Celexa 20: A Case Study

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.

As per medical report dated 2/18/16, patient complains of constant low back pain in a L4-5 distribution. Patient has undergone physical therapy as well as medication management without amelioration of the pain and continues to be symptomatic. He had previous epidural steroid injection. He also had acupuncture

Based on the medical report dated 12/28/15, the patient continues to report lower back pain that radiated to his left leg to his anterior/lateral thigh and anterior lower leg (shin) to his ankle and paresthesias. He has completed a conservative course of PT in which he underwent aquatic therapy. He was seen in October of

Based on the medical report dated 12/15/16, the patient complains of constant pain to her neck, bilateral shoulders and bilateral knee/leg. Pain is described as sharp, stabbing, achy and

Subjective: R.S. reports experiencing aching, burning pain, sometimes cramping-like pain sensation in feet and legs with walking. She states the pain comes and goes, although before, the pain went away quicker with rest or no pain at all when the least active. Lately, she noticed that the pain takes longer to go away. According to R.S. the pain started two months ago. The pain has been worsening the last couple of weeks. She feels weak and tired with pain. During the interview, she has pain with the brief walk from the parking lot. She has been unable to do many chores at home, avoiding the stairs. Patient states moderate relief with use of over the counter extra strength acetaminophen.

Based on the latest medical report dated 10/6/16 by Dr. Simhaee, the patient has been having low back pain. The pain in his back is a constant ache with a burning sensation, which he rates an 8/10. The pain

On admission, Ms. Kelly complained of low back pain ranging in intensity from 7 to 8, out of 10, on the pain scale where 0 is no pain and 10 is the worst imaginable pain. She subjectively describes this pain as throbbing, stabbing, burning and radiating along the posterior and anterior aspect of both upper legs, left worse than right. She has sharp, stabbing, burning pain in both her arms, particularly the left arm, and experiences intermittent tingling and numbness sensations in both her hands as well. She has pain in her neck and shoulder that she defines as tension-type pain. Factors that can aggravate the

Per the medical report dated 06/07/16, the patient complained of pain with a pain rating of 6/10. He states continued relief with use of his current medication regimen.

At today's visit, she is found sitting in her chair. She is awake, alert. She complains of chronic dull, intermittent pain in her right lower extremity with a severity of 4/10. She states that her current pain regimen helps relieve her pain. The staff reports that she her pain regimen seems to manage her pain well. She denies shortness of breath, depression and chest pain.

At today's visit, she is awake, alert and oriented. She is accompanied by her private help. She complains of chronic, constant shortness of breath that is worse with minimal exertion, has not worsened or improved, is on continuous oxygen. She continues to sleep in her recliner due to increased dyspnea when she lies in a regular bed. She has to seep in an upright position that she cannot achieve in a regular bed. She complains of chronic, dull, intermittent right hip, knee and back pain, her hip pain radiates down her legs, severity 2/10. She states that today her pain feel good because she takes her pain medication. She denies chest pain and reports a great appetite and having regular bowel movements.

Very educational post. Looking at all the symptoms and the data given, I would also agree with your priority diagnosis of Sciatica. Here the patient is complaining of acute low back pain which is associated with pain and burning that radiates along the lateral thigh, leg, and foot. Sciatic pain is a sharp, burning pain that radiates down the posterior and lateral leg to the foot or ankle. This Sciatic pain could be related to herniated disk (Dains, Baumann, Scheibel, 2016). According to De Campos (2017), in 90% cases, sciatica is caused by a herniated disc with nerve root compression. Lumbar stenoses and tumors are less likely to cause this. Many people think that the worse the pain, the more likely something bad is going on. However, this

Office notes dated 06/21/2016 revealed that the patient complained of right foot pain with a pain rating of 6/10. Physical examination revealed tenderness

09/30/14 progress report states that the patient has a history of cervical spine discomfort at 3/10, right shoulder discomfort at 6/10