posted by editor on Feb 8
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A patient presents for pain management. This is the initial visit.
Subjective: You present with chronic foot pain. The pain started approximately a week ago while you were putting equipment back into a shed. You state that it occurs intermittently during the day, is moderate and is exacerbated by excessive walking, and relieved by rest. You report a history of a back injury playing football in college, with rare flares of mild symptoms, for which you use 600mg ibuprofen as needed. You have otherwise gained a bit of weight and have a high cholesterol level and hypertension.
You report occasional pain in your lower extremities, but no other symptoms except rare light headedness. You regularly use a medication for lowering cholesterol and another for his blood pressure. You take a multivitamin daily, but no other dietary supplements. You perform nightly warm foot soaks.
You are an usher at a local Christian church. Additionally, you volunteer as an assistant to a scouting leader. You particularly enjoy the outdoors, hiking and camping activities.
Your family medical history is unremarkable.
You work full time as a salesman at a warehouse type hardware store, walking most of the day. Other than noted above, you are not involved in much in the way of non-vocational and recreational activities except for taking your dog for long walks of approximately two miles every other day.
You are single, with friends related to work, church, scouting and from the neighborhood.
Objective: You are a 35 y/o male, 6’ and 275 pounds, with a muscular build. You appear not to be distressed. Your blood pressure is 125/85. Pulses and general, peripheral circulation and sensation are normal. You exhibit tightness in musculature of lumbar back and lower extremities. You have mild tenderness in your plantar feet (soles). The remainder of your lumbar and lower extremity examination is normal. Tests for sciatica are negative, the lower extremity symptoms do not appear to be referred from the low back. X-rays of your feet and spine are normal.
Assessment
• Pain-probable plantar fasciitis.
• Pain-minor strains of hamstrings and calves
• Probable repetitive strain related to prolonged standing at work and non-work
activities
• Pain-lumbar, chronic
• Hypertension, hypercholesterolemia, obesity
• Lightheadedness, cause unsure
Plan – In your case, like most, you have a lot of options. The effects of some interventions will take a while to be fully realized. Engaging others may be limited by a number of factors. The following are not prioritized, rather are listed regarding how they may contribute to the plan.
1. prescription medications – anti-inflammatory and analgesic types.
2. homeopathic medications – not available via your allopathic physician.
3. naturopathic medications – not available via your allopathic physician.
4. herbs – may complement or replace use of prescription medications.
5. cannabis – not available legally in all States, but has anti-inflammatory and
analgesic properties.
6. acupuncture – may complement intervention options 1-5.
7. acupressure – may complement intervention options 1-5.
8. electroacupuncture– may complement intervention options 1-5.
9. electrical stimulation (various forms) – may function very similarly to 6-7,
overlapping benefit.
10. manual intervention may complement all 1-9 stretching the tissues from lumbar
distally, including hamstrings and plantar feet, increasing circulation, and
relieving pain.
11. light therapy – may provide circulatory support.
12. hypnosis, psychotherapy – patient exhibits no adjustment problems related to
symptoms.
13. distraction (mental) – all healthy, non-contributory activities that distract
patient from symptoms may be considered.
14. heat – analgesic and improve circulation.
15. ice – if swells acutely
16. dietary adjustments – needs dietary consultation and plan for losing 50 pounds.
17. spiritualism – positive attitudes are probably reinforced as result of his
participation in church activities.
18. work, non-vocational activities and recreation should be changed to decrease
physical stress within the framework of your ability to do so.
Discussion
Evaluation and consideration of alternative treatments of hypertension, hypercholesterolemia, obesity, and light headedness in this case are beyond the scope of this post. Otherwise, your initial plan and subsequent adjustments will follow preferences, resources, limiting factors and response/effectiveness.
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