ASMR Full Body Physical - Testing for Inflammation & Sensory Abnormalities | Head to Toe Check Up

[00:00:00]Hello, Miss Erica. How's everything going today? Good. It's nice to have you in the office again. Looks like this time we have you in for a bit of a specialty assessment. Okay, so just going to go ahead and open your chart. I was reading up on what we had going on earlier.

[00:00:17]Okay, so it looks like you've had some kind of inflammatory symptoms, a little bit of swelling in the notes. Okay. Um, let's see. also saw that there was some notes about some possible tingling or numbness and you're not quite sure if the two are related. Okay, so I'm definitely going to look into that.

[00:00:36]Let's see.

[00:00:38]I had some time earlier. I was looking at your chart from your previous assessment and it looks like we did a thorough head to toe and there was nothing really that was concerning. So, this is fairly new aside from your chronic fibromyalgia. So, I do have that noted.

[00:00:51]Doesn't look like there's been any changes there. Have you had any emergency appointments in between now and your last appointment?

[00:00:57]>> No.

[00:00:57]>> No. Okay, good.

[00:01:00]And then as far as your symptoms today, um have you had any illnesses recently?

[00:01:04]Any like viruses or sickness? Anything that you think would be causing some of that inflammation?

[00:01:09]>> Um just like a sore throat.

[00:01:10]>> Sore throat. Okay.

[00:01:13]Sore throat. Any fever?

[00:01:15]>> No.

[00:01:15]>> No fever. Good.

[00:01:19]All right.

[00:01:22]Now Sarah did take your vital signs or medical assistant and it looks like everything was fine. Maybe some very mild hypertension but I do see that that's kind of in your medical history as well.

[00:01:35]All right, let's see.

[00:01:39]Okay, so I did see a note here. It looks like some of that tingling is kind of isolated to your face. And then do we have any like going down the neck or going down the arms?

[00:01:49]>> A little bit on my left side.

[00:01:50]>> A little bit on your left side. Okay.

[00:01:52]So, left side of the face.

[00:01:57]Anything in your legs? Do you feel like it's gone down further in the body? Your legs feel okay? Nothing that you've noticed.

[00:02:06]All right.

[00:02:09]Any pain associated with that? Any like sharp stabbing pain, throbbing, dull pain? No. Good. Okay.

[00:02:18]All right. So, I'm going to perform a physical assessment. I'll go through a couple things. Test a couple of your cranial nerves and kind of the function of your brain essentially. And then definitely test some sensation. See if there's anything we need to rule out there. Do some palpation and just kind of fill around your face, fill around your head. We'll pay some attention to that left side if I think something's more concerning. Okay. All right.

[00:02:40]So, aside from that, is there anything else you wanted me to have a look at today?

[00:02:44]>> I think that's it.

[00:02:45]>> Okay. So, it has been about a year since your last general assessment. So, I will work some of that in today and just do kind of an overall physical assessment and then of course we'll focus on the things that we're a little bit more concerned about today. So, that's totally fine.

[00:03:00]Just saves you from having to come back in for your annual. Okay.

[00:03:04]All right.

[00:03:07]So, I'm just going to go ahead and cleanse my hands and we can get started.

[00:03:13]Now, since the last time I saw you, have you been keeping up with your ancillary appointments? So, like your optometrist and your dentist, you've had all of those. Did your glasses prescription change at all since your last appointment? Okay. So, all of that is the same. I'll probably do just a brief test of your visual acuity. Just make sure all of that's fine.

[00:03:32]>> All right. So, let's go ahead and get started. Um, I think to start with, I'm just going to kind of look and see if there's anything that I'm noticing.

[00:03:38]Okay. So, I'll have you just kind of relax for me. I'm just going to kind of have a brief assessment. I'm just going to look at the overall state and kind of external well-being. So, just looking at your face and just kind of the overall structure. I like to look at the brows and eyes for any sort of misalignment or asymmetry.

[00:04:01]Specifically around the mouth, we like to look for any drooping. That looks okay.

[00:04:07]Don't notice any misalignment at the shoulders. were fairly even there.

[00:04:13]Elbows are midline with torso.

