OpenNotes entry of Dec. 24:
Initial – MCM
Note Date: 12/24
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Active Medication list as of 12/24:
Medications – Unknown
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This is a first office visit to my clinic by “Patient K,” an extremely pleasant gentleman, upon the urging of his wife, Mrs. “K,” who is accompanying him. Mrs. “K” states that the patient is about to embark on a long journey and hasn’t been to a doctor in some time; she expresses concern about his physical condition for the trip. We are not certain why this patient selected us for this visit.
“Patient K” is elderly – well past retirement age – and obese. According to his wife, he is a “workaholic” who owns a large factory and has a number of diminutive employees. His most strenuous physical activity occurs during a long around-the-world trip that he takes annually. He is constantly exposed to extreme low temperatures, wild animals and, on occasion, chimney smoke and soot. His face appears flushed, but upon closer inspection his cheeks are merely a rosy color.
He is a “binge” eater who consumes massive quantities of high-sugar/simple carbohydrate items during his journey. He prefers milk to all other beverages. He is a smoker – preferring pipes to cigarettes, cigars or other tobacco products – and a very light drinker.
“Patient K’ has a remarkably good gait with excellent overall strength. The musculature of his upper body, particularly his arms and back, is exceptional for his age – indicating years spent carrying large objects upon his shoulders. His extremities appear to be sensory intact and very well perfused. He indicates no symptoms of arthritic pain, pain on initiation of motion, winter pain or pain at the end of the day – in fact, he expresses no pain at all.
“Patient K’s” past medical history was unavailable, but his intake sheet was reviewed. He refuses to provide any written documentation or date of birth, but states “I’m as old as my tongue and a little bit older than my teeth.” He takes no prescription or over-the-counter medications. His blood pressure was exceptional, but I cautioned the reading might not be reliable – our BP monitors have been on the fritz and may not be functioning properly.
We had a long and frank conversation with “Patient K” and his wife. I have explained that, given his abdominal obesity and his eating habits, he needs to look carefully at his diet and focus more on higher-fiber carbohydrates (like whole grains and vegetables) and healthy proteins and fats (such as fish, walnuts/almonds, avocados, etc.). We recommend blood pressure screening, cholesterol levels and hemoglobin A1C levels to evaluate his risk related to hypertension, hyperlipidemia and diabetes. Based on the results, we would start targeted medication and lifestyle treatments.
Since “Patient K” is likely behind on multiple preventive health services, he needs to have a wellness visit with a health care provider to make sure he is up-to-date on all of his screenings and immunizations, including colon cancer, cholesterol and diabetes screenings, an annual influenza vaccine, and pneumonia, zoster (shingles), tetanus, diptheria and pertussis immunizations. We also recommend a daily baby aspirin to help prevent heart attack or stroke.
He needs to start a regular exercise program under the supervision of a health care provider. Emphasizing moderate aerobic exercise, like a brisk walk, and some simple strength training with low intensity would help him prevent some of the consequences of his abdominal obesity. His exercise goals would be 30 minutes per day, five days per week of moderate-intensity aerobic activity and two days per week of some muscle-building resistance training, along with flexibility exercises.
We also discussed enrolling in a smoking cessation program is a high priority. We recommend a referral to the ACT Center for Tobacco Treatment, Education and Research at UMMC and a lung cancer screening with a low-dose CT scan.
Despite these warnings about his potential to fall into ill health, the patient remained in remarkably good humor. Overall, we had a nice conversation and, although “Patient K” resides in another country, we will try to keep in touch in the future through UMMC’s Telehealth service. We spent half the time of this new 30-minute visit discussing and counseling the patient regarding his findings, and I felt compelled to share my wishes for this clinic.
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Postscript – The morning after this patient encounter we received a phone call from our office staff on duty, who informed us that, overnight, brand-new BP monitors were installed in every examination room. We are uncertain who is responsible for this much-needed equipment.
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Signed by Mary Crist-Moss, M.D. on 12-25 at 3:32 p.m.
Editor’s Notes: Dr. Joshua Mann, professor and chair of the Department of Preventive Medicine at UMMC, and Dr. Josie H. Bidwell, associate professor of nursing at UMMC and director of the UNACARE Clinic in Jackson, provided medical expertise for this article.
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