SUBJECTIVE, SUMMARY, HISTORY, AND HISTORY OF PRESENT ILLNESS

SUBJECTIVE, SUMMARY, HISTORY, AND HISTORY OF PRESENT ILLNESS

Details about the patient's health conditions

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General problem

The patient returns today for a followup of her hypertension and to review the results of her carotid Doppler study.

Cardiac related

The patient is a 43-year-old with diabetes, hypertension, obesity, hyperlipidemia, elevated triglycerides, low HDL, and chest pain.  She denies any PND, congestive heart failure, or syncope.  Her EKG shows mild non-specific ST-T segment changes.  She has not had prior cardiac workup. Her hemoglobin A1c is markedly abnormal.  Diabetes hemoglobin A1c 13.7.  Lipids:  Triglycerides 381, HDL 38, and LDL 151.

The patient is a 67-year-old female with a history of palpitations and atrial fibrillations who presents for a routine followup.

The patient returns for a followup after a noninvasive test and she reports that another blood pressure pill has been added to her regimen, but cannot recall the name.  Otherwise, she notes that she has had no recent episodes of chest pain.  She feels quite well.  She was concerned about some weight gain and therefore, her Zyprexa and Zoloft were discontinued and she was begun on Seroquel and Wellbutrin for her psychiatric issues.

The patient is an approximately 83-year-old demented, black female seen recently by Dr. Duran with tachybrady syndrome.  The patient had failed pacemaker attempts with bilateral pneumothoraces.  Plans are now being made for her to be admitted to hospice care and re-consultation is requested due to altered mental status and tachycardia.  She was subsequently found to have a blood sugar of 28, and her heart rate improved after receiving her Cardizem.  No further cardiac evaluation planned at this time.  Per Dr. Duran's note, she is not to receive additional AV node blocking agents because of previous bradycardia and pauses.  She is not a candidate for pacemaker.  She is not to be resuscitated, and is probably going to be sent to hospice in the next 24 to 48 hours.

SUBJECTIVE, SUMMARY, HISTORY, AND HISTORY OF PRESENT ILLNESS

The patient returns today after going to back California, to Headache Clinic, for continuing migraines.  At that time, she was placed on "detox" diet, and while at the clinic, she suffered a syncopal episode.  She was seen by a physician at the clinic who told her that it was partly due to a detox diet, but also decreased her Toprol XL to 25 mg b.i.d.  She has seen her headache specialist here since returning and her medicines have been switched.  She still has incomplete treatment of her migraines with occasional breakthroughs, denies recurrent syncope, however.

The patient is a 35-year-old woman who for several years has noted occasional palpitations, occurring approximately once every six weeks.  But a month ago, the patient went to Santa Fe and was at altitude of 7000 feet and had a sudden onset of palpitations that lasted for 16 hours.  She felt that her heartbeat was fast and irregular.  There were no associated symptoms of shortness of breath, chest pain, lightheadedness, dizziness, or syncope.  The patient has recently decreased her caffeine intake but is not clear as to whether this has changed the episodes of palpitations.  The patient otherwise denies any chest pain or shortness of breath syndrome.  She does not exercise regularly but denies any limitation to exertion.  She has no symptoms of heart failure and has never had syncope.

The patient is a pleasant 74-year-old female who is here for evaluation and management of underlying chronic atrial fibrillation and hypertension.  The patient has been doing well since her last visit with no complaints of palpitations.  No shortness of breath, syncope, near syncope, leg edema, PND, orthopnea or chest pain.  She has continued to follow with Orlando Heart Center Coumadin Clinic on a regular basis and has had no problems with bleeding.  Blood pressures, during her Coumadin appointment, have been ranging 130-140s/60s-80s.  Her INR today was 3.9.  She recently had a carotid ultrasound, which showed left internal carotid artery 40% to 59%.  Her lab work was performed by Dr. Cowan showing her LDL slightly elevated.  Overall doing well and tolerating current medications.

SUBJECTIVE, SUMMARY, HISTORY, AND HISTORY OF PRESENT ILLNESS

The patient is a 48-year-old female, who recently underwent nuclear stress test, which showed some abnormalities, therefore had a left heart catheterization and subsequent PVC stent to the proximal and mid RCA and proximal LAD and first diagonal.

Postprocedure, the patient did well with no complications.  She states that she still continues to have occasional episodes of chest pain, have much improved from previous precatheterization.  She states she gets some chest pressure, couple times a week, when she does physical activity and sometimes even at rest.  She has not had any chest discomfort for last 2 days.  She has occasional left arm achiness, which appears to be constant.  No shortness of breath, leg edema, PND, orthopnea or palpitations.

This 75-year-old black female with history of multiple medical problems including chronic arthritic pain, presented to the emergency room with complaint of severe cough, which has been getting progressively worse over the past one week.  The patient was advised to take Robitussin DM one week ago and notes that her symptoms have not completely resolved.  She otherwise feels okay except for chronic pain, which is more severe in her shoulders.

The patient is a 79-year-old man with a past medical history of hypertension, who had been complaining of knee pain and swelling for the past approximately two months.  He had presented initially for drainage of his right knee, but this re-accumulated.  He states that prior to his most recent return, he had fevers approximately 100 degrees by thermometer and his knees felt warm and tender.  He presented again to his primary care physician on 04/26/2005, at which time his left knee was again drained.  At that time, microscopy demonstrated findings consistent with gout.  Today, the patient was notified by telephone that the cultures from his knee effusion had grown out Streptococcus salivarius and that he should present to the hospital for admission and treatment of infection.  He, therefore, presented this time.  He states that his knee is much improved from prior to the drainage, but still rather tender.  He denies any recent fevers, chills, and no other symptoms.

The patient is an 84-year-old female who states she does not why she was brought to the emergency department.  Per EMS report, it was reported that the patient was responding unusually earlier today when she was getting out of bed.  For this reason, EMS was contacted and the patient was brought to the emergency department.  The patient denied any burning with urination, shortness of breath, cough, or chest pain.  Upon evaluation in the emergency department, the patient was found to have a fever.

SUBJECTIVE, SUMMARY, HISTORY, AND HISTORY OF PRESENT ILLNESS

Cancer related problem:

The patient is pleasant, unfortunate, 59-year-old Caucasian male, with a long standing history of stage-4 mantle-cell non-Hodgkin lymphoma, including bone-marrow involvement.  He had original diagnosis made back in the year 2001, and has gone through numerous different treatments and radiation therapies.  He was referred to Moffit Cancer Center years ago already, but due to his insurance situations among other reasons, he was turned out to have the bone marrow transplantation and stem cell transplantation done at Moffit.  In any event, he had a recent progression of his disease as noted by his CT scan, as well as physical examination, and was started on next line of salvage chemotherapy systemically.  He successfully received the first cycle of Epoch chemotherapy at this institution a month ago, and comes in today for his second course of the chemotherapy of the same.  Clinically, he has done much better since the last chemotherapy, with improvement of his night sweats and sweating problems.  His appetite also improved and no longer has any problems with abdominal pain.  I also noted regression of his chest wall mass, as well as neck lesion.