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A long time ago, in a galaxy far, far away……..

A long time ago, in a galaxy far, far away…….. Our hero Maniken Skywalker was suffering from an unknown ailment. This is his story……. Family Practice Doctor. Vital Statistics: Human male 31 years old. Dr. C. Dooku. Initial Presentation. Vital Statistics Initial Presentation

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A long time ago, in a galaxy far, far away……..

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  1. A long time ago, in a galaxy far, far away…….. Our hero Maniken Skywalker was suffering from an unknown ailment. This is his story…….

  2. Family Practice Doctor Vital Statistics: • Human male • 31 years old Dr. C. Dooku

  3. Initial Presentation • Vital Statistics • Initial Presentation • Stiff patches of skin on hands and arms; waxy • texture; episodes come and go • Acid reflux, difficulty swallowing, abnormal • bowel movements • Stiffness in joints (specifically hands and • wrists)

  4. Family Physician - Treatment Diagnostic Tests • Urinalysis • Conducted at office • Blood Panel (CBC) • Conducted off site

  5. Maniken Skywalker 32 X Dr. C. Dooku KP 6/24/13 6/24/13 X X + NEGATIVE Send report ASAP to Dr. C. Dooku

  6. Skywalker, Maniken 120850MS 4/19/1981 32 years Male 6/2713 6/27/13 Run by KP on 6/25/13 No impairment

  7. Diagnosis All tests returned within normal ranges Skin and digestive issues could be due to changes in stress level or environment (patient mentioned recent intergalactic voyage and near death experience Gen. Grievous) Lack of regular stretching and exercise has contributed to joint pain and stiffness

  8. Treatment Prescription for antihypertensive (Lisinopril) OTCs suggested - heart burn – Prevacid - joint swelling and pain – NSAID - skin – oil based cream – Glaxal Base, Eucerin Regular stretching/exercise plan to be put in place Referrals to Dr. ChuyBacca and Dr. J.B. Hutt

  9. Any Ideas?

  10. Dermatologist Vital Statistics: • Human male • 31 years old Dr. Jesus “Chuy” Bacca

  11. Visual Examination

  12. Diagnostic Test Shave Biopsy of skin patch on posterior forearm

  13. Test Results

  14. Treatment OTC Moisturizer / Emollient Cream Prescription Topical Corticosteroid Cream · Antihistimines Oral corticosteroids or immunosuppressive agents

  15. Any Ideas?

  16. Gastroenterologist Vital Statistics: • Human male • 31 years old Dr. J.B. Hutt

  17. Diagnostic Tests • Referred by Dr. C Dooku • Upper GI endoscopy - This procedure uses a light, flexible endoscope was to see inside the upper GI tract. • Anal myography - Used to determine if there is nerve damage causing incontinence.

  18. Diagnostic Tests I

  19. Test Results • Upper endoscopy revealed inflammation of the esophagus. - Diagnosis: gastroesophogeal reflux disorder (GERD) • Anal myography revealed that there was no nerve damage.

  20. Test Results Esophagogastroduodenoscopy Report DATE OF PROCEDURE: 7/12/2013 PROCEDURE PERFORMED: Esophagogastroduodenoscopy (EGD) PHYSICIAN: Dr. J.B Hutt INDICATION: Heartburn after eating meals. Burning sensation in esophagus and upper stomach region after eating. POSTOPERATIVE FINDINGS: 1. Inflammation of the esophagus. MEDICATIONS: Versed 10 mg IV, fentanyl 75 mcg IV. IMMEDIATE COMPLICATIONS: None. PROCEDURE: Upper endoscopy TREATMENTS 1. Over the counter H2 blockers such as amotidine (Pepcid AC, Pepcid Oral) 2. Modify Diet

  21. Test Results Anal Electromyography Results - Normal

  22. Treatment • GERD - Modify diet - H2 blockers (Pepsid, Zantac) reduce the production of stomach acid • Incontinence - Modify diet be sure to eat foods high in fiber. Referral to Dr. Wan Kenobi - Rheumatologist

  23. Any Ideas?

  24. Rheumatologist Vital Statistics: • Human male • 31 years old Dr. Wan Kenobi

  25. Diagnostic Test and Result • ESR indicates presence of IgG and IgM - IgG = 13.2 U/L - IgM = 1.5 U/L • CRP present • Antinuclear antibodies detected

  26. Treatment Blood pressure medication (continued from Dr. Dooku) and monitoring at home Renal function monitoring Corticosteroid cream for skin (continued from Dr. Bacca) Immunosuppressive medications to reduce internal organ involvement Physical therapy to maintain dexterity and ambulation

  27. Any Ideas?

  28. Cutting Edge Treatment Should complications from Systemic Scleroderma Stem Cell Transplant may be necessary - Hematopoietic stem cells (bone marrow) *will “reset” autoimmunity - Mesenchymal stem cells (bone marrow) *immunomodulatory role in autoimmunity High-dose Monthly Cytoxin - chemotherapy drug

  29. The End!

  30. GREAT JOB!

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