Virtual Thrombosis Consult Letter

Dear referring MD

Thank you for the opportunity to review Ms. Julia. The patient provided consent for telehealth.

Past Medical History
Chronic kidney disease with recent improvement in glomerular filtration rate from 61 to 64. Fibromyalgia, previously treated with Gabapentin and Duloxetine, both ineffective. Anxiety and depression under psychiatric care. Dyslipidemia, managed with dietary and lifestyle modifications.

Other Medications
Midodrine (recently reduced to once daily, with plan to taper off), turmeric supplements.

Allergies
None reported.

History of Presenting Illness
Ms. Julia presents for follow-up of fibromyalgia, chronic kidney disease, and dyslipidemia. She reports adherence to daily blood pressure monitoring at home. She has not initiated the previously prescribed cholesterol-lowering medication, preferring to attempt dietary and lifestyle modifications first. She describes a plant-based diet, high intake of blueberries, avoidance of meat and fried foods, and use of turmeric supplements. She also reports regular consumption of water and maintains a hydroponic garden for organic vegetables. She continues to use Midodrine but has reduced the frequency to once daily due to cooler weather. She denies any new symptoms or acute complaints at this time. There have been no recent hospitalizations. Recent laboratory evaluation on April 10th revealed negative rheumatological markers, low inflammatory markers, and a slight improvement in glomerular filtration rate.

There is no recent surgery, trauma or immobility. No estrogen use. The review of systems is negative with no constitutional symptoms.

Medication adherence is excellent. The patient denies any clinically significant bleeding history including hemoptysis, hematemesis, bright red blood per rectum, epistaxis or hematuria.

Social History
Ms. Julia has not worked since the age of 40 and is considering applying for Supplemental Security Income (SSI) due to her medical conditions.

Family History

Physical Exam
Blood pressure 126/84 mmHg

Labs
All rheumatological tests negative, including lupus, mixed connective tissue disorder, Sjögren's, and scleroderma. ESR 8, CRP less than 1. Glomerular filtration rate improved from 61 to 64.

Summary and Impression
Ms. Julia presents for follow-up of chronic medical conditions, including fibromyalgia, chronic kidney disease, and dyslipidemia. Laboratory results indicate stable inflammatory markers and improved kidney function. She is managing dyslipidemia through dietary and lifestyle modifications.

Plan
The jury duty exemption form was completed and signed due to Ms. Julia's fibromyalgia and spine issues. She will continue her natural approach to managing dyslipidemia for the next six months, which includes adhering to a plant-based diet, consuming blueberries, and taking turmeric supplements. She was instructed to taper off Midodrine gradually over the next month by taking it every other day for two weeks, then every third day, and finally discontinuing it. A follow-up lipid panel and kidney function test have been scheduled in two months to monitor her progress. Additionally, documentation was provided to support her SSI application, detailing her severe fibromyalgia, previous unsuccessful treatments with Gabapentin and Duloxetine, and ongoing psychiatric management for anxiety and depression.