Nutrition Case Reflection Template

Name Robert Schmidt S0211495 

/student
number
Patient/ Age / Sex Female, 28 
subject
information
   
  Presentation  Postural problems, fatigue, lethargy, headaches.
 

   
  Investigations/approaches  Thorough history and physical examination. Discovered that the
patient had previously been diagnosed with low iron from blood
 
tests. The patient did not report any heavy or abnormal menses.
Patient was working long hours at work and was not sleeping well.
The poor sleep was a result of stress and neck/shoulder pain. The
patient had not been exercising as much as usual and was not
happy about that. The patient’s diet was reasonable but was not
hitting the RDI’s for iron and calcium. The patient spent the
majority of her day seated behind a desk and was not getting
much natural light. Physical assessment showed forward head
carriage, protruded shoulders, increased thoracic kyphosis and
reduced cervical lordosis. The patient was hypertonic through her
paraspinals, upper traps, levator scapular and sub-occipital
muscles. She had a leg length discrepancy while laying prone and
had some pain on palpation through the left SIJ.
 
 
Biometrics    weight BP …………. ……… ……… ……….
… … .

pre  54 134/78         

  post  54 128/74         

Relevant Medication Dosage Before Dosage After

  Intervention Intervention

N/A
   
  Diagnoses  Postural problems were causing the hypertonicity throughout the
muscles. Hours of sitting and not enough exercise was causing SIJ
 
dysfunction.
Lack of quality sleep was a Ddx for the lethargy. Diet was also
discussed as a cause for fatigue. A regular exercise program was
established along with daily sunshine in the early morning.
 
 

treatment/ Nutrition  
intervention  Options were discussed to increase the daily intake of iron and
calcium. More leafy greens were added to the diet as was
  kangaroo meat for the evening meal. It was decided to try the
  new food plan for one month and then reassess.

Physical activity/rehabilitation  
A weekly exercise plan was established that involved a short walk
and movement pattern in the morning while getting sunshine. Bi-
weekly pilates and weights sessions were started. A 10 minute
evening stretch with a 5 minute meditation was also started.
 
Chiropractic Management  
 Bi-weekly adjustments were planned in to try and restore some
of the C curve and make her body more aware of the posture that
it should be in. Full spinal adjustments and postural assessment
was completed at each session. Advice was given around taking
micro breaks throughout the day and some simple exercises
including chin tucks and thoracic stretching to be performed
during work hours.
Co-management/interdisciplinary  
management  It was discussed that if fatigue had not reduced within a month
that a GP consultation would be completed, and more blood tests
would be performed.

Other  
 

Clinical Process /  The patient responded extremely well to the chiropractic treatment. The pain
summary management / throughout the neck and back reduced and the headache frequency diminished
review significantly. Energy levels increased and the sleep duration and quality improved. The
patient felt better about themselves for doing more exercise. The diet was able to be
stuck too without too much difficulty which helped with compliance.
 

Outcomes /  After a month the patient felt much better about themselves and did have a marked
results improvement with many aspects of their life. Thy did however still feel that they were
fatigued more that what would reasonably be expected. A GP appointment was booked,
and more blood tests were done to check iron levels. It was decided by the GP that an
 iron injection would be the most appropriate intervention. The medication that they
took was Ferinject – 1000mg iron – ferric carboxymaltose injection which is a proven
cost effective way to increase iron levels (Scott, 2018).
 
 
 
Reflections/  
Notes When the patient first presented, they were in pain and feeling very run down. After a history was taken it
was discovered that along with poor posture, she also had lifestyle factors which were influencing her
health. Chiropractic treatment was aimed at fixing the physical posture problems that were influencing her
pain, but advice and guidance were also given to assist in improving the postural problems through
rehabilitation exercise. Suggestions were given for ways of improving sleep cycles and diet advice was also
given to help with the low iron levels.
With a patient like this who had a known long-standing issue of low iron a multimodal approach to her
healthcare would be recommended. As chiropractors we able to offer advice and recommend foods that
people can increase into their diet to help increase micronutrient intake, but we are not qualified to write
food plans. This patient could have benefitted from the help of a dietician or nutritionist, but they chose not
to. Also, with the psycho-social aspect of not being able to sleep due to stress a councilor could have been
used but they had good results just from changing their evening routine.
This does show that sometimes diet alone can not be the silver bullet that fixes all nutritional deficiencies.
Many people with low iron have problems processing and storing it in their body (Chiabrando, Vinchi,
Fiorito, Mercurio, & Tolosano, 2014). Low iron can have negative affects on many aspects of a persons life
including sleep and stress (Control & Prevention, 2002) so it was important that this was addressed with this
patient. Due to iron deficiency being one of the biggest risk factors for disability in the world it was
important to address with issue as soon as possible (Zimmermann & Hurrell, 2007).
Follow up blood tests to my knowledge have not been completed to see if the iron injection had any
physiological effect on the patient. The patient does however feel better and is reporting that they have
more energy and are able to wake up better in the morning.
This patient is still under my care and is receiving weekly chiropractic adjustments to help maintain her
posture and stay pain and headache free. She has been able to maintain the exercise routine and continues
to get some sunshine every morning before starting work. It is important to try and influence people with
their healthcare and to try and follow natural approaches to everything where possible but when a person is
fatigued and run down they would do most anything to feel good again.
It will still be part of my duty of care to help influence her diet in positive ways and to make sure she is
managing her iron levels. The improvements that have happened currently are extremely positive, but it is
important to monitor her health and make sure continues down the path of good health.

 
 
 
 
 
 
 
 
Chiabrando, D., Vinchi, F., Fiorito, V., Mercurio, S., & Tolosano, E. (2014). Heme in pathophysiology: a
matter of scavenging, metabolism and trafficking across cell membranes. Frontiers in
pharmacology, 5, 61.
Control, C. f. D., & Prevention. (2002). Iron deficiency--United States, 1999-2000. MMWR. Morbidity and
mortality weekly report, 51(40), 897.
Scott, L. J. (2018). Ferric carboxymaltose: a review in iron deficiency. Drugs, 78(4), 479-493.
Zimmermann, M. B., & Hurrell, R. F. (2007). Nutritional iron deficiency. The lancet, 370(9586), 511-520.