July 15, 2022, Friday Today, around 6:00 AM, I woke up with a toothache on the upper right side of mouth. I also noticed a sore on the inside of my mouth, on the right side of my upper lip. My upper lip on the outside also seemed to be a bit swollen. So, I went to Wal-Mart and purchased some orajel and spred it around on the inside of my mouth and on the upper right tooth where I felt pain. All it seemed to do was numb the areas. I had planned to go biking with my friend and did not want to cancel because I had a toothache, so we left to go biking in Piqua, Ohio to bike the Great Miami Valley Bike Trail. As the day went on the pain in my tooth increased and then I noticed other teeth on the right side were also beginning to hurt. Every now and then sharp shooting pains would shoot through the teeth on my right side. My bottom teeth on the right side were now also beginning to hurt. I continued to spread orajel on the affected areas and continued with my day. As the day progressed, my friend suggested that I call my dentist and make an appointment. So, I did, but could not get in until Wednesday of next week. I did not make an appointment at that time, and continued with my day, applying orajel every now and then as the pain on the inside of my right upper and my teeth increased. I got home at 6:00PM that day and the pain continued to increase. My dentist's office was open until 7:30 PM so I called and made an appointment for the following Wednesday. I went to bed around 8 PM that night. July 16, 2022, Saturday I woke up at 1 AM with intense pain in my teeth and my right upper lip inside my mouth and outside my mouth hurt. So, I decided to go to the Emergency Room. I arrived at the ER at 2 AM. I was examined and was told that I had shingles.The ER nurse told me I had a rash on my cheek and on my temple area, as well as my lip. I was given Hydrocodone for pain; Valacyclovir and antivirus medication; Lidocaine ointment for my lip; and a prescription for Magic Mouthwash. Prescriptions for Hydrocodone and Valacyclovir were called into Walmart, which I picked up later that day, along with the Magic Mouthwash. I began taking these medications immediately. July 17, 2022, Sunday The right side of my face seemed to be a bit swollen and the rash was more evident on my right cheek. The sharp shooting pains going through my teeth continued. I continued to take the medications as prescribed throughout the day. Went to WalMart and purchased L-Lysine and and began to take 500 mg twice a day along with the other meds, because from research I found it was supposed to help with singles. Also purchased Zinc, 50 mg, and began to take it. July 18, 2022, Monday There did not seem to be a signifigant change on my face. Continued to take the medications as prescribed. July 19, 2022, Tuesday Discontinued the Zinc because I thought it made the rash worse. Probably just my imagination and may continue its use later. No sharp shooting pain in teeth all day. No tooth pain at all, all day. July 20, 2022, Wednesday Facial features much worse today. Scabs have developed on the right side of my nose and my right upper lip. Right eye seems much smaller than left eye. Puffiness on right side of upper eyelid. Rash on right cheek more severe. Nose seems to be swollen. Had put eyedrops in right eye which may have caused area around eyelid to puff out. Not sure. Took some scabs off upper right lip. Tooth pain subsided. No tooth pain at all today. July 21, 2022, Thursday Had two doctor appointments today. First, I went to see my primary care physician. She said she would not renew the medications I am currently on for shingles. She said she would give me gabapentin for pain, but I refused the prescription because I had tried gabapentin before and did not like the effect it had on me. She did prescribe a new facial ointment (not lidocaine) but it was too expensive, so I did not get it. She gave me the okay to resume my normal activites because I had been taking it easy and not doing anything stressful for fear it would aggrevate my condition and make it worse. But she said I would be fine going back to my normal activities. She insisted I go to my eye doctor. So when I got home I called my eye doctor and was able to get in this afternoon. He examined my eye and said I had shingles inside my right eye and that is why my right eye hurt. He prescribed two medications and said if the first one, an eye drop gel, is not available at the pharmacy, then get the second one, which was for a renewed prescription for the antiviral medication. He wants to see me in two weeks to see if the shingles are cleared up. I went to Walmart pharmacy to pick up the prescription. The eye drop gel was not covered by my insurance and was over $100. And the pharmacist was not even sure they had any. So, instead of having him check to see if they even had it, I just told him to fill the prescription for the antiviral medication. So I will continue taking the antiviral medication for one more week. Then the following week I have an appoointment with the eye doctor for August 4, 2022. July 22, 2022, Friday Since I was given the okay by my primary care physician to resume normal activities, I decided to mow my lawn, which I had not done for two weeks. I had no issues mowing the lawn. Everything went as usual and everything was done as I normally do it. No problems as all. I seem to have a bit more energy and my right eye does not seem to be as swollen. However, the pain in my right eye is still present. July 23, 2022, Saturday I decided to resume taking Zinc and had my first dose today. Will see if it has any effect on me. August 11, 2020, Thursday Had Right Knee X-Rayed at 9:00 A.M. My right knee was giving me a lot of pain so I made an appointment with an orthopedic physician to have it x-rayed. Here are the results: XR KNEE RIGHT 3 VIEWS - 8/11/2020 9:00 am. Right knee pain, unspecified chronicity. FINDINGS:
There is no acute displaced fracture or dislocation. There is mild-to-moderate tricompartmental osteoarthritis, most significant the medial compartment. No definite joint effusion. A fabella is noted. Soft tissues are unremarkable. Impression: Degenerative changes without acute osseous abnormality.
