As we are all professionals, I didn't think it necessary to explain that
I had her informed consent to post this.
Kleea.
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Sent: 01 May 2002 13:05
To: [log in to unmask]; [log in to unmask]
Subject: Re: Advice sought
I have to point out that it is rather indiscreet to publish the
details of this persons background etc on the internet along with
medical info. Not sure that I would be happy to know that this much
info was circulating about myself.
Heather George OH&Safety Adviser Direct Line Group Services
----Original Message Follows----
Interesting case - but is it not up to her GP to decide which
specialist
to refer on to? Or what about a referral to an occupational medicine
consultant, because it looks as if there are some complex workplace
issues as well? Good luck - Kate
>>> Kleea Prout 29/04/02 16:32:54 >>>
Dear Colleagues
I have been following your discussions with interest and am looking
for
advice on the management of a patient.
Back ground :
I am an OH Adviser in a Food processing plant. There are 2 factories
under one roof - one of them packs raw poultry, the other processes
coated or breaded products.
My patient normally works with coated products, but occasionally did
some overtime in the poultry packing factory.
She is a retired registered nurse who spent most of her life working
in
Cardiac Intensive Care. She has quite a frenetic personality and was
not
happy with the restrictions I placed on her when she returned to
work.
She has now accepted that she would not have managed an immediate
return
to her normal duties, but very frustrated with the delay in her
recovery.
Details are listed below :
7 November 2001 -56 year old female (Vegetarian) with history of
duodenal ulcer admitted to hospital with rectal bleeding and coffee
grind vomitus - investigations revealed Campylobacter Jejuni
infection.
7 Weekly stool tests were done and GP treated her with Erythromycin
and Ciprobay. Stools were negative, but she had a relapse end of
December and had one positive stool sample. Cleared up after
another
course of Erythromycin and has not recurred.
7 January 2002 - developed arthritis of shoulders and hip joints (a
known complication of severe Campylobacter infection).
7 Returned to work 3rd March on a Recovery plan, doing 8 hours day
shift. Kept out of factory as food production areas are cold ( 9-12
deg. C) and she still had some joint pain. She also had limited
energy reserves, so was accommodated in administrative and
Amenities
areas (issuing PPE) where she could sit down most of the time and
work at her own pace.
7 Had Physiotherapy funded by the Company with good result and as she
was symptom free at end of March, I allowed her back in the factory
for 1 hour a day to introduce her slowly to the repetitive work
environment. She seemed to be coping well and we added 1 hour per
day to each week that followed.
7 Last week she did one day of 4 hours in the factory and apart from
feeling tired, felt that she coped well. She lives alone and has
nobody at home making demands on her time, so she is able to rest
well. The following day, she was 2 hours into her 4 hour stint,
when
she 'fainted.' She told me that she had not felt well the previous
evening due to a migraine and nausea, so did not eat before coming
to work. After a cup of coffee and toast she felt better, but I
kept
her out of the factory for the next few days.
7 She saw her GP again to discuss her lethargy and was told that she
now has an enlarged liver. He has taken blood for FBC and Liver
function.
I would like to refer her to a Consultant for an opinion, but can't
decide if the referral should be to a Rheumatologist or a
Gastro-enterologist or both?
I have also heard that there are Consultants who specialise in
Reactive
Rheumatology, but have not been able to find one. The Microbiologist
at
the Lab. who does our stool tests, told me that the arthritis can
recur
if she is exposed to Campylobacter in future.
Your opinions and advice will be appreciated.
Kleea Prout
OH Adviser
Sun Valley Foods, Hereford.
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