A long time ago, in a galaxy far, far away……..
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A long time ago, in a galaxy far, far away…….. Our hero Maniken Skywalker was suffering from an unknown ailment. This is his story……. Family Practice Doctor. Vital Statistics: Human male 31 years old. Dr. C. Dooku. Initial Presentation. Vital Statistics Initial Presentation

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A long time ago in a galaxy far far away

A long time ago, in a galaxy far, far away……..

Our hero Maniken Skywalker was suffering from an unknown ailment.

This is his story…….


Family practice doctor

Family Practice Doctor

Vital Statistics:

  • Human male

  • 31 years old

Dr. C. Dooku


Initial presentation

Initial Presentation

  • Vital Statistics

  • Initial Presentation

    • Stiff patches of skin on hands and arms; waxy

    • texture; episodes come and go

    • Acid reflux, difficulty swallowing, abnormal

    • bowel movements

    • Stiffness in joints (specifically hands and

    • wrists)


Family physician treatment

Family Physician - Treatment

Diagnostic Tests

  • Urinalysis

  • Conducted at office

  • Blood Panel (CBC)

  • Conducted off site


A long time ago in a galaxy far far away

Maniken Skywalker

32

X

Dr. C. Dooku

KP

6/24/13

6/24/13

X

X

+

NEGATIVE

Send report ASAP to Dr. C. Dooku


A long time ago in a galaxy far far away

Skywalker, Maniken

120850MS

4/19/1981

32 years

Male

6/2713

6/27/13

Run by KP on 6/25/13

No impairment


Diagnosis

Diagnosis

All tests returned within normal ranges

Skin and digestive issues could be due to changes in stress level or environment

(patient mentioned recent intergalactic voyage and

near death experience Gen. Grievous)

Lack of regular stretching and exercise has contributed to joint pain and stiffness


Treatment

Treatment

Prescription for antihypertensive

(Lisinopril)

OTCs suggested

- heart burn – Prevacid

- joint swelling and pain – NSAID

- skin – oil based cream – Glaxal Base,

Eucerin

Regular stretching/exercise plan to be put in place

Referrals to Dr. ChuyBacca and Dr. J.B. Hutt


Any ideas

Any Ideas?


Dermatologist

Dermatologist

Vital Statistics:

  • Human male

  • 31 years old

Dr. Jesus “Chuy” Bacca


Visual examination

Visual Examination


Diagnostic test

Diagnostic Test

Shave Biopsy

of skin patch on

posterior forearm


Test results

Test Results


Treatment1

Treatment

OTC Moisturizer / Emollient Cream

Prescription Topical Corticosteroid Cream ·

Antihistimines

Oral corticosteroids or immunosuppressive agents


Any ideas1

Any Ideas?


Gastroenterologist

Gastroenterologist

Vital Statistics:

  • Human male

  • 31 years old

Dr. J.B. Hutt


Diagnostic tests

Diagnostic Tests

  • Referred by Dr. C Dooku

  • Upper GI endoscopy

    - This procedure uses a light, flexible endoscope was to

    see inside the upper GI tract.

  • Anal myography

    - Used to determine if there is nerve damage causing

    incontinence.


Diagnostic tests1

Diagnostic Tests

I


Test results1

Test Results

  • Upper endoscopy revealed inflammation of the esophagus.

    - Diagnosis: gastroesophogeal reflux disorder (GERD)

  • Anal myography revealed that there was no nerve damage.


Test results2

Test Results

Esophagogastroduodenoscopy Report

DATE OF PROCEDURE: 7/12/2013

PROCEDURE PERFORMED: Esophagogastroduodenoscopy (EGD)

PHYSICIAN: Dr. J.B Hutt

INDICATION: Heartburn after eating meals. Burning sensation in esophagus and upper stomach region after eating.

POSTOPERATIVE FINDINGS:

1. Inflammation of the esophagus.

MEDICATIONS: Versed 10 mg IV, fentanyl 75 mcg IV.

IMMEDIATE COMPLICATIONS: None.

PROCEDURE: Upper endoscopy

TREATMENTS

1. Over the counter H2 blockers such as amotidine (Pepcid AC, Pepcid Oral)

2. Modify Diet


Test results3

Test Results

Anal Electromyography Results - Normal


Treatment2

Treatment

  • GERD

    - Modify diet

    - H2 blockers (Pepsid, Zantac) reduce the production of stomach acid

  • Incontinence

    - Modify diet be sure to eat foods high in fiber.

    Referral to Dr. Wan Kenobi - Rheumatologist


Any ideas2

Any Ideas?


Rheumatologist

Rheumatologist

Vital Statistics:

  • Human male

  • 31 years old

Dr. Wan Kenobi


Diagnostic test and result

Diagnostic Test and Result

  • ESR indicates presence of IgG and IgM

    - IgG = 13.2 U/L

    - IgM = 1.5 U/L

  • CRP present

  • Antinuclear antibodies detected


Treatment3

Treatment

Blood pressure medication (continued from Dr. Dooku) and monitoring at home

Renal function monitoring

Corticosteroid cream for skin (continued from Dr. Bacca)

Immunosuppressive medications to reduce internal organ involvement

Physical therapy to maintain dexterity and ambulation


Any ideas3

Any Ideas?


Cutting edge treatment

Cutting Edge Treatment

Should complications from

Systemic Scleroderma

Stem Cell Transplant may be necessary

- Hematopoietic stem cells (bone marrow)

*will “reset” autoimmunity

- Mesenchymal stem cells (bone marrow)

*immunomodulatory role in autoimmunity

High-dose Monthly Cytoxin

- chemotherapy drug


The end

The End!


A long time ago in a galaxy far far away

GREAT JOB!


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