tokens: 959086752 PUOMC 6824024 094907 812890 2/1/2000 12:00:00 AM Discharge Summary Signed DIS Report Status : Signed DISCHARGE SUMMARY NAME : RATHELIFE , TIEANAKI B UNIT NUMBER : 342-07-28 ADMISSION DATE : 02/01/2000 DISCHARGE DATE : 02/08/2000 PRINCIPAL DIAGNOSIS : Non-healing ulcer on the right leg . PRINCIPAL PROCEDURE : Right fem to below knee pop bypass graft . HISTORY OF PRESENT ILLNESS : This patient is an seventy eight year old female with history of peripheral vascular disease who is status post above knee to fem pop bypass graft with 6 millimeter PTFE . This operation was performed for two months of increased rest pain . Her pain resolved after surgery and she has been doing well since , although at baseline now she is minimally ambulatory from bed to commode . For the past couple of months the patient has had a non-healing right dorsal foot ulcer which has been increasing in size and started as a pin hole and she does not recollect any trauma , as similar small ulcers developed on the left foot as well around the same time , but that has subsequently healed . The ulcer was managed conservatively at Har Hospital by Dr. Holes with Silvadene b.i.d. lower extremity non-invasive study obtained at that time showed poor distal right extremity perfusion . The patient was referred back to Dr. Pop for the possibility of a revascularization procedure . She is status post angiography today . She has just finished a ten day course of Ciprofloxacin . She denies any fevers or chills . She does have rest pain in the right foot and ankle . PAST MEDICAL HISTORY : Significant for Guillain-Barr syndrome , Lupus , status post multiple decubiti , peripheral vascular disease , status post right total knee replacement and status post cholecystectomy , status post hysterectomy , status post goiter and left lung fibrosis , status post methicillin resistant Staphylococcus aureus pneumonia . MEDICATIONS ON ADMISSION : Prednisone 5 every other day , alternating with ten every other day . Trental 400 milligrams t.i.d. , Cytotec 100 milligrams t.i.d. , Ativan 2 milligrams q.h.s. Darvon 65 milligrams two q.i.d , Relafen 500 milligrams b.i.d , Vitamin E , Prilosec 20 milligrams once a day , Zantac 150 milligrams b.i.d , Lasix 120 milligrams every other day PRN edema . Didronel 1 q day which has been on hold . Proventil inhaler via nebulizers 0.5 milligrams with Atrovent . ALLERGIES : The patient is allergic Ampicillin , Tylenol , Clinoril , Biaxin , Codeine , Sulfa and Aminophylline . PHYSICAL EXAMINATION : She is afebrile , her vital signs are stable . Her pupils equal round reactive to light and accomodation , normocephalic , atraumatic , extraocular muscles intact . Neck , she has II+ bilateral carotids , no bruits , no jugular venous distention . Lungs decreased breath sounds at bilateral bases with minimal expiratory crackles on the right . Abdomen , soft , non-tender , non-distended , normal active bowel sounds . Extremities on the right , she has a II+ femoral , no distal pulses beyond that . On the left she has a II+ femoral and II+ popliteal , no distal pulses beyond that . She has on her right ankle anteriorly a four centimeter ulcer with necrotic base . Minimal surrounding erythema . She is able to wiggle her toes bilaterally . Sensation is intact bilaterally . Her legs are tender to touch bilaterally . Her angiography showed a right proximal popliteal occlusion , anterior tibial dominant foot vessel . Small posterior tibial occlusion on the distal calf and a small peroneal goes down to the ankle . On a rectal examination she is guaiac negative , no masses and no gluteal ulcers or decubiti . HOSPITAL COURSE AND TREATMENT : The patient was admitted and taken to the operating room on the following day and she underwent a right fem to below knee popliteal bypass graft using a six millimeter ring PTFE . She had a strong popliteal doppler pulse intraoperatively and good PVR on the right postoperatively . The patient did well in the postoperative period . She was afebrile , her vital signs were stable . She was making adequate urine output anywhere between 20 to 50 ccs an hour . Her hematocrit was 26.8 and she was transfused 1 unit of packed red blood cells . Her diet was advanced from clears to a diet as tolerated . On postoperative day two the patient was noted to have some swelling in her left lower extremity and this was felt to be a hematoma secondary to her PVR cuff . There is mild amount of surrounding erythema and the patient was started on Ancef at that time . The patient was seen by physical therapy . The area of erythema on her left leg enlarged slightly and the patient was placed on Vancomycin for several days after which time her erythema again began to decrease . Her right foot remained warm . She had wounds which were clean , dry and intact and the patient was stable from a respiratory standpoint using her respirator at night . The patient required an additional blood transfusion during her hospital stay as her hematocrit had decreased to 27 on postoperative day three . The patient while in bed had her legs elevated . The patient was tolerating a general diet , she was voiding on her own and the patient was discharged to home as her daughter is a nurse . She was discharged with PO Keflex that she was to take for the next ten days . The patient is to follow up with Dr. Pop in one week and the patient was afebrile with stable vital signs at the time of discharge . LAYMIE ASLINKE , M.D. DICTATING FOR : Electronically Signed EDRY R YELLOW , M.D. 03/16/2000 13:21 _____________________________ EDRY YELLOW , M.D. TR : nw DD : 02/09/2000 TD : 02/12/2000 1:41 P cc : EDRY R YELLOW , M.D.