Document NVoaNXdvwbm0kKv04VxMR37g

Denver Clinic Medical Centers, PC. Celebrating 30 years...1956-1986 ^ Corporate Offices 701 East Colfax Avenue Denver, Colorado 80203 (303) 831-7171 ^ r March 4, 1987 Tom Henderson, Esquire Henderson & Goldberg 1030 Fifth Avenue Pittsburgh, PA 15219 /vf> u-A i 1 H- i- ' 5 y Dear Mr. Henderson: Thank you very much_for..r.eferring Vernon Pettus to me for evaluation._--------- I interviewed and examined him on February 27, 1987. I have also reviewed the past medical records which you supplied. Based upon my examination I have determined that Mr. Pettus had substantial exposure to polychlorinated biphenyls during his work at the Ford Motor Company plant. Mr. Pettus worked as a die casting operator at the Sheffield casting plant from September 1957, until June of 1979. During the course of this work he was frequently exposed to PCB containing cooling fluids which were utilized as quenching agents for the recently cast materials. The process which was underway at the plant utilized molten metal which was transferred from a Reynolds Aluminum Company factory to the Ford Motor Company plant where it was handled in large dies, some of which were as large as a human being. Mr. Pettus had occasion to be exposed to the molten metal, to the PCB containing quench oil which boiled off and sizzled off the product, and to the breakdown fumes of the PCBs. Mr. Pettus indicated that on many occasions, he actually had to climb into the dies and clean them and remove the oil, utilizing his hands and rags, and other materials. Mr. Pettus currently has clinical evidence of hepatitis, and of skin damage from PCBs. Because of various headaches, and other complaints, and of low grade peptic ulcer disease, Mr..Pettus has been taking cimetidine, and Tylenol. Both-of these medications are hepato-toxic. When their effect is superimposed on the underlying PCB induced toxic hepatitis, a considerable aggravation occurs. The patient has indicated that he had headache for many years, He has hypertension for which he takes Inderal for a number of years. </! Central: 701 E. Colfax, Denver80203*831 -7171 East: 9450 E. Mississippi, Denver 80231 *751-1241 North: 84th & Zuni, Suite 225, Denver80221 *429-1529 West: Denver West Office Park, Bldg. 52, Golden 80401 279-7525 Aurora: 15101 E. Iliff, Suite 140, Aurora 80014 *696-7525 LJttleton: 1900 W. Littleton Blvd., Littleton 80120 * 797-6700 Tiffany Plaza: 7400 East Hampden, Denver 80231 770-3200 See reverse for professional staff listing 001G1 HARTOLDMONOQ21733 In addition to his hepatitis, Mr. Pettus has evidence of neurological disorder, the findings on neurological examination are consistent with a demyelinating disorder which effects his right hand and forearm. This is characterized by a continuous tremor. His reflexes show an absence of the right biceps, and triceps reflexes. All other reflexes are normal. He does have sensory changes, as well, and some evidence of a problem with attention and concentration. He also has evidence of impaired finger tapping bi 1 aterally. This appears to be a resuTt of peripheral rather that central change. Mr.-Pettus also demonstrates evidence. of-Jieurastheni-a-,------------------------ ---------- The neurological examination revealed postural and terminal intention tremor characteristic of--.toxic exposure, and an action dystonia, in addition to his peripheral neuropathy. . His past history reveals evidence of chloracne which has largely resolved. In addition to his neuro1'rical, skin, and liver disease, Mr. Pettus has evidence of mild small a',, way disease. In view of the fact that he was undoubtedly exposed to breakdown products of PCBs since the molten aluminum would have reached temperatures above that at which PCBs degrade, I believe that his small airway disease is in part related to his PCB exposure. In summary then, Mr. Pettus has neurological disease, skin disease, toxic hepatitis, and small airway disease related to or associated with his PCB exposure. . In my opinion, Mr. Pettus had a significant and pathological exposure to PCBs during his employment at the Ford Motor Company. It is further my opinion that the PCBs contributed to or caused to a significant degree the illness from which he currently suffers. If you have any questions, please do not hesitate to call. Si/iczerely, La Daniel T. Teitelbaum, M.D. /Is 