FOLLOW UP:



FOLLOW UP:

|29/08/2010 |Purpose of Review: |Tracy, in fact this is all a positive report. I was telling people at dinner tonight |

| | |about your e-health. This confirms the benefits. I have reduced contact from the 9th |

| | |for 4 months so if my responses are slow do not worry. I can do your record from |

| | |Italy. Terry NO DAPSONE increase. |

| | |From: tracey [mailto: tickle@] |

| | |Sent: Saturday, 28 August 2010 7:28 PM |

| | |To: Hannan, Terry J |

| | |Subject: Re: Updated record. |

| | |Hi Dr Terry |

| | |Long time no txt. |

| | |No Mum. No boyfriend. Definitely no alcohol. Moving house temporarily. |

| | |Swelling of face  in morning gone by night. Minor. Something different, one nostril |

| | |nearly swollen shut? Weird. |

| | |Starting to get itchy and rashes are starting to appear. |

| | |Terribly tired . Not sleeping well. |

| | |Would it be the thing to do if you gave me permission to increase dapsone dose. |

| | |Also started taking lexapro tabs for anxiety and depression. Anxiety attacks. |

| | |10 mg. |

| | |I exercise, tai chi, walk most places, am learning to play ukelele ( fun) doing |

| | |pliability exercises and radio two three times a week. Church on sunday bible study |

| | |one evening a week. At least six hours two times a week programming for radio. |

| | |Will check for your reply tomorrow. |

| | |Thanx ,Tracey. |

| | |Keeping busy, Dont want to get on the downward spiral. |

| | |Just concerned about health. |

| | |On Thu, May 27, 2010 at 10:22 PM, tracey < tickle@> wrote: |

| |Assessment: History | |

| |Assessment: | |

| |Examination | |

| |Investigations: | |

| |Management: |2214 hrs-I think your ‘disease’ is stable but the ‘stresses’ that causes it are not. |

| | |In fact it is amazing how well you are handling them. If you recall you ended up in |

| | |the DEM at LGH when we could not control the recurrences. Look upon yourself as an |

| | |excellent survivor (with a little help from your friends.) |

| | |From: tracey [mailto: tickle@] |

| | |Sent: Sunday, 29 August 2010 8:10 PM |

| | |To: Hannan, Terry J |

| | |Subject: Re: Updated record. |

| | |Hi Dr Terry |

| | |thanx for your reply . Have a great time in Italy. Could be a good idea to tell me why|

| | |no increase in dapsone. Then I wont do it. Thanx again Tracey |

|26/05/2010 | |2343 hrs-DrTerry |

| | |Fuck shit what the heck. |

| | |Have stomach pain constantly. |

| | |Being tested for chlamydia gonorrhea?. |

| | |mostly on left side from 6-12+ not much after. |

| | |bloods+urine. |

| | |Mostly think out of med prof that it is bowel what ever+I shoul\d be gluten free. |

| | |acording to angio+aspergers. |

| | |Lets see. X T |

|25/05/2010 | |25/05/2010 |

| | |Hi Tracy, Yes the Depo sounds good. Your symptoms based on what we know, are very |

| | |likely related to maternal issues-all normal. |

| | |From: tracey [mailto: tickle@] Sent: Tuesday, 25 May 2010 11:32 PM |

| | |To: Hannan, Terry JSubject: Re: Updated record. |

| | |Hi Dr Terry. |

| | |This is the whole poo farm. |

| | |My eyes Have a bit of swelling around them and my throat feels like it is being |

| | |squeezed a little bit. just enough to be slightly uncomfortable. |

| | | I am seeing dr E tomorrow and I think the depo provera shot would be a good idea. No |

| | |estrogen. What do you think.  |

| | |I know all the the things that could go wrong by not having the balance , but , |

| | |the things I have been looking at on the web about aspergers females is so me. Could |

| | |someone be so chromosomally challenged? |

| | |I get so sick when I have break through bleeding with the depo. I wonder is it saving |

| | |me from worse?  |

| | |When do you go on holidays next?   T |

|19/05/2010 |Purpose of Review: |From: tracey [mailto: tickle@] |

| | |Sent: Wednesday, 19 May 2010 9:49 PM |

| | |To: Hannan, Terry J |

| | |Subject: Re: Updated record.Always with food  So I say Hi my name is Tracey and I'm an|

| | |alchoholic . What problem do people have with that? My Mum goes into paliative care |

| | |tomorrow. Suck eggs. As long as it is what she needs cos she is so sick . I cant take |

| | |the drugs that u can take.I dont want to die, dont people understand?Is your Mum |

| | |alive?T |

| | |On Wed, May 19, 2010 at 10:01 PM, Hannan, Terry J |

| | |wrote:OK. Hold onto your pants. The next short time period will be tough. As the |

| | |French say “merde”. However, you CAN do it. Palliation permits you to come to her AS A|

| | |DAUGHTER/LOVER and let the clinical people do the physical caring. |

|26/04/2010 |Purpose of Review: |2114 hrs- Hey Dr Terry |

| | | So tired. I seem to pay all day for 20 mins in the garden lately. Looking back on what|

| | |I have eaten I seem to have ingested some estrogen based foods. They truly do affect my|

