CLINICAL CASE STUDY Michael is a 67-year-old white man who is a lifelong resident of Sherman Oaks, CA, a suburb of Los A

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Clinical Case Study Michael Is A 67 Year Old White Man Who Is A Lifelong Resident Of Sherman Oaks Ca A Suburb Of Los A 1 (153.3 KiB) Viewed 38 times

CLINICAL CASE STUDY Michael is a 67-year-old white man who is a lifelong resident of Sherman Oaks, CA, a suburb of Los Angeles. He was a high school football star and now runs a small landscaping business and volunteers as a local football coach. He enjoys taking walks in a park that is next to a large freeway. Sometimes he will go on an easy hike in the nearby hills with his wife, Lisa. They are happily married and both love Mexican food (especially chips and salsa, tacos, and margaritas) and music by the Beatles. Michael was diagnosed with Parkinson's disease 3 years ago, after Lisa noticed that his hands were shaking at rest. She noted that he had been complaining about having to move more slowly at work and at football practices, too. Michael is coming in for a regular check-up appointment. He has been taking Sinemet (mix of levodopa and carbidopa) and Neupro (rotigotine) to control his symptoms. His symptoms are well managed, but he's experienced some nau- sea and dizziness on these medications that he just lives with because they keep him functional. He also takes coenzyme Q10. St. John's Wort, and a high potency multivitamin with 75 mg pyridoxine. He is 6'0" and currently weighs 160 lb. He was 180 lb at his last visit 3 months ago. Lisa thinks he's lost a little weight, but isn't sure. He's always been fit and lean. What she has noticed is that they don't talk as much during meals anymore and that it takes him a long time to finish his food. After speak- ing with the couple for a while, Lisa remembers one time recently when she'd made his favorite banana bread and the whole house smelled amazing, but he didn't notice. Her feelings had been hurt. She admits that sometimes he loses interest and doesn't seem to have the energy to finish his meals. When she encourages him to eat, he can be either apathetic or irritable. Nutrition Diagnostic Statements ● Inadequate energy intake related to PD progression, hyposmia, and decreased appetite, as evidenced by recent weight loss of 12% in 3 months (severe), decreased food intake, and fatigue. • Difficulty swallowing related to PD progression as evidenced by slow eating pace. • Environmental factors to consider are long-term exposure to car pollution and herbicides from his landscaping work. Nutrition Care Questions 1. What dietary advice do you have for Michael and his caregiver? 2. What changes in Michael's diet and lifestyle would you recommend? 3. What other evaluations does Michael need? 4. What possible food-drug interactions could be occurring? 5. What strategies can Michael use to decrease his exposure to car pollution and herbicides?