Document 15LBmYJpMvewzdONwLxMpbRpo

FILE NAME: RT Vanderbilt (RTV) DATE: 1982 July 23 DOC#: RTV038 DOCUMENT DESCRIPTION: Hospital Records of Lester Merritt, admitted for Asbestosis - Had a History of Talc Packing PATIEN T'S NAME . , . . MERRITT, LESTER H LENGTH OF STAY 3 days Mr A . PROBLEMS ON ADMISSION `. & > 1. pulmonary asbestosis 2. Past history of gout - - ->H O S P IT A L N O . .. .. 416-138-6-029 ADM ITTED / -v .^. 7/23/82 f B. SIGNIFICANT PHYSICAL FINDINGS 1. bibasilar rales, diffuse rhonchi muscle use 2. serum uric acid 8.3 mg % C. MANAGEMENT ANDINVESTIGATION OF PROBLEMS 49 year old white male with 23 yr history of talc packing who carries the diagnosis of pulmonary asbestosis first diagnosed 4/81 by open lung biopsy when he presented and in acute SOB and PND. Has had 1 SUH admission since then for worsening SOB aid PND. Presently presents to S U H ^ f w j ^ a y history progressive worsening PND and SOB despite 18h|? home 02. Additionally complins of 3 days of cough productive of clear, thin white sputum. Hospital course remained uneventful. Patient ambulated in halls without SOB, denied PND and admitted to improvement in cough. WBC remained wnl with no l e f ^ t n diffential. Pt remained afebri4, CXR revealed no significant changes from previous films. FEV1 was 1.2L, FVC 1.6 {last FEV^ 6/9/82 wa3 1.3) Sputum cultures revealed normal flora, gram stain showed 1-4 polys/HPF but no organisms. Nuclear V gram 5/81 showed ejection fraction 35% and patient was placed on digoxin. Admission dig level of 1.5 (therapeutic). Serum potassium remained therapeutic on his usual Lasix of 60 mg po qd. Serum uric acid in creased to 8.3 mg % . D. STATUS AND DISPOSITION OF PROBLEMS AT DISCHARGE See above. E. CONDITION OF PATIENT AT DISCHARGE Improved DISCHARGE DIAGNOSES Pulmonatfy asbestosis . MEDICATIONS Digoxin 0.25 mg po qd, Lasix 60 mg po qd, FeS04 1 tab po bid, Dalmane 30 mg po q hs, Allopurinol, 100 mg po tid DIET As. tolerated - . ' ,: TREATMENTS . . ' . . .: \ . LIMITATIONS -As tolerated = ' ' ' - J ' 'V FOLLOWUP Privately with Dr Auchincloss . . . , ; :'TTQ)biNG-'.t^'^^iihciM9 ' HOUSE. OFFICE .Dr^ Bisibp ; ' et:-r' STATE UNIVERSITY HOSPITAL ' SYRACUSE NEW YORK / PATIF.N 3 NAME MERRITT, LESTER LENGTH OF STAY: 9 days A. PROBLEMS ON ADMISSION 1. asbestosis HOSPITAL NO416-138-6-019 ADMITTED DISCHARGE SUMMARY 1DISCHARGED 5/12/81 1 5/21/81 SIGNIFICANT PHYSICAL FINDINGS 1. rales to \ way up lungs 2. g u a i a c 0 stools 3. 4j- clubbing of nail3 C. MANAGEMENT AND INVESTIGATION OF PROBLEMS The patient is a 48 year old white male with a 23 yr history of packing talc in a factory. In Apiril 1980 a severe episode of PND load to a hospitalization in Texas; subsequent open lung biopsy lead to a diagnosis of asbestosi3. Left heart cath was normal. He now comes to SUH after being home 2 weeks; he c/o severe PND and DOE. He is comfortable at rest, however his resting P02=50(or less) and his pC02=50. He is to be sent home with home oxygen at 2 liters/min for 18 hours per day. follow up is with Dr. Auchincloss at chest clinic. D. STATUS AMD DISPOSITION OF PROBLEMS AT DISCHARGE See above E. CONDITION OF PATIENET AT DISCHARGE Improved DISCHARGE DIAGNOSES Abestosis, Congestive heart failure - mild MEDICATIONS: Digoxin .25 mg po q am, Lasix 60 mg po q am, FeS04 325 mg po bid, Allopurinol 100 mg po tid, Dalmane 30 mg po q hs prn DIET Reg TREATMENTS Home oxygen at 2 liters/min via nasal cannula for 18 hours per day LIMITATIONS As tolerated FOLLOW UD Schedule for chest clinic with Dr. Auchincloss in 1 month ATTEN'DDIINNG aDii . Auchinclos>s&)> HOUSE'OFFICER Dr. Hittman ?77 V. V .". ^Doctor: .5 v-'W* .Admitted. ;>, 'Operation;;,. Discharged; 1Dlcfpted: 7 Transcribed saw* 'b r e a th , ema years , was-taken to ^heileft/heart-catneteriiaac^y ^?^ p ^ ^ ' ^ ^ ^ v ^ r^ iefeivpuin^natXipres^ur , ' nhnaal^Lef t ,v e n t r i c a l a r j f r y / ^ * l c v n t ed ^ e ^ n i ^ r ; form al except low W sepressorcin^thepulntoM end d i a s t o l ic p r e s s u r e .; Hi 57%. Dr'. `Kupplnger;vwas 'c o p s u l t ^ _and^e s wh i c h ' v a s - i ^ - ^ P . ^ v^ ^ 8 ^ ^ u-iu^je-u-r ^t j_g^]jnj^ fe rt^ ^ n o u s-b o ^ -- T his re v ealed i n t e r s t i t i a l f i b r o s i ; w . t , . u eni expo^ed to talc for nianyiyears t h i s i - r i e . consistent with a s b e s t o s ^ ^ due to h is w y , c o n s is te n t w ith; t h a t d i a g n o s e V - V * - P,Mu s t^ a lV - :<a e^etv.trbrn the bed ,to th e b a th . slow response. ' Most of J i J S S d v f t V i i e d i ^ h e ^ l a s t several days he has room, and become ivery -markedly 1 * ^ i5* been abie to walk th e h a l l s ^ tv a s 1SSraain5 ^rSlatv6ly com ioirtable. I t h a s b e - w**0^ of blood te s s^ - * ' c o m ^ a p p l r e n t ^ d u r i n g . 