Week 6 Discussion
Patient With Polydipsia and Weight Gain
FM is a 52-year-old man complaining of excessive thirst. He was in his usual state of health until about 3 to 4 weeks ago when he experienced a significant weight gain that he blames on the stay-at-home order in response to the COVID-19 pandemic. He has been lonely and depressed and sitting at home eating everything in sight. Over the past week he has noticed increasing thirst, urinary frequency, and blurred vision.
Past Medical History
Hypertension
Hyperlipidemia
Medications
Lisinopril, 10 mg daily
Hydrochlorothiazide, 25 mg daily
Atorvastatin, 10 mg daily
Physical Examination
Height: 68 inches; weight: 262 lbs.; BMI: 39.8; blood pressure: 158/96; pulse: 82; respiration rate: 16; temperature: 98.2 F
Well-developed obese Latino male in no distress
Lungs: clear
Heart: regular rate and rhythm
Extremities: no edema
Neurological: no deficits
Labs
Hematocrit: 42%
Random capillary blood glucose: 358 mg/dL
Hemoglobin A1c: 11.4% Urinalysis: specific gravity 1.010, pH 7.4, 4+ glucose, zero acetone
Discussion Questions
1. What nonpharmacologic treatments should be recommended to FM?
Fibromyalgia syndrome (FMS) is a painful and debilitating condition characterised by widespread musculoskeletal pain and fatigue. It is estimated that about 2 million people in the United States are affected, making it one of the most common rheumatological conditions. Fibromyalgia affects women more than men and occurs more frequently in older age groups.
Nonpharmacologic treatments should be recommended to FM. These include exercise, nutrition, massage therapy and diagnostic testing (such as a 24-hour urine collection). The role of each treatment depends on the severity of symptoms.
The optimal treatment for FM is still unclear; however, it appears that lifestyle interventions are more effective than pharmacological interventions in reducing fatigue and improving function.
The role of exercise in the treatment of fibromyalgia syndrome is well-documented.
Exercise can help you feel better and improve your quality of life by:
Massage therapy can help reduce pain and fatigue, improve sleep, reduce depression and improve quality of life. It is a safe treatment option that has been used for more than 4,000 years in traditional Chinese medicine (TCM).
The key components of any massage are pressure on specific points on the body to release tension in specific areas. For example: applying pressure to trigger points in your neck or shoulders may relieve you from headaches or back pain; applying pressure to muscle knots around your knee will reduce joint stiffness; pressing deep into the muscles along your spine releases chronic stress that keeps you tense throughout the day; releasing muscle spasms by rubbing looser tissue using thumbs over an area such as carpals (the rings connecting bones together) can decrease cramping during menstruation or childbirth
There are several diagnostic tests that can be used to help determine whether a patient has fibromyalgia. These include:
FM is a complex disease, and treatments for it will vary depending on the severity of symptoms. Treatments may include medication, physical therapy, and exercise (walking). The role of nutrition in FM treatment is unclear. Massage therapy has been used as a treatment for this condition but remains understudied as a potential treatment option.
Fibromyalgia syndrome is a disease that affects millions of people. The cause of the disease isn’t known, but it is characterized by extreme pain in multiple areas of the body and chronic fatigue. There are many possible treatments for FM including nonpharmacologic approaches such as exercise, nutrition, massage therapy and cognitive behavioral therapy (CBT). This list should not be considered exhaustive and there are no guarantees that one treatment will work better than another so it is important to discuss all options with your doctor before making any decisions about how best treat your condition.
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