ASSESSMENT:
History of shortness of breath, wheezing with exertion and/or sleep, rule
out post inflammatory hypersensitivity and reactive airway disease secondary to
chlorine gas exposure status post chlorine exposure on 07/06/98
and cigarette smoking .
History of post traumatic stress, i.e., fear of recurrent chlorine gas
exposure, status post chlorine exposure on 07/06/98.
History multiple rib fractures, early 1970's, 1980's.
History multiple fractures of the toes.
History multiple fractures of the nose.
History fracture right and left clavicle, early 1980's.
History of laceration left wrist, 1965, with post surgical scarification.
Smoker.
In
my opinion, by review of medical history and physical examination, this
examinee's history of shortness of breath and wheezing with exertion and/or
sleep is, within reasonable medical certainty, consistent with the long term
effects of chlorine gas exposure.
The
examinee has been advised of the nature of his injury and of the likelihood that
chlorine gas exposure, in addition to cigarette smoking, has contributed to an
increased sensitivity of the distal airways manifesting in symptoms of shortness
of breath and periodic wheezing when sleeping and/or exercising.
To
further elucidate the examinee's underlying condition, the additional pertinent
medical records from Medical Center and the Workers' Compensation
physicians would need to be reviewed, and the examinee should have a chest
x-ray, pulmonary function test, treadmill stress test, functional capacity
evaluation and evaluations by a pulmonologist and psychologist.
Additional specialized evaluation of the airways may be recommended after
pulmonary consultation.
The
examinee is advised to avoid smoking, perfumes, colognes, hydrocarbons, paints,
and any and all other respiratory allergens or irritants, and he should consider
using an air filter at his home and office in conjunction with various inhalers
including corticosteroids (Azmacort) and/or bronchodilators (Serevent).
Should
the examinee experience more severe or disruptive symptoms, he should seek
medical reevaluation and maintain a relationship with a family physician or
pulmonary specialist.
After
review of additional pertinent medical records, diagnostic studies, treatment
course and upon attaining maximum medical improvement, the examinee's condition
may be reviewed with regard to any permanent effect as a consequence of the
chlorine gas exposure on 07/06/98 and
an impairment rating assessed.
Medical
care was not provided by Dr. M.D. for
this examinee who was seen one time for the sole purpose of this medical
evaluation.
THE
HEALTH PLACE
A Private Medical Practice of David P. Kalin, M.D., M.P.H.
P.O. Box 6009
Palm Harbor, Fl 34684
Tel 813.966.1431 Fax
813.925.1932
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