1. Health Improvement Plan By: Ana Tellez

2. Client Overview Gender: Female Age: 21 Education: 9 month program at Anthem college Profession: Chiropractic Assistant Family Situation: Left family home, Lives with boyfriend and two children Chief Complaints: Client has low back pain due to endometriosis. She is unhappy about her weight gain and lack of exercise and unhealthy eating

3. Overview of Health History Weight before Pregnancy: 123-125 lb. Current weight: 163-165lb. Height: 5’2” ft. Adult Illnesses: Endometriosis (20 years old) Family Health History: Asthma, diabetes, high blood pressure Modes of Relaxing: exercising and getting 11 hours of sleep

4. Research Two abdominal muscle patterns were tested in the same group of individuals, and their effects were compared in relation to sacroiliac joint laxity. One pattern was contraction of the transversus abdominis, independently of the other abdominals; the other was a bracing action that used all the lateral abdominal muscles. (Richardson, C., Snijders, C., Hides, J., Damen, L., Pas, M., Storm. J., 2002). This will demonstrate the client the biochemical effect of the exercise for the transversus abdominis known to be effective in low back pain. Dienogest is a selective progestin that has been investigated in a clinical trial programme for the treatment of endometriosis. (Strowitzki, T., Marr, J., Gerlinger, C., Faustmann, T., Seitz, C., 2010). This is some information if client’s body were to accept progesterone in her body. Lindsey Konkel says that pregnant women who don’t gain enough weight lose fat when the fetus grows.(Konkel, L., 2014) This tells the client that if a pregnant woman has inadequate body fat, she could lose fat stores during the last trimester, when the baby grows rapidly. Christine says whether you’re recovering from misjudging a heavy load, dealing with a lingering injury, or have a chronic problem, you don’t necessarily need to resort to popping tons of pain relievers. (Mattheis, C., 2010). This helps me give my client different exercise's to treat her back pain.

5. Target Behavior Eat more fruits and vegetables and exercise for at least 45 minutes every other day

6. Theory (HBM) High Perceived Susceptibility: due to her lack of fruit and vegetable intake and lack of exercise, client has a higher risk of getting low back pain because of her endometriosis. Low Perceived Severity: her back pain may get worse since she doesn’t plan on having surgery and can’t go through hormone therapy, but exercising can lower the pain Perceived Barriers: won’t be able to deal with stress, having two children and a boyfriend to feed is a lot more work than she expected High Self-Efficacy: may exercise at work (Pilates) and has support from family and friends

7. Theory (cont.…) Changing her diet will help her become happier, healthier and low back pain will decrease Increased Perceived Severity: back pain has increased due to client’s pregnancy and lack of exercise throughout her pregnancy Different Ways of Coping With Stress: different exercising ideas and healthy meal plans and have a schedule to work with Raise Perceived Benefits: increase amount of exercise and eat more fruits and vegetables to be healthier and reduce risk of increasing low back pain Never Say Negative Things: keep self-efficacy up

8. Smart Goal In 3 weeks client will have increased her fruit and vegetable intake from 1-2 intakes to 4-5 intakes a day and exercise for at least 45 minutes every other day Slowly get client to change by letting her take as much fruit and vegetables as she wants the first week and then go up to 5 intakes and then down to 4 … (etc.) to slowly change her intake of fruits and vegetables. The pattern will continue of eating at least three fruits or vegetables a day

9. Intervention Highlights Client kept up with keeping track of her exercise and fruit/vegetable intake Changing client’s Health Behavior exercising for at least 45 minutes every other day

10. Results  Client succeeded in changing from having 1 to 2 fruits or vegetables a day to having 4 to 5 fruits or vegetables. She also added exercise for at least 40 minutes every other day in her weekly routine  For stress reliever eating a small snack of carrots, celery, apples slices, or watermelon helped her throughout her day, also stretching at least twice a day helped back pain decrease WeekMon.Tue.Wed.Thur.Fri.Sat.Sun. 1X,EXE 2X 3X XEXX Key: X= 4-5 fruit/veggie Intake E= 45 min. exercise Table 1: Days Client had her Intake and Exercise Complete

11. Figure 1: Client’s total intake within a week of fruits or vegetables before the intervention and after the intervention Total Intake Within a Week Week Number

12. Personal / Professional Analysis Using the Health Belief Model to explain the client’s health problem was the easiest Using the articles was the hardest part of the intervention Helping someone who normally helps me with my health situations was fun because I got to help someone who normally helps others

13. References Richardson, C., Carolyn, A., Snijders, C., Hides, J., Damen, L., Pas, M., Storm J. (2002, February 15). The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain. Retrieved from: http://journals.lww.com/spinejournal/Abstract/2002/02150/The_Relation_Bet ween_the_Transversus_Abdominis.15.aspx Strowitzki, T., Marr, J., Gerlinger, C., Faustmann, T., Seitz, C. (2010, January 19). Dienogest is as Effective as Leuprolide Acetate in Treating the Painful Symptoms of Endometriosis; a 24-week, Randomized, Multicentre, Open-label Trial. Retrieved from: http://humrep.oxfordjournals.org/content/25/3/633.short Konkel, L. (2014, May 9). Weight Gain During Pregnancy May Protect Babies from Chemicals. Retrieved from: http://www.scientificamerican.com/article/weight-gain-during-pregnancy- may-protect-babie Mattheis, C. (2010). 15 Natural Back Pain Remedies. Retrieved from: http://www.health.com/health/gallery/0,,20800897,00.html