Natie Bumpkin

Chief Complaint:

"My ankles have been hurting for the past couple of months.  I'm having a lot of trouble walking, it is real painful."

History of Present Illness:

Ms. Bumpkin is a 35 year old divorced, Caucasian female.  She is complaining that around two months ago she woke up and noticed her right ankle sore.  Over the next day or two both ankles began to hurt and the pain was so severe she went to the emergency room.  The physician in the emergency room took x-rays of her ankles and concluded that nothing was wrong.  "Your ankles look completely normal".  He advised her to take Tylenol or Motrin for the pain and that it would get better.

Instead the pain has become worse.  The following week the pain progressed to flu-like aches in her joints and muscles.  Several subsequent visits to the ER and a nurse practitioner have been inconclusive.  Today she woke up with her ankle red and swollen and has immediately come in to the clinic.

"I kept telling you doctors there was something wrong with my ankles, but nobody believed me because they looked normal.  Well, this doesn't look normal." 

On questioning, she thinks she might have had a fever off and on for the past month, but is unsure since she never took her temperature.  Aside from the aches  and pains she feels "OK".