Gait abnormality

The patient presents today for follow-up evaluation. She had the neuropathy protocol for both hands, but she failed to receive any improvement. She was started on physical therapy with ultrasound treatment of both wrists using ProloGel. She reports no significant improvement from this therapy. Therefore, it will be discontinued. She continues complaining of numbness and tingling involving both hands and feet, worse on the hands. I asked about the spinal cord stimulator therapy, but in my opinion this is not a good option since she is chronically anticoagulated and placing spinal cord stimulator lead in the neck will pose and increased risk of bleeding and hematoma with motion of the neck. Neural prolotherapy would not work for her since I could not elicit any points of tenderness of pain. We will continue treatment with opiates and I am also recommending the performance of TENS unit in an attempt to control the pain in the hands.

DIAGNOSES:
1. Stocking and glove distribution peripheral neuropathy.
2. Gait abnormality.
3. Benign paroxysmal positional vertigo.

RECOMMENDATIONS:
1. We will start the patient on Nucynta 50 mg one tablet p.o. q.8h. as needed; 10 tablets for a free trial was given to the patient.
2. Physical therapy to adjust the patient for a TENS unit in both wrist and lower extremities.
3. Follow-up in two weeks to evaluate the benefit and use of the Nucynta. The plan is if the patient experience good relief with the pain, we will start her on long-acting regimen of Nucynta along with the rest of medication.
4. Follow-up in two weeks.

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