Colon Cancer
A Major Case Study
By: Emily Macieiski
Introduction:
J.W. is a 53-year-old male who was admitted to Atrium Medical Center (AMC)
with anemia and abdominal pain. He also presented with an elevated HgA1c of 9.02%.
His admission weight was 183 pounds, and he is 5’11”. His BMI upon admission was
26.47 kg/m2; classifying him as overweight. J.W. was admitted on February 19, 2014,
and was assessed on January 21, 2014 due to the elevated HgA1c, placing him at
“moderate” nutritional risk. He was discharged from AMC on February 26, 2014. J.W.
was chosen for this study because of his positive outlook on life, even when things were
not going well for him at the moment. Also, he has no past medical history. During his
stay at AMC he was diagnosed with both type II diabetes mellitus and stage IIIB colon
cancer. The fact that he was so enjoyable and had such a positive outlook, despite all the
hardships he was currently going through, made him really stand out among most
patients. The focus of this study will be on colon cancer, because of the fact that J.W.
will have to battle this disease for quite some time.
Social History:
J.W. used to fly planes, and became homeless after he turned down a pilot job due
to his ailing health. He is single and has no children. His brother lives in the area and
visited him often during his stay at AMC. J.W. has no health insurance, so he was unsure
how he would be paying for the expenses from his stay. Since he has barely any money,
his food supply is less than adequate and far from nutritious. He also does not smoke or
drink alcohol.
Normal Anatomy and Physiology of Applicable Body Functions:
The colon and rectum are parts of the gastrointestinal (GI) system. The stomach
and the small intestine make up the first part of the GI tract. This is where food is
processed for energy. The colon and the rectum make up the last part of the GI tract,
where solid waste is passed out of the body. The small intestine is about 20 feet long. It
is narrower than the large intestine but longer than the large intestine, which is only 5 feet
long.1
The colon has four different sections: ascending colon, transverse colon,
descending colon, and sigmoid colon. The ascending colon starts with the cecum, where
the small bowel attaches to the colon and extends up to the right side of the abdomen.
The transverse colon extends across the body from the right to the upper, left abdomen.
The descending colon extends downward on the left side of the abdomen. The sigmoid
colon extends in the shape of an “S.” After the waste travels through the various parts of
the colon it is considered stool, and then flows into the rectum; the last six inches of the
digestive system. The stool is stored in the rectum until it is passed through the anus.1
Past Medical History:
J.W. does not have any past medical history.
Present Medical Status and Treatment:
Colorectal cancer is the third most common cancer (excluding skin cancers)
diagnosed in men and women in the United States. In 2014, according to the American
Cancer Society’s estimates for colorectal cancer, there are 96,830 new cases of colon
cancer and 40,000 new cases for rectal cancer.1 The risk of developing colorectal cancer
is about 1 in 20 (5%). It is the second leading cause of cancer-related deaths in men and
women combined, making up about 50,310 deaths during 2014.1 Over the past 20 years,
death rates have been dropping. There are now more than 1 million survivors of
colorectal cancer in the U.S.1
Certain risk factors can contribute to developing colorectal cancer. About 90%
of people with this disease are over the age of 50. 2 The average age of diagnosis is 72
years old. A personal history of colorectal polyps increases the risk of developing
colorectal cancer. Also, if one has already had colorectal cancer, even though it was
removed, there is an increased risk of developing new cancers in other areas of the colon
and rectum. Those with type II diabetes have an increased risk as well, especially with a
less favorable prognosis. Inflammatory bowel disease (IBD), which includes ulcerative
colitis and Crohn’s disease, increases the risk of developing the disease. In addition, it
often occurs in people with a family history of the disease or adenomatous polyps. About
5-10% who develop the disease have inherited mutations that cause it.1 First-degree
relatives with a history of colorectal cancer are at an even higher risk.
The two most common inherited syndromes linked with colorectal cancers are
familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer
(HNPCC). FAP is caused by mutations in the APC gene that is inherited from parents.
