This record documents a 55-year-old female patient with a 18-year history of Type 2 Diabetes Mellitus (DM2) and 3-year history of Hypertension (HTN), currently admitted for an elective hysterectomy.
Clinical Summary:
Presentation: Admitted for management of a subserosal uterine fibroid (found incidentally via ultrasound during workup for chronic lumbosacral back pain) and glycemic stabilization.
Observations: The primary physician notes that the back pain is clinically correlated with lumbosacral degenerative changes rather than the fibroid, raising concerns regarding the surgical intervention's efficacy for symptom relief. There is documented consideration of potential placebo effects and cognitive dissonance as factors in the patient's post-operative outcome.
Metabolic Status: At admission, the patient presented with hyperglycemia (recorded GRBS at 239 mg/dL and a history of levels up to 515 mg/dL).
Management Plan:
Transition from long-term oral hypoglycemic agents (Glimi-MP2/Dapa-M) to an inpatient insulin-based/titrated regimen.
Strict metabolic monitoring (4-point GRBS checks).
Continued management of hypertension and comorbidities with existing and supplementary medications (e.g., Telma-H, Rosuvastatin, Pregabalin, and Librium for sleep/anxiety).
Post-operative planning remains active.
The logs reflect a professional clinical environment focused on aggressive glycemic control and a skeptical evaluation of the surgical rationale for the patient's primary complaint of back pain.
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