| | |condition or else I crave them sub consciously because of an imbalance in my body |

| | |chemicals. Just something a Chinese herbalist put me on to. |

| | |  Do you like Tom Waits? I find his music to be very male. I admire his talent.Men seem|

| | |to be attracted to his style more so than women. I am not a loony , just burning a cd |

| | |for my boyfriend. Just like giving him a bunch of flowers! He likes Tom. |

| | |  Radio music wise Foxwell Brown is Star fm's latest prediction for a hit. We get music|

| | |months in advance of popular commercial radio. You can find him on YouTube. Cute. |

| | |Funny. Aussie. |

| | | Tired of feeling tired at the moment. |

| | |  Reading Augustin Burroughs Running with scissors. Read Dry and Wolf at the table. |

| | |Very easy reads. Take just over a day. |

| | | Am reading Janet Frame. NZ writer. She wasn't run of the mill either.  |

| | |  The thing I like about getting older is discovering that there are so many books out |

| | |there. So many interesting theories, thoughts ,people , lives lived and still living, |

| | |music still to be heard and never will there be enough time to discover it all. Forget |

| | |space ( outer ) the earth's resources don't need to be used in this wasteful fashion. |

| | |Earth friendly cars and travel Vehicles would be the coolest. |

| | |  Sometimes I feel we are one of  God's most interesting experiments Look at you and me|

| | |. You have an amazing talent. Your diagnostic skills are incredibly accurate. You saved|

| | |two lives in a matter of minutes. Mine and the lady in the bed across from me. It was |

| | |awful to watch how she was getting sicker and sicker. And me in St Helens a cute but |

| | |swollen question mark. I flew to you on silver wings , delivered by angels, you took |

| | |one look at me and I was saved ! I hav'nt thanked you for a while so , here I |

| | |go...Thank you Doctor Terry. Thank you for saving my life. |

| | | You must also know for the record that Ro . The nurse at St Helens hospital suggested |

| | |to the Dr that I should go to Launceston to see you so that I might get an accurate |

| | |diagnosis. She knew. Lots! |

| | |All this from your eternally grateful patient , Tracey . |

|06/04/2010 |Purpose of Review: |From: tracey [mailto: tickle@] |

| | |Sent: Monday, 5 April 2010 9:28 AM |

| | |To: Hannan, Terry J |

| | |Subject: Re: Updated record. |

| | | |

| | |Hi Dr Terry. |

| | |I'm concerned that I might be feeling a bit depressed. Not handling having to dicipline|

| | |a 13 yr old . Not up to the stand offs. Been doing it all the last few weeks and am |

| | |feeling a bit overwhelmed. Actually the confrontations remind me of bullying, with me |

| | |being the one suffering the bullying. That depresses me as it reminds me of the girls |

| | |father. It bugs me so much that I zone out and forget my tablets. |

| | | Just got to warn you I'm not into Platitudes at the moment. Can't see the goodness in |

| | |them .( I think they are full of shit.).         Think that says it all .!!! |

| | | I'm aware that this could be menopause related. Certainly do feel like the crazy lady.|

| | |    Your question, do I feel suicidal? Yes I do and I feel like crying alot too. |

| | |   Might get you thinking that I have been here before. |

| | |Enough to recognise the signs and symptoms very early. |

| | |  If I see the Dr, he will most likely want to put me on tablets. I need your advice on|

| | |this in particular as I have tried these things before and they make me feel very much |

| | |worse , so much so that I have avoided them up till now. Used to take atarax before |

| | |they took that one off the list. They only have the evil mind bending ones now. Nothing|

| | |is very easy for me at the moment, but I don't want to get talked into taking their God|

| | |awful pills. |

| | |  Will wait for your reply. |

| | |  Tracey |

|22/03/10 |Purpose of Review: |1943 hrs-20/03/2010-Hi Dr Terry |

| | |some minor swellings. As could be fore told in the prophecy. Stress city. Seeing dr E |

| | |next wed if I remember.Blood tests on monday. sent |

| | |to you. I like my new look. Having a good time on radio. Moving |

| | |house in 2 weeks.Am aware that I rate high in the life stress charts. |

| | |Gee I hope we have an easter where we dont meet. As much as i like seeing your smiling |

| | |face. Hey I havent thanked you for saving my life for a while. Thankyou very much Dr |

| | |Terry I relive that time often .You wouldnt think I had much to be happy about at the |

| | |moment but it is life and i`m living it and there are lots of kind people that make |

| | |every day I WAKE UP WORTHWHILE. thanks again Tracey |

| |Management: |Tracy, a very appropriate insight and no platitudes from here. |

| | |I agree with the word ‘depressed’. The words you use suggest “reactive” (to |

| | |environment) rather than “endogenous” (internal/chemical imbalance). |

| | |Your past notes also indicate the possible role of your mother’s illness in all this. |

| | |The “letting go /aloneness” that comes with this. |

| | |The tablet regimen will be one of the first to go in situations like this (normal). It |

| | |is important to remember that we are ‘of the understanding’ that “stress” can induce |

| | |your angioedema attacks so keep that in mind. |

| | |This is not a platitude but your ability to reach out like this is a sign of your inner|

