HISTORY OF PRESENT ILLNESS: The patient was seen in the office today. He is a (XX)-year-old man who had a deceased donor liver transplant just over 3 months ago. Overall, he is doing well. His main complaint is a dryish cough that he has had for a few days. He denies any fevers or shortness breath. He has had no abdominal pain, nausea, vomiting or other such complaints.
CURRENT MEDICATIONS: Aggrenox twice a day, acyclovir 400 mg twice a day, Tenormin 37.5 mg daily, Prilosec 20 mg daily, prednisone 5 mg daily and Prograf 3 mg twice a day.
ALLERGIES: No known drug allergy.
PHYSICAL EXAMINATION: On exam, the patient appears well. His weight is 184 pounds. Blood pressure 164/62. Heart rate 54. He is afebrile. Chest is clear. Abdomen is soft and nontender. Surgical site is clean and dry. His biliary stent is out. He has no pedal edema.
LABORATORY DATA: Hematocrit is 11.6, WBC is 6.6, creatinine is 1.6, AST is 22, ALT is 26, total bilirubin 0.8. Prograf level is pending.
IMPRESSION AND PLAN: Overall, the patient is doing well. His liver functions are normal and his creatinine is improving. He will continue on Prograf and prednisone therapy for immunosuppression. I have ordered a chest x-ray today given his persistent cough. He will otherwise return to see us in 4 weeks’ time. He is also scheduled to have an abdominal MRI at that time for hepatocellular carcinoma surveillance.
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HISTORY OF PRESENT ILLNESS: The patient returns for followup visit. She is now (XX) days post deceased donor kidney transplant. This was complicated by delayed graft function and a wound infection. She currently received vacuum dressing to the right lower quadrant wound. In general, she feels well. She still has some incisional pain requiring Percocet and is now also complaining of constipation. However, she has had no fevers and is voiding without difficulty.
CURRENT MEDICATIONS: Aranesp 100 mcg p.r.n. weekly, Colace 100 mg t.i.d., Synthroid 0.125 mg daily, milk of magnesia p.r.n., Lopressor 50 mg twice a day, CellCept 500 mg twice a day, Protonix 20 mg twice a day, K-Lor 20 mEq daily, Prograf 6 mg twice a day, Valcyte 450 mg daily and Coumadin 3 mg daily.
ALLERGIES: No known drug allergies.
PHYSICAL EXAMINATION: The patient appears well. Weight is 150 pounds. Blood pressure is 116/64. Heart rate is 82. She is afebrile. Chest is clear. Abdomen is soft. The vacuum sponge was removed and the wound inspected. It is granulating extremely well and is about 40% smaller in size than last week. There is no longer any necrotic tissue on the sides to debride, only healthy granulation tissue.
LABORATORY DATA: Labs today show a creatinine of 1.8, hematocrit of 28 and white count is 6400.
IMPRESSION AND PLAN: The patient is doing well with good kidney graft function. The wound is also granulating very nicely. She will continue with vacuum dressing to the wound. There are no changes to her immunosuppressive regimen. She will receive 100 mcg of Aranesp subcutaneously today for her anemia. She will return to see us in 2 weeks’ time. She will continue with weekly blood work.
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HISTORY OF PRESENT ILLNESS: I saw the patient in the office today. He is now (XX) days post deceased donor kidney transplant. He has had excellent kidney graft function with a creatinine in the low 1 range. He had a scald burn to his left thigh a few weeks ago after he spilled hot tea, and I have been seeing him for this. He reports that this area is healing nicely and he continues with twice daily Silvadene application. He has no pain here now. Otherwise, he appears to be doing well with no abdominal pain, nausea, vomiting or fevers.
PHYSICAL EXAMINATION: On exam, he appears well. Blood pressure is 134/54, heart rate is 66 and he is afebrile. His weight is 190 pounds. Chest is clear. Abdomen is soft. Surgical site is well healed. The second-degree burn on his medial left thigh is healing nicely with no evidence of infection and 60% reduction in wound area since I last saw him 3 weeks ago. He has no pedal edema.
LABORATORY DATA: Labs showed a creatinine of 1.1, hematocrit of 34.4, and normal LFTs and a Prograf level of 9.2.
IMPRESSION AND PLAN: The patient continues to do well. His kidney function is excellent. His burn wound is also healing nicely. He will continue with Silvadene application twice a day. He will see us in 3 months’ time but continue his routine followup with Dr. John Doe. Once the burn wound heals, it would be reasonable to resume Rapamune therapy that he was on pretransplant.
