Cranial nerves and Depo

CC: numbness in legs and hands in 23-year old female

newFNP: hmm... neuro. Maybe neuromuscular.

PMH: Unremarkable. 2 kids. Using Depo for birth control.

S: Numbness in legs and hands x 2 weeks. Worse at night, with walking. Notices inflammation in hands with walking.

newFNP: OK, this is either MS, something rheumatoid, or it's a result of it being hot as shit outside. Better not chalk it up to "hot outside." BTW, newFNP was just thinking "neuro lesion" but a seasoned NP specifically said MS.

O: Let's see, nothing, nothing, nothing. Oh wait! Something. Ocular movement craziness. Reactive to light, no accomodation. Deviation to left with right-facing gaze. Neuro exam otherwise unremarkable but thank god because I couldn't deal with much more on a neuro exam on Day M.F.-ing 2!

newFNP: Can she understand my crappy Spanish? Is she fucking with me, thinking that I am a big idiot because my Spanish is less intelligible than her 18-month old's? Does she understand that I want her to follow my finger??? Consult!!

O: with one MD and one NP, both get the same results on the eye exam. Thank god because who wants to fuck that up on day 2?

A/P: 1) swelling as side effect of depo/heat - not my dx, but the MD told me that this is a common side effect.
2) neuro lesion vs. ophthalmological deficit - ophthalmology referral

Check back in December 2005-February 2006 to see when this woman gets her referral. That's the system when you have no health insurance. It blows.