Paul Callaway
Age: 77 years old male
Doctor
Patient’s Data
Patient’s name: Paul Callaway
Age: 77 years old male
Past medical history
- Hypertension
- Myocardial infarction (Feb 2023) – significant proximal LAD disease (85% stenosis), two stents inserted
- Peripheral arterial disease
- Metastatic prostate cancer- On palliative care
- DNACPR in place
Drug history/Repeat template
- Ramipril 2.5mg OD
- Amlodipine 10mg OD
- Clopidogrel 75mg OD
- Atorvastatin 80mg OD
- Tamsulosin 400mcg OD
- Zomorph 60 mg BD
- Oramorph 10mg/5ml – 5–10ml PRN every 4 hours
Alerts and QOFs
- No advanced care plan in place
Recent consultation/Notes
Hospital discharge letter from Oncology- 4 weeks ago
RE: Paul Callaway/77 years old Male
Dear GP
As you may know, the above named has metastatic prostate cancer. Recent CT showed widespread metastases to bone, spine, lungs, liver and spleen.
We had extensive discussion with patient and his family, and they are informed that not much can be done at this stage and he is for best supportive care. Please can GP add patient to gold standard framework and ensure community palliative team is aware of him. Prognosis should be weeks to months.
Regards
Dr Emeka Okonkwo MBBS, MRCP (UK) PhD
Consultant Clincal Oncologist
Recent Blood Test Results (4 Weeks Ago)
| Test | Result | Reference Range |
|---|---|---|
| eGFR | 61 mL/min/1.73m² | >90 (normal), >60 acceptable |
| Sodium (Na⁺) | 139 mmol/L | 135 – 145 mmol/L |
| Potassium (K⁺) | 4.1 mmol/L | 3.5 – 5.3 mmol/L |
| Urea | 6.5 mmol/L | 2.5 – 7.8 mmol/L |
| Creatinine | 81 µmol/L | 59–104 µmol/L |
| Haemoglobin (Hb) | 108 g/L | 130 – 170 g/L (Male) |
| WBC | 6.4 x10⁹/L | 4.0 – 11.0 x10⁹/L |
| Platelets | 220 x10⁹/L | 150 – 400 x10⁹/L |
1 week ago – Seen by Dr Native (Clinical Practitioner Access Role)
Presenting complaint: Ongoing abdominal and bilateral calf pain despite Zomorph 30mg BD. Increased use of Oramorph: Previously 5mls x6/day. Now requiring 10mls x5/day. Total morphine dose ~160mg/day.
Examination: Vitals: BP 100/76, Pulse 75 bpm. No clinical signs of opioid toxicity
Impression: Pain likely related to cancer progression
Plan: Increase Zomorph to 60mg BD. Continue Oramorph 5–10mls PRN. Review as needed. Patient has been visited by district nurse Alice Goodenough, who is now on the phone and has requested to speak with the GP regarding his condition.