CC Mrs. Leahy is a 72-year-old female here today with complaints of right leg pain. HPI The patient tells me this has been ongoing now for the last two months. There was no specific injury or trauma. She was describing a pain and ache in her right leg. She said she was not paying much attention to exactly where it was and elected to go see urgent care on September 3th. I do have that note from the physician that she saw there. At that time, her main complaint was right knee pain. She had x-rays done that showed some mild osteoarthritis and she is here today to follow up on that. She says after that visit, she really started trying to pay attention to where the pain was coming from and she realized it is really coming throughout the whole leg, particularly the thigh area, the knee, down the back of the leg as well, and she also feels it a little into the right buttock. No injury or trauma. There is no real low back pain associated with this. No weakness that she has noticed. No numbness or tingling that she has had. She is having no other joint issues that she can recall. She is not having fevers. There has been no redness or swelling. She is overall feeling okay. She is a little bit more tired than typical. No associated fevers, chills, or other body …show more content…
aches. She tells me her appetite is good and her weight is stable here in the office today. She does have a history of lupus. She also has a history of colon cancer diagnosed last year. She has never had this particular symptom before. She did do a trial of Advil, which she does not feel was helpful. The patient is wondering whether the leg pain might be secondary to her chemotherapy, which she stopped in the spring. She also wonders whether it might be related to the fact that her thyroid dose was changed with her hypothyroidism based on her lab from July 31, 2015 with a TSH of 5.04. Her dose was increased to 0.112 from 0.1 because of that. Medications Amlodipine 10 mg daily, azathioprine 50 mg daily, Nexium 40 mg daily, levothyroxine 0.112 mg daily, Diovan 80 mg daily, prednisone 5 mg daily, vitamin D supplement 2000 units daily, 81 mg aspirin, a multivitamin, a probiotic. Social History She is a lifetime nonsmoker. O Vital Signs Temperature: 97.5. BP: On arrival 158/88. Recheck at the end of visit 132/80. HR: 74. R: 14. W: 162. General A well-developed, well-nourished female in no acute distress seated comfortably in the exam room. She is alert and oriented. Very pleasant. Extremities Her bilateral lower extremities were examined.
No pain with pelvic rock. She has full flexion and extension at the bilateral hips. It seemed equal. She has full flexion and extension at the knee and otherwise normal. No redness. No swelling. No pain directly over palpation of the femur, the tibia or fibular area. No obvious swelling or tenderness directly in the calf. She points essentially all over her lower leg as to where she is having pain, and is finding it difficult to identify a specific area. She is somewhat tender in the right buttock is well. There are venous changes noted on her bilateral lower extremities with multiple varicosities, but an otherwise essentially normal
exam. A/P Andrea Leahy is a 72-year-old female here with several month history of right leg pain that seems to be worsening. We talked about options. She is concerned for blood clot with her history. Though I suspect it's low likelihood, I did order an ultrasound. I will review those results with her when available. She is also updating her thyroid level with her hypothyroidism and dose adjustment. I have added some labs for that, including Lyme and a CBC and I will review results with her when available. Depending on those results, consideration for further imaging, or a referral for physical therapy, orthopedics can be done at that time. She has also noticed some changes in how she has been walking. She feels as though she is rotating at the hip of the right leg when she is walking and she is going to try to focus more on trying to keep that straight, as she thinks she might be making it worse. She will let me know if her symptoms are not improving as we discussed and we will review results when available. All questions were answered in the office today.
Cynthia Adae was taken to Clinton Memorial Hospital on June 28, 2006. She was taken to the hospital with back and chest pain. A doctor concluded that she was at high risk for acute coronary syndrome. She was transferred to the Clinton Memorial hospital emergency room. She reported to have pain for two or three weeks and that the pain started in her back or her chest. The pain sometimes increased with heavy breathing and sometimes radiated down her left arm. Cynthia said she had a high fever of 103 to 104 degrees. When she was in the emergency room her temperature was 99.3, she had a heart rate of 140, but her blood
A summary of the case details (provide the circumstances surrounding the case, who, what, when, how)
The applicant Mr. Arthur Hutchinson was born in 1941. In October 1983, he broke into a house, murdered a man, his wife and their adult son. Then he repeatedly raped their 18-year old daughter, having first dragged her past her father’s body. After several weeks, he was arrested by the police and chargedwith the offences. During the trial he refused to accept the offence and pleaded for innocence. He denied accepting the killings and sex with the younger daughter.
