online case RM/Feb. 04
Posted: Fri Feb 22, 2002 3:18 pm
Dear all, here is another case from Rochelle which she would like comments
on. As always please mail your comments to the group so we can all share
them. Best wishes, Joy Lucas.
Case JL146
Background
This 40 yr. old woman d.o.b. 28.8.61 has come to me from recommendation from
her Mother. She is a solicitor and presented in a very smart business like
blue and black suit. The first thing that struck me was how loud her voice
and laugh was. She was wearing pearls and no make up. Her skin was clear.
She of average build and about 5 foot 6. She sat relaxed with her hands in
her lap and sometimes learnt forward, as she is hard of hearing. She
sometimes wears a hearing aid when the loss is bad. At the moment it is not
too bad. She is happily married (17 years) and has a child of 7. She is the
eldest of 3.
20th February 2002
Presenting Complaint
Chronic otitis externa with complications.
It started 9 years ago with no obvious aetiology. (See below) It presents as
a red ear exuding a watery clear liquid. This has a "bodily type" of odour.
The is debris in the ear of skin which is brown and is sometimes vacuumed
out by the doctor. The whole thing is itchy and sore. It was worse when
she was pregnant 8 years ago. 2 years ago this condition went into a
secondary stage which is unusual according to the consultant. A skin or
membrane starts to grow to heal the damaged ear canal. This was repaired
with a meateoplasti (?) where the skin is removed and a skin graft put in.
They did the right ear in November 2000 and the condition has now started
off again. They did the left ear but this didn¹t work as her body reacted to
the antiseptic packing used in the operation. They redid the operation but
the eardrum is or has disintegrated. She has hearing in her right ear that
comes and goes.
9 years ago 3 or 4 months previously she had been abroad and suffered from
labrynthitis. She had been skiing and damaged her knee ligament. The
condition she has started after she had been swimming a lot to exercise the
leg.
She says she is organised, active, does the best to enjoy life. Is busy and
always on the go. She is a partner in the law firm. She has an open door
policy and gives guidance. She works on the strategic side of things. She
leads meetings and makes the decisions although when I asked her she said
she would be willing to change them if others thought she should. She thinks
she is a good listener.
"I am happy to delegate if there is not a skills gaps. I am probably not as
firm as I should be. I lead by respect. I show emotions more than my num. I
show love, care and exasperation. I don¹t tend to have a temper but I used
to have. I try to find the solution and do it with as little grief as
possible. I am a great mediator." (Mag?)
"I can get tearful but want to be on my own. This happens in connection with
unfair criticism and people not being fairly treated. I can get emotionally
involved with my clients¹ problems. Clients look to you to be guided by
you."
"I am happy spending time with my family and daughter. We tried to have
another but it never happened. I don¹t take precautions. The first 5 years
of married life I was on the pill but felt it emotionally affected me. It
made me numb. There was no pressure to have a child or to have another. I
had my daughter after my 10th wedding anniversary, no problems. I breast fed
for 2 months and went back to work. I am the main breadwinner."
Menses regular can be painful with water retention but this seems to
have gone.
Anger "People at work who don¹t do things. I hate people who are sloppy
and unreasonable clients. At home there is criticism at the amount of time I
am not at home but working. My spare time I spent with my child rather than
my husband." She mentioned this last bit a few times so I reckon it causes
friction.
Marriage "Very good. He makes the meals. It affects me that he takes the
traditional household chores. I want to switch off at the weekend but my
husband is raring to go and do things. Things will happen and get done when
they do."
Energy "good but not when compared with husband. I am laid back at the
weekend. I don¹t let things get to me as much as they could. I could spend
until 11pm at the office but don¹t. After my daughter has gone to bed I may
get files out and work in the evening or on a Sunday evening at the weekend.
Some people might describe me as a workaholic. I will work at home in the
evening if I have to."