August 11, 2023, Friday Exactly three years later at 9:00 A.M. I was getting ready to climb down the ladder from the attic at my house when my right knee began to hurt a lot. When I got on the first rung of the ladder with my right knee, it hurt extremely. So, very carefully I climbed down the ladder in extreme pain when I had to put pressure on my right knee. I could not bear weight on my right knee without it being very painful. When I got off the ladder I looked at the time and it was 9:00 A.M. I later decided I needed to go to the hospital emergency room to get my right knee x-rayed because the pain was not subsiding. About 12:50 P.M. I arrived at the emergency room. Had right knee x-rayed and here are the results: EXAMINATION:
XR KNEE RIGHT 2 VIEWS (STANDARD) 08/11/2023, 1:08 PM.
HISTORY: Pain/swelling.
COMPARISON: 08/11/2020.
TECHNIQUE:
AP and lateral views.
FINDINGS:
I do not specifically see any acute-appearing fracture.
TECHNOLOGIST PROVIDED HISTORY:
Injury/Trauma.
Reason for exam: Pain/swelling right knee.
1. No acute fracture of the right knee is seen.
2. There has been a considerable progression and degenerative joint disease and arthritic change. There is tricompartmental joint space narrowing being most severe in the medial joint compartment. Patellofemoral arthritis is seen. I am not seeing any large joint effusion, however.
Notice that it was exactly three years to the date from the date I had my right knee x-rayed on August 11, 2020, to the date my right knee again began to hurt on August 11, 2023. Notice also that I had the x-ray at 9:00 A.M. on August 11, 2020, and at 9:00 A.M. on August 11, 2023, my right knee began to hurt again. Omen? Sign? Does it mean something or just a coincedence? August 24,2023, Appointment with Dr. Canini It had been two weeks now since my right knee first began to hurt. I had been keeping my right knee on ice and elevated. The day before this appointment my right knee no longer hurt, but I kept my appointment anyway. In general we discussed various treatment options for arthritis including activity modification, NSAIDs, steroid injection, Visco injection, knee replacement surgery in detail. We discussed that if she has another flareup or an increase in pain to give us a call and we can discuss a steroid injection as the likely next step and to return if symptoms worsen or fail to improve. The following is Dr. Canini's notes from that appointment.
Progress Notes
C Canini at 8/24/2023 8:18 AM
08/24/23
Benita M Cutarelli
3/20/1953
CHIEF COMPLAINT
Right knee pain
HISTORY
Benita M Cutarelli is a 70 y.o. year old female presents today for evaluation of right knee pain. She states that a few years ago she had some knee pain and was told it was arthritis. She states that she has been doing overall pretty well since then. She states that a few weeks ago she was coming down a ladder when she noticed increasing pain to her knee. She states that she had a hard time bearing weight due to the swelling. She states that over the past 2 weeks it has gotten quite a bit better and she is now back to her baseline. She denies any numbness or tingling. Denies fevers chills or sweats.
REVIEW OF SYSTEMS
10 point ROS performed and is negative except as stated in HPI
PAST MEDICAL HISTORY
The patient's Medications, Allergies, Past Surgical History, Medical History, Family History and Social History were reviewed and can be found in their online medical record.