[00:04:17]Legs as well are even. I don't notice any dropping of the feet. That looks good.

[00:04:23]All right.

[00:04:25]Okay. So, let's go ahead and go in with our light.

[00:04:30]And I'm just going to start by having kind of a more in-depth visual assessment. Excuse me. So, I'm going to move your hair just a little bit and kind of peek around. You're welcome to close your eyes or keep them open, whatever is more comfortable. It is fairly bright. Not shining it in your eyes directly at this point. I just kind of want to have a look there's any abnormalities of the skin again. Brow hair looks good. Nice and full. Lashes are nice and full.

[00:05:05]Overall skin complexion is nice and even. I don't notice any sense of redness or urethma. There's no rosacea.

[00:05:21]It's mild pink at the nose which is normal. Just blood flow. Lips are a good color. Don't look overly pale.

[00:05:29]I don't notice any signs of bless or lack of circulation there.

[00:05:33]So, also just having a look at the thyroid. I like to look for any signs of swelling.

[00:05:38]Of course, do some palpation. As you said, this is where you had some of that inflammation, but I don't see any abnormal pulsation or any protrusion there. So, that looks good. Okay. I'm just have a look at the upper extremities. I'll just take your arm here. Just going to have a look at the skin.

[00:06:04]We did do a skin assessment on your last examination and your tattoos all looked normal.

[00:06:14]You do have a fair amount of freckles and moles. Do you ever see a dermatologist and just have everything looked at?

[00:06:22]Okay. Beautiful nails. Very well groomed.

[00:06:28]Nice and clean. I don't notice anything abnormal there.

[00:06:33]So, if you flip your hand over for me, I'm just going to have a look at the palm.

[00:06:41]No signs of redness or excess moisture.

[00:06:44]That looks good. Okay. All right. And then I'm just going to look at this left side.

[00:06:51]Now, you said you notice some of that kind of abnormal sensation on the left side of your face. anything on the arm as well or is it >> um I just kind of get goosebumps almost.

[00:07:03]>> Okay.

[00:07:06]>> And there's nothing you've noticed that kind of makes it worse.

[00:07:09]>> Okay.

[00:07:11]Don't notice any swelling or anything on this side.

[00:07:17]Okay. All right. That looks so good.

[00:07:21]All right. So, let's go ahead and continue.

[00:07:24]Before I start with any palpations and just kind of start touching you, I'm going to take a couple places of your temperature. I just want to see if there's anything concerning there. So, going to start here at the neck. So, I'm just going to test kind of behind the ear.

[00:07:46]So, does look like there's actually a little bit of variation. Normal temperature here at the front, but as I come here, maybe just a tad warmer by the ear.

[00:08:03]Okay. So, I'm just going to check at the forehead.

[00:08:11]Definitely a little bit of warmth there.

[00:08:12]So, just a touch.

[00:08:17]It is bilateral.

[00:08:20]So, could just be that we're looking at some sort of mild inflammation. Maybe your body is trying to fight virus coming into summertime. There's a lot of pollen in the area. So, all of that could be a factor as well.

[00:08:36]I'm just going to test the arms as well.

[00:08:50]Okay.

[00:08:53]So, doesn't look too bad.

[00:08:58]Temperature of the arms is very consistent. I do just want to check here a little bit more precisely at the thyroid. 98.3.

[00:09:13]Okay.

[00:09:15]So, an average normal temperature reading there. So, that's okay.

[00:09:22]All right.

[00:09:25]So, let's see. Let's go ahead and get a couple things out of the way. I'm going to have a look in your eyes.

[00:09:32]So, firstly going to test for normal pupilary constriction and dilation. Are you comfortable removing your glasses?

[00:09:40]Okay. So, I'm going to shine this light in your eyes. It is fairly bright. I do apologize there. I know you're familiar with this examination. So, just going to have you kind of look at me. Nothing super specific. And then I want you to focus on the light here and just keep your gaze there for a second. So, just going to test pilary response to light as it comes in.

[00:10:10]Checking for consensual and independent response. So direct and consensual.

[00:10:20]Just going to come in from the side.

[00:10:26]Very healthy response of the pupils as I do a bit of a faster motion here. I'm getting normal response.

