Forrest 5-18

ACCURACY: 78%

CONSULTATION REPORT

PATIENT NAME: Lisa Marie Cobb

HOSPITAL NO.: 4569870

DATE: January 14, _____
CONSULTANT: Susan C. Miller, MD

This 48-year-old female is seen at the request of Dr. Nathan Penn concerning multiple, rather vague, complaints. She was a missionary in India for quite a number of years, and while there, unfortunately, suffered the loss 1.5 INCORRECT ENGLISH MAJORof a kidney apparently from staghorn calculus. Actually the kidney was removed here but the problem developed there, and she admits that this event has led 0.5 INCORRECT ENGLISH MINORher to seek medical attention at the slightest hint of any possible abnormality, and she feels that she frequently overreacts to mild symptoms. Additionally, she feels that the stress of caring for her 93-year-old mother certainly 0.5 INCORRECT ENGLISH MINORis adding to the symptomatology 1.5 INCORRECT ENGLISH MAJORshe might be experiencing. Having begun her conversation with those 2 statements, she then related a long list of somatic complaints including substernal and epigastric burning and discomfort, a right lower quadrant pain, and a fear of colon cancer related to prior polyps removed by Dr. Teresa McCullin several years ago. She was actually admitted because of a positive treadmill study done as an outpatient followed by the onset of some epigastric and substernal discomfort. Since admission, a thallium 3.0 INCORRECT MEDICAL TERMstudy has been negative and multiple additional studies including gallbladder ultrasound, pelvic ultrasound, and ultrasound of the right kidney have been normal. I was asked my opinion concerning additional GI studies. Finally I should mention that just prior to admission, she was on nonsteroidal anti-inflammatory medication and was seen in the ER by Dr. Danny Craven several days ago who felt that some of her discomfort might have been related to esophagitis caused by the nonsteroidal which she has since discontinued.

PHYSICAL EXAMINATION
GENERAL: Physical exam 0.5 CAPITALIZATION ERRORreveals a pleasant, elderly female who is alert, cooperative, and in no distress. HEENT: Normal
NECK: Supple
CHEST: Clear
HEART: Regular rhythm without murmur that I appreciate.
ABDOMEN: Soft and nontender, has well-healed appendectomy scar noted. No organomegaly, masses or tenderness. Bowel sounds normoactive. Rectal not performed.

Available for review are her colonoscopic 3.0 INCORRECT MEDICAL TERMstudies from Our Lady of the Lake Hospital from 1995 which indicate a normal exam at this time. My opinion is that this absolutely excludes any possibility of significant colon lesion at this time, and I have counseled her that she need not concern herself with colon cancer specifically.

Actually I think that she is probably quite correct in her belief that much of this is functional and related to stress. I concur completely with the use of H2 blocker and anticholinergic in conjunction to treat both what is probably some degree of reflux coupled with functional complaints. If she fails completely to respond, then we might consider upper endoscopy, but I would certainly give her a trial of both medical therapy and hopefully some lifestyle rearrangement before considering that step.

I appreciate the consult. I see no reason to do further GI studies at this time.