Offender Returns To Clinic Case Summary

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.

The medical evidence shows a chest CT taken on 9/2015 indicated the claimant was positive for mild atelectasis and mild fatty liver. The physical exam on 8/15 was normal. 5/15 he was positive for chronic heart failure with an ejection fraction of 565 and he

Mr. ___ [NAME] is a 49-year-old white male, a patient of Dr. ___ [NAME], with a history of right knee replacement x 4, secondary to a gunshot wound in ___ [DATE]. Left knee, he has had multiple surgeries, primarily on the ligaments and I understand the meniscus. Also has right hip pain. The hip is probably related to his difficulty with the right knee. He has chronic pain in the knees. He has a need for testosterone as his labs are very low. PTSD, (___) anxiety. Really here today to follow up on the testosterone. Lab was drawn; other results are not yet available. His non-fasting glucose today was 106 and the hemoglobin A1c that was done was 5.9. He does have some history of hyperglycemia, but I think there were primarily non-fasting, he may just have some glucose intolerance. Complains primarily of knee pain and right hip pain. He is having erectile dysfunction, was given Viagra, and when he saw the urologist he was told that he needed testosterone, as it was quite low at 1.8.

General: Describes health status as “fair”. Height attained 5’2” weight 183 lbs. Patient states she has not experienced any changes in her weight over the past couple of months. Her ability to do activities has decreased since diagnosed with COPD and Congestive Heart Failure. She notices walking from the car into the house or activities such as watering the garden take more of an effort and her breathing becomes labored. Denies fever, chills, sweats, or night sweats unless exacerbation of respiratory problem. She states her living situation is “good”; she lives in a single story house on her own and able to perform activities of daily living.

The patient is a 34 year old female who presented to the ED with increase depressive symptoms and SI since medication changed last week. Denies suicidal plan and reports having back pain for 2 months due to passing of kidney stones as well as upper jaw pain from tooth being pulled last week. Patient denies HI or symptoms of psychosis.

The patient is a 44-year-old gentleman who no longer sees an endocrinologist as that office closed. He was last seen here in October of 2014. He had an appointment in April, but showed up late and decided not to stay for this. He did have lab work that he was supposed to do from December, but he never did get this done. He does tell me he continues to work two jobs and finds it very difficult to take good care of himself, he does not eat well. He continues to smoke greater than a half a pack of cigarettes per day.

The patient is a licensed carpenter and is the sole provider for his household. He lives with his wife in a small apartment in an inner city. He admits that he does not get involved in physical activities due to unsafe neighborhood with high crime rate. He has no hobbies and prefer to read at home. He eats one large meal a day after work, misses breakfast majority of the times. He admits eating unhealthy meals for lunch, few serving of fruits and vegetables, and high- calorie food mostly pasta and meat at home. He does not engage in any street drugs or alcohol intake, however he admits smoking cigarette one pack per day for the past thirty years.

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.

In the ER, I have an African American female patient, age 32, who presents with sickle cell anemia. She has come into the emergency room with 2-day history of heart palpitations, headache, dyspnea, fatigue, and back pain. She states her appetite has decreased. She states that she is voiding well and having regular bowel movements. The backache extends from above the lower T-spine to the lumbosacral spine. The patient is allergic to codeine, but states she is able to take morphine. She is currently taking folic acid and Tylenol. She has had no previous surgeries and denies any smoking or drug use. Upon examination, her vitals were the following; a temp of 38 degrees tympanic, pulse was 105 BPM indicating tachycardia, and blood pressure is 115/50

Lab Values and Diagnostics On September 2nd patients hemoglobin A1c level was 5.4 and within normal limits. Blood glucose was elevated at 112 mg/dl, normal values for this lab is 65-105 mg/dl. Patient’s cholesterol was 153, triglycerides 72, LDL cholesterol 89, HDL cholesterol 50, and Cholesterol/ HDL ratio was 3.1. All lipid values were within normal limits. T4 was 6.0 ug/dl and TSH was 1.11 ul/ml. Both thyroid test were within normal limits. Patients AST was 14u/l, and ALT was 13 u/l both of these liver function values were within normal limits. Patient’s chart did not state any prolactin levels.

The patient was not seeking medical help for many years. She started to follow the physicians for the last few years. She had some CKD that is progressing to stage 5 recently. Her kidney disease is attributed to longstanding insulin dependent diabetes mellitus. She has never had a kidney biopsy done. Her last creatinine is 3.8 with an estimated GFR of 13. She had 4.5 proteinuria in July 2015. She is still not on dialysis yet. She will be starting peritoneal dialysis when it is medically indicated. She has not been evaluated for kidney or pancreas transplant in the past.

Assessment: Appears to be hypotonic hypovolemic hyponatremia secondary to several days of vomiting and diarrhea.

N.L. has history of constipation and fecal impaction several years ago. Patient also has history of Diabetes Mellitus type 2 for 9 years, Hypertension for 15 years, and Chronic Obstructive Pulmonary Disease (COPD) for 5 years. Patient has also had laparoscopic appendectomy 5 years ago for erupted appendicitis and total hysterectomy 3 years ago due to uterine fibroids. N.L. smoked half a pack of cigarettes for 20 years and recently cut down to 2 cigarettes per day. N.Ll also drinks alcohol occasionally, approximately 2 drinks per month.

This is 41 year old white male. Patient is here complaining of back pain that is radiating down to his legs, sharp pain. Patient reported that he was attacted and was severely bitten and also was stumped on his lower back was hospitalized for several weeks , about one month ago from that he is also experiencing post dramatic distress syndrome. anxiety and panic attach and nightmares. Patien denies chest pain, SOB, N/V/ D,or fever. Current pain 6/10. Patien is a current tobacco user with a 30 pack year history, histroy of alcohol abuse, and substance abuse, currently in a group home.

The patient is a 78-year-old female who was transferred from a local nursing home because of altered mental status transfer from care one of Wayne. On presentation initial blood pressure was 126/86 with pulse of 80, respirations of 16, and a low-grade temp of 99. Her history is significant in that she has known to have metastatic cervical carcinoma, she has a diversion colostomy, urostomy and she had chemotherapy and radiation in May of 2015. She was hospitalized previously with urinary tract infection which grew an enterococcus. She comes in now presenting again with altered mental status. She herself is complaining of weakness. Initial lab work on admission reveals her to be tachycardic. She has no white count. Her hemoglobin was