Informatic Cancer Case Studies

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal

Morphine 15mg BID, Elavil 50mg 1-2 QD, Motrin 800mg TID, Tramadol 50mg BID, Nucynta 50mg BID 12/28/17

who had a complication with a tendon in the finger. I witnessed the progression of

DOI: 6/12/2014. Patient is a 59-year-old right-handed male machine operator who sustained work-related injuries to his right arm, shoulder and neck when his right hand got caught in a mixer. As per office notes dated 9/6/16, the patient returns complains of continued neck pain with burning hot pain extending into the forearm down to the hand along the C6 and C7 distribution with numbness and tingling in the hand. The patient has undergone multiple medications, physical therapy, TEN both in physical therapy and home use. It was also noted that the pateint denies having cognitive behavioral therapy. The provider notes, that it would be appropriate as based on the history including postoperative right forearm fracture repair and forearm open reduction and internal fixation of the right distal radius that an additional surgery to the right arm and continue physical therapy, yet continues to have swelling

DOI: 2/3/2014. Patient is a 20-year-old male cashier who sustained injury to his right ankle when he slipped and fell. Per OMNI, he was diagnosed with right ankle sprain.

DOI: 11/17/2015. Patient is a year old male mechanic who sustained injury while he was throwing a broken urinal into dumpster when it broke and cut his left wrist. Per OMNI, he was initially diagnosed with laceration to left wrist/forearm flexor tendons to middle, ring and pinky fingers. Surgery was done on 11/25/15 for left forearm repair.

Per the operative report on 10/27/15, the patient underwent right wrist arthroscopy, debridement of triangular fibrocartilage tear, synovectomy and debridement of scapholunate ligament tear.

HISTORY OF PRESENT ILLNESS: Brandon is a right hand dominant trailer manufacture worker who has been off work since his injury, who injured his right dominant hand seven weeks ago when he caught it between a heavy TV set he was carrying at home and the wall, sustaining a painful deformity of the right hand. That treatment consisted of a closed reduction of the fourth and fifth metacarpal bases done by Jake Heiney, MD. The patient had a benign post-operative course and was recovering uneventfully. His records were reviewed for this visit. He reports no complaints of pain or swelling. No neurovascular or muscular changes. He feels much better overall. No pain at all with most activity. Occasionally sore when he has used it a lot.

He could not feel his finger. There is numbness. The symptoms are continuous in nature and currently present. He also reports paresthesias. There were no chemical or toxic compounds involved. The findings were consistent with the injury. There were no conditions that may impede or delay the recovery. The exam revealed circumscribed laceration around the PIP joint of the middle finger. ROM: the finger is pale and cool without restriction. Neurologically: no sensation in his right middle finger. Plan: OR for revascularization, possible operative fixation, possible revision amputation, possible nerve graft, and possible vein

According to the IME report on 11/9/15 by Dr. Shashi Patel, the patient has not reached maximum medical improvement for any of the body parts and a follow up care with pain management is appropriate.

Patient JC is a 63-year-old male, he is Caucasian and is not Hispanic. He presented to the emergency room on Monday April 4th after noticing pain, swelling, and a “blue tint” to his left fifth digit. He has a history of hyperlipidemia, GERD, cardiac disorder, osteoarthritis, hematuria, prostate cancer (resolved), and hammer syndrome. He has dentures and partial vision loss in both eyes. JC is a construction worker. The patient’s current problem with his left fifth digit is believed to come from his history of hypothenar hammer syndrome. Hypothenar hammer syndrome is caused by repeated use of the palm of the hand, such as when you use a hammer to push or grind objects. This can result in damage of certain blood vessels in hand, especially the ulnar artery. This artery goes through the hypothenar area of the palm and supplies blood to the fingers, damage to the ulnar

Current request is for 30 Tablets of MS Contin 15mg; 60 Capsules of Lyrica 50 mg; and 180 Tablets of Norco 10/325mg between 11/17/2016 and

Reviewed all medications received by the patient and confirm patient understanding of how to use these medications.

Patient X’s medical history includes Hepatitis C, coronary artery disease, hypertension, atrial fibrillation, pacemaker placed in 2014, heart attacks in 2013 and 2014, kidney disease, gout, renal calculi in 2000, peripheral neuropathy, hypothyroidism, benign prostatic hyperplasia, testicular cancer and left orchiotomy in 2008, hyperlipidemia, and arthiritis. Medications are Pradaxa, Amiodarone, Digoxin, Gabapentin, Carvedilol, Lisinopril, Simvastatin, Avodart, Furosemide, Indomethacin as needed for gout, Levothyroxine, Percocet as needed for back pain, and Ambien and Xanax as needed for sleep.

Injuries or Pathologies (diseases) that require reconstructive hand surgery include: Hand Sepsis, Buergers Disease , and Symbrachydactyly. These diseases cause abnormalities within the limbs of an individual. Individuals born with Buergers and Sepsis can develop infections in their body that result in the loss of limbs, or the necessity to amputate the limb so the infection does not spread. On the contrary, Symbrachydactyly is a genetic abnormality where individuals are born with abnormal limbs, or the growth of the limbs do not occur normally during the initial growth of the child.