Date Of Birth: 11-09-1946
Height: 5' 3"
Spouse: Duane Bristow
Eva Bristow is a 70 year old female who has had a lumpectomy followed by radiation and chemotherapy for breast cancer in 2004 and now is diagnosed with rheumatoid arthritis and mild cases of pulmonary hypertension and bronchiectasis as well as diastolic dysfunction. The cancer treatments have resulted in ongoing gastrointestinal problems and low grade anemia. She also is overweight and is sleepy during the day and complains of restless legs at night and has hypertension and a low level of type II diabetes probably caused by use of steriods for her rheumatoid arthritis. She also has bladder problems (interstitial cystitis) and her cholesterol levels are high without medication. She uses a nebulizer twice a day with Albuterol and Brovana and Budesonide to alleviate breathing problems due to the bronchiectasis as prescribed by her pulmonologist. She has noticed sinus problems and some back pain and coughing which she attributes to the nebulizer treatments.
After a childhood of recurrent pneumonia and lung problems she had a medically uneventful adulthood except for two children born by c-section. About the age of 45, in the early 1990s, she developed high blood pressure which took several months to bring under control due to the need to find a very specific medication regime which worked for her. Later in that decade she developed osteoarthritis expressed as pain in the knee joints which limited her ability to get exercise by walking and gardening which probably resulted in her subsequent weight gain.
She has a family history of asthma and breast cancer and in 2004 she was diagnosed with breast cancer in the left breast. This was treated with a lumpectomy followed by chemotherapy and radiation. After this she was afflicted with gastrointestinal problems and low grade anemia and restless legs.
She had total knee replacements in 2007 and 2011 and during this time was diagnosed with rheumatoid arthritis. After these surgeries she was still unable to exercise vigorously due to breathing difficulties.
In 2014 she was diagnosed with mild sleep apnea.
It is thought that the bronchiectasis is probably a result of her childhood bouts with lung problems and the diastolic dysfunction was probably caused by the period of time in which her hypertension was out of control. The lung problems and the cancer can probably be partially attributed to a genetic predisposition.
Beginning at the end of September 2016, she noticed pressure in her chest and abdomen and more than usual difficulty breathing and weight gain as well as increased heart rate.
After extensive medical tests over the following 7 or 8 months, the conclusion was that Eva did not have any specific diagnosis that was life threatening or even would be a significant threat to her quality of life, but that the combination of all her problems together was significantly decreasing the quality of her life primarily due to problems breathing caused by fluid retention and lack of ability to lose weight, lack of energy, sleepiness, and gastrointestinal, bladder and restless leg problems as well as attacks of rheumatoid arthritis.
In the summer of 2017, Eva began to have skin problems expressed as reddened, irritated splotches on her neck, below her right breast, on the right of her stomach at the leg bend, around her mouth, and also vaginal itching. This was found to be due to psoriasis and was treated with skin creams. The problems with the mouth were diagnosed as perioral dermatitis.
In addition to the above problems, Eva has also had a pinched nerve in her neck resulting in pain in her right arm and has low bone density.
The Cimzia treatment which is necessary to reduce Eva's rheumatoid arthritis attacks also compromises her immune system so that she has infections that require hospitalization and large doses of antibiotics once or twice per year. These antibiotic treatments tend to upset the probiotic balances in her digestive system so that a prolonged period of probiotic replacement, which is problematic due to general lack of knowledge about the interactions among various species of intestinal flora and fauna, is necessary to get her back to what, for her, passes for normal gastrointestinal processes.
Poor administration of the medications and diet that she requires for daily living by the staff in hospitals also usually results in fluid buildup and other problems which have to be overcome after each hospitalization episode. For example, they seem to think that a diabetic diet is a low fat diet without concern for carbohydrates and that the timing of medications is unimportant as long as they are given.
Dr. Smith reported, after doing a right heart catherization, that he recommends that she adhere to a low sodium, low fat diet; continue treatment for obstructive sleep apnea and maintain systemic blood pressure control. He said he did not find any evidence of pulmonary arterial hypertension.
Questions: The treatments for Rheumatoid arthritis create a compromised immune system resulting in frequent infections. Is this the best situation that can be achieved? Frequent infections often result in a regime of treatment with antibiotics which decimate gut bacteria and result in digestive problems which are pretty much ongoing. What is the best combination of prebiotics and probiotics or other treatments to combat this? Eva generally has a low grade anemia and after her last hospitalization had to be put on iron pills for 3 months. What is the best way to manage this problem? Eva is often very sleepy during the day. She sometimes has restless legs at night. Perhaps she has restless legs more than she realizes and thus seldom gets a good night's sleep. Starting about the end of September 2016 Eva noticed weight gain and she began to have more trouble breathing. She thought this was due to fluid retention. She also developed a cough. Later tests did not show any fluid retention but her weight went to 224 at the end of September and then to 248 by mid December. After Dr. Cherry took her off aldactone after Nov. 9 her feet and legs swelled quite a bit and even though Dr. Cherry put her on 80 mg. lasix per day the swelling of the feet and legs did not subside. In the summer of 2017, Eva began to have skin problems expressed as reddened, irritated splotches on her neck, below her right breast, on the right of her stomach at the leg bend, around her mouth probably due to use of the CPAP and also vaginal itching. Nov. 18, 2016 - Ultrasound - thyroid - solid left single nodule measuring 2.3 x 1.5 x 1.5 cm. Nov. 18, 2016 - Ultrasound - pelvis - endometrium abnormally thick for a patient of this age measuring 2.3 cm. Nov. 20, 2015 - MRI - Right Shoulder - Supraspinatus Tendinopathy and possible intrasubstance tear and degenerative changes of the glenoid labrum. Nov. 19, 2015 - MRI - Cervical spine - Degenerative Disc Disease, Particularly at the C5-6 level. Thyroid abnormality. hypertension - most medications raise heart rate unacceptably and/or exacerbate breathing problems. rheumatoid arthritis osteoarthritis diabetes caused by use of steroids for rheumatoid arthritis 2015 - Two pulmonary diagnoses: pulmonary hypertension and Bronchiectasis - minor in lower right quandrant March 31, 2017 - Dr. Shaun Smith, Cardiac Pulmonologist at the University of Louisville says that Eva has mild cases of pulmonary hypertension, bronchiectasis and sleep apnea as well as diastolic dysfunction meaning that because the heart walls are stiff and thickened due to age and HBP the heart does not expand and contract as it should. He says the treatment protocol for Eva's condition is limiting salt intake to 1500 mg per day or less and use of a CPAP machine when sleeping. It seems that this condition can cause difficulty breathing as well as edema. no other heart problems except ventricular hypertrophy due to high blood pressure. interstitial cystitis Restless legs?? Problem possible cause possible solution ------------------------- --------------------- -------------------------- Pain 2 kinds of arthritis pain medicine/monthly shot Sleepiness sleep apenea CPAP machine restless legs Pill for sleep switch according to Dr. Sandy Gastrointestinal problems missing gut microbiome FMT & probiotics cancer genetics in remission none HBP medication none Diabetes medication none cholesterol medication (too low cholesterol can cause low vit. D & memory loss) bladder pain interstitial cystitis medication Breathing problems Bronchiectasis nebulizer pulmonary hypertension weight loss diastolic dysfunction fluid retention diastolic dysfunction Aldactone Back pain probably nebulizer Anemia maybe low red blood count medication rt. arm tingling & pain pinched nerve in neck Neurontin & traction Low immune system medication (Cimzia) ?????? Low bone density medication ?? Coughing probably nebulizer medication