REASON
CHIEF COMPLAINT: Chronic lower back pain.
HISTORY
The patient is a 40-year-old male with chronic lower back pain and radicular symptomatology in the left lower extremity and then the right. The patient underwent epidural steroid injection therapy on 08/18/2016. The patient underwent a right L5-S1 and an S1 transforaminal ESI under fluoroscopic guidance. The patient states that he did fairly well after injection therapy up until 12/2016 when his symptoms began to come back though not nearly as intense as they were before. Previously, he was having the radicular complaints on a continuous basis. Currently, he states that he has the same type of symptoms but they are not present all the time. He also notes that his symptoms may have also gotten worse as a result of a recent urologic surgery that he underwent which required him to be lying on his back with his legs elevated for several hours until the procedure was completed. He currently denies any new changes with regards to his bowel or bladder function or increased pain with Valsalva-type maneuver. No recent fever or infection. No weight loss. No new constitutional symptoms.
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Weight 195.2 pounds, BP 118/68, pulse rate 63, temperature 97.4, respiration rate 14. The gait once again is not antalgic. He can perform a full squat without difficulty. Single leg squats reveal knee adduction bilaterally, which is mild. Palpation of the lower back shows only mild tenderness at the lower lumbar paraspinals and only at the right sciatic notch, not at the sciatic nerve trunk exit. Motor power in the lower extremities is at the 4+/5 both proximally and distally. Sensation remains diminished in the L5-S1 distribution. Reflexes were present at the knees bilaterally and absent at the right ankle, but now present at the left. Toes were downgoing. The straight leg raising maneuver was negative. The figure-of-four test revealed lower back pain
For the lab test part, in this case we can do a muscle biopsy on him. A muscle biopsy is a procedure that removes a small sample of tissue for testing in a laboratory. The test can identify the disease is caused by nerve or by the muscle atrophy.
Currently, I am involved in a prospective cohort study with other colleagues from King Fahad Medical City that aims to study the effect of a low back care educational program on low back pain prevalence among health-care professionals.
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
Witter, R. Z., Martyny, J. W., Mueller, K., Gottschall, B. & Newman, L.S. (2007). Symptoms
Definition of the condition: " Chronic pain is described as a long-lasting pain that people experience beyond a normal healing time (Hasenbring, Rusu & Turk, 2012). This time is usually up to three or six months prior to an incident (Hasenbring, Rusu & Turk, 2012). Chronic back pain can include a common diagnosis of muscle spasms, back strain, or myofascial syndrome (Weiner & Nordin, 2010). There are three different types of chronic back pain: simple musculoskeletal back pain, spinal nerve root pain and serious spinal pathology (Jackson & Simpson, 2006). Hasenbring, 2012.
In a society where wealth and status are often tied to personal worth, the correlation between affluence and moral character should be questioned. The Catcher in the Rye by J.D. Salinger explores this question from the perspective of the protagonist, Holden Caulfield. The book is set in the 1950s, and follows Holden’s retelling of his wild two-day adventure that takes place after he was expelled from prep school. Through Holden’s ambivalent attitude towards materialism and social status, Salinger suggests that good moral character and integrity is not directly proportional to wealth. During Holden’s negative encounters with the wealthy, Salinger reveals that riches alone do not create good character.
The patient was receiving a combination of oral prednisolone, hydroxychloroquine and methotrexate for her complaints of seronegative spondyloarthropathy. Further, to counter her dysthymia, she had been initiated on oral escitalopram two weeks prior to presenting in our hospital. Her blood sugar levels were being managed using a combination of fast and long acting insulin. Further, on obtaining a detailed history and after a thorough clinical examination, the mild abdominal pain was attributed to severe constipation. Her initial work-up revealed her to be severely hyponatraemic with serum sodium level of 107 mmol/L. Her previous sodium levels, prior to starting escitalopram, was normal (137.6 mmol/L). At this juncture, in view of a possibility of drug induced hyponatraemia, escitalopram was withheld. Further investigations revealed high urinary sodium level (36 mmol\L), elevated urinary osmolality (291 mmol/kg) and reduced serum osmolarity (235 mmol\kg). The low serum urea (11.0 mg/dL), serum creatinine (0.4mg\dL) and low uric acid (2.2 mg/dL) added substance to the
Patient comes in with a complaint of chronic right lower extremity pain due to a surgery that he had back in 2011. He apparently does have hardware in the proximal tibial area and apparently, this has been chronically infected. He is supposed to have this hardware removed by his orthopedic surgeon but he got incarcerated prior to having that done. He is also following with infectious disease. He states he has had an infection in there for at least 2-3 years and currently is on Bactrim suppression therapy. He also has some acne on his face that he would like to try Cleocin for which has worked well in the past. Otherwise, his pain has been his biggest issue. He understands that we cannot prescribe narcotics but he states that
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.
A Case Analysis of Human Factors in The Crash of UPS 1354 Robert P. Drummond Embry-Riddle Aeronautical University-Worldwide October 19, 2016 Summary In the early hours of 14 August 2013, An Airbus A300 Cargo plane operated by the United Parcel Service experienced a Controlled Flight into Terrain less than one-mile South of its destination, the runway at Birmingham-Shuttlesworth International Airport (NTSB, 2016). The aircraft was operating under normal parameters, with one exception; the landing would be performed without the normal full complement of navigational aids (Fox News, 2014). The crew of the airliner was unable to adequately guide the craft onto the runway with the modified equipment, and unfortunately both the Pilot in Command and the First Officer were killed.
In February of 2016, I released my book Life Beyond Chronic Pain: The Step-By-Step Guide to Healing Chronic Illness Naturally. It’s done well on Amazon Kindle so far, and it has gotten great reviews. I’m very proud of its success!
Advice on current best practice in the structure and operations of the ICM model for rough sleepers with complex needs
Significant pain, with no physical cause, that disrupts the client’s life leaving them depressed and anxious which contributes to a cycle worsening the pain.
There are many people of all walks of life who suffer with incapacitating back discomfort. Unfortunately, there are a lot of sufferers who don’t know how to treat and banish back discomfort from their life permanently. The article below can help you find ways to get rid of back pain for good. While waiting to get medical attention for an injured back, it is common to experience extreme discomfort while sitting down and lying in bed.
If you’re in chronic pain, it’s important to know that you already have the tools to reduce the intensity of your pain. Body discomfort and chronic pain is as much about how we think about our body and live in it, than it is about the specific syndrome or diagnosis we’ve been labelled with. I believe this so much! Without putting myself out of a job here, relying on just other specialists to heal really isn’t a good approach to managing your pain and injury, by doing this we forget in a feat to alleviate our pain, that we actually have ourselves