42   yers old femlae pt 
knonw to have   scleroderma and  brest  ca 
scleroderma   scine childhood 

she is known to hve  connetive tissue  doseasae  wotj sclerodema  diagnosed sicne the last  15  years on regfuler fpollow up  with her  ehrumatolgsut  
she has been maintained on plaquneil and  she  also  has   berest  cancer   treated with  surgical intervention    radio and  chemotheraoy 
now  she is   on hormonal therapy 
zuladix  monthly     and  she  has normal  echo and normal hrchest  ct 
exceopt for paratracheal   soft tussue leasion   1.2   then  1.2  ten  0.9 
she  has  loud  p2  
impressio    scleroderma  with    face and  hand  feature

she has    dyficulties in swlloing   and  she was recommeded to see  gastroenterolgist  for   endoscopies 



she  had  abdominal  ct  that showed   right side d  hydronephrosis   with balloning    of the renal pelvic   which may be ie  to  PUJ  stenosis 

she has  right   suded   hydronephrossi  with b allooing  of the renal pelvis  which may be  due to  puj  stensosi   


labs  were   done and showed   a1c     4.5   
esr  1 5 
cbc       5.3   hgb12   plt 152
urine analysis showed no  proteinuria 
no  hemturia 
creatinine  0.6 

medication 
plqunril  200 mg 1x2 
litrazol  instead of  tamixfim 
zoladex 


plan 
add mag  3 
do   do   labs  and then reevalaution