| | |health and yes life is ‘shit’ at the moment. |

| | |Do not be afraint o discuss with your local doc but state you are concerned about |

| | |medications and your angioedema. |

| | |Terry |

|11/02/10 |Purpose of Review: |1142 hrs- Hi Dr Terry. You are the best! You will never guess what just happened! Met a|

| | |lady in the OP shop who has a family history of angioedema. She is in her 60`s and two |

| | |of her brothers have it and it seems to be skipping a couple of generations. |

| | |has`nt come out in a definite medical way in later generations. Don`t know what type |

| | |they are . So glad to bump into this lady it has made my year. She said that her mother|

| | |had it and she was a survivor of the nazi concentration camps. It is just hitting me |

| | |now what an amazing thing has occured.Thankyou for making the career choices you did. |

| | |Thanks for being there. Tracey |

| |Assessment: History |25-Feb-10-1321 hrs-Tell me about it Dr Terry!!!!! |

| | | O.K. Neesha was in hospital last weekend, so not over boyfriend bust up then I get a |

| | |call last night that Mum is in hospital. She lives in Geelong. Some sort of bowel |

| | |infection. Her Dr wouldn't listen to her when she said something was wrong. A new Dr |

| | |she is seeing.. Poor old bugger. |

| | |   Sooooooo I think I have reached my limit. Eldest daughter and two grandsons coming |

| | |to visit for a week too. Megan is a very kind and thoughtful girl so not too much to |

| | |worry about there. |

| | |  Okay I'm starting to go under with all this unasked for pressure. The asked for stuff|

| | |is manageable. and I have to move out of the house I'm in ,in about 8  weeks. Too much |

| | |rubbish rattling around in my head. Would like to hide under a rock till it is all |

| | |over. Mostly remembering to take tablets. No catch up doses! These pills are doing a |

| | |good job to keep up. |

| | |  Stressed x 10. Tracey. |

|01/02/2010 |Purpose of Review:|so.kay  ! the word for it should be changed from unplanned to un expected.The last one in |

| | |my late 40s died so i didnt have to make that choice. i have been so good with my anti |

| | |baby injections it still sits in my mind that dapsone could interfere with my best plans. |

| | |decided to see what happens and not freak out. dr Inness had something to do with the |

| | |lepers in central australia. He is the Dr i am seeing at the moment cos i`m not impressed |

| | |with the other Drs being scared for whatever reason to approach you. Dr I seems to be a |

| | |colleague you have something in common with. When I consult with him he seems to me, a |

| | |complete layman, to see the links with hormones and others concerning my skin condition as|

| | |well. He said to take it easy for acouple of days to see if the swelling settles. My |

| | |throat under my chin has started to swell so he said cut out too much physical stuff and |

| | |take it easy. I start to see that something might happen and I clean up my act and do more|

| | |than i need to . I just dont want things to be in a mess if things do go wrong. |

| | |Anxiety?Fear Stress. I simply just want to live. Dont have any plans .Only want to wake up|

| | |in the morning. |

| | |      Thanx Tracey.   P.S   He also said tongue in cheek that I am allergic to men. |

| | |Believe me that got a reaction. |

| |Assessment: |1758 hrs 03/02/2010- Hi Dr TerryDr Iness Is at the gp north clinic here in st helens. Will|

| |History |email details to you tomorrow. Dr I would like to work in on this one with you. Will think|

| | |about going off depo as soon as it runs out . What to use instead? No condoms . too |

| | |frustrating for the man . Seems the older guys get the urge dies  like r.i.p no second |

| | |chances if they have to wait to put a condom on.  things aren`t too good on that front as |

| | |I seem to be sharing the bed with his ex his daughter and wait thats not all his last |

| | |girlfriend of a decade ago. they didnt have much about for guys  re counselling for abused|

| | |men in relationships. AAAAARRRGGGGHHHH!!!!!!!!!!! what ? whats that you say? I must have |

| | |killed a china man .!!! Dr I is looking to getting something done about one of the nerves |

| | |in my hand. Needs fixing. What is the neurologist situation up there. Have they found |

| | |someone to replace the fellow specialist that died? Will text more tomorrow.    Thanx T |

|26-Jan-10 |Purpose of Review: | |

| |Assessment: History |From: tracey [mailto: tickle@] |

| | |Sent: Monday, 25 January 2010 11:23 AM |

| | |To: Hannan, Terry J |

| | |Subject: Re: FW: Scanned from MFP-05372228 04/01/2010 14:02Hi Dr Tery |

| | |not feeling so good. Will make appointment 4 soon with Dr E. is thyroid problem|

| | |to be expected? |

| | |Having a bit of trouble swallowing & dealing with nausea. Rash I only had when |

| | |things were bad is back but not too bad. Feel yuck. Body heat is high and i |

| | |sometimes wonder if my hands and feet could boil water. Well enough chat . Hope|

| | |things arent too challenging for you.   best wishes Tracey |

| | |1306hrs – 27/01/2010-Nothing on calender. My throat feels weird. near adams |

| | |apple. Hormones/estrogen. I have pimples i normaly get during pre period time. |

| | |Things are o.k but idon`t feel well. just like before things went wrong. I am |

