<s>[INST] Male aged 66 weight 120 Kg -reducing at 1 Kg per week as diuretic takes effect. Cushings, Conn s, Ulcerative Colitis, Diabetes 2. Bone density OK. New Problem of concern is Unilateral ankle pain and swelling for over three weeks, causing limp, no fever, feels like a sprain but no accident or bruise discolouration. Prone to gout but on 300 mg Allopurinol per day. SOB, fatigue, mobile pitting edema, probably due to incipient diabetic nephropathy - Bumetanide 2 x 1mg per day. CBC - (All mmol/L)- Serum Corrected Calcium low 2.15, Urea 10.6, Cholesterol 4.5. Creatinine 156 umol/L, Parathyroid high 13.6 pmol/L, GFR 36. Various anemia indicators contradict - Ferritin 163 ng/mL, RBC 4.23, Haematocrit 0.409, MCV 96.7 fl, MCH 30.7 pg, RCDW 14.4%, MCHC 318 g/L, Neutrophils 7.66 x 10^9/L, Lymphocytes 1.44. Vit D3 8 ng/mL Urine Albumin:Creatinine Ratio 0.5 mg/mmol [/INST] I understand your symptoms and complaint. Diuretics efficiency may be decreased. Past history and blood urea is more than normal and indicate uncontrolled gout case. First, Applying cold bath on foot, compression band on foot and topical anti-inflammatory cream. Increase water intake and decrease salt intake. Continuous uric acid analysis should be monitored every 3 weeks. Take analgesic and anti-inflammatory tablets 3 times daily for one week. </s>