DK is 52 year old woman with chronic GI symptoms. Her most recent symptoms inclu

Question

DK is 52 year old woman with chronic GI symptoms. Her most recent symptoms include alternating bouts of constipation and diarrhea. She also reported that, based on a bone density scan, she has “severe” osteoporosis of the spine.

Medical Diagnosis by MD:  Irritable Bowel Syndrome (IBS), osteoporosis

Initial Assessment of DK:

Height: 5’6”

Weight: 140 lbs

BMI: 22.6

History:

DK is from Austria. While living there about 15 years ago, she contracted “parasites”. She was diagnosed and took medication and was apparently cured. She said she “felt great”. Gradually, over time, she began to feel worse again, but subsequent tests detected no parasites. She moved to the U.S. 10 years ago, changed her diet and felt better. By 2007, she again was experiencing diarrhea with 6 to 7 bowel movements daily. She was diagnosed with C. difficile at that time and was treated with antibiotics. Treatment eradicated C. difficile, but since then has had what is diagnosed as irritable bowel syndrome (IBS). She strictly controls her diet, eats a lot of vegetables, rarely eats gluten, avoids most dairy, must take psyllium seeds every morning or she does not have a bowel movement. She currently describes her condition as “kind of under control” but still experiences severe diarrhea 2-3 times yearly. She is most concerned at present about the recently diagnosed osteoporosis.

Medication and Supplements:

No medications

Probiotics- 10 billion CFUs daily

Vitamin D- 1000 IU daily

Colostrum- 10 g daily

Questions:

3-Day Diet Journal- DK Day 1 Breakfast Chili made with beans and brown rice, Manna bread Lunch Chili, manna bread with butter, small banana, almonds Snack Prunes and oat bran Dinner Vegetable soup with rice, vegetable pizza with a little cheese Day 2 Breakfast Vegetables and rice Lunch (at basketball game) hot dog, 3 french fries Snack Tofu and tomatoes, 2 oz chicken Dinner Vegetable omelet with sunflower seeds, prunes, chicken Day 3 Breakfast Miso soup, manna bread with butter and cinnamon Lunch Lentil loaf with breadcrumbs and rice with garlic Dinner Miso soup, 4 oz chicken, potato, cole slaw, fruit and almonds, soy milk She drinks mainly water or tea throughout the day

Explanation / Answer

1.Major problems addressed:

1. Alternate construction and diarrhea

II.From history:

1. Parasites: this infection causes irritable bowel syndrome

2. C.difficle: Clostritium difficle infection also causes irritable bowel syndrome

Both of these infection affects bowel wall.

III. Additional issues:

1. Avoids milk products that causes calcium deficiency and osteoporosis.

IV:Diet assessment:

1.More vegetables

2. Reduce gluten

3. Avoid milk

V.Diet suggestion:

1. Increases calcium diet:

Rational:

Calcium diet makes the bone strong and treats osteoporosis.

2. Vitamin D

Rational:

Vitamin D helps in absorption of calcium and helps in treatment of osteoporosis.

3.Soft diet and bland diet:

Rational:

This diet helps in reducing bowel irritation due to IBS.

VI. Further assessment:

Clinical:

1. Assess the signal and symptoms of hypocalcemia like muscular rigidity, irritation, tetany, trousers sign etc

2. Assess for bowel pattern to rule out IBs.

II. Anthropometric:

1. Assess for height and weight

2. BMI

3.Dietary:

1.Assess for 24hours meal intake

2. Dietary calcium and vitamins d

3. Dietary fiber.

4.Biochemical:

1.Serum calcium level

2.Bone marrow density

3.Vitamin D estimation

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