Pituitary Nikoma Case Study

This writer met with the patient to address the conflicting issue with his medication. According to the patient, his PCP was prescribing him with his benzodiazepine medications; however, the patient says, " I had to seek a psychiatrist because it was only temporary." This explains the conflicting issues with the Rx Scripts on file. The patient started his treatment with his now psychatrist on 6/12/2017 and signed an ROI. Addressing picking up his medication from two different pharmacy, the patient was advise that he needs to be pick up his medication with only one pharmacy as it is required. The patient agreed to the terms and said, " I like CVS better than Walgreens. Sometimes they would my refill to Walgreens or whatever is closer to me,

A visit note from Dr. Carico, dated 06/20/2017, indicated that the claimant continued to have

The pt Poteat, Edward L is supposed to tx today at unit 1087. The unit 1087 is requesting the referral source to send a shortened and missed treatment report in order for the pt to be accepted. This report is not one of the requirements that is needed in order for a pt to transfer to a FKC unit. Also the referral source stated the she sent the report several times and received several conformations and clinic 1087 is stating that they never received it. The referral source and the unit 1087 have been in contact and I am just now finding out about this. Please let me know if the pt is accepted and to see what we can do regarding this patients

S: "I got dizzy and lightheaded." Subject stated he was on hi way home to Kansas City when he took a surge energy drink. Pt attend after that he got lighthead and dizzy so he pulled over. Pt stated at that time he started having anxiety problems and hyperventilating and his hands began to cramp. Pt stated he called his mom who called 911. Pt stated he felt better after he claimed down and got his breathing under control. Pt states he rarly drinks caffeine and avoids coffe or any type of energy drink. Pt states his mom gave it to him for the long drive home. Pt denies any current s/s and states "I feel fine now." Pt states, "I will be fine and don't need to

This writer and the Program Director met with the patient to share an explanation about dosing time arrangement. According to the Program Director, she provided the patient with an explanation as to why he will have to dose between 9am-11:30am due to patient #394 and her husband medical issues. If the patient returns back to work and needs to dose at an earlier time, the patient must provide proof his work schedule for the dosing time arrangement to be changed again. The patient requested for assistance from the clinic to preschedule his Logisticare transportation of which the Program Director and this writer agreed to assist him with. After the discussion with the Program Director, the patient was not pleased and began to get emotional as he feels victimized again. This writer explained to the patient, the patient reason for the dosing arrangement is due to the allegation and safety reason. However, the patient understood the purpose of the arrangement, but he was more concern about getting the earlier appointment rather than a later time. This reiterate about what the Program Director mentioned about if the need to change the dosing time, the patient needs to provide proof for such request. The patient provided this writer with a copy of his ER visit dated for 02/23/2017 of which the patient did in fact received one pill of Klonopin.

SC received called from Pa on 5/6/2016. SC completed monitoring phone call with the Pa. The Pa reported that last month he was brought to the ER at Penn Presbyterian Medical Center by ambulance. The Pa reported the he fell and hit his head and he called for help and was taken to the hospital. He reported that after he was examined by the doctor, he was sent home with instruction to take OC pain killer for pain. The Pa reported no recent hospitalization, change in health status or medication. SC informed the Pa that his nutritionist from DaVita Dialysis called the SC and expresses concern that he is not getting adequate nutrition from his meal intake and suggest that he gets HDM. The Pa stated that he had met with the nutritionist early in the

Patient was here with cousins to be seen. This occurred at end of the visit approximately 1:15 pm. I was called by Madelyn Ramirez (PCT) that there was an incident in the exam room. I spoke to the mother, she said he was fine that he did not hit his head. No injuries noted, mother decline being evaluate by provider. But, patient was evaluated by Dr. Ritchin after fall.