001U2 HARTOLDMON0021734 MEDICAL DICTATION RE: Vernon Pettus .BY: Dr. Daniel Teitelbaum DATE: 3/4/87 Vernon Pettus is a 56 year old white male, retired Ford Motor Company employee who was exposed to PCBs while working-at the Sheaffeld plant, from September 1957 to June of 1979. He presents wi-th a chief complaint of liver disease. Present IIIness: _ _____ __________ Mr. Pettus indicated that in 1980,he was hospitalized because of chest pain. He went to the emergency room for 2 visits. Following the second visit he was put into the hospital. He was very nervous and had significant chest pain. The work-up was stated to be'negative for myocardial infarction, but positive for liver disease. He was given a diagnosis of toxic henatitis. His physician inquired in depth about his drinking history. H''- .old the physician he did not drink. He was told to take no medications, and to take no other toxic materials. At that time he stopped taking Tagamet. He had been taking Tagamet for approximately 1 year when the toxic hepatitis was diagnosed. At the beginning of the period he took Tagamet, 4 times a day, and later he took it cpnsiderably less often. He reverted to taking the medication only when he was having peptic difficulty. He indicated that he takes occasional Tylenol. He took 2 to 3 Tylenol at a time. He takes BC powders, approximately twice a day, and extra strength Tylenol twice a day. He began to take Tylenol in 1979. Before that he took aspirin. He has had persistent severe headaches for 12 to 14 years. He has had hypertension for several years. He takes 1/2 tablet of Inderal per day. His blood pressure normally runs 140/120 to 138/90. During his work at the Ford Motor Company, he was a die casting operator. . The die casting was done by pouring molten metal into steel dies. Then a .pressure -type - stamping^process=was^used-.-._--This~is a hot-metiil...activdty.g^========i= The metal was delivered hot. It was kept hot when it was delivered from a .nearby aluminum smelter^_-The metal., was .kept in holding furnaces ..which were.._______ induction type"electric furnaces, metal was obtained from Reynolds Metal Company. The dies were coated with PCB oils which function as releasing compound. In addition, PCBs were utilized in the cooling of the dies. Temperatures between 1000 and 1200 degrees were regularly achieved. When _ the PCBs were added or poured over the dies, they sizzled "1 ike a hot ' " ' frying pan". There would immediately be a "sweetish" smell in the air (this is highly suggestive that there was phosgene in the air . On many . occasions, the tanks would blow and gallons of PCB would be bTown into the plant. The PCB smoked. It burned their eyes; they coughed, and had severe respiratory discomfort. No respiratory were usually provided. Paper respirators could be obtained towards the end of his working time. Cotton coveralls, safety glasses and no hat were the general gear. Mr. Pettus has ooie;* HARTOLDMONOQ21735 multiple burn scars on his arms because of the splashed material on his skin. Mr. Pettus indicated that temperatures in the area in the summertime - were frequently as high as 130 degrees. In he winter time they were considerably cooler. Product which had been covered with PCB oils was frequently set out wet, allowed to air dry. . Mr. Pettus denies ever having been a welder. He stated that welding did take pi ace in his area. The patient states that on many occasions he had to actually enter into the 1arge die machines to clear the dies out, and to clean the strike out. In these instances there was a great deal of PCB -exposure. One of these dies might have been as large as a human being. He states that many photographs were taken in the plant. (These should be obtained if possible) He states that he cannot work, he is weak, he has headaches, he tingles in his -feet and hands. He -feelsjtense much of he time. He has right arm tremor which is persistent and is quite obvious. This commenced approximately 3 to 4 years ago. He states that he cannot hold up a song book in church becau:-'? of this. He can't walk any distance. His appetite is good. He cannot sleep at night. His weight has been stable. He has nausea, vomiting or diarrhea. Review of systems: He indicates that he is having problems with his throat. His hearing has been bad for many years. He does not have the energy to work, he has an occasional cough. He wakes up with a cough. He stopped smoking approximately 20 years prior to this interview. Prior to that, he smoked 1 package of cigarettes for 20 years. The patient denies ever working with lead or other toxic metals. Social History: ' His social history reveals that he drinks 2 to 3 ounces of alcohol per month. He is recently divorced. He is remarried. He has central heating and air conditioning. The patient has complained of shortness jaf breath-which^has-43een--4ns444ous-^= in onset. ' This is somewhat^improved recently, but is unclear precisely how much discomfort he has. Pulmonary testing.