[00:10:40]Also have a little card here that I can use.

[00:10:47]I'm just going to cover one eye here.

[00:10:52]Very healthy independent response there.

[00:11:03]Very good. Okay. I'm going to have you follow the light for me. So, I want you to keep your head fixated. You'll see a point on the wall there. I want you to look at that point. Try not to move your head. And now, you're just going to follow the light with your eyes.

[00:11:18]Very good. Just follow with your eyes.

[00:11:25]This is testing motor function, your brain's ability to move your eyes.

[00:11:31]We're going to come out and we're going to follow that all the way in.

[00:11:37]Good.

[00:11:40]Now, hold down an object here.

[00:11:43]I want you to look at this for me and then look at the light.

[00:11:48]Good. And then look at this.

[00:11:51]And look at the light. Very good. Switch hands here. So, I want you to look here and look at the light.

[00:12:00]And look here and at the light. Very good. Okay.

[00:12:07]Very good job. So your pupilary constriction and dilation was normal. So your eyes are moving to light accordingly. So before I allow you to put your glasses back on. I'm just going to have a look in your eye with my opthalmoscope.

[00:12:25]So, this device allows me to have a magnified look inside of the eye.

[00:12:34]Look here.

[00:12:41]Good. Okay. So, I'm going to have you look here. You're going to keep your gaze here for me. I'm going to come in and I'm going to have a look directly in your eye. Okay. So, I'm going to start here.

[00:12:52]Just going to gently hold your eye open and I'm going to come very close to your face. I'm just going to have a look directly at your eye.

[00:13:04]Looking at optic discular health. Just looking at the anatomy of your eye.

[00:13:13]Looks like the retinopathy. I don't see any corial dysfunction. I'm going to hold down at the lid and have you look up for me.

[00:13:21]No signs of abnormal mucosa.

[00:13:24]Normal pinking.

[00:13:27]And I'm going to have you look down.

[00:13:31]Very good. Okay. Nice and healthy on that side. Turn your head towards me and we'll have a look at this other side.

[00:13:39]Good. So, same thing. I'm going to come in.

[00:13:46]Coming in from the side.

[00:13:51]Optic disc is visualized.

[00:13:56]Sides of tearing. You look down for me, Erica.

[00:14:03]Some wild information there.

[00:14:06]Go ahead and look up.

[00:14:12]Any pain or tenderness here at the left side? Yeah. Okay. All right. So, I did see a little bit of inflammation on that left side. So, I'm going to look in that a little bit further when I come over on that side of the table. So, just going to take a quick note. You can go ahead and put your glasses back on if you'd like.

[00:14:33]Let's see. So, leftoscopy mildly out of scope.

[00:14:45]So I do see some inflammation, some mild corial distension. Have you had any like scratches or anything or anything stuck in your eye? Just allergies. Okay.

[00:14:59]>> Okay. So that sometimes we might accidentally just cause like a mild abrasion of the eye. It can cause some swelling. So I will have a look and see if there's anything more concerning there. I did just notice just some mild inflammation. So, I'm just taking a quick note here.

[00:15:16]All right. Okay.

[00:15:21]All right.

[00:15:23]So, we can go ahead and get a couple things out of the way with your eyes. I have Let's see.

[00:15:32]Can use this here. So, got this little checkerboard pattern here. And this is going to test for any floaters of your vision. So, if you've ever been dizzy or maybe if you've had some episodes of hypertension and you've gotten up too quickly and you kind of see stars around the room, if that's happening more frequently, this can kind of induce that. So, what I'm going to do is have you look here. I'm going to have you look right at the middle at this black dot. I'm going to move this around your visual field. I want you to tell me if at any point you start to see any floaters of the vision, any stars. Okay?

[00:16:02]So, just going to keep looking here.

[00:16:07]Come very close and then very far.

[00:16:13]You let me know if at any point you see any double vision, blurry vision, if you can no longer see the black dot, or if it turns white, any issues so far?

[00:16:30]Good. So, I'm going to have you do the same thing. I want you to keep looking here. This time, I'm going to cover one of your eyes. So, we're going to test independently. So, we're going to come close and then far.

