Aberfoyle Park Medical Centre

Cnr Manning & Summerford Roads Aberfoyle Park, SA, 5159

Phone 82705211 Fax 83707153

Management Plan - 15/08/2006

Mr T

Review Date:

15/2/2007

 

Active:

Date

Condition -- Comment

 

HYPERCHOLESTEROLAEMIA

Target established is 4.0

 

LEFT VISUAL LOSS 6/60

 

MULTIPLE BCC'S

1982

HYPERTENSION

2000

CORONARY STENT

2000

DIABETES

Dietary management - low fat, low sugar and high fibre diet. Regular exercise - walking 5Km alternate days.

2000

GOUT

2000

INFERIOR MYOCARDIAL INFARCTION

2003

MODERATE HYPERTRIGLYCERIDAEMIA

2005

?NECK INDUCED TINGLES RIGHT THUMB AND FOREFINGER

Inactive:

Date

Condition -- Comment

2003

SMALL LEFT VARICOCELE

2005

BCC RE-EXCISION-EAR & SSG(Right)

15/8/2006

30/12/2005

721

2517

Current Medications:

Drug Name

Strength

Dose/Freq./Special

ASTRIX 100 Tablet

100mg

1 daily

ATORVASTATIN Tablet

40mg

1 daily

FLUVAX Syringe

TRIVALENT

For Doctor's use only

FLUVAX Syringe

TRIVALENT

For Doctor's use only

METFORMIN HYDROCHLORIDE Sr Tablet

500mg

1 t.i.d.

NITROLINGUAL PUMPSPRAY Spray

400mcg/dose

1-2 as required. Don't inhale it

PERINDOPRIL ERBUMINE Tablet

2mg

1 daily

VIAGRA Tablet

50mg

Use one tablet at a time. Allow one hour for effect.

 

Immunisations:

29/05/2001

INFLUENZA

 

30/05/2002

INFLUENZA

 

4/06/2002

PNEUMOVAX

 

7/11/2002

ADT

 

15/04/2003

INFLUENZA

 

1/04/2004

FLUVAX

 

30/03/2005

INFLUENZA

 

28/03/2006

FLUVAX

 

Allergies:

No known allergies.

Warnings:

Difficulty with anaesthetic induction HT,NIDDM,MI stent

Comments:

DIABETES

GOAL ONE

Maintain glycosylated haemoglobin less than 7%

Glycosylated haemoglobin is a measure of how sugar is affecting the cells of the body.

A level of less than 7% is very good, a level between 7% & 8% is adequate, and over 8% is associated with poor control of blood sugar levels as well as an unacceptably high occurrence of nerve and blood vessel damage.

MANAGEMENT STEP

Three to six monthly blood test for HbA1c - glycosylated haemoglobin

PERSON RESPONSIBLE

T and Dr. Terry Rose

GOAL TWO

Monitor Kidney function. This is achieved by assessing the amount of a protein in the urine called microalbumin, and by measuring the blood creatinine level

MANAGEMENT STEP

Annual urine test for urinary microglobulins and creatinine

PERSON RESPONSIBLE

T and Dr. Terry Rose

GOAL THREE

Maintain cholesterol below 4.0

This minimizes the effects of diabetes on the blood vessels

MANAGEMENT STEP

Six monthly cholesterol reading

PERSON RESPONSIBLE

T and Dr. Terry Rose

GOAL FOUR

Maintain blood pressure as close as possible to 120/80 if it is naturally higher.

This minimizes damage to small blood vessels throughout the body

MANAGEMENT STEP

Monitor blood pressure three monthly

PERSON RESPONSIBLE

T and Dr. Terry Rose

 

 

Smoking status: not known

Test name

Why is this measure important?

Your latest reading is

Your target level is

       

HbA1C

This measure reflects average blood sugar readings, but is not an actual blood sugar reading

8.2 %

Less than 7%

Cholesterol

The fat in the blood that is most responsible for the build up of chunks of fat on the inside of arteries

5.6

under 4

       

Blood Pressure

The lower the better

120/60

130/80 or less

Current weight

Again, keeping your body weight as close to ideal as possible will help minimise complications of diabetes

90 Kg

If your Body mass index is over 25, aim for a 5% weight loss over the next 6 months

Body mass index

This is the measure that lets us work out your ideal weight based on your height

31.9

25

Creatinine clearance

This measure helps us know how your kidney is going

 

Over 60

Urine

Micro-

albumin

We measure this protein in the urine to see if the holes in the filter system of the kidneys are being damaged. Weight loss helps

24

Less than 15

Last Eye specialist consult

The blood vessels in the eye are very sensitive to high sugar levels and can start to leak and clog up. A lot of these changes can be helped if diagnosed early

Your last specialist appointment

 

15/2/ 2006

A visit to the eye specialist within the past two years

 

 

DIET AND EXERCISE

There is considerable scope for lifestyle modification including:

We recommend at least 3 hours a week brisk walking

We recommend a low fat, high fibre diet with at least 2 litres of water per day

 

PREVENTIVE HEALTH

We recommend a yearly fluvax and a pneumonia vaccination every 5 years.

"Insure" screen for bowel cancer every year. This test is very specific for human blood, as well as being quite sensitive. A negative test is good news, but does not totally exclude a bowel tumour. A positive test indicates bleeding from somewhere and this can include bleeding form a tooth, the stomach and also from a polyp in the bowel. So a positive test is an indicator for follow up, and is not diagnostic of a tumour.

 

Progress notes shortcuts - copy and paste them into the "Comments" section in the Progress notes

 

"cdm" = chronic disease management

Benefits and procedures of a management plan considered, explained and agreed.

Goals, needs and actions discussed.

Other providers mutually chosen and contacted, and permission to share relevant information obtained.

Items –

721 Plan 725 Review

723 Coordination 727 Review

Treatment/services to be provided by collaborating providers

 

"diab" = diabetes 12 month assessment

Diabetes 12 month assessment

Patient educated about diet, exercise and risk factors

Medication reviewed

BP and BMI measured and feet examined within past 6 months and performed twice in this cycle of care

Feet - normal colour, temp, sensation and pulses

HbA1c, lipids and microalbumin checked within past year

Ophthalmologist seen within past 2 years

Items level B 2517, level C 2521, level D 2525