Inflammatory Bowel Disease

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C​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ase Study: Inflammatory Bowel Disease Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain. Onset of the symptom was about 4 days ago. She reports thinking she is running a fever but has not taken her temperature. She concerned that she is starting to feel weak. When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months. In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily. She denies recent travel and reportedly has not been on any antibiotics in the past few weeks. In reviewing her record, you notice that her health history is positive for history of ulcerative colitis. She has not been on any medications for this over the last few years as she had not been symptomatic. Mrs. Z is on an oral contraceptive. She takes slippery elm capsules and has for the last several years. She reports that she has been taking 2 to 3 doses of Benef​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​iber prebiotic fiber for the last couple days. Objective data: BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1 Abdomen – active bowel sounds all 4 quadrants, mild tenderness with palpation Otherwise her exam is unremarkable for pertinent positives or negatives. Labs – WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3 • What pharmacologic therapy would you prescribe for Mrs. Z? • How will you evaluate the effectiveness of this therapy? • What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed? • Are there any pharmacogenetic considerations related to what you prescribed for the patient? • Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z? • What, if any, lifestyle changes would you recommend? Instructions: Please prepare and submit a paper 4 pages [total] in length (not including APA 7th ed. format) answering the questions below. Please support your positi​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​on with examples.

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11 Dec ‘14339964.5/5

Brush with death

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By Nicholas Klacsanzky

GanpatipuleI was on an excursion in Ganapatipule, which is a town on the coast on the west side of India, arranged right on the Indian Ocean. I was with my long-term companion, Janu, and his mom, remaining in an inn for a couple of days. The get-away so far was the epitome of unwinding: eating crisp mangoes, getting up late, feasting out constantly (for the most part fish curry), swimming a couple of times each day in the Indian sea, and kidding around with old buddies.

Around three toward the evening on a cloudless day, the sea shore on our side was vacant of individuals other than my companion, his mom, and I. It was liberating to be distant from everyone else on this immense sea shore, known to be a blessed spot among Hindus. Ganapatipule is named after the god Ganesh, and there is a popular Ganesh hallowed place close there where a swayambhu (a model raised from the earth itself as a divine being) is venerated. Washing in the sea around this region should scrub individuals of their pessimism and visiting the place of worship decontaminates people also.

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As I began to swim in the warm sea, hopping over waves, I abandoned my companions. I was wearing a white kurta, or a conventional clothing for men in India, which was overwhelming in the water, however my feet was effectively contacting the sea floor consistently. I generally washed my garments by swimming in the sea when I was there.

In any case, at one moment, I felt that my feet couldn’t contact the sea floor any longer and I dove into the water, weighted somewhere near my garments. The waves continued coming and now they were threatening, as I was getting sucked into the profundities each opportunity they came—regardless of whether I emerged from the water and attempted to swim back to the piece of the sea where I could get an a dependable balance. I had been sucked into a riptide, truth be told, and was stuck in a plunging valley, in spite of my hard endeavors to arrive at security and my hollering to my companions out yonder.

In the wake of battling intensely for a couple, long minutes to conflict with the suction of the riptide, and yelling to my companions out there close to the shore without much of any result, I started to unwind, tolerating my destiny. I never again battled to arrive at the edge of the sea valley to get a decent footing, and during the time spent being maneuvered into the sea and returning up to the surface, I conversed with God so anyone can hear. I talked about what I had fouled up in my life and what I did well. I closed in reflection that my life was satisfying generally speaking, and I felt prepared to bite the dust, tolerating the current condition as the real world.

However as soon I gave up myself to the circumstance, a gigantic wave came and pushed me out of the riptide and the profound valley I was sucked into. On the float of the wave, I arrived close to my companions, who appeared to be bewildered at my demeanor and my expressions of depiction. They were ignorant that I experienced been difficulty. However, it didn’t make a difference at that point—I was glad to arrive at land again and felt my life was reestablished.

I later took in the time I swam was foreboding for swimming at Ganapatipule, as the locals accept the god Ganesh washes around three in evening in the sea there. Maybe Ganesh pardoned me for the interruption, and discharged me from the resentment of the sea against divine convention.

 

 

 

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