Neurosurgeon Case Study

October 16th 2013 I was at work performing my normal duties, when as I lifted on a box to put it on a self above my head, I felt and heard a tearing/popping sound coming from my left shoulder. I was in serious pain after that. My employer had me feel out an accident report, and then sent me to their doctor. After being examined by the doctor, I was told that I just strained my left shoulder and put me on a temporary restriction, which limited the amount of weight I could lift. I was also told to come back for physical therapy once a week. After 5 weeks of physical therapy and with the pain almost unbearable, I decided to go to my own doctor. My doctor examined me and immediately scheduled an MRI. The MRI showed that I had a tear down the

     The medical staff role in the care of trauma c-spine injuries is to make sure that proper exams are done so that a proper diagnosis can be made. This is achieved by a good physical assessment as well as proper communication with the EMT’s about mode of injury, and evaluation of radiographs that have been ordered. If the radiographs are inadequate to rule out a fracture, then the need for repeated or additional X-rays or a CT scan should be obtained, until all vertebrae are visible and the possibility of fracture can be ruled out. This is how it is supposed to work.

On Tuesday 06/27/2017, veteran Mr. Saenz walked very angrily in my office with his wife about 11:00 AM. I greeted them and offered to sit down; Mr. Saenz and Mrs. Saenz were very upset and asked me where they need to go as they have VA examination, they both said “nobody tells them anything; they have been sitting in waiting room”. They told me that the lady on the desk told them to come to me.

In addition, CA MTUS criteria for the use of epidural steroid injections include an imaging study documenting correlating concordant nerve root pathology; and conservative treatment. As noted above, this is an appeal to the previously denied request on 02/09/16. The appeal letter states that the patient has low back pain. MRI report showed disc bulge at L5-S1 with left neural foramina narrowing. However, 01/06/16 progress report noted that there was no radiculopathy with a negative SLR on exam. The guidelines require documentation of radiculopathy on exam. In addition, there is no documentation of a trial or failure of conservative treatment, including PT, as recommended by the guidelines. Furthermore, there is no documentation of any focal neurological deficits on the exam that would indicate nerve pathology. The motor and sensory exam was normal. Medical necessity has not been established. Recommend

Dr. Abiera had reviewed a September 3, 2010 MRI of the cervical spine that revealed central protrusion/herniation at C3/C4, left paracentral protrusion/herniation at C7/T1, Disc bulges C4/C5, C5/C6 and C6/C7, left paracentral extrusion/herniation at T3/T4 and straightening of cervical lordosis. In addition, Dr. Abiera noted an August 11, 2010 x-ray of the cervical spine which revealed blastic lesions, incidental Clay Shovelers Fractures of C7 and an August 11, 2110 x-ray of the thoracic spine which was

Dr. Adams reviewed the MRI films. The family found a man who makes custom cervical collars in Florida and they asked for a order so they could try and have one made. Dr. Adams said he is more concerned about the Kyphosis. He asked if the collar had been removed. Mr. Messing said he thought the collar could be removed, Ms. Messing said it has not been removed. Dr. Adams said a custom collar is not the solution, he feels she needs a Halo. He said he doesn’t do those any longer. He recommends Henry Ford, Beaumont or the U of M hospital. He ordered a new ct scan to be done. While were in the exam room Mr. Messing called his daughter a nurse practioner and Dr. Adams spoke with her. She will speak with the neurosurgery department at her hospital and find the appropriate doctor. I spoke with Gail after the appointment as she had requested and provided her with an update. Gail had requested an open claim letter so she could make arrangements for her mother to see her neurologist and her PCP but needs a open claim letter. The letter was obtained and faxed to Dr. Kala

Wrong kind of dye used to test the location in spinal cord caused the patient’s death in Tufts Medical Center. The neurosurgeon ask for a specific dye to provide it to the patient’s spine, however the pharmacy provided the different one due to the lack of the proper one. After checking the label, the neurosurgeon injected the dye to the patient’s spine. The patient woke up with a terrible pain and seizures and died the next day. The dye’s label warned against using it in a spine injection.

