Document VJkKDq9437Q16gpmeyXy4ogLg

FILE NAME Talc TALC DATE 1982 DOC TALC034 DOCUMENT DESCRIPTION Medical Records oe a wer < saney aa Vr : Pas a2 wrt Sn : eo} wach Gs Te x ae on MERRITT LESTER et . HOSPINTOAL ~~ _ 416-138-6-029| LENGTH OF STAY - 3 days } A. PROBLEMS ON ADMISSION 1 pulmonary asbestosis 2 Past history of gout S _ B. SIGNIFICANT PHYSICAL FINDINGS wy eg 1 bibasilar rales diffuse rhonchi oe muscle use 2 serum uric acid 8.3 mg % a C. MANAGEMENT ANDINVESTIGATION OF PROBLEMS 49 year old white male with 23 yr history of talc packing who carries the pulmonary asbestosis first diagnosed 4/81 by open lunglung biopsy when he diagnosis of acute SOB and PND Has had 1 SUH admission since then for worseningworsening SOpBreasnedntePdNDand in Presently presents to SUH home 02. for day history progressive worsening worsening PND and SOB despite 18hr18hr complins day Additionally 3 days of cough productive of sputum Hospital course remained uneventful Patient ambulated in clear thin white and admitted to improvement in cough halls without without SOB denied PND WBC remained wnl with no leftain diffential Pt remained afebriE CXR revealed no significantsignificant changes from previous films 1.2L FVC 1.6 last FEV1 was stain showed FEV1 6/9/82 was 1.3 Sputum cultures revealed normal flora gram 1-4 polys but no organisms Nuclear V gram 5/81 showed | 35 and patient was placed on digoxin Admission dig level of 1.5 ejection fraction : potassium remained therapeutic on his usual Lasix of 60 1.5 therapeutic Serum creased to 8.3 mg % mg po qd Serum uric acid in- | D. STATUS AND DISPOSITION OF PROBLEMS AT DISCHARGE See above E. CONDITION OF PATIENT AT DISCHARGE Improved DISCHARGE DIAGNOSES oy Pulmonary asbestosis MEDICATIONS Digoxin 0.25 mg po qd Lasix 60 30 mg po q hs Allopurinol 100 po tid mg po qd FeSO4 1 tab po bid Dalmane DIET tolerated . | TREATMENTS LIMITA- ATs ItoOlerNatSed Auchinclos|s AB | 7/29/82 Fee eyapeg' STATE UNIVERSITY sna SYRACUSE NEW YORK ; PATIENTS PATIENTS NAME MERRITT LESTER HOSPITAL = DISCHARGE HOSPITAL NO ADMITTED SUMMARY SUMMARY SUMMARY SUMMARY SUMMARY DISCHARGED 416-138-6-019 ADMITED 5/12/81 | 5/21/81 LENGTH OF STAY 9 days A. _ PROBLEMS ON ADMISSION 1. asbestosis B. SIGNIFICANT PHYSICAL FINDINGS inim rales to } way up lungs inim guaiac CKH s tools inim 4. clubbing of nails 3 C. MANAGEMENT AND INVESTIGATION OF PROBLEMS The patient is a 48 year old white male with a 23 factory In Apiril 1980 a severe yr history of packing talc in a subsequent open lung biopsy lead episode to of PND load to a hospitalization in Texas a diagnosis of asbestosis Left heart cath was normal He now comes to SUH after being home 2 weeks he o is comfortable at rest however his resting P02 severe PND and DOE He less and his be sent home with home oxygen at 2 liters for 18 hours pC02 He is to Dr. Auchincloss at chest clinic per day follow up is with D. STATUS AND DISPOSITION OF PROBLEMS AT DISCHARGE See above E. CONDITION OF PATIENET AT DISCHARGE Improved DISCHARGE DIAGNOSES Abestosis Congestive heart failure - mild . : i MEDICATIONS Digoxin .25 mg po q am Lasix 60 Allopurinol 100 mg po tid Dalmane 30 mg po g hsmgprpno q am FeSO4 325 mg po bid . DIET Reg re tow (- . TREATMENTS Home oxygen at 2 liters via nasal cannula for 18 hours per day LIMITATIONS As tolerated FOLLOW UP ATTENDING Schedule for chest clinic with Dr. Auchincloss in 1 month DI Auchinclose ; OFFICER Dr. Hittman { . to walk apparent that anemic fibrosis Since organizing exposee xposed d exposed exposed course has continuing continuworkinging is working Upstate Medical Center N 750 E. Adams Street13210 - Syracuse New York 13210 College of Medicine Department of Medicine 315 473-4480 February 1982 . Thaddeus B. Oot Oot & Fallon 501 East Washington Street Syracuse NY . 13202 , Dear Mr. Oot ' oe ; a ; 2 . 2 J982 . J982 - I received via Lester Merritt today- 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 agreat portion of the time I did not measure the oxygen saturation today because it has been measured in the past and found to be much reduced Also it is saturation the necessary to removeoxygen the patient from oxygen for several minutes in- - order to have oxygen *a valid reading Such removal discomfort from oxygencan cause Thepatienthas an increased . heart rate of 100minutes and I found the blood pressure difficultto hear today was 80/60 and has been 100/60 in the past Thus the patient has pulmonary and cardiac disabilityin and this is no surprise because the patient was in this condition inand the hospital Inanswer to the question as to whether the pul-that monary condition aggravates the cardiac condition I can say that CF 7 ; the cardiac condition probably would not existwithout 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 in patients with advanced pulmonary diseaseconditon From . a medical point of view he has an obvious case 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 heartphysical disease and it is almost solely related to the avoidance of physical exertion and the use of oxygen in the home Therefore patients who have heart disease secondary to lung disease are particularly vulnerable to ability further attacks of severe failure and the question of . work should not even be brought up to . Thadd-e B uOost- -2- February 11 1982 1 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 would unthinkable I am glad that .Dr Aiello concurred with this opinion Mr. Merritt's advanced state illness represents the - worst case of occupational lung disease that I have seen in more than years and I think that it 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 Auchincloss J. Howland Jr. M.D. Chief Pulmonary Disease Section . toe? BHP GAs ' Rares tener