[00:16:44]Any issues there?

[00:16:46]Good. Same thing. We're going to do this side. So, I'm just going to have you turn your head slightly.

[00:16:52]We'll go like this.

[00:16:58]Any issues on this side? Good. Very good.

[00:17:03]Let's go ahead and put this away. And then I'm going to do just a very brief check for your color deficiency. You didn't have any abnormalities on that last one. But I'm going to go ahead and test this because I did see that inflammation. I want to make sure we're not putting any pressure on your optic disc. So just let's see.

[00:17:30]All right.

[00:17:32]Should see a set of numbers here. Can you read that out loud for me?

[00:17:36]>> 29 >> in here.

[00:17:39]>> Good.

[00:17:46]See anything here? Good.

[00:17:50]Test.

[00:17:54]>> Very good.

[00:17:57]We'll do one more.

[00:18:00]Make sure we test red and green.

[00:18:03]Anything here?

[00:18:04]>> 45.

[00:18:05]>> Good. Okay. So, don't think there's anything wrong really with the optic disc itself, aside from just a little bit of that inflammation, which I will check further. So, we can take a break from the eyes for a second.

[00:18:21]And I'm going to go ahead and check your ears. I just want to have a bit of a look inside the ear. Have you had any issues with like pressure of the ears or any abnormal ear wax or pain of the ears? Anything?

[00:18:34]>> Just sometimes ringing in the >> ringing on the only on the left side.

[00:18:37]Okay. Does that occur when all of the other symptoms are happening or is it just kind of intermittent?

[00:18:43]>> Just here in there, but my allergies could >> Okay. So, it could be that there's just builds up pressure. Just make sure that there's no damage to the tempanic membrane or your eardrum. So, just going to have a look inside your ear. So, you turn your head for me.

[00:18:58]Just going to move your hair out of the way for a second.

[00:19:08]All right.

[00:19:10]So, I am going to pull up and back on your ear and then you're going to feel me come in and it's going to tickle just a little bit.

[00:19:21]Have a look inside.

[00:19:25]Panic membrane is visualized. Your ear is actually nice and clear. No signs of ear wax at all really. Also, no abnormal debris. I don't notice any excess dead skin cells and no abnormal discoloration. It's nice and pearly gray.

[00:19:44]This side looks really good.

[00:19:47]So, I did see a little bit of inflammation on that left ear.

[00:19:57]And then you said you've been having the ringing. So I am going to perform a hearing test and see if there's any issues with your hearing, if there could be any occlusion.

[00:20:12]Okay.

[00:20:18]Now, you said you've been having issues with your allergies, but I know that's kind of chronic for you.

[00:20:23]>> Any like stuffiness or occlusions of the Nars or issues with your nose, issues with smelling or smelling things that you think are maybe abnormal, any smelling of smoke, anything like that?

[00:20:34]>> Just kind of normal stuffiness. Okay.

[00:20:37]>> So, I'm first just going to have a look and then I'll do a little bit of pulpation. Okay. So, now you tilt your head just very slightly.

[00:20:46]Just look for any signs of irritation.

[00:20:48]So, I do see just a little bit of redness right at the base of the nare doesn't look too bad. I don't notice any deviation or anything. So, just very mild inflammation there.

[00:21:05]Okay. So, I'm going to have a look at your throat as well. If I can have you just open for me and if you can say ah >> very good even midline nice and even maybe mild inflammation at the back of the throat actually lift your tongue up for me to the roof of your mouth. Soft pallet looks good though smile with your teeth just looking for any inflammation of the gums. Oh, you got to do it on your tooth. Is that permanent jewelry that you've had placed there?

[00:21:39]>> Um, it's just with like the >> like resin.

[00:21:42]>> Um, it's the the same thing they use for braces.

[00:21:45]>> Okay. Okay. Okay. Does look good. It doesn't look like it's caused any damage or anything to your tooth.

[00:21:51]Very nice. Okay. I assume you've had that done professionally.

[00:21:54]>> Okay. For years.

[00:21:56]>> Okay. Good.

[00:21:59]I didn't notice that on your last examination. I don't think I must have overlooked it.

