[NP-Clinical] Case updates

[Christine Smith]

I have been overwhelmed with numerous issues but I want to update the list on a few cases I presented for help and feedback in recent months.
  a.. First - my 70 mother with chronic hematuria and scheduled for a knee replacement. She did have a bladder CT but they have not figured out the cause of her persistent hematuria yet. She then developed the HZoster on her face, had her knee surgery delayed and lost 15 lbs (not good). She was able to have the knee replacement this past Friday and has done well - discharged yesterday without complications. She  is doing well and will further investigate the hematuria as soon as she is moving a bit better. She is active and can't wait to get back into her routine and is actually managing the  16 steps in their house fairly well right now.

  a.. In January I posted a case on a never married, 40ish yo Latino with new onset paranoia. If you recall, he "has always been a bit off" per his  brother but suddenly quit a job, quit smoking cigarettes and was lighting small fires in his mothers house to ward off spirits and hearing voices. No prior Schizophrenia sx except a very brief episode last year that the family did not seek tx for. I admitted him for R/O Organic Brain Syndrome (etiology unclear) as opposed to sending him straight over the County Psych Unit. Which, by the way, the County Psych Hospital wants all the workup done before they show up - they do not want to do it there. Well, he can back with Syphilis being the etiology for his mental changes!!!  I ran into his brother recently who said he is getting the help he needed.

  a.. The 19yo male with variegated skin pigment. Never even thought of Tinea Versicolor - Mom thinks that is what it was called years ago too. I have him doing the OTC Nizoral shampoo tx once a week at Ted and others suggestions. I think he will be more attentive to the régime then he was at age 13 due to his significant interest in a females now.

  a.. My friends sudden death after a routine colon polpectomy that ended up with a cholecystectomy, major abdominal incision and then death.  I have reviewed numerous medical records  with the family. The coroner ruled his death as being caused by Left Ventricular Hypertrophy. No prior knowledge of theLVH per EKGs and Echo in Sept 2006.  Not sure how LVH causes Sudden Death. My friend did have some impending doom feelings when he arrived home from the hospital, he then coded and died that day with the Code sheet showing first Atrial Fib with a pulse in which he was cardioverted at the scene, then rapid atrial fib without a pulse in the ER for which he was given EPI and CPR (treated like PEA) and then asystole less than two minutes later then death. It does sound very much like he must have had a PE but I don't know why the Coroner did not mention anything like that. The family is seeking legal advice, primarily I think, because they are angry, hurt and don't understand what happened. While a PE is a risk for surgery, and maybe there is no malpractice here, there are some red flags that the family wants to understand.

  a.. Lastly, my own foot problem. S/P First Metatarsal fusion last Sept. I have continued to have significant swelling and pain to the dorsal toe. I saw my podiatrist who drained out a 15cc Blood filled Bursa from the top and shot in some cortisone three weeks ago. It improved somewhat, I am able to stand some  when cycling now and I was able to ride 40 miles last week without difficulty. Hopefully, when I pick up my orthotics tomorrow I will have an easier time of walking. Otherwise, I think I may have to do more teaching and less patient care because of the persisting toe pain with ambulating.
Thanks for all the help, wisdom and comments. The expertise that the members of the listserve offer is always appreciated!!!
Christine Smith, NP
Antioch, CA
   
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