Paper Writing Services Significant for uncontrolled type 2 diabetes, insulin dependent. The patient reports the last hemoglobin A1c of 10.2. He also has hypertension, gout,

Discussion Topic 1: Fatigue SUBJECTIVE Fred, a 62-year-old male, presents to the primary care clinic with the cef complaint of fatigue. Upon further questioning, he also reports some difficulty concentrating and a decreased sex drive. Further review of symptoms reveals dry skin, left knee weakness, occasional heartburn, and polyuria and wheezing on exertion. He denies any chest pain or palpitations. He reports being on antidepressants in the past but did not take them as directed. He is easy to get along with, forthcoming in s complaints, and describes s fatigue as a little bit more pronounces in the last couple of months. He also complains of erectile dysfunction, wch he has noticed is worse in the last few years, especially since s diabetes is out of control. Past Medical and Surgical story: Significant for uncontrolled type 2 diabetes, insulin dependent. The patient reports the last hemoglobin A1c of 10.2. He also has hypertension, gout, obstructive sleep apnea (with refusal to wear CPAP), and dyslipidemia. s past surgical story includes a deviated septum repair 20 years ago. Family story: s mother died at the age of 81 of Parkinson’s disease; s father died at the age of 57 of Hodgkin’s disease; and he has one sister who is alive and well at the age of 58. Screening: He had a negative colonoscopy in 2008. s most recent PSA value was 3.1 in 2007. Social story: He reports drinking 2 drinks of hard liquor daily. He quit smoking 20 years ago and drinks 4 cups of coffee every day. He reports not adhering to s prescribed diabetic diet and has many financial and marital stressors at home. He is self-employed with some college education. Medications: Humalog, 75/25, 20 units in the morning and 20 units at night Nexium, 40 mg daily Crestor 10 mg daily Allopurinol, 300 mg daily Trazodone, 150 mg at night Lopid, 600 mg twice daily Baby aspirin, 81 mg daily Micardis 40/12.5 daily Actos, 30 mg daily Allergies: NKDA, NKFA, or environmental allergies. All immunizations are up to date. OBJECTIVE Vital signs: Temp 98, Pulse 72, RR 20, B/P 138/90. s weight is 312 lbs. and s height is 58 inches. General: He has a very pleasant attitude. s is a morbidly obese male, calm, pleasant and in no acute distress. Skin: s color is pale. s skin is clear. Small senile keratosis is noted on s left arm. HEENT: Negative Neck: He appears to have short neck syndrome. He has not palpable nodes, no JVD. Cardiovascular: Regular rate and rhythm. S1 and S2 are present without any murmurs, rubs, or gallops. Respiratory: Breath sounds CTA with equal rise and fall of chest. Abdomen: Obese, nontender, bowel sounds present in all four quadrants. Musculoskeletal: Full range of motion to all four extreme. Genital: He has normal genitalia. There is no evidence of swelling. s testicular exam is normal and there is appropriate hair growth: