Review the case study information and type your answers toquestions 1-3 below.
Michael is a 67-year-old white man who is a lifelong resident ofSherman Oaks, CA, a suburb of Los Angeles. He was a high schoolfootball star and now runs a small landscaping business andvolunteers as a local football coach. He enjoys taking walks in apark that is next to a large freeway. Sometimes he will go on aneasy hike in the nearby hills with his wife, Lisa. They are happilymarried 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 notedthat he had been complaining about having to move more slowly atwork and at football practices, too.
Michael is coming in for a regular check-up appointment. He hasbeen taking Sinemet (mix of levodopa and carbidopa) and Neupro(rotigotine) to control his symptoms. His symptoms are wellmanaged, but he’s experienced some nausea and dizziness on thesemedications that he just lives with because they keep himfunctional. He also takes coenzyme Q10, St. John’s Wort, and a highpotency multivitamin with 75 mg pyridoxine.
He is 6’0” and currently weighs 160 lb. He was 180 lb at hislast visit 3 months ago. Lisa thinks he’s lost a little weight, butisn’t sure. He’s always been fit and lean. What she has noticed isthat they don’t talk as much during meals anymore and that it takeshim a long time to finish his food. After speaking with the couplefor a while, Lisa remembers one time recently when she’d made hisfavorite banana bread and the whole house smelled amazing, but hedidn’t notice. Her feelings had been hurt. She admits thatsometimes he loses interest and doesn’t seem to have the energy tofinish his meals. When she encourages him to eat, he can be eitherapathetic 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 byslow eating pace.
Nutrition care questions
- What dietary advice do you have for Michael and hiscaregiver?
- What other evaluations does Michael need?
- What possible food-drug interactions could be occurring?
- What strategies can Michael use to decrease his exposure to carpollution and herbicides?
