Upon the Hessian’s assessment, the patient’s vitals are normal, but showing minimal signs of discomfort. Patient is restless; shifting positions intermittently. Inspection of the trapezium and scapular muscles showed diffusion tenderness to palpation, but no rebound tenderness. She showed some tenderness around joints, but no obvious synopsis. Patient shows slight muscle weakness. No signs of swelling, deformities, or rather present. Vitals: BP 125/60, Pulse = 68 BPML, Respiratory Rate 16, Temperature = 98. F, pan = 5/10 personal History: Patient states she is a social smoker, does not drink alcohol or use any recreational drugs. Patient has no know allergies. Exercise is adequate and nutrition is good. Patient has previous diagnosis of irritable bowel syndrome (BIBS), depression, and post-traumatic stress disorder (PUTS). P T SD stemming from sexual abuse as a child. Surgical history includes a cesarean section in 2013. Current medications include Approach (MGM), Asana (MGM), and Topcoat (MGM). Social History: Patient lives with husband and their three young children.
She works outside the home as a second grade teacher at Broadband Elementary. She states that caring for her children is difficult sometimes due to the pain and weakness she has been experiencing. Family History: Mother is diabetic (Type II), suffers from high blood pressure and high cholesterol. Father is an alcoholic and suffers from manic depression as well as bi-polar disorder. Maternal grandmother has muscular degeneration. Paternal grandmother died suddenly as a result of an aneurysm subtractions hemorrhage.
Discussion: Upon entry to the emergency department, the triage nurse took the patients vital signs and documented her chief complaints. The nurse gathered background information on the patient including medical, family, social history and current list of medications. Patient stated she has been dealing tit “widespread” pain for roughly seven months. Initially, the patient is suspected of drug seeking. This is a common occurrence in an emergency department, especially when no obvious signs of pain or illness are visible, by appearance, examination, ordered test, or lab work (Beck).
The patient complained about general pain throughout her body, with more intense pain radiating from the upper back, specifically pointing towards the trapezium muscle. Upon physical examination, patient appears alert and oriented. She does appears to be in some distress. Head, Eyes, Ears, Nose, and Throat (HEN) are all normal. The neck is movable without resistance, no abnormalities in the cervical or supercritical area. The thyroid feels slightly enlarged but otherwise normal. Lungs are clear to auscultation, with symmetrical air entry.
The heart is of regular rate and rhythm, with no murmurs, Arles, or gallops. Abdomen is soft, non-tender and does not appear distended. Bowel sounds are regular and found in all four quadrants. No signs of edema, cyanogens, or clubbing can be found on patient’s extremities. Pulses were strong and positive, bilaterally in both the upper and lower extremities. Her joints were assessed to rule out any signs of inflammation, UT showed no signs of inflammation. Patients joints did not feel warm or appear red or swollen.
Patient had free range of motion in all joints with minimal pain. No deformities were noted. The physician then conducted a test designed specifically for diagnosing formability syndrome (FM), a chronic disorder characterized by widespread musculoskeletal pain, fatigue and localized tenderness (Martini, Nathan, Bartholomew). The exam consist of 18 specific “tender points” and a few control points. This assessment requires a physician to apply 4 keg of pressure to the predetermined areas. A positive est. will show sensitivity from the patient to a minimum of 11 tender points.
This test is the only specific testing related to diagnosing formability. The patient showed sensitivity to 16 of 1 8 tender points and didn’t respond to any of the control points during the exam (Monoclinic). Because the patient passed the sensitivity test, indicating the widespread pain could be caused by FM, the physician has requested blood be drawn and some labs completed. To diagnose FM, a physician must exclude every other possibility. Although the physician is strongly leaning towards FM being the diagnosis, hypothyroidism must be ruled out.
Hypothyroidism can also include pain throughout the body, fatigue, weakness, muscle and joint pain, constipation, and depression (Summon). The labs requested will do just that. The Lab results for patient’s Erythrocyte Sedimentation Rate (SEERS) was 14 mm/her, normal range is 1-20 mm/her. The SEERS is an indicator of inflammation in the body that measures red blood cells settling in a tube of blood over a period one hour. A Muscle Enzyme Test (KC & OLD), another way to look for inflammation, Were normal. Results for KC were 1 08 1_J/L and 64 LLC/L for OLD.
