BONE

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BONE JOINT

• PLUS MUSCLES, BLOOD VESSELS, TENDONS, LIGAMENTS

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Where to start? History

• The Chief Complaint .
• HPI aka SUBJECTIVE When did the problem start,
  what makes it better, what makes it worse, what
  have you done for it that was helpful or not
  helpful or even or maybe worse?
• PAST HISTORY MEDICAL SURGICAL FAMILY AND SOCIAL

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More History

• Review of Systems.constitutional, neck,
  respiratory, CV, musculo-skeletal, GI, GU, ENT,
  eyes, skin
• Medication
• Injuries

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Some Histories

• Young woman with bilateral hip pain
• Teenager with intense toe pain, right foot, mild
  fever
• Teenager treated for neurological disorder with
  steroids, alcoholism now with left hip pain,
  thought to be faking, injected for trochanteric
  bursitis
• Young woman with intense right knee pain joint
  exam normal
• Another young woman (an R.N.) with back pain

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More Histories

• 50s male with three weeks of neck pain
• Young woman with right hand swelling following
  home improvement project
• Young male with sausage swelling of third
  finger left hand.
• Middle age male with RA. Failed all Rx including
  biologics
• 30 year old with backache, father alcoholic

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So, what is the common denominator?

• Humans in trouble, minding their own business
• None were related to injury
• None expected or deserved
• Treatments were different, but generally medical.
  Good place to mention surgery, physical or
  occupational therapy. Alternative or natural
  therapy.

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Other Considerations

• PHYSICAL EXAMINATION the little finger story
• LAB
• IMAGING includes x-ray, nuclear, MRI, CAT,
  ultrasound the hip consult
• TREATMENT.next slide

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TREATMENT
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Whaaaaaaaaaaaaaaaa

• Please dont hurt me!
• I dont want ANY _at_/? or of that or that or that
  or that, just give me something
• I read that it curls your fingernails and you
  have body odor and..and..and..
• My computer says
• A friend told me not take that
• Is it a big pill? What do you mean pills?

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Most Important Parts of Medical Treatment

• Determine what to treat
• Of course best guess about how long to treat.
  i.e. Gout vs. Rheumatoid
• What route to treat Oral, Sub Q, IM, IV
• ANDmy very favorite word or phrase other than
  automatic and please fax it for me is..

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PREAUTHORIZATION
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Better known as the.

• The story of the yugo plan with the cadillac
  dream. Or its the dealers fault!

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Rx

• Non steroidals
• Steroids
• Aspirin Based
• Plaquenil
• Methotrexate and others
• TNF
• Biologicals

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BONE ISSUES

• We talk about osteoporosis when the language
  needs to be Bone Health
• Who is checked?
• Age, Sex, Race, Meds, Diseases, other

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DXA

• Scores
• T score 0.0 to -1.0 to -2.5
• Z score age matched

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Treatment

• Calcium
• Vitamin D
• Multivitamin
• Bisphosphonates note about ads
• PTH

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