Question

A.) A 67-year-old patient has just been diagnosed with metabolic syndrome with hypertension, obesity, dyslipidemia, and insulin resistance. She is asking for more information about this syndrome and what she can do about it.

– How will you define metabolic syndrome for this patient?

– What does this diagnosis mean for her future health and health care needs?

– Knowing that multiple lifestyle changes are recommended, what is your first priority for patient education?

Answer 1

ANSWER-SUBPART 1.DEFINING METABOLIC SYNDROME FOR THE PATIENT

The patient has to explained that her body metabolism balance is deranged due to excessive intake of nutrients and fats more than her requirement causing a complex plethora  of a metabolic derangements.These can increase her chances of getting heart disease,diabetes,stroke and other serious diseases in the future,

in simple words,the metabolic syndrome can be defined for patient as under:

excess fatty intake and insulin resistance=excess fat=excess weight=excess sugar, lipids and blood pressure=multiple diseases like hypertension,insulin resistant diabetes,dyslipidemias; all together with one underlying cause{metabolic syndrome)

Metabolic syndrome as to be defined for the patient includes the following features.

1.obesity and excess fat around the waist.;central obesity with apple shaped body.

The patients generally have abody mass index>30kg/^m2

The patients have generalised obesity more so there is increase in the belly fat with increase in the waist circumference of more than 35 inches (89cm)in female patients and 40 inches(102cm) in the male patients.

2.High blood pressure>130/85mm of Hg or previously diagnosed hypertensive on regular antihypertensives.

3.Elevated blood glucose levels fasting blood glucose >100mg/dl.Insulin resistance prevents insulin from acting like normal and hence glucose cannot enter the cell and the blood glucose levels in blood gradually rises.The patient may be a prediabetic initially and a full blown diabetic later.

4.increased triglyceride levels.>150mg/dl,Hypertriglyceridemias is one of the key finding in metabolic syndrome.

5.decrease in HDL cholesterol{good cholesterol} HDL Cholesterol is the good cholesterol in our blood.It is cardioprotective.

normal levels >=40mg/dl men

. >=50mg/dl women.HDL Cholesterol levels lowering increases susceptibilty to accelerated atherosclerosis and increases the risk of stroke and heart disease.

ANSWER SUBPART 2: MEANING OF THE DIAGNOSIS FOR HER FUTURE HEALTH AND HEALTH CARE NEEDS.

The patient is at increased risk of following diseases as far as her future health is concerned.

1.increased risk of a full blown diabetes from the existing prediabetic state due to insulin resistance,

2.increase risk of ischemic heart disease,myocardial infarction and heart failure.

3.increased risk of stroke and cerebrovascular accidents.

4.increased risk of fatty liver disease and altered hepatic functions

5.increase in incidence of gallstones

6.increase in the conditions like sleep apneas and sleep disturbances.

7.polycystic ovarian disesase,asthma,early onset osteoarthritis,hyperuricemia and gout etc are few of the other associated diseases.

MEANING OF THE DIAGNOSIS FOR THE PATIENT'S FUTURE HEALTH NEEDS INCLUDE :

1.the need for regular monitoring of patient weight,blood pressure and vitals by expert physician.

2.the need to have baseline ecg,blood tests at regular intervals to determine the increase or decrease in the blood sugar,triglycerides and hdl cholesterol.

3.the need to be prepared for antidiabetic drugs or insulin injections in case the blood sugars are not controlled and maintained in the normal range.Hba1c estimation helps to determine blood sugar control over long periods.

4.the need to have regular physician consultation and examination,support of nutritionist and fitness expert.

The patient also needs to be alert for symptoms of chest pain,sweating,body edema,breathlessness,limb weakness,sudden loss of consciousness,slurred speech and report immediately to the emergency department.

The patient needs to be educated about the possible complications that can arise during the course of her treatment and the symptoms of the same.

5.the need of having to take anti hypertensive drugs and cholesterol lowering drugs regularly.

6.the need to be asked to take long term aspirin by the physician if the patient is found at risk of stroke(prothrombotic state)

7.the need of having to undergo bariartric surgery if all other modalities faiil and serious metabolic derangements ensue.However this option is one of the last to be consisdered in an elderly patient.

8.the need to be ready mentally for any emergency and keep help at bay in case an emergency arises.

The seriousness of the condition and its complications has to be explained to the patient thoroughly and the family involvement sought.

ANSWER SUBPART 3:FIRST PRIORITY FOR PATIENT EDUCATION IN THE MULTIPLE LIFESTYLE CHANGES RECOMMENDED.

SELF CARE AND INTENSIVE LIFESTYLE CHANGES INCLUDING DIET AND EXERCISE is the first priority in the patient education for the multiple lifestyle changes recommended.

a)IDEAL BODY WEIGHT AND EXERCISE:

Patient should focus on attaining her ideal body weight and her ideal body mass index.she has to be motivated to lose her body weight and start exercising.She should be encouraged to start regular walking and exercise gradually increasing the duration and intensity of her workout.She should be encouraged to move as much as possible during the day and remain active.A proper gradual workout plan can be charted for her keeping her age and medical condition in mind with the help of a fitness expert or professional.

b)DIET PLAN

A diet high in fruits and vegetables and whole cereals and low in saturated fats has to be followed.She has to strictly follow the diet plan.Her diet should include a lot of vegetables and fruits and whole cereals and less of refined flours. She should decrease er intake of salt,processed and junk foods.Food items to be avoided include butter,cheese made from whole milk,whole milk,oils like coconut oilicecreams,pastries,cakes,chips,fried fatty junk foods,fatty meats.She may seek the help of a qualified nutritionist specialised in the field of weight loss and metabolic syndrome.

.c)STOP SMOKING AND DRINKING ALCOHOL.

Both smoking and alcohol accelerate atherosclerosis and can worsen the condition of a patient with metabolic syndrome if continued unsupervised.if the patient is a smoker;she has to stop smoking to prevent worsening of her disease condition.She also has to decrease the consumption of alcohol and stop it completely to prevent further metabolic derangements..The patient can take help of a deaddiction physician to achieve her goal.

Regular physician consultations,monitoring of her weight,blood pressure,sugars,HBA1C levels,blood test for lipid levels at regular intervals need to become a part of her regular routine.Medical treatment of diabetes,hypertension and dyslipidemias under the supervision and monitoring of a specialist.She should take her blood pressure medications,anti-diabetics and antilipid drugs along with minerals and multivitamins to restore her metabolic state and body functions back to normal.

SUMMARY:Metabolic syndrome is a lifestyle disease starting with excess intake and sedentary lifestyle,leading to metabolic derangements of insulin resistance,obesity,increased sugars,lipids,blood pressure,causing complications like diabetes,heart disease,stroke and needs urgent lifestyle modification exercise and dietary control with medicines for its control and reversal.