Document Z06MLLVDNYoqzRv2yy9oZ9QV

FILE NAME: Talc (TALC) DATE: 1982 DOC#: TALC034 DOCUMENT DESCRIPTION: Medical Records 1. pulmonary asbestosis 2. Past history of gout B ' SIGNIFICANT physical findings 1. bibasilar rales, diffuse rhonchi muscle use 2. serum uric acid 8.3 mg % S^1 c* ,,MANAGEMENT andinvestigation of problems i-' s S S s L cp = r^ r stherapeutic on hu usuai usix f 60 STATUS AND DISPOSITION OF PROBLEMS AT DISCHARGE See above. E* ,,CONDITION OF PATIENT AT DISCHARGE Improved s ir * fyis.* mm $& eSiA- DISCHARGE DIAGNOSES Pulmonary asbestosis ' . 30 mg po qShs,DAlloJurino;,^ormgdpo^idX 6 DIET As-tolerated ' *" . TREATMENTS /' ' ' P P FeS4 1 tab P bid' D*lmane ... ,' . ' : aw .LIMITATIONS .As tolerated' , ,` ^OLLOWUP Privately with Dr Auchinclpss fel; v'-D*- 7 / 2 6 / 8 2 - . ''V'' ' '7/29^82.^.;./!,.,; ... g- pi"}/..' : ; ' , . : V. - .. 'V.., "'"-' -i'fei' f '' .. . : : -4v ' ' V^V < --. imm STATE UNIVERSITY HOSPITAL SYRACUSE, NEW YORK PATIENt a AME MERRITT, LESTER LENGTH OF STAY: 9 days A. PROBLEMS ON ADMISSION 1. asbestosis HOSPITAL NO. ~ - 416-138-6-01Q ADMITTEO DISCHARGE SUMMARY joisCH ARO eO 5/12/81 i 5/21/81 B * .SIGNIFICANT PHYSICAL F INDINOS 1. rales to J way up lungs 2 . g u a i a c 0 stools 3. clubbing of nails MANAGEMENT AND INVESTIGATION OF PROBLEMS S a^severe%pisode^of r,EaCkinS ^ ln a subsequent open lung biopsy lead to a diap-v><n-a r u *.a ^ospitalIzation in Texas; normal. He Sow c o S s t o S U H a f t e r beiS^hSme I h ^ 8 ' U f t heart " > la comfortable at rest, however his resting P02=50 lor 'less' a n d ' S ' - c m . TM ' 1 "E '' be sent home with home oxygen at 2 liters/min for* in . 15 PG02-50. He is to Dr. Auchincloss at chest clinic. llterS/min for 18 hours Pr day. follow up is with D. ,,STATUS AND DISPOSITION OF PROBLEMS AT DISCHARGE See above E * - CONDITION OF PATIENET AT DISCHARGE DISCHARGE DIAGNOSES Abestosis, Congestive heart failure - mild ai" S :io" S x" * DIET Reg S t jp S 8 Fas" 3251 - TREATMENTS Home oxygen at 2 liters/min via nasal cannula for 18 hours per day LIMITATIONS As tolerated I'.'. FOLLOW UP Schedule for chest clinic with Dr. Auchincloss in 1 month ATTENDING Di , Auchinclopej HOUSEOFFICER D r . Hittman il STATE UNIVERSITY of NEW YORK Upstate Medical Center 750 E. Adams Street Syracuse, New York 13210 February 11,. 1982 College of Medicine Department Of Medicine (315) 473-4480 - Thaddeus B. Oot Oot & Fallon . 501 East Washington Street Syracuse, NY 13202 . ' ' ? a 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. 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 necessary to remove the rpatient from oxygen for several minutes in order to have the ;oxygen aafut'ation -a valid reading.. Such removal from oxygen can cause discomfort.. The-patient ..has an increased heart rate of 100 beats/minute and I found th blood pressure difficult to hear-today. It/liras `80/60 and has been 100/60 in the past.' Urns, the patient, ha pulmonary and cardiac disability, and this is no surprise because the patient 'was in this, condition in . the-hospital* -"In answer to 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 medical point of view he has an obvious cas f.this condition because h has sevejre 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" th 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 further attacks of- severe failure, and the question of ability.to work, should not even be brought up. - ' . - Thaddeus-B. Oot- . -2- : 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 would be unthinkable. I am glad that Dr. Aiello concurred with this opinion. Mr. Merritt's advanced state of- A l n ess represents the worst case of occupational lung, diseas " that I have seen in more than'10`"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/ms - - - j.'Howland Auchincloss, Jr., M.D. Chief, Pulmonary Disease Section-