Meredith Ansel 01/31/73
June 2016-March 2017
Nagging intermittent lower back pain. Meredith is a pediatric speech pathologist who works in a very active play-based environment. She is otherwise healthy, eats well, and stays in shape with a variety of activities at the gym including bar classes, spinning classes, pilates, walking, etc.
She was prescribed Diclofenac by Dr. Fluitt of Austin Preferred Integrative Medicine and it alleviated the pain for two weeks. The pain returned when she discontinued the medicine.
Her only major health concern was childhood onset atrial tachycardia, which was ablated in 2001 and has not recurred.
During a visit to Texas Orthopedics (Dr. Mukai), Meredith underwent a normal range of motion exam and felt her first “twinge” in her right hip/groin area.
Meredith felt a sudden sharp, electric, pulsing pain in her right groin/leg in the shower and fell. She crawled out of the shower and was able to continue with her day.
Her condition worsened such that she was able to only find comfort in a lying position.
Meredith revisited Texas Orthopedics and met with P.A. Michael. He ordered a lumbar MRI, results of which are attached on accompanying drive. Later that night, while sitting on the toilet, she suffered a massive excruciating spasm with accompanying shooting nerve pain in her right leg/groin. She lay on the floor of the bathroom for hours delirious with pain, and eventually I moved her to the bedroom floor and propped her right leg with pillows.
She lay in that condition for nearly eight hours until we were able to have our daughter woken and removed from the house. We called 911 and had Meredith taken to ER at St. David’s South Austin Medical Center. She was administered medications including valium, morphine, and dilaudid. When an ER tech attempted to elevate her torso in bed, she was thrown back into excruciating spasm. She was admitted and placed on pain medications now including gabapentin. Attending physician Dr. Frances Velez and Dr. Nicolina Martinez. Neurosurgeon Dr. Timothy Hopkins and Dr. Sahni 713-419-9113.
Pelvic CT scan report and image.
Right L2-L3 transforaminal epidural steroid injection report.
Right L3-L4 transforaminal epidural steroid injection report.
Neurologist Dr. David Hoak. Discussed ilioinguinal nerve because of location (anterior and medial upper thigh and groin), severity and persistence of pain. At this point Meredith still cannot sit up or stand. At this point Meredith still cannot sit up or stand. At this point and throughout, all of the shooting nerve pain in the groin is coincident with what we think is psoas muscle spasm. She is having greater range of passive motion including hip flexion, but activating the hip to lift the right leg at all sends her into spasm.
Neurologist Dr. Obih. Recommended peripheral ilioinguinal nerve block with Dr. Martin Thai of Austin Pain Associates. Also recommended EMG (nerve conduction study). Since pain level was unimproved he mentioned gabapentin alternatives horizant and gralise.
Acupuncturist Jingyu Gu visit.
Meredith was able to come quickly to standing (sitting still excruciating and can put her back into strong spasm) and walk with a walker in a small circle around her room and back to bed.
Meredith was able to walk 50 feet with a walker. I believe we began to wean Meredith from steroids on this day.
Meredith was able to walk 100 feet with a walker and sit briefly at the edge of the bed in relative comfort.
Meredith began to notice a rash along her spine during the night and it spread during the day.
Rash worsened. Suspect gabapentin or norco. Gabapentin was discontinued but norco use continued into rehab hospital and was eventually discontinued. Discharged from St. David's. Discharge report. Admitted to Health South Rehab. Dr. Bogar attending physician.
Rash worsened and now covered Meredith's entire body. Pain level very high. Only pain med is Tramadol.
Meredith had her best day yet of PT, was able to walk with a cane. Horrible night, high pain.
Added Lyrica because of still high nerve pain. Consultation with Dr. Ramsey Ashour, Seton neurosurgeon. He felt diagnosis of broad-based far lateral L3 herniated disc pushing on dorsal root ganglion could explain the unusually high pain.
Right side L2 L3 epidural steroid injection by Dr. Robert Wills of Austin Pain Associates. In consultation with Dr. Ashour, Dr. Wills agreed to perform L2 L3 injection instead of ilioinguinal peripheral nerve block as ordered by Dr. Obih back at hospital. That night, very bad pain episode getting out of bed for bathroom, a la "day 1."
Meredith continues to improve in PT, walking with walker and cane and sitting for longer periods in comfort and able to get into and out of car. She is taking Tramadol every 6 hours and Oxycodone every 4 hours, Lyrica BID, prednisone.
Meredith was discharged to home from Health South Rehab. Consultation with Dr. Esther Yaniv of Seton. Meredith's right knee did not respond to reflex hammer. She prescribed PT at Seton south and we scheduled an EMG with her. Report.
Reduced prednisone to 10mg. Meredith had a very low energy, depressed day. Added diclofenac. Pain is slightly increased.
Morning pain is significantly increased.