-should-be____ _ performed close to the -time of trial Tin'Mr. Pettus. Medications: . Occasional Tagamet, 2 Tylenol per day, BC powders, twice~a"dayfIncferal for hypertension. Physical ex ami nation at this time reveals a well developed, muscular male appearing younger than his stated age. Blood pressure was 138/90; pulse 72 and regular; temperature was 98; respirations were 14. Estimation of the head, ears, eyes, nose, and throat was unremarkable except for the fact that he was edentulous. The chest revealed rales at both bases. The heart was in regular sinus rhythm. There were no thri 11s, rubs, or murmurs OOlB'l HARTOLDMON0021736 noted. Liver was not tender, no masses were noted. Skin showed multiple scars and burns, and some small papular eruptions. Neurological examination revealed him to be alert and oriented. The cranial nerves were intact. There was continuous tremor of the right hand and forearm from the elbow to the fingers. There were absent reflexes in the triceps on the right. The remainder of the reflexes were 2+ and equal. Cerebel lar examination was normal except for marked dysmetria on both sides. There were no lymph nodes enlarged. The rectal ex ami nation was not done. There were no gloves provided. Diagnoses: 1) Toxic syndrome 2 to PCB with: a) Toxic hepatitis ^ b) Peripheral neuropathy c) Neurosthenic syndrome d) Demyelinating disorder, type unknown e) Cognitive/behavioral defect ' f) Chloracne g) Small airway Disease h) Action dystonia 2) Headache 3) Hypertensive cardiovascular disease 4) Peptic ulcer by history ^ ^t6-' __ . ____________________ '~ -- , 00165 HARTOLDMON0021737 Name: VERNON PETTUS Date of Birth: 12/05/30 I have reviewed and considered the clinical note of Dr. Daniel T. Teitelbaum. In addition, I have noted the following history from Mr. Pettus. This 56 year-old man worked for Ford Motor Company from 1957 to 1979. For much of this time he came into contact with hydraulic oils. He has had problems with shortness of breath, possible hepatitis, peptic ulcer, and anxiety. He has noticed increased sensitivity to #the sunlight in the past two years burning easier than formerly. He occasionally gets blisters on the exposed skin and the skin of the trunk. During the time he worked with oils he had many blackheads on the forehead. These gradually resolved after no longer being exposed to oils. He has had several cysts excised from his back in the early 70' s. He has also had frequent episodes of athlete's foot during the last fifteen or twenty years. Examination reveals scattered hypopigmented atrophic scars over the upper back and chest. He has moderate wrinkling and mottling of the face and arms. There is a 4 x 4 mm brown macule on the left lower chest with slight irregularity of the borders and pigmentation. There is a 4 or 5 x 5 mm firm dermal nodule on the inner aspect of the left thigh. Scattered skin tags are present both axilla. He has moderate scaling and slight redness of the soles of both feet and whitish discoloration and thickening and subungual debris involving the toenails of the lefr first and third toe and the right first toe. I have examined and evaluated Mr. Pettus with reference to his possible dermatologic problems. I have likewise reviewed various hospital, medical, and related records of Mr. Pettus. I also performed a potassium hydroxide from the toe webb between the left fourth toe web. Based upon my examination, the test indicated, and various portions of the records, it is my opinion that Mr. Pettus suffers from: . 