REASON FOR VISIT Follow up Philadelphia-positive acute lymphoblastic leukemia baseline accomplished report of Dr.

John Windgard _______ 3522650525. HISTORY OF PRESENT ILLNESS Mrs. OrtizXXX returns for reassessment of followed up of Philadelphia-positive acute lymphoblastic leukemia. She is now seen in most scheduledan unscheduled visit for a considerable rehab. Ondiarrhea. Over the past two several weeks, Mrs. OrtizXXX has developed a chronic diarrhea fluctuatedfluctuating between two to three episodes to up to eight to nine episodes in a day. She has taken Imodium with some response. I also givegave her prescription for _______Lomotil which in her opinion was ineffective. Mrs. OrtizXXX has lost about 7seven pounds in a period of one month. No fever, chills and nightor sweats. No nausea or vomiting. Mrs. OrtizXXX states that since she startsstarted taking birth control, she relatesbelieves her diarrhea has gotten worstgot worse. She has been on Gleevec for several years, and even though her stools have been soft and Diuril. Nausea andsoftened it never been diarrheal. She had stool studies: At at the ageUniversity of 4, theyFlorida that were negative. PAST MEDICAL HISTORY Unchanged. PAST SURGICAL HISTORY Unchanged. SOCIAL HISTORY Unchanged. FAMILY HISTORY Unchanged. MEDICATION HISTORY Unchanged. REVIEW OF SYSTEMS For full review of system, please refer to the written chart. PHYSICAL EXAMINATION VITAL SIGNS: Weight is 117 pounds, blood pressure is 110/74, pulse is 72, respiratory rate is 20, and temperature is 98.2. GENERAL: She is alert. She is oriented, in no distress. But Slightly thinner than before but is still wellnourished. HEENT: HEENT: Conjunctivae clear. Sclerae white, no icterus. Extraocular movements are intact. I do appreciate mouth ulcerations or evidence of mucositis NECK: Supple. No edema.JVD. No thyroid enlargement. LYMPHATICS: No palpable neck, axillary or inguinal adenopathy. LYMPHATICS:

LUNGS: Lungs are clear.Clear. CARDIOVASCULAR: Regular rate. No rubs or gallops. ABDOMEN: Soft, nontender. Liver and spleen are nonpalpable. No palpable masses. Bowel sounds are present. EXTREMITIES: No peripheral edema. No clubbing, . No cyanosis. No grossjoint deformity. NEUROLOGICAL: GrosslyCranial nerves are intact. Pain Motor strength and sensation is normal. IMPRESSION/PLAN Mrs. OrtizXXX has a recurrent diarrhea. She is strong ________ butstrongly believes that this might be associated with her birth control medications. I have currently stoppedencouraged her fromto stop taking these medications. Occasions at least for the next week, or two to see if her if symptoms improved. I willhave also givegiven her a prescription for Donnatal for symptom relief, if the. If symptoms diddo not improvedimprove within a week, I will sentsend her to Dr. Vic GolpoXXX for a possible colonoscopy. I will assurealso mentioned to Mrs. OrtizXXX that her diarrhea could be related to a graft- versus- host disease affecting the gutblood versus the effecteffects of Gleevec.