PHYSICAL EXAM
General: Patient is well developed, well nourished in no apparent distress. They are awake and oriented x 3. Appropriate mood and affect. Pt ambulates with a normal gait. Appropriate balance.
Knee - Right
Inspection: Examination of the LE reveals the skin to be intact with no edema, erythema or ecchymosis. Effusion: Mild.There is no obvious deformity.
Palpation: Medial JLT., Crepitance: Moderate.
ROM:Full ROM of the knee.
Strength: Normal strength against resistance.
Instability: None.
Neurovascular: Grossly normal NV exam in the distal LE.
Special Tests:
Mcmurray's Test: Negative
Patellar Grind: Positive
J Sign: Negative
IMAGING
X-rays of the right knee from 8/11/2023 were reviewed independently by me and demonstrate severe tricompartmental degenerative changes with no obvious fracture or dislocation
IMPRESSION
Right knee osteoarthritis
PLAN
At this time we had a long discussion. I think she likely had an acute flare of underlying osteoarthritis. Fortunately she is back to her baseline at this point. We discussed various treatment options for arthritis including activity modification, NSAIDs, steroid injection, Visco injection, knee replacement surgery in detail. We discussed that if she has another flareup or an increase in pain to give us a call and we can discuss a steroid injection as the likely next step. All questions were answered and patient is in agreement with plan.
X-rays upon next visit:No.
Cameron Felix Canini, DO
Note: To expedite correspondence this note was generated by Dragon voice recognition software. Some grammatical or spelling errors may occur using the system. November 30, 2023, Appointment with Dr. Canini Both my knees were hurting me so I went to see Dr. Canini today about options, again. We discussed perhaps getting gel injections instead of steroid injections. But my insurance had to be approved for gel injections. So I left his office and later they denied payment for gel injections and I did nothing for awhile until my knees began to hurt again alot. The following are Dr. Canini's notes from November 30, 2023.
Progress Notes
C Canini at 11/30/2023 7:53 AM
11/30/23
Benita M Cutarelli
3/20/1953
CHIEF COMPLAINT
Bilateral knee pain
HISTORY
Benita M Cutarelli is a 70 y.o. year old female presents today for evaluation of her bilateral knees. I have seen her recently for right knee osteoarthritis. She states that she is not having pain to both of her knees. She states that the left has been bothering her a little bit more as of recent. She is here to discuss options for her arthritis.
REVIEW OF SYSTEMS
10 point ROS performed and is negative except as stated in HPI
PAST MEDICAL HISTORY
The patient's Medications, Allergies, Past Surgical History, Medical History, Family History and Social History were reviewed and can be found in their online medical record.
PHYSICAL EXAM
General: Patient is well developed, well nourished in no apparent distress. They are awake and oriented x 3. Appropriate mood and affect. Pt ambulates with a normal gait. Appropriate balance.
Knee -bilateral
Inspection: Examination of the LE reveals the skin to be intact with no edema, erythema or ecchymosis. Effusion: Mild.There is no obvious deformity.
Palpation: Medial JLT., Crepitance: Moderate.
ROM:Full ROM of the knee.
Strength: Normal strength against resistance.
Instability: None.
Neurovascular: Grossly normal NV exam in the distal LE.
Special Tests:
Mcmurray's Test: Negative
Patellar Grind: Positive
J Sign: Negative
IMAGING
X-rays of the bilateral knees from today were reviewed independently by me and demonstrate severe tricompartmental degenerative changes with no fracture or dislocation
IMPRESSION
Bilateral knee osteoarthritis
PLAN
At this time we had a long discussion. We once again discussed the various treatment options. Activity modification, NSAIDs, steroid injection, Visco injection, knee replacement surgery in detail. After 3 hours and benefits she does wish to proceed with bilateral Visco injections. We will submit for approval. I will plan to see her back to perform the injections. All questions were answered and patient is in agreement with plan.
X-rays upon next visit:No.
