Current subjective complaints (from claimant) and objective observations: Mr. Anderson continues to walk using 2 canes, his legs shake when he is walking; he has frequent tremors of his legs while sitting. Since having the permanent spinal cord implant done on 6/19/17 He reports that his pain has increased from the incision and to the right rib area. He is not able to sleep or get comfortable. He reports standing for more than 5 minutes is difficult. Said he was told to increase his Dilaudid and Percocet for 3 day by Dr. Shah but due to the level of pain he has he just continued with the increase dosage until the appointment with Dr. Rampersaud on 6/29/17.
Review of claimant’s stated pain/limitations: He continues to rate his pain at a 7 at best and up to a 10. Mr. Anderson said the pain interferes with all aspects of his life. It affects his sleep. Mr. Anderson said any activity increases back spasms. There is an increase in pain from the incision and right rib area for the implantation of the spinal cord device.
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Anderson was given printed information on the spinal cord pain stimulator device by Dr. Rampersaud.
MD visit details: On 6/29/17 I met Mr. Anderson at the office of Dr. Rampersaud. The permanent spinal cord stimulator was placed on 6/19/17. Mr. Anderson said since it was placed he has had an increase in right rib pain, incision pain and some shortness of breath. He reports that Dr. Shah told him to increase his medications for a few days. He said that since his pain was so severe he did not decrease the medications back down and is almost out of medications. He also reports he is not able to stand for very long, spending most of his time in bed.
Patient denies any complications and new complaints associated with epidural steroid injection procedure; however, he states that approximately 5 days after the injection procedure, he felt a sharp shooting pain down the posterior aspect of both legs to the feet to the feet when lying on his back with his feet on the floor. Otherwise, he reports ongoing axial lower back pain and weakness with no significant radicular symptoms at this time. He reports only mild relief with use of over-the-counter ibuprofen. In addition, he reports of moderate pain located at the low back which describes as an aching, continuous and sharp pain. He rated his pain as 5/10 in severity at the time of visit.
2. EMG/NCV studies consistent with peripheral motor and sensory neuropathies, from October 2008 12/15/15 Progress Report described that the patient has ongoing low back pain. He was last seen on 10/28/15. The patient stated that his current medication regimen has been helpful. He rated the pain 9/10-scale level, which is brought down to 6/10-scale level with the medications.
QEP Scripts for Two Recordings – Audio for Musculoskeletal System; “OK, Team! We have a new patient in Room 3B who is being admitted with a progressive (gradual, advancing) decrease in mobility (movement) of his back and legs, and increase in pain located in the lumbosacral (lower back above the tailbone of the spine) area. The patient’s Primary Care Provider has sent along Computed Tomography scans (CT, a rotating x-ray emitter, detailed internal scanner) showing spinal stenosis (narrowing of the spine causing pressure on the nerves and spinal cord causing lower back pain.) and decrease of the normal lordosis (abnormal curvature lower spine, excessive inward curvature of the spine) in the thoracic vertebrae (upper and middle back). Lumbosacral
He has no Romberg 's sign. IMPRESSION: History of chronic inflammatory demyelinating polyradiculoneuritis. The strength and sensation of his extremities continues to improve after this, with no recurrence of symptoms from this with weaning off of Imuran. PLAN: Continue off of Imuran. Continue observation from a neurological standpoint.
All C-8.1s were held in abeyance. Please immediately schedule an IME with an orthopedist on the issue of the neck and the shoulder as we only have forty-five (45) days. My office will schedule the depositions of Dr. Shah and Dr. Guchinskiy. Dr. Guchinskiy is with Crystal Run in Newburgh and Middletown and he examined the claimant on 07/07/17. If you have any questions regarding this hearing, please do not hesitate to contact me.
Pain is located in the low back and left leg, rated as 4/10. There is associated numbness to the left thigh and foot, and pins and needles sensation to the left foot. He continues with Percocet with 80% help with use. CURES was very consistent and appropriate.
Dr. Kristen Radcliff - Spinal Surgeon with the Rothman Institute An experienced physician who holds certification through the American Board of Orthopaedic Surgery, Dr. Kristen Radcliff holds a cum laude BS in biology from Harvard University and an MD from the Duke University School of Medicine. She completed a residency through the Department of Orthopedic Surgery at the Baylor College of Medicine and a spinal cord injury and spine surgery fellowship through Thomas Jefferson University. In addition to her fellowship at Thomas Jefferson, Kristen Radcliff, MD, served appointments at the University as both an associate professor of orthopedic surgery and an associate professor of neurological surgery. Since 2020, Dr. Kristen Radcliff has treated
The patient has completed physical therapy, time, rest, medications, chiropractic care, and acupuncture with no alleviation of the pain. Significant pathology on the MRI is noted with degenerative disk disease, neural foraminal stenosis and a nerve root impingement in the cervical spine. Treatment plan includes epidural at the bilateral C5-C6 level, continuation with home exercise program and medications and follow up in 2 weeks.
States I have bone disease, I had bilateral hip replacement. I need knee replacement. I can’t walk.” The record goes on to state “patient walked out prior to MSE with steady gait on
He has also recently received part of a series of synvisc injections, which have helped somewhat. He reports increased pain since last
All health providers describe neck strain radiating down his shoulder. He had physical therapy three times a week for 6 months but still experienced pain at the end of 2012 to the beginning of 2013 when his physical therapy ended. DHD referred him to Dr. Katzman who discussed the need of surgery to his left shoulder which he didn’t have because no fault cut him off. He also had an MRI of his cervical spine and
Although CMS can issue noncoverage NCDs, such as acupuncture in 2004 and artificial lumbar spinal disk replacement in 2006, it rarely does so. The majority of NCDs establish evidence-based conditions of
His doctor recommended the applicant to have acupuncture and physical therapy. He said that there has not been any discussion of surgeries or injections. He takes Naprosyn three times a week. He claims that he began having radiating pain into his knee since he started treating at Southland Spine. He claims this pain occurs three times per month.
Classroom Observations Mrs. Canada is the first grade teacher that I observed, and the subject that she was teaching was reading. She had planned well-organized power points and crafting materials in advance, so she was prepared for the lesson. The two times I observed, the lesson that was being taught at both times was reading. Children in the classroom used a lot of previous knowledge for the lesson.
I attended Reshogofaditswe High School. I observed grade 9 classroom, that consist of 40 learners. It was an eye opening experience, as I have not done my teaching practice at a High School before. The atmosphere at the school is very welcoming.