Harnessing Experience

groups of her lower extremities bilaterally. Sensory exam is normal to pin prick and light touch

On the Statement of Medical Necessity on MG-2 form dated 03/14/16 by Dr. Charles Gordon, patient presented with neck pain. The symptom is alleviated by injections and medication. It is located in the mid neck area, trapezius muscle, and in lower cervical/shoulder area. It is d described as pressure, shooting and burning, and radiating to the scapula and shoulder. Plan is to undergo a left cervical facet rhizotomy at C3-4, C4-5 and C7-T1 then right cervical facet rhizotomy at C3-4, C4-5 and C7-T1.

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

Based on the medical report dated 04/01/16, the patient complains of pain in the neck with radiation to bilateral upper extremities and pain to the lower back with radiation to the lower extremities with tingling/numbness and weakness. He rates his pain 8-9/10.

The carrier has denied coverage of an MRI of the cervical spine as not medically necessary. There is a letter to the member from the carrier dated 11/05/15. In the letter, the carrier states in part: “According to the American College of Radiology Appropriateness Criteria regarding MRI of the cervical spine, MRI may sometime be beneficial in patients with neck pain and no history of trauma and no neurologic deficits. If their neck pain is persistent and they have had findings of degenerative changes on plain radiographs and “following failure of conservative management only in select cases.” In this patient’s case, the patient has self directed her care, having seen specialists and chiropractors without a firm diagnosis

On 5/30/18 I met Mr. Reid at the office of Dr. Rampersaud. I explained that the insurance carrier is not getting the form filled out correctly regarding his narcotic medications. I asked his permission to meet with Dr. Rampersaud when they go back to the examination room and leave once we discussed the form. Mr. Reid agreed. He reports that since having the spinal cord stimulator battery replaced his pain is 60% better. He reports his pain level is a 6. He continues to have his legs give out unexpectable. He reports needing help from his wife to roll him over when he is in bed. He continues to use a wheelchair. Mr. Reid said he wanted to speak with Dr. Rampersaud regarding decreasing his medications at least for the summer. He feels the warm weather makes his pain more tolerable.

R.P. is a 74-year-old married Caucasian female that is a homemaker that lives at home with her husband. Reason for her care is due to a recent fractured left hip and left wrist. She stated that she slipped on a rug in her home and landed on her left side. R.P. reports pain being 10/10 and sharp and radiates all over body stating, “even the slightest touch of skin hurts so much”. It all began a few minutes after the fall. Pain is alleviated with narcotics (hydromorphone and morphine) and immobilization.

Pt is seen in the ER room and states that he is tired and had tremors so he came to the ER to be on the safe side. Daughter also states that he had tremors in the morning and. Patient's CC is that was tired and had tremors in the morning. States that he stays alone, was worried, and has no past history. Assessment of the head shows no sign of deformities or trauma. Neck shows no sign of deformities or trauma. Chest shows no sign of

Per medical report dated 10/26/15 by Dr. Parsioon, the patient was initially seen on 9/14/15 for evaluation and treatment of cervical pain. At that time, he had neck pain without radiculopathy and bilateral hand tingling. IW stated that physical therapy made his neck pain increase and he wanted to make sure that it is okay to continue this. His chief complaint is pain in his neck radiating to the right shoulder and arm. He states the only time he gets the tingling sensation in the hand is

On 2/21/17 I went to the office of Neurosurgeon Dr. Schell. Ms. Ostrander had arrived and left before I arrived. Dr. Schell will not speak with case managers. I called Ms. Ostrander. She said Dr. Schell looked at the MRI disc and told her the compression fractures to her Thoracic spine had not healed and she needs a vertebral plasty done. This is going to be scheduled. He also told her that she has compression issues in her cervical spine but he would deal with this after the thoracic spine is taken care of. Dr. Schell’s office is supposed to schedule the surgery. The MRI done on 2/16/17 with and without contrast showed that the mild compression fractures at the anterior superior endplates of T5, T6, T7, and T9 are healed.

Patient has a history of a myocardial infarction (MI, or also known as a heart attack) in 2004, she had a hip pinning in 2005, and a traumatic amputation of fingers on her left hand in 1974 from a lawnmower accident.

Kristie had a road traffic accident some time ago and had concerns about a throbbing pain in her lower back and neck. She also had concerns about a slight pain in her shoulders.

The patient tells me she was cutting an avocado on September 17th. She said she was using a knife to remove the pit of the avocado and was holding the avocado in her left hand, the knife in her right hand, and was trying to stab at the pit. Unfortunately, she missed the pit and cut her hand. She said the wound was to the area above her fifth metatarsal, more on the palm side, than on the finger side itself. She said right away it was extremely painful and she noticed after some of the pain dissipated, that she was feeling a little numbness there. She said initially she did think much of it, but when she talked to her husband about it, he was worried about the numbness and prompted her to go to the emergency room. She was evaluated at Exeter Hospital. There, the wound was irrigated. She had two sutures placed. She did receive a tetanus vaccine while there, as well and was sent home. She was told that perhaps there was a mild injury to the nerve, but they did not think that there was a true severing of that nerve. She said she did not think much of it. The cut seemed to heal fine. There was no redness ever. It does not, in her mind, seem to be swollen. However, just in the last week, has noticed worsening types of pain. The pain is not over exactly where the stitches were, but more proximal, as well as if she has her fifth finger fully extended, she feels pain

Unfortunately I have been in significant pain with my neck since Sunday and have had to visit a chiropractic clinic. I have had an assessment and diagnosis and receive my second treatment session tomorrow. The clinician informed me that my pain and restricted movement is a combination of moving things around at home, falling asleep in front of the telly and the formation of scar tissue, I’m not sure of this this correct medical term. It seems that my neck has degenerated beyond my years and that I am now likely to suffer after minor strains on neck which previously wouldn't have been an issue before the accident.

History of Present Illness/Interval History: The patient initially presented to the Emergency Department on Monday after developing severe lower back and leg pain accompanied by fatigue. The patient had attended and participated in her aunt’s wedding on Sunday evening and had spent a good portion of the evening dancing and helping out with the wedding. The patient took ibuprofen (200mg) twice without relief. On Monday, after being in too much pain to attend school, the patient presented to the ED. After doing x-rays of the lumbar spine, sacroiliac joints and sacrum which showed no abnormalities and ruling out a neurological cause for her pain, she was discharged with ibuprofen treatment for lower back pain secondary to strenuous exercise. The next day, (which is the day of admission) the patient had developed a cough which produced a dark yellow sputum and continued to have lower back pain. This prompted the mother to bring her back to the emergency department for further evaluation. On presentation back to the ED, she described the pain as being the same as the day before, rated an 8/10 in severity, non-radiating and constant. She could not describe the quality of the pain