Promise Clinic
Busy day...
I want to write about Promise Clinic, the new free clinic at RWJ.
I went tonite, it was really cool. There was one MSII,one MSIII and me.
It was really neat, cuz i got to lead the group. It was kinda scary being I was the person everyone was turning to for questions. But i want to thank Mr. X for being a really great patient who had a very interesting story to tell.
(I this this is legal.. as long as i dont mention names)
Mr. X
Hes a 40's yo gentleman with a classic classic story for Obstructive Sleep Apnea. He said he was really fatigued, sleeping 8 hrs a day woke up and fell asleep 2-3 times a day. It's been going on for a couple of years, and is finally looking to get some help. He had an extensive social history which i dont feel i should put up. But I wanted to discuss the differntial for fatigue..
so what we came up for possibilites were:
OSA, tuberculosis, Hep B/C, Depression, HIV, Syphilis, Anemia
so he had a tb test recently during his time in prison, and had not been tested for HIV for 5 years. He was negative for the screening questions for depression except occasional suicidal thoughts without a plan. On PE he had a pretty narrow glottis with a BMI of 36. He was also Hypertensive at 150/90, with a possible new diagnosis of HTN.
So heres what we did for him:
We're trying to get him a sleep study which is easier said than done, also we ren all the appropriate blood tests hep b/c (which i learned can cost about 100 dollars) HIV/RPR, CBC
We got the CBC results rite away, he was not anemic, but had a pretty low MCV with at 75 NL 80-100. I havent really seen this b4. I was thinking about doing iron studies.. but i need to think that over. (everything is coming out of the promise clinic mild budget) He had one episode of bleeding from his colon which we need to explore some more.. (we ran a little over time as it was)
So other than that we're calling him back in 3 weeks to re-evaluate his HTN, i htink he might need some HCTZ. All advice on diet/excercise were given. I think HCTZ is a good first line drug, B-Blocker would be a sad choice since his chief complaint was fatigue. Maybe ACEI/ARB, but he doesnt have any renal disease/DM as we know. HCTZ is pretty cheap tho, and i think thats a better choice.
I have ACLS (advanced life support where i learn how to RUN a code) sometime this month i hope it doesnt interfere with the follow up apt.
alright
Thats all for now
I want to write about Promise Clinic, the new free clinic at RWJ.
I went tonite, it was really cool. There was one MSII,one MSIII and me.
It was really neat, cuz i got to lead the group. It was kinda scary being I was the person everyone was turning to for questions. But i want to thank Mr. X for being a really great patient who had a very interesting story to tell.
(I this this is legal.. as long as i dont mention names)
Mr. X
Hes a 40's yo gentleman with a classic classic story for Obstructive Sleep Apnea. He said he was really fatigued, sleeping 8 hrs a day woke up and fell asleep 2-3 times a day. It's been going on for a couple of years, and is finally looking to get some help. He had an extensive social history which i dont feel i should put up. But I wanted to discuss the differntial for fatigue..
so what we came up for possibilites were:
OSA, tuberculosis, Hep B/C, Depression, HIV, Syphilis, Anemia
so he had a tb test recently during his time in prison, and had not been tested for HIV for 5 years. He was negative for the screening questions for depression except occasional suicidal thoughts without a plan. On PE he had a pretty narrow glottis with a BMI of 36. He was also Hypertensive at 150/90, with a possible new diagnosis of HTN.
So heres what we did for him:
We're trying to get him a sleep study which is easier said than done, also we ren all the appropriate blood tests hep b/c (which i learned can cost about 100 dollars) HIV/RPR, CBC
We got the CBC results rite away, he was not anemic, but had a pretty low MCV with at 75 NL 80-100. I havent really seen this b4. I was thinking about doing iron studies.. but i need to think that over. (everything is coming out of the promise clinic mild budget) He had one episode of bleeding from his colon which we need to explore some more.. (we ran a little over time as it was)
So other than that we're calling him back in 3 weeks to re-evaluate his HTN, i htink he might need some HCTZ. All advice on diet/excercise were given. I think HCTZ is a good first line drug, B-Blocker would be a sad choice since his chief complaint was fatigue. Maybe ACEI/ARB, but he doesnt have any renal disease/DM as we know. HCTZ is pretty cheap tho, and i think thats a better choice.
I have ACLS (advanced life support where i learn how to RUN a code) sometime this month i hope it doesnt interfere with the follow up apt.
alright
Thats all for now
posted by AKJ at
8:13 PM
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