Hypertension

The patient is a 76-year-old gentleman who is retired. He has had the sensation of numbness in both feet for several years. It has worsened over the last year. In addition, he has had problems with the circulation in both lower extremities, but worse on the left leg. This problem required for him to undergo angioplasty of the lower extremity large vessels. He was having severe venostasis on the left leg but after the angioplasty it improves. He is still having the sensation of numbness in both feet. He described this problem as follows: Triggering event: Diabetes mellitus. Duration: Constant. Quality and intensity: 7/10. Radiation distribution: Ankle and feet bilaterally. Aggravating factors: Walking or any activity that carries applying pressure to the feet. Alleviating factors: Being off his feet. Description of the pain: Numbness sometimes pins and needles.

DIAGNOSES:
1. Peripheral neuropathy likely due to diabetes mellitus.
2. Hypertension.
3. Diabetes mellitus.
4. Coronary artery disease.
5. Peripheral vascular disease.

RECOMMENDATIONS:
1. An EMG of both lower extremities will be performed in order to document the presence of peripheral neuropathy versus demyelinating neuropathy versus radiculopathy. This will allow the determination of other treatment.
2. Neurontin 100 mg p.o. q. night.
3. I discussed with the patient the neuropathy protocol in detail including the risk, benefit, alternatives and technical aspects.
4. Followup in three weeks in order to assess the progress with the Neurontin and adjust the medications.

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