A lab for Complete Blood Count (CB) came back with no flags. Another lab ordered by the physician to test for inflammation was a C-reactive protein (CORP.). Lab results for the CORP. were Omg/C falling within normal ranges and indicating no signs of inflammation. Next labs ordered were for Anti-Nuclear Antibodies (ANA) and Rheumatoid factor. ANA values were 1 :32, bearing a negative result. The positive ANA lab would suggest the presence of an autoimmune disease. Patient’s Rheumatoid factor was 8 LLC/ml, within normal range. Renal function and liver enzymes were measured, both within normal range.
Serum calcium, Parathyroid hormone (PATH) levels were valued at 25 g/ml, Epstein-Barr virus (EBB) test were negative, indicating patients Symptoms are not caused by mononucleosis. Thyroid Stimulating Hormone (TTS) levels were measured. Therefore hypothyroidism is ruled out due to the patients results, 2. 16 ml/L (Guide to Understanding Laboratory Test). Because the physician was able to rule out hypothyroidism, as well as any autoimmune disease, the diagnosis is formability. Conclusion: In conclusion, the physician was able to exclude a diagnosis of hypothyroidism and give the patient a proper diagnosis of FM.
A referral has been made to a local Rheumatism’s, a physician who specializes in autoimmune diseases and formability, to discuss and start any treatments necessary. There is no cure for FM, one can only try to treat the symptoms and relieve the pain associated with the syndrome (N FAR). Although there hasn’t been a definitive finding on what causes the syndrome, researchers have been able to make connections to several factors. Research has shown a genetic correlation in the development of the disorder; patients with first- degree relatives who have FM have an eight times greater risk of developing the illness.
In addition, there has also been a link between environmental stimuli and childhood trauma (AIMS). In this case the patient’s history of sexual abuse as a child could be a contributing factor to the onset of FM. According to Lucie Low and Peter Chickenhearted, “It is possible that the impact on early abuse and trauma contributes to FM via disruption of neurotransmitter systems such as the serotonin and deprogramming systems and impacts stress management via the HAP axis” (2012). Formability patients often go undiagnosed or misdiagnosed for years.
This can be due to FM consisting of mostly somatic symptoms. Another reason, according to WebMD, is FM consist of symptoms that are commonly found in many other conditions (2012). These symptoms are called commodities, also known as overlapping disorders, such as restless legs syndrome, irritable bowel, and chronic headaches (Millie, Holloway). The patient has self- reported having history of all three commodities. Because there is no cure for FM (WebMD), the patient will likely be given treatments to help relieve the symptoms associated with the diagnosis.
FM sufferers are often given a cocktail of prescription drugs to treat the multiple symptoms. The referred Rheumatism’s will presumably prescribe the patient with Several (MGM), one of three drugs approved by the FDA to treat FM. Colonnaded (1 MGM) would be given for the patient’s restless leg syndrome and to help with sleep interruptions. A muscle relaxed, Filler (20 MGM), is proven to help with spasms and pain related to the muscles. To help relieve patient’s irritable bowel syndrome, Bentley (20 MGM) would be recommended.
Cabinet/ Neurotic (2000 MGM) is a popular drug known to help with neurotic pain in FM patients. Because the patient has chronic migraines, her current medication, Topcoat (75 MGM) would still benefit her. Immateriality (40 MGM) is a common drug known to FM sufferers that can help with the associated pain ND sleep issues. There are many options available to treat the symptoms, but it can be a difficult task to find the right combination and dosage on an individual basis. Another form of treatment that could be beneficial to the patient is Cognitive behavioral therapy.
This therapy focuses on current thoughts and behavior and how they affect the patient (Patient. Co. UK). With any cognitive therapy, there will be speculation, but is still recommended to the patient. Even with all the medications listed above, experts agree that the most effective way to ease symptoms of FM is by exercise. Because of this, he importance of exercise will be strongly emphasized to the patient Types of exercise for the patient to consider are walking, swimming, bicycling and strength training (Patient. Co. UK). Exercise can hard for someone in pain on a daily basis.