Left foot first digit MTP joint pain

The patient presents today for his first follow-up visit since I initially consulted him on May 24, 2013 for his left foot first digit MTP joint pain. Since that last visit, he had been hospitalized for acute renal failure and ultimately decided to undergo dialysis. His daughter presents today and states that his kidney function was reduced to 9%. She does not recall any creatinine values. She does recall that his pulse oximetry reading in the emergency room is down to 83%.

Otherwise, he is continues to have severe pain in the left grade toe, specifically at night. This appears to be related to gout plus or minus osteoarthritis of the joint.

IMPRESSION:
1. Suspected multifactorial left foot first digit MTP joint pain; suspected gout pain plus or minus osteoarthropathy.
2. Multiple other issues including history of stroke and suspected multifocal bronchogenic carcinoma with recent exacerbation of renal failure.
3. Status post nephrectomy.

PLAN:
We will see how well he does with the procedure today. If he does not do well during the corticosteroid phase, I have renewed my recommendations for fluoroscopically guided procedure. He cannot have this done previously as he became sick on the day he was supposed to have the procedure with Dr.
We will see how he does with the procedure today. I will see him back for follow-up as needed.

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