Voluntary Observation Report

Based on the latest medical report dated 04/08/16, the patient presents for follow-up of his lower back pain. He is status post radiofrequency facet on the left that initially helped with left sided lower back to 60%. He stated that PT was stopped by insurance for the past 2 weeks. Since he started PT, he has been having increased spasm across his lower back with pain into the left lower extremity. IW feels that PT

Pain is rated at 3-4/10. The patient saw Dr. Abbassi on 05/07/15 who recommended diagnostic medial branch blocks around L4-L5 and L5-S1 on the right side, 2 levels. The patient would like the medial branch blocks to be done. Dr. Abbassi further writes, “I believe he is a candidate for diagnostic medial branch blocks, 2 levels, at the time starting from L4-L5 and L5-S1 on the right, later L2- L3 and L3-L4 if he still has pain, and if these injections help him for a short while but significantly and then the pain returns then radiofrequency ablation is an option.” Diagnoses are chronic fracture of T8, upper thoracic pain, lumbar pain with radiation to left L5 region with left L5 radicular pain with moderate listhesis at L4-5 and mild to moderate bilateral L5-S1 denervation. Treatment plan includes diagnostic medial branch blocks, 2 levels, right sided, at L4-L5 and L5-S1, to await approval for physical therapy, modified duty, and follow-up in 4 weeks.

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

Diagnosis: Other spondylosis with radiculopathy lumbar region, other spondylosis with radiculopathy lumbosacral region, Sacroiliitis, Sacrococcygeal disorders, Low back pain, other intervertebral disc displacement, lumbar region

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.

As per progress report on 5/24/16, the patient is still having a lot of low back pain that radiates to his lower extremities. He continues to find his

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.

As of this report, an MRI done on 03/14/16 showed multilevel lumbar spondylosis. No significant central canal stenosis was noted. There were few areas of neural foraminal stenosis secondary to disc bulging and mainly bilateral facet

02/09/16 Progress Report noted that the patient’s current medication regimen provides moderate pain relief without any adverse effects. The patient stated that he has seen Dr. Smith for IT pump clearance and would like to proceed with the trial. He has chronic lumbar back pain. The pain radiates the left buttock, left posterior thigh, left lateral thigh, left lower leg, left foot, and right lateral thigh. The patient describes the pain as sharp, dull, aching, bumping, stinging, and throbbing. The onset was sudden immediately after the injury. The symptoms are constant and the episodes occur daily. The symptoms are described as severe and worsening. Back motion, lifting, and bending exacerbate the symptoms. Associated symptoms include leg numbness, foot numbness, leg weakness, and foot weakness. Current treatment includes opioid

On 12/19/2017, the claimant presented with lumbar pain. She had continued constant nagging pain with radicular pain in the left lower extremity. She had weakness and numbness. In 2012, she underwent L4-S1 fusion. She had lumbar medial branch block in 04/2017, which helped with the axial low back pain by more than 50%, but the radicular pain becomes severe. She stated that the previous bilateral L5 and left S1 selective nerve root block on 06/21/2017 provided 100% pain relief for 3 days before the pain gradually returned. She also had epidural steroid injection and trigger point injection, which did not help with the pain. The alleviating factors include medication, rest, heat, and TENS unit. The previous physical therapy and chiropractic care had helped significantly. Objective findings showed positive straight leg raise test on the left with tenderness in the left lower lumbar area and bilateral

Mcclurg, the patient presents for his neck pain, described as dull and aching. Treatment to date includes activity modification, acupuncture, and 9 sessions of chiropractic care. Condition is improving. Current care has provided 70% pain relief. Of note, MRI of the cervical spine dated 3/25/2015 revealed C5-6 discogenic spondyloarthropathy with mild central canal stenosis and mild bilateral C4-5 facet arthrosis.

Mr. Anderson continues to report subjective pain levels that exceed 10 even with medication adjustments. He now is reporting severe cervical pain that required an emergency room visit. He has been treating with Dr. Rampersaud for the cervical pain, staff continues to be updated that it is not related to the work injury and keep billing accordingly. Mr. Anderson has also been evaluated by his family doctor regarding kidney stones. He has a history of kidney stones and with the rib pain, they wanted to rule out kidney stones. All tests were negative. He will continue to have a consistent reduction of pain medications at each medical appointment with Dr. Rampersaud. Mr. Anderson has started and failed physical therapy. He had the permanent spinal

Equally important to remember is that the patient has neuropathy which will affect his balance and further increase his fall risk so guarding closely is crucial. In addition, completing positional changes slowly will be critical with the majority of his medications have side effects of dizziness/lightheadedness. Increased risk of bleeding and decreased ability to clot is imperative to realize especially if the patient falls or gets cut during an

While at the Volunteer fair I found out about different organizations that anyone can help with in order to benefit other people. I was able to talk to someone from Alternatives Incorporated where they help give individuals support and help people with disabilities. Before going to this event, I was unaware that such organizations existed and that you could be given a chance to volunteer your time to them. At the volunteer fair you are able to learn about foundations and organizations that you never knew of. I enjoyed the event, I think it is a good way for first year students to contribute to their community. The volunteer fair makes students think about other people and put effort in to doing something other than school work. I would attend

Throughout my time spent on this project, the method that I used to obtain the information I received was through covert observation. Although at the beginning, I did not know that what I was doing at the time, I could not have used another method to obtain the findings than covert observations. I know this because, when I went to observe one time for at least a hour, I tried to get involved in had what happened to one of employees named Larissa who took a drive-thru and was treated very rudely by the customer, who refused to accept that there was not a student discount. At the end, she handed out what the customer had ordered and threw their straw wrapper at her and drove off. When I observed this, I was hesitant to speak up and try to