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Family History of Diabetes Mellitus Type 2, Microvascular damage, St.…

- - - - Fluoxetine (Prozac)
      - Chlordiazepoxide (Librium)
      - Inadequate nutrition
        
        Weight loss
        
        Lost "about 20 pounds" over the last couple of months
        
        Poor eating habits due to heartburn and upset stomach, caused by gastroparesis from chronic hyperglycemia/diabetes
        
        "I get full so easy and my food takes forever to move, and I get heartburn
        
        Pantoprazole (Protonix)
        
        Famotidine (Pepcid)
        
        George has an albumin level of 2.4 (low) because of his malnutrition related to poor appetite, heartburn and protein loss in his urine which has lead him to lose 20 pounds in 2 months. This also affects how his medications are absorbed and metabolized because many of his medications are protein-bound.
        
        George's RBC level is 3.9 (low) and Hgb level is 13.6 (low) because he has experienced high weight loss and poor nutrition which affects RBC production. Many of his medications can interfere with RBC production as well. When people have low RBCs, Hgb have less moelcules to attach to, leading to less ability to transport oxygen.
        
        George has a Vitamin B12 value of 210. This is not out of range but it is on the lower end or normal. He is taking Metformin which can interfere with B12 absorption, potentially causing negative neurological affects. George's decreased food consumption could also be the cause of his lower B12 value as he is not consuming enough B12 rich foods
        
        Can cause numbness and tingling, which could contribute to neuropathy
      - Reports feeling "down, especially since I'm on my own"
- - - - Impaired blood flow
      - Complains of occasional blurred vision
- - - - Poor uptake of glucose into cells
        
        Chronic hyperglycemia
        
        Endothelial cell dysfunction and increased fatty deposits with plaque build up
        
        Damage and narrowing of peripheral blood vessels
        
        Reduction of blood flow
        
        Decreased amount of hemoglobin which carry oxygen
        
        3 more items...
        
        Reduced oxygen and nutrients to tissue
        
        1 more item...
        
        Macrovascular damage
        
        Peripheral Artery Disease/ Accelerated Atherosclerosis
        
        Coronary Artery Disease
        
        Polydipsia
        
        Polyuria
        
        Nocturia
        
        Cellular and metabolic stress from insulin resistance and high glucose
        
        The metabolic stress triggers the hypothalamus and pituitary gland
        
        CRH and ACTH trigger the adrenal glands to release cortisol
        
        High cortisol
        
        2 more items...
        
        Metformin (Fortamet)
        
        leads to capillary damage and then the tissues do not get the energy and perfusion they need
        
        George's HgA1c is 8.0 which is elevated. This is due to his poorly controlled diabetes and means his average blood glucose over the past three months was increased. Due to his older age, we expect this A1C to heave a steady increase as well.
        
        Diagnosis of Diabetes Mellitus Type 2
        
        Risk factors for Osteoarthritis
        
        Dyslipidemia
        
        Atorvastatin (Lipitor)
        
        Diagnosis of Osteoarthritis
        
        Severe pain and stiffness
        
        Joint damage
        
        2 more items...
        
        "sometimes I just have these achy muscles and joints"
        
        Joint space narrowing and loss of function
        
        Development of bone spurs and inflammation of synovial membrane
        
        1 more item...
        
        Celecoxib (Celebrex)
        
        Asper creme with Lidocaine Max
        
        Occupation: Farming
        
        George's glucose level is 148. This is high due to his insulin deficiency and not being able to transport glucose into cells. The glucose is high in his bloodstream because of this.
- - - - prostate presses on urethra and interferes with urine flow
        
        Benign Prostatic Hypertrophy
        
        urinary hesitancy and increased frequency
        
        Reports urination has decreased in the last 2 days