Training As Treatment? - Page #1

Author: Keri Denay, MD
Co Author #1: Sherrie Ballantine-Talmadge, DO
Co Author #2: Shana Miskovsky, MD
Editor: Margaret Gibson, MD, FAMSSM
Editor: Margaret Gibson, MD, FAMSSM

Patient Presentation:
26 year-old male elite figure skater presented for pre-season PPE. No complaints or concerns.

Past medical history includes: concussion with prolonged recovery, arrhythmia as infant but details unknown, GERD, Asthma (uses budesonide-formoterol and albuterol prn during season), possible influenza 3 months prior, seasonal allergies (using fexofenadine prn), scattered MSK injuries but none active.
No surgical history.
Social history: Denies any tobacco, alcohol, drug use. No supplements, herbals, vitamins, no disordered eating/eating disorder. Trains outside US. Trying to gain weight and working with team dietician.
Review of Systems: mild fatigue at baseline. Six months prior, he began noticing that he would have sudden onset of one arm being very cold while the other is very hot. No skin changes. Sides inconsistent.

Physical Exam:
BMI: BP 110/68 Vision 20/20 each HR 118 POx 98% on RA
General: Well-appearing, calm, good spirits, breathing and conversing normally.
Neck: no LAD, no thyromegaly, no JVD
Heart: Tachycardia with irregularly irregular rhythm, no m/r/g, no S3 or S4; rate slightly decreases in supine position with carotid massage and/or Valsalva to 98 temporarily but still irregularly irregular
Lungs: CTAB Abd: +BS, non-tender throughout without AA murmur or palpable masses
Ext: 2+ distal pulses, no edema
Skin: no rash/discoloration on exposed surface.

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