Helper's Case Summary

Thank you for sending James back to see me some 3.5 year since his last appointment. During that time, James has continued to experience unrefreshing sleep with some daytime somnolence. He is typically sleeping seven hours per night with no significant sleep onset or maintenance insomnia. Snoring has perhaps become more prominent of late. Of note, when James was working in Tasmania and exercising regularly, his symptoms were less noticeable with his weight dropping down to around 80kg. With his weight increasing to 90kg, the symptoms have increased.

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

Such patients endure a long list of sleep issues including insomnia, alpha wave intrusions, obstructive sleep apnea (OSA), narcolepsy, and restless leg syndrome.

Medical: Wellness Coach asked Mr. Hallet how was his day and he said he was doing well. He also express that he been taking his medication but the sleep pills is causing to have irregular patterns of sleep. Mr. Hallet has been falling to sleep everywhere even while traveling on public transportation. He also stated that the sleep pills are causing him to even fall asleep during the work hours. Wellness Coach and Family Counselor Clair Arzon discuss with Mr. Hallet that maybe creating sleep pattern will then decrease the irregular sleeping. He express that he has tried everything. Family Counselor Ms. Arzon inform Mr. Hallet to try not taking the sleeping pills for a few days to see how his sleep habits will be. If he gets sleepy then to take walks or drink water to help keep Mr. Hallet up during the day and when bedtime come try turning the TV off therefore you can relax.

Based on the orthopedic consultation report dated 03/04/16 by Dr. Strudwick, the patient reports that his symptoms have returned and he has pain at night with elevation, pushing, pulling, reaching and heavy lifting at shoulder level and above.

Key Facts: Plaintiff and defendants went on a hunting trip. Plaintiff explained them safety rules and instructed them to be careful when shooting. However, while hunting, defendants fired in Plaintiff direction, injuring him in his right eye and face. It was unknown which pellet was fired by who. The plaintiff brought suit for negligence against both defendants.

During the time I spent shadowing PA Constantino, I was able to notice how well rehearsed he was with medical literature. We saw about eight patients who presented with varying complaints such as spontaneous nocturnal leg pain, foreign body in ear, wellness checks, possible celiac disease, refill for medications, change of medications, and cold like symptoms. I was particularly interested on how he handled the case with the spontaneous nocturnal leg pain. According to the mother, the child would wake up in the middle night with bilateral leg pain that was soothed with warm baths and Motrin. The child had not sustained any injuries and after the second episode of leg pain he was taken to the Emergency Room to be evaluated.

Dr. Avi Weisfogel is the founder of Dental Sleep Masters. He is highly experienced in the treatment of sleep and sleep disorders. Old Bridge Dental Care was his first established dental practice in 1999. After 15 years in office, he received tributes from the public. He has been the best-known dentist over a long time. He uses the opportunities that come his way in learning about how dentists and doctors help patients grieved with sleeping illnesses. He established a Dental Sleep Masters to assistance dentists through the aid of oral appliances. Through his company, he has been able to understand sleeping apnea. This information has helped dentists find latent patients and assist them in getting treatment. Dr. Weisfogel got his BA in biology

PO was not present for IOP group today. CDP received a voice message from PO, which stating that she is not feeling well, and will not attend group today. Chrono was made. CCO was notified via OMNI and Email on this date.

The ONS PEP schema has 6 categories and Sleep in the Hospitalized Patient qualifies under the “Effectiveness Not Established” category. As defined on the ONS website, this classification consists of “interventions for which insufficient or conflicting data or data of inadequate quality currently exist, with no clear indication of harm”. Although the data in this article is primarily consistent, it is in fact insufficient. The data is completely based off of surveys based on patient and nurse perception, which is open for bias. The sample size is only 84 patients (Vincensi et al., 2016). Although the data obtained in the surveys were insufficient, there were no indications for harm, therefore classifying this article as “Effectiveness Not Established” as described by the ONS.

Complainant, who is African-American, alleges that Respondent’s employee had a scowl on her face, talked down and attempted to belittle him, but was extremely helpful to a Caucasian customer. Respondent asserts that denies that its employee subjected Complainant to differential terms and conditions based on his race. Respondent asserts that Complainant requested and received the services, in-person hearing regarding his parking tickets, that he requested.

Based on the progress report dated 03/17/16, the patient presents with the same complaints of lower back pain bilaterally and lower extremity numbness and tingling and at times pain shooting down into the Lower extremities, bilaterally. She has been sleeping okay though now since she has been taking Elavil at night as needed.

Thank you very much for referring Neil along for further investigation of likely obstructive sleep apnoea. As you are aware, his wife who I work with at Warringal has been noticing witnessed apnoeas for many years now and has talked Neil into coming along today. Neil in himself sleeps reasonably well and is currently going to bed at around 10.00pm. He will awake between 2.00am and 4.00am and be awake for a short amount of time but will then fall back to sleep until about 7.30am or 8.00am. He wakes reasonably refreshed but of note does have some drowsiness in the afternoon. He will occasionally have an afternoon nap and quite regularly falls asleep on the couch at night. He has been retired for the last 18 months, but prior to that, he

The patient is a 64-year-old gentleman who tells me nine or 10 days ago he started having pain in his right shoulder which started in the morning. He states that prior to this he has been doing increased amount of work at his horse farm. He has had to not only bale hay, he has needed to lift 15 car batteries up onto a platform. He also tells me he caught a heavy "I beam" and felt a jerk of his shoulder several days prior to onset of pain. He states the day after the onset of the pain, he had such back pain, he had a difficult time sleeping. He was taking Advil every six hours, but this was not helping the pain. At that point, the pain was gone up not only in his right shoulder but going up his neck and down his arm. He tells me that he then switched to Aleve, two tablets twice a day and started using ice alternating with heat. He states the ice seems to work magic for him and one week after the pain started he woke in the morning and had no pain. He states that he still gets an occasional twinge, but it is almost completely resolved. He does worry because he works on a horse farm and does not want to have any sort of intervention if not needed. He does occasionally get aches and pains in his shoulders and at this point, this is the state he is in.

DOI: 11/25/2014. Patient is a 47 year old male laborer who sustained injury to his left side of body, back, shoulder, and ankle while he was walking/smoothing tar when he was hit by double bottom truck while working at job site. Per OMNI, he sustained strain to lower back, left shoulder, and left ankle.