good D sharp gold hi Angelina hello thank you for coming in I'm G to go ahead and take a look at your file here last time you were here it was about two months [Music] ago can you please verify your date of birth July 21st 2005 okay and changes in your medication no any new allergies no just seasonal allergies have you had any complication since the last time I saw you um I've noticed some tingling kind of like on the back of my arms and numbness same thing with like my kneecaps as well after some time of being in like the same position for a while I just kind of feel like a numbness or tingling okay and um I guess along with that when I wear like bigger headphones I've noticed like some numbness at the top of my head as well all right it does sound to be neurological I'm going to ask you a few questions to see if we need to test any more nerves today haven't noticed any changes in your vision lately um not that I've aware of but my eye has been a little Twitchy but other than that no okay have you noticed any dryness um or difficulty breathing um my nose has been like runny but other than that no have you experienced any palpitations okay and with the numbness are you experiencing any pins or needles in your fingers yes sometimes what about your toes not as much are you experiencing frequent headaches um occasional I wouldn't say they're frequent okay are you taking any medicine on a daily basis just vitamins and supplements okay any back problems back aches um no other than an injury from when I was younger but it doesn't affect me now and have you noticed any winking in your [Music] ears okay have you noticed any difficulty in grasping objects or strength wise um no I haven't okay any family history of neurological disorders I believe on my mom's side okay we're going to go ahead and do a cranial nerve exam and full body sensory to see exactly the regions that we're dealing with but first let's go ahead and take a look at your eyes okay okay go ahead and look right here okay and look here okay I'm going to have you follow my fingers with your eyes only don't move your head okay I'm not noticing anything think I'm normal there I'm just going to go ahead and bu baate around your eyes let me know if you're feel any pain okay going have your look down okay great check your reflexes go ahead and relax your jaw going to have you relax your heart okay good going to have you relax a little bit diminished on the right side okay goad and relax your arm okay okay going to go ahead and listen to your heart and your lungs this is going to feel a little bit cold I'm going to have you relax I can hear only S1 and S2 no S3 no S4 go ahead and take a deep breath in breathe out and again breathe in and exhale theist with the Bell we're listening for murmurs going to have you take a deep breath in and hold it for one two three breathe out okay going to listen to your back I'm going to have you turn towards the wall so I can listen to your back okay going to have you breathe in breathe out and again breathe in breathe out Breathe In Breathe Out Breathe In Breathe Out breathe in and exhale good take your reflexes on the spine okaying a little bit of abnormality here at the last cervical to make a Mark here at last cervical going to be able to easily erase this and I have here nervoscope just going to take a look and see if there is any difference in temperature so I'm sliding it down on the bar spinal muscles just thoughts about D3 84 okay I'm going to have it turn around I'll take your Vital Signs then I'll have you lay down and do some more tests and see exactly what we're dealing with okay have you noticed any f- like symptoms in the last 48 hours no just going to take your temperature 97.7 and then this will go on your upper on we take your blood pressure I'm going to have you un cross your legs and relax okay five brush right is 121 over 70 SL this down I'll take your pulse I'm just going to put two fingers around your wrist okay I'm going to go ahead and compare PES are strong and symmetric those signs of heart failure just going to test your strength now go ahead and squeeze my fingers okay very good I'm going to have you put your arms like this in front of you going to test your strength bilaterally so first I'm going to push on one arm without telling you which one and I'm going to have you to resist okay okay have you close your eyes good okay okay little bit decreased on the right side again going to try to open your arms don't let me do that going I try to glose them don't let me do that okay go ahead and relax going to put my hands on your shoulders I'm going to have your shr down now go ahead and try to touch your chest with your chin okay relax I'm going to have you turn your chin towards the left and towards the right okay very good as your eyes are closed I'm going to have you tell me with which ear you hear this sound right or left left right both okay and I'm going to cover one nostril go ahead and breathe in breathe out and the other side breathe in breathe out okay okay you can go ahead and open your eyes going to take a look inside your mouth and see if there is any swelling or redness have you noticed redness in the back of your throat okay go ahead and push with your tongue inside your cheek and the other side okay stick your tongue out and move it up and down okay very good I didn't notice any symmetry color was pink and normal go ahead and give me a big smile good and frown with your eyebrows okay keep them FR going try to push them down keep them fr okay go ahead and relax have a change in this SC and then I'm going to take a look at your sculp okay and put gloves on to Pulpit your face first I'm looking for any nodules or changes in texture the hairline looks well [Music] defined just going to buat sinuses in between your eyebrows and right after your eyes let me know if you feel any pressure any tenderness trying to figure out why you're experiencing that twitching could be coming from the tri gem on there sometimes there may be a misalignment putting pressure in the nerve and misfiring the neurons that are connected to the nerve pulping the lym notes we're looking at pror regular lymph [Applause] notes baiting poster regular left noes looking to see if there's any L fat in a bath allting the C notes tracha tricky Smith line not feeling any naul and also right here on the bottom we have the thyroid gland it's not enlarged I'm going to have you swallow okay it's perfect it's non poppable and pulping the semental lymph nodes they're right under your chin go going to check your ocular reflex I'm going to have you open your eyes good you can go ahead and close good for any swelling around the sinuses and also to see if there is any symmetry between right and left for I'm going to have you take a deep breath in through your nose and out through your mouth go ahead and tell me if you can identify this smell it kind of smells like