CONSULTATION REPORT
Patient Name: SCOTT, TOM J.
MRN: 100023
Billing No:100000023
Admit Date: 01/21/2013
Discharge Date:
Service Date: 01/21/2013
ESA Attending Dr:
Report Status:
Extra Copies:
REASON FOR CONSULTATION:
Anal cancer, volume depletion.
HISTORY OF PRESENT ILLNESS:
The patient is a 58-year-old man, recently diagnosed with localized anal cancer. He is currently undergoing chemoradiotherapy with Dr. Vacarro and Dr. Whitman. He is due to receive his second round of chemotherapy later this week.
He has been doing fairly poorly from a p.o. intake perspective, although he is doing his best to minimize this to me today. His appetite is definitely off. He tries to drink fluids everyday, but some days are better than others.
He presented to the hospital today with complaints of simply feeling awful. When he tries to stand up, he felt like he was 'going to die.' Here, he was found to have remarkably dry mucous membranes. He was symptomatically orthostatic, although not hypotensive at rest. For some reason, despite no complaint of shortness of breath, a D-dimer was drawn, which was not surprisingly positive. This apparently is leading to a CT angiogram. He did actually have a brief episode of syncope earlier today, which is probably the explanation for this testing.
He is being admitted to the hospital by his primary care service for further hydration. I have been asked to consult for management and recommendations.
He is using Silvadene on his backside, which is quite sore. He has not had any bowel movements at all in several days other than 'pellets.' He has not noticed any urine output in almost a day. A bladder scan in the emergency department showed the bladder to be quite empty.
No fevers or chills or sweats, although he did have some low-grade fevers at home. Following the chemotherapy, he did have several days of fairly bad diarrhea, which has since resolved. He did not have any mouth sores. He does have a Port-A-Cath on the right side of his chest.
PAST MEDICAL HISTORY:
1. Anal cancer.
2. Anxiety.
3. GERD.
4. Tobacco abuse.
MEDICATIONS:
Reviewed.
SOCIAL HISTORY:
Twenty pack-year smoker. No significant alcohol use. Works in maintenance. Lives with his girlfriend.
FAMILY HISTORY:
Noncontributory to the present illness.
PHYSICAL EXAMINATION:
VITAL SIGNS: Reviewed. There were clearly orthostatic changes and tachycardia in the emergency department. His blood pressure at rest is normal.
GENERAL: He does not appear toxic. In good spirits.
HEENT: Dry mucous membranes, no thrush or mucositis.
NECK: Supple, no cervical adenopathy.
CHEST: Port-A-Cath site clean, dry and intact.
HEART: Regular, normal S1 and S2.
ABDOMEN: Soft, somewhat protuberant, no organomegaly.
RECTAL: Looks like large external hemorrhoids, as well as tumor. Quite a bit of radiation dermatitis, covered with a lot of Silvadene. No bleeding.
EXTREMITIES: No clubbing, cyanosis or edema.
LABORATORY DATA:
White count 4.8, hemoglobin 11.6, platelets 311,000. Basic metabolic panel is fairly normal. Creatinine 1.0. Magnesium 2.1. D-dimer 452.
IMAGING DATA:
Chest x-ray is unremarkable.
A recent liver MRI shows that a lesion of concern was an hemangioma.
IMPRESSION:
1. Volume depletion: The patient has been doing poorly with p.o. intake related to chemotherapy. Mostly, simple poor appetite, not a lot of mucositis or volume loss from diarrhea. He has not really been particularly proactive about letting us know, and we spoke about this at some length. Oftentimes, admissions like this can be avoided if he lets us know and we provide outpatient hydration. He still has 2 weeks or so of therapy to go, so good communication is paramount to get through the rest of treatment safely. Given the degree of volume depletion, the lack of urine output for the last day, and syncope, I think admission for hydration certainly makes sense and hopefully, this will be a short hospital stay.
2. Anal cancer: In between treatment cycles right now. I will let the radiation team know that he is down here. Dr. Whitman will return in the morning. Hopefully, we can get back on our treatment schedule for later this week.
Thank you for asking me to see your patient in consultation. Please call with questions or concerns.
