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Suggest Remedy For Hyperlipidemia
a 52 year old male with a PMH Type 2 DM, Hyperlipidemia, and HTN. He is a new patient to your office stating he stopped his meds several months ago and he cannot remember what he took in the past. His BP is 150/90. HR 88, RR 20 BMI 35. HGB A1C is 9.6, Total chol 225, LDLs 183, HDL 35. CBC, CHem, LFTs are wnl. Discuss the focused pertinent physical exam for this patient as well as what further diagnostics are needed in providing evidenced based care. What medications are important to start for this patient to treat his co-morbidities. Include the follow-up for this gentleman along with pertinent diagnostics. needed at time of follow-up and written prescriptions to treat this gentleman's HTN, hyperlipidemia, and Type 2 DM.
Fri, 28 Apr 2017
Welcome to HCM,
There are many things that need to be addressed in lowering your health risk and in particular addressing hyperlipidemia, hypertension, uncontrolled diabetes and obesity. The first thing I would probably do is put him on Metformin at a minimum due to the weight loss potential with this medication. Then, consider a statin immediately while you attempt to dovetail with some lifestyle interventions that will umbrella the co-morbidities. These other changes are 1) refer to a Dietitian for a complete dietary instruction on a combination DASH/low fat/high soluble fiber diet high in necessary omega-3 fatty acid supplement and a review of how to eat when you have diabetes. Encourage him to go to diabetes classes if here in the US
Suspect he is low in vitamin D. Can test for verification and hope its above 30. If not, supplement with 1,000IU D3 until repleted and re-evaluate dose. If triglycerides are high, enter another treatment but I did not see triglycerides mentioned. His fat intake should not be above 7% saturated fat, 28% total fat, high lean protein if kidney gfr normal and the rest carbohydrate, but no added sugars, restrict juices or sweetened beverage.
Cardiac tests? We need him on some type of scheduled exercise routine that his heart can handle and preferably designed by physical therapy because of the size/risk.
Morbid obesity patients rarely lose weight without a lot of support, follow-up, teaching, counseling (emotional eating, stress eating, bad habits). They should also be offered some of the new prescription weight loss pills to help them, a hypoallergenic multi-vitamin, food diary tracking, group support and individual dietitian follow-ups per doctors instructions. Left to their own, this is all too much for them to handle.
Definitely run a TSH, free T4, free T3 and screen for symptoms of fatigue or any hormonal symptoms aside from those expected from someone with thick blood, high blood pressure, heart risk, weight and blood sugar.
I believe, that systematically implemented using a team approach and close followup, this gentleman can turn his life around.
Respectfully,
Kathryn Shattler, MS,RDN
There are many things that need to be addressed in lowering your health risk and in particular addressing hyperlipidemia, hypertension, uncontrolled diabetes and obesity. The first thing I would probably do is put him on Metformin at a minimum due to the weight loss potential with this medication. Then, consider a statin immediately while you attempt to dovetail with some lifestyle interventions that will umbrella the co-morbidities. These other changes are 1) refer to a Dietitian for a complete dietary instruction on a combination DASH/low fat/high soluble fiber diet high in necessary omega-3 fatty acid supplement and a review of how to eat when you have diabetes. Encourage him to go to diabetes classes if here in the US
Suspect he is low in vitamin D. Can test for verification and hope its above 30. If not, supplement with 1,000IU D3 until repleted and re-evaluate dose. If triglycerides are high, enter another treatment but I did not see triglycerides mentioned. His fat intake should not be above 7% saturated fat, 28% total fat, high lean protein if kidney gfr normal and the rest carbohydrate, but no added sugars, restrict juices or sweetened beverage.
Cardiac tests? We need him on some type of scheduled exercise routine that his heart can handle and preferably designed by physical therapy because of the size/risk.
Morbid obesity patients rarely lose weight without a lot of support, follow-up, teaching, counseling (emotional eating, stress eating, bad habits). They should also be offered some of the new prescription weight loss pills to help them, a hypoallergenic multi-vitamin, food diary tracking, group support and individual dietitian follow-ups per doctors instructions. Left to their own, this is all too much for them to handle.
Definitely run a TSH, free T4, free T3 and screen for symptoms of fatigue or any hormonal symptoms aside from those expected from someone with thick blood, high blood pressure, heart risk, weight and blood sugar.
I believe, that systematically implemented using a team approach and close followup, this gentleman can turn his life around.
Respectfully,
Kathryn Shattler, MS,RDN
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