| | |letting people close to me know  that I can`t take too much stress at the |

| | |moment. I.E.  arguing , intense discussions silly jokes. Will do what I have to|

| | |do if things go haywire. I would just rather not. Bit of swelling around eyes& |

| | |boyfriend said face looked a bit puffy. Being doing a few extra shifts at radio|

| | |station. Daughter has been away for two weeks. Feeling a bit emotional. |

| | |Hormones? Just don`t feel well. Will get dr to do pregnancy test? possible. |

| | |Would like to cancel that one out. I feel sick in my throat not my stomach. |

| | |Think i will leave it for you to have a Look at and get back to you tomorrow. |

| | |Thanks Dr Terry. Tracey |

| |Assessment: Examination|1755 hrsTracey, any ‘events of significance’ occurring at this time? |

| | |Anniversaries, birthdays, conflict days or just memories? Thyroid?? |

|09-Jan-09 |Purpose of Review: |1215 hrs-Hi Dr Terry  No wonder I couldn't wait to get off the steroids. Must have been like WW3 inside me. Have told |

| | |you about the nausea taking over from the eat everything in sight feeling. Fluid retention is up with this hot |

| | |weather.some other weird stuff is happening , nothing too deadly. |

| | |  Seem to be handling stemitil tabs ( 5mg ) okay. I usually react to the first dose. |

| | |  The rash I still have is confined to the inner thigh and groin area and is irritated by sweating. Being so much |

| | |heavier this year is not very pleasant.  Thank God for reverse cycle air conditioners. And thank God for you too! |

| | |      Thanks Tracey On Thu, Nov 5, 2009 at 10:47 AM, Hannan, Terry J wrote:Tracey, I |

| | |was able to find an interaction between Prednisolone and Dapsone (the first decreases the levels of the 2nd). So now |

| | |off the Prednisolone the Dapsone should be at a higher dose in your body. So best to observe over the next week or so.|

| |Medical Assessment: |Never...! Thanx again. Tracey |

| | |On Thu, Jan 14, 2010 at 5:44 PM, Hannan, Terry J wrote:OK. This IS normal. Just don’t |

| | |do CATCH UP. |

| | |From: tracey [mailto: tickle@] |

| | |Sent: Thursday, 14 January 2010 4:47 PM |

| | |To: Hannan, Terry J |

| | |Subject: Re: FW: Scanned from MFP-05372228 04/01/2010 14:02 |

| | |Hi Dr Terry having trouble remembering to take my tablets. is this a thing that happens when you feel better? I will |

| | |try harder.Just feel too good I guess. Thanx Tracey |

| | |On Tue, Jan 5, 2010 at 2:15 PM, tracey < tickle@> wrote: Sounds to me like we have been truly blessed ! |

| | |On Tue, Jan 5, 2010 at 2:12 PM, Hannan, Terry J wrote: Hi Tracey, This sounds like a |

| | |‘new’ (uncovered) person. I have my grandsons here at the moment. |

| |Investigations: | |

| |Management: |Hang in there champ! |

| |Review: |05/12/2009-1046hrs-Hi Dr Terry    Feeling so much better. Finally got Dr E to diagnose rash. Eczema . Cortisone cream |

| | |gave almost instant relief. Can mow heaps of grass without feeling like I am going to die. Might be going on a bike |

| | |ride tomorrow. Thanks for being there for me. Tracey |

| | |On Sat, Nov 28, 2009 at 10:52 AM, tracey < tickle@> wrote: |

| | |Hi Dr Terry, Welcome back. There is the biggest thunder storm happening as I am Emailing you. evil thoughts are no |

| | |indication of good health. |

| | |still got bad rash happening. would like to deal with this. investigating estrogen in foods and altering diet due to |

| | |the effect it has on me. thank cyber space for the internet. Have felt more like looking into HAE3 of late. best to |

| | |take information in small bites. it goes in better.         must go Good to have you back. Tracey |

|04-Jan-09 |Purpose of Review: |1540hrs 30/12/2009 |

| |Assessment: History |Hi Dr Terry Just to let you know that I had a blood test today and the results should be sent to you. Should be |

| | |interesting I think. Well I`m interested. Not liking blood tests at the moment . they hurt more than usual. Must be |

| | |the sensitive type. I am 50 now. |

| | |  The rash i`m being treated for is most annoying and dr Innes has prescribed a stronger  cream. I hope it works for a|

| | |while at least. |

| | |       Happy new year!!!!!!!!!!  Tracey |

| |Assessment: Examination | |

| |Investigations: | |

| |Management: | |

|29-Oct-09 |Purpose of Review: |1047 hrs-04/11/2009- Tracey, I was able to find an interaction between Prednisolone and Dapsone (the first decreases the|

| | |levels of the 2nd). So now off the Prednisolone the Dapsone should be at a higher dose in your body. So best to observe |

| | |over the next week or so. |

| | |*** |

| | |1727 hrs-28/10/09-Tracy, this strongly suggests the Dapsone is working. Stress-pre-angioedema symptoms-insight-control. |

