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JD: The CAD Gauntlet

Meet JD:. JD is a 46-year old white male who presented to his PCP to discuss his body weight. He states that he has always had a weight problem (generally overweight vs. obese) but that over the last 3 years he has noticed a steady weight gain (~ 20 pounds). He also expressed that he always feels ti

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JD: The CAD Gauntlet

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    1. JD: The CAD Gauntlet One man’s dramatic struggle to develop healthy habits despite a boring federal job, two unappreciative daughters, the same old crap on TV, and a lifestyle that has left his body in shambles….. ...Will he make it?

    2. Meet JD: JD is a 46-year old white male who presented to his PCP to discuss his body weight. He states that he has always had a weight problem (generally overweight vs. obese) but that over the last 3 years he has noticed a steady weight gain (~ 20 pounds). He also expressed that he always feels tired. He has not been to see his PCP for several years. All of JDs medical and surgical histories are negative. He has significant family history for obesity and T2DM on his maternal side. He is a social drinker (~ 6 pack of beer in a given weekend) and has been a smoker for 25 years. He reports no recreational, prescription or OTC drug use. Married with 2 teenage daughters, he has worked at the U.S. post office for the past 20 yrs. He also reports early morning headaches and daytime drowsiness. His wife claims he snores and he awakes during the night often. He denies any history of angina or dypsnea on exertion. He is sedentary and does not understand the basics about nutrition. JD has no hobbies except movies and sports on TV.

    3. Additional Health Info: Temperature – 98.7 F BP = 136/88 mmHg HR (rest) = 92 bpm Respiratory rate = 12 Height = 69 inches Weight = 228 lbs Waist circumference = 42 inches

    4. Pre-participation risk-screening algorithm JD falls in the Level 2, Moderate-risk category in the ACSM Pre-Participation Screening Algorithm. He is over 45, and he meets at least three of the ACSM CAD risk factors. It would not be surprising if he had impaired fasting glucose, and/or dyslipidemia, based on his sedentary lifestyle and poor eating habits. It is possible that he is at high risk for two reasons: One, he does not exercise or exert himself so he might not know whether he experiences angina or dyspnea upon exertion. Two, his waking during the night may be on account of orthopnea or paroxysmal nocturnal dyspnea. Because the moderate-risk stratification requires a medical screening anyway, it can be determined at that point if he needs to be moved up to the high-risk category or not.

    5. Risk Factors for CAD 3 positive risk factor for Coronary Artery Disease: 1) Cigarette Smoker for the past 25 years 2) Sedentary lifestyle: works at the post office in a sedentary job and admits t doing no physical activity. 3) Obesity: BMI ~35; Waist: 42in Considerations: Pre-hypertensive? Full Hypertension

    6. Patients Readiness for Physically Active Lifestyle Motivation (lack of) key aspect -History of being overweight and leading sedentary lifestyle Patient is in the “Precontemplation” stage -expressing a lack of interest in making a change Needs educational classes regarding proper nutrition and the benefits of leading a physically active lifestyle. The wife and children can help persuade him to change his unhealthy habits.

    7. The Next Step… More info needed on current fitness level: Cardio, resistance, and flexibility need to be addressed/tested Because of a family history of Type 2 Diabetes/obesity, screening for diabetes is necessary LDL/HDL levels, BMI Testing necessary for fatigue, high cholesterol, obesity, glucose

    8. Exercise Prescription Guidelines Primary Concern: Cardiovascular conditioning: weight loss (obese state), sedentary state, T2DM prevention, Hypertension prevention Rx: initial: 3 weekly, 50-60% HRR, 20-30min. (progress slowly) Could use gym equipment, outdoor walks/jogs, cycling, etc. Because of his weight, he will progress to longer times and higher intensities once he can. Strength Training: Preferably circuit training (short rest periods, full body). (Squats, etc, major movements: lower body, multi-joint could be neglected in beginning, depending on state of respiration ability) Rx: 2x weekly, 10-15 reps (because strength is not really the goal) Flexibility: This is a small factor overall, but something that should not be neglected. His age, sedentary life and weight could benefit with some flexibility training. Rx: 3x weekly: stretches held for 20sec. Done at conclusion of cardio sessions. ADLs: Of course his sedentary lifestyle needs to change. If he can’t become active at his job, then find ways to get active going to and coming home from work. 2 teenage daughters could keep you physically busy as well, one would think. Daytime drowsiness: a high glycemic lunch?/Go for a 10min brisk walk to re-energize at lunch?

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