User talk:Janndae

jpowsang_hlm-6808-3664-20080723_430868

OUTPATIENT NOTE

Patient’s name: Orbin Smith MR#: 2687378 Date: July 23, 2008

The patient is a 72-year-old male patient with clinical T1c __33_prostate cancer in 3 out of 12 biopsies. He was diagnosed in December 2007. The patient is ___45__as an option and would like to proceed with treatment desired rather than active surveillance. I discussed different ___54__ and did not recommend surgery. My main recommendation is that the patient considers either a seed implant or external beam radiation therapy. I discussed prior surgery as well as risks and complications and told him that I would this as a second option to radiation therapy. The patient __73_ with Dr Haze to discuss radiation therapy option on July 28, 2008.

jschaffer_hlm-45901-3664-20080705_415764

PATIENT’S NAME: DANIEL, WILLIAM C. MR #:  202130 DATE OF VISIT: June 24, 2008

This is a 79-year-old man with a history of superficial bladder cancer. He has undergone resection and has had intravesicle BCG. He had a left adrenal mass which was biopsied. The biopsy was negative for malignancy. He is status post a transurethral resecton of a 4 papillary tumors. He was in the GU clinic today for a postprocedure visit for medications: 1.	Lipitor 10 mg daily. 2.	Zebeta 5 mg daily. 3.	Plavix 75 mg daily. 4.	Micardis 20 mg daily.

PAST MEDICAL HISTORY: The patient reported that he had a “mini stroke” approximately 2 years ago. He is followed by a cardiologist.

REVIEW OF SYSTEMS: Generally, he is feeling pretty well. He denies fevers. He denies nausea. His urine stream is fairly strong. The strain is a little slow to start. He denies urinary frequency. He feels like his bladder is empty when he finishes urinating. He has nocturia x1. He denies any burning or pain associated with urination. He had gross hematuria for approximately 12 hours after the biopsy procedure. His urine then cleared.

SURGICAL PATHOLOGY DATA dated June 10, 2008:

High-grade papillary urothelial carcinoma with no invasion identified. Muscularis is identified and is free of malignancy.

ASSESSMENT AND PLAN: A 79-year-old man with a history of bladder cancer. He has had resections and intravescle BCG. He is status post transurethral resenction of 4 bladder tumors on June 10, 2008. Surgical pathology was high-grade papillary urothelial carcinoma with no invasion identiied. Muscularis propria was identified and was free of malignancy. I discussed the patient with Dr. Tom Pang. Our plan is mitomycin weekly for a total of 6 weeks of treatment. Dr Tausang would like to do another transurethral resection of bladder tumor1 month after completion of intravesicle therapy.

jstrosberg_hlm-18322-3664-20080715_424391

GARRETT BURNS 533089 Date of Service: 07/15/08

This is a 58-year-old man with metastatic bronchial carcinomic tumor who is here for followup status post first hepatic artery embolization.

HISTORY OF PRESENT ILLNESS: The patient presented in July 7, 2007 with fevers and abnormal chest x-ray. CT scan eventually showed primary tumor in the right lower lobe with multiple liver metastasis. Biopsy revealed metastatic carcinomic tumor. A 24-hour urine 5-HIA was normal. He was started on Sandostatin LAR for its antiproliferative effect. His fever and sweats resolved. In May 2008, CT scan of the chest and abdomen revealed growth in his liver metastasis. At that point, we recommended a hepatic artery embolization and he underwent his first embolization on June 4, 2009. Overall, he developed significant right upper quadrant pain radiating to the right shoulder and he required admission to the hospital for intravenous opiate treatment. At this point, he has completely recovered from his embolization and is feeling well. He mentioned that he has an occasional cough as well as occasional right upper quadrant abdominal discomfort but denies any other symptoms.

PAST MEDICAL HISTORY: Please see note dated 01/16/08

MEDICATIONS: Please see note dated 01/16/08

ALLERGIES: Please see note dated 01/16/08

SOCIAL HISTORY: Please see note dated 01/16/08

FAMILY HISTORY: Please see note dated 01/16/08

REVIEW OF SYSTEMS: Please see note dated 01/16/08.