Cameron Felix Canini, DO
Note: To expedite correspondence this note was generated by Dragon voice recognition software. Some grammatical or spelling errors may occur using the system. My Knee Dilemma Continues My knees were again hurting a lot so I sent Dr. Canini this message through My Chart. Dr. Canini: My Aetna insurance denied payment for visco gel injections into my knees because I had not yet tried physical therapy or steroid injections. At home I have been keeping my knees elevated and on ice, which helps a few hours until I need to repeat the process. I also have taken Aleve, walk as I can, and wear insoles. I have ongoing knee pain and need to proceed to the next step to eliminate knee pain in both knees. Would steroid injections be the next step? Thank you for your response. He later replied: Yes, I would recommend steroid injections. You can reach out to the office and we should be able to get you on the schedule. January 18, 2024 Before I even called his office, his assistant called me and scheduled me for steroid injections on January 18, 2024. But I began to have second thoughts about steroid injections and sent Dr. Canini this message through My Chart:Dr. Canini: I am having second thoughts about having the steroid knee injections this Thursday, January 18, 2024. My first concern is that Lidocaine injections make me dizzy and nauseated, and you know what could follow nausea. I understand that Lidocaine might be mixed in with the steroid injection to control pain and that would not be a good thing for me. My second concern is that I am pre-diabetic and I understand that steroid injections raise blood sugar levels. With these two concerns I am leaning away from the steroid injections. What are my alternatives? Thank You. He replied with:Option one would be to try therapy for 4-6 weeks to see if this helps with the pain. Option two would be to do a steroid injection with no lidocaine in it. It can raise blood sugar levels for one-two weeks but they typically return to normal after that. Either option is okay with me to start with. I then replied with this: Dr. Canini: I will just skip the steroid injections altogether because of the risks. I have been trying to keep my glucose under control and don't want it to rise because of steroid injections and risk going full blown diabetic. If the only other option is therapy then I will do that. Do I need to keep my appointment with you this Thursday or is therapy something you can just order and I go to? Thank You. To which he replied: No worries at all about the steroid injection. No appointment is needed. I will have the staff put the therapy prescription in. Therapy should call you in the next few days to schedule. If you do not hear from them please let us know. I am scheduled for six sessions of physical theray for both of my knees.
February 2, 2024 - February 23, 2024
Had physical therapy sessions for both of my knees. At my last appointment, on February 23, in the evening, around 8:25pm, I became dizzy, nauseated, and began vomiting. The last thing I remember I looked at the clock and it read 8:25 pm. I always try to make it a point to look at the time every time I get sick. The next thing I remember is looking at the time again and it was 2 am in the morning. I either had passed out for five and one-half hours, or I fell asleep. At any rate I was out for five and one-half hours. February 28, 2024
Had a follow-up appointment with a physical therapist to check on my staus. I told the physical therapist that I had gotten ill on the day of my last therapy session and that I did not want to continue with the sessions. I also told him I had an appointment with my primary physician on March 4, 2024 to discuss getting some medication for nausea so I could have it at home should I have another dizzy, nausea attack. March 4, 2024
Saw my primary physician today and told her that I had a dizzy, nausea, vomiting attack on February 28, 2024. I asked her if I could have some nausea medication so I could have it on hand should I get ill again. She said I might need to go back to Dr. Aashrai Gudlavalleti, my neurologist, if I have another attack. She prescribed the nausea medication for me and I left her office. Upon leaving her office I got a bit upset that she suggested I see Dr. Aashrai Gudlavalleti again. I did not want to go back to him because I felt he diagnosed me with a condition I did not have. The medication he prescribed for me for the condition he said I had, did nothing for my pain. Therefore, I felt I did not have that condition because the medication did not help me. I felt he was just making it up, just to diagnose me with something, just to get me on some kind of medication. I was very upset and absolutely and positively did not want to go back to him again. I dwelt on it for a few days, being upset about it for a few days. I mean I was very irate about the thought of seeing him again and thought too long and too hard about it. March 11, 2024
Dr. Aashrai Gudlavalleti died unexpectedly today, just seven days after my private outburst. Is this a coinincidence? Is this an omen? Is this some kind of sign? Do I feel sad, remorse, guilty? Yes, of course. He was only thirty-five years old. This kind of stuff in my life just continues to happen. My condolences go out to his family and friends. I don't know why God has not cured me from this eye and head pain, and I don't know why no physician has ever been able to help me with this problem.
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