About 1% of colorectal cancers are caused by the mutation of the FAP gene.1 Those
individuals with FAP usually start having problems in their early teens or adulthood.
Hundreds and thousands of polyps can form, and cancer usually develops by age 20.
Usually by age 40 many people with FAP will already have colon cancer if the colon is
not removed. The second inherited syndrome, HNPCC (or Lynch syndrome), accounts
for about 2-4% of colorectal cancers.1 Usually this disorder is the result of the genes
MLH1 or MSH2. Unlike FAP, this syndrome only causes a few polyps and does not
begin at such an early age. However, individuals with this syndrome can be at an 80%
increased risk in developing the disease.1
The other three syndromes linked with the disease are Turcot syndrome, PeutzJeghers syndrome, and MUTYH-associated polyposis.1 Turcot syndrome consists of two
types: one can be caused by mutations in which cases the brain tumor are
medulloblastomas, and the other can cause mutations in which cases the brain tumors are
glioblastomas.1 Those with the rare, inherited condition known as Peutz-Jeghers
syndrome have freckles around the mouth, and a type of polyp known as hamartomas, in
their digestive tracts.1 This syndrome is caused by the mutations in the gene STK1.
Finally, those with MUTYH- associated polyposis develop colon polyps, which can
become cancerous if the colon is not removed.1 There is also an increased risk in bladder,
ovarian, skin, and small intestine cancers as well.
Life-style related factors also play significant roles in the risk of developing
colorectal cancer. Diet, weight, and exercise are very significant in colorectal cancer
risk. These certain life-style risk factors include: diet high in red meats and processed
meats, physical inactivity, obesity, smoking, and heavy alcohol abuse.3
Colorectal cancer begins when healthy cells that make up the lining of the colon
or rectum change and grow uncontrollably.4 These cells can eventually form a mass or
tumor, and can either be benign (noncancerous) or malignant (cancerous). Colorectal
cancer usually begins as a polyp, a noncancerous growth that may develop on the inner
wall of the colon or rectum. Adenomatous polyps can change into cancer. Hyperplastic
and inflammatory polyps are usually not pre-cancerous. Most polyps form a mound on
the wall of the colon, while about 10% are flat and difficult to find with a colonoscopy.4
These types of polyps require a dye to show that they exist. If cancer forms in a polyp, it
can eventually grow into the wall of the colon or rectum. Cancer can then spread to the
blood or lymph vessels, lymph nodes, and to different parts of the body, such as the liver,
lungs, peritoneum, or a woman’s ovaries.4 This spread of cancer throughout distant parts
of the body is called metastasis. During this process, cancer cells can start to grow and
develop new tumors.
Colorectal cancer may cause a variety of different symptoms. These include: a
change in bowel habits, such as diarrhea, constipation, or narrowing of the stool; pain
without a bowel movement; feeling that the bowel does not empty completely; rectal
bleeding, dark stools, or blood in the stool; cramping or abdominal pain; weakness and
fatigue; and/or unintended weight loss.1 J.W. presented to AMC with many of these
symptoms, including abdominal pain, unintentional weight loss, fatigue, weakness,
diarrhea, and constipation.
J.W.’s medications can be found in Appendix 1.5
Laboratory values can be found in Appendix 2.
