Long-standing bilateral lower extremity polyneuropathy

The patient claims that he has had bilateral peripheral neuropathy for over 20 years with the diagnosis of diabetes mellitus. He has been to many hospitals for evaluation for pain management over the years and has received an array of medications including Neurontin, Lyrica, and some other medications that the names of which he has forgotten or to no avail. He has had studies including EMG and nerve conduction study before 2011. He has tried TENS unit, which did not help. Additionally, the patient has had acupuncture and physical therapy and thought that they were not helpful to him either. The patient claims that in January 2014, he was on a cruise and developed infection related to a virus that other passengers sustained as well and that made his weakness and pain worse.

ASSESSMENT:
1. This patient has a long-standing bilateral lower extremity polyneuropathy.
2. He has a history of hypertension and coronary artery disease.
3. Diabetes mellitus.

PLAN:
The pathology, anatomy, and treatment options for this condition were discussed in detail. It is suggested that he undergo electromyelogram and nerve conduction study first followed by a SudoScan for confirmatory evidence of neuropathy and then an evaluation by Dr. and myself to explain the results of those tests. In regards to treatment options, the patient may be a candidate for P-stim if he desires to pay for that out of pocket as it is no longer being offered through insurance company as a treatment option. We also discussed the possibility of Botox injection of peripheral nerves depending on the outcome of the nerve conduction and electromyelogram studies. We discussed the possibility for physical therapy although the patient does not want that at this time; henceforth, we discussed the possibility of a spinal cord stimulator trial followed by implant for his bilateral lower extremity peripheral neuropathy. The patient will return to see Dr. and myself for his studies and evaluation after the studies are completed.

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