[00:22:03]Just take a quick note there just so I have it on your file. So that is your right. Let's see one more time.

[00:22:21]So for medical purposes, we document that you have a cosmetic implant.

[00:22:29]Okay.

[00:22:35]All right. So, let's go ahead and move on. I think at this point, we should go ahead and perform some of our palpation assessments. So, I'm going to put on a pair of gloves. I'm going to be feeling around your face a little bit.

[00:22:57]All right. So, I'm going to start by feeling up at the scalp if that's okay with you.

[00:23:19]So, I'm just going to have a feel around your head. So, I'm just going to feel if you could just turn your shoulders just slightly for me. Perfect. So you let me know if any of this causes you any tenderness. So we're kind of looking for any signs of inflammation here. So start with bilateral palpation. So you can tell me if this feels different comparatively on either side or if that feels about the same.

[00:23:42]>> About the same.

[00:23:43]>> Okay. And if we come kind of centered here. Does that feel about the same?

[00:23:50]>> Okay. And then at the top of the head, any soreness or inflammation kind of sensation here?

[00:23:56]>> No.

[00:23:57]>> And then back of the neck. Does that feel about the same on both sides?

[00:24:01]>> Okay. So now I'm just going to palpate around and see if I notice any symptoms of inflammation or any signs of swelling.

[00:24:13]Feeling for any lumps.

[00:24:21]like to feel along the cranial structure. See if there's any ridging.

[00:24:28]It's pretty smooth.

[00:24:38]Okay.

[00:24:42]All right. And then I'm just going to feel along right along the forehead here. Just feeling along the hairline.

[00:24:51]Sometimes get some inflammation here, but I don't think I feel anything here.

[00:24:58]I'm just going to feel along the ear lo behind the ear. Is there any pain or pressure along that mastoid process?

[00:25:08]>> No.

[00:25:08]>> No. Sometimes there can be a build of inflammation there, but that just feels okay.

[00:25:16]coming down clvicular line maybe a mild palpable node there actually.

[00:25:31]Okay. So it's about three finger spaces in from the right side.

[00:25:41]All right. And we'll do the same on this side.

[00:25:52]any tenderness at that left ear?

[00:25:54]>> No.

[00:25:55]>> And then again behind the ear here.

[00:25:58]>> No.

[00:26:01]Coming down the clavvicular line once again maybe just some mild inflammation there.

[00:26:18]So interesting. Okay.

[00:26:26]So I am feeling some distension at the nodes for sure.

[00:26:32]I want to do a deeper palpation here does feel just does feel just a little bit abnormal.

[00:26:43]Okay. So we're going to come back to that. I do want to do a bit more of an in-depth examination of your nodes. I do feel some inflammation there. So I'm just going to take a quick note.

[00:26:53]We're going to do a secondary assessment of the nodes. So, I'll test some of these other functions and then we'll come back and we'll palpate a little bit more there.

[00:27:03]Okay.

[00:27:09]All right. In the meantime, I'm going to have a look at your hands. So, just feel around the veins. Feel for any signs of inflammation at the joint.

[00:27:24]Do you ever have any issues with your joints, with your hands, any kind of swelling or good?

[00:27:31]>> Nice and soft. I don't feel any rigidity. Skin itself is very smooth to the touch. Nice and well moisturized.

[00:27:41]Going to check for capillary refill at the back of your finger since you do have nail enhancement. So very normal return there.

[00:27:55]Nice and healthy blood flow. Don't notice any signs of lack of circulation there. So that's good.

[00:28:05]All right.

[00:28:10]Feels okay.

[00:28:12]Just going to kind of squeeze along your arm here. Just want to feel for any hardness, any swelling.

[00:28:21]Checking for any third spacing or edema.

[00:28:26]That does feel okay.

[00:28:30]Arms are just a little bit cold.

[00:28:34]Hands are warmer. That can't be. Is it okay if I move your sleeves a little?

[00:28:40]Just going to roll this up slightly.

[00:28:46]I do feel just a bit of temperature variation. So, here at the shoulder, actually quite cool to the touch.

[00:28:56]A little bit warmer as we come down.

