General: 

Weight has been stable. 

Appetite isn’t as good as it used to be, but “forces herself to eat.”

Always feels tired. 

Sleep impaired from “stress” and pain in feet.

Head & Neck:  Chronic recurrent headaches, daily, dating back 50 years. Vision is moderately impaired from macular degeneration.  Hearing is mildly decreased, but functional. No other concerns.  Has dentures.

Cardiovascular:  No angina.  Shortness of breath on exertion for years (when doing stairs or walking more than a few blocks).  Edema in legs up to knees for 3 years. No claudication. No orthopnea or paroxysmal nocturnal dyspnea.

Respiratory:  Shortness of breath as described previously.  No cough.

Gastrointestinal:  No concerns other than constipation, not new.

Genitourinary:  No concerns.

MSK:  Pain in hands and knees, worsening throughout the day, not new, somewhat relieved by acetaminophen.  Aches all over, all the time.  Chronic low back pain, worse with prolonged standing or walking.  No radiation of pain.  Aches and some recent increase in pain in her legs relating to her ulcers.

Neuro:  Constant numbness and burning in feet, keeps her awake at night. No other neurological concerns.

Psych:  Admits to feeling “down”, but says she is not depressed.  Is not tearful. No suicidal or homicidal ideation. No psychotic symptoms.

Derm:  Leg ulcers had significantly increased pain and yellowish discharge 2 days ago.  The doctor in the ER prescribed antibiotics and the drainage is much better.