Isabel's digestive problems
isabel, a 24-year-old latina, was recently married and started doing lots of home cooking. she likes to prepare the spicy foods that her mom taught her how 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 found that she has gained weight since the 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.” apparently, isabel has been feeling a pain in her chest or upper abdomen nearly every evening, especially right before bed or right when she lies down. her husband tells her it must be heartburn, but truthfully isabel did not understand what heartburn really meant until she googled it. now she is starting to suspect that maybe her diet is involved.

here is a brief excerpt from her conversation with her primary care physician:

doctor: so tell me more about this pain you mentioned.

isabel: well the pain in my chest is happening most nights around 9 or 10 pm. we usually eat dinner late--around 8 pm because it takes a while to cook after we get home from work.

doctor: do you have any food or other allergies you know about?

isabel: no

doctor: how about medications. you said you aren’t currently taking any? did you recently start or stop any?

isabel: no

doctor: does anyone you know have this problem?

isabel: my mom always used to complain about “the burn in her chest” after our spicier meals, but i thought she was being dramatic. now i think i know what she meant.

doctor: do you have any history of other medical conditions in your family?

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 does love to cook--omelets!

doctor: ok, let’s get back to the chest pain. when did you first start noticing this problem?

isabel: about six weeks ago.

doctor: and how often does it happen?

isabel: every night. the only time i don’t get it at night is if i eat something really bland for dinner, like a sandwich.

doctor: do you have any other symptoms or issues besides the chest pain?

isabel: well, i’ve noticed more of a dry cough lately and my throat keeps getting sore on and off. i also have this constant bad breath--my husband made a comment the other day, so i’ve been brushing my teeth and chewing on gum more lately.

doctor: does your pain in your chest extend anywhere beyond your chest region-- for example, to your neck, shoulders, arms, etc.?

isabel: no

doctor: and how would you describe the pain?

isabel: sort of like a burning/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 you feel on an average night?

isabel: anywhere between a 4 and a 6, i guess.

doctor: and once it starts each night, how long does it usually last?

isabel: about 30 minutes to an hour, but sometimes longer.

doctor: is there anything that you’ve noticed makes it worse?

isabel: generally when i eat a lot or it’s really spicy, it’s worse than usual.

doctor: is there anything you’ve tried that makes it better?

isabel: i’ve tried tums but they don’t really much. if i keep standing or sitting, it’s better than laying 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 her lose weight?

3.would you suggest that isabel give up hispanic foods or can she eat ethnic foods and still be healthy? explain your answer.