Multiple. S The patient is a 58-year-old female who tells me she has been having multiple symptoms and worries whether she might be having some tick borne illness or perhaps Bartonella, which she had in 2006. She tells me at that time, she was diagnosed with Lyme, Bartonella, ehrlichiosis, babesiosa. She was treat treated for all four of these. She states she was seeing Dr. Sam Donta in Boston at the time, but apparently he moved to Falmouth, Massachusetts. She has not seen him. I have no records from this time. She was on antibiotics for about a year, at that time. She also saw Dr. Caprio, as well as Dr. [____] and in fact she did try to make contact with Dr. [____] about a month ago, but he was charging quite a large fee and her …show more content…
insurance does not cover it.
The patient's current symptoms include joint pain, ringing in her ears, loss of taste and smell that is been ongoing for two months, loose bowel movements that occur every morning, but not in the afternoon, she has bilateral rib soreness that comes and goes, she has noticed hair loss, she has random tooth pain in different parts of her mouth and has seen her dentist, who told her there is nothing wrong with her teeth or gums. She also has aversion to smells, she gets headaches, which mostly are frontal that she rates as a five out of 10 in severity and occurs about one time per week. Tylenol will take them away. She has also been having weight loss, noticing that her clothes are not fitting well. She has been taking an herbal supplement that includes things like cats claw, red root, St. John's wort, etc. She is overdue for her colonoscopy, given that she has a family history of colon cancer. Her last
colonoscopy was December of 2007. She denies that she has any blood in her stools. She is due as well for her mammogram, but does tell me she is scheduled for this already. She does have some rhinorrhea, no postnasal drip. Wonders whether she might have a sinus infection causing the loss of taste and smell. She did have blood work in September of 2014 and her fasting blood sugar was 105. She has no family history or personal history of diabetes known. She denies any early satiety, she has never been a tobacco user, she is not coughing, no shortness of breath, no abdominal pain. Medications Include herbal supplement, vitamin D, multivitamin, fish oil. Objective Vital Signs Blood pressure 112/78. Pulse is 78. Respiratory is 12. Temperature is 97.8. Weight is 100 pounds, which is down from 115 pounds in August of 2014 and down from a high of 121 pounds in February of 2014. General The patient is thin, she is alert, she is oriented, she is in no acute distress. HEENT Sclera white. TMs are normal. Oropharynx is benign. Neck Supple, lymphadenopathy. Lungs Clear to auscultation bilaterally. Heart Regular rate without murmurs, rubs, or gallops. Abdomen Soft, nontender, nondistended, [____], no masses. Neurologic Cranial nerves 3 through 12 are intact. A/P Multiple symptoms, question underlying etiology. Certainly the weight loss, loss of taste and smell are concerning. She is having some symptoms of a sinus infection. At this point, will treat with Augmentin 875 mg one p.o. b.i.d. x10 days. If her loss of taste and smell does not come back after this, I will do an MRI of her brain. The patient is fairly adamant that she would like to do a Western blot Lyme titer, despite her negative ELISA test, recently. I did give her a lab slip to check this. She did state that if this is negative, she will go on to do further testing and I gave her a lab slip to do CBC, CMP, TSH. As noted above, she does have a history of an elevated fasting blood sugar. Her last TSH was back in 2010. She is overdue for her colonoscopy, based on family history and obviously, I think this is important as well. She wanted however, to hold on setting up the screening colonoscopy to see if she may also need an esophagogastroduodenoscopy, depending on whether we find an etiology of her weight loss from other things. At this point, therefore we will Test a Lyme Western blot, as per patient's request. Treat a loss of taste and smell and headaches as sinusitis with Augmentin 875 one p.o. b.i.d. x10 days. Get secondary blood work if Lyme titer is negative including CBC, CMP, TSH. Get an MRI of brain if her loss of taste and smell is not improved by the Augmentin. Perform other testing, if no etiology is found from above. At that point will have her come in for a followup appointment, if that is the case.
Dr.Bain ordered a CT scan of Cynthia’s chest to rule out a possibility of an aneurism. Dr. Bain also did another CT scan of Cynthia’s abdomen to evaluate her liver. Additional lab work and thyroid testing was done. Around 5:00pm she was discharged with instructions to follow up with her primary care physician Leah Avera, M.D within one week. In Cynthia’s discharge summary that was signed by Dr. Pesante, states, in part, "it just seems like Cynthia’s problem may have more so been either some kind of infectious process or possibly a thyroid
A summary of the case details (provide the circumstances surrounding the case, who, what, when, how)
Nimi Feghabo is an Atlanta-based consultant in Capgemini’s Custom Software Development service line. She has worked and acquired knowledge in many different industries spanning from Accounting to the Legal Industry. She brings significant leadership experience along with a proven track record. Prior to Capgemini, she has had experience in various industries which include legal, manufacturing, and international professional services. Her contributions include software implementation, ERP development, and facilitating changes. Through these projects, she has gained valuable insight and is able to develop transformative solutions into an effective facilitation strategy.
