Opinion ID: 772834
Heading Depth: 5
Heading Rank: 1

Heading: Treating Physician, Dr. Kratche

Text: 23 Family practitioner Dr. Robert Kratche first treated Buxton from late 1991 to late 1992. In response to a question regarding Buxton's limitations to do work-related activities, Dr. Kratche wrote: In my opinion, Fran Buxton is fully capable of performing any and all activities delineated above. She is bright and articulate andhas no demonstrable physical disability. Dr. Kratche directed the reader's attention to his patient notes for July 15, 1992 and August 5, 1992. Dr. Kratche's note on July 15, 1992 reads as follows: 24 S: Patient is a 43 year old white female who presents quite upset with a complaint of 3 year history of chronic fatigue. She states that various chemicals including the chlorine in her water at home tend to make her quite weak. She also gets some sore muscles and some symptoms of urethritis with burning. She has apparently been doctor shopping over the last 3 years seeing a multitude of doctors giving each a 6 month window to cure her. She has had all kinds of allergy testing which has been positive via skin testing for practically everything. She currently is being treated for allergies to dust, mites, molds, corn, wheat, yeast, beet sugar, chocolate, milk, soybean, tomato and tea as well as fermelohide [sic], ethyl and chlorine, phenol and glycerine and Candida. Some of her old records that were forwarded include a positive EBV [Epstein-Barr Virus] titer. She is convinced that she has chronic fatigue syndrome secondary to EBV now. She also has positive anti-thyroid antibodies both antimicrobial and antithryroglobulin. She states that she has had RAST testing as well although these results have not been forwarded to this office. She apparently was treated with Synthroid for several months but finished her medication a couple weeks ago and never got it refilled. When asked about depression she began to cry and state [sic] that many of the doctors that she has seen have told her to have something done about her head, however she does not seem to want to accept this type of approach. She states that once she feels good she is fine but when she feels sick that is when she gets depressed. She apparently has considered suicide by taking all of the pills in her house. However she has never attempted this and does not appear to be suicidal at this time. 25 Dr. Kratche's note on August 5, 1992 reads as follows, in relevant part: 26 S: Patient is a 43 yr. Old white female who presents for a physical without a pap.... Her only complaints are that of the chronic fatigue along with the sensation of weakness and chronic cystitis symptoms. 27 O: On physical exam - she is a well developed, well nourished white female in no acute distress. BP is normal. HEENT exam is clear. She has had multiple dental fillings. Neck is supple without thryomegaly. There are 2 submandibular lymphnodes which are slightly enlarged and tender. These are located one on either side - approximately 1 cm in diameter. Lungs are clear to auscultation. Cardiac exam demonstrates regular rate and rhythm without any murmurs, rubs or gallops. Back exam - there is no SS or CVA tenderness. She had full range of motion. Abdominal exam - belly is soft, flat without HSMG. Bowel sounds are present and normal throughout. She has some mild tenderness to palpation in the left lower quadrant. There is no rebound or guarding. Breast and pelvic exam are deferred. Extremities - there is full range of motion without any cyanosis, clubbing or edema. Neurologic exam - DTR's are +3/+2 bilaterally at the knee jerk and ankle jerk. Cranial nerves II-XI are grossly intact. Old records have been reviewed. 28 Dr. Kratche's interpretation of this was that Buxton was Basically Normal. 29 After a period of approximately two years since her last visit, Buxton again began seeing Dr. Kratche in October of 1994. Dr. Kratche treated her, notingsome urine dips that were positive for blood, refilling her Vicodin prescription, and referring her to Dr. Frank for evaluation of her questionable chronic fatigue syndrome. 30