The patient comes in today for follow-up visit. He underwent eight treatments for peripheral neuropathy in the lower extremities. He reports a 60%-65% improvement in his lower extremities and 45% and 50% improvement in his left lower extremities. He has numbness and tingling at this point. It is only intermittent where it was constant prior to treatment. He minimally is experiencing tightness in the distal aspect of his feet bilaterally. He has had no significant amount of pain. He continues to take nortriptyline at night for his neuropathy as well. He is diabetic and is also on Prograf. He has a history of rheumatoid arthritis, psoriasis, diabetes, and hypertension. He had a kidney transplant in 2008 and right knee replacement. He denies any change in his past medical history, past surgical history, medications history, allergies, family history, social history, or review of systems.
Since we have seen improvement, but still he has significant amount of symptoms of neuropathy. We will recommend proceeding forward with another four weeks of treatment. We will recommend he increase his activity level and suggested that he may talk to his physician about increasing nortriptyline to 75 mg q.h.s. We will see the patient back and ask to continue peripheral nerve blocks and high frequency nerve stimulation. If he has any problems in the interim, he will contact the office.