1. Chloracne by history 2. Recurrent skin lesions of the upper chest and back related to sun exposure, possible transient acantholvtic dermatosis (Grover's disease) 3. Dermatofibroma, inner aspect of left thigh 4. Junctional nevus, left lower chest 5. Acrochordon (skin tags), axilla 6. Dermatophytosis of feet and toenails I also have considered the relevant medical and scientific literature regarding exposure to PCBs, dibenzofurans, and dibenzodioxins and certain adverse health effects associated with exposure to those chemicals. It is my further opinion 0016ii HARTOLDMON0021738 page 2 that the following diagnoses are related to, i.e. caused or contributed, Mr. Pettus' previous exposure to PCBs and/or their contaminants: 1. Chloracne by history 2. Dermatophytosis of feet and toenails These opinions are within a reasonable degree of medical probability. Edgaj' B. Smith, M.D. Professor and Chairman Department of Dermatology University of Texas Medical Branch Galveston, Texas 77550 0016 V HARTOLDMONOQ21739 THE UNIVERSITY OF ROCHESTER MEDICAL CENTER 300 CRITTENDEN BOULEVARD ROCHESTER, NEW YORK 14642 AREA CODE 716 SCHOOL OF MEDICINE AND DENTISTRY SCHOOL OF NURSING STRONG MEMORIAL HOSPITAL Eric D. Caine, M.D. Associate Professor of Psychiatry and Neurology Director, Ambulatory Services Director, Neuropsychiatry Program (716) 275-3571 NEUTOPSYCHIATRIC EVALUATION NAME: Vernon H. Pettus DOB: 5 December 1930 Thank you for the opportunity to evaluate Vernon H. Pettus, who I assessed on 26 February 1987. In addition to examining Mr .""Pettus, I reviewed and '' considered the clinical note of Dr. Daniel T. Teitelbaun. I have also reviewed various hospital, medical, and other related records of Mr. Pettus. Mr. Pettus underwent a canprehensive neuropsychiatric evaluation. This evaluation included administration of the Neuropsychological Symptom Checklist (NSC), the 28-item version of the General Health Questionnaire (GHQ), the abbreviated version of the Beck Depression Inventory (BDI), tb revised 90-item version of the Hopkins Symptom Checklist (SCL-90-R), and a semi-structured interview using the Schedule for Affective Disorders and Schizophrenia - Lifetime Version (SADS-L), with the Global Assessment Scale (GAS). The NSC is a general, qualitative (non-quantitative) symptom inventory useful for preliminarily assessing patients with possible neurological, emotional, or intellectual dysfunction. The GHQ is used typically in medical, non psychiatric settings to establish the presence of clinically prominent emotional distress. The BDI is used to establish the overall severity of depressive mental symptoms, which can be grouped as mild, moderate, or severe. The SCL-90-R is used in a variety of clinical settings, most often for defining problems in patients having behavioral or emotional symptoms. From data gathered using the SAES-L interview, it is possible to develop a standardized, rigorous lifetime psychiatric diagnosis, where applicable. The __-GAS .is.-.useful-for-establishing _the overall level_o_-Current._disease-.severity.--______ and functional impairment due to psychopathology. Mr. Pettus was also" evaluaTed "v/ith"an':arr^y"of standardized neuro-7 ~ ' psychological tests to assess his intellectual functioning. These tests included assessments of orientation, attention/concentration, verbal and nonverbal menory, visuospatial abilities, language/reasoning, and motor/ "Executive" functions. .......- "' ' ' - --......... Based upon my examination, including the tests that I have indicated, as well as Mr. Pettus's records and Dr. Teitelbaum's evaluation, it is my opinion that Mr. Pettus suffered frcm a dysthymic disorder which increased in severity over a 10-12 year period before remitting, followed by a a residual persistent neurasthenic syndrome. Neuropsychological test results were within normal 00168 HARTOLDMON0021740 Vernon H. Pettus 26 February 1987 Page 2 limits, although Mr. Pettus demonstrated significant bilaterally slowed finger tapping indicative of peripheral sensory motor dysfunction. I have also considered the relevant medical and scientific literature regarding exposures to PCBs, dibenzofurans, and dibenzodioxins, and adverse health effects associated with the exposure to those chemicals. It is my opinion that the above conditions are related to, i .e., caused or contributed to, his previous exposure to PCB's and/or their.contaminants. This opinion is within a reasonable degree of medical certainty- _ If you have any questions, please feel free to call me. I UA~t> 0016vi HARTOLDMON0021741 lU'SH-PRESHYTERIAX-ST. LUKE'S