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Monday, January 24, 2011

Personal Medical Log Stardate 11063

Isn't it a bit unnerving that doctors call what they do "practice"?
August 19, a Friday
Seen Dr Helen Chow at HH K-6 9:10 am
re Gout "Stay away from red meat" - What am I going to do with the steaks I am barbecuing tomorrow at the reunion picnic?
Updated information: High uric acid and causes; and purines

June 2 at 10:17am
Yesterday behind my right big toe hurts at the joint! Possible sprain, broken, infection, or gout, in order of severity
Severe sleep-less pain that night. Went in to Highland Hospital Emergency the following morning. After a short wait, and a shorter still cursory examination, I was given the bad news. I have gout.
Hydrocod/APAP (Vicodin) 500-1000 mg tab every 4-6 hours as needed prescribed for pain and Indomethacin 50 mg cap anti-inflammatory.
2x200 mg ibuprofen works in lieu of the above to keep pain and internal [not swollen] inflammation maintained 6 hours during a 2-3 day flare-up.

2011 05/27 1430 a Friday
Change in medication by Dr Swift after regular CHF check-up
Enalapril tabs 10mg tab take 1 tablet by mouth twice daily - doubled the dosage
Digoxin .125mg tab 1 tablet by mouth Daily
Meds [4]                                 May after Cardiologist check-up
Spironolactone [Aldactone] 25mg tab ½ pill every day
Aspirin tabs  81mg [baby aspirin] 1 tablet by mouth Daily
Carvedilol [COREG] 25mg tab take I tablet by mouth twice daily
Enalapril tabs 5mg tab take 1 tablet by mouth twice daily- do not take both at the same time during the day (caused dizziness and rapid drop in BP)
- Furesomide [Lasix] tabs 40mg 1 tablet by mouth when needed
- Simvastatin  80mg tab 1 tablet at Bedtime no longer
Rod's log stardate 110320.6, SFO. Upon getting out of the car and walking to the terminal- Dizzy, blurred vision, and hurts behind the eyes [sockets]. Clammy, pale, and assumed low blood pressure; shallow pulse. On standing and when looking at something. At home now, self-observing, and reclined. -Sun 3/20 1pm DST

Medical log, supplemental stardate 110324: BP 77/40 Cardiologist check-up. Severe dizziness standing after sitting in waiting room for 3 hours. Dosages changed to possibly alleviate side-effects. -Thu 3/24
See Dr if not well by Monday.

Weekend update: Wake up. Take meds. Drive in an hour for more than 20 minutes. Severe dizziness for a minute, diminishes after 3 minutes if 'walking it off.'
January 20, 2011 Thursday
8a Checked in to  Highland Hospital Emergency
- Shortness of breath [SOB];
- abdominal pain below left rib when going into coughing fits
3 day, 2 night stay
Felt like I was dying going in. Excellent care. I will be back there next week for my follow-up.
Following a new home care regimen of meds and moderate diet. Feeling a lot better than when winter started.

Discharge Summary
52 yo  with systolic dysfunction, CHF (EF 15-20%) since 1994, s/p AICD placement (8/2010) p/w progressively worsening SOB x 2 weeks, LLE swelling & orthopnea. Noncompliant with low salt diet, but compliant with medications. Denies CP. Denies fever/chills. In the ED, pt placed 2L NC oxygen, given ASA 325mg, Levofloxacin 500mg, & Furesomide 40mg IV. On physical exam, pt had bilateral rales at the lung bases, and +2 BL pitting up to the hips.
 (1) CHF exacerbation 2/2 fluid overload. Echocardiogram ordered to check EF. Furesomide increased to 40mg IV TID. Pt diuresed to get rid of the fluid overload.

Continued ASA 81mg PO Qday,
Carvedilol 25mg PO BID,
Spironolactone 25mg Qday,
Simvastatin 80mg PO QHS, &
Enalapril 20mg PO BID.
Monitored myo/trops q6 (trops trending down) abd Strict I/Os. Pt weights 91kg.

Urine output of 900ml on hospital day 1. BNP 2725>>>2983. Pt placed on 2g low sodium diet. (2) Transaminitis 2/2 congestion vs. viral hepatitis. Monitored LFT trend and hepatitis panel ordered. LFTs normalized on hospital day 2. On day of discharge, bilateral pitting edema improved, lungs clear to auscultation, pt able to ambulate without any distress and medicallystable.

See My Calendar for hourly events.

At Home - Activity Log
Meds [6] [5, 3, 2] [am, pm, sleep]
- Spironolactone 25mg tab [Aldactone] #90 1 tablet Daily by mouth
- Aspirin tabs 81mg #90 1 tablet by mouth Daily
- Enalapril 10mg tab #120 1 tablet Twice Daily by mouth
- Carvedilol tabs 25mg #120 1 tablet Twice Daily by mouth
- Furesomide tabs 40mg 1 tablet by mouth 3 Times Daily
- Simvastatin  80mg tab 1 tablet at Bedtime
Fluid Intake limit 1.5 L [48 fl oz]... 1 oz sip / 2oz gulp / 8oz mug / 12oz can
Expire est 3 L per 'day'

Thursday January 27, 2011 a week later...
Lung capacity at 60-70% normal; no shortness of breath otherwise. Articulation better, full sentences. Still some cough fits, but no associated pain. Any muscle pain is due to posture only. No pain upon moving position as before. Slow walk ok at any distance. Swelling is visibly down. Feet and ankles still swollen and dehydrated. Overall physical and mental health outlook: good.

New entries will be at the top of this post.

This is a continuation of last year's Medical Log.

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