There are different tests to diagnose cancer and to find out if it has spread. Most
often people will develop symptoms after the cancer has already developed. If a person
develops with any of the signs or symptoms for colorectal cancer, a doctor will review
medical history and conduct a physical examination. Different blood tests may be
ordered, such as complete blood count, liver enzymes, or tumor markers (CEA).1 High
levels of CEA can indicate that the cancer has spread to different parts of the body. It is
often used as a marker in those already receiving treatment, versus screening or
diagnosing. Sometimes colorectal cancer bleeds into the large intestine or rectum. People
with this disease may then become anemic. In J.W.’s case this did occur, because his
doctor diagnosed him with microcytic anemia. In addition, there are certain tests and
procedures that can be done to detect colorectal cancer. These include: colonoscopy,
biopsy, molecular testing of the tumor, CT scan, MRI, ultrasound, chest x-ray, and PET
scan.1
The different types of treatment for colon and rectal cancer include surgery,
radiation, chemotherapy, and targeted therapy. For the colon, an open colectomy,
laparoscopic assisted colectomy, or polypectomy can be done. A colectomy (sometimes
called hemicolectomy, partial colectomy, or segmental resection) removes part of the
colon and nearby lymph nodes.1 A laparoscopic assisted colectomy involves a small
video camera that allows the surgeon to see inside the abdomen and remove the diseased
part of the colon and nearby lymph nodes.1 A polypectomy involves the removal of a
polyp through a colonoscope.1
For rectal cancer a polypectomy can be performed, where an instrument is
inserted through the anus and polyps are removed. In a transanal resection, an instrument
is inserted through the anus and cuts through all the layers of the rectum to remove any
cancerous tissues.1 Low anterior resections are for more advanced stages of colorectal
cancer, such as stage II or III. This procedure is used in rectal cancers that are closer to
the colon. In this operation, the part of the rectum containing the tumor is removed. The
colon is then attached to the remaining part of the rectum, so that bowels can move
regularly after surgery.1 Sometimes the entire rectum will need to be removed in most
stage II and III rectal cancers. This is called a proctectomy. With a colo-anal
anastomosis, the colon can be connected to the anus.1 An abdominoperineal resection
(APR) can be used to treat some stage I and stage II and III rectal cancers in the lower
part of the rectum, near the anus. In this procedure, the surgeon will remove the anus,
sphincter muscle, and tissues around it.1 A permanent colostomy will be needed after the
procedure. Finally, a pelvic exenteration is recommended if the rectal cancer is spreading
to nearby organs. The rectum will be removed, along with the bladder, prostate in men,
or uterus in women if the cancer has spread.1 A colostomy will be needed due to the
removal of the rectum. A urostomy will be needed if the bladder is removed.
Radiation therapy is another treatment for either colon or rectal cancer. Radiation
therapy involves high-energy rays or particles to destroy cancer cells. It can be used in
those with colon cancer that has spread to the lining of the abdomen or other organs. It is
also used to help treat cancer that has spread to the bones or brain. For rectal cancer,
radiation therapy can either be given before or after surgery. This helps prevent the
cancer from coming back. It is usually given along with chemotherapy, known as
chemoradiation.4 Chemoradiation is often used in rectal cancer patients before surgery to
avoid a colostomy, reduce scarring of the bowel where radiation was given, and decrease
the chance the cancer will recur.4 Certain side effects of radiation therapy include: skin
irritation at the site of radiation; nausea; rectal irritation causing diarrhea, painful bowel
movements, or blood in the stool; bowel incontinence; bladder irritation;
fatigue/tiredness; and/or sexual problems.1
Chemotherapy is another colorectal cancer treatment route. It can be given in
different ways: systemic or regional. Systemic chemotherapy uses drugs that are injected
into a vein or given by mouth.1 These drugs then enter the bloodstream and travel to all
different areas of the body. In regional chemotherapy, drugs are injected directly into an
artery leading to a part of the body containing a tumor.1 This approach causes fewer side
effects. There are also various drugs that can be used to treat colorectal cancer.
Chemotherapy cycles usually last about two to four weeks, and people usually get several
cycles of treatment for about six months. The drugs most often used for colorectal cancer
include: FOLFOX (a type of combination chemotherapy used to treat colorectal cancer);
Camptosar (used when colon cancer has metastasized or returned); Avastin (used when
colorectal cancer has spread, it starves tumors of blood and oxygen); Erbitux (it helps to
stop cancer cells from reproducing); or Vectibix (used when colorectal cancer has spread
despite chemotherapy). 3 The common side effects of these drugs include: hair loss;
mouth sores; loss of appetite; nausea and vomiting; low blood counts. Chemotherapy can
also lead to increased infections, easy bruising or bleeding, and fatigue.1
Those with colorectal cancer are given stages in with their diagnosis. The stage
helps describe where the cancer is located, if or where it has spread, and whether or not it
is affecting other parts of the body.1 The stage is an important factor in determining
prognosis and treatment options.4

Stage 0: Also known as “carcinoma in situ”, where the cancer cells are
only found in the mucosa (inner lining) of the colon or rectum.