CONSULTATION REPORT
Patient Name: SCOTT, TOM J.
MRN: 100023
Billing No:100000023
Admit Date: 01/21/2013
Discharge Date:
Service Date: 01/21/2013
ESA Attending Dr:
Report Status:
Extra Copies:
REASON FOR CONSULTATION:
Anal cancer, volume depletion.
HISTORY OF PRESENT ILLNESS:
The patient is a 58-year-old man, recently diagnosed with localized anal cancer. He is currently undergoing chemoradiotherapy with Dr. Vacarro and Dr. Whitman. He is due to receive his second round of chemotherapy later this week.
He has been doing fairly poorly from a p.o. intake perspective, although he is doing his best to minimize this to me today. His appetite is definitely off. He tries to drink fluids everyday, but some days are better than others.
He presented to the hospital today with complaints of simply feeling awful. When he tries to stand up, he felt like he was 'going to die.' Here, he was found to have remarkably dry mucous membranes. He was symptomatically orthostatic, although not hypotensive at rest. For some reason, despite no complaint of shortness of breath, a D-dimer was drawn, which was not surprisingly positive. This apparently is leading to a CT angiogram. He did actually have a brief episode of syncope earlier today, which is probably the explanation for this testing.
He is being admitted to the hospital by his primary care service for further hydration. I have been asked to consult for management and recommendations.
He is using Silvadene on his backside, which is quite sore. He has not had any bowel movements at all in several days other than 'pellets.' He has not noticed any urine output in almost a day. A bladder scan in the emergency department showed the bladder to be quite empty.
No fevers or chills or sweats, although he did have some low-grade fevers at home. Following the chemotherapy, he did have several days of fairly bad diarrhea, which has since resolved. He did not have any mouth sores. He does have a Port-A-Cath on the right side of his chest.
PAST MEDICAL HISTORY:
1. Anal cancer.
2. Anxiety.
3. GERD.
4. Tobacco abuse.
MEDICATIONS:
Reviewed.
SOCIAL HISTORY:
Twenty pack-year smoker. No significant alcohol use. Works in maintenance. Lives with his girlfriend.
FAMILY HISTORY:
Noncontributory to the present illness.
PHYSICAL EXAMINATION:
VITAL SIGNS: Reviewed. There were clearly orthostatic changes and tachycardia in the emergency department. His blood pressure at rest is normal.
GENERAL: He does not appear toxic. In good spirits.
HEENT: Dry mucous membranes, no thrush or mucositis.
NECK: Supple, no cervical adenopathy.
CHEST: Port-A-Cath site clean, dry and intact.
HEART: Regular, normal S1 and S2.
ABDOMEN: Soft, somewhat protuberant, no organomegaly.
RECTAL: Looks like large external hemorrhoids, as well as tumor. Quite a bit of radiation dermatitis, covered with a lot of Silvadene. No bleeding.
EXTREMITIES: No clubbing, cyanosis or edema.
LABORATORY DATA:
White count 4.8, hemoglobin 11.6, platelets 311,000. Basic metabolic panel is fairly normal. Creatinine 1.0. Magnesium 2.1. D-dimer 452.
IMAGING DATA:
Chest x-ray is unremarkable.
A recent liver MRI shows that a lesion of concern was an hemangioma.
IMPRESSION:
1. Volume depletion: The patient has been doing poorly with p.o. intake related to chemotherapy. Mostly, simple poor appetite, not a lot of mucositis or volume loss from diarrhea. He has not really been particularly proactive about letting us know, and we spoke about this at some length. Oftentimes, admissions like this can be avoided if he lets us know and we provide outpatient hydration. He still has 2 weeks or so of therapy to go, so good communication is paramount to get through the rest of treatment safely. Given the degree of volume depletion, the lack of urine output for the last day, and syncope, I think admission for hydration certainly makes sense and hopefully, this will be a short hospital stay.
2. Anal cancer: In between treatment cycles right now. I will let the radiation team know that he is down here. Dr. Whitman will return in the morning. Hopefully, we can get back on our treatment schedule for later this week.
Thank you for asking me to see your patient in consultation. Please call with questions or concerns.