MEDICAL CENTER i.vi wkst concukss r.utKw.w. ciiicaco. ii.i.ixois jkmu-j DEPARTMENT OF NEUROLOGICAL SCIENCES 19 March 1987 Thomas W. Henderson, Esquire Henderson & Goldberg, P.C. 1030 Fifth Avenue Pittsburgh, PA. 15219 ................................... ....... ..................... .................. RE: Vernon Pettus Dear Mr. Henderson: ,. I have reviewed and considered the clinical report of Dr. Daniel T. Teitelbaum. I have examined and evaluated Mr. Pettus with reference o his possible neuro logic problems. I have likewise reviewed various hospital, medical, and related records supplied to me by your office. I also obtained a history at the time of the neurologic examination which I performed. Based upon my history and examination and supported by various portions of the records, it is my opinion that Mr. Pettus suffers from: 1. Postural tremor and terminal intention tremor (action tremor); 2. Action dystonia; 3. Peripheral neuropathy; 4. Neurasthenic syndrome. I also have considered the relevant medical and scientific literature regarding exposure to PCBs, dibenzofurans, and dibenzodioxins and certain adverse health -effects associated with exposure to those--cbenricals.~---I-t----'i-s-my -further-opinion -- that Mr. Pettus's previous exposure to PCBs and/or their contaminants caused or - contributed to all of the above diagnoses. _ ... ........... . . . - - - - - These opinions are within a reasonable degree of medical probability. Since: " Harold L. Klawans, M.D. Professor, Neurology & Pharmacology /gi 1725 W. Harrison, Suite 915, Chicago, Illinois 60612, (312) 942-5936 00 ITU HARTOLDMON0021742 HARRIS BUSCH, M.D., PH.D. PROFESSOR ANDCHAIRMAN DEPARTMENTOF PHARMACOLOGY BAYLOR COLLEGE OF MEDICINE TEL. 17131 790-US7 1200 MOURSUND AVENUE HOUSTON. TEXAS 77030 EXAMINATION Dr. Harris Busch Dr. Frank Smith PETTOS, Vernon March 23, 1987 Mr. Pettus is a friendly, obese, 58 year old white male whose chief complaints are shortness of breath and peptic ulcer, which is apparently under control. He says he has a hiatal hernia but it appears to be epigastric. Mr. Pettus is 58 years of age and has multiple medical complaints including frequent headaches, dizziness, joint pain and stiffness, tingling in the arms and legs, weakness of th.e arms and legs as well as anxiety and depression. He has a variety of symptoms of depression for the last 4-5 years including sadness, insomnia, anxiety, headaches and dizziness. Although at one time he had been reported to have cardiovascular disease, at present this is not a major problem. On physical examination, Mr. Pettus is found to be somewhat obese and is cooperative. His blood pressure is 160/100, respiratory rate is 8 per minutes and pulse rate is 92 per minutes and regular. There is no adenopathy. The lungs are clear to auscultation and percussion. There are no rubs, murmurs or gallops on cardiac examination. The liver size is normal and there is no liver rub or bruit present. There is no splenomegaly or ascites. He has a mild intention tremor on the right but otherwise, he is neurologi cal ly intact. His CBC is normal but his SMA-13 discloses an SGPT of 155 units/L, as well as an SGOT of 62 units/L. His other liver function tests are normal. It is noted that he had a history of "toxic hepatitis" made in 1980. The etiology of this hepatitis is not evident. It is suggested that Mr. Pettus have further evaluation of his liver function tests through the aid of his family physician or a gastroenterologist. It is possible that a liver scan and hepatitis blood tests may be of value to him for future delineation of hepatic dysfunction. Preliminary Diagnosis 1. Hypertension, probably essential 2. Toxic hepatitis, residual 3. Dysthymia 00171 HARTOLDMON0021743 Dr. Joseph C. Sehoolar Tape transcription Cecil Scott, et al vs Monsanto Company, et al Pettus, Vernon Hugh WM 5 6 3-24-87 CC: Pt comes in for psychiatric evaluation because of "the 1awsuit." HPI : Mr. Pettus states that his symptomo1ogy referable to the CNS began 8, 10 or even 12 yrs ago with "nervous" problems. This he described as a mild anxiety and depression manifesting itself as chronic worrying with a feeling of ' vague apprehension. It seems to be worse on arising from bed in the mornings, especially when he realizes that he cannot "do the things I used to do." He elaborates that he does not have the energy that he