Thank you for referring Glenys Park, a 74-year-old retired home carer who is a non-smoker and does not consume alcohol.
As you are aware, back in September, Glenys underwent a gastroscopy and colonoscopy for investigation of abdominal pain. A gastric polyp was identified. Thereafter, Glenys developed haematemesis and melena. She was admitted to Maroondah Hospital from the 11th to 13th October and was noted to anaemic with a haemoglobin of 76. She was transfused one unit of pack cells with an Hb increasing to 83. She was also given a proton pump inhibitor infusion and thereafter Nexium 40mg daily. She underwent a repeat gastroscopy and had a gastric polyp excised from a hiatus hernia. No active bleeding was identified. Glenys then re-presented to Maroondah ED on the 17th November due ton ongoing dyspnoea and lethargy. She was again noted to be anaemic and had a transfusion
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She was first diagnosed with this around 20 years ago, reporting fairly typical symptoms in the evening and also during the night. She has generally managed her symptoms with Sifrol 250mcg nocte day.
At the onset of her bleeding issues, she began to notice symptoms early in the day, such as playing bingo at around 11.00am. She got the point of taking Sifrol one tablet three times a day at 3.00pm, 7.00pm and 2.00am. Since having the second blood transfusion and iron infusion, her symptoms have settled such that she is now back to taking one to two Sifrol tablets at night only.
I note she also underwent an echocardiogram, and this revealed normal LV size and systolic function with some diastolic dysfunction and elevated pulmonary artery pressures with a PAP of 35mmHg, assuming RA pressure of 3mmHg. There was mild aortic regurgitation.
On review today, Glenys is much improved and believes that there is no ongoing dyspnooea. As mentioned, her restless legs symptoms are similar to