SC met with Pa, for scheduled RA HV in Pa's home on 03/1/2016. The completed both the LCD and CMI assessment. Pa appeared clean, appropriately dressed in PJ's and sitting on the couch SC in the home. Present in the home were the Pa visiting nurse Scott from Millennium home care. He was on the phone trying to order the Pa medicines. Also Pa’s aide was present from the agency aide. Pa appeared weak and in discomfort. The SC asked Pa if she okay and she reported that she is in a lot of pain. The SC asked if she is taking her medications and she reported that she ran out that’s why the nurse is helping now. The SC asked the Pa how did that happen and she stated that when she saw her PCP in January for her post hospital and rehab discharged he

RT had a scheduled medication management appointment with Mary Pestrak at 4:30pm on 6/15/16, but RT called NP Mary and rescheduled. RT stated that she wouldn't be able to come to TSI for her appointment. However, writer met with RT and inquired about RT's well-being and RT stated " I am doing good". RT informed writer that on 6/14/16, she went to her PCP and did blood work and is scheduled to go back to her PCP on 6/21/16 to get the completed physical form hat was provided to RT by writer. RT's medication management appointment is rescheduled for 6/22/16, RT ensured writer that she will be there. Writer informed RT that she is awaiting to hear from Marguerite to get more information on a GED program. RT was appreciative of writer's assistance.

Two pt verifier name and dob confirmed. Pt is requesting her profile for her knees and left shoulder be renewed. Pt states that she is schedule for her MRI in Oct. Informed the pt that request be sent to her provider and will call her with his recommendations. Pt agrees and verbalizes

Dr. Orrego in Endo completed a consult on a patient (MRN 901142698) with pituitary macroadenoma, the patient has a benign tumor in her optic and sinus area, and she was referred to KP neurosurgery for further evaluation. The only doctor that performs this surgery at KP (Dr. Colapinto, neurosurgeon) reviewed the MRI and because of the size of the tumor referred her to University for surgery with Dr. Lilihei. The referral has been denied because she is not a plan participant.

Telephone contact made to the patient. Two patient verifier used to confirm name and DOB. Patient states that she continue to have severe lower back pain that worsen with movement and standing for greater than 30 mins. Currently, patient rates her pain 5/10 resting, with an occasional pinching feeling in the lower back. Patient states that she is very concern because she needs her husband help for almost everything such has help with ADL, household chores. Patient states that her husband is due to deploy in January 9. Patient states she is schedule for her MRI January 5. Patient is requesting that her MRI be done asap. Patient states that she is taking her medications as prescribed but she continue to be in pain. Acute Apt was schedule for

Two pt verifier name/dob confirmed. Pt states that he has a hx of back pain and he would like another appt to discuss a pt profile because he has a upcoming PT test; also he needs a refill on his Naproxen and Lodicane patches. The pt states he originally had an appt schedule for today but it was cancelled. Therefore he needs to reschedule. Pt denies new onset of symptoms. Assist the pt sheduling a f/u appt.

A pituitary tumor can cause loss of vision in one or both eyes depending on its size and shape. The pituitary gland sits in the pituitary sella, which is almost directly behind the eye. If the pituitary tumor gets large enough and grows laterally, it can push against the optic nerve and stop the message for getting to the cerebral cortex. An individual with a pituitary tumor will first notice notice dark, blurry, or dim vision. Sometimes it will only affect vision on one side, when it affects both sides of vision, it's pressing against the optic chiasm.

Pituitary gigantism is a rare endocrine disorder in which the anterior pituitary releases an excess of growth hormone (GH) during childhood before the epiphyseal plates close, causing abnormal increased somatic growth in the patient, occurring usually because of a pituitary tumor, also called an adenoma (Goldenberg et al. 2009). There are several treatments that can usually prevent pituitary gigantism or halt the rapid growth if caught early enough. These treatments include drug therapy, surgical removal of the adenoma, and radiation therapy (Flitsch et al. 2000). It is crucial that pituitary gigantism is detected and treated before excessive growth occurs, as it can cause uneven and abnormal growth in the extremities, facial deformities, severe headaches, blindness, and a shortened life expectancy (de Herder 2008). However, if treated soon enough, patients can live a long, healthy and happy life. Below, I will detail the different methods of treatment and how they work.