Notes

Good afternoon Dr Brauchla,
Pam sees you for a much needed follow-up. Daily Pam is having progressively worse panic and anxiety attacks. Maybe or not since Dr MacPhail tried increasing her Coreg. She tells me she cries daily. She wants to go to the ER constantly. She is distressed to the point of daily exhaustion and can't breathe. But when we show up, she calms down. She feels she is too ill to get out and do things, won't go on vacation, visit family or leave town. I have shown her how to breathe in for 6 counts and exhale 6 counts to get more oxygen. But claims I accuse her of making things up. She fears eating other's food will make her sick even though she rarely cooks because she has never been much of one to cook. Nothing tastes well; opting for ice cream, jello, candy, soda, denying foods or variety that will give her energy during the day. She feels people aren't listening, and allowing her to die. There is great distress such that her quality of life is poor. Her attacks have worsened maybe without correlation since the increase in Coreg almost 3 months ago. But maybe she should get off it for a while to see. She seems afraid to be alone because of her health and denies recommendations to help her. About 4 years ago she was placed on Cavedilol. Not a year later these symptoms kicked in typical of this drug. Not sure if it is coincidence or cause: Per web MD: "Side effects that can occur with carvedilol oral tablet include: dizziness. backache. trouble breathing. depression. loss of appetite. heart irregularities. chest pain.unusual tiredness. bladder control. tingling. blood pressure. diarrhea. blood sugar problems. lack of energy or weakness." I didn't look this up until after seeing her cardiologist. I am racking my brain trying to find away to find her relief. She is unlikely open to the idea that fear and panic attacks make things worse. When you see her tomorrow, please keep this as much between us as we can. She will want to talk to you herself. I wouldn't like knowing things are said without my presence. I just want you to hear what she may not be able to articulate tomorrow. She may deny all medication if we have a hunch Carvedilol is the cause before proof. Maybe you can talk to Dr. MacPhail if you need to about side effects of Coreg. 574-533-7476

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BMH: 2014 Passing out. So BMH ran EKG, Scans of the brain, etc. Results unknown.
Somewhere in there she began Losartin & Coreg. During this year her symptoms began.
KCH: 2018 Tremendous stress while living in Muncie; so she sold her condo to build near us in
North Webster; temporarily moved in with us into separate in-law apt for 1
1 year while her new home was built. She was terribly distressed, Multiple ER visits
showing nothing.
Dr BRAUCHLA: 2018 New patient & follow-up: CBC, flu-shot, Bone density, menopause take Gabapentin.
Dr MACPHAIL: 12/10/18 Stop Losartin, increase Carvidelol, take baby aspirin, U/S shows good heart, valve &
arteries. Stress test shows some heart irregularities. Blood pressure her normal high.
2/18/19 Heart & Vascular center of Goshen FOLLOW-UP appt.
-Did not order brain MRI because he set her up to see a Neurologist ASAP.
-Told her she is able to take the medicine for Osteopenia.
2/25/19 Ordered 1wk Ziopatch Goshen hospital again(3rd time) to see if script changes helped.
- Since he could not successfully get useful information from Pam.
3/14/19 Scheduled Neurologist Dr Neer from the Goshen Neuro Center instead to get her in ASAP.
-Parkview scheduled her many months out.
Dr Brauchla: 3/5/19 Follow-up appt. Symptoms anxiety/panic attacks daily, bothersome heart, dizziness,
nausea, loss of appetite.
Dr Trump: 3/5/19 Warsaw, IN Midwest Eye Consultant for cloudy vision and poor night vision
Dr MacPhail: 5/24/19 Follow-up, review latest Ziopatch results & determine changes in medication.