G.J., a 71-year-old overweight woman, presents to the Family Practice Clinic with a long history of bilateral knee discomfort. Her symptoms worsen with rainy weather and improve with warm and dry weather, but she noticed that her arthritis did not improve over the summer. The discomfort in her left knee is greater than in her right knee. She also experiences low back pain that has been increasingly severe, making it difficult for her to use the stairs in her home. G.J. had previously visited a rheumatologist who prescribed various NSAIDs, which provided only mild relief but caused significant stomach discomfort. Eventually, she found relief with oxycodone, but developed increasing tolerance and began requesting higher doses. The rheumatologist suggested surgery and refused to prescribe more oxycodone. G.J. is now seeking medical care at the Family Practice Clinic. Additionally, G.J. has gained 20 pounds in the past nine months, which has exacerbated her knee pain. Her joints are most stiff when she has been sitting or lying for an extended period, and they tend to “loosen up” with activity. Despite concerns about osteoporosis due to a family history of the disease, G.J. has not experienced any nonclinical manifestations of osteoporosis.
H.M., a 67-year-old female, recently retired from her position as a school teacher after 40 years. Her husband passed away two years ago due to complications of a cerebrovascular accident (CVA). Her medical history includes controlled hypertension with Olmesartan 20 mg once daily. Her family history does not contribute to her current symptoms, and her last annual visits with her primary care physician yielded normal results. H.M. lives alone, but her children visit her regularly. Her daughter noticed that she is having difficulty focusing during conversations, is not as organized at home, repeats and asks the same questions multiple times, and recently had trouble navigating her way back home from the grocery store.
In these two case studies, both patients present with cognitive decline and memory impairment. G.J. demonstrates symptoms consistent with osteoarthritis, while H.M. exhibits features indicative of cognitive decline, possibly related to a neurodegenerative disorder such as Alzheimer’s disease. This analysis will explore the potential underlying causes, implications for treatment, and the role of the Family Practice Clinic in managing these conditions.
For G.J., her longstanding knee discomfort and recent worsening, along with stiffness that improves with activity, are characteristic of osteoarthritis. The fact that her symptoms are worse with rainy weather suggests a potential link between weather changes and joint pain. This phenomenon, known as “weather sensitivity,” has been linked to changes in barometric pressure, temperature, and humidity. While the exact mechanisms are not fully understood, it is thought that these weather factors may affect joint fluid pressure and alter pain perception. Additionally, G.J.’s weight gain may contribute to increased load on her knees, exacerbating the pain. The Family Practice Clinic could consider a multimodal approach to managing G.J.’s osteoarthritis, focusing on weight management, physiotherapy, and appropriate analgesic medications.
In contrast, H.M.’s symptoms suggest cognitive decline and memory impairment. Her difficulty focusing, organization problems, repetitive questioning, and trouble with spatial orientation raise concerns for a neurodegenerative disorder. Alzheimer’s disease is the most common cause of dementia and typically presents with progressive memory loss and cognitive decline. Given her age and the presence of vascular risk factors, it is also essential to consider vascular dementia as a possibility. The Family Practice Clinic could play a crucial role in evaluating H.M. further, referring her for a comprehensive geriatric assessment and neuroimaging studies to aid in diagnosis and treatment planning.
In conclusion, G.J. and H.M. present with distinct clinical features and health concerns. G.J.’s case highlights the impact of osteoarthritis on her daily functioning and the potential role of weather sensitivity and weight management in managing her symptoms. On the other hand, H.M.’s symptoms are suggestive of cognitive decline, potentially due to a neurodegenerative disorder such as Alzheimer’s disease or vascular dementia. Both cases call for a multidisciplinary approach, involving the Family Practice Clinic, to address the patients’ concerns, optimize their care, and improve their quality of life.