Stage I: The cancer has grown through the mucosa and has invaded the
muscular layer. It has no yet spread to lymph nodes or distant sites.

Stage IIA: The cancer has grown into the outermost layers of the colon or
rectum, but as not gone through them.

Stage IIB: The cancer has grown through the layers of the muscle to the
visceral peritoneum. It still has not spread.

Stage IIC: The tumor has spread through the wall of the colon or rectum
and has grown into or attached to nearby tissues or organs.

Stage IIIA: The cancer has grown through the inner lining or into the
muscle layers of the intestine. It has spread to one or three lymph nodes,
or into other areas of fat near the lymph nodes.

Stage IIIB: The cancer has grown through the bowel wall or into
surrounding organs. It has spread to one to three lymph nodes.

Stage IIIC: The cancer of the colon, regardless of how deep it has grown,
has spread to four or more lymph nodes, but not to other distant parts of
the body.

Stage IVA: The cancer has spread to one other part of the body, such as
the liver or lungs.

Stage IVB: The cancer has spread to more than one distant organ or set of
lymph nodes, or it has spread to distant parts of the peritoneum.
During J.W.’s stay at AMC, an ultrasound was done and showed a mass-like area
in the abdomen as well as a cyst in the right kidney. A GI consult was placed to have an
EGD/colonoscopy with a small bowel biopsy and rectal polypectomy. The postoperative
diagnoses included diverticulosis, mass in the colon, and rectal polyp. Also, in the mid to
proximal transverse colon, there was a mass that was most likely cancerous. On February
21, a right hemicolectomy procedure was done. A right hemicolectomy is a surgical
procedure performed on those patients with cancer between the cecum and ascending
colon. J.W. would have to wait for the pathology results. An oncology consult was
placed due to the likelihood that the mass would be cancerous. On February 24, the
pathology results showed that J.W. had stage IIIB colon cancer. With this stage, surgery
(colectomy) and adjunct chemotherapy (chemo after surgery) are the standard
treatments.6 Adjunct chemotherapy works by killing any cancer cells that may have been
left behind after surgery.6 It helps kill the rest of the cells that may have escaped from the
tumor and spread to different parts of the body. J.W. would need to have a port placed in
the future for chemotherapy.
