Document JJyLLoyV2mnnoOnw6k5vxoqbX

IK 'MAC WtCICIMl Mua . ' **.TI(hOu?, '> . >. W.9- A. . MIMOlUiO. .0. *. m, in<r. m.o. 0. e. ooi^him **.9. 4. . A*Min9Ml, *.. mkUAB NtCHOCL m, O. oiatXTmor,-orMicQr.OQt n, 9. 3*M*3tkk. w.n. 11)<(nr o, HOwoati, m.O. ^C^tArnica V A 3 9. AVaOIOM, u.o. 9, M. OAMMlTf A, M.9. 4. M, JITIlCH. M. O. auancur e. r. >toH<Tyn, .o. aHN O. Cinoir, M.O. o-itMOPAtoic auaacQt . f. MOMireun, .o. TMO^ACrC A Tie UdQCnV UftOlOQY BAVIO w. CHtOI. M.9. AAOIOIOQT wavTch *. can, w.o. IU9tMt 00UtlV**0, .. ' ;OMM *4. 3*<TT*, W.O. QCMCRAt RRACTICC 9, MVIM (IM. M.O. UAriAAO 3 M.O. X STHATION OwtN f. Ml(klOn ( ,vjm amo v/i n:i :aowa/ OO* l . 'l? t MJE 3ULA, ? ONTAN s I I U I l \ I w ' TSI.; .`MOMS u o-ss.-jt June 22, 1959 !I i P'.ul J. Saif rt, Jr., H. D. 2 :< 695 Libby, Montana- Rc: Charles M. Uagncr Dear Doct r Seifert: I aa writing you regarding Mr. Charlc.' M. Wagner of L bby. Mr. Wagner was down to see ua on 17 June about hia problem of shortness of breath and "fast heart." Mr. Wagner presents an interesting but soaevhat difficult probl a in differencial diagnosis, and 1 an not completely certain that ve have the answer. However, v/e do have an opinion and I have pl'.ced hia on a program as a resulc of thio. The history you are familiar with, so I will not record that here, but my impression is that his distress has principally been or.' of ahortress of breath on exartion nd has probably gone back for several years. He stated that he had lost about 40 pounds during the pa3t three years but that in December 1958, the climax was reached when you hospitalized him. He has been caking the medication faithfully. . The physical examination shewed the blood pressure to be 140/60. His apical rate was 110 and after a short rest period, thio de clined to LOO. His skin was normal and no abnormal lymph node were felt. The eyes were negative as were the ears. Examination of the mouth showed poor oral hygelne and acme chronic re !ness in the posterior pharynx. There v;-.s no abnormal adenopachy in the neck and the thyroid gland was not palpable. The thorax showed some increase in Che AP diameter and excursions veto slightly limiced, but equal bilaterally. The breach sounds were definitely diminished in both bases and a recpir.tory wheeze could be heard in the right posterior base. No murmurs could he heard in the heart and the rhythm was regular. I could not determine definite enlargement on examination. Liver, kidneys and spleen were- not palpable. Examination of the genitalia showed a bilateral hydrocele which apparently has been present for many years. Rectal examination showed slight- G0G4Q33 l1 Doctor Paul Seifert (2) Juri 22, 1959 Re: Chnrle3 M. Wagner : internal hemorrhoids. The prostate was normal. A voided urine speci men was negative. Hemoglobin was 14.8 gvxau and the vhite blood count was 11,000 with 43 polys, 12 scabs, 40 lympho, 4 monocytes, 1 cooionphil. The cedicentation rate was 24 ran. in 1 hour (V'estcrgrcn) . The fasting blood sugar was 107, a SUN 20.2 eg. percent, and a blood cholc!)torol 275. Total bilirubin was 0.9 and a thymol turbidity vr.s 1 unit. An x-ray of hi9 chest ihcv-.d the claphragna to be lev and sccicvhst flat, and there vaa an emphysematous character to both lung fields. The heart contour and oiza was normal. An eloctrocarrfiogram shewed P-wavcs to be somewhat peaked and perhaps slightly elevated in lead 2 and in AVF. Otherviae the tracing was normal except for digitalis affect and sinus tachy-ardia. At this point we felt thrt there might bo acne 'efinite hyperthyroidism present, but our tests were not remarkable. An I]^ upteke measured about 507,, which is certainly on the upper limits of normal and by stretching our imagination, it could be called slightly elevated. How ever a serum Protein Bound Iodine was only 5.4 meg. percenc and thi3 is well within the limits of normal. As a iurthcr chock, however, a BKR was done and on two tests he averaged about a 21 or 22 plus. Wc did not f :el this Justified our treating him at th p I'esccc time for hyperthyroidism, but it must be kept in mind. Our final diagnosis was pulmo lary emphysema. His vital capacity waa slightly under 60% and after exercising him and further examining him we feel chat this is the cause of his trouble. As for treatment, I cm sure the best thing he can do for himself is to stop smoking. I also placed him on sane potassium iodide enseals, 1 b.i.d. and scae Caycine vich phenobarbital, l t.i.d. At the present time I do not feel that he needs digitalis and I suggested that he discontinue this medicine. We may be senewhat prematura about this, and you will have to use your Judgment as to whether or ..ot he should continue on this medication. He will be tn to see you in a few days for follow up care. I indicated to Mr. Wagner that we would like to see him again in a month or so, but I realize chat this may not be practical in regard to disc .nee. If this cannot be accomplished, I would certainly appreciate a note fre i you as to what is going on. Respectfully^yours , 3DC :ms B. D. COLWELL, M.D G004034