A 52 year old man presented to the outpatient clinic where he has been cared for the past several years. He has been diagnosed with hyperlipidemia, hypertension, sleep apnea, and obesity. He requested routine exam and check up as he knows that his insurance was about to expire because of a job change. He is submitted to the examination and lab work. He was continued on Vytorin,Tricor, HCTZ, and low dose ASA.

His physical examination was essentially unchanged. His laboratory studies revealed the following data:

            Triglycerides                             1605  mg/dl

            Total Cholesterol                      239 mg/dl

            Glucose, fasted                        223 mg/dl

            Electrolytes                               Normal

            EKG                   & nbsp;           Unchanged      

One week later, his wife – who is also seen individually in the same clinic – came in asking for her husband’s results. The wife states that her husband has no insurance now.  The husband just started a new job and cannot possibly take time off to come to the doctor.

What are the issues to consider in this simple request? How do you react to the wife’s request?
Submit your answers to drsolomon@gordonclinic.com 

A 29 year old Afro-Caribbean man comes into the emergency room because of severe weakness and nausea and vomiting. He has no history of illnesses in the past otherwise. He came to this country with an immigrant visa to work in computers and has settled in South Borward County.

His symptoms appeared about one month prior in retrospect. At first he felt good about them because he was loosing weight and his BMI at the time was 26 kg/meter squared.

On arrival at the ER he is in acute distress, retching and pale. His pulse oxymetry is 98%. His initial labs reveal the following:

Na 143 mEq/L, K 4.3 mEq/L, Cl 100 mEq/L, Bicarb 24 mEq/L, BUN 14 mg/dl, creatinine 1.0 mg/dl, glucose 432 mg/dl

QUESTIONS

1. What is your list of differential diagnoses?

2. What laboratory study would you order immediately to diagnose this patient?

Send your answers to: SOMJournal@finlay-online.org

A 77 year old woman is admitted to the hospital because of weakness. She has a history of iron deficiency anemia diagnosed and treated 8 months prior. At that time she was referred to a local colon and rectal surgeon. The upper gastrointestinal endoscopy revealed gastritis, negative for H pylori. The colonoscopy revealed mild diverticular disease. The study could not be carried out to the ceacum because the sigmoid colon was very tortuous. A barium enema performed immediately after the limited colonoscopy was found to be negative for masses, colitis or obstruction. She was transfuse at that time to a hemoglobin of 11 gm./dl. At this time she is admitted with a hemoglobin at 6.7 gm/dl. She has heme negative stools. A CT of the abdomen and pelvis is negative for mass or inflammatory change. The patient is being transfused again.

What plans would you now undertake?