Diabetic peripheral neuropathy of the bilateral lower extremities

The patient presents today for EMG follow-up. I initially consulted him back on May 23, 2013 for suspected non-insulin-dependent diabetic peripheral neuropathy.

IMPRESSION:
1. Diabetic peripheral neuropathy of the bilateral lower extremities.
2. Suspected peripheral vascular disease.
3. Obesity with obvious deconditioning.
4. Hypertension.

PLAN:
I had a 60-minute follow-up visit with Mr.today discussing treatment options. We discussed taking wait and see approach versus medication management versus physical rehabilitation modalities versus interventional pain therapies. I do not feel that medication management in the long run is going to be best for him and I do not feel that any physical rehabilitation modalities will offer him a long duration of relief.

We discussed interventional pain therapies including lumbar sympathetic blockade versus neuromodulation. At this point, I think a trial of P-stim would probably be best for him and we discussed this modality in detail. I did provide him with a handout of both the P-stim and neuromodulation.

He would like to move forward with the trial of P-stim and we will move forward with authorization. We will call him once everything is authorized to get him started on a series of four to seven weekly treatments. He will do his homework researching this on the internet in the interim and will call with any questions or concerns.

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