Musculoskeletal Function

G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

Name the most common risks factors for Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.

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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Case Study 1: G.J.

Osteoarthritis vs. Osteoarthrosis

Osteoarthritis (OA): A degenerative joint disease characterized by the breakdown of cartilage, leading to pain, stiffness, and loss of joint function. It is a progressive disease that often affects weight-bearing joints like the knees and hips.
Osteoarthrosis: An older term that is less specific and may refer to any joint degeneration, including osteoarthritis.

Risk Factors for Osteoarthritis in G.J.

Age: Older age is a significant risk factor for osteoarthritis.
Obesity: Excess weight puts additional stress on the joints, particularly the knees and hips.
Joint Injury: Previous injuries to the knees can increase the risk of osteoarthritis.
Genetics: A family history of osteoarthritis can increase susceptibility.

Osteoarthritis vs. Rheumatoid Arthritis

Feature	Osteoarthritis	Rheumatoid Arthritis
Onset	Gradual	Often rapid
Joint Involvement	Usually affects a few joints, often asymmetrically	Typically affects multiple joints, often symmetrically
Morning Stiffness	Mild and short-lived	Severe and prolonged
Systemic Symptoms	Usually absent	Often present (fatigue, fever, weight loss)
Diagnostic Tests	X-rays showing joint space narrowing	Blood tests showing rheumatoid factor and anti-CCP antibodies

Treatment for G.J.’s Osteoarthritis

Non-Pharmacological Treatment:

Weight Loss: Encouraging weight loss can significantly reduce joint stress.
Physical Therapy: To improve strength, flexibility, and range of motion.
Occupational Therapy: To adapt daily activities and promote independence.
Assistive Devices: Canes, walkers, or braces can help with mobility and pain relief.

Pharmacological Treatment:

Topical Analgesics: Can provide localized pain relief.
Oral Analgesics: Over-the-counter pain relievers like acetaminophen or ibuprofen can be used for mild to moderate pain.
Topical Corticosteroids: Can be injected into the affected joints for short-term relief.
Hyaluronic Acid Injections: Can provide long-lasting relief by lubricating the joint.

Osteoporosis Prevention

Diet: Encourage a diet rich in calcium and vitamin D.
Exercise: Regular weight-bearing exercise can help strengthen bones.
Medication: If indicated, consider bone-strengthening medications like bisphosphonates or denosumab.

Case Study 2: H.M.

Risk Factors for Alzheimer’s Disease

Age: Advanced age is the primary risk factor.
Family History: A family history of Alzheimer’s disease increases the risk.
Genetics: Specific genetic mutations, such as APOE4, can increase susceptibility.

Alzheimer’s Disease vs. Other Dementias

Feature	Alzheimer’s Disease	Vascular Dementia	Dementia with Lewy Bodies	Frontotemporal Dementia
Onset	Gradual	Sudden or stepwise	Gradual	Gradual
Memory Impairment	Significant memory loss	Variable memory impairment	Significant memory impairment	Early and prominent behavioral changes
Motor Symptoms	Gait disturbances and balance problems later in the disease	Early motor symptoms, such as gait instability and falls	Early motor symptoms, such as parkinsonism	Early changes in behavior and personality

Diagnostic Criteria for Alzheimer’s Disease

The National Institute on Aging and Alzheimer’s Association criteria for Alzheimer’s disease include:

Impairment in memory and learning
Impairment in one or more cognitive domains
Functional impairment in daily living activities

Therapeutic Approach for H.M.

The best therapeutic approach for H.M. would involve a multidisciplinary team, including a geriatrician, neurologist, and social worker. The focus should be on:

Medication: Cholinesterase inhibitors and memantine can help manage cognitive symptoms.
Non-Pharmacological Interventions: Regular physical activity, cognitive stimulation, and social engagement can help slow cognitive decline.
Supportive Care: Addressing behavioral symptoms, providing assistance with activities of daily living, and ensuring safety.
Family Support: Educating and supporting family members to help them cope with the challenges of caring for a loved one with dementia.

By addressing the underlying causes of cognitive decline and providing appropriate support, it may be possible to slow the progression of the disease and improve the quality of life for individuals with Alzheimer’s disease.

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