A 35-year-old male, Mr. NX, presents to your clinic today with complaints of back pain and “just not feeling good.” Regarding his back, he states that his back pain is a chronic condition that he has suffered with for about the last 10 years. He has not suffered any specific injury to his back. He denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, and denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. He describes the pain as a constant dull ache and tightness across the low back.
He states he started a workout program about 3 weeks ago. He states he is working out with a friend who is a body builder. He states his friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so he started those medications at the same time he began working out. He states he also takes Kava Kava for his anxiety and garlic to help lower his blood pressure.
His historical diagnoses, currently under control, are:
Type II diabetes since age 27
High blood pressure
Recurrent DVTs
His prescribed medications include:
Glyburide 3 mg daily with breakfast
Lisinopril 20 mg daily
Coumadin 5 mg daily
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Expert Solution Preview
Introduction:
The patient, Mr. NX, presents with chronic back pain and a feeling of general malaise. He has recently started a workout program and is taking several supplements and medications for diabetes, high blood pressure, and recurrent DVTs.
1. What are some potential causes of the patient’s chronic back pain?
Possible causes of chronic back pain include degenerative disc disease, spinal stenosis, herniated discs, osteoarthritis, and muscle strain. Given the patient’s lack of specific injury, it is possible that his back pain is related to one of these conditions.
2. What potential drug interactions should be considered with the patient’s current medication regimen and supplement use?
Creatine supplementation may increase the risk of bleeding when taken with anticoagulants such as Coumadin. Kava Kava may interact with Coumadin as well, and has been associated with liver damage. Coenzyme Q10 is generally well tolerated, but may interact with blood pressure medications such as lisinopril. Garlic may also increase bleeding risk and interact with blood pressure medications. It is important for the patient to inform his healthcare provider of all supplements and medications he is taking to monitor for potential adverse effects and drug interactions.
3. What additional information would be important to gather from the patient’s history and physical examination?
Further information would be important to gather regarding the patient’s workout program, including specific exercises and frequency of workouts, as well as any previous injuries or pain related to exercise. A thorough neurological examination would also be necessary to rule out any radicular symptoms or weakness. Blood work including an complete blood count, metabolic panel and an A1C hemoglobin test would provide additional information regarding the status of his diabetes and its onset.