| | |Well done. |

| | |We can consider fine tuning the dose soon. I need to research the doses. |

| | |From: tracey [mailto: tickle@] Sent: Wednesday, 28 October 2009 4:15 PM |

| | |funny you should ask. just drove in to st H to pick up child & was late due to an unexpected visitor. child was txt |

| | |hassling me to come get her. started feeling there was going to be some problem with breathing. used ventolin puffer. |

| | |not sure if it is doing much. feel like it is more in the area of my thyroid gland. rash got excessively irritating |

| | |about an hour and a half ago. thought this morning that maybe i was a bit worried about nothing as the symptoms werent |

| | |progressing.  not sure what to do. can you ring me if you need to as i wont be near a computer till tomorrow. |

| | |thanks Tracey |

| | |p.s  just trying to stay calm. so i can tell what is going on. |

| | |On Tue, Oct 27, 2009 at 4:43 PM, Hannan, Terry J wrote:Can you breathe? Eyes OK but |

| | |airway would be of concern. Maybe Dapsone is modifying response. Send email tomorrow or earlier if necessary.From: |

| | |tracey [mailto: tickle@] Sent: Tuesday, 27 October 2009 2:28 PM |

| | |Hi Dr Terry . Not sure how on earth you could tell from a photo when my face is already so swollen. hard to do the photo|

| | |thing as online access is not available. this is how it starts. itchy eyes . swelling around eyes. rash. seems not to be|

| | |as aggressive. itchy eyes usually means i might not be able to see the next morning. will try to get you a photo later |

| | |this afternoon. Thanks Tracey |

| |Medical Assessment: | |

| |CNC Assessment | |

| |Investigations: | |

| |Management: |Hi Dr Terry  |

| | |Rash is getting pretty bad. didnt sleep well last night.swelling around eyes is much worse. feel tired and short of |

| | |breath. swelling in throat area is same as yesterday. |

| | | got an appointment to see dr E.  at 4.15. he will probably want to put me back on steroids. [Take copy of this to him |

| | |with notes] |

| | |NO steroids! At least your airway is safe based on what you tell me. We are in NO MAN’S LAND at the moment but I feel |

| | |OK. Rash is not typical of angioedema. |

| | |will check my email before i go to see what you say. the symptoms are awfully hard to bear at the moment as the rash is |

| | |like someone puting pins in the nerves. the itching is worse at night but a nuisance in the day. dont understand what |

| | |the dapsone is meant to be doing. can you please explain.[I am not sure people know how it works or when it does.] |

| | |thanks Tracey |

| | |From: tracey [mailto: tickle@] Sent: Thursday, 29 October 2009 2:16 PM |

| | |Hi Dr Terry Rash is getting pretty bad. didnt sleep well last night.swelling around eyes is much worse. feel tired and |

| | |short of breath. swelling in throat area is same as yesterday.  got an appointment to see dr E.  at 4.15. he will |

| | |probably want to put me back on steroids. will check my email before i go to see what you say. the symptoms are awfully |

| | |hard to bear at the moment as the rash is like someone puting pins in the nerves. the itching is worse at night but a |

| | |nuisance in the day. dont understand what the dapsone is meant to be doing. can you please explain.   Thanks Tracey |

| |Review: | |

|21-Dec-09 |Purpose of Review: | Use of the internet in patient care has proved a lifesaver for me. It has cut my stress levels enormously by getting |

| | |answers to solve problems I might be having very fast. I have found that it has kept my spirits up and helped me in my|

| | |recovery. You are so prompt with your replies it is great. |

| | | Thank youTracey |

| | |On Tue, Dec 15, 2009 at 2:25 PM, Hannan, Terry J wrote: |

| | |Good. I am in Sydney at a conference relating to patient's use of Internet for their own care |

| | | From: tracey [mailto: tickle@] |

| | |Sent: Tue 12/15/2009 11:19 AM |

| | |To: Hannan, Terry J |

| | |Subject: Re: Updated record |

| | |Hi Dr Terry |

| | |No1 ok |

| | |No2 ok |

| | |No3 read it on drug info site on internet. |

| | |No4 I am relieved. |

| | |Thankyou |

| | |Tracey |

| | |Best wishes and a safe and happy Christmas to you and your family! |

| | | On Mon, Dec 14, 2009 at 4:33 PM, Hannan, Terry J wrote: |

| | |B12 once every 3 months. |

| | |If still anemic then ANOTHER cause. |

| | |We do not want you off Dapsone. Who considered that? |

| | |DO not need lots of blood tests. |

|14-Oct-09 |Purpose of Review: |From: tracey [mailto: tickle@] Sent: Wednesday, 14 October 2009 12:46 PM |

| | |Hi Dr Terry down to 10mg. getting a little bit itchy. no rash yet. Notice the itchy bit because it hasn`t been an issue |

| | |for quite a while. Haven't been to see Dr E yet to get the results of last bloods. |

| | |  Dragging my feet a bit. Trying to keep up with the housework. Hard to find the energy some days. Looking forward to |

| | |the 28th when i don`t have to take steroids for a while. Maybe I can get my girlish figure back ! Well for a while |

| | |anyway. Great weather for ducks. Not for lawn mowing. Don`t have any ducks but have lots of lawn. Take care Tracy |