Fears "New situations but I do cope. If anything happens to my child. I am
not comfortable with heights but not scared of them. I don¹t like speed but
drive slowly. I walk rather than getting into lifts because I have been
stuck in the one at work too often.
Environment would like to live in the mountains if she had a choice. She
feels the cold but doesn¹t like either extremes of temperature.
Food Hates fat on meat. Avers. Hot spicy Likes sour *** savoury, fish,
fruits
Bowels years ago she has an investigation for spastic bowel which has
sorted itself.
Fainting ever since age 12. (Sorry forgot to ask what happened!!)It
happens as a reaction to shock to the body, e.g. first time she ever put in
her contact lens, long periods of standing, hunger. She knows she is going
to faint because she gets clammy and her eyesight goes. She can¹t see. (1 Rx
Plumbum).
Alcohol sensitive and gets migraines never mind what she drinks.
Migraines More frequent pre menstrual. Pain behind the right eye extending
down side of nose. She is not "terribly sick". They last 24 hours > lying in
a quiet dark room and relaxing.
Company Only in small numbers.
Tidy
Impatient
Sleep good
Dreams reoccurring as a child was one of disappearing down a hole. More
lately of her daughter being in bed with her. (Petro.) Her dreams are vivid
and often when she wakes in the night she believes that there are objects in
the room like animals. (Rubric illusions animals)
Confidence- "If I am honest I have a lack of self confidence - I put on a
front of being confident. As a woman I have to feel better than a man.
Failure hits me hard".
Childhood Earliest memory is of a younger brother being born when she was
4. Happy childhood. Her father wanted her to do better academically and
thought he could buy love with gifts and money. Lack of emotional love from
Mother. She married at 21 to her only boyfriend who was and is her best
friend.
She likes to travel, work less and spend more time with the family.
The going out of the door statement I got was "I am trying to balance being
a mother, a wife and work. I try to plan time for each but my husband loses
out."
Family Medical History
Father died at 54 from heart disease.
Mother (my patient) has recovered well for vulva cancer after op to remove
it and has had cataract operations.
Grandparents died of cancer.
on. As always please mail your comments to the group so we can all share
them. Best wishes, Joy Lucas.
Case JL146
Background
This 40 yr. old woman d.o.b. 28.8.61 has come to me from recommendation from
her Mother. She is a solicitor and presented in a very smart business like
blue and black suit. The first thing that struck me was how loud her voice
and laugh was. She was wearing pearls and no make up. Her skin was clear.
She of average build and about 5 foot 6. She sat relaxed with her hands in
her lap and sometimes learnt forward, as she is hard of hearing. She
sometimes wears a hearing aid when the loss is bad. At the moment it is not
too bad. She is happily married (17 years) and has a child of 7. She is the
eldest of 3.
20th February 2002
Presenting Complaint
Chronic otitis externa with complications.
It started 9 years ago with no obvious aetiology. (See below) It presents as
a red ear exuding a watery clear liquid. This has a "bodily type" of odour.
The is debris in the ear of skin which is brown and is sometimes vacuumed
out by the doctor. The whole thing is itchy and sore. It was worse when
she was pregnant 8 years ago. 2 years ago this condition went into a
secondary stage which is unusual according to the consultant. A skin or
membrane starts to grow to heal the damaged ear canal. This was repaired
with a meateoplasti (?) where the skin is removed and a skin graft put in.
They did the right ear in November 2000 and the condition has now started
off again. They did the left ear but this didn¹t work as her body reacted to
the antiseptic packing used in the operation. They redid the operation but
the eardrum is or has disintegrated. She has hearing in her right ear that
comes and goes.
9 years ago 3 or 4 months previously she had been abroad and suffered from
labrynthitis. She had been skiing and damaged her knee ligament. The
condition she has started after she had been swimming a lot to exercise the
leg.
