He has some numbness and tingling into the posterior aspect of the left thigh and states that after the facet joint injections, he has had about two to three weeks of complete pain relief. He has noticed increased pain in the last couple of weeks with symptoms similar prior to the injection. He has been using ibuprofen and Robaxin with good benefit and states that the pain is usually worse with activity, standing for long periods of time. The patient had previously completed six physical therapy sessions, 12 chiropractic sessions, and 12 acupuncture sessions, but continues to have symptoms down his left
Speech and language functions are adequate. Patient is alert and compliant. Patient reports no hallucinations. MEDICAL DECISION MAKING AND OTHER DIAGNOSIS Axis I Bipolar 2 disorder, Hypomania and depression Axis II Differed Axis III None Axis
DOI: 4/25/2014. The patient is a 37-year-old male laborer who sustained a work-related injury to his wrist, left elbow, ribs, and head when the ladder he was on collapsed. MRI of the right knee obtained on 01/26/16 revealed the following: medial meniscus: Grade 2 mucinous change, posterior horn; discoid lateral meniscus; anterior cruciate ligament (ACL) partial tear; medial cruciate ligament (MCL) thickening due to sprain or stress change; 1.5 cm osteochondral lesion at the medial femoral condyle with differential diagnosis that includes osteochondritis dissecans versus old osteochondral impaction fracture; medial femorotibial joint space narrowing; and Patella chondromalacia grade 1/2. Urine drug screen result dated 06/28/2016
Fundus assessment (done using ophthalmoscopy and fundus photos) showed CD ratio of 0.5 (H+V) OU which followed ISNT rule. The disc appeared slightly pale with healthy margins and peripapillary tissue. AV was ratio of 1:3, the macula appeared healthy and the foveal reflex was seen. Upon viewing the peripheral fundus, pigmentary mottling and bone spicule were seen in all four quadrants. Slit lamp assessment showed clear healthy lids and lashes with open puncta.
She reports of increasing lumbar pain, described as aching, burning and stabbing that radiates into the bilateral lower extremities with paresthesias and numbness. Her pain level is an 8/10. The pain is more prominent in the left upper extremity. She did undergo the bilateral L4-5, L5-S1 facet block which she reports was 75% beneficial in decreasing the deep stiffness aching sensation.
Phil Bury is a 64-year-old man with a history of chronic cough, moderate sputum production and breathlessness on exertion. He has had several hospital admissions with exacerbations and chest infections in the past three years. He was employed as an electrical engineer until three years ago when he was forced to retire due to ill health. Mr Bury is a life-long smoker, smoking between 30-40 cigarettes a day although he has tried to cut down. Following deterioration in his wife’s health due to a stroke last year, they now live in sheltered accommodation.
DOI: 6/21/2014. The patient is a 52-year-old right-handed female technician who sustained a work-related injury to when metal paper holder sprung out and hit her. She did not lose consciousness but was disoriented and confused. Based on the latest medical report dated 02/27/16, the patient reports that after the injury, she had headaches on the right side of the head and had tinnitus almost right away. She developed blurry vision the next day, nausea disruptions to balance and hearing changes on the right side.
Primary Diagnosis: Disorder of bone/cartilage. Secondary Diagnosis: Obesity. This was a Reconsideration- Disability Hearing Unit (DHU) case, stated his medical condition was worse than ever before. 41-year-old male alleged sarcoidosis of skin and lungs, severe depression, lumbar facet syndrome, degenerative joint/disc disease (neck, lower back, bilateral knees). Limited range of motion left shoulder, morbid obesity (6’2” and 291 pounds), chronic lower back pain, lumbar spondylosis, osteoporosis (knee).
occasions for assisting in suicide; so popular is he that he has been labeled "Dr. Death". One of his "patients", was Ronald Mansur, a real estate agent. Mansur had been too sick to drive and carried a morphine pump with him to fight the pain. He had bone and lung cancer. He eventually began to almost go insane from the pain, and he called Dr. Kevorkian.
DOI: 05/21/2015. Patient is a 52-year-old male control operator who sustained an injury to his low back after lifting 42-pound rolls. Patient is diagnosed with lumbar isthmic spondylolisthesis, lumbar degenerative disc disease, lumbar foraminal stenosis, and lumbar radiculopathy. MRI of the lumbar spine dated 09/01/15 showed L5 to S1 pars defects with mild spondylolisthesis. There is a 4.5mm generalized disc bulging and redundancy of the disc annulus with impingement of existing L5 nerve roots at neural foraminal level, right greater than left.
He has failed more conservative treatments, including NSAIDs. He is weaning off his medications. CURES report was reviewed. The patient stated that pain is relieved by medications and aggravated by sitting and standing. Current meds included morphine, amlodipine, maxzide, ecotrin, halfprin, testosterone injection, Suboxone, Norco, dyazide and alprazolam.
DOI: 09/26/2010. The patient is a 63-year-old male route sales representative who incurred a work-related injury to his left foot and ankle due to repetitive job duties. Based on the progress report dated 03/18/16, the patient presents for reevaluation of his left ankle. He underwent left ankle surgery on 10/15/13. His left ankle has been worse the past two months.