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James 54 y/o, male presenting with psoriasis, joint pain and poor sleep…
James 54 y/o, male presenting with psoriasis, joint pain and poor sleep onset.
Causative Factors
Sustaining factors: poor circadian rhythm, prolonged stress, staphylococcal infection (psoriasis & arthritis). Long-term prednisolone use then cessation (HPA dysfunction & liver enzyme elevation).
excitatory factors: perspiration, stress, caffeine, high carbohydrate diet, alcohol use, poor sleep, overactive SNS and less PNS actions.
Predisposing factors: genetics; father and brother have psoriasis / arthritis. Previous sport injuries as a teenager in joint pain areas. Asthma as a child (immunity may be weak).
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Body systems
integumentary system: high inflammation, redness, itchy; psoriasis presentation. Could be associated w/ stress and lack of restorative sleep. psoriasis indicates immune system response is overactive; due to stress, anxiety and genetic predisposition.
Immune & nervous system: low rest and digest actions of the parasympathetic nervous system leading to a constant state of flight (racing thoughts, poor sleep as a result).
recent lab tests show high inflammation markers; poor sleep leading to high cortisol, HPA axis dysfunction (stress exacerbation) & inflammatory cytokines increased. high sympathetic nervous activity, high inflammatory markers from poor sleep leading to anxiety, poor stress responses and integumentary system is impacted due to these factors. Circadian rhythm is disturbed.
muscoskeletal system: possibly arthritis presentation (genetics, previous injuries, high inflammation in lab tests). three joint areas affected (knees, forearms & left scapular); could be polyarticular septic arthritis (Kerin, K (2021). inflammation from liver, immune & cardiovascular system comorbidities could be a factor in muscoskeletal inflammation & pain. Anti-inflammatory factors to ease and prevent further musculoskeletal pain/conditions.
Liver & Gastrointestinal systems: lab analysis show high inflammatory liver enzymes and poor liver function. GIT symptoms show up as reflux/ due to low fatty acid intake high carbohydrate ratio, liver effected.
** Cardiovascular system: Blood pressure reading indicates stage three hypertension (155/90) placing him at significant risk of myocardial infraction or a stroke. His cholesterol is elevated (hyperlipidaemia);
Nervous sx: Short Term: improve sleep onset via increasing production of neurotransmitter GABA (MOA) & normalise circadian rhythm. Anxiolytic/anxiety herbs.
Integumentary system: Short-term aim: ameliorate integumentary inflammation (psoriasis is currently in inflamed phase) to reduce stress, anxiety surrounding itchiness / pain of psoriasis.
Nervous system: Short-term aim: Parasympathetic NS: promote rest & digest actions of PNS to calm overactive sympathetic nervous system. To reduce stress, blood pressure & promote restful sleep.
Integumentary / Immune system: Short-term aim: decrease staph bacteria formation which may be causing psoriasis or arthritis flare-up.
Cardiovascular system: Long-term aim: Preventing further cerebral or cardiovascular complications (i.e. stroke or myocardial). Mechanism of action: alteration of homocysteine levels & lowering blood pressure.
Musculoskeletal system: Long-term aim: Reduce inflammation associated with arthritis presentation. Salix alba, sarsaparilla, turmeric as examples of anti-inflam herbs.