CC
Mrs. Amazeen is an 86-year-old female here today for a followup. She would like to talk about her visit with Roger Epstein, MD, regarding her abnormal findings on CT of her liver.
HPI
The patient tells me that she was not exactly happy with her visit with Dr. Epstein. After reviewing her CT dated August 26, 2015, it does show abnormal vascularity within the left lobe of the liver with increase in size when compared to 2011. Dr. Epstein reportedly gave her three options. One was to do some laboratory studies. The other was to do a biopsy and the third was to just repeat imaging. Reportedly, he said, "what do you want to do?" The patient felt that he should be telling her what to do, and she felt somewhat disconcerted about that. …show more content…
She has atrial fibrillation, history of coronary artery disease, status post intervention back in 2004 with a CABG. She is feeling well from that standpoint. She is not having any chest pain. She is not having shortness of breath. She does have hypertension. She is taking her medications as prescribed. Her blood pressure here today is excellent at 128/78.
The patient reports that she is just tired. She notices sometimes, she cannot remember things. She is not sure that she wants to do anything more about this, but it is something that she has been noticing. She tells me her appetite is good. She enjoys being with her friends, but just gets worn out.
Medications
Crestor 20 mg daily, 81 mg aspirin, Coumadin per Coumadin clinic, temazepam 15 mg at bedtime, metoprolol 25 mg half tablet twice daily, magnesium 400 mg daily, lisinopril 5 mg twice daily, sotalol 80 mg …show more content…
She asked me to review the lab results with her. I did have those, so I did. It does show a mildly elevated CA 19-9 at 43, the CEA and AFP tumor markers were normal. I have asked her to call Dr. Epstein to the results and talk about the next option. She was also given the option of seeing a new gastroenterologist. She is not sure what she wants to do. She is going to talk with her daughter and she knows she can contact me to discuss whatever she would like to do next. She is going to let me know if I can assist her further with that.
Atrial fibrillation. The patient will keep her follow up with Dr. Jacobs. She will continue with her current medications and Coumadin per the Coumadin scale.
Fatigue. We did talk about this at length. How much of this is due to her age, how much to her medical issues versus other, is unclear. I did offer to do some additional laboratory studies. She declines that today, but she will let me know if she changes her mind about that.
Memory concerns. We again talked about this at length. Time did not allow a full mental status evaluation. This is not a new issue that she has brought up to me. Should he decide that she wants to investigate this further, she will let me know, but she declined further evaluation for this
Mrs. Amazeen is an 86-year-old female here today for a followup. She would like to talk about her visit with Roger Epstein, MD, regarding her abnormal findings on CT of her liver.
HPI
The patient tells me that she was not exactly happy with her visit with Dr. Epstein. After reviewing her CT dated August 26, 2015, it does show abnormal vascularity within the left lobe of the liver with increase in size when compared to 2011. Dr. Epstein reportedly gave her three options. One was to do some laboratory studies. The other was to do a biopsy and the third was to just repeat imaging. Reportedly, he said, "what do you want to do?" The patient felt that he should be telling her what to do, and she felt somewhat disconcerted about that. …show more content…
She has atrial fibrillation, history of coronary artery disease, status post intervention back in 2004 with a CABG. She is feeling well from that standpoint. She is not having any chest pain. She is not having shortness of breath. She does have hypertension. She is taking her medications as prescribed. Her blood pressure here today is excellent at 128/78.
The patient reports that she is just tired. She notices sometimes, she cannot remember things. She is not sure that she wants to do anything more about this, but it is something that she has been noticing. She tells me her appetite is good. She enjoys being with her friends, but just gets worn out.
Medications
Crestor 20 mg daily, 81 mg aspirin, Coumadin per Coumadin clinic, temazepam 15 mg at bedtime, metoprolol 25 mg half tablet twice daily, magnesium 400 mg daily, lisinopril 5 mg twice daily, sotalol 80 mg …show more content…
She asked me to review the lab results with her. I did have those, so I did. It does show a mildly elevated CA 19-9 at 43, the CEA and AFP tumor markers were normal. I have asked her to call Dr. Epstein to the results and talk about the next option. She was also given the option of seeing a new gastroenterologist. She is not sure what she wants to do. She is going to talk with her daughter and she knows she can contact me to discuss whatever she would like to do next. She is going to let me know if I can assist her further with that.
Atrial fibrillation. The patient will keep her follow up with Dr. Jacobs. She will continue with her current medications and Coumadin per the Coumadin scale.
Fatigue. We did talk about this at length. How much of this is due to her age, how much to her medical issues versus other, is unclear. I did offer to do some additional laboratory studies. She declines that today, but she will let me know if she changes her mind about that.
Memory concerns. We again talked about this at length. Time did not allow a full mental status evaluation. This is not a new issue that she has brought up to me. Should he decide that she wants to investigate this further, she will let me know, but she declined further evaluation for this