Medical Nutrition Therapy:
Due to the fact that J.W. is homeless, he is never sure when his next meal will be,
where it will be, or what it will be. J.W. reports that since he only has a limited amount
of finances, he can only afford to purchase really cheap food items. He will accept
anything that is offered to him. Since it was difficult to obtain a usual eating pattern,
J.W. provided an example of a day’s worth of food. For breakfast, he will have about 1
cup of oatmeal. For lunch, he will have two McDonald’s cheeseburgers. For supper, he
will have potato chips and a slice of pizza. Provided below is an example of a 24-hour
recall in J.W.’s day. This diet was analyzed using “Super Tracker” from the USDA
website.7
Calories
1887 kcals
Protein
88 grams
Carbohydrate
171 grams
Fiber
14 grams
Total fat
96 grams
Saturated fat
38 grams
Cholesterol
241 mg
Sodium
3618 mg
J.W. was placed on the diabetic high diet during the later part of his stay. At first,
he was NPO for the EGD/colonoscopy and the hemicolectomy. After that, he was placed
on full liquids on February 22. The doctor advanced him to a Regular diet on February
24. Since he was recently diagnosed with diabetes, it was important for him to maintain
good blood sugar control. A “Dear Doctor” note was left requesting that J.W. be placed
on the diabetic high det. The diabetic high diet limits calories to 2,000-2,500, cholesterol
<200 mg, sodium 2300-2400 mg, and total fat to 25-35% of calories. The daily
carbohydrate allowance on a diabetic high diet is about 225-240 grams/day. Not many
people at AMC are placed on the diabetic high diet. The reason he needed those extra
calories was because of his significant weight loss and malnutrition. Using the Hamwi
formula for ideal body weight, J.W. should be around 165 pounds. His estimated energy
needs were based on 25-30 kcal/kg. This calculated out to be around 2,075- 2,490
calories/day. His protein needs were based on 1.0-1.2 grams/kg due to his protein-energy
malnutrition from unintentional weight loss. This calculated out to be around 86-100
grams protein/day. After it was confirmed that J.W. had stage IIIB colon cancer, his
estimated needs were increased. His estimated energy needs were increased to 30-35
grams/kg and his protein needs increased to 1.2-1.5 grams/kg. Therefore, his estimated
calorie needs were 2,430-2,835, and his protein needs were 97-122 grams/day.
J.W understood the need to be on the diabetic diet at AMC. During his stay he
was constantly given education on diabetes management due to his new diagnosis. Since
he was dealing with the new diagnosis of colon cancer as well, J.W. had a lot to deal
with. It would not be easy trying to manage his diabetes on top of starting chemotherapy
to treat his colon cancer. J.W. was intelligent enough to learn how to manage his
diabetes. He was given the “Diabetes Inpatient Survival Skills” book that is full of
information on diabetes management. Various nurses reviewed the material with him.
During J.W.’s stay at AMC, the following nutrition related problems with
supporting evidence were used:

Unintended weight loss related to malabsorption as evidenced by 75
pounds weight loss (29%) over 6 months.

Altered nutrition-related lab values related to newly diagnosed DM as
evidenced by HgA1c of 9.0%.

Increased calorie and protein needs related to newly diagnosed colon
cancer stage IIIB as evidenced by biopsy results.

Altered GI function related to changes in motility as evidenced by
constipation x 5 days.
Since J.W. was so malnourished from his unintentional weight loss, he agreed to
drink a Glucerna oral supplement three times per day. During his stay, he actually lost an
additional five pounds. He was very accepting and willing to try anything that would
provide him with extra calories and protein. His oral intake on the diabetic high diet was
excellent; 100% of most meals. He drank every Glucerna shake that was provided to
him. He was also given Glucerna coupons so that he could purchase them once
discharged.
J.W. was provided with the Academy of Nutrition and Dietetics handouts:
Carbohydrate Counting for People with Diabetes, Fat Content of Foods List, and Fiber
Content of Foods List. The importance of counting carbohydrates, eating meals
consistently, checking blood sugars, and exercising were discussed with him. J.W. stated
that once he felt better he was going to start exercising. He was encouraged to attend the
Diabetes Wellness Center and a pamphlet was provided to him. J.W. was also informed
about the importance of eating fiber-rich foods once his bowels returned to normal. The
importance of avoiding high fat foods (especially red meats) was continually stressed.
He was consuming a lot of red meats before his admission to AMC. His diet was also
lacking fruits and vegetables due to the lack of convenience and availability. He had
issues with constipation during his stay. He did not end up having a bowel movement
until he was discharged on February 26.
J.W. is a very intelligent man. All the diet education that was provided to him he
was willing to learn and apply. His brother was with him during the majority of his stay.
When it was asked where J.W. would be staying, his answer was not with his brother. He
voiced that he would be staying with family friends in the area that would provide him
with food and transportation to get to chemotherapy. It was not voiced why he would not
be staying with his brother. However, his brother was very supportive during J.W.’s stay
at AMC. He asked questions and provided information when J.W. was out of the room.
