TC is a 26-year-old runner who came into the office today complaining of constant pain in the right ankle
Module 6 Discussion
- What lifestyle modifications do you recommend for JJ?
- What medication do you prescribe for JJ, including how long to use?
- What counseling points about this medication do you give JJ?
Expert Answer and Explanation
Module 6 Gastroesophageal Reflux Disease
JJ has had recurrent heartburn and has been diagnosed with gastroesophageal reflux disease. While medication can work, JJ needs to make lifestyle modifications as they will alleviate his symptoms. It is also important to counsel him so that he can understand his condition and how he can recover fully.
Lifestyle Modifications
One of the lifestyle modifications that JJ should make is dietary modification as these are the main sources of his issues. Yuan et al. (2019) note that JJ should avoid spicy food or other food that exacerbates his heartburn. In the future, although he can consume spicy foods it should be limited and he should go for smaller more frequent meals as compared to large ones. Another modification is elevating his bed, by about 6 inches. This will prevent acid from flowing back into the food pipe during sleeping.
It is also necessary for JJ to avoid lying down for at least 2-3 hours after a meal as this will encourage digestion and will reduce the risk of reflux. If JJ is overweight, he should start losing some weight because excessive abdominal fat usually puts pressure on the stomach and worsens the symptoms he is experiencing (Clarrett & Hachem, 2018). If JJ smokes or uses alcohol, it is important to quit the two as this can play a great role in reducing the symptoms he is experiencing.
Medication
The best medication that can work on the symptoms is a proton pump inhibitor mainly used for gastroesophageal reflux disease. According to Kröner et al. (2021), this can be omeprazole, esomeprazole or lansoprazole. A common prescription can be 20 mg of omeprazole daily. It is also notable that the period of consuming the medication should be determined by the care provider. In many instances, proton pump inhibitor therapy is recommended for about 4 to 8 weeks but depends on the patient’s symptoms and their responses to the drugs. If the symptoms cease completely, it is possible to reduce the intake after 4 weeks or cease consumption completely.
Counseling Points
When communicating with JJ about his diagnosis it is important to insist that he takes the medicine as directed which is usually before a meal (Guadagnoli et al., 2022). Additionally, he should adhere to the days given to take the medication as skipping or taking too much will affect their action and might be ineffective in addressing the current symptoms. It is also vital to inform JJ of possible side effects of the PPIs.
This includes headaches and diarrhea. Mentioning the effect of long-term use of the drugs is also critical as they can lead to issues such as vitamin B12 deficiency. This is why it is important to insist on lifestyle modification as it will eliminate the need for the drugs in future.
The healthcare provider must also monitor JJ for improvement and encourage JJ to check his symptoms and if they do not improve he should seek further medical advice. This can include an adjustment of the dose or a complete change of the drugs (Guadagnoli et al., 2022). It is also significant to mention the use of over-the-counter pain relievers. JJ had mentioned his use of ibuprofen and acetaminophen which can both exacerbate the symptoms.
He can instead choose different pain management strategies such as sleeping, resting, or trying to use herbal medicine. It is crucial for JJ to follow the suggestions for lifestyle modifications and to follow the medication regimen. This will successfully manage the symptoms and ensure that he avoids complications associated with chronic reflux.
References
Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal Reflux Disease (GERD). Missouri Medicine, 115(3), 214–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/#:~:text=The%20primary%20acid%20suppressive%20medications
Guadagnoli, L., Simons, M., McGarva, J., Taft, T. H., & van Tilburg, M. A. (2022). Improving Patient Adherence to Lifestyle Changes for the Management of Gastroesophageal Reflux. Patient Preference and Adherence, Volume 16, 897–909. https://doi.org/10.2147/ppa.s356466
Kröner, P. T., Cortés, P., & Lukens, F. J. (2021). The Medical Management of Gastroesophageal Reflux Disease: A Narrative Review. Journal of Primary Care & Community Health, 12, 215013272110467. https://doi.org/10.1177/21501327211046736
Yuan, L.-Z., Yi, P., Wang, G.-S., Tan, S.-Y., Huang, G.-M., Qi, L.-Z., Jia, Y., & Wang, F. (2019). Lifestyle intervention for gastroesophageal reflux disease: a national multicenter survey of lifestyle factor effects on gastroesophageal reflux disease in China. Therapeutic Advances in Gastroenterology, 12, 175628481987778. https://doi.org/10.1177/1756284819877788
Module 7 Discussion
TC is a 26-year-old runner who came into the office today complaining of constant pain in the right ankle. While running his usual route, he accidentally stepped on a branch lying in his path, twisting his ankle inward. He denies hearing a “pop.” He was able to walk, or limp, the remaining ¼ mile back to his home, where he immediately elevated and iced the ankle for 30 minutes.
He took two acetaminophen 325mg, showered, dressed for work, and drove to his place of employment. He continued to experience significant pain in the ankle, worse when walking. He repeated the acetaminophen dose for 24 hours with no effect. His foot became swollen.
