Clinical gerontology March 31

I note that he was reviewed by Professor M from a cardiac perspective with a view to having knee replacement surgery. He underwent angiography which showed stable disease and that his graphs were still patent. Unfortunately he was told by by the vascular team that they awere a bit reluctant for him to have a total knee replacement because he has such poor blood supply in his affected leg.

From an osteoarthritic point of view his knee is getting progressively worse. He says that he gets pain from certain angles but no locking. He clarifies this further and   said he is fine when he is on the static exercise bike but when he is walking it can sometimes be a little difficult. He has used paracetamol on as as required basis in order to manage his knee pain and has also used paracetamol gel to good effect. He is happy with his pain control regime.

He has reported that he is a bit concerned about his blood pressure. I understand that you increased his ramipril to 2.5 mg about two months ago. He regularly records his blood pressure and has been achieving systolic readings of between  10-170 mmHg. I understand that he has sent you a spreadsheet about his home readings.

He tells me that things are stable from a haematological perspective and that he has become a little anaemic but at present the plan is to watch and wait.

I examined him today blood pressure 146/59, pulse 66 bpm, saturations 96 on room air, weight 65 kg and temperature 36.4. Examination of the cardiovascular and respiratory systems was normal.