online case RM/May02
Posted: Thu May 02, 2002 9:27 pm
Dear all, here we have a second case for May - this time from Rochelle - as
always please try to respond with ideas and advice etc to the group as a
whole. Thanks to Rochelle for sending this case.
Regards, Joy Lucas
----------
From: "rochelle"
Subject: Case management/now ulcerative colitic case
Background
57 yr. old man d.o.b. 31.3.46 . He presented as a handsome, white haired
man who arrived with his case from work and was very smartly dressed in a
mustard shirt + tie. He runs a computer centre. He is on a lot of
allopathic medication and has been for many years.
30th April 2002
Presenting Complaint - Ulcerative colitis, which began in June 1981 and
flares up annually when the weather gets warmer. I was living down South at
the time and commuting for my job. The flare-ups seem to take longer to
resolve even with the medication. He takes Salazopyrin 'EN' tablets daily
since 1982 500mg. He is not sure what they do! During a flare-up he uses
Predsol enemas 20mg as required which is usually nightly for 14 nights. At
this moment he is on the last of these and problem is on the way out. It
presents as a show of blood, followed by excessive flatulence when he passes
mucous. The mucous is a pale yellow. The stool is not a problem it is the
flatus with involuntary mucous discharge that gets him down. " It lasts so
long that it gets me down. I work all day and at certain times it is so
uncomfortable as I can't keep going to the toilet. With the flatulence is a
nagging pain under the ribs. I have a solid concrete type feeling after
eating. This present acute started 5 weeks ago."
Diabetes - recent December 2000. "It is getting worse. I am now on 2 x 80g
tablets of Glycoside a day. The blood sugar should be between 5 and 7 but
it is 10 and I feel fine with it. When it did get down to 5 once I felt
terrible and asked the doctor if it is possible that what you should be is
different for some people than others. I knew I had it because I was tired
all the time and my eyes suddenly went foggy and I was drinking a lot. I cut
out sugar - I have always had a sweet tooth and lost some weight. I am now a
steady 13 stone.
Stress - " In my job it concerns me that I haven't done this or that. It
worries me. At the end of the day it will get done. I am not in fear of a
job loss. I have a lot of managerial responsibility. I want things done my
way. I don't like to leave things undone. I can't delegate easily because
other people don't do things the way I want it done. I like to think
fairly - I'm not bombastic and will tell people in the nicest possible way
what to do. I use sarcasm instead of ranting and raving. If I am critical
with them, then they deserve it. " I asked about his next in line at work.
"I'm not happy with his attitude with everything he does. No I probably
wouldn't discuss it with him. He doesn't do things as well as me. We had an
ex boss who we all disliked. He was consistently inconsistent. What was good
last week wasn't good this week."
"I am not good at accepting criticism. There are times I am wrong. I wouldn'
t blame someone else but I would argue that it was caused by this or that
happening. You see yourself as the truth but others don't see it like that.
My wife would tell you that I am miserable and that I can't see what she
means. She's accused me of things that I don't remember and I don't believe
I have a problem. I feel confused. If you are hiding behind a problem you
can be better but I don't know what the answer is. I say to her 'explain to
me where I am going wrong'. I am the 4th husband and the one that has
stayed longest! My wife says I am not capable of doing more than one thing
at a time. If I do I forget the other thing. If I do start something I will
finish it."
"I think I am honest and trustworthy. She has said to me because I am so
tired, 'why don't you go off sick for a week', but I wouldn't do that. My
first wife died and I would still be married to her if it wasn't for that. I
wanted to get on with my life. I said to my present wife once that I wish I
had met her later on and that didn't go down well. I have been married 12
years now to her. No there have been no indiscretions as I'm not that type
of person. My late wife died in Dec. '88 and I met my present wife at the
crematory as the plot of her youngest daughter is next to my late wife's. We
met in the summer of '89 and went out the following New Year's Eve. I did go
out with someone else between but it was not physical. She was a
spiritualist, a medium who told me things only my late wife and I would have
known. My sex drive was average but because of diabetes it is now reduced."
"If I am in a queue I am patient as a rule. I have always been a patient
person. I am not impatient".
Affectionate- "I am mediocre and don't require a lot."
Company - Prefers to be on his own. He has an office at home and is often in
there. He does sit with his wife and watch TV. "I am not am not an
extrovert. In a crowd of people I am usually quiet. I will chat to a person.
I am bashful and not enthusiastic about public speaking. I can do it but I
don't want to make a habit of it."
Nosebleeds - all the time. He has always had them. No modalities in that
they can happen anytime and are only mild.
Environment - Doesn't like the heat as it makes him irritable. Does like the
sun. Doesn't like the cold. Thunderstorms - loves to watch them.
Anger - from stupidity in others and he is sarcastic when angry.
Upset - falling out with people and would sulk on his own.
Tidy.
Fears - I like to be safe and secure and have fitted burglar alarms. I
always lock doors and the car door when I leave. "Anything mime and I've
worked for should remain mine. I fear being poor as I have always been self
sufficient."
Religion - not important
Dreams - strange. "They are to do with only being able to get access through
a confined space. They semi represent things in childhood. I have to get
over obstacles and through small apertures to get to where I am going."
I asked where he felt in society and he said "Fractionally above middle
class".
Food - loves fish but not shellfish, cheese, pasta, desires sweet**
Dislikes a lot of salt, thinks spicy may agg, broccoli
Drinks - tea, milk. Hates water.
Family Medical History
Father - d. 68 ruptured aorta Grandfather 80 cancer, Uncle - diabetes.
