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Jonathan this is uh dr. Jones and our internal medicine service team hi Jonathan were gonna be Im gonna be presenting your case to them is that all right if I do that in the presence of your girlfriend and co-worker here yes thanks Jonathan so this is the first UMC visit for Jonathan who is a 24 year old african-american with a history of sickle-cell disease who presented to the emergency department with a 2-day history of bilateral knee pain hes ectomorphic and is in moderate distress the pain began Tuesday at approximately 4:00 a.m. while he was working a night shift at Walmart he had a difficulty sleeping because of the pain that night and the pain gradually continued to increase due to severity of eight out of ten today the pain was exacerbated with walking and standing and was not docHubly relieved with percocet which she received from another physician that we arent sure who it was jonathan has never experienced knee pain to this extent before but he did say that hes ha