Enhanced Primary Care and Bariatric Review Letters

Sarah Jenkins Swan Valley Allied Health & Physiotherapy 42 Great Northern Highway Midland, WA 6056 (08) 9274 5100 s.jenkins@swanvalleyphysio.com.au 14/05/2025

Dear Dr David Chen,

Re: Enhanced Primary Care (EPC) Plan for Joanne Maree Taylor, 12/08/1979 0412 883 901

I am writing about Joanne Maree Taylor, 12/08/1979, following their initial consultation under an Enhanced Primary Care (EPC) plan. Their current health information and the suggested management approach are set out below.

Presenting Condition

• Bilateral medial knee OA pain, insidious onset over 2 years, aggravated by stairs and prolonged weight-bearing (> 20 mins). Previously trialled paracetamol and rest with minimal relief. Limits walking tolerance and occupational duties.
• Mild stress urinary incontinence (SUI) with coughing and sneezing; nil bowel dysfunction or dyspareunia reported.

Medical History

• Laparoscopic sleeve gastrectomy (19/02/2025), HTN, T2DM (in remission), G2P2 (SVD).

Current Medications

• perindopril (Coversyl®) 5 mg PO daily
• paracetamol (Panadol Osteo®) 1,330 mg PO TID PRN
• colecalciferol (Ostelin®) 1,000 IU PO daily

Allergies

• Penicillin (rash)

Social History

• Lives with husband and two teenage children in a single-storey house. Non-smoker, nil ETOH. Works part-time as a primary school teacher assistant.

Proposed Management Plan

• 5 EPC physiotherapy sessions focusing on progressive lower limb kinetic chain strengthening, hydrotherapy transition, and pelvic floor muscle training (PFMT). Expect improved functional load tolerance within 8–12 weeks.
• Progress tracked via Lower Extremity Functional Scale (LEFS), 30-second sit-to-stand test, and bladder diary review at session 5.

"Thank you for helping coordinate this person's care."

"Yours sincerely,"

Sarah Jenkins BSc (Physio), APAM Swan Valley Allied Health & Physiotherapy

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Thank you for referring Joanne.

I reviewed Joanne, aged 45 years, to assess progress following sleeve gastrectomy on 19/02/2025, at 12 weeks after surgery.

Related Issues

She presents with bilateral medial knee osteoarthritis and mild stress urinary incontinence, which have previously limited her capacity for land-based impact exercise.

Background to Condition

Progressive weight gain occurred over the past 15 years following her second pregnancy, compounded by a sedentary lifestyle and comfort eating linked to work stress.

Anthropometry

Current weight: 98.5 kg, Height: 165 cm, BMI: 36.2 kg/m² 17.9% weight reduction from baseline steady weight: 120.0 kg on 01/11/2024. 21.5 kg across 6 months. 12.1% weight reduction from surgical weight: 112.0 kg on 19/02/2025. 13.5 kg across 12 weeks. Projected total loss by 12–18 months: 35–40 kg Current mean weekly weight-loss rate: 1.1 kg/week

Previous Weight Loss Attempts

She previously trialled commercial shakes, intermittent fasting, and liraglutide with transient weight loss followed by weight regain upon cessation.

Weight History

Weight history over lifespan

Heaviest adult weight: 122.0 kg How the patient feels about current body image and weight: She feels significantly more confident and mobile, though she remains self-conscious about emerging skin laxity on her upper arms and abdomen.

Dietary Assessment

Regularity of eating pattern: She consumes three small main meals and two planned protein-rich snacks daily. Portion sizes: Portions are appropriately restricted to approximately one cup per meal using a side plate. Comparison of diet against Australian dietary guidelines: She meets daily lean protein targets well, though vegetable and wholegrain intake remains below guideline recommendations due to early satiety. Eating behaviours: She chews food thoroughly, separates fluids from meals by 30 minutes, and reports no regurgitation or dumping syndrome.

Social

She does not smoke and has abstained from alcohol since surgery. Living arrangements: She resides at home with her supportive husband and two children. Employment/study and hours of work: She works 24 hours per week over four days as a teacher assistant.

Physical Activity

Current activity level: She walks 20 minutes flat three times per week and has commenced daily home-based squats and bridges. Past activity level: She was previously sedentary due to severe knee pain and dyspnoea on exertion. How the patient feels about physical activity: She is keen to increase her exercise load to preserve lean muscle mass as her knee pain subsides.

Bowels

Current bowel habits: She passes a Bristol Stool Chart Type 3 motion every second day without straining. Bowel history: She experienced transient constipation during the first four weeks post-operatively, which resolved with increased fluid and fibre intake.

Client Perspective

Why the patient wanted to have the surgery: She pursued surgery to resolve her metabolic comorbidities, reduce joint pain, and remain active for her children. Current feelings about the surgery and progress: She is delighted with her weight loss trajectory and reduced knee pain, noting no regrets regarding the procedure.

Multivitamins

She is fully compliant with her daily bariatric-specific multivitamin and calcium citrate supplementation.

Medications

She currently takes perindopril 5 mg PO daily, colecalciferol 1,000 IU PO daily, and paracetamol 1,330 mg PO TID PRN.

Education

Education was provided regarding progressive resistance training to prevent sarcopenia during rapid weight loss, pacing strategies for knee osteoarthritis, and pelvic floor bracing during resistance exercises.

Written Materials Provided

She was provided with an illustrated home resistance exercise sheet, a pelvic floor muscle training guide, and a post-bariatric hydration and protein tracking log.

Plan

She will attend fortnightly physiotherapy sessions for supervised lower limb strengthening, transition to twice-weekly hydrotherapy, and maintain daily pelvic floor exercises.

Thank you for the referral. The next review is scheduled for 28/05/2025.

"Please contact me if you have any questions. I look forward to reviewing the patient again."

"Kind regards,"

Sarah Jenkins