ASPLENIC / DIABETIC
IMMUNOCOMPROMISED due to Asplenia
WIFE
Colleen
650-814-5686
ckirk@calpoly.edu
BROTHER
Rick Myers
617-538-7350
MOTHER
Elizabeth Myers
413-637-7109
650-736-5370 24 hr
> Dr Kurt M Hafer
> Stanford Concierge Medicine
> 900 Blake Wilbur Dr, Second Floor
> Stanford, CA 94304
> tel 650-736-5370
> fax 650-736-5380
> email kmhafer@stanford.edu
This patient is asplenic and at risk for potentially fatal, overwhelming infections. Immediate medical attention is required for a fever of >= 101 F (38.3 C) or other signs of serious illness. Suggested management includes:
1. Physical Exam, CBC and Blood Culture
2. Administration of a long-acting, broad-spectrum parenteral antibiotic (e.g. ceftriaxone) accompanied by close clinical monitoring while awaiting blood culture results.
3. Hospitalization and broadening of antimicrobial coverage (e.g. addition of vancomycin) may be necessary under certain circumstances, such as the presence of marked leukocytosis, neutropenia, or significant change from baseline CBC; toxic clinical appearance; fever >= 104 F; meningitis, pneumonia, or other serious focus of infection; signs of septic shock; or previous history of serious infection.
See: http://www.survivorshipguidelines.org/pdf/healthlinks/English/splenic_precautions_Eng.pdf
To Whom It May Concern:
This is to verify that Christopher R Myers has been under my care at Stanford Concierge Medicine since 7/10/2017. Mr Myers asked me to write this letter on his behalf to document his complicated past medical history that includes:
History of Splenectomy in 1994 due to severe gastric ulcer GI bleeding episode requiring transfusion of 41 units of PRBCs. For this reason, he is susceptible to encapsulated bacterial infections and sepsis (due to S. pneumoniae, H. influenzae type b, and N. meningitidis, as well as Giardia, Cryptosporidia, and Campylobacter). He has a standing prescription for Augmentin twice daily that he should begin taking at first signs of significant fever or infection.
History of treatment from 1977 to 1980 for Non-Hodgkin's Large Cell Histiocytic malignant Lymphoma, Initially had XRT 4000 rad to main thyroid tumor, f/b 2.5yrs chemo: Adriamycin, Vincristine, intra-thecal MTX, asparaginase, cyclophosphamide, prednisone, as well as 3 weeks CNS XRT of 2400 rads (13 fractions, 17 days), One of 29 pts in Study published in Blood Vol 64: No 2 (August), 1984: pp422-426.
Family history of hemochromatosis, with genetic testing revealing he is compound heterozygous for HFE C282Y and H63D which places him at a relatively low risk of ever developing iron overload.
History of pericarditis (2002, 2006).
History of scarlet fever in 1973, with Left Bundle Branch Block and 1st degree AV Block on EKG. WPW on EKG resolved after 2002 pericarditis episode.
Diet-controlled type 2 Diabetes diagnosed in 2005.
Peripheral Neuropathy
Thyroid Nodules.
Please contact me directly if you have any questions.
Sincerely,
Kurt M. Hafer, MD
Medical Director
Stanford Concierge Medicine