Henry Ford NEWS

MEDICATIONS:

1.  Atenolol 50 mg daily.

2.  Ibuprofen 800 mg once or twice a day.

3.  Dyazide.

4.  Tylenol No. 3 (prescribed, but not taking).

REFERRING PHYSICIAN: 

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REASON FOR CONSULTATION: 

 Evaluate patient’s complaints of wrist pain and swelling to establish rheumatologic diagnosis.

PATIENT’S CHIEF COMPLAINT:  Generalized aches and pains and swelling of the legs.

HISTORY OF PRESENT ILLNESS:  The patient is a 69-year-old African‑American female seen by Dr. Nwapa in April of this year, where swelling of both wrists was noted for which prednisone in decreasing doses over a period of 10 days was prescribed.  Patient reports that her wrist pain and swelling subsided completely only to return when that medication was stopped.  Now, patient has wrist pain and swelling from time to time.  She also has generalized aches and pains.  She is concerned about swelling in her feet, which she began to notice when she began taking ibuprofen 800 mg once a day.  Ibuprofen also <___> to moderate patient’s symptoms.  Patient is also complaining of numbness and tingling in the fingers of both hands, digits 1 through 3 bilaterally, more on the left then on the right.  She complains of being stiff all over in the morning.

REVIEW OF SYSTEMS:  No abdominal pain associated with the use of ibuprofen.  No headaches.  Back pain from time to time.

PAST MEDICAL HISTORY:  Hypertension.  Patient is currently being worked up for hypercalcemia.

FAMILY HISTORY:  Diabetes and heart disease.

SOCIAL HISTORY:  Patient smoked a pack of cigarettes for about 50 years.  She drinks from time to time.

PHYSICAL EXAMINATION:

VITAL SIGNS:  Weight 149 pounds  Temp.  98.4  BP  98/62  Pulse 75

MUSC/SK:  A complete peripheral joint evaluation for swelling, tenderness on palpation, limitation of motion, and deformity was performed today.  I found what appeared to be hint of swelling of the dorsal aspect of both wrists, although there was no clear-cut fullness, nor fluctuance.  Wrist extension was about 45 degrees bilaterally.  Tenderness on palpation over the dorsal aspect of both wrists was intermittent.  Traction maneuvers were sometimes painful and sometimes not.  Patient is able to make a fist bilaterally.  No swelling in the DIPs, PIPs nor MCPs.  No swelling of the elbows.  In the lower extremities, no pain with range of motion of hips.  The knees were cool to touch.  No anterior effusions.  No lateral instability.  No pretibial edema.  No swelling of the ankles of the feet.

IMAGING STUDIES:  Radiographs of the hands and wrists were reviewed.  No evidence of chondrocalcinosis articularis.  Weightbearing radiographs of the knees revealed chondrocalcinosis articularis.  No radiographic evidence of arthropathy involving the feet, nor the ankles.  There have been hint of joint space narrowing in both hips, perhaps right more than left in the axial direction.

LABORATORY STUDIES:  Rheumatoid factor screen negative.  Antinuclear antibody screen weakly positive.  Corrected serum calcium level 11 mg/dL.

IMPRESSION:  This patient may have had an episode of inflammatory joint disease; the nature of which is unclear to me.

MEDICAL DECISION MAKING:  I gave the patient a prescription for Medrol Dosepak to use should her knee pain and swelling become more of a problem.  I believe she is experiencing water retention associated with the use of ibuprofen, so I suggested that she take the Tylenol No. 3 that was prescribed and consider the use of naproxen sodium 220 mg, which is available over-the-counter.  She is strongly undergoing of her hypercalcemic condition.