According to Sylvia Escott-Stump, there are different nutritional
recommendations to follow. A low-fat, high-fiber diet can prevent future polyps, and
reduce the risk of adenoma recurrence. Fiber should be limited until the bowels return to
normal, especially after surgery. Once the bowels start functioning properly, the diet
should be rich in whole gains, fruits, and vegetables (especially cruciferous). Red meat
should be consumed less. Instead, more poultry, fish, tofu, and beans should be
consumed for protein. This will help decrease saturated fat intake. Omitting trans fatty
acids is also suggested. It is also important to consume the healthy unsaturated fats, such
as flaxseed, salmon, canola oil, and olive oil. Caffeine and other stimulants, such as
alcohol and tobacco are strongly discouraged. Drinking 6-8 glasses of filtered water
daily, as well as exercising at least 30 minutes, 5 days a week is encouraged.8
In addition, taking fish oil supplements can be helpful in reducing inflammation.
Eating plenty of protective foods such as calcium-rich foods, lutein and lycopene (tomato
products, watermelon, spinach, kale, greens, broccoli, and pink grapefruit), flavonoids
(apples, onions, green tea, and chamomile tea), and selenium foods (Brazil nuts) is also
encouraged. A multivitamin is beneficial, particularly for folic acid, and vitamins B6 and
D3. Folic acid can also be found in spinach, broccoli, asparagus, avocado, orange juice,
dried beans, and fortified cereals. Dairy products are also encouraged (if tolerated), for
calcium and vitamin D.
Before J.W. was discharged, he was aware that he would need to make a followup appointment to have a port placed for chemotherapy. He was also being sent home
with Metformin, as well as glucose test strips and a meter. His doctor already set him up
to receive a free class at the Diabetes Wellness Center, which he would be attending in
April. It was encouraged that J.W. follow the nutritional guidelines that were provided to
him in the handouts.
Prognosis:
Due to J.W.’s willingness to keep fighting for his life, there is no doubt that he
will take control of his diabetes and colon cancer. His doctor had already set him up for a
free class at the Diabetes Wellness Center, which he stated that he was going to attend.
He also knew that his diet would have to change. Since he would be living with family
friends, food would be provided to him so that he would not have to rely on cheap
McDonald’s cheeseburgers, chips, and pizza for nutrition. He was also willing to start
chemotherapy to kill any remaining cancerous cells. Since his colon cancer is stage IIIB,
it has not yet spread to other organs in the body. The doctors have a lot of faith in him
that he is going to do well, especially with how driven he is to make a full recovery.
Summary:
This case study was definitely an eye-opener. This man could have easily given
up on himself. He was homeless and was also diagnosed with diabetes mellitus and stage
IIIB colon cancer in the span of a few days. However, after speaking with J.W., he was
very calm and collected about his diagnoses. He was willing to learn. He was willing to
do anything he could in order to fight his diabetes and colon cancer. I was able to learn a
lot about him and have quality conversations with him about various topics. He told me
riddles (none of which I could solve), and told me how proud he was in how far I have
come in my career. Despite the fact that so many negative things were happening to him,
he was one of the most positive people I have come into contact with at AMC. I have no
doubt in my mind that he will live a long and happy life. He has what it takes to fight
cancer; willpower and motivation.
Bibliography:
1. "Colorectal Cancer." American Cancer Society, 2013. Web. 21 Apr. 2014.
<http://www.cancer.org/acs/groups/cid/documents/webcontent/003096-pdf.pdf>.
2. "Colon Cancer Treatment." Treatment for Colon Cancer. N.p., 2014. Web. 21
Apr. 2014.
3. "Colorectal Cancer." University of Maryland Medical Center. N.p., 2014. Web.
21 Apr. 2014.
4. "Colorectal Cancer." Cancer.net. American Society of Clinical Oncology, 2014.
Web. 21 Apr. 2014.
