Jimmie Bowman was seen in followup for CIDP, causing previous weakness and numbness of his distal lower extremities. He states that the strength of his distal lower extremities [____] continues improved and is staying normal. He has occasional mild feeling of numbness of his feet, but states this is staying down to what he can tolerate. He is not having pain of his feet. He is no longer on Imuran. He was on this previously for CIDP.
ROS: Genitourinary - History of BPH, for which he is on tamsulosin.
EXAMINATION: He continues awake and alert. He converses easily and appropriately. He is in no acute distress. Blood pressure 120/78. Pulse 70 and regular. Weight 177 pounds. Height 5 '6". Cranial nerves continue intact, including the extraocular eye movements being intact without nystagmus. Visual fields are full in both eyes. He had no papilledema or atrophy of either optic disc. Pupils react from 4 down to 2 mm, bilaterally brisk and round to light and accommodation. He continues to have good strength with normal bulk and tone throughout his extremities. He had normal sensation to light touch, pinprick, and vibration sensation throughout both upper and
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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. Followup in one year to make sure he is not having any worsening of the strength or sensation of his extremities. I have advised him to contact me soon than this, though, should he have worsening of the strength or sensation of his extremities, especially of his distal lower extremities or other neurological difficulties before then.
Thank you for allowing me to participate in this patient 's care, Craig Johnson,
Circumstance: Ayden will maintain contact with medical team monthly. Ms. Smalls (MHP) and Mrs. Wigfall (MHS) discuss Ayden’s recent medical appointments and therapy. Action: MHS report Ayden will start physical therapy at an outside clinic. MHP and MHS discuss Ayden receiving all therapy at the same clinic to reduce several therapy appointments during the week. MHP and MHS review reports given since last week.
There is decreased sensation of the left anterior thigh. He has forward leaning stiff gait with ability for heel and toe rise.
Range of motion is limited with flexion and extension of 20 degrees limited by pain. Spurling test is positive. Sensation is diminished C5-C6 bilaterally. Diagnoses are cervical strain, bilateral C5-C6 cervical radiculopathy, and diminished sensation, C6 reflex bilaterally.
CURES report was reviewed. Last urine drug screen on 12/04/14 was appropriate. On examination, there is tenderness upon palpation over right medial knee joint line. Mild atrophy of right medial quadriceps muscle is noted.
Gait Markedly antalgic. Equivocal Romberg. DTRs 2+ in the upper extremities and knees, trace at the ankles. Labs/Studies CAT scan and C-spine are as noted
A- Based on this writer 's assessment, the patient appears to be good-spirited about his recovery, alert, and oriented. There 's no evidence of SI/ HI. P-The patient will continue to attend all scheduled
His appetite is much better. Mr. Liwak said he really doesn’t have much pain other than the arthritis pain he has in his left knee. He normally has an injection with Dr. Wilson to the left knee every 90 days. He is supposed to have one at the appointment with Dr. Telehowski on 2/27/17. This helps with his pain.
He does have a slight elevation in his total bilirubin is 0.3. Other liver function testing is normal. He has previously had a liver ultrasound back in October of 2014, showing hepatic steatosis, otherwise negative abdominal ultrasound. He has previously has declined evaluation by gastroenterology or hematology and he is still not sure that he wants to do that. He is not having any belly pain.
He was a known heroin user and was in and out of treatment. You were able to see the track marks in both of his arms. His skin was cyanotic, pale and clammy, along with pinpoint pupils. The ALS provider struggled to get an IV due to the long term drug abuse, so his veins were not adequate. Also, there wasn 't a clear report on when the patient was last seen at his baseline and responsive.
Both the ambulance and the police arrived at the scene and took him to Kings County Hospital but because of the long wait they went to Beth Israel. His aunt drove him and his girlfriend. At the hospital he complained about his shoulder and wrist on the left side. He doesn’t remember the hospitals instructions regarding follow up care and he never returned to the hospital. His record says he complained about back problems and that he refused immobilization but he did go to DHD Medical and Dr. Katzman.
Skin warm and dry. Unlabored respirations with no use of accessory muscles. Breath sounds clear in all areas. Braden score is 23. Colostomy present on left lower quadrant of abdomen.
He had a pituitary tumor removed, an operation on his knee and metal pins placed in his hips. And his jaw was split into fine pieces in order to be expanded because of the acromegaly. Doctors Notes • Swelling of right knee. • Ulcerated sores on lower left leg. • Abnormal hormone levels.
Symptoms can also cause difficulties in determining if an object is hot or cold, a lack of balance, or “slapping feet”, a condition where feet slap the floor when walking because the feet cannot be lifted very high. Several different forms of CMT provide different sets of symptoms; Roussy-Levy Syndrome includes high arches, low reflexes, tremor in upper limbs, sensory loss, lack of coordination, and distant limb weakness (Krajewski). CMT3 is a name given to Dejerine-Sottes Syndrome, a severe early development of the disease that can either be classified more broadly under CMT1 or CMT4. CMTX5 is a distant case of CMT which, in the worst circumstances, can lead to deafness and vision loss (“Understanding CMT”). Before many of these symptoms can become prevalent, a diagnosis can be made using Nerve Conduction Testing.
Gait Normal. Negative Romberg. DTRs 2+ throughout. Toes are downgoing.
Data regarding Socio demographic profile, clinical profile, lab parameters, ECG, ABG, Radiological investigations will be collected. Patients will be followed up every day. Outcome of the patient will be assessed at the time of