Since his job in a sporting goods store requires that he be on his feet most of the day, he was unable to continue his normal workday and made a same-day appointment to be seen. He has no chronic diseases, takes no medication, and denies recent use of NSAIDs, as aspirin and ibuprofen have caused him to have gastritis in the past. He did not remember what and how he took those medications specifically. He sprained his ankle last year but was able to manage that injury at home.
Assessment
A 26-year-old, otherwise healthy male presents limping into the examination room, holding his right shoe in his hand. He grimaces with partial weight-bearing of the affected foot. He has local ecchymosis and 1+ edema over the anterolateral ligaments of the right ankle. Capillary refill, pulses, and sensation of the foot and toes are intact. There is no lateral or anterior instability of the joint or tendons. X-ray of the ankle and foot are negative for fracture or dislocation. He has a grade I lateral ankle sprain.
What do you recommend for pain management for TC? Please be specific in medication, dosage, frequency, and duration. What counseling points do you give him, including specific counseling for the medication prescribed? Is any follow-up or monitoring needed?
Expert Answer and Explanation
Overview of TC Medication
For TC’s pain management, I recommend a combination of non-pharmacological and pharmacological approaches to effectively address his grade I lateral ankle sprain. Non-pharmacological approaches are essential components of TC’s pain management plan for his grade I lateral ankle sprain. These measures aim to provide relief and support the healing process without the use of medication (Bedwell et al., 2023).
Firstly, TC is advised to rest the affected ankle by minimizing weight-bearing and refraining from activities that could worsen his pain. Additionally, the application of ice, in intervals of 15-20 minutes every 2-3 hours within the initial 48 hours, can effectively reduce swelling and alleviate discomfort. To provide further stability and reduce swelling, TC should wear a compression bandage or brace. Lastly, elevating the injured ankle above the level of the heart whenever feasible is recommended, as it aids in decreasing swelling and promoting faster healing.
The pharmacological approach to managing TC’s grade I lateral ankle sprain involves the use of over-the-counter pain medication. Specifically, I recommend TC to take ibuprofen, a Nonsteroidal Anti-Inflammatory Drug (NSAID), known for its effectiveness in alleviating pain and reducing inflammation (Sahin et al., 2023). The prescribed medication is ibuprofen, with a recommended dosage of 600 mg, equivalent to three tablets, each containing 200 mg of the active ingredient.
TC should adhere to a dosing frequency of one tablet every 6-8 hours, always with food to minimize the risk of gastric irritation. It is essential to emphasize that the duration of ibuprofen usage should align with the presence of pain, with the crucial caveat of not exceeding the recommended dose for more than 7-10 days.
Counseling Points
Comprehensive counseling points are provided to guide TC in effectively managing his grade I lateral ankle sprain. First and foremost, TC is advised to rest the affected ankle and refrain from engaging in strenuous activities for a designated period, facilitating the healing process (Raeder et al., 2021). When applying ice to the injured area, using a cloth or towel as a buffer is recommended to prevent direct skin contact and minimize the risk of cold-related discomfort. The use of compression bandages or braces is encouraged, with a crucial emphasis on wearing them as instructed to ensure they do not constrict blood flow excessively.
Follow-Up and Monitoring
Follow-up and monitoring are crucial aspects of TC’s pain management plan for his grade I lateral ankle sprain. It is advisable that TC schedule a follow-up appointment after one week to assess the progress of his sprain and ensure that he is on track for recovery. During this follow-up, any persistent or worsening pain, as well as signs of infection, should be addressed promptly, necessitating immediate medical attention (Mosca et al., 2020). TC should be reminded that if he experiences any adverse effects while taking ibuprofen, discontinuation of the medication is essential.
References
Bedwell, G. J., Chikezie, P. C., Siboza, F. T., Mqadi, L., Rice, A. S., Kamerman, P. R., … & Madden, V. J. (2023). A systematic review and meta-analysis of non-pharmacological methods to manipulate experimentally induced secondary hypersensitivity. The Journal of Pain.
Mosca, M., Caravelli, S., Massimi, S., Fuiano, M., Catanese, G., Barone, G., … & Benedetti, M. G. (2020). Evaluation of proprioception and postural control at a minimum 1 year follow-up after ankle capsuloligamentous lateralplasty with Brostrom technique: A cohort study. Medicine, 99(17).
Raeder, C., Tennler, J., Praetorius, A., Ohmann, T., & Schoepp, C. (2021). Delayed functional therapy after acute lateral ankle sprain increases subjective ankle instability–the later, the worse: a retrospective analysis. BMC Sports Science, Medicine and Rehabilitation, 13(1), 1-9.
Sahin, G. K., Gulen, M., Acehan, S., Satar, D. A., Erfen, T., & Satar, S. (2023). Comparison of intravenous ibuprofen and tenoxicam efficiency in ankle injury: a randomized, double-blind study. Irish Journal of Medical Science (1971-), 192(4), 1737-1743.
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