[00:29:26]So, little bit of variation. Nothing that looks like it's out of range. Just something to note there.

[00:29:44]All right.

[00:29:46]So, I'm just going to fill your pulse while I'm here.

[00:29:52]Nice and strong.

[00:29:58]I don't feel any arythmia. It's very steady.

[00:30:03]Good. And feel at the wrist as well.

[00:30:11]again. Nice and strong. Very steady.

[00:30:20]Okay.

[00:30:22]All right.

[00:30:35]Okay. So, I'm going to go ahead and check reflexes on this side while I'm here.

[00:30:41]So, I'm going to test on this side. I want you to just kind of allow me to take the full weight of your arm here.

[00:30:47]It's going to feel a little tickle.

[00:30:50]Good.

[00:30:57]Good.

[00:31:03]Okay. Of course, I'll check that on the other side when I come around.

[00:31:09]Check some facial reflexes as well while I'm here, though. So, I just going to move your hair slightly from your forehead.

[00:31:22]All right. So, you're going to feel some mild tapping at the eye. It's going to feel just kind of like this. Very soft.

[00:31:28]You don't have to do anything. I want you to keep your eyes open, but don't hold them open. So, just allow yourself to blink. Okay?

[00:31:54]I'm seeing maybe mild overreaction on the left side.

[00:32:30]left side is giving me just a little bit of an abnormal reaction. So, I will retest that when I come over. I'm going to have you hang your jaw just kind of loosely open for me so it's separated at the teeth. Good.

[00:32:44]Okay. Good. All right.

[00:32:53]So, just have a little brush here. It's kind of just give you an example. It's kind of wiry. It doesn't hurt. It's just a little scratchy. So, I'm going to do the same thing. Is it okay if I have you take your glasses off for just a second?

[00:33:06]So, I'm going to do the same thing. I'm going to come just a little bit closer to the lash line. So, again, just allow yourself to blink. Okay.

[00:33:20]It's definitely normal reaction on the right side.

[00:33:24]Nice and responsive. I'm not getting like an oversensitivity or a tearing of the eye.

[00:33:30]That looks good. I'm going to touch your lashes. Very good.

[00:33:36]Test that on the left side. So see just a little bit of Do you feel any twitching or pulsation underneath your eye there?

[00:33:51]>> No. Okay.

[00:33:54]All right.

[00:34:00]Have you keep your glasses off for just a second. I'm going to go ahead and just put this back.

[00:34:16]Okay. So, I have kind of a pressurized tool here. I'll just show you what it feels like. So, just it's a little bit of pressure. So, I'm just going to kind of come closer here and I'm going to apply some mild pressure different areas of your eye.

[00:34:33]Let me know if any of this causes you pain.

[00:34:37]A little pocket of swelling here below the left eye.

[00:34:47]Maybe just a little bit of fluid buildup if it would be related to the allergies.

[00:34:52]See something above the brow as well.

[00:35:15]That causing any pain? No.

[00:35:24]Mild inflammation there. Same thing on the right side.

[00:36:10]Okay. All right. Go ahead and relax.

[00:36:16]Coming back in at the top of the cranium. America, I'm just going to move your hair slightly out of the way as I perform my secondary palpation assessment.

[00:36:26]I did notice a little bit of swelling.

[00:36:29]So, I want to feel around a little more and see if we can kind of isolate where some of that inflammation is coming from.

[00:36:40]want to rule out whether this is it's like a compression of the cranial nerve because of some of that inflammation or if it's just kind of anomalous. So I'm just feeling around just kind of a flatanded pressure here feeling a couple different areas. So maybe some mild inflammation at the base of the skull.

[00:37:10]mostly on that left side which I know you said is where some of that pain was isolated or some of that not pain but kind of tingling and inflammation. So just feeling there does feel just a little bit swollen to me.

[00:37:33]Then I'm going to come down and feel here just below the cheekbone.

[00:37:40]Just feel sides of the sinus inflammation. Just palpate right along that sinus cavity.

[00:37:52]You feel any pressure here?

[00:38:02]As I come down towards your lymph nodes, definitely feel a little bit of that inflammation here.

[00:38:17]Couple palpable nodes.

[00:38:31]submental.