| |Medical Assessment: |1250hrs-Well done. |

| | |You are experiencing the “steroid withdrawal” syndrome. |

| | |I was just sharing lunch with Libby as she is working with us this week. |

| | |Blood tests-NORMAL |

| | |Remember “our past determines our present. We determine our future. |

| |CNC Assessment | |

| |Investigations: | |

| |Management: |1701 hrs-15/10/09-1. Steroids rev up the system, change your blood sugar to diabetic in some situations, thin your |

| | |bones, make your muscles weak and make you feel like s..t. |

| | |2. Your symptom documentation suggest 'modulation/modification' of the angioedema and that makes me hopeful it is |

| | |working. WE (including Libby) have been discussing your case today with the intention of trying to get it published. |

| | |Hi Dr Terry re point 2.   Could you please enlighten me to the other charming aspects of steroid withdrawal syndrome so |

| | |i don`t start confusing things . |

| | |My face and neck are swelling and my eyes are itchy. now none of this is anything but slightly annoying in the |

| | |discomfort zone but it is noticeable. |

| | |just thought i would mention it rather than not. thanks Tracey |

| | |Well done. |

| | |You are experiencing the “steroid withdrawal” syndrome. |

| | |I was just sharing lunch with Libby as she is working with us this week. |

| | |Remember “our past determines our present. We determine our future. |

| |Review: |1429hrs-26/10/2009-Hi Dr Terry itchy swollen eyes &rash getting progressively worse. Will stick this out . want to get |

| | |off the steroids.  Daughter out herself into hospital with bad stomach pains not related to pregnancy. Better now. they |

| | |couldnt find what it was only what it wasnt. Keep forgetting to ask if she is seeing another specialist. got to go |

| | |illegally using library computer . online access closed for a course. Thanks   tracey] |

| | |1644 hrs 27/10/09-Can you breathe? Eyes OK but airway would be of concern. Maybe Dapsone is modifying response. Send |

| | |email tomorrow or earlier if necessary. |

| | |From: tracey [mailto: tickle@] Sent: Tuesday, 27 October 2009 2:28 PM |

| | |Hi Dr Terry . Not sure how on earth you could tell from a photo when my face is already so swollen. hard to do the photo|

| | |thing as online access is not available. this is how it starts. itchy eyes . swelling around eyes. rash. seems not to be|

| | |as aggressive. itchy eyes usually means i might not be able to see the next morning. will try to get you a photo later |

| | |this afternoon. Thanks Tracey |

|02-Oct-09 |Purpose of Review: |Angioedema review. |

| |Medical Assessment: |Recurrent stress symptoms and NO episodes of Angioedema. She doe NOT require steroids. Most of her symptoms are |

| | |stress-related. |

| | |Dapsone appears to working in reducing attacks of angioedema. |

| | |BP is stress and Prednisolone effects (as well as elevating WBC). |

| |CNC Assessment | |

| |Investigations: | |

| |Management: |Same dose of Dapsone |

| | |WITHDRAW AND ELIMINATE STEROIDS AS FOLLOWS. |

| | |2/10/09-5/10/09 25MG/D |

| | |6/10/09-12/10/09 15mg (3 x5mg) a day |

| | |13/10/09-20/10/09 10mg (2x5mg) a day |

| | |21/10/09-28/10/09 5mg (1 x 5mg) a day |

| | |Cease on 28/10/09 |

| |Review: |By email [1519hrs 6/10/10-Hi Dr Terry  I start taking 15mg tabs tonight . Fluid retention is increasing. Irealise that |

| | |most symptoms I have now are to do with the drugs and not the condition. will discuss all with dr E today and get back |

| | |to you if I need to . doing bloods today. hope all is going well with you. Tracey] |

| | |07/10/09-1336 hrs-Yeah ,Yeah .!!!! Such " lateness" for bloods. will get them done today. Had a good session with my |

| | |psychologist. She is helping me with different ways of seeing things. cds for relaxing and not thinking. Great stuff to |

| | |round out what you ( we) are trying to achieve.Would rather deal with Drs when I am feeling well. It is easier and less |

| | |stressful. thanking you ] |

|28-Sep-09 |Purpose of Review: |From: tracey [mailto: tickle@]Sent: Sat 9/26/2009 10:56 AM |

| | |thanks Dr TerryCan I ask you how the blood test went ? Feeling a bit down at the moment. Not too much. My footy team |

| | |Geelong is in the grandfinal so today will be stressful for a few hours.   Say hi ! to libby for me.  Will remember to |

| | |make sure the Drs & hospital do an ecg next time. Lost the draft of an email I was to send as I am not too familiar with|

| | |the procedure. It wouldnt send so I had to save it. Glad I`m not a doctor!   Puting on weight fit to bust. Would like to|

| | |have a break from the steroids but can`t seem to see the end of it all. Maybe this is what is getting me down. Well |

| | |today is bright and cheering for the soul and so I am.  see you soon. Tracey |

| |Medical Assessment: |1552-27/09/09-Tracey, I am in Sydney airport. I agree the steroids are probably not good for you and are having side |

| | |effects that are maksing waht we are trying to achieve. I have a 'feeling' the Dapsone is working and we awill trya na |

