Interview With Dr. Eigner's Case

I have spoken with the home care nurse regarding the wound and the physical therapist and occupational therapist. The physical therapist recommended a front wheeled walker as his weight bearing activity was progressing, including his transfers and more independence. The occupational

On 9/23/16 I met with Mr. Russell at the Covenant Occupational Medicine. Mr. Russell said his pain level is at a 1 to 2 now. He is able to tolerate sitting, standing and walking more since starting physical therapy. He reports he is doing a home exercise program also. Dr. Eckstein said he would increase his work restrictions. He would like him to have 2 more weeks of physical therapy. He hopes at the next appointment to be released.

DOI: 1/23/2014. This is a 36- year old male relief driver who sustained injury while he was putting away the automatic tarper when he was struck on the right shoulder and got driven into the ground and twisted his right foot. Per OMNI, he was diagnosed with right shoulder strain, and back/neck/right foot fracture. As per office notes dated 6/3/16, the patient is complaining of numbness in all extremities specifically the bilateral feet, arms and bilateral elbows. He has had a flare-up of pain that past couple of weeks around lateral column of the right foot made worse with walking and standing. He has been taking Neurontin 300 mg thrice a day which is helping control his symptoms. He apparently had a bilateral upper extremity upper extremity

I spoke with Mr. Sutter several times since 3/2/17. Mr. Sutter moved his medical appointment from 2/23/17 to 3/2/17. I was not unable to attend nor was I able to find a co-worker to attend. I spoke with Dr. Olenyn’s office staff many times for updated scripts and next appointment time. Mr. Sutter has lymph edema to the right and left legs. He was supposed to elevated and also wears compression stocking. His legs are so big the stockings cut in. Dr. Olenyn told Mr. Sutter he must get the swelling down because that will affect the healing of the fractures. He is at high risk for infections from open skin. Some of the bones are healing but not all. Mr. Sutter continues to use a bone stimulator daily. I have spoken with Mr. Sutter and

The expectation dates for David’s reviews are based on a two week schedule; See Appendix A. Return to Work Plan.

Treatment plan includes follow up evaluation in 6 weeks, follow-up visits and right ESI at L4-5 level as the patient has persistent subjective complaints suggestive of radiculopathy. The epidural injection is required because of spinal surgery recommendations.

The patient has attended 3 PT sessions for the ankle per daily note dated 04/05/13.

On 12/29/17 I met Ms. Becquette at the office of Dr. Saleh. She arrived ambulating with crutches. She had on an ankle brace and a full leg brace. The pin sites have all healed. X-rays done today showed that there is bone healing, the fractures have not fully healed yet, there is also some osteopenia, which we would expect from the dis- use of the bones. She can only bend her knee to 26 degrees, the ankle she cannot bend it is dropped and contracted, and she is able to wiggle her toes. The numbness she has had to the leg and foot is gone. The EMG has not been done yet because of Mom's schedule. She said she would call and make an appointment soon. Physical therapy is making some improvement. Dr. Saleh said he wants her to work really hard in therapy, he said it would be a last resort to go in and release the adhesions to the knee and the Achilles tendon for the ankle. Dr. Saleh said he feels she can work through this. She is allowed to bear weight as tolerated. The new brace has not arrived yet and is supposed to be in next week. We did address the attendant care and Mom was hesitant to decrease to 8 hours a day. Ms. Becquette will be going back to public school on 1/19/18. Physical therapy will continue even after her return to school.

I s/w Dr.Kim he will see pt at rad dept pt is there now for Paracentesis he is waiting for a room s/w nurse at PIH she will contact Dr.Kim once Pt is in a room. Also I s/w sister Teresa whom stated pt has been declining for the past week c/o confusion, nausea, loa, abd pain also states patient is on lactulose.

After undergoing surgery to reconstruct the lateral collateral ankle ligaments, the patient’s lower leg, ankle, and foot will be immobilized in a cast for six weeks. The patient will be touchdown weight bearing around 2-5 days post-surgery (Sherry, 2014). Upon removal of the cast, he or she is ready to begin the therapy program. The program is centered on enhancing the mobility of the talocrural and subtalar joints by strengthening the flexor and extensor muscles of the lower leg and foot (Moore, 2016). Treatment will progress in difficulty through three therapeutic exercises. Each therapeutic exercise will consist of three phases: the preparatory phase, the force phase, and the recovery phase. This slow gradual

This surgery was performed three days following the accident, due to swelling of the affected limb.

S: Pt. reports no pain in the residual limb but still has difficulties getting in and out bed independently. Pt also complains of loss of balance when hopping from the kitchen to the bathroom c the RW. O; Pt. began the session c vital signs assessment: BP, HR, RR and SpO. Pt. performed Functional activities. Bed mobility: Supine to sit, sit to supine x5 Mod.I. Patient completed x3 standing pivot transfer Mod. I in order to improve getting in and out of bed without difficulties. Pt. also performed pre-gait activities: Sto S x15 c one arm support and prolonged standing c RW x5, 10 sec holding to improve balance. Pt. hoped about 16 feet c RW Mod.I. Pt. educated in HEP during TE training: Clamshells c GTB seated 3x10; Adduction ball squeezes

With the additional image # 4 this changes how this person will do in rehabilitation. Given the presumed medical diagnosis of diabetes, accompanied by the left great toe amputation, the changes in the integrity of the foot as a result of the diabetes, and fibular/ lateral malleolar fracture course of rehabilitation for this person will be different. According to Kristiansen (1980) in the diabetic patient, fractures of the ankle are the result of neuropathic joint changes. Diabetics often have impaired pain sensation, therefore pain is not a reliable indication of the state of the fracture, and the ankle must be immobilized and the patient non weight-bearing for size weeks, including malleolar fractures (Kristiansen, 1980). Past medical history, age, comorbidities, lifestyle will all impact how this patient will do in rehabilitation. His physical therapy management is not going to be as aggressive and will take longer as compared to an individual who has only sustained a lateral malleolar fracture, on account of the absence of the great toe and clawed toe deformity. While the left ankle is immobilized, this person can be strengthening the right leg and hip and knee musculature of the left leg. Once it is determined that his fracture is stable, this person will need to begin his ROM and strengthening exercises of the left ankle and foot as tolerated, along with gait training. Shoe wear and orthotics will be major factor, as with all

Per IME dated 07/15/2015 by Dr Varriale, physical therapy should be continued twice a week for four weeks for the left hip. One further orthopedic visit within four weeks with the claimant’s treating doctor is warranted. There is no need for transportation, household help or future diagnostic

I think he is very smart as he said in the interview for matriculation at Harvard University, “I’m fucking smart,” but his intention and attitude was too much wicked towards people who he bankrupted as a leader of a company. The neuropsychologist Ian Robertson at Trinity College, Dublin (2012), used Jeff Skilling’s case when he demonstrated the critical sample of addiction to power on his book. Professor Robertson described that testosterone is strongly boosted up after many leaders have experience of victory and power. Some are apt to be addicted to power if they continue to experience it. This status quo is called a winner effect. Mr. Skilling had a reputation for being arrogant and laid off the bottom 10 percentages of executives and staff members whose business results he evaluated. Moreover, he had ever shown even his middle finger to workers who lined up in the parking lot because of him, passing by them. He had sold his shares of Enron three years before Enron filed for bankruptcy protection. How wicked he is. When the professor researched on Jeff Skilling with a question of what he was when he was young, he found out that ironically, Mr. Skilling’s friends at Harvard remembered him as being common and nice. Mr. Robertson described that power is a necessary evil for a leader, but Mr. Skilling spoiled himself with addiction of power.