Diabetic peripheral neuropathy

The patient is a very pleasant 79-year-old gentleman with suspected lower extremity diabetic peripheral neuropathy. He was diagnosed with non-insulin-dependent diabetes in 1989, but has only noticed pain in his feet for the last several years. It has progressively worsened to the point where he has sought out treatment with us today.

He has not tried any specific therapies for this pain and he is under the care of his primary care physician Dr. in addition to some type of vascular specialist. We did have a little bit of problem communicating today due to a language barrier, but we appeared to be able to get through this.

He does have appropriate sensation in his lower extremities to pinprick but does feel pins and needles especially in the medial toes. He presents today for evaluation.

ASSESSMENT:
This is a 79-year-old gentleman with bilateral foot pain/paresthesias due to suspected diabetic peripheral neuropathy.

IMPRESSION:
Bilateral foot paresthesias consistent with diabetic peripheral neuropathy; the patient is non-insulin dependent and was diagnosed 25 years ago.

PLAN:
I had a nice 60-minute consultation with the patient today. I hand wrote my diagnosis and recommendations for him.

At this time, my recommendation is to obtain bilateral lower extremity EMG for his suspected peripheral neuropathy in order to ascertain how progressive the disease process is. I will also try him on gabapentin 100 mg p.o. q.h.s. x3 days, then 200 p.o. q.h.s. x3 days, then 300 p.o. q.h.s. x3 days, then 100 p.o. q. morning and 300 q.h.s. x21 days, #102 dispensed.

I would like to see him back in four weeks’ time where we can review the EMG study to hopefully be performed by Dr. and see how he responded to medication. Future treatment modalities would include aggressive medication management versus physical rehabilitation modalities versus peripheral nerve blocks versus sympathetic nerve blocks versus peripheral stimulation “P-stim” versus dorsal column spinal cord stimulation. We will see how he does from a conservative management first and see the results of the EMG and then I will see him back as scheduled for follow-up in three weeks.

He seemed very happy with this visit today and I look forward to working with him.

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