| | |dsort all this out at the next meeting. Terry |

| |CNC Assessment | |

| |Investigations: | |

| |Management: | |

| |Review: | |

|24-Sep-09 |Purpose of Review: |1457hrs-23/09/09-Hi drs  T&L in answer to q1.  o.k . will remember next time. |

| | |Q3. more so. it is constant and uncomfortable. a constant pressure. |

| | |Q4. can you clue me in on this one. |

| | |Heart still a bit fast. Having bloods done today. Should I see Dr E ? Thanks |

| | |Tracey |

| |Medical Assessment: | |

| |CNC Assessment | |

| |Investigations: |Bloods as ordered |

| |Management: |0930 hrs-Q3-this sounds more like the ‘stress’ symptoms than the angioedema-always will be difficulot to differentiate. |

| | |Q4-there is a high risk of blaming everything on the angioedema. You are ‘allowed’ to develop other symptoms of other |

| | |problems. It will always need ‘careful’ clarification. |

| |Review: | |

|22-Sep-09 |Purpose of Review: |From: tracey [mailto: tickle@] Sent: Tuesday, 22 September 2009 2:53 PM hi Dr Terry things started getting |

| | |worse yesterday so went to see dr E and he sent me to the hospital for an injection of hydroncortisone. not sure of |

| | |dose. heart beat was going at 100 miles an hour and throat started swelling more than it has been for the last few days.|

| | |tablets being taken , one prednesilone + one dapsone in the morning and same at night. taking it very easy today. |

| | |injection seemed to help but heart still beating fast but not as fast as yesterday. looked in the side effects of |

| | |dapsone and that was one of them. glad Libby went well. say hi to her for me. see you on the 3rd of next month. tracey. |

| |Medical Assessment: |1456hrs-Tracey, |

| | |Make sure they get an ECG-cardiograph. |

| | |The fast heart rate may be due to the ‘attack’. |

| | |Was the swelling ‘less’ than before? |

| | |We have to be careful ‘what we are treating’ here. |

| | |Terry c.c. Dr. E. Cawson |

| |CNC Assessment | |

| |Investigations: |FBC,UEC, LFTS |

| |Management: | |

| |Review: | |

|11-Sep-09 |Purpose of Review: |Review of response to Dapsone |

| |Medical Assessment: |Improving symptoms |

| | |Clarified allergy history – perhaps more drug intolerances than allergies |

| | |Clarified Angioedema history with photographic evidence of partial attacks over the past 11 years |

| | |History of undiagnosed acute abdominal pain as a child – consistent with type III Hereditary Angioedema |

| | |Discussed social history with significant stressors related to past relationships |

| |CNC Assessment | |

| |Investigations: |FBC, UEC, LFTs |

| |Management: |Added 25mg night dose of Dapsone |

| | |Reassurance that on the correct diagnostic pathway and will eventually withdraw steroids completely |

| | |Maintain withdrawal regime of oral steroids |

| | |F/U with Terry Hannan on 25th September |

| |Review: |1558 hrs-17/09/09 |

| | |Tracy-case presentation well received and Libby did fantastically |

| | |IF attack is less severe then it may be the Dapsone |

| | |Try a whole tablet at night i.e. 2 per day |

| | |From: tracey [mailto: tickle@] Sent: Thursday, 17 September 2009 3:31 PM |

| | |hi Dr Terry Not feeling good. swelling in face and neck. rash on arms legs and face. Not as bad as before because |

| | |steroids  control most swelling. stress recognised and being dealt with. No driving. only to shops. too many tourists! |

| | |Seeing Dr E tomorrow. See you on the 25th. Tracey |

|04-Sep-09 |Purpose of Review: |1326 hrs- Hi Terry Just to let you know i picked the new drugs up and start them today. Got a query about depo provera .|

| | |forgot that i had that injection and must be ready for another one. Will this be OK ? Sorry forgot about mentioning this|

| | |one.Glad you got the photo OK. it was a bit of a trial with needing help to do it. Should be simple you would think. |

| | |Hmmmmm!!!!!! Have the best day See you next Friday . Thanking you Tracey |

| |Medical Assessment: |Tracey-I have just performed a literature search and am unable to find any interaction between the Dapsone and |

| | |Medroxyprogesterone acetate. This does not mean it will not occur as they are a rare combination. |

| |CNC Assessment | |

| |Investigations: | |

| |Management: |05/09/09-   Hi again Sorry Terry sometimes I can be slow on Picking up things that are being  pointed out to me. The |

| | |surprise ! is obviously that the assessment confirms the hereditary angioedema ? Hi terry  |

| | |In answer to your questions . injection every three months. I will be seeing you next Friday and will bring photo then. |

| | |Got a nice normal photo. Not too scarey. e you then Tracey ri, Sep 4, 2009 at 4:35 PM |

| | |Well. Done. |

| | |Can you send a NORMAL photo. It was pointed out to me they should be put side by side in your record!! |

| | |Which dose are you on? |

| | |DEPO-PROVERA (Injection) Prescription required. S4 |

| | |Medroxyprogesterone acetate; NaCl, hydroxybenzoates; susp (vial); |

| | |Dose: Endometrial, renal cell carcinomas: initially 600-1200 mg IMI wkly; then 450-600 mg every 1-4 wks. Breast |