[00:38:35]Okay.

[00:38:37]I come down along the chest. I'm going to feel supervicular.

[00:38:43][snorts] I did feel a node there that was palpable and I can still feel it here on that right side. So, we're about about three spaces in there. a pable node there.

[00:39:02]Supervicular feel directly along the throat.

[00:39:12]Just compress gently here the thyroid ability for any pulsation. Any abnormal inflammation or irritation? Maybe some mild inflammation. Actually think I do feel a little bit there.

[00:39:40]All right. So, I'm going to come back up to the scalp. I think I want to perform a couple perussions here. Again, I want to feel for any inflammation.

[00:39:53]Specifically at the top of the scalp, I tend to see a little bit of tenderness here.

[00:39:59]Percuss near the temporal region.

[00:40:07]It's not so much there.

[00:40:15]Okay.

[00:40:21]Keep your eyes closed for me. I'm going to shine my light here.

[00:40:30]Mild is worse on the side.

[00:41:00]the same thing on this side.

[00:41:04]Again, I do just see a little bit of mild inflammation there, but it is kind of isolated to the external quadrant of the left orbital socket. And then maybe some emphyma here and then maybe some inflammation here along the temporal region of the left side as well. So we do seem to have kind of a trail of swelling that I'm noting.

[00:41:47]Okay, just going to shine directly over the center of your face. Looking for any symmetry at the N. You don't notice top of the nose is midline to the forehead.

[00:42:02]Okay.

[00:42:05]Shoulders is so well.

[00:42:10]Just going to palpate here.

[00:42:16]So, just a little bit tight, which could be related sometimes if we're having an inflammatory response. Our body can kind of show signs of inflammation in the joints. Our shoulders tend to carry a lot of that tension. So, I do feel a little bit of tightness there.

[00:42:38]>> Feels a little tender to you.

[00:42:47]All right. So, I'm going to come over on this left side and have a bit of a closer look.

[00:42:53]I am on your left side and I'm going to palpate a little bit more directly here.

[00:43:01]Isolate where I think this inflammation could be happening. So, I'm going to alternate between palpating with my hands and maybe manipulation with a couple of tools. So, you just relax for me. I am going to have you turn your head slightly to the right if that's okay so that I can have a better look here cuz you did say there was some ringing of the ears. So just feel here.

[00:43:40]Just going to continue my palpation here below that left side. So palpating along your jawline, feeling along that mastoid process.

[00:43:57]do sense some inflammation here as well.

[00:44:07]Just going to have a look. I don't notice any redness.

[00:44:15]Let's look at the ear itself. So there is just a little bit of pinkening here the external lo and then following up towards the cartilage.

[00:44:29]Just a mild increase there, but it doesn't look too bad.

[00:44:37]Come along the PA coming down towards the labial and then just along that mastoid process.

[00:44:51]Any signs of irritation here. The skin does look just a little bit inflamed internally.

[00:45:13]Use tool here to pull along the skin. Just really gently.

[00:45:27]Just let me know if that causes you any discomfort. I'm just pulling along sessing some of that.

[00:45:38]Mildly inflamed here. And then as we come further down the neck does dissipate but again I do still just feel some inflammation. So overall feels like your body is producing I would say moderate inflammatory response. You may be fighting some sort of internal infection. So be a good idea to do some labs follow up with your blood work and see if we test positive for any of the normal strap or flu. It is out of season but not unheard of.

[00:46:35]Fill around the shoulder.

[00:46:43]of the clical mild pressure build up here at the lower clavicles. It's just below your left collar bone.

[00:47:06]Just a little bit of inflammatory built up there. So, it could just be that your lymph nodes are not quite draining properly. Some of that lymphatic fluid may just be built up here in your train of nodes, which can be common during allergy season. Your body is just having trouble working through the pollen. So, I'm going to come in and perform a few tests for sensory dysfunction.

[00:47:55]Now, just not quite sure if this is a reaction to your cranial nerves being oluded by swelling.

[00:48:09]So, if you have any inflammation or edema that's pushing on your nerve that is responsible for sensory function, then that could explain why you have some of these tingling sensations. This could also explain some of the ringing of the ears