5. Pronsky ZM, Crowe JP. Food Medication Interactions. 17th edition. Birchrunville,
PA: Food-Medication Interactions; 2012
6. "Colorectal Cancer." Welcome to the Johns Hopkins Colon Cancer Center. N.p.,
2001-2014. Web. 21 Apr. 2014.
7. "SuperTracker." ChooseMyPlate.gov. United States Department of Agriculture,
2014. Web. 21 Apr. 2014.
8. Escott-Stump, Sylvia. "Colorectal Cancer." Nutrition and Diagnosis- Related
Care. 7th ed. Philadelphia: Lippincott Williams and Wilkins, 2012. 759-62. Print.
9. Mahan, L. Kathleen., and Sylvia Escott-Stump. "Medical Nutrition Therapy in
Cardiovascular Disease." Krause's Food, Nutrition, & Diet Therapy. 11th ed.
Philadelphia: Saunders, 2004. 730-731. Print.
10. "Colon Cancer Nutrition." EMedTV: Health Information Brought To Life.
Clinaero, Inc, 2006-2014. Web. 21 Apr. 2014.
Appendix 1
Drug
Use and Purpose
Cefotan
Antibiotic
Heparin
Anticoagulant
Zofran
Antiemetic,
antinauseant
Sennagen
Laxative,
stimulant
Venofer
Hematinic,
antianemic,
mineral
supplement, iron
deficiency
treatment
Drug/Food
Interactions
N/A
Caution with
diabetes and
ESRDhyperkalemia.
Caution with ↓
hepatic or ↓
renal function
N/A
Side Effects
Blood/Serum
Anorexia, oral
candidiasis and sore
mouth and tongue
with long term use,
nausea/vomiting,
diarrhea
Bleeding,
hemorrhage,
dizziness, headache,
bruising
Eosinophilia
Dry mouth,
abdominal pain,
constipation,
diarrhea, headache,
fatigue, dizziness,
hypoxia, fever/chills,
flushing, hiccups,
rash, drowsiness
N/A
Electrolyte balance
with excessive use, ↑
intestinal peristalsis,
bowel movement in
6-12 hours,
nausea/vomiting,
cramps, diarrhea,
laxative dependence
and loss of normal
bowel function with
long term use/abuse
May take with
Anorexia, dental
food to ↓ GI
stains with liquid
distress, but food forms,
↓ absorption by
nausea/vomiting,
50%. Take one
dyspepsia, bloating,
hour before or 2 constipation,
after bran, high
diarrhea, dark stools
phytate foods,
fiber
supplement, tea,
coffee, red grape
↑ AST, ALT,
PT/INR, ↓
platelets
N/A
N/A
↑ Hb, HCT,
ferritin, Fe, %
transferrin
saturation, ↓
TIBC
Protonix
Decadron
juice/wine, soy,
dairy products or
egg. 200 mg Vit
C/ 30 mg Fe will
↑ absorption.
Meat/fish/poultr
y ↑ absorption.
Take carbonate
antacids, Ca, P,
Zn, or Cu
supplemented
separately by ≥ 2
hour.
Antigerd,
N/A
May decrease
antisecretory
absorption of iron,
decrease absorption
of B12, ↓ gastric acid
secretion, ↑ gastric
pH, diarrhea
Corticosteroid,
Take with food
Esophagitis,
antito ↓ GI effects.
nausea/vomiting,
inflammatory,
Ca-Vit D
dyspepsia, peptic
immunosuppress supplement
ulcer, bloating, GI
ant
recommended
bleeding/perforation,
with long term
↑ appetite, ↑ wt,
use. Caution
negative nitrogen
with
balance due to
grapefruit/relate protein catabolism,
d citrus.