Team owner Fay Sollenberger was pleased that the team was recognized at their awards banquet.
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.
The court’s decision based on the treatment of young people in this case emphasizes on the concept of social justice, which means the fair allocation of wealth, resources and opportunity between members in a society. The appellant in this case, Louise Gosselin, was unemployed and under the age of 30. She challenged the Quebec Social Aid Act of 1984 on the basis that it violated section 7 of her security rights, section 15 of her equality rights in the Canadian Charter of Rights and Freedoms and section 45 of the Quebec Charter of Human Rights and Freedoms. For the purpose of this essay, we shall explore the jurisprudence analysis of section 7 and section 15 of the Canadian Charter of Rights and Freedoms. Section 7 states that everyone has the
Life. Life is what gives you the ability to think, to speak, to breath and to be a part of this world. It is worth more than any amount of money, your life is priceless. Without it, we would seize to exist; our world would be utter darkness. Honourable Judge, Ladies and Gentlemen of the jury, today Mary Maloney stands on trial before you. A woman who took the away the life of not just an innocent citizen, but her very own husband. She was thought to be an ordinary women, a typical housewife and a soon to be loving mother. However, the facts presented before you today conclude that Mary Maloney was not just an unordinary detective’s wife, but also a murder. On April 13th 1953, the life of Patrick Maloney came to a tragic end because of leg of lamb in the hands of Mary Maloney. For the following reasons, Mary Maloney, wife of the deceased, is guilty of 1st degree murder.
She was having pain in her neck and soreness in her thigh and back. she claimed that she felt continuous pain because of this
The patient tells me at least six or eight weeks ago, she noticed that she was having some discomfort in the left axillary area. She around the same time had started doing a lot of exercising, specifically Zumba classes and attributed her discomfort to that. She describes it as an aching, nagging type of pain that is not there consistently. It seems to come and go. Yesterday, she did Zumba and noticed following that it was little bit achy and last evening she was lying down with her arm above her head and was checking the area where it was tender and felt a lump there. This is the first time she felt a lump, despite multiple checks previously.
L. H. a 22-year-old female who came into the clinic as a new patient complaining of lower back pain. Vital signs include: height 62 inches, weight 108 lbs., and 16 respirations. The patient stated that her back pain has gone on for quite sometime now (about 2 years total). She works as a nursing assistant in a nursing home in Wahoo. The physician stated that he wanted to taper her off tramadol (she takes 150 mg a day). He also wants to taper her off Effexor as well. The doctor noticed that the painful region was in the patient’s upper left side of her back. He recommended to the patient that L1 to L2 and L2 to L3 facets would benefit from steroid injections. The patient and her mother wanted to make sure they met their
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
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
Tim is a 50 year old hill farmer experiencing low back pain radiating into posterior aspect (R) thigh, sometimes accompanied by P&N. It has been present for about 6 months. This pain is intermittent aggravated by walking and standing. He is currently experiencing difficulties at work (W 6/10) pain is relieved by flexing the spine or lying down. He has no Red flags, but some concerns about his future.
General: Patient is alert, oriented, not in acute distress. Not in labored breathing. Gait is non-antalgic. Cooperative and talkative mood affect. On exam of left knee inspection noticed some swelling compared with the right. Tenderness and swelling in left knee medial aspect. The scar from anterior knee is well healed. No sign of infection. Vascular exam is normal, dorsalis pedis pulses posterior, tibial pulses and capillary refill. Neurologic exam is within normal limits. Sensation and motor is intact. Motor and sensory are intact equal bilaterally. Hyperextension and flexion is within normal limits. Lachman test is negative. Knee anterior drawer test is negative. McIntosh test is negative. Inspection is no ecchymosis but there is a mild swelling in the medial
DT is an 88 year old female; she is 4’9 and 152 pounds. She recently retired from Wal-Mart in January of this year and was living at home with her husband up until her recent admission to the hospital. She presented to the emergency room with right knee pain and was admitted to the medical surgical unit. Her knee was swollen and she was unable to walk on it due to the pain it was causing her. She had synovial fluid drained from her knee and there were no signs of any organisms, but many white blood cells. Before her discharge they decided that the swelling and pain was due to inflammation arthritis due to her osteoarthritis. DT also has diagnoses of hyperlipidemia, hypertension, history of nephrolithiasis, and an arrhythmia