He told her that she will have some pain and swelling for up to a year. He wants her to wear compression stockings, get back into physical therapy and be fitted for a lace up brace. The sutures to the outer and inner aspect of the ankle were removed. She feels pressure and rubbing from everything on the incisions. Dr. Nwuso told her to stop using the crutches, do not use a cane, and let physical therapy wean her out of the cam boot. When asked for work status, Ms. Iversen said she could not work with a boot or a limp. Finally Dr. Nwuso wrote for her to start with restrictions and work no more than 8 to 14 hours per week. He will advance them as she deems necessary. She will follow up in 6 weeks, on 5/1/17. I asked how her back was doing and she said it was fine. She has completed physical therapy and is doing a home exercise program. She is worried that her cervical spine was damaged. She has a prior issue with her neck. I asked her if her neck is worse or the same than it was. She said it was the same but worries something

Possible symptoms of a herniated disc include pain that radiates through the back and possible down the arms or legs, depending on the location of the herniation. There can also be noted numbness and weakness of the arms and neck. Some people may not even know that they have a herniated disc because not all cases present with leg or back pain. Other signs and symptoms of a herniated disc may include muscle spasms or deep muscle pain. In extreme cases, a patient may present with weakness in both legs and/or the loss of bladder control and bowel control. This is a serious problem called cauda equine syndrome and requires immediate medical attention.

On 7/15/16 I met Ms. Pletscher in the office of Dr. Easton. Ms. Pletscher had a cervical fusion on 6/15/16. Ms. Pletscher was driven to the appointment by her daughter. She was wearing a hard aspen collar. X-rays taken showed that there was good alignment with her hardware. She may now be fitted for a soft collar. The incision is well healed with no signs of infection. She will be allowed to start physical therapy after 7/29/16. An operative report was obtained. Ms. Pletscher had a list of questions. She is concerned about the left shoulder being lower than the right; she also said that it doesn’t seem to be tracking. I did point out that she had already been evaluated by an orthopedic surgeon and the MRA of the shoulder was fine. She agreed

S: Aerotek TM is in HMMA Medical Clinic to follow up with Low Back strain with lumbar radicular pain that radiates down to back of his RIGHT HEEL. According to TM the incident occurred on 6/14/17. TM’s initial radicular pain was down to his left leg but now it is down to his right leg. According to TM for the past 6 weeks he hasn’t done nothing but raying around the house, and his back is not getting batter.

It appears that the treating doctors you constantly echoed in my ear that I am allowed to see under the 504 WORKERS COMPENSATION INSURANCE POLICIAL SUDIVISIONS is now not part of the network or you did not approve the doctor’s visit. I was told by you, Ms. Franco I had two choices to choose from Care Now and Concentra. Care Now was not my choice and I choose Concentra. I had no treating doctor at Care Now and Concentra, I am seeing whoever is on duty that day. I have complied with all asked of me. I have not been given the minimal standard of medical care as of today. My injured happened September 13, 2017, and it was not until October 24, 2017, I had an x-ray taken.

S: TM is here for follow up of her Right Knee Contusion. Tm reports her current pain is 6/10, sore ness that is localized to her right patella area. TM report she did ice her right knee at home last night and she took her ibuprofen this am. She may go see per PCP. TM was informed, if she goes and sees her PCP, it becomes personal condition and TM would not be treated by HMMA Medical Clinic. TM reported that wasn’t a problem with her since she only had one body. Her personal feeling is she needs to go home today and return to work tomorrow since she is still sore from the contusion that had occurred yesterday. Explained to the TM, there is difference between the soreness and

Preliminary conversations with an anesthesiologist have indicated that this DNP project is something they are interested in. If the chart review shows that another antiemetic should be added into the preoperative or intraoperative treatment plan for high-risk patients, this DNP student will need to advocate for the change with individuals high on the chain of command, such as the director of anesthesia and anesthesiologist. Much of the work required for this project will be done by this DNP student, such as the literature review, chart review, and development of the protocol. Assistance will be needed to access the patients’ charts so that data can be gathered.

The DNS is a hierarchical organized system which offers the essential mapping between human names and their IP addresses so that it can provide appropriate access to internet. DNS does so by two essential methods; the first one is authoritative DNS which gives original, actual and complete data to your DNS queries and those data are installed in its configuration system not data that are cached in other servers.