The patient is a 47-year-old lady, who was the patient of Dr.. She was last seen in this office on August 6, 2012. At that time, we discussed the use of her opioid medication and the fact that we needed a letter from Dr. .Multiple attempts to have Dr. write a letter from the patient failed. He called this office and I returned a call, but I did not reach him and instead left a message on his answering machine. He never returned my phone calls. In view of the fact that the patient has been suffering with no medication, I will start her on opioids. She started using the Cymbalta, but was taking it the wrong way. The medication was prescribed to be taken twice a day, but she was taking only once a day. She had not noticed any difference yet. She had the lumbar MRI and I have reviewed the films with her. We do not have an official report yet.
1. Morbid obesity.
4. Radicular lumbar pain.
5. Herniated lumbar disc.
6. Degenerative disc disease, lumbar.
7. Bilateral knee osteoarthritis.
8. Right knee popliteal cyst.
9. Smoking cessation.
10. Weight loss.
1. The patient will start taking Cymbalta 25 mg twice a day.
2. MS Contin 30 mg one tablet p.o. b.i.d. (60 tablets).
3. Oxycodone 30 mg one tablet p.o. q.8h. as needed (70 tablets).
4. Opioid contract was reviewed by the patient and signed.
5. Urine toxicology was performed.
6. Followup in one week for injection of steroids in her left knee.
7. Once her knee pain is under control, we will address the low back pain and a bulging disc with a lumbar epidural steroid injection. The procedure will be done in the office.