Dr. Sanchez refers this 30-year-old, RH, active duty Coast Guard male for evaluation of myalgias. He states he was doing well until 03/2017. Around that time he started noting achiness in his muscles in his upper and lower extremities and felt the joints were involved to a certain degree. He recalls that when he was on the Coast Guard ship, he had trouble getting out of his bunk-type bed. He was feeling weak overall. He denied any fevers. The patient had been on Lipitor at that time for almost two years, he states, for elevated lipids, which runs in his family. When he saw Dr. Sanchez, I believe in May 2017, he was taken off the Lipitor. At that time he had CK, myoglobin, RF, and TSH, which were all normal. He also had a normal neurologic exam. He was referred to my office on 05/30/2017. …show more content…
At that time he started working out again and doing what he normally would, he enjoys lifting weights. He was at sea again at the end of June until the end of August and states everything went okay, no recurrence of symptoms. Per the patient, he apparently has had elevated liver function tests, and Dr. Sanchez has been evaluating this with ultrasound and referral to GI, has not yet done the latter. He is still off statin medications. The patient tells me that before he was on Lipitor, he was on Zocor for a year or two and does not recall having any muscle aches with that. This was stopped a couple of years ago and then he was put on the Lipitor. The patient denies any history of muscle disease. He has not really noted any twitching, fasciculations. He denies any neck or back pain. MEDICAL HISTORY: Fractured ankle, right foot. SOCIAL
and a 5-year history of angina pectoris. During the past week he has had more frequent episodes of
States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.
Patient is a 50-year-old-year-old left-handed white male who presents with his wife for evaluation of multiple symptoms that have been present since an MVA in 02/2013. At that time, he was T. boned and his car was totaled. He has amnesia for the event and is unaware whether or not he hit his head. The airbag did deploy. Afterwards, he was confused and noted significant pain in his neck and upper back. Since then, he has had multiple symptoms. He does have involuntary twitching on the right, more than left, both hands, legs, and sometimes feet. He demonstrates one of these twitches and it looks like a focal myoclonic jerk of a limb. These occur on a daily basis. He also has problems with his left thumb and index finger locking up. When he is fatigued, especially when his neck gets tight, he has some problems with word finding, paraphasic errors, and syntax errors. He did see Anthony P. Knox,
On Exam: BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the
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.
Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1
On 1/13/17 I confirmed the appointment with Dr. Rampersaud. I also spoke at length with Mr. Anderson. He has been in Florida since 1/4/17. He reports he has done a lot of walking and increased his activity level. He reports his pain levels have increased due to that. He also had confirmed with Walgreens in Michigan before traveling that he could refill medications in Florida. He is having trouble getting medications filled there. He reports he will be back in time to attend his appointment on 1/16/17.
At today's visit he is awake, alert and oriented. He complains of generalized pain. He states “I have pain all over today, my head, my back, my feet" I have not felt good for the last few days”. He rates his pain as 6/10 in severity; he describes his pain as shooting pain in different places. His pain does
05/21/2018 at 1400 hours Dr. Delaney [child and adolescent psychiatrist at Comtrea Counseling] contact CSW Anderson and stated that she has concerns for Payton well-being due to Ms. Sutton actions during Payton’s psychiatric assessment. Dr. Delaney stated Payton is admitted to St. Joseph Hospital in Waynesville specified the past weekend due to Payton runaway. Dr. Delaney specified it is not beneficial for her office to set a {Community Support Specialist} for Payton since Ms. Sutton exhibit unbeneficial support to Payton: “she is psychotic, in a manic state [referring to Ms. Sutton] and previous notes from her PC said she got bus from coming from her vaginal area,” said Dr. Delaney. Dr. Delaney states that Ms. Sutton “is all over the places”
There is a current court ordered between Mrs. Santiago-Leon and Mr. Glenn Hall Sr., father, to the children in which Mrs. Santiago-Leon gets unsupervised visit with the children at her home twice monthly. There is heightened concerned that since the allegations have been made, that there will be retaliation on the part of Mrs. Santiago-Leon against her daughter, Gina. Gina disclosed to SC DSS that her mother discipline her by hitting her with a broom. There were also disclosures made that Mrs. Santiago-Leon puts soap into the eyes of Glenn Hall Jr. Baths him in cold water, in an attempt to get him to calm down and that she has physical outside lock on the Glenn’s bedroom door and uses the lock to lock him inside his bedroom so that he can’t
Based on the medical report dated 03/25/16, the patient continues to have significant headaches and bilateral neck and shoulder pain. IW has numbness and tingling in both arms with neck pain.
This is 51 year old AAM. Patient has a history of HTN and DM, his current medications are glipizide 5 mg QD and lisinopirl 5 mg QD, but hasn't been taking them for more than one week. Patient reports neuralgia, tingling and prickling sensation at his bottom of his feet. Patient is a current resident at a Group Home and unable to afford any of the medications and needs community resources. Patient also report blurred vision, denies chest pain, SOB, N/V/ D,or fever. Patient is a current tobacco user, denies use of alcohol or illicit drugs.
Dr. Arlett Seijo Perez has been working in a pharmacy since she was 18 years old, first as a pharmacy technician, and then for the last 35 years she has been working as a valuable pharmacist. While working as a technician, with the help and guidance of Michael Escudero, which at that time was her manager, she decided to apply to pharmacy school. She graduated from Nova Southeastern University (NSU) where she earned her degree as a Doctor of Pharmacy (pharm D) . For the first 20 years after she graduated she worked in CVS Pharmacy, a job she loved since she was always passionate about helping patients and having the interaction of pharmacist to patients. After several years, she decided to look for other options, to experience a different
On 5/9/17 I met Mr. Kraxner at the office of Dr. Morse. He demonstrated the range he has behind his back, and also the trouble he has raising his arm very slowly above shoulder level. He reports sharp pains that come out of nowhere. He reports his pain is a 5-6 on a 1 to 10 scale. He has stopped taking the Motrin except for when he has pain. The medication
The case of Miguel presents various challenges that should be addressed immediately and assessed accurately in ways that are culturally valid, effective, and in accordance with diagnosis criteria listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5, 2013). Delamater & Hasday (2007) stated that various disciplines contribute to an understanding of human sexuality including biology, evolutionary psychology, psychology, anthropology, women’s studies, communications, family studies, and sociology. However, while the field of humanities addresses the range of behaviors like thoughts and feelings associated with human sexuality, it is the sciences that seek to create and assess principal explanatory