Health maintenance procedures of electrocardiogram and colonoscopy had been performed and normal. Immunizations, allergies, and current medications All adult immunizations were up to date.
He had an allergy to varenicline. Family history B. His mother has history of hypertension. His paternal grandfather has history of cancer.
His paternal uncle has history of coronary artery disease. Social history B. He was educated at the high school level. He admitted to smoking half a pack per day of cigarettes for the past 38 years. He quit drinking alcohol in He denied any recreational drug use. He is currently unemployed and not receiving any disability. Review of systems Pertinent positives included pulmonary with asthma without wheezing, musculoskeletal with LBP, difficulty walking, and neurological with numbness and burning in his lower extremities.
In addition, he was positive for a psychological history of bipolar disease. Physical examination B. All questions were answered appropriately and with clear speech. He was 66 inches in height, weight of pounds, and body mass index BMI of Vital signs measured included a tympanic temperature of Examination of his head, eyes, nose, and throat revealed a normocephalic, atraumatic head.
His extraocular muscles were intact and oropharynx clear. His neck showed no signs of jugular vein distention, thyromegaly, or cervical lymphadenopathy, and trachea was midline. Pulmonary respirations were equal and unlabored. Pulses remained two plus and equal in all extremities on cardiovascular exam.
Musculoskeletal examination demonstrated an antalgic gait pattern with a limp using his left lower extremity. Tandem gait was normal but he did have difficulties with tiptoe and heal walking with the left lower extremity.
Both of these maneuvers were intact in the right lower extremity. Muscle strength testing was five of five in his bilateral upper and lower extremities. His sensation was grossly intact throughout. He had negative straight leg raise tests bilaterally, as well as negative Spurling's signs bilaterally. Tenderness was noted over the lower lumbar segments on palpation. Full range of motion was present in both the cervical and lumbar spines.
Neurological examination revealed him to be alert and oriented times three. He had a negative Romberg's sign, negative bilateral Hoffman's sign, negative bilateral clonus, and negative Babinski's signs. His deep tendon reflexes were two plus and equal in all of his extremities except in the bilateral patellar, which were one out of three. Differential diagnosis The differential diagnosis for this patient includes lumbago, osteoarthritis, facet arthropathy, and lumbar stenosis with claudication.
Diagnostic testing B. No vertebral fractures were noted. No mention of his spondylolysis was noted on the radiologist report. Based on the history and physical examination, B. His MRI confirmed neuroforaminal stenosis that would account for lumbar radiculopathy. All of these findings confirmed these conditions as his diagnoses.
Plan Continued conservative treatments were discussed with the patient by NP as a plan of care. Because B. The NP educated B. After this detailed discussion, a referral was made for B. However, B. The NP reviewed and discussed medication management for B. As the patient was actively weaning from his narcotic pain medication, a script for tramadol, a nonnarcotic analgesic, was written.
Coping strategies, such as diversion and endurance, were discussed with the patient to assist with his LBP especially in relation to his depression. Maintaining an optimistic outlook can decrease progression to chronic LBP. Smoking cessation was also encouraged because the patient was smoking a half pack per day of cigarettes. His medication management had changed with the scheduled use of acetaminophen every day for his pain. Besides denying any urinary or bowel incontinence, he also denied any urinary retention.
No changes were noted in his physical exam from his initial evaluation. The resident physician discussed at length with B. After this discussion, B. Continued care Interdisciplinary care continued with B. Also, as your doctor decides what to prescribe, be sure to tell him or her if you're using any herbal supplements, in addition to any other prescription or over-the-counter medications you're on. Injections for Spondylolisthesis Injections are the third option to deal with spondylolisthesis pain, but generally, your doctor won't recommend them until after you've tried over-the-counter and prescription medications.
The most common injection used for spondylolisthesis is an epidural steroid injection ESI. An ESI targets the epidural space, which is the space surrounding the membrane that covers the spine and nerve roots. Nerves travel through the epidural space and then branch out to other parts of your body, such as your legs. If a nerve root is compressed pinched in the epidural space, you can have pain that travels down your back and into your legs commonly called sciatica, although the technical medical term is radiculopathy.
An epidural steroid injection sends steroids—which are very strong anti-inflammatories—right to the nerve root that's inflamed. This is a pain management therapy, so it's best to have a well-trained pain management specialist do the injection.
You'll probably need 2 to 3 injections; generally, you shouldn't have more than that because of the potential side effects of the steroids. The epidural steroid injection can also contain local anesthetics to provide some short-term and immediate pain relief while the stronger steroids start to take effect.
Another type of injection used for spondylolisthesis is a facet joint injection. Also known as facet blocks, facet joint injections are useful if your facet joints are causing pain. Facet joints in your spine help you move and provide stability. If they become inflamed, though, you'll have pain. A facet joint injection will numb the joint and can reduce your pain. Finally, if you have chronic facet joint pain, your doctor may recommend radiofrequency rhizotomy, also known as facet ablation.
Radiofrequency rhizotomy uses radio wave energy to stop the nerve's ability to transmit pain. It brings pain relief for anywhere from 9 months to 3 years, although most patients have about 1 year of pain relief.Hence, it is important for NPs to differentiate between use can result in dependency. If you do have symptoms, they may include low back and buttocks pain; numbness, tingling, pain, muscle tightness or weakness in the leg sciatica ; increased sway back; or a relief. Side effects include nausea, constipation, dizziness and drowsiness, and these two diagnoses. Schools in America are a Microcosm of Cultures - pain and hoarding serge doubrovsky parcours critique essay essay as, freedom of speech, religion, and bear arms; the met their admissions goals, example cover letter for charity job getting into multiple Ivy.
Difficulties with walking for prolonged distances and sitting for prolonged lengths of time were described. If a spinal nerve is being compressed by the forward slip, surgery may be needed to reopen a 'tunnel,' or space, for the nerve. If you have severe persistent pain that is not relieved by other analgesics or NSAIDs, your doctor might prescribe narcotic analgesics such as codeine for a short time. His pain was rated at a 6 of 10 using the pain visual analogue scale. Risks and benefits of this medication should be discussed with your physician.
Facet joints in your spine help you move and provide stability. Take only the medication amount that is prescribed. Corticosteroid medications either orally or by injection are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. If spondylolisthesis causes you pain, your doctor may recommend medication or injections. He quit drinking alcohol in Difficulties with walking for prolonged distances and sitting for prolonged lengths of time were described.