Isabel's Digestive Problems
Isabel, a 24-year-old Latina, was recently married and began cooking at home. She enjoys preparing the spicy foods her mother taught her to cook. When she cooks for herself and her husband, they often eat large meals with lots of beans, rice, and sausage with lard. She has also noticed weight gain since her wedding. At her annual wellness exam, she asks her Nurse Practitioner if she could be referred to a physician specializing in “stomach or heart problems.” Isabel has been experiencing chest or upper abdomen pain nearly every evening, especially before bed or when lying down. Her husband thinks it's heartburn, but Isabel didn't understand what heartburn meant until she researched it online. Now, she suspects her diet might be a factor.
Here is a brief excerpt from her conversation with her Primary Care Physician:
**Doctor:** So, tell me more about this pain you mentioned.
**Isabel:** The pain in my chest occurs most nights around 9 or 10 pm. We usually eat dinner late—around 8 pm, because it takes a while to cook after work.
**Doctor:** Do you have any known food or other allergies?
**Isabel:** No.
**Doctor:** How about medications? Are you currently taking any? Have you recently started or stopped any?
**Isabel:** No.
**Doctor:** Does anyone you know have this problem?
**Isabel:** My mom always complained about "the burn in her chest" after spicy meals, but I thought she was exaggerating. Now I think I understand what she meant.
**Doctor:** Do you have any family history of other medical conditions?
**Isabel:** My dad died of a heart attack when I was 14. My grandparents all passed from different types of cancer. My mom is pretty healthy.
**Doctor:** What have you eaten so far today? (It is 11 am)
**Isabel:** A chorizo & pepper omelet that my husband made for me. That's the one thing he loves to cook—omelets!
**Doctor:** Ok, let's return to the chest pain. When did you first notice this problem?
**Isabel:** About six weeks ago.
**Doctor:** And how often does it occur?
**Isabel:** Every night. The only time I don't get it is when I eat something really bland for dinner, like a sandwich.
**Doctor:** Do you have any other symptoms besides chest pain?
**Isabel:** I've noticed a dry cough lately, and my throat gets sore on and off. I also have constant bad breath—my husband mentioned it, so I've been brushing and chewing gum more often.
**Doctor:** Does the pain extend beyond your chest, like to your neck, shoulders, or arms?
**Isabel:** No.
**Doctor:** How would you describe the pain?
**Isabel:** Like a burning or stabbing sensation.
**Doctor:** On a scale from 1-10, with 10 being the worst pain you've ever felt, where would you rank the pain on an average night?
**Isabel:** Between a 4 and a 6.
**Doctor:** Once it starts each night, how long does it usually last?
**Isabel:** About 30 minutes to an hour, sometimes longer.
**Doctor:** Have you noticed anything that makes it worse?
**Isabel:** Eating a lot or when it's really spicy, it's worse than usual.
**Doctor:** Have you tried anything that makes it better?
**Isabel:** I've tried Tums, but they don't help much. It's better if I stay standing or sitting rather than lying down.
Answer the following questions:
1. What recommendations would you make to Isabel to alleviate her heartburn?
2. What suggestions could you offer Isabel to help her lose weight?
3. Would you suggest that Isabel give up Hispanic foods, or can she eat ethnic foods and still be healthy? Please explain your answer.
