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63 yr old female Non smoker Not diabetic Obese BMI 31 Motor scooter dependent

63 yr old female Non smoker Not diabetic Obese BMI 31 Motor scooter dependent Lives alone in the country with dogs, cats, horses, & pigs s/p laparoscopic supraumbilical hernia repair with mesh 2005 & bilateral salpingo-oophorectomy 2000 Diagnoses & medication follow on the next slide.

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63 yr old female Non smoker Not diabetic Obese BMI 31 Motor scooter dependent

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  1. 63 yr old female • Non smoker • Not diabetic • Obese BMI 31 • Motor scooter dependent • Lives alone in the country with dogs, cats, horses, & pigs • s/p laparoscopic supraumbilical hernia repair with mesh 2005 & bilateral salpingo-oophorectomy 2000 Diagnoses & medication follow on the next slide

  2. Tumor, Kidney-Malig. Bronchitis Tumor, Ureter-Malig. Pes Planus Irritable Bowel Syndrome Chronic sinusitis Cataract, Nuclear Hernia, Ventral Vitreous Detachment / Syneresis Mood Disorder due to a General Medical Condition Major Depress. Recurr Renal Mass Menopause Asthma, unspecified Fatty Liver Gastroesophageal Reflux Disorder Dysthymic D/O Spinal stenosis in cervical region Osteoarthritis Chronic Low Back Pain Hepatitis C without mention of hepatic coma • METHADONE TAB • MORPHINE SO4 TAB (SA) • OXYCODONE HCL • ALBUTEROL 90MCG (CFC-F) 200D ORAL INHL • ALBUTEROL SO4 0.083% INHL 3ML UD - • ARTIFICIAL TEARS POLYVINYL ALCOHOL - • ASCORBIC ACID 500MG TAB • BENZONATATE 100MG CAP • BUPROPION HCL 150MG 12HR SA TAB • CALCIUM 500MG/VITAMIN D 200 UNT TAB • CETIRIZINE HCL 10MG TAB - ACTIVE 90 • CHOLECALCIFEROL (VIT D3) 1,000UNIT TAB - • CYCLOBENZAPRINE HCL 10MG TAB - • DICYCLOMINE HCL 10MG CAP - • DOXEPIN HCL 10MG CAP • ETODOLAC 400MG TAB • FLUNISOLIDE 0.025% 200D NASAL INH • FORMOTEROL FUMARATE 12MCG INHL CAP • FUROSEMIDE 40MG TAB • GABAPENTIN 600MG TAB • LISINOPRIL 40MG TAB • METFORMIN HCL 500MG TAB • MOMETASONE FUROATE 220MCG ORAL INHL • MONTELUKAST NA 10MG TAB • MULTIVITAMIN/MINERALS CAP • OXYBUTYNIN CHLORIDE 5MG TAB • PANTOPRAZOLE NA 40MG EC TAB • POTASSIUM CHLORIDE 10MEQ SA TAB • RANITIDINE HCL 150MG • SENNOSIDES 8.6MG TAB • SUCRALFATE 500MG/5ML SUSP • VENLAFAXINE HCL 225MG 24HR SA TAB • ZOLPIDEM TARTRATE 10MG TAB • ERYTHROMYCIN ES 200MG/5ML SUSP

  3. The next 9 slides show her 1 year postoperative follow up

  4. Her 2006 postoperative office concluded by telling her to loose weight • She came to my clinic once a year complaining of abdominal pain, nausea, vomiting, constipation • 2012 she returns to my clinic having lost no weight still complaining of pain The next 10 slides are the 2012 cat scan

  5. The skin at the “apex” of the hernia is surrounded by engorged veins. You can see peristalsis under the skin. There are areas with pitting edema. The are also several small weeping ulcers What should I do?

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