DEPARTMENT OF REHABILITATION AND AGE CARE

1 December 2023

Dr Oliver Chen
Brighton Beach Medical Centre
Unit 6/22 Hughie Edwards Drive
MERRIWA WA 6030

Dear Dr Chen,

Re: Mr Peter Croft

DOB: 12/02/47
4 Pymore Crescent BUTLER WA 6036
H: 9562 7734 M: 0417 928 082

Diagnoses:
1. Poor mobility likely multifactorial due to severe peripheral neuropathy, morbid
obesity, and sedentary lifestyle
1.1. Evidence of severe peripheral neuropathy
1.2. MRI lumbar and thoracic spine November 2022, mild to moderate L3/4, L4/5
central canal stenosis, and L4/5, L5/S1 moderate foraminal stenosis without nerve
compression, multilevel facet joint arthropathy
1.3. One fall in the last 12 months
1.4. No recent DEXA scan
1.5. Walks using a walking stick
2. Ischaemic heart disease
2.1. Seven stents
2.2. Recent coronary angiogram, no intervention, was done at Hollywood Private
Hospital
3. Atrial fibrillation
4. Type 2 diabetes with micro- and macro-vascular complications
4.1. Recently more controlled with most recent HbA1c 6.5, evidence of peripheral
neuropathy
4.2. Sees podiatrist on a regular basis, and has not seen an optometrist for eye check
for few years
5. CKD
6. CLL, in remission
7. Obstructive sleep apnoea, on CPAP
8. Bilateral orchidectomy elective in 2022
9. Bilateral cataract surgeries
Regular Medications:
Ryzodeg 15 units twice a day
Ozempic once weekly
Jardiamet 1000/12.5 mg twice daily
Gliclazide 30 mg once daily
Pradaxa 150 b.d.
Lyrica 150 at night
Ezetimibe 10 mg
Aspirin 100 mg once daily
Colchicine 500 mcg once daily
Metoprolol 50 mg once daily
Thyroxine 50 mcg once daily
Estradot 100 mcg patches

I had the pleasure of reviewing Mr Croft at the geriatric clinic at Joondalup Hospital on a
referral from GP for assessment regarding poor mobility and high falls risk. Mr Croft is a
retired electronic technician, worked at Channel 7 most of his adult life until the age of 52
when he retired. He lives alone and has strained relationship with his siblings, only
contacting through e-mails. He lives alone in his own home.
 Peter Croft / 2

He is usually independent with personal activities of daily living, independent with

medications through a Webster Pak and independent with mobility using a walking stick. He
is on a level II home care package and he gets cleaning services on a weekly basis.

He is an ex-smoker. Alcohol use: drinks double-strength two cans of beer and one glass of
wine a day.

Peter reports issues with mobility for at least the last five years. He reports having Rickets as
a child and he tells me his left leg is shorter than the right leg he saw a podiatrist and wears an
orthotic. His mobility has deteriorated in the last three years and that is mainly due to poor
balance with symptoms severe peripheral neuropathy. He reports burning sensation and
numbness in his feet up to his knee levels. He denies radiculopathy symptoms and denies
significant back pain or hip pain. Denies neck pain. Mr Croft had one fall earlier this year
where he lost balance while turning and fell on the ground. He struggled to get off the floor.
Luckily, he has not sustained any major injuries and he reports no previous fractures. He
denies symptoms of postural dizziness. Mr Croft has exercises at home and keen to
participate in a programme for muscle strengthening and balance.

Mr Croft also reports what seems like restless leg syndrome where he reports feeling the urge
to move his legs mainly at night-time, gets better when he gets up for mobility and that has
been affecting his sleep. He has tried Sifrol up to 1 mg with little effect. I have looked at his
investigations and evidence of iron deficiency back in February and iron deficiency is linked
with restless legs syndrome, he will follow up with you for management and further
investigations. Restless legs syndrome as well is associated with obstructive sleep apnoea, so
I have encouraged Mr Croft to use his CPAP machine for the whole duration of his sleep at
night.

Examination:
Blood pressure 150/70, no postural drop, heart rate 65, respiratory rate 18, saturating over
96% on room air.

Weight 124 kg.

MMSE in clinic today 30/30.

No cervical, thoracic, or lumbar spine tenderness on palpation and no tenderness on bilateral

hips on palpation.

Neuro Examination:
Hip flexion 4/5 bilaterally. Rest of muscle power in lower limbs are 5/5, muscle power upper
limbs all muscle groups 5/5.

Reflexes, knee jerk reflexes within normal limits bilaterally. Babinski equivocal bilaterally.
Reduced pinprick sensation in lower limbs up to knee level bilaterally, reduced vibration
sense and reduced proprioception.

Romberg’s positive.

Gait, wide-based gait with mildly reduced foot clearance on the left.

Plan:
1. I have referred Mr Croft to outpatient physio for muscle strengthening and balance
exercise programme.
2. I suggested that Peter follows up with you for bone health optimisation including
arranging DEXA scan if he has not had one in the last two years and treat osteoporosis
if indicated.
3. I have advised Peter to cut down alcohol intake and recommended using a pendant
alarm, he can access that through his package.
4. Mr Croft had a blood test form Feb that suggest iron deficiency, with no obvious
bleeding source on history, I suggested to Mr Croft to follow up with you for repeat iron
studies and consideration of iron infusion that could improve symptoms of restless legs.
He would also require further investigation to look for aetiology of iron deficiency, this
would include endoscopy/colonoscopy, I will leave that in your hands.
5. He is going to follow up with the psychiatrist for management of depression. I have
offered him duloxetine that he said he tried before and it did not work for him and he wants to
wait until he sees the psychiatrist to manage his depression.

Peter
Croft / 3

6. Recommended continuing addressing cardiovascular risk factors including blood

pressure management and diabetes management. Currently, his blood pressure is reasonably
controlled and his diabetes is currently managed well with a well-controlled HbA1c. Ongoing
podiatry input and 12 monthly eye checks with optimist and three to six monthly HbA1c and
ACR measurements is recommended.
7. Discharged from geriatric clinic.

Thank you for your ongoing care. Please do not hesitate to contact us if you have any
questions or concerns.

Kind regards.

Yours sincerely,

Sighted but not signed

Dr Ali Hassan Dr Steven Jujnovich
Geriatric Advanced Trainee Consultant Physician
Dept. of Rehab & Aged Care Dept. of Rehab & Aged Care

AH/ms Day Therapy Unit

JHC File Joondalup Hospital
DTU