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45 F presenting with chronic lower back pain
Progress
- Reports having bilateral lower back pain with radicular left leg pain for months
- Describes shooting pain to toes with occasional toe numbness
- Flares when standing
- No weakness, trauma, heavy lifting, bowel/bladder incontinence, fevers, weight loss
- Has trialled analgesia (unsure of name) without significant benefit
- Relief from topical creams
- Has seen GP and been referred to sports med centre, MRI pending end of April
- Used a mobility scooter during recent Singapore trip due to pain
PMHx
- Meningitis
- Hip OA
Medications
- Vitamins
- Magnesium
Allergies
- NKDA
SHx
- Home with wife
- iADLs
- Nil smoking
- Social EtOH
- Nil IVDU
O/E
- Appears well
- Mobilising independently
- No midline spinal or paraspinal tenderness
- Straight leg raise positive on left lower limb, negative on right
- No erythema/back swelling
- Lower limbs
  - normal tone bilaterally
  - power 5/5 in all domains
  - fine touch sensation intact, no asymmetry
  - reflexes present
  - babinski downgoing
  - pain flares with left ankle dorsiflexion
Impression
- Degenerative spinal changes with sciatica
Plan
- XR
- Analgesia
- Safety net
- LBP clinic

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One Lord of the Rings Marathon

Calculation: 7 days × 15 patients × 6 minutes saved = 11 hours