During this time the DJS student Raquazia Donyia-Shoalyne Gross was being assessed by the Nurse Carol ; another staff Telethia Menefee (Care Specialist) and April Smith (Residential Unit Supervisor) and Ephraim Okech (Residential Counselor ) was able to calm DJS student Raquazia Donyia-Shoalyne Gross down and the letting go process began. DJS student Raquazia Donyia-Shoalyne Gross was able to spit the screw she was holding in her mouth into a cup when the student was totally back to baseline she agreed to walk out of her room and sat in Gwendolyn Simmons Residential Unit office.
MILLERSBURG — After deliberating for three hours, a jury of four women and eight men found a Holmesville man guilty of making and possessing methamphetamine, all within the vicinity of juveniles and a school.
Is Steve Harmon innocent or guilty you decide. Steve Harmon is put on trial of the murder of Mr. Nesbitt and the robbery of his drug store. During the trail Steve Harmon is seen as guilty by the prosecutor Sandra Petrocelli. The witness Allen Forbes testimony proves that the gun used in the murder was registered under Mr. Nesbitt. This helps prove that the gun was used in the murder and the robbery and the gun was later found in the store. This witness helped me prove that Steve Harmon could have used the gun to kill Mr. Nesbitt or had taken part in the robbery at some point in the crime. “I went around behind the counter and I saw Mr. Nesbitt on the floor—there was blood everywhere and the cash register was open. A lot of cigarettes were
During the 1990s, Samara Brothers, Inc. designed and manufactured children’s clothing that was sold in department stores. The clothes made by Samara Bros. consisted of one-piece outfits that were made of seer-sucker fabric with large appliques in a variety of decorative themes for girls and boys. Around the same time, Walmart Inc. hired a clothing manufacturing company to create a line of children’s clothing based on the current line from Samara Bros. Walmart Inc. named their copied line of clothing “Small Steps” and successfully sold it at a lower cost in their national chain of stores making millions in profits. Once Samara Brothers, Inc. learned of the copied garments, they sent numerous letters to Walmart, Inc. to stop the sale and production of the materials they believed they had the right to defend under trade dress laws. When Walmart, Inc. still continued to sell the copied garments, Samara Brothers, Inc. took Walmart, Inc. to court.
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
Mrs. A is a 71-year-old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother 's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:
Through all the media coverage, Sam Reese Sheppard began to have nightmares that his dad was electrocuted, and that he should be to (Quade). He has guilt that made him have the decision to not have kids because it is hard for him to hold his own life together. There has been a huge change in opinion from people who assumed Dr. Sam Sheppard was guilty. Now people see that he was unfairly convicted. This led people to believe that the death penalty should not be used. Although the case will probably never be decided, with all the evidence that has been found, Dr. Sam Sheppard should be considered innocent.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
cancer that is causing all the debilitating pain. Anytime that either doctor would enter into her
As the story begins, the unnamed doctor is introduced as one who appears to be strictly professional. “Aas often, in such cases, they weren’t telling me more than they had to, it was up to me to tell them; that’s why they were spending three dollars on me.” (par. 3) The doctor leaves the first impression that he is one that keeps his attention about the job and nothing out of the ordinary besides stating his impressions on the mother, father and the patient, Mathilda. Though he does manage to note that Mathilda has a fever. The doctor takes what he considers a “trial shot” and “point of departure” by inquiring what he suspects is a sore throat (par. 6). This point in the story, nothing remains out of the ordinary or questionable about the doctor’s methods, until the story further develops.
Patient profile: Heterosexual Muslim Woman who has been in the United Stated for three years. She came from Pakistan. She is 42 forty-two years old, from low socioeconomic standing, English language barrier, and is Muslim rituals and practices. She came to emergency department with her husband due to shortness of breathing, high fever, severe cough. She was dignosed with new onset of pneumonia and currently on antibiotic. she also has history of Vitamin D deficiencies and diabetes mellitus type II. She admitted to medical-surgical floor for observation...
The patient has experienced fever, chills on body, headaches and anorexia as well as sweating especially during the night. The patient has also been feeling fatigued, muscle aches and nausea as well as vomiting especially after eating (WHO, 2010, p. 117). These symptoms started forty eight hours ago, and the patient has not taken any medication except for some aspirin.