Cas ase Pr Pres esent ntat ation D Dat ate: Febru ruary ry - - PDF document

Cas ase Pr Pres esent ntat ation D Dat ate: Febru ruary ry 6 6 2 2020 020 Pr Presen enter er: Sue T Tobi bin Main Q n Questi tion n ab about th the e Case

What is considered “Untreated or Inadequately treated psychiatric illness in relation to mental health and overeating?” How can I prepare patient mentally while waiting for intake into program?

Dem emograp aphic I Informat ation

63-year-old female Currently waiting orientation session through London program

Med edical al H History/Stat atus

Current P Prob

• blem List:

BM1 45.5 EOSS Stage 3 HTN DM2 Hypertrophic cardiomyopathy Atrial Fib Mitral Valve & tricuspid regurgitation Sleep apnea Dyslipidemia Gastritis GERD COPD Hiatus hernia Multiple seborrheic keratosis and verruca vulgaris PMHx Hx: Appendectomy 2000 Partial hysterectomy 2002 Cholecectomy/ABD hernia 2004 Hospitalized for Atrial Fib 2014 Hiatus Hernia repair on hold due to risk associated with obesity Medica icatio ions: s: Xarelto 20 mg od (AFIB) Symbicort 200 -6 mcg 1 inhalation bid (COPD) Ventolin HFA 100 mcg/actuation 1-2 inhalations q4h prn (COPD) Esomeprazole magnesium 20 mg delayed release capsule od (GERD)

Rosuvastatin 20 mg od (DYSLIPIDEMIA) Diltiazem 180 mg od (AFIB) Chlorthalidone 25 mg (HTN) Bisoprolol 1 tab od (AFIB/HTN) Janumet XR 100-1,000 mg 1 tab od (DM) Pristiq 200 mg od (MDD) Specia cialist sts s Involved in C Car are: Cardiologist Internal medicine General surgeon Chronic disease nurse Referral t to O

• OBN:

October 2018: Initial referral Jan 2019: Attended Orientation Session in Guelph April 2019: Advised NP at appt that she was not going to pursue bariatric surgery because she “couldn’t navigate Guelph”; offered to request Hamilton with same response; advised that London program was opening this year; pt replied, “I would go to London, but then again I think I just don’t care enough” August 2019: Appt with Chronic Disease Nurse re: DM/HTN/COPD; stated she had lost 11 pounds and was willing to pursue bariatric surgery again if London was open; NP required to delay referral until after 1 year from date of original referral October 2019: referred and request made to attend London; Nov 2019: pt received notice of orientation in Guelph Dec 5 2019; NP contacted Guelph OBN site and advised that OBN sites are automatically chosen based on geography, but Guelph was able to arranged referral to London Nov 2019: reassessed by CDN; weight increase of 7 pounds, gave up on goals previously set; states eating more sugar than ever To RTC Feb 12 2020 April 2020: Pt scheduled for orientation session at London site

Men ental H Heal ealth th H His isto tory/Status

Major Depression Disorder History of trauma (remote) In winter rarely leaves her bed Denies suicidality Refuses counselling Has attended 1:1 “Craving Change” sessions with our Chronic disease Nurse but would not attend the associated group

Most often apathetic about making life changes, ‘I don’t care enough”. Patient is pleasant with sarcastic and witty communication pattern and somewhat victim-oriented thought pattern.

Social al H His isto tory/Statu tus

Divorced, lives alone Retired Police Dispatcher Isolates self from others, friends Reports she uses her weight as “armour” to keep people away, particularly men

Nutrit itio ional nal H Histo tory/Statu tus

Query binge eating disorder: describes buying cookies and eating the entire bag in bed Refers to self as a “sugar addict” Exercise is limited to walking to fridge and bedroom most days, with periods of pursuing walking down hall of appt building and in grocery store; has a Fit Bit Periods of working toward change with NP and Chronic Disease Nurse for the purpose of staying alive for her grandchildren, and being able to have them sit on her lap, then returns to overeating patterns stating she doesn’t care

Recommend ndations ns

Med edical al & S & Surgical al

• Omega 3 (caution b/c pt on blood thinner)
• Possible medication therapy (Contrave, Saxenda)
• Referral to Medical Program through OBN
• Ensure medically stable for sx interventions

Nutr triti tion & & L Lif ifesty tyle

• Screen for binge eating disorder
• Referral to community RD to support with nutritional knowledge
• Food/Mood journaling
• Explore why Craving Change strategies are not working for pt.
• Would need to see demonstrated diet and lifestyle changes

Psych chiatric & & Psych cholog logica cal

• Explore other medication possibilities outside of Pristiq
• Trauma therapy
• Would need a mental health support following pt throughout sx process/able to see more
• ngoing post-operatively
• Referral to psychiatrist in Bariatric Clinic

Soci

• cial (Inc

ncluding ng support n net etwork, f financ nces es, em employment nt, a and nd housing ng)

(including support network, finances, employment and housing)

• Identify any personal supports
• Examining her drive for sx, is it self driven or pressures from medical professionals to

decrease weight to assist with comorbidities