Primary Care Physician’s follow up medical visit.

HPI: This 39 year old man presents in follow-up 1 month after radiofrequency rhizotomy, right T12 to L5 levels. He says besides 1 to 2 days of soreness from the procedure, it has worked wonderfully. He has no pain, he was able to stop Percocet and ibuprofen, and he was able to avoid getting back on morpine. He started exercising 3 days a week. He does have some numbness in the right side of his back an right buttock, which I expected with the procedure. In the last year, he has lost 40 pounds.

I/P: I encouraged him to get back in an exercise program and appropriate dieting program, otherwise he is at risk for recurrence. I discussed that weight typically causes increased lumbar lordosis with standing, as weight is distributed forward and it converts androgens to estrogens and women are more prone to facet arthropathy and degenerative spondylolisthesis, likely based on estrogen. There are estrogen receptors on the facet joints. Weight loss would decrease the conversion of androgens to estrogens and potentially decrease future facet arthropathy. Follow up as needed.

Sincerely,
Successful Treatment