Lakewood Family Medicine

A1C trending up (7.8%). Patient reports intermittent adherence to Metformin — skips doses when she feels fine. Discussed importance of consistent dosing. Will recheck A1C in 4 weeks. Consider increasing Metformin to 1000mg BID if no improvement. BP still above target at 138/86 — may need to add second agent if Lisinopril alone insufficient. Patient expressed concern about medication costs — explore generic alternatives and patient assistance programs.

MRI shows L4-L5 disc bulge with mild neural foraminal narrowing. No surgical indication at this time. Patient reports pain is manageable with current regimen (Cyclobenzaprine PRN + home PT exercises). Recommend continuing conservative management. If radiculopathy develops or pain worsens significantly, consider epidural steroid injection referral. Patient works as a medical assistant — prolonged standing may exacerbate. Discussed ergonomic modifications.

Comprehensive metabolic panel largely within normal limits. Kidney function preserved (eGFR 92). LDL elevated at 128 — discussed dietary modifications before considering statin. Patient is motivated but managing diabetes, hypertension, and back pain simultaneously is overwhelming. Social history: single mother, two children, works full-time. Transportation to appointments is sometimes a barrier. Consider telehealth for follow-ups when appropriate.