
| Things to Implement |
| Fast Food: If she currently chooses chains or prepared food 4 times a week, try lowering it to 3 times a week and preparing one meal at home Drinking: If going to the bar on Fridays, maybe try to cut back on the number of glasses, even just by one Perhaps replace a glass of wine with a glass of seltzer or water before having another glass of wine Finding another way to relax and let off steam other than drinking might be beneficial for Alexi. She could plan date nights with her husband, try going on a family walk, baking, watching a movie—whatever her past hobbies have been or whatever she’s interested in trying! |
| Brief Intervention |
| Alcohol Usage |
| For Alexi, I would conduct a brief intervention for alcohol use. This is important because Alexi has mentioned that she has 4 glasses of wine when she goes out on Fridays, and right off the bat that puts her in the “risky Use category”. I would first screen using CAGE questioning first to assess for alcoholism. I would ask the following questions: 1. Have you ever felt you should cut down on your drinking? 2. Have people annoyed you by criticizing your drinking? 3. Have you ever felt bad or guilty about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)? I would then use the 3 question AUDIT-C to asses her alcohol use. I would ask the following questions: How often did you have a drink containing alcohol in the past year? How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? How often did you have six or more drinks on one occasion in the past year? Because Alexi has mentioned that she has as many as four glasses of wine on most weekends, her AUDIT score for these questions is 3 points. This signals that she may misuse alcohol, so I would need to know her complete score on the AUDIT system using more information. I would then ask her the following questions: How often during the last year have you found that you were not able to stop drinking once you had start? How often during the last year have you failed to do what was normally expected from you because of drinking? How often during the last year have you needed a drink in the morning to get yourself going after a heavy drinking session? How often during the last year have you had a feeling of guild or remorse after drinking? How often during the last year have you been unable to remember what happened the night before because you had been drinking? Have you or someone else been injured as a result of your drinking? Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down? Following those results, I would conduct a brief intervention for alcohol. Most likely, she is in the risky use category, which means she will need alcohol education and simple advice. I would use the 5 A’s of brief intervention, paired with motivational interviewing strategies, in order to counsel her on alcohol use. It’s important to have a brief intervention to assess how Alexi is feeling about things and provide education and resources to her. I would use the questions as follows: Ask: Would you be comfortable talking to me about your drinking a little bit more? Advise: Now that I have a better understanding of your drinking habits and your feelings related to drinking, I think it’s important for you to cut back on your drinking. Do you know the health risks associated with alcohol use? Assess: Do you feel like you’re ready to start making some small changes related to your drinking? What is holding you back from making these changes? Assist: Can I work with you to come up with a plan to make some changes that you feel comfortable with? *We would come up with a plan together that she feels comfortable with and is willing to implement* Arrange: Can we schedule an appointment to follow up on this and see how the changes are going? *I would encourage her to see me within a month so I can monitor her progress and make adjustments as needed |
| https://www1.nyc.gov/assets/doh/downloads/pdf/chi/chi30-1.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555649/ https://www.aafp.org/dam/AAFP/documents/patient_care/alcohol/alcohol-manual.pdf |
| Order of Items to Address with Alexi |
| 1. Screenings—this will give me an overall idea of Alexi’s health and give me insights to other issues that may be affecting her 2. Alcohol use—because Alexi is in the “risky use” category, it’s important that we address her alcohol use and implement small changes 3. Exercise 4. Diet |
| Other sources: Substance Use and Recovery Powerpoint Writing an Exercise Prescription Powerpoint |
