Patient : My father in law is a 63 year male from small town North Dakota. He quit smoking about 40 years ago, and very, very minimal alcohol use. He has a history of hypertension, gout, hypercholesterolemia, acid reflux, and his primary physician told him that he is prediabetic. The above concerns have been managed very well on the current medications that he has been taking. He had developed shortness of breath and upper respiratory infection symptoms. He was seen by his PCP 11-18-2011 and was told that he had bronchitis. He was prescribed an antibiotic, and he finished the antibiotic as prescribed. Most recently he has developed the following symptoms: severe headaches, increased shortness of breath, chest pain (upper left chest near left shoulder), (lower) abdominal pain, increased flatuance (very foul smelling), increased fatigue, emesis, decreased appetite, and weight gain. On 11-18-2011 his weight was 234, on 12-28-2011 his weight was 257, today his weight was 267. His abdomen is very distended, his face appears very full and red, and he has edema of the lower extremeties. He has not had a change in bowel or urinary habits. He was seen by his PCP 12-28-11, and she advised him to increase the omeprazole to twice a day instead of once; and take probiotics. He was seen at the local E.R. today and was sent home with the diagnosis of uncontrolled hypertension. The following tests were done while he was in the E.R.: CT of the chest and abdomen with oral and I.V. contrast, chest xray, labs of CMP, CBC, Triponin, CK, DNP, and a urinalysis. All of these tests revealed normal results. Terry (and myself) requested that an echocardiogram be done, but the physician refused to order it because he felt that it was not necessary, as all of the other tests were normal. His blood pressure has been within normal limits the last 6 months or so, including the 6 hours he was in the E.R. today. He checks his blood pressure at home very frequently with a blood pressure machine. I am a registered medical assistant and I check them for him manually quite often also. His surgical history: neck surgery (repair of a "worn out disc"), elbow surgery (fracture of the elbow), and hand surgeries (fractures in the hand). Terry is a very active man. He is a self employed farmer (crop)and rancher (cattle). He is veteran (Vietnam War) and was exposed to agent orange at that time. As family members we would like help as to where to turn. It is difficult to see Terry not feeling well, and things getting worse with no help from the local physicians. I do have CD's of the CT and xray along with the reults, the results of the labs that were done and the medical documentation from the E.R. and the recent clinic visits with his PCP. If any of those would be beneficial, please let me know. We really appreciate all of your extra time, efforts, and expertise.
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