31 year old female presents at pain clinic for complaints of neck and low back pain, history of ORIF ankle after MVA. She has been on Oxycodone IR without Tylenol and MS Contin from another clinic for greater than a year without any lab evaluation. Admits to 15 year history of heavy alcohol use but none for 6 months. Rest of history is unremarkable. She does not complain of abdominal pain and no jaundice noted.
She takes 10 Goody Powders daily for headache, and joint pain, and has for years. Last saw a MD with the delivery of child 3 years ago.
CMP abnormal-AST 90 (12-45), Bilirubin- normal, alkaline phosphatase 620 (25-124), ALT 78 (7-51), Protein 7.1 (6.1-8.6) , albumin 2.9 (3.5-5.0), calcium 8.3 (8.8-11), Ion Balance 2 ( 7-16), creatinine <0.0 (0.5-1.31).
Advised her to stop the Goody Powders and referred her to establish a primary care provider to coordinate the work up.
I scheduled her a PCP appt and told her she would need further laboratory studies and will probably need to see GI also.
Curious as to how the MD's would work this patient up?