PHYSICAL EXAMINATION:

GENERAL: A pleasant healthy-appearing man who is alert and oriented.

VITAL SIGNS: Please see power??__138__ chart.

HEENT: Sclerae anicteric. Oropharynx is clear.

NECK: No adenopathy.

LUNGS: Clear to auscultation.

CARDIAC: Regular rate and rhythm. No murmurs.

ABDOMEN: Soft. Nontender. No hepatosplenomegaly.

EXTREMITIES: No clubbing, cyanosis, or edema.

LABORATORIES:

CBC and CMP are unremarkable.

ASSESSMENT AND PLAN: This is a 58-year-old man with metastatic bronchiole carcinomic tumor to the liver. He will complete his second of 2 hepatic artery embolization tomorrow and I would like to see him back in the clinic in 4 to 5 weeks with repeat CT scan of the chest and 3-phase CT scan of the abdomen as well as labs and chromogranin A. Based on the results of his scan and symptoms, we will decide whether he requires any additional treatment at that time.

jwalker_lagr-30550-26821-[040608]-216175.wav

DISCHARGE SUMMARY

Patient’s Name: Karyll L. Rovella Date of Birth: 03/31/21 ___11_6244879. Date of Admission: 03/09/2008 Date of Discharge: 03/11/2008

This is an 87-year-old female who was admitted to the hospital with possible pneumonia. Upon examination of her the morning following admission, I really questioned this diagnosis and therefore she actually was not started on any additional antibiotics. Other diagnoses at admission included congestive heart failure, atherosclerotic heart disease, atrial fibrillation, and hypothyroidism. The patient had a normal white blood cell count. She had no fevers and therefore on March 11, 2008, she was discharged back to the nursing home. With medications including Dumex 2 mg p.o. q.d., Coreg 3.125 mg p.o. b.i.d., vitamin B12 1000 mcg p.o. q.d., digoxin 0.125 mg p.o. q.d., Lexapro 10 mg p.o. q.d., Vytorin 10/20 1 taablet p.o. q.d., guiafenesin 200 mg p.o. q.h., levothyroixine 125 mcg p.o. q.d., Provigil 200 mg p.o. q.d., Protonix 40 mg p.o.q.d., potassium chloride 20 mEq p.o. q.d., Risperdal 0.5 mg p.o. q.h.s., Coumadin 1 mg p.o. q.h.s., Tylenol p.r.n., Albuterol and atrovent nebulizer t.i.d. as well as q.4 h. p.r.n., and 0.4 mg sublingual nitroglycerin p.r.n. for chest pain.

jwilson_bol-70310-26821-[061708]-246765.wav

Patient: Roop, Michael Date of Procedure: 06/17/08 MR#: 031278 Date of Birth: 06/26/50

Diagnosis: Cervicalgia/cervical facet arthropathy.

Procedure: Medial branch nerve ablation, left cervical medial branch nerve at C5, C6, and C7.

Indication for the procedure: The patient has undergone cervical medial branch ablation in the past and had approximately 6 to 8 months of complete relief of his left-sided neck pain. Given the __86__i repeat the procedure today using informed consent.

Description of the procedure: The patient was placed in the prone position. His neck was prepped with a Hibiclens solution and draped in sterile fashion. Under fluoroscopy, the cervical spine was identified. There were 7 cervical vertebrae in good alignment. The medial branch nerve sites on the left at C5, C6, and C7 were identified. The skin and subcutaneous tissues along with pathway in a tunnel vision view were anesthetized with 1% lidocaine. An 18-gauge radiofrequency cannulas with 10-mm active tips were advanced to the medial branch nerve sites. Sensory and motor testing were adequate, and radiofrequency lesions were performed at 80-degree centigrade for 90 seconds at all sites. The needle/cannula were removed intact. Sterile dressing was placed over the insertion sites.

The patient was discharged with stable vital signs and asked to follow up with me in 2 weeks.