| | |carcinoma: 500 mg/day IMI for 4 wks; then 500-1000 mg at wkly intervals. Endometriosis: 50 mg every wk or 100 mg every 2|

| | |wks IMI for greater than or equal to 6 mths. Contraception (150 mg/mL vial only): 150 mg deep IMI every 3 mths, see full|

| | |PI |

| | |Pack: 50 mg /1 mL 1 mL [1] : PBS/RPBS (Rp 1) PBS: $11.79 |

| | |Pack: 150 mg /1 mL 1 mL [1] Brand substitution is permitted. : PBS/RPBS (Rp 1) PBS: $17.75 [$3.27 BPP] |

| | |Please confirm receipt of record. |

| |Review: | |

|28-Aug-09 |Purpose of Review: |Review of angioedema. |

| |Medical Assessment: |Hereditary Angioedema confirmed. [pic] |

| |CNC Assessment | |

| |Investigations: |NIL [Do LFTS and FBC] |

| |Management: |Explained nature of her condition and saw photographic evidence of angioedema |

| | |Commenced dapsone 50 mg daily for angioedema |

| | |Decrease dose of corticosteroids slowly. |

| | |50 mg per day until 11th September |

| | |25 mg per day until 25th September |

| | |Dose determined following the review by Dr Hannan |

| |Review: |Dr Hannan 2 weeks [1535 hrs-02/09/09-Hi Terry  Please find attached photo as discussed for you to use as spoken about |

| | |. Hope this will assist Tracey   |

| | |To whom it may concern . I Tracey Mary do give my permission to Dr Terry Hanan to use this photograph of me for any |

| | |medical reasons he sees fit.] |

|17-Aug-09 |Purpose of Review: |Dear Terry You are the man ! TraceyFrom: tracey [mailto: tickle@] Sent: Monday, 17 August 2009 11:32 AM Hi |

| | |Terry You must be on holidays by now. i don't have the internet on at home so i use the online access centre in St |

| | |Helens. my condition is worsening ie; swelling where the rash is on arms face throat and legs .Not feeling too good but |

| | |no breathing difficulties so far. they don't want to see me in the hospital down here unless I am having breathing |

| | |difficulties. Is it ok for them to give me  steroids to take the swelling down now before the swelling gets too bad ?  I|

| | |am puting on my best front as my best face is out of action at the moment.  I hope you are having the best holiday ever |

| | |you deserve it.    yes I would like to make an appointment to see you. do I contact the specialist clinic at L G H ? see|

| | |you soon Tracey |

| |Medical Assessment: |On Mon, Aug 17, 2009 at 12:01 PM, Hannan, Terry J |

| | |Steroids safe |

| | |I am chasing results |

| | |Do you have or you should make an appointment to see me next week. As I am away |

| | |c.c. Specialist Clinics URN 197967 Tracey |

| |CNC Assessment | |

| |Investigations: |C1 Esterase C1 Est Functional 164 % (>70) |

| | |Report from St Vincent's Hospital, Melbourne. |

| |Management: | |

| |Review: | |

|11-Aug-09 |Purpose of Review: |1309 hrs-Hi Dr Hannan thankyou for the email. Have to say that after leaving you yesterday lots of questions started |

| | |popping into my head. like how serious is this condition? The questions you were asking made me think that it is life |

| | |threatening in that it could wipe me off the planet any old time. I would be most interested in seeing any information |

| | |you currently have on angioedema. Awaiting your reply. |

| |Assessment: |1345 hrs- Tracey, by chance I had received a review of this condition yesterday from the worl literature. It was |

| | |essential for my continuing education. |

| | |Several issues were new to me. |

| | |Stress is often a major precipitant (of which you have had your fair share). |

| | |Adrenaline (Epi-Pen) is not the appropriate therapy. |

| | |Some new therapies are available for prevention and acute attacks. |

| |Investigations: | |

| |Management: |I will try and collate some materials for you as YOU will often need to educate those who manage you. These materials I |

| | |am trying to have sent to me to distribute to the medical staff in the LGH. ALL the more reason for YOU to have your |

| | |own record. |

| |Review: |1723 hrs-Tracey, yes I will send information to whomever you give permission to do so. |

| | |I also recommend that you ‘email it to yourself’ so there is a copy available anywhere in the world. You diagnosis and |

| | |management profile are not yet complete so we need to clarify that together. You do have another appointment with me? |

| | |Terry |

| | |From: tracey [mailto: tickle@] Sent: Friday, 14 August 2009 4:46 PM Hi Terry. was wondering if you could |

| | |send any information you have on current treatment to st helens district hospital so they can put it in my file as the |

| | |nurses who are my  champions in the battle for my life, as are you.   I am eternally in awe of you.  Tracey |

|10-Aug-09 |Purpose of Review: |History is suggestive of Angioedema |

| |Assessment: |She is currently well. |

| |Investigations: |Awaiting C 1 esterase assay |

| |Management: |Cease Prednisolone |

| | |NO further medications unless review by Dr Ecchetema or Dr Hannan |

| |Review: |After blood results available |

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