The visit with the ENT at Mayo had this to say in his follow-up notes:
ASSESSMENT / PLAN
#1 Parotitis
It was a pleasure seeing Ms. Jerauld in clinic today. She is a 58-year-old female who had an episode of parotitis which was appropriately treated. There was concern for a parotid mass, but a CT scan performed did not demonstrate any masses or lesions. I did call Dr. N. to confirm because I did see a hypodensity in 1 of the axial slices, but he confirmed that this was artifact and was not seen any of the other slices. I told her that this is all good news. Should she have recurring symptoms, sialoendoscopy could be considered in the future but certainly not at this time. She can follow-up on an as-needed basis.
The results of the spinal X-Ray was as follows:
#2 Osteopenia
Have placed order for spinal x-ray given significant loss of height. If compression fractures are present would recommend treatment with bisphosphonate therapy. If negative, then recommend continuing conservative therapy. Will follow-up with her with those results on the portal. She was encouraged to continue with current calcium and vitamin D regimen as well as routine exercise.
ADDENDUM:
Vitamin D levels are adequate, with 25 Hydroxyvitamin D total 57 ng/mL. Spine x-ray demonstrates anterior wedging of several mid and upper thoracic vertebral bodies and compression of superior endplates of T4 and T5. Contacted patient by phone to discuss recommendation to initiate bisphosphonate therapy. Discussed risk/benefit of Alendronate therapy along with appropriate administration technique and she is agreeable to proceed. Prescription was sent to her local Walgreen's Pharmacy at her request. Placed order to repeat bone density in one year. Patient has requested that copy of this note be sent to her local spine surgeon n Joplin, MO.
#3 Cancer Thyroid Papillary Personal History
No worrisome features for recurrent or metastatic disease on thyroid ultrasound.
ADDENDUM: Patient notified via phone call that her Thyroglobulin level is undetectable. She is now 10 year cancer survivor. Recommend repeating thyroid ultrasound in 5 years unless abnormal physical exam or laboratory results.
The research into Alendronate now is underway and I will likely start that soon.
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