cancer wasting with
long term use, Cr
deficiency may ↑ risk
for steroid induced
diabetes, edema, ↑
BP, insomnia,
masking of infection,
slow healing,
bruising, weakness,
dizziness, headache,
osteoporosis/necrosis
, fractures, muscle
wasting, cataracts,
pancreatitis,
adrenocortical
insufficiency,
Cushing’s syndrome,
↓ growth in children
↑ gastrin
↑ Na,
Glucose, ↓ K,
Ca
Lantus &
Humalog
Antidiabetic,
hypoglycemic
N/A
↑ wt, alcohol ↑
hypoglycemic effect,
caution with severe
hypoalbuminemia,
caution with
decreased hepatic or
renal function, hyper
or hypothyroidism,
hypoglycemia
↓ glucose, Hb
A1c
Appendix 2
Labs- 2/21/14
Glucose
HgA1c
Serum Albumin
CRP
Calcium
Iron
IBC
Hemoglobin
Hematocrit
RBC
MCV
MCH
MCHC
RDW
Actual Lab
358 mg/dl
9.0%
2.3 gm/dl
9.37 mg/dl
8.0 mg/dl
9 ug/dl
240 ug/dl
5.6 gm/dl
22.3%
3.62 m/ul
61.6 fl
15.5 pg
25.1 g/dl
18.8%
Normal Range
70-100 mg/dl
4.2-6.3%
3.5-5.0 mg/dl
0-0.30 mg/dl
8.7-10.2 mg/dl
42-135 ug/dl
250-450 ug/dl
14-18 gm/dl
42-52%
4.7-6.1 m/ul
80-94 fl
27-31 pg
32-36 g/dl
12-15%
High
High
Low
High
Low
Low
Low
Low
Low
Low
Low
Low
Low
High
Labs- 2/24/14
Glucose
HgA1c
Serum Albumin
CRP
Calcium
Iron
IBC
Hemoglobin
Hematocrit
RBC
MCV
MCH
MCHC
RDW
% Neutrophils
% Lymphocytes
Absolute
Lymphocytes
Actual Lab
137 mg/dl
9.0%
2.3 gm/dl
9.37 mg/dl
8.1 mg/dl
9 ug/dl
240 ug/dl
7.8 gm/dl
28.8%
4.20 m/ul
68.6 fl
18.6 pg
27.1 g/dl
25.2 %
78%
11%
0.76 k/ul
Normal Range
70-100 mg/dl
4.2-6.3%
3.5-5.0 mg/dl
0-0.30 mg/dl
8.7-10.2 mg/dl
42-135 ug/dl
250-450 ug/dl
14-18 gm/dl
42-52%
4.7-6.1 m/ul
80-94 fl
27-31 pg
32-36 g/dl
12-15%
40-74%
19-48%
0.9-5.2 k/ul
High
High
Low
High
Low
Low
Low
Low
Low
Low
Low
Low
Low
High
High
Low
Low
Labs- 2/25/14
Potassium
Creatinine
Glucose
HgA1c
Serum Albumin
CRP
Calcium
Iron
IBC
Hemoglobin
Hematocrit
RBC
MCV
MCH
MCHC
RDW
% Neutrophils
% Lymphocytes
Absolute
Lymphocytes
Actual Lab
3.3 MEQ/l
1.6 mg/dl
139 mg/dl
9.0%
2.3 gm/dl
9.37 mg/dl
7.9 mg/dl
9 ug/dl
240 ug/dl
7.9 gm/dl
28.3%
4.12 m/ul
68.7 fl
19.2 pg
27.9 g/dl
25.2 %
74%
14%
0.76 k/ul
Normal Range
3.5-5.3 MEQ/l
0.4-1.5 mg/dl
70-100 mg/dl
4.2-6.3%
3.5-5.0 mg/dl
0-0.30 mg/dl
8.7-10.2 mg/dl
42-135 ug/dl
250-450 ug/dl
14-18 gm/dl
42-52%
4.7-6.1 m/ul
80-94 fl
27-31 pg
32-36 g/dl
12-15%
40-74%
19-48%
0.9-5.2 k/ul
Low
High
High
High
Low
High
Low
Low
Low
Low
Low
Low
Low
Low
Low
High
WNL
Low
Low