This is a followup letter to our brief discussion. As a background, she has had 20 years of “nervous stomach,” describing abdominal discomfort with certain foods and stress. She would get relief intermittently with Donnatal, Di-Gel, and Maalox. Additionally, she has been taking 8 Excedrin per day for approximately 20 years.
More recently for her shoulder problem, she was treated with prednisone, Naprosyn, Flexeril, Excedrin with codeine,
Tylenol No. 3, Percodan, having been off all prednisone and Naprosyn for approximately 4 weeks. However, despite being off those medications, she still describes some “indigestion,” described as a midepigastric discomfort associated with mild nausea. This discomfort is worse with food and with tight clothes. She describes loss of appetite and basically being afraid to eat anything. She has no visible bloating, vomiting, acid regurgitation, nocturnal symptoms, or dysphagia. She does describe some improvement in the symptoms with soda crackers, creme de menthe, and liquid Maalox, as well as belching. She continues to take 8 Excedrin per day.
Tylenol No. 3, Percodan, having been off all prednisone and Naprosyn for approximately 4 weeks. However, despite being off those medications, she still describes some “indigestion,” described as a midepigastric discomfort associated with mild nausea. This discomfort is worse with food and with tight clothes. She describes loss of appetite and basically being afraid to eat anything. She has no visible bloating, vomiting, acid regurgitation, nocturnal symptoms, or dysphagia. She does describe some improvement in the symptoms with soda crackers, creme de menthe, and liquid Maalox, as well as belching. She continues to take 8 Excedrin per day.
Her physical examination was remarkable for findings of a right pleural effusion, and her stool was Hemoccult positive.
In view of her many years of dyspeptic symptoms, her recent multiple drug ingestion, as well as the continued aspirin intake, one has to presume that her midepigastric discomfort and nausea are due to these multiple medications and the continued use of aspirin. In view of this likelihood, it would seem most reasonable to treat her presumptively with Tagamet as well as taking her off regular aspirin and placing her on Ecotrin (the enteric-coated aspirin), which seems to have less gastroduodenal effects. To this end we started her on Ecotrin, Tagamet, and should she have no improvement in her symptoms over the next several weeks, then endoscopy is recommended to evaluate the source of her pain.
Thank you, Bob, for asking me to see this patient, and should she have no improvement, I will keep you informed of the results of her endoscopy.
Sincerely,
Name.
FOOTNOTE
Line 13 (Page 1). Re (regarding) was not dictated but was supplied to demonstrate proper letter format.
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