Case
Female, Vegetarian, 48yrs old, 5' 3", 82 Kg = 180.4 Lbs
Diseases and medications she is taking:
-
Diabetes:
- VoliboM (voglibose analpha glucosidase inhibitos): 0.2/500mg
- Metphormin: 1000mg after dinner (continue)
- Thyroid:
- Thryronom: 75mg on an empty stomach (will be increased to 100 mq)
-
Dermatomyocitis: Muscle weakness auto immune disease
- Steriod: 7.5mg since Nov 2011. Will be tapered to 5 mg starting tomorrow.
- Azoran (azathioprine - immunosuppressive agents): 75mg twice a day since October 2012
- HCQS (hydroxychloroquine - aminoquinoline antimalarial, used in this pt. for Immuno- suppression): 40mg once a day since October 2012
- Chemotheraphy: Cyclophosphomide from April - September 2012 (Finished)
- Migraine:
- Topamac (Cipla): 25mg twice a day
- Propranolol: 40 mg once in a day
- Vit-D deficiency:
- Taking Vit-D
Treatment Recommendation
This patient presents as the occasionally complicated person we can see who would benefit greatly from a VLCD because of inadequate diabetes control. If her dermatomyocytis is clinically stable on the oral meds listed, I think she could do fine on a VLCD. Adequate water intake and glucose med adjustments are a priority. If, however, she is not stable and requires high dose steroid treatment in intervals, I would not do the VLCD. We successfully use the VLCD in stable, treated RA, lupus and other collagen vascular diseases. —Peter H. Jones, MD