ONCOLOGY FOLLOWUP NOTE
DIAGNOSES:
1. Diffuse large B-cell lymphoma, stage III-A.
2. Anemia, chronic disease.
3. Chemotherapy-related
neutropenia.
4. Dysphagia.
5. Hypokalemia.
6. Coronary artery disease.
SUBJECTIVE: The patient returns to clinic today
for continued evaluation of his lymphoma. He is unfortunately not due for chemotherapy until this Friday, and it is unclear
why he was scheduled this day. In the past few weeks, he has needed to be taken by ambulance to XXXX Hospital. He was
apparently significantly hypokalemic, although we do not have records, and although it appears that he only received replacement with
oral potassium rather than intravenous potassium. He was also told that he had “a touch of pneumonia,” and apparently got a
z-pack; he has improved. Apparently, he had rigors. The patient never takes his temperature at home, so we do not know
if he had a fever. Today, he is feeling fairly good. His major complaint today, besides the dysphagia which has improved,
is numbness in his left hand, greater than his right hand.
OBJECTIVE: TEMPERATURE: 97.9 degrees Fahrenheit; BLOOD PRESSURE:
154/69; PULSE: 85; WEIGHT: 159 pounds. On examination today he still has a mass in the retropharyngeal space.
LABORATORY
DATA: From today, chemistries and liver function tests are normal, other than a glucose of 116. His potassium is normal at 4.5. CBC: White count 7.6; hemoglobin 15.5; hematocrit 46.8; platelet count is 266. Differential is 68.6% neutrophils; 15.8% lymphocytes.
ASSESSMENT: A XX-year-old gentleman with diffuse large B-cell lymphoma who will be due for chemotherapy on Friday, and I will
write his orders today. Unfortunately, he did not receive enough Neupogen. It is unclear if he was neutropenic at the
time that he had pneumonia, and for this cycle, he will get 6 doses of Neupogen. In addition, because of his neuropathy, I will
cut is vincristine dose to 1 mg.
PLAN:
1. Cancel chemotherapy nurse today.
2. Chemotherapy nurse to be scheduled on Friday.
3. Premedication with ondansetron 8 mg and dexamethasone 12 mg IV piggyback.
4. Cytoxan,
1,400 mg IV push.
5. Vincristine, 1 mg IV push.
6. Prednisone, 100 mg p.o. q. day x5 days.
7. Rituximab, 700 mg IV.
8. Neupogen 300 mcg, subcutaneous q. day x6 days beginning 1 day following chemotherapy.
9. Return on August 2, 2005 for post-chemotherapy check.
Oncology Dictation Key