wait can I smell it again yeah right here so just breathe in oh it kind of smells C okay let do that again this is a different smell we dusting your Al Factory nerve now it kind of smells more like eucalyptus that smells like lavender okay honestly at some point if we keep on going like that your nose is going to get saturated and you won't be able to identify them anymore so I'm going to take a break and we're going to do a taste dust going to put piece of paper on your top you can go ahead and identify what this tastes like tastes like lemon lemon okay okay let's try one more that one's really like sour or better let's try one more that one super sweet just going to go back to this mouth go ahead and take a deep breath you nose it smells minty okay your factory nerve seems to be intact kind of test your facial Sensations go ahead and tell me if you feel this on the left or right of your face I'm going to say that one more time okay go ahead and tell me if you feel this on the left or right of your face we're going to test your facial Sensations right right left I think that was middle right left left right right do you this cold or warm cold warm gold do you feel this all the way down does it change in temperature you know water Bon now it's the same okay is this same as this yeah okay and is this the same as this it felt colder on the right this is the same as this yeah going to touch you with two textures one it's going to feel dull this is what dull is going to feel like and the other one is going to feel sharp go ahead and tell me if you feel this sharp or D sharp sure sharp sharp I'm going to move around the hairline same thing sharper D sh okay I'm going to focus on your eyebrows sharp sharp Shar Shar sure just checking your facial reflexes a little bit diminished on the right side go and relax your jaw take a look at the crown and here's scope okay go ahead and tell me if you feel this cold or warm gold gold cold warm gold gold C do you feel this on the left or right of your scope on the right right right right do you feel this two or one pressure point okay go and tell me if you feel this two or one one one one okay and do you feel this all the way down yeah okay I'm going to go ahead and check your back now I'm going to it for I'm looking for any deviations of the spine normal curvatures not noticing any swelling around the far to bra just going to listen to your spine first looking for any crackling any swishing sounds that can be heard microscopically for for going to take some measurements with FR symmetry for little bit of swolling on the right side seems like there is fluid retention for go ahead and tell me if you feel this pressure or vibration vibration feel this colder one this t feel the same the second one this feel the same as this same you feel this gold all the way up yes for [Applause] I'm going to pull I'm going to put a gel like consistency on the left side and this usually helps for the sensation to be felt a little bit less I'm going to have you tell me what shape I'm drawing okay Circle what letter am I drawing now okay what shape am I drawing CLE what letter am I drawing nowart now and now okay going to go ahead and check your abdomen now okay I'm going to go ahead and take a look at your abdomen and see if there is any asymmetry redness is it okay if I pop it yeah it's okay first let's go and listen with the stereoscope this is going to feel a little bit cold for e okay I'm not hearing any abnormal sounds okay this is going to feel a little bit cold go ahead and tell me if you feel this on the left or right the right right left left middle middle okay I'm going to do the same thing go ahead and tell me if you um Can distinguish what shape I'm drawing square triangle triang a circle what number is this three two going to do the same thing on the other side go ahead and tell me what number you feel seven zero there seems to be a little bit less conductivity on the right side and it is consistent with everything that I've been noticing so far I'm going to go ahead and Pall Pat your abdomen let me know if you feel any kind of pain just going to listen one more time on the right side going to compare with left going to check your reflexes on the lower part of your body okay so we're going to do some testing on this upper side I'm going to lift the Gown a little bit go ahead and tell me if you feel this cold or warm cold war cold cold do you feel this the same on the right and left yes do you feel this the same on the right and left yes go ahead and tell me if you feel this vibration or pressure vibration pressure vibration okay do you feel this cold or warm cold cold do you feel this equally on both sides it was lighter on the one more was still lighter on the left do you feel this on the right or left left right right left right right left left do you feel this two or one pressure point one one one one one one going to check your reflexes going to have you relax your knee okay I'm going to put the left foot on top of the right one relax okay will beat okay relax I will do the same thing okay very good going to check your toes I'm going to have you kind of like spread your toes AP okay going try to close them don't let me do that okay I'm going to have you wrap your toes around my fingers okay I'm going to try to push your um feet towards you don't let me do that I'm going to try to push them towards me don't let me do that little bit weak okay going to try to open them don't let me do that I'm going to try to close don't let me do that you feel this pressure or vibration vibration pressure pressure vibration pressure vibration pressure vibration you feel this cold or warm cold cold warm warm okay your right foot feels a little bit colder than the left one going to check your tedo pulses I'm not noticing any peening in tea I'm going to check your binsky reflex go ahead and tell me if you I feel any pain go okay very good I'm going to have you stand up now like sit back on the table and we'll talk about the results okay Angelina it does look like there is a deficiency in vitamin B12 I'm going to prescribe a high dose of vitamin B I'm going to have you take it once a week try to stick to the same day and same time every week so that you don't forget it becomes a habit also going to test your vitamin D level and see if that makes a difference and what your levels are but I think the numbness comes from a vitamin vitamin deficiency and once we correct that it should get back to normal okay perfect okay I'm going to have you run to the lab as soon as you get dress so that we draw a little bit of sample and test for vitamin deficiency otherwise if you have any questions feel free to um ask me anything I'm here every day and you can um find out whatever is concerning to you and I can help you with that okay thank you you're welcome thanks for coming in thanks
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