Request for Consult 1

Topics: Diabetes mellitus, Diabetes, Insulin Pages: 2 (538 words) Published: April 2, 2011
Patient Name: Gerald Edwards
Hospital No.: 11058
Consultant: Gary Sheldon, Podiatrist
Requesting Physician: Catherine Baker, MD, Emergency Services Date: 07/16/2011
Request for Consultation: Right foot ulcer, complications of diabetes mellitus. HISTORY OF PRESENT ILLNESS: The patient well known to me is pleasant 53-year-old diabetic male, with a one week history of a six cm diameter grade two diabetic ulceration beneath the medial cuneiform of the right foot. The patient also has a significant history of Charcot’s disease of the right foot and diabetic neuropathy of the lower extremities bilaterally. The patient received partial thickness skin graph about four months ago over the large diabetic ulceration of his right foot, which ulcerated upon ambulation after the surgery. The patient has had conservative office treatment consisting of a walking brace, ulcer debridement every fourteen days, and a tie over dressing that is changed every day. The patient presented to my office July 15 complaining of a new ulceration on the plantar forefoot, right foot, with sanguinopurulent discharge, and fever. Temperature in the office that day was 100.5 degrees. The patient was sent to the ER at Hillcrest Medical Center for subsequent incision and drainage, intravenous antibiotics, care of the diabetes mellitus, and further work up. PHYSICAL EXAMINATION: See Dr. Baker’s dictated note for complete H&P, but please note the following. The patient has moderate to severe Charcot’s deformity of the right foot with the prominent subcuneiform mass. Beneath this mass is 2.5 x 3.0 cm grade 2 ulceration. The base of the ulceration has the plantar musculature exposed with granulation tissue hyperkeratotic order. Pulses are palpable bilaterally. There is digital hair growth. There was a sinus track and S-scar at the center of the plantar forefoot of the right foot. There is airathema, induration, and calor to right...
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