Triple Bypass  Aug 1990

Six stints 1994

Heart attack 1996

Pacemaker 2004

Pacemaker replaced in 2014

Gallbladder Removed

Hip replacement Aug 2015

Heart Failure & Heart Pump November 16, 2015

Heart transplant November 6,2016

Cataract Surgery  2020 

Basel Carcinoma Removed Surgery 2021

Immunosuppressed status (HCC)
Disseminated histoplasmosis
Long term (current) use of systemic steroids
Stage 4 chronic kidney disease (HCC)
Type 2 diabetes mellitus with stage 4
chronic kidney disease, with long-term
current use of insulin (HCC)

1. Is type 2 diabetes.  Diagnosis pre transplant.  Pre transplant A1c was 5.7% post transplant A1cs have run anywhere between 5.6 and 12%.  He has been followed by diabetic specialty clinic within the last year.  His current medical regimen is Trulicity 1.5 mg weekly, and empagloflozin 10 mg daily, Lantus 18 units at bedtime.  He has extremely rare hypoglycemic reactions.  He checks his sugar once a day and blood sugar readings are between 100 and 140.  His A1 c is 6.6%.  Most recent fasting sugar is 140.

Problem 2. Stage 4 chronic kidney disease followed by Nephrology felt to be secondary to tubular interstitial disease.

Problem 3. History of heart transplant for ischemic cardiomyopathy and congestive heart failure heart transplant was complicated by donor related histoplasmosis which became disseminated.  He is now on suppressive fluconazole on a daily basis.  Heart transplant has gone well he has no congestive heart failure no valvular heart disease no evidence of heart rejection.  Denies any chest pain, shortness of breath, palpitations, dizziness, edema.

Problem 4. Essential hypertension currently on a calcium channel blocker not a good candidate for diuretic or Ace or Arb due to stage 4 chronic kidney disease.  Blood pressures from home range from 130/85 to 140/100.