formerly had, that he gets out of breath, that formerly he would "try to go ahead and do things anyway," but now does not because he is simply "not in physical shape." Additional manifestations of the patient's reported depression include decreased ability to sleep, decreased interestS' and rumination about his health. Mr. Pettus states that he goes to bed at 10 or 11 o'clock, is able to go to sleep, but sleep is turbulent and he suffers from early morning awakening. He apparently never feels that he gets a good, restful night's sleep. He may awaken at 1, 2 or 3 a.m. and be quite unable to go back to sleep, or on the other hand he may be conscious of tossing and turning all night long until 4:30 or 5:00 a.m. when finally he "gives up" and gets up. His hobbies and interests have included fishing and woodworking, but lately he has lost interest in these activities. The loss of interest in woodworking is complicated by the fact that he has very little strength, such as that required for hammering. The patient ruminates to a significant degree about "this PCB," which he describes in almost anthropomorphic terms as if it is an existence that has somehow invaded him. Significantly, although the patient reports depressive symptomology, there has been no change in his appetite, no weight loss, no feelings of guilt, hopelessness, despair, no suicidal ideation, no loss of interest in sex, and no diminution of sexual activity (every 3-4 days), or any of 0017 li HARTOLDMON0021744 the other usual vegetative signs of endogenous depression. Pt. is currently is not under the care of a psychiat ris t, and in fact has never been seen by a psychiatrist before except that 3-4 weeks ago he has apparently evaluated by a psychiatrist and by a psychologist in Chicago in somewhat the same manner as today's evaluation and for somewhat the same purpose. He cannot remember the name of the psychiatrist or the psycho 1ogis t or the location of the evaluation. He reports that he is not on any psychopharmacologic medication, and has never taken any. Psychosocial Hx: Pt was born in a rural community in northern Alabama, Lauderdale County, in a small village of Green Hill, near Florence. His father's occupation was that of merchant and farmer, the mother a housewife. Pt.1s family consisted on his parents and 7 siblings. Father was a cotton and grain farmer as well as a merchant. He is described as having been a good father, well thought of in the community, something of a leader. He was a strong understanding individual whom the pt respected greatly. He never saw his father drink or smoke. Father died in 1973, he believes of a stroke, at age 72. He had been in a nursing home for the past 2 yrs of his life. Pt states that his father's "mind left him," especially after mother's death in 1973. Mother is described as a "salt of the earth" individual. She never worked outside the home. She died also in 1973, age 67, also of a stroke. The family is described as a hard-working, rather devout family (Baptist), regular in their church attendance and given to the work ethic. Father was a strict disciplinarian but in no wise abusive. Family activities centered around the local community, largely church and agrarian social activities. The pt grew up in the country, was active in hunting, fishing, and esp. during school years was active in sports. He played noseguard on the football team and was also on the basketball team. His siblings, 3 sisters and 4 brothers, are reported all to have done well in life, none of them suffering from any behavioral or emotional difficulty. The patient is #6 of the 8 children, and the youngest son. A brother died at age 61 from cancer "all over" but the others are living and well. Pt attended Green Hill e1ementary and high schools, graduating from high school in 1950. He was an average student, did not find school life and academics particu1arly enjoyable, but neither did he find it very distasteful. He was relatively noncommittal about his school life, could not remember how many were in the school or even in his graduating class. He "guessed" that about 100 graduated 00173 HARTOLDMON0021745 r along with him. In 1950 the pt entered Univ. of North Alabama, in Florence, intending to major in accounting. He dropped out almost immediately, however, and joined the U.S. Navy. The reasons for his dropping out of school