Case Summary
A patient presents to the office with the following for initial visit:
- 42-year-old Caucasian female, BMI 45, BP: 152/86, Pulse: 91, O2: 97%
- Past Medical Hx: Hypertension, Pre-Diabetes, Osteoarthritis, Chronic Migraine
- Past Surgical Hx: none
- Social: Occasional Smoker, Occasional alcohol use (1-2 per week), no drug use
- Most recent labs (that you had access to):
- Total Cholesterol: 172, Triglycerides- 253, HDL- 19, LDL- 130
- Thyroid function tests: WNL
- Fasting glucose: 119
- A1C: 6.4.
Diagnosis
The metabolic syndrome requires complex solutions in therapy that can alleviate the patient’s state. The results of the interventional and observational studies conducted by Myers et al. (2019) show that the increase in regular physical activity leads to positive outcomes in mitigating the diagnosis. Every characteristic of metabolic syndrome, including pre-diabetes and hypertension, is influenced by the improvement of the patient’s stamina and overall activity level. In particular, the BMI lowers, the cardiovascular system improves, blood pressure decreases, and insulin resistance increases when the patient introduces regular physical activity to their life (Myers et al., 2019). Patients who made intense physical activity part of their routine report about positive results in weight loss, a decrease in cardiovascular risk factors, and improved insulin resistance in six months (Myers et al., 2019). A minimum of 150 minutes per week of physical activity and a low-calorie diet are among the recommendations that the patient should receive (Myers et al., 2019). It allows therapists to recommend physical activity to people with metabolic syndrome to control and alleviate their state.
The development of cardiovascular issues and diabetes are closely connected with the measurement of the body parameters the patient should check. For instance, waist circumference is associated with BMI, but the results of these measurements are primary (Fahed et al., 2022). When people have abdominal visceral obesity, they have more risks of developing metabolic syndrome than those with subcutaneous fat accumulation (Fahed et al., 2022). Therefore, it is necessary to recommend that the patient measures and controls her waist circumference and understands her metabolic syndrome’s progress.
Following recommendations concerning medication against hypertension, insulin resistance, health diet, and physical activity can minimize the risks of metabolic syndrome development. According to the results of the control trial, the incidence of the aggravation of the metabolic syndrome decreases by more than 40% in the group where the participants change their lifestyle habits (Fahed et al., 2022). The severity of the metabolic syndrome lowered by 17% among the participants from the group where patients took metformin during a prolonged period (Fahed et al., 2022). Therefore, the patient should be aware of the possibilities to improve their physical health using the comprehensible guide provided by the therapist.
Interview Questions
I would ask the following questions to explore further the choices the patient has made to manage their disease processes and to ascertain their knowledge of metabolic syndrome:
Previous history: Have you previously experienced improvements in your physical state when following lifestyle and medication recommendations?
Onset: When did you notice the first negative symptoms connected with the aggravation of your disease?
Location: Are you aware of the situations when the negative symptoms bother you most?
Duration: Are the negative symptoms you experience constant and long-term?
Characteristic: What are the most typical signs of increased blood pressure and glucose changes?
Aggravates: Do you know which habits and actions make you feel worse?
Relief: Are you aware of how to decrease high blood pressure and stabilize the glucose level?
Time: When do the symptoms of metabolic syndrome become most evident? Do they appear in the evening or the morning?
Scale: How can you evaluate your ability to cope with hypertension, changes in the glucose level, migraine, and osteoarthritis?
Overall Health and Psychophysiology
Metabolic syndrome is the umbrella term scholars use to define the combination of symptoms. The pathophysiology of the metabolic syndrome features characteristics such as hypertension, obesity, pre-diabetes, chronic migraine, and osteoarthritis, among the most common signs of the metabolic syndrome (Fahed et al., 2022). These symptoms of the disease are aggravated by occasional alcohol use and smoking. Moreover, the inability of the patient to follow dietary recommendations, medical advice concerning regular physical activity and ignoring medication for hypertension are risk factors associated with the diagnosis.
The patient’s overall health is influenced by several significant issues, including obesity, hypertension, osteoarthritis, and pre-diabetes. The paleopathology of the metabolic syndrome is the increase of insulin resistance combined with fatty acid flux (McCracken et al., 2018). Another hypothesis explaining metabolic syndrome development’s mechanism is oxidative stress and chronic inflammation (McCracken et al., 2018). In all cases, the reasons that lead to metabolic syndrome development depend on the patient’s individual characteristics. It is impossible to state that obesity is the primary factor that triggers the development of other illnesses that are part of metabolic syndrome, even though it is the most common visual sign of this state.
The diagnosis of the patient corresponds to the description of the metabolic syndrome. The symptoms the patient reports are the consequences of the unhealthy lifestyle and habits she does not want to change. It is critical to inform the patient about the necessity of following the recommended dietary plan, physical activity, and control of body weight, hypertension, and glucose level (Fahed et al., 2022). It is essential to explain to the patient that metabolic syndrome is among the most widespread risk factors for morbidity worldwide (Fahed et al., 2022). The health state of the patient can worsen significantly in case of ignoring these recommendations.
References
Fahed, G., Aoun, L., Bou Zerdan, M., Allam, S., Bou Zerdan, M., Bouferraa, Y., & Assi, H. I. (2022). Metabolic syndrome: Updates on pathophysiology and management in 2021. International Journal of Molecular Sciences, 23(2), 786. Web.
McCracken, E., Monaghan, M., & Sreenivasan, S. (2018). Pathophysiology of the metabolic syndrome. Clinics in Dermatology, 36(1), 14–20. Web.
Myers, J., Kokkinos, P., & Nyelin, E. (2019). Physical activity, cardiorespiratory fitness, and the metabolic syndrome. Nutrients, 11(7), 1652. Web.