CHIEF COMPLAINT: Nonfunctioning Port-A-Cath.
HISTORY OF PRESENT ILLNESS: The patient is a very pleasant (XX)-year-old gentleman, who has history of colorectal cancer. He has been treated now with chemotherapy as he has metastatic disease. We placed a right subclavian port in him back in July of (XXXX) and he has been using that as well without any problems. Presently, he is on Xeloda, but he does use the port to check his blood levels and if he needs access for further chemotherapy. Unfortunately, he had trouble using the port last time he went to use it. He drew back blood pretty well, but when we tried to flush it, there was some difficulty with extravasation. He went for a Port-A-Cath study and there was found to be some extravasation along the neck of the catheter where it attaches to the port. He therefore was sent here for evaluation. He denies any fevers, chills or night sweats or any problems with the port from the pain standpoint.
PAST MEDICAL HISTORY: Significant for colon cancer, as noted above, that is metastatic. He also has hyperlipidemia, hypertension, and peptic ulcer disease. He is status post partial colectomy, appendectomy, and cholecystectomy. He has benign prostatic hypertrophy and was treated with transurethral resection of his prostate.
MEDICATIONS: Includes Xeloda. He is also on lisinopril and on lovastatin. He has some other medications that he is on that he does not have with him and cannot remember, but none of them, he says, are blood thinners, but he is going to call us and give us what those medications are.
ALLERGIES: He is allergic to ASPIRIN, QUINOLONES, MACROLIDE ANTIBIOTICS, BACTRIM, PENICILLIN, NONSTEROIDAL ANTI-INFLAMMATORIES, and NITROFURANTOIN.
SOCIAL HISTORY: Smoking history is remote from over 14 years ago and he does not drink.
FAMILY HISTORY: Negative for colon cancer.
REVIEW OF SYSTEMS: Not changed since I saw him last. He has no cardiovascular, respiratory, GI or GU complaints. No recent fevers, chills, no weight loss. No new skin lesions or skin rashes. No problems with his ears, nose, and throat.
PHYSICAL EXAMINATION:
GENERAL: This is an (XX)-year-old gentleman who looks his stated age, in no acute distress.
HEENT: Normocephalic, atraumatic. Ears, nose, and throat are clear.
NECK: Supple. Trachea is midline.
CHEST: Clear bilaterally. He does have a Port-A-Cath in place in the right chest area that appears fine without any usual findings. No redness, no tenderness.
HEART: Regular rate and rhythm with normal S1 and S2.
ABDOMEN: Soft and nontender with a well-healed scar.
EXTREMITIES: No pitting edema and no deformities.
NEUROLOGICAL: He is alert and oriented. Sensory and motor function screened and intact.
IMPRESSION: The patient has metastatic colon cancer with ports not functioning any more. Somehow, its connection to the catheter and port is torn or not holding up well and there is some extravasation. We think the only way to fix this would be to replace the port. We went over this with him and he has agreed to proceed as an outpatient.
PLAN: Remove this old port and place a new port.