She says she is organised, active, does the best to enjoy life. Is busy and
always on the go. She is a partner in the law firm. She has an open door
policy and gives guidance. She works on the strategic side of things. She
leads meetings and makes the decisions although when I asked her she said
she would be willing to change them if others thought she should. She thinks
she is a good listener.
"I am happy to delegate if there is not a skills gaps. I am probably not as
firm as I should be. I lead by respect. I show emotions more than my num. I
show love, care and exasperation. I don¹t tend to have a temper but I used
to have. I try to find the solution and do it with as little grief as
possible. I am a great mediator." (Mag?)
"I can get tearful but want to be on my own. This happens in connection with
unfair criticism and people not being fairly treated. I can get emotionally
involved with my clients¹ problems. Clients look to you to be guided by
you."
"I am happy spending time with my family and daughter. We tried to have
another but it never happened. I don¹t take precautions. The first 5 years
of married life I was on the pill but felt it emotionally affected me. It
made me numb. There was no pressure to have a child or to have another. I
had my daughter after my 10th wedding anniversary, no problems. I breast fed
for 2 months and went back to work. I am the main breadwinner."
Menses regular can be painful with water retention but this seems to
have gone.
Anger "People at work who don¹t do things. I hate people who are sloppy
and unreasonable clients. At home there is criticism at the amount of time I
am not at home but working. My spare time I spent with my child rather than
my husband." She mentioned this last bit a few times so I reckon it causes
friction.
Marriage "Very good. He makes the meals. It affects me that he takes the
traditional household chores. I want to switch off at the weekend but my
husband is raring to go and do things. Things will happen and get done when
they do."
Energy "good but not when compared with husband. I am laid back at the
weekend. I don¹t let things get to me as much as they could. I could spend
until 11pm at the office but don¹t. After my daughter has gone to bed I may
get files out and work in the evening or on a Sunday evening at the weekend.
Some people might describe me as a workaholic. I will work at home in the
evening if I have to."
Fears "New situations but I do cope. If anything happens to my child. I am
not comfortable with heights but not scared of them. I don¹t like speed but
drive slowly. I walk rather than getting into lifts because I have been
stuck in the one at work too often.
Environment would like to live in the mountains if she had a choice. She
feels the cold but doesn¹t like either extremes of temperature.
Food Hates fat on meat. Avers. Hot spicy Likes sour *** savoury, fish,
fruits
Bowels years ago she has an investigation for spastic bowel which has
sorted itself.
Fainting ever since age 12. (Sorry forgot to ask what happened!!)It
happens as a reaction to shock to the body, e.g. first time she ever put in
her contact lens, long periods of standing, hunger. She knows she is going
to faint because she gets clammy and her eyesight goes. She can¹t see. (1 Rx
Plumbum).
Alcohol sensitive and gets migraines never mind what she drinks.
Migraines More frequent pre menstrual. Pain behind the right eye extending
down side of nose. She is not "terribly sick". They last 24 hours > lying in
a quiet dark room and relaxing.
Company Only in small numbers.
Tidy
Impatient
Sleep good
Dreams reoccurring as a child was one of disappearing down a hole. More
lately of her daughter being in bed with her. (Petro.) Her dreams are vivid
and often when she wakes in the night she believes that there are objects in
the room like animals. (Rubric illusions animals)
Confidence- "If I am honest I have a lack of self confidence - I put on a
front of being confident. As a woman I have to feel better than a man.
Failure hits me hard".
Childhood Earliest memory is of a younger brother being born when she was
4. Happy childhood. Her father wanted her to do better academically and
thought he could buy love with gifts and money. Lack of emotional love from
Mother. She married at 21 to her only boyfriend who was and is her best
friend.
She likes to travel, work less and spend more time with the family.
The going out of the door statement I got was "I am trying to balance being
a mother, a wife and work. I try to plan time for each but my husband loses
out."
Family Medical History
Father died at 54 from heart disease.
Mother (my patient) has recovered well for vulva cancer after op to remove
it and has had cataract operations.
Grandparents died of cancer.