Illusion / Broken Hearts Anonymous

This is the case of S.N.I. a non-diabetic, non-HPN, occasional drinker, 20 something, female, physical therapist.

Present condition started 2 years PTC when px. experienced lightheadedness, dyspnea, euphoria and palpitations, whenever the phone rings, the cell phone beeps or when a certain thought intrudes. Px. ignored her condition thinking it was a normal and temporary reaction to the situation at hand. But as the months progressed friends of the px. began noticing some emotional and behavioral changes; Like blank far away looks, smiling suddenly when nothing is funny, sudden bursts of excitement and uncharacteristic enthusiasm in going to work. Px. seems to be in a constant state of confusion but adamantly denies that something strange is happening.

One and a half years PTC px. was rushed to a nearby friendly clinic when she suddenly felt pain P/S(6/10) in the left chest area and shortness of breath. Px. was thought to have angina pectoris when px. exhibits the following symptoms; constricting/squeezing tightness of heart, with deep, aching and burning heaviness of chest area. A gradual increase then fading substernal pain on stressful stimuli sometimes accompanied with palpitations, sweating, and precipitating pallor. Upon further examination it was concluded that the px. has incurred the venereal disease called love. She was advised to rest, not to fight it and not to think too much. But patient remains in a state of denial.

One year PTC, px. again endured left substernal pain P/S(8/10) upon hearing and finding out some disturbingly hurtful news. It triggered severe attacks of dysphoria, and chest pains. Px. also began exhibiting neologisms, verbal paraphasia, and cachexia. Px. was given some stress management advice and support by similar suffering friends. However the pain and discomfort still persisted although with lesser intensity so px. took to watching comedies and going out.

A few months PTC px. experienced on and off pain, unnatural behavior and episodes of weirdness. Px. was advised by cousin to take alaxan for the pain and ginpomelo for the depression. But still it persisted, so finally she decided to go to BHA center for another consultation. Several unrecalled tests and laboratory exam were done, the results of which led to the diagnosis of temporary encephalopathy with dysphoria secondary to a bruised heart. After a week of confinement, wallowing and drinking sessions she was released with directions to come back for follow up treatment and check-up.

SUBJECTIVE COMPLAINT
     "Laging masakit at kumikirot ang dibdib ko. Madalas akong malungkot at napapaiyak lalo na pag may naaalala ako."

     Px. complains of pain (PS 8/10) on the medial aspect of the chest and episodes of depression.

Palpation:
Ø      Normothermic on all 4’s
Ø      Normotonic on all 4’s
Ø     (+) Tenderness on left med
      aspect of chest ( gr. 2)
Ø     (-)   Edema

ROM
All jts. of both UE/LE are WNL actively and passively done pain free.

MMT
All m’s of both UE/LE are grossly graded 3-4/5.

Sig: General muscle weakness secondary to lethargy.

Special test
(+) Bitternasia test
sig: (+) Bruised heart
(+) Crayola on saditusmovitus test
sig: (+) Dysphasia

Gait anaysis
No gait deviation noted

ADL
Px. is independent in all aspects of ADL

ASSESSMENT
Dx : Temporary encephalopathy with dysphoria secondary to a bruised heart

Problem List:
1. Pain (PS 8/10) on med. aspect of
left chest area
2. Tenderness on med. aspect of
chest
3. General body weakness
4. Swelling and redness of eyes
5. Depression

Glossary:
ADL - activities of daily living
Dx. - diagnosis
Fxn'l - functional
HMP - Hot Moist Pack
HPN - hypertension
jts. - joints
LE- lower extremities
LTG - long term goal
m's - muscles
MMT - manual muscle test
PTC - prior to consultation
P/S - pain scale
Px. - Patient
O.I - Ocular inspection
ROM - range of motion
STG - short term goal
Tx. - Treatment
UE - upper extremities
V.S. - vital signs
WNL - within normal limit

OBJECTIVE FINDINGS

V.S.

BP = 110/70 mmhg RR = 19 cpm
PR = 82 bpm T = afebrile to touch

O.I

Ø      Ambulatory s assistive device
Ø      Mesomorph
Ø      Alert, coherent, cooperative
Ø      (+) Swelling and redness of the eyes
     (+) Postural deviation
       (-) Deformity on all fours
   (-)   Gait deviation

Neurologic evaluation
     Sensory testing
          STD’s used: Pin for pain, brush for light touch, thumb for deep pressure
          Findings:   100% sensory intact as to pain, light touch and deep pressure

DTR : R L

0 = areflexia
+ = hyporeflexia
# = normoreflexia
+++ = hypereflexia
## = clonus

Findings: Normoreflexive

Postural analysis
      Frontal view
              Shoulders slightly forward and depressed
              Hips, knees and ankles aligned
        Lateral view
            (+) kyphosis secondary to drooping shoulders noted
       Posterior view
             Shoulders aligned but slightly depressed
             T2 - T6 spine concave curve
       Sig:   Melancholy posture

PLAN
STG:

1. To decrease pain and tenderness on the med. aspect of chest from a PS of 8/10 to 5/10 in 5 tx. sessions.
2. To increase muscle strength to a grade of 5 in 8 tx. sessions.
3. To decrease swelling and redness of eyes.
4. To alleviate depression

LTG:

1. To prevent secondary complications such as contractures and atrophy of the heart.
2. To improve gen. body conditioning
3. To attain highest fxn’l level of the px. which is to be able to love again without pain and emotional baggage.

Management:

1. HMP on chest area for 20 mins.
2. Tens on pectorals X 20 mins.
3. Comedy movies X 2 hrs. / 1 week
4. Lambanog (bubble gum or grapes flavor) 1 drinking session/month
5. Chorus of Monologues + outlet for anger and hurt
6. Circulate and meet new people
7. Date other guys.

Home Mngmt:
     1. Keep busy and think of other pleasant things.
     2. Gather all memorabilia's and put them away in a box (Don't throw for future
          reference).