are not at a 11 clear. In fact he himself "can't exp lain it." At any rate he joined the navy at age 19 and served from 1950-1954, mostly on a dest royer/mine 1ayer in and around Korea, with his major responsibility being a member of an underwater demolition team. He liked the service, and in fact considered staying in the navy as a career and would have if he had had "a little more shore duty." Apparently he did not like prolonged sea duty. He was discharged honorably as a First Class Petty Officer. Following his navy discharge the pt attended Larrimore Business College (1954-1957), majoring in accounting. Following graduation he worked for a few weeks on the railroad as a clerk and then when Ford Motor Co. opened their local plant he went to work for Ford. He was employed at Ford from 1957-1979, starting as a clerk and finishing his career as a supervisor in the die-cast dept. He believes Ford is a good co. to work for, but nonetheless he enjoyed his tenure at Ford only modestly, only "so-so." Socially the pt began to date at about age 16, going out in groups in the normal local fashion. He has been married twice. Marriage #1 was from age 23-52, and ended in divorce in 1983. His wife was 1 1/2 yrs younger than he. He is very noncommittal about his life with his wife, stating that they "thought" they loved each other, but his wife was a musician, and finally wound up "stepping out on him." Another contributor to the divorce was the fact that "I had nerve problems." Two children were born to this marriage, a daughter 29 who is married, without children, doing well; and a son, 25, who is a musician in Muscle Shoals, married, but without children. The pt's second marriage occurred 11 months ago, to a school teacher, age 46, ten years his junior. She has two grown sons. Pt. retired at age 48. He gives as the ostensible reason for his retirement the fact that he broke his right ankle on the job and was hospitalized for purposes of surgical repair. But his heart "flared up" and the operation was delayed. It was finally decided by the doctors that the operation was either unnecessary or was unwise, I am not clear which. At any rate the pt rec'd a medical disability retirement from Ford Motor Co. and since that time has not worked. ry n 1 of re s in t omTM ,,,,,, HARTOLDMON0021746 status evaluation. He was well oriented, knew his location, time, date, place, generally what is going on in the world.' Hi s memory for the details of his own history seemed to be we 11 within norma 1 limits. Hi s fund of general information seemed within norma 1 limits for an individua1 of his current status of inactivity and self-preoccupation. Reca 1 1 was. de ficient. He could remember hat, but no t "rose", nor 1 492 . His general memory comp 1 aint is one of preoccupation and lack of at tent ion rather t han a frank memory deficit. For examp 1e, he goes to the cabinet and cannot remember what he went for; or he starts to put something in the cabinet and finds himse1f opening the refrigerator door. When one tests his attention, however, it is within norma 1 limits. There is no concreteness, and judgment and insight seem to be within norma 1 limits. In other words, this patient does not show significant signs of organic brain syndrome. So his diagnosis is dysthymia, mild, without endogenous component. II. No diagnosis, or dependent personality. No dx on 3,4,5. Unresolved issues: There is no real justification for getting psycho logical testing in this pat. except to try to determine his underlying persona 1ity structure better. I suspect though, on the basis of his having started in college and stopped, having accepted business college rather than a formal academic college, and having wound up in the same spot in a "so-so" job for 22 years, as well as his ready acceptance of inactivity following a medical disability retirement at age 48, that this pt has a dependent personality. Impression: Dys thymia Passive-dependent personality 001713 HARTOLDMONOQ21747 SPECIMEN OATE ULt.KOAY/DAY OF SI AY TIME 2Sf1AR8r ftOH 1 12A3HRS HEMATOLOGY REFERENT PO.YCr TEST ------ *U J1'!' GFlL PROF I It A.5 it n r/ijl RPC A. AO- 6. (JO N/UL RFC 1A 0- 1? (J G/OL KGB Al. il- 51.0 i. HCT 32.0- 100 0 FL HCV 27.0- 34.0 PG MCH 32 0- 36.0 /. HCHC 150- A00 k/UL PLATELET - FLOOD SMEAR PERCENT DIFF - 35- '1J /. SEGS 25- o5 7 LYMPHS |J- 1U / MONO a- 5 7 EOS - El'jOi) SMEAR MORPHOLOGY -- PLT ESTIMATE 7. A 3.05 16.0 46.9 92.8 31.7 3A. 1 190 A9 37 10 A ADEQUATE rc ; . J . T (oooo>10910:4-3-708: SEX ft ACE 56 YSS PRINTED: 24rtAR87 07:02 * = VALUE OUTSIDE REFERENCE RANGE I RESULI CORRECTION HEMATOLOGY ^ /Methodist _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ .0000)10918254-8 7082 PETTUS VERNON H The Methodist Hospital Oepartmenl ol Pathology Houston, Texas 77030 Pnmnlatluo Pnthnfnrr 'firt UHKH PAGE 1 OH 1 71) HARTOLDMON0021748 h u ij j : j h 7 7030 'w I. r;< SPECIHEH DATE WEEKDAY/DAY OF STAY TIHE REFEREHCE RANGE TEST - ELECTRQLYTE/PRQFILE CHEMISTRIES - 8- 24 MG7DL BUN 0.5- 1.5 HG/DL CREATININE 65- 110 HG/DL GLUCOSE 4.0- 9.0 HG/DL URIC ACID 160- 275 HG/DL CHOLESTEROL 60- 290 HG/DL TRIGLYCERIDES 8.7- 10.7 HG/DL CALCIUH 2.5- 4.5 HG/DL PHOSPHORUS 6.0- 8.4 G/DL TOTAL PROTEIN 3.5- 5.1 HG/DL ALBUMIN 0.2- 1. 2 HG/DL TOTAL BILIRUBIN 30- 115 U/L ALK PHOS 5- 40 U/L ALT (SGPT) 5- 35 U/L AST (SCOT) 75- 200 U/L LD 23MAR87 HON 1 1245HRS CHEMISTRY 15 1.5 95 9.0 213 F 180 9.2 3.6 6.7 4.2 0.5 63 155H 62H 169 G <0000/1091654-8-7082 SEX n AGE 56 m PRINTED: 25MAR87 07:14 f = FOOTNOTES 23HAR87 1245 CHOLESTEROL SEE INTERPRET IUE DATA AT END OF REPORT k = UALUE OUTSIDE REFERENCE RANGE t = RESULT CORRECTION ' CHEMISTRY ^ yWethcaiist ......................... The Methodist Hospital ..... ....... .. ........ ... -. --10000)1091854-8 7082 PETTUS UERNON H Department ol Pathology _ - Houston, Texas 77030 , Cumulative Patholc Report (MX PACE 1 0017 V HARTOLDMON0021749 one pay: as u L A 3 A HOUS r0N 77030 IX SPEC MEN DATE WEEKDAY/DAY OF STAY TIRE 23HAR8? HQN 1 1245HRS HEHATQLQGY REFERENCE RANGE TEST ........ PL00D CELL PROFILE 4.5- U.G K/UL UPC 4.40- 6.00 ft/UL BBC 14.0- 13 0 S7DL HQB 41.0- 51.0 I HCT 82.0- 100 0 FL HCV 27.0- 34.0 PG HCH 32.0- 36 0 /. HCHC 150- 400 K/UL PLATELET - PL00D SHEAR PERCENT DIFF - 35- 65 1 SECS 25- 45 l LYHPHS o- 10 V. HONO o- 5 l EOS -- BLOOD SHEAR HORPHOLOGY -- PLT ESTIHATE 7.4 5.05 16.0 46.9 92.0 31.7 34.1 190 49 37 10 4 ADEQUATE -Ei.. . ixnJ.4 .> (00i)8)10Y:8EA-8-?082 SEX R AGE 56 YRS PRIXTED: 25HAR87 07:16 m = VALUE OUTSIDE REFERENCE RANGE I = RESULT CORRECTION HEHATOLOCY /Hethadist - ------- -- -------- ------------------ ------ ------*0000)1091854-8 7082 The Methodlsl Hospital Department ol Pathology Houston, Texas 77030 ~ , Cumulative Pathology Roort PETTUS VERNON H urn PACE 2 00178 HARTOLDMON0021750 ".i t: A I L it R HOUSTON 77030 ' ' t:< CHOLESTEROL AGE 2-1? YRS 20-29 YRS 30-39 YRS 39+YRS INTERPRETIUE DATA t.0000 : lOv lb- ? Oil 2 SEX AGE 56 YRS PRINTED: 25NAR87 07: H MODERATE: RISK FOR CHD GREATER THAN 170rtg/dl GREATER THAN 200ng/dl GREATER THAN 220nj/dl GREATER THAN 2A0ng/dl HIGH RISK FOR CHD GREATER THAN 185ng/dl GREATER THAN 220ng/dl GREATER THAN 240nj/dl GREATER THAN 280nj/dl * = UALUE OUTSIDE REFERENCE RAH6E = RESULT CORRECTION yMethcsiist The Melhodlil Hospital -<000Q>lQ?1834-8 7082 Department ol Pathology Houston, Texas 77030 Cumulative Patholor oort PETTUS UERHON M UNKN PACE 3 0017B HARTOLDMOn6o2"i 751  ' -fe ,i '-w'; '* :S.`ZtoLi.s- i i i ' > . I i Ml " i ii i 1 ' i > i'. i `i i, , : ! Ill, i i i .1 Ml - I 'I'll 11 v 4WB . .-I ' ' K .1 V , If' I I * * ' ' ' V i t . I ir- I. t r- il ^ 'll I.". i-ii t;'i i "'u *n ; i limit-,. ill*' ` V f ..ii *r 'll l jU --' ,i. `I ! . ' f * * * r t'* I `.rf 11? - I I f I ' I . } | . ! Iv r ! -`f*'.. I'iO oi.di.'f uI u.',n mi , i.i.ji.i* i L l* . | *J)7v/ i'Lii.ij-> i:! 1 , i i. I,-.. %*/ : ii ^ m ' yidethcslist The Melhodlil Hospital Department ol Radiology 6jb:> 1 .if'i'n i Houston Texas 77030 1 HI m J 0018U * HARTOLDMON0021752 I\ *:HitCIrtL'ri DATE HUKDAY/DAY Uf STAY EIRE 2JMAR37 HEIN 1 1154HRS HEMATOLOGY REFERENCE RANGE TEST ------- BLIMP CELL PROFILE ----------- A 1- 11.0 k/UL NEC A. AO- (Ml fl/UL RDC 14 0- G7DL HGP A1 II- 51 i) / HC1 02 0- 100 i) FL NCU 27.0- 3A.0 PG NCH 32.0- 36.0 nchc 150- AOO K/UL PLATELET - blood SMEAR PERCENT OlFF - 65 / n- .: SEG3 BANOS 25- A 5 /. LYMPHS o- 10 7. MONO -- BLOOD SMEAR MORPHOLOGY -- PLT ESTIMATE 6.5 A. 90 15.5 45. A ?2. 7 31.6 3A.1 201 38 1 25 16H ADEQUATE ' l ' . ; J) i OOO.J .* 10 V 4 - 0 - ?08 2 SEX M AGE 57 YRS PRINTED: 2AMAR87 07:02 * = 0ALL! LUTS IDE REFERENCE RANGE l - RESULT CORRECTION HEMATOLOGY /Methodist (nnnrmn9iBM4-n 7082 The Methodist Hospital Dopailment ol Pathology Hr Texas 77030 Cumulative Path'- port FRENCH JANES P SLBA PAGE 2 00181 HARTOLDMON0021753