The patient is a 42-year-old Asian male of Pakistani descent residing in Plano, Texas. He is currently self-employed as a stock market trader and has worked in this field for the last 15 years. He has been single since his divorce in 2016 (he was married from 2012-2016). He has two biological sons, ages 12 and 16 years old. The information is provided through the patient, who appears to be a reliable historian. The chief concern for this visit is to complete a lipid panel, as the patient reports he is concerned he may have “high cholesterol that runs in his family”.
The patient reports that his father was diagnosed with high cholesterol when he was 35 years old. He also reports that his sister was diagnosed when she was 26 years old. The patient wants to know about natural ways to lower high cholesterol, as he reports eating more red meat and fried foods lately.
He is updated on his immunizations and receives the flu vaccine annually. He received Pfizer for his COVID-19 vaccine and reports he had both doses and one booster, but he cannot recall the dates. He reports only going to his PCP once within the last three years and reports he is not up to date with his year-end annual exam. Denies any food, drug, or environmental allergies. Denies any past transfusions. The patient appears to be in good overall health. Denies any childhood or major adult illnesses. Denies any surgeries other than a hair transplant in 2019. Denies any functional limitations. Denies any medical hospitalizations. The patient denies taking any current prescriptions but reports he takes supplements (2,000 mg of fish oil and three tablets of multivitamins daily).
His parents are still both alive and have been married for sixty years. His father is 78 years old, and his mother is 72 years old. Both of his parents stay home full-time in Pakistan. His father has a medical history of hyperlipidemia. He is currently taking Lipitor 40 mg daily. His mother has a medical history of breast cancer. She was diagnosed with breast cancer in 2019 and is currently undergoing treatment. In 2020, she underwent a double mastectomy. The patient has a 42-year-old sister, alive. She has a medical history of hyperlipidemia and takes Lipitor 20 mg daily. She has three daughters (alive), ages 6, 9, and 11. None of the daughters have any significant medical history. The patient reports he has two sons (alive), ages 12 and 16 years old, and reports both are healthy with no medical problems. The patient cannot recall any medical history regarding his grandparents from either side.
The patient was born in Karachi, Pakistan. He graduated from Karachi High School when he was 17 years old. At 18 years old, he moved to London, UK, and obtained his master’s in business administration from London University. At 24 years old, he moved to Lindenhurst, New Jersey, to obtain his degree in master’s in finance. The patient currently lives alone in a house except when his sons spend time with him. The patient denies any previous admissions. He denies any recreational drug use, smoking, or drinking. He reports going to the gym daily for 1.5 hours. He likes running on the treadmill and weightlifting. He reports that he likes to cook his own meals, eating red meats, vegetables, and fruit. He reports eating fried fish and chips 3-4 times a week. He reports he has an addiction to soda and drinks a can of Coke 3-5 times per week. The patient reports following the Islamic faith and regularly attends the local mosque. The patient is in good hygiene. Reports having access to care as needed. Reports he is not sexually active. The patient reports that the home is clean, with electricity, running water, and access to food. Denies any military service.
The patient denies any fever, chills, weight loss/gain, malaise, night sweats, disturbed sleep patterns, and fatigue. The patient is 6 feet and weighs 155 pounds; his body mass index is 21.0, which is considered healthy. He reports he has always been around that weight. He denies any skin abnormalities such as current hair loss, lumps, dry, itchy skin, nail problems, pigment changes, excessive sweating, and sun sensitivity. He denies any migraines, headaches, dizziness, syncope, head injuries, seizures, and loss of consciousness. He wears contact lenses daily due to impaired vision; he reports he has been wearing contacts since he was 18 years old; prior to that, he was wearing glasses since the age of seven. He denies any eye pain, dry eyes, eye trauma, glaucoma, or worsening vision loss. He denies any hearing loss, ear pain, swollen ears, tinnitus, draining from ears, or vertigo. He denies any nasal congestion, recent colds, obstructions, postnasal discharge, epistaxis, changes of smell, or sinus pain/tenderness. He denies any loss of taste, dry mouth, sores in the mouth or on the tongue, difficulty swallowing, bleeding gums, sore throat, missing teeth, cavities, or hoarseness. He denies any lymph node enlargement or tenderness. He denies any shortness of breath with or without exertion, coughing, coughing up blood, wheezing, cyanosis, sputum, hemoptysis, night sweats, exposure to tuberculosis, and chest pain. Denies any breast lumps, discharge, or tenderness. He denies any irregular heartbeats, lightheadedness, swollen extremities and/or change in color, heart murmur, leg cramps with walking, chest pain, palpitations, dyspnea, orthopnea, claudication, hypertension, any history of myocardial infarctions, or intolerance to exercises. He denies any cardiac testing ever conducted. He denies anemia, abnormal bleeding tendencies, bruising, claudication, thromboses, or blood transfusions. He denies any changes in appetite, digestion, dysphagia, abdominal pain, heartburn, nausea, vomiting, diarrhea, hemorrhoids, food intolerances, blood in stools, jaundice, or constipation. Reports he has a daily bowel movement that is soft and nonpainful. Reports eating the same amount of food. Reports he has a dietary restriction and only eats Halal food and does not consume products that have pork. He does not drink coffee but has a can of Coke 3-5 times per week. Takes fish oil and multivitamins daily. He reports he had oatmeal for breakfast today. He denies thyroid enlargement or tenderness, heat/ cold intolerance, diabetes, polydipsia, polyuria, changes in facial or body hair, increased hat or glove size, or skin striae. Puberty onset was 15 years old. He denies painful erections, testicular pain, penile discharge, or ulcers. He denies any prostate pain, libido issues, or infertility. He denies any pain/burning with urination, changes in urination, difficulty urination, blood in urine, incontinence, or history of STDs. He denies any joint stiffness, pain, restriction of motion, swelling, redness, heat, or bony deformity. He denies any syncope, seizures, weakness or paralysis, tremors, loss of memory, or abnormalities of sensation or coordination. He denies any depression, anxiety, altered sleeping patterns, suicidal/homicidal ideation, or hallucinations.
Familial hypercholesterolemia is the term used when high cholesterol occurs in the family. It is composed of elevated low-density lipoprotein (LDL) cholesterol and can either be autosomal dominant or codominant transmission (Vaezi & Amini, 2022). Familial hypercholesterolemia can lead to serious cardiac problems, such as coronary artery disease, stroke, and even death (Vaezi & Amini, 2022). Familial hypercholesterolemia is usually treated with a drug class called statins. For patients with familial hypercholesterolemia, it is recommended to stop smoking, maintain ideal body weight, and reduce foods that contain cholesterol, trans fat content, and saturated fat, such as whole eggs, fried foods, and red meats (Vaezi & Amini, 2022). Instead, one should eat lean meat, such as salmon and baked chicken. Plant sterols are a natural way to reduce cholesterol and are found in olive oil, pistachios, and almond butter.
Three Generation Genogram
References
Vaezi, Z., & Amini, A. (2022). Familial Hypercholesterolemia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556009/