Bilateral lower extremity paresthesias

The patient presents today for first follow-up visit since I initially consulted with her on May 23, 2013. She obtained the MRI of her lumbar spine and brings in the disc today, but there is no report available. She is much improved since we started Elavil at her last visit. She does state that she feels a bit fatigued more than usual, but this just began over the last few days.

IMPRESSION:
1. Bilateral lower extremity paresthesias; MRI appears to rule out radicular pain, but report is not available.
2. Patient with diabetes; most likely diabetic peripheral neuropathy – doing well with Elavil thus far.

PLAN:
Unfortunately, I did not have her consultation note available at the time of visit today. I also did not have the lumbar MRI report available at the time of the visit today. Hopefully, those will be forwarded to me later this week for perusal. I have recommended a P-stim device as the best noninvasive treatment option for her issues. I am incurred that she is responding to Elavil. I have told her to increase the Elavil by one pill in the evenings over the next three days as she does not have to go back to work until Saturday. If she notices an increase in fatigue, it may be side effect from the Elavil and we will have to decrease it to the most tolerable level. Overall, she looks much better than she did at her initial consultation and we will work with her. We will set her up with Dr. for the P-stim device and she also requested to be set up with dietary and she is interested in possible lap-band procedure.

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