132? ^he 1*,<>'- drawn h e-h as become anctaic wi q yr i c acid has>been elevated up. to 15. ^ ' cfur encattii&n irntffteeS|wti^ahs ta3v-y:f2b5e-e8n1^e.?le:ya ai >todd;^wina.|o^lud^^S G O T ^in th^ee^ O O j:s ^ a ik a lin ao'p htohse> ^l ilv* eh -rs. li.sAhctlidy r x " r*. IV*4V* -i1***< Bo* JiS 'vrTi'i* *W ^ r1 Dr. Kuppin#f* 4 KVUj; % >.V.**:- '"'V-1 ; DISCHARGE APM Ss-jwv'tfsl /vT<V^^2F'CrV^SSB^-iis'tST-*`tir'* 3 & 9 iS & B & G ith tm p & -* fM J* r jS^4 *?? ># v v ^ , Jv. !&** *St DATE OP CONSULTATION- ^ reasoh ^FOfc^ S i n ^ T Kara. I , <g*. c> .* i J< '. ' r-^-. * **1 nAJT**c. U--nJ,<&t..M\fi{h.N..-ofit: -aJ"1 & 'j S ^ \ ' Admitted.- *?* ' ' ' Operation', f ^ -i* ** Discharged: , . y;f11X69712 >*S ** - >ri--vyi ciws. r.-sss* TT-lciMS. VRUNGTOI ^ .EXTREMITIES ' ederoa n o ted , : ;Shcw rsignifii^rit clubbing,andj 7_y. y C' J ' i ~ ~ y h ' '; ? ' :/\ ;'' His on, admission;-sfiow large heart and bilateral alveolar infiltrotes," '- ' 1' ' `i- vascular redistribution. Tha sequence of .films; then demonstrates progressively;smaller ffi-V;- _!trt flze ,nd clearlni5 of the large, part of theyniveoiar infiltrates but a harder"a, residual, this is more ---- - -r. ---- decom pensation, due to hypoxeotia... t. Will' ADDENDUM; -restrictive ventilator^;' cap.-city w a s 7.05 whiftlgwablp Thaddeus B. Oot Oot & Fallon . SOI East Washington Street Syracuse, N Y 13202 Dear Mr. Oot: I received via Lester Merritt today a request for an updated report to the Workmen's Compensation Board. The.question was raised as to whether talcosis results in permanent and total - disability in this patient and whether his pulmonary condition aggravates his heart condition.. The answer to both of these questions is "yes". The patient's forced expiratory volume in the first second was 1.35 liters today, and this is a very much reduced value. The patient inhales oxygen a great portion of the time. 1 did not measure the oxygen saturation today because it has been measured.in the past and found to be much reduced. Also, it is necessary to remove the^patient from oxygen for several minutes in order to h a v e the oxygen-saturation a valid reading.. Such removal from oxygen can cause discomfort.- The patient has an increased heart rate of lOO.beats/minutei and I found the blood pressure difficult to hear today. Xt/Vas `80/60 and has been 100/60 in the past.- -Thus, the patient ha6 pulmonary and cardiac disability, and this is ho surprise beeause the patient was in this_ condition in the hospital. In a n s w e r t o the question as to whether the pul monary condition aggravates the cardiac condition, I can say that . the cardiac condition probably would not exist /without the pul monary condition. The patient has what is called "cor pulmonale". an ancient Latin term which is used to describe the presence- of cardiac failure ih patients with advanced pulmonary disease. From a medici point of view he has an obvious cas of this condition because he has severe pulmonary disease accompanied by a deficit in oxygenation of the arterial blood. These are the only two features that one must have for a plausible diagnosis of cor pulmonale. The management of cor pulmonale has very little to do with treatment of the heart, in contrast to other forms ,of. heart disease., and it is -almost solely related to the avoidance f physical exertion and the use of- oxygen in the home. Therefore, patients who have heart disease secondary to lung disease are particularly vulnerable to further attacks of- severe failure, and the question of ability to work, should not even be brought up. . f- Thaddeus-B. Oot February 11, 1982 I am glad to say that as a result of the oxygen therapy which I Introduced and a very sedentary lifestyle and avoidance of work that Mr. Merritt is in surprisingly good condition- His survival to this point after the catastrophic illness of last spring is a matter of some surprise to me. Any return to work would create the conditions of last spring and w o u l d be unthinkable. I am glad that Dr. Aiello concurred with this opinion. Mr. Merritt's advanced state of-- Illness represents the worst case of occupational lung disease that I have seen in more than 10`"years-, and I think that :Lt shows that ideas that the. problem of exposure to talc In Gouverneur, New York have been brought under control must be considered premature. ' _ ' : Yours sincerely, JHA/ms J. Howland Auchlncloss, Jr., M.D. Chief, Pulmonary Disease Section /,