Mother/Daughter day aka more Dr apts. We tried a new restaurant out today and are having lunch between apts at Noodles and company.

Really the only changes that occurred today were that Lyrica was increased to 150 mg a day and Imitrex 100 mg was added as an abortive medication.

I did receive the Doctor notes from my pain psychologist and it is always interesting to see what I talk about and what I am stressed about, etc.

Medical notes from Dr. Lake

Headaches: Mixed experience with headaches since RFA procedure with Dr. Shamas on 5/22/15.  She had some significant improvement within about a week of the RFA which would be unusual as a direct result of the RFA.  At that point she began doing more when the pain level was at a low range (1-2 on a 5 point scale), may have done too much, her headaches escalated, and she began to back off on the level of activity.  More recently in the past 2 1/2 weeks there has been mixed ups and downs with some severe headaches back up to the incapacitating level, but she understands this is still quite early to determine the efficacy of the RFA procedure – we would not respect significant results this early.

Botox: It was her understanding it would be scheduled today with Dr. Da Silva.  I am giving her chart to our charge nurse to confirm that the product is available and planned for today’s visit although that does clearly appear to be Dr. Da Silva’s intention in documentation of the chart (unfortunately Heather informed in a passing conversation with me at the end of the day that her insurance will not cover Botox at this time – I did not have an opportunity to explore that further).

Return to Work Issues: We faxed the FMLA forms that she had given us to her work Human Resources group on 5/22/15.  Heather informed me today that although we had extended her return to work date until 8/16/15, her work has given her another form different than the last one that they insist must be completed today.  I am arranging for her to talk with Margaret in our medical records group to review the form and determine what might be reasonable in terms of communicating with them and actually completing this.  To get this kind of form completed on the day she is seen here is not a reasonable expectation, but she will show it to Dr. Da Silva and get his overall view of it.  I do not believe she is in any position to sustain a successful return to her former job at this time and we will need to reassess in early August if it would be possible for her to return to work by 8/16/15.

Carpal tunnel syndrome: She has had some episodes of significant carpal tunnel symptoms in the past, and has carpal tunnel braces that she wears when symptoms flare.  Normally she does not wear it.  She had some issues with her right arm that she addressed by wearing the brace continuously for a period of time, and function and appearance improved significantly.  I encouraged her to consider wearing the brace routinely at night, to minimize any low-end RE:incipient irritations of the nerve.  This is particularly critical both in terms of her work as a microbiologist but also in terms of her alternative potential employment as a photographer since she holds the camera with her right hand that is difficult when the carpal tunnel is acting up.  She has however taken some pictures recently of her kids showing me the change from the first and last day of school and a recent haircut and is trying to be more active in general.

Functioning: She stated she is trying to do more walking and other activities when she feels better, trying to find the right balance between overextending herself as noted above when she had those 5 good days in a row shortly after the RFA.

Cognitive functioning: She continues to report some words switching such as telling her kids “load the refrigerator” when she meant loading the dishwasher.  Although she has had occasional examples of this occurring in the past, the frequency is now several times a day, and appears correlated with increasing her dose of Lyrica.  She states when she does at the beginning of the week it is more noticeable and appears to improve a bit as the week progresses.  She is currently at 125 mg twice a day and will be titrating to Dr. Da Silva’s recommended 150 mg twice a day.  She is not sure at this point how much Lyrica is helping her.  She did report some similar kids of issues at my last session with her before the RFA procedure.

Adherence with relaxation and biofeedback techniques: Excellent.  We did not have an opportunity to review some of that in session today but she gave me examples of using the techniques on an ongoing basis as well as helping herself relax as she goes through the physical therapy procedures with her neck which she feels is helping improve range of motion function as well.  She will see our physical therapist Andrea Sherman later today and request another physical therapy prescription.