Unusual Symptoms

Doctor's File Notes July 27, 2005



Annual Exam:

Patient presents for his annual exam and for follow-up of his possile chrionic hypomagnesemia as well as a severe chronic depression on multiple medications and ECT as well as hyperlipidemia.  Overall he is doing well.  He has now completed 20 courses of ECT and remains on multiple medications as noted above including the new addition of Lamictal.  He does not feel particularly frustrated and/or depressed or suicidal.  He is between jobs and is consulting.  He denies fever or chills, chest pain, shortness of breath, nausea or vomiting.


Recent blood tests show a normal glucose of 109, normal electrolytes, normal LFT's, normal CBC, a cholesterol of 220 with an HDL of 104 and PSA that is normal at 2.9 and a normal Ck.


He has no knopwn allergies  He does not smoke and drinks very minimally.  He continues top reside by himself here in San Francisco.


On examination he is a well developed, well nourished thin male in no apparent distress.  Weiight of approximately 174 pounds, respiratory rate of 16.  He is afebrile with a pulse of 79 and regular.


SKIN - warm and dry without rashes or lesions.
HEAD and NECK - oropharyx is clear, neck is supple.
BACK - reveals no CVA tenderness.
CHEST - clear to A and P.  CV - notable for an S1, S2 without S3, S4, murmur or rub.
ABDOMEN - soft, supple, nontender without hepatosplenomegaly.
GU - unremarkable.
RECTAL - reveals an enlarged prostate and very hard stool.
EXTREMITIES - nonfocal.
NEUROLOGIC - nonfocal.

Impression:

  1. Chronic constipation - suspect secondary to medication and urged higher use of Metamucil and Colace.
  2. Depression - stable on Wellbutrin and Cymbalta, Provigil, Geodon and Lamictal.
  3. Hyperlipidemia - doing well on Lipitor and has a high HDL pattern.  Most recent LDL was quite acceptable at 91.
  4. Health care naintenance - up-to-date with recent eye exam.  Will need repeat heart scan in 1 or 2 years.