  The patient is an 88-year-old Caucasian female.  She comes here today with a friend.  The patient has no complaints.  She states she has been feeling well.  Her knees are not hurting her at all anymore and she is not needing Bextra any longer.  I think the last steroid injection that she had with Dr. XYZ really did help.  The patient denies any shortness of breath or cough.  Has no nausea, vomiting, abdominal pain.  No diarrhea or constipation.  She states her appetite is good.  She clears her plate at noon.  She has had no fevers, chills, or sweats.  The friend with her states she is doing very well.  Seems to eat excellently at noontime, despite this, the patient continues to lose weight.  When I asked her what she eats for breakfast and for supper, she states she really does not eat anything.  Her only meal that she eats at the nursing home is the noon meal and then I just do not think she is eating much the rest of the time.  She states she is really not hungry the rest of the time except at lunchtime.  She denies any fevers, chills, or sweats.  We did do some lab work at the last office visit and CBC was essentially normal.  Comprehensive metabolic was essentially normal as was of the BUN of 32 and creatinine of 1.3.  This is fairly stable for her.  Liver enzymes were normal.  TSH was normal.  Free albumin was normal at 23.  She is on different antidepressants and that may be causing some difficulties with unintentional weight loss.