Grandmother - 78 stroke
www.rochellemarsden.co.uk
always please try to respond with ideas and advice etc to the group as a
whole. Thanks to Rochelle for sending this case.
Regards, Joy Lucas
----------
From: "rochelle"
Subject: Case management/now ulcerative colitic case
Background
57 yr. old man d.o.b. 31.3.46 . He presented as a handsome, white haired
man who arrived with his case from work and was very smartly dressed in a
mustard shirt + tie. He runs a computer centre. He is on a lot of
allopathic medication and has been for many years.
30th April 2002
Presenting Complaint - Ulcerative colitis, which began in June 1981 and
flares up annually when the weather gets warmer. I was living down South at
the time and commuting for my job. The flare-ups seem to take longer to
resolve even with the medication. He takes Salazopyrin 'EN' tablets daily
since 1982 500mg. He is not sure what they do! During a flare-up he uses
Predsol enemas 20mg as required which is usually nightly for 14 nights. At
this moment he is on the last of these and problem is on the way out. It
presents as a show of blood, followed by excessive flatulence when he passes
mucous. The mucous is a pale yellow. The stool is not a problem it is the
flatus with involuntary mucous discharge that gets him down. " It lasts so
long that it gets me down. I work all day and at certain times it is so
uncomfortable as I can't keep going to the toilet. With the flatulence is a
nagging pain under the ribs. I have a solid concrete type feeling after
eating. This present acute started 5 weeks ago."
Diabetes - recent December 2000. "It is getting worse. I am now on 2 x 80g
tablets of Glycoside a day. The blood sugar should be between 5 and 7 but
it is 10 and I feel fine with it. When it did get down to 5 once I felt
terrible and asked the doctor if it is possible that what you should be is
different for some people than others. I knew I had it because I was tired
all the time and my eyes suddenly went foggy and I was drinking a lot. I cut
out sugar - I have always had a sweet tooth and lost some weight. I am now a
steady 13 stone.
Stress - " In my job it concerns me that I haven't done this or that. It
worries me. At the end of the day it will get done. I am not in fear of a
job loss. I have a lot of managerial responsibility. I want things done my
way. I don't like to leave things undone. I can't delegate easily because
other people don't do things the way I want it done. I like to think
fairly - I'm not bombastic and will tell people in the nicest possible way
what to do. I use sarcasm instead of ranting and raving. If I am critical
with them, then they deserve it. " I asked about his next in line at work.
"I'm not happy with his attitude with everything he does. No I probably
wouldn't discuss it with him. He doesn't do things as well as me. We had an
ex boss who we all disliked. He was consistently inconsistent. What was good
last week wasn't good this week."
"I am not good at accepting criticism. There are times I am wrong. I wouldn'
t blame someone else but I would argue that it was caused by this or that
happening. You see yourself as the truth but others don't see it like that.
My wife would tell you that I am miserable and that I can't see what she
means. She's accused me of things that I don't remember and I don't believe
I have a problem. I feel confused. If you are hiding behind a problem you
can be better but I don't know what the answer is. I say to her 'explain to
me where I am going wrong'. I am the 4th husband and the one that has
stayed longest! My wife says I am not capable of doing more than one thing
at a time. If I do I forget the other thing. If I do start something I will
finish it."
"I think I am honest and trustworthy. She has said to me because I am so
tired, 'why don't you go off sick for a week', but I wouldn't do that. My
first wife died and I would still be married to her if it wasn't for that. I
wanted to get on with my life. I said to my present wife once that I wish I
had met her later on and that didn't go down well. I have been married 12
years now to her. No there have been no indiscretions as I'm not that type
of person. My late wife died in Dec. '88 and I met my present wife at the
crematory as the plot of her youngest daughter is next to my late wife's. We
met in the summer of '89 and went out the following New Year's Eve. I did go
out with someone else between but it was not physical. She was a
spiritualist, a medium who told me things only my late wife and I would have
known. My sex drive was average but because of diabetes it is now reduced."
"If I am in a queue I am patient as a rule. I have always been a patient
person. I am not impatient".
Affectionate- "I am mediocre and don't require a lot."
Company - Prefers to be on his own. He has an office at home and is often in
there. He does sit with his wife and watch TV. "I am not am not an
extrovert. In a crowd of people I am usually quiet. I will chat to a person.
I am bashful and not enthusiastic about public speaking. I can do it but I
don't want to make a habit of it."
Nosebleeds - all the time. He has always had them. No modalities in that
they can happen anytime and are only mild.
Environment - Doesn't like the heat as it makes him irritable. Does like the
sun. Doesn't like the cold. Thunderstorms - loves to watch them.
Anger - from stupidity in others and he is sarcastic when angry.
Upset - falling out with people and would sulk on his own.
Tidy.
Fears - I like to be safe and secure and have fitted burglar alarms. I
always lock doors and the car door when I leave. "Anything mime and I've
worked for should remain mine. I fear being poor as I have always been self
sufficient."
Religion - not important
Dreams - strange. "They are to do with only being able to get access through
a confined space. They semi represent things in childhood. I have to get
over obstacles and through small apertures to get to where I am going."
I asked where he felt in society and he said "Fractionally above middle
class".
Food - loves fish but not shellfish, cheese, pasta, desires sweet**
Dislikes a lot of salt, thinks spicy may agg, broccoli
Drinks - tea, milk. Hates water.
Family Medical History
Father - d. 68 ruptured aorta Grandfather 80 cancer, Uncle - diabetes.
Grandmother - 78 stroke
www.rochellemarsden.co.uk