Document 85wBeD60bzq10naYdYB89qeXm

FILE NAME: Norfolk & Southern - WC Case - Ancel Wheeler (NS) DATE: 1951 June 26 DOC#: NS032 DOCUMENT DESCRIPTION: Physician Report . A- tJ a i t U B J U l l O U i l - U J J l , X.1. U t THE AUBJRNDALE DOCTORS BUILDING 2508 AUBURN AVENUE CINCINNATI 1 9 , 0I0 C 0 P . June 26, 1951 t Dr* VT* H. Whitman, C h ie f Surgeon, Norfolk and Western Railway Company, Roanoke, V irgin ia Re: Hr. Aneol Wheels? Weight? 280# Blood Pressuras 160/100 rrr Dear Doctor Whitmans 1 wish to report to you concerning Ur Ancel Wheeler, who va c in the Good Samaritan H ospital recently fo r various examinations jf HIST ORE: CHIEF COMPLAINT? Congestion in the c h e s t, w ith shortness o f b reath , eigh t months duration* PRESENT ILLNESS: Approximately eight months ago th is man noticed a pain in his chest which he described as fe e lin g lik e a m atal red running perpendicularly through the r ig h t side* About th is time he noticed also shortness o f breath w ith L exertio n, which was mild at f i r s t and i s new only moderate Since the onset hs t has had a dry eough, e s p e c ia lly follow ing exertion He has f e l t w e ll otherwise, and has had no other symptoms The p a tie n t' s job i s such th a t be i s exposed p con stan tly to asbestos dust He -has held th is job fo r s ix years* PHISICAL FINDINGS* GENERAL APPEARANCE? Obose white male, not appearing acu te ly i l l HEAD AND NECK? Negative* EYES} The p upils are round, ro gu lar, equal, and react to li g h t and accommodation ENT? The pharynx i s not in jected Tongue normal HEART? No enlargement* No murmurs. Rhythm and rate normal : CHEST? Equal expansion b ila te r a lly Equal resonance to percussion b ila t e r a lly , ^ Narked decrease in breath sounds on the r ig h t a id e , as compared to the l e f t side No abnormal sounds ^ ABDOMEN? Markedly obese No adequate palpation o f organs performed PROGRESS RECORD? (6-19-51)* This 3S year old white male railro ad man began noting soreness across the upper anterio r chest about October 1 , 1950 This gradually increased in seve rity and by November 18 i t had become very severe, e s p e c ia lly in t'ho rig h t upper anterior chest and he began having dyspnea, e sp e c ia lly on .. exertion A lso , on Bovenbsr 18 ho began having c h i l l s . These gradually decreased .a fte r about a week, but the dyspnea on exertion-has persisted A lso , on exertion j, he coughs rathsr severely, unproductive No orthopnea. No ankle edema. No hemoptysis. Sines Ostdser 1 , 1950, he has had occasional sp e lls in which he ^ fe e ls weak and ths room w hirls around. These s p e lls la s t one minute, and he must support him self to keep from f a l l i n g . The patient has worked in a m a l l room b grinding asbestos fo r the fa s t s i x y e a rs, no p ro tective devices used, ^ PAST HISTORY? Operative - negative {  /* Fge.,4'2 Dr. ft. R, YJhltean, Norfolk & bestem Railroad Res ?r. Ancel Wheeler HEADs Ho headaches; no fa in tin g EEKTs He wears g la s s e s . GASTRO-INTESTINAL* Appetite good; bowels regular; no melenso GEiITO-ORinAEn Negative. WEIGHT: Constant, FHTSICAL EXAMINATION: Reveals an obese white 38 year old male* a le r t and cooperative, in no apparent distress# HEAD: Symmetrical, no exostosis# EXES* Pupil3 round and re g u la r, react to li g h t and accommodation. ENTs The to n s ila are quit enlarged# HECK: No masses# CHEST* Equal in sis and expansion, resonant t o percussion b ila t e r a lly . The broath sounds are gen erally somewhat d is ta n t, s l ig h t ly more marked on the r ig h t . HEART* Not enlarged, regu lar rhythm, and sounds o f good q u a lit y . No murmurs. BLOOD PRESSURE* 160/100. ABDOMEN: Very obesej. li v e r and spleen not f e l t ; no masses or tenderness. EXTREMITIES 1 No edema. (6-21-51) Note from Dr. Heusinkvelds Ho asb esto sis; he can go home any time so fa r as I am concerned: (6-21-51) Palpation o f the abdomen showe the abdomen to bo s o f t . Ho palpable masses, no tenderness. The so lid organa are not palpable. There is marked excess panniculuso URINALTSIS* (6-20-51) C o lo r: C le a r amber Spec.- G ra v .: QNS Reaction: Acid Albumin: Negativ Sugar: Negative Acotcne: Negative Blood: Negative White Blood C e lls : Epithelial Cells: Some mucus 4/HPF Few BLOOD (MORREOLOS!) (6-20-51) Hemoglobins 93 Hemograms* 13*5 Red C e llo : 4,700,000 White C a lls * 6,100 P olys: 68 lymphocytes : 3 2 Koncytees 1 Stabs* 1 Shift* 1 BLOD CHEMISTHit 6-20-51 Sugar: 90 ngm$ Urea Hitrogen* 25.6 Urea: 54#7 Creatinine : 6- 22-51 22.8 48.7 1.5 VITAL CAPACITI* S ittin g * 3-2/3 l i t e r s lying* 2-3/8 lite r s BASAL METABOLISM: Plus 2g# BLOOD SEDIMENTATION RATE: (Cutler Method) 2 mm. in 5 minutes. ELECTROCARDIOGRAM* Shows a regular rhythm o f 100 per minute. Mechanism sinus The PR -intorval measures .18 secnda, showing the auricu lo -v e n tricu la r conduct tin s to b normal. Tbs QK5 in te rv a l measures #08 seconds, showing the in tr a - Page #3 Dr, VJ. R. YJhitman, Norfolk & Vieste m Railroad * Res Ur. Ancel Viheeler ventricu lar conduction tin e to be normal The ST-segraenta are is o -e lc c tid e . The T-waves are inverted in lead 3 There ia l e f t axis s h i f t . The p ectoral leads are not remarkable. There ia no evidence o f gross myocardial damage, nor conduction defects* STEREOSCOPIC AND RIGHT LATERAL CREST: The ribs reveal no destruction or pro duction. The trachea and mediastinal structures are in m idline. The heart is not enlarged. Thera are no areas o f in filt r a t io n , con solidation, or effu sio n . Thers i s , however, a Light thickening o f the pleura along the righ t a x illa r y lin o extending from the apex to the coetophrenia su lcu s. UiPRESSICii: Thickened pleura over the right lung. CONCLUSIONS: Reviewing the examination then wa fin d a markedly oboa8 in d ivid u al, weighing 280$, whose blood pressure was 160/100. He complained o f congestion in the ch est, and shortness o f breath which he has noticed fo r the past eight monthsj th is ia worse with e x e rtio n . Thero are no signs o f an a ctiv e in fe c tio n being present, the sedimentation rata being 2 mm. in a 5 minute period, which i s normal* The v i t a l capacity was lower than normal, and the heart wa3 not p articu la rly en larged. The electrocardiogram showed no gross myocardial damage. The urine showed no albumin or sugar, but the urea nitrogen, urea, and creatinine in the blood were a l l elevated. The b asal metabolism was plus two (2 ), which i s normal. He had a continuous l i t t l e hacking cough when we were examining him, which appeared to be nervous in character, but i t i s my impression that th is man' s heart i s labor ing a great deal because o f the tremendous, obesity, and i t i s gradually as the years go b y, losin g the myocardial tone and not keeping up the adequate c ircu la tio n . This is evidenced by the hacking cough and the changes in the kidney in which the fi lt r a t io n o f the poisonous produots o f the blood i s impaired. The v it a l capacity also was a lig h tly lowered. 1 believe that most o f his complaints are due t o the o b e sity . In order to eliminate any possible malignancy in the trachea or bronchial tr e e , I asked him i f we might not have a sp e c ia lis t psrform a bronchoscopy. I also wanted to do a Master twostep te s t fo r coronary in s u ffic ie n c y , bub he l e f t the ho sp ital refusing to have these te s ts dons. Very tru ly yours, -- /s/ Dale P . Osborn Dale F . Osborn, M. D. DP0:EH