DATE OF SERVICE: MM/DD/YYYY
SUBJECTIVE: The patient is a very pleasant (XX)-year-old female who returns today on prednisone, newly indicated, for the diagnosis of polymyalgia rheumatica. Fortunately, the patient reports feeling significantly better. We had originally started her on 10 mg of prednisone, had followup visitation in Rheumatology, felt the dose should be increased, and having increased, many of those symptoms have improved.
Unfortunately, she continues to have numbness and tingling in bilateral wrists, which is thought to be predominantly due to carpal tunnel. Carpal tunnel has been evaluated recently by Orthopedics, nerve conduction studies support this, as well as some mild ulnar entrapment as well.
The patient does not endorse neck complaints, neck pain or numbness and tingling that radiate down the arms. Her symptoms are generally made worse by doing things like washing dishes.
She states the injections that were performed helped with those complaints greatly, and at a later date, she may in fact be a candidate for surgical intervention. Hopefully, however, between the injections and now being more consistent about using carpal tunnel splints, the patient will improve. She plans to continue her followup visitation with Rheumatology. This is encouraged.
Notably, the vitamin D levels, that were evaluated a few weeks ago, were slightly diminished. The patient takes some vitamin D. We have asked her to increase her vitamin D to 2000 International Units daily as of today.
Last visitation, we had made arrangements for complete metabolic profile and hemoglobin A1c when we came to understand that the prednisone would be initiated. Her potassium is low. We also started potassium chloride 20 mEq one daily. Fortunately today, her potassium is corrected. Sugars are running high, and the overall hemoglobin A1c has come up to about 7.3.
She has done a great job of checking blood sugars, which were consistently very good when she first wakes up in the morning. In the afternoons, it is not uncommon to be in the 180s or sometimes 200. Hence, we discussed taking 1 mg of Amaryl on a daily basis, watching for any symptoms of hypoglycemia.
We also asked the patient to visually monitor blood pressures on prednisone. Fortunately, those do not appear to have changed, and she still shows excellent control.
The vast majority of this visitation was focused on potential side effects of prednisone with emphasis on hypertension and diabetes.
ASSESSMENT AND PLAN:
1. Polymyalgia rheumatica, symptoms overall improved.
2. Diabetes. Initiating Amaryl 1 mg one tablet p.o. daily, #30, 6 refills provided.
3. Hypertension. Believe remains adequately controlled. The patient was accompanied by her daughters. They had ample opportunity to ask questions but frankly did not have any. The patient will return to the clinic with this practitioner in three months. Flu shot today was provided.
