Ehlers Danlos Syndrome: A Case Study

The author read Mrs. X’s medical notes prior to their initial consultation to afford herself the knowledge she required should she need to prescribe for her when fully qualified. It was evident from reading her medical notes that there were a few considerations to take note of before commencing any treatment, such as her medical history, drug history and allergies. Her past medical history consisted of Type 2 diabetes mellitus, which was diet controlled, hypertension, hypercholesterolaemia, neuropathy, rheumatoid arthritis and raynauds syndrome.

Mr.’s Jones suffers from the following symptoms, painful joints particularly her knee, and hip, fingers and back, joint stiffness, limited joint movement and swollen feet and enlarged joints. These symptoms are due to significant problems with Rheumatoid Arthritis (RA) and Osteoarthritis (OA).

Scenario: Mr. B, a 67-year-old-man, came to the ER complaining of severe pain to his left hip and leg after falling over his dog at home. Left leg appears shortened with swelling in his calf, bruised, and limited range of motion.Mr. B has a history of impaired glucose tolerance and prostate cancer. Home medications include atorvastatin and oxycodone for chronic back pain. Mr. B’s labs, taken during a previous visit with his primary care doctor, revealed elevated cholesterol and lipids.

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

My case study is that of a 28-year-old vegetarian female who presents for a routine physical. The patient has no complaints

Ms. Heigle testified that she suffers from carpal tunnel syndrome, lower back pain, and facial numbness. Ms. Heigle stated that she is still under the care of her chemotherapy doctor, Further, Ms. Heigle stated that on November 2, 2017, she has an appointment Dr. Adam Lewis and would like to submit a copy of his report for review.

Patient reports no weight fluctuations. Denies fatigue, malaise, weakness, sweats, night sweats and chills. Patient reports mild left leg weakness secondary to left tibia fracture June 2012, but ambulates well and is able to be active in school sports, hiking, biking, and swimming. Patient reports working on building strength in left leg through sports and recreational activities. Patient reports asthmatic exacerbations with exercise. Patient reports trying to build lung capacity by running and swimming which exacerbates his asthmatic condition and uses inhalers.

Marcy is a 34-year-old female here today with her daughter for a followup regarding her chest pain and GERD. The patient tells me following her last evaluation on July 1st, she did take the Nexium as was recommended. She was taking 40 mg for about a month. She said that worked very well. Her symptoms lessened and ultimately resolved. However, when she ran out of the Nexium, the symptoms are back again. She feels a pain in the lower sternum area, as well as in the upper epigastric area and was relieved when it went away with the Nexium. She has not continued to take it and wonders what she should do next. She is eating and drinking normally. She did try to cut back on dairy as she initially thought that might be related, but found that was not the case and now has that back in her diet. She is up three pounds since I last saw her and is at her highest weight that I have in the office. She is having no nausea, no vomiting. No early satiety. There is no diarrhea. No constipation. No blood in the stool. No melena. She wonders what the next step should be. She does tell me that when she was talking with her family, her mother has had an ulcer and her sister has been diagnosed with "stress ulcers" in the past.

-Contacted Desert Springs facility and follow-up on the patient. Spoke to medtech Muriel and stated that another caregiver has been going to patient’s room and no complaint or concern was raised from the patient. Instructed Muriel to see the patient and she stated that patient is the same and “normal” sitting up in her recliner’s chair. Speech is clear and no facial droop per Muriel. Per Muriel, patient did complaint about a week ago with right foot

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

She states it had been causing her pain for a couple of days and the pain got unbearable. DG has a medical history of stroke, encephalopathy, cataracts and macular degeneration, COPD with chronic respiratory failure, type 2 diabetes, peripheral vascular disease, neuropathy, and GERD. The client also has a surgical history of cataract removal, hysterectomy, angioplasty (2011), sixth toe amputation, and right, above the knee amputation performed in April of 2017. DG has no known allergies.

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

A progress note from Timothy Carrabine, MD, dated 08/08/2017, indicated that the claimant present with a recent diagnosis of hyperthyroidism and multiple sclerosis with increasing difficulty with gait secondary to balance weakness and left lower extremity difficulties. She had stiffness and spasticity symptoms and weakness of the lower extremities with the left side greater than the right. SHe reported some generalized change

Cano, the patient is status post right carnal tunnel release. She has been on physical therapy for the last three weeks. She states she is doing much, much better. Her left hand will be operated on 5/03/16. She complains of severe insomnia. This has been chronic with headaches and chronic depression. She states she is hearing voices, hearing auditory hallucinations with paranoia. This started after the oral steroids. She is psychotic and severely depressed. There is a past history of post-traumatic stress disorder (PTSD), generalized anxiety, and chronic depression. Previous antidepressants included Celexa, BuSpar and Xanax. She states she has been clean. There is no evidence of any type of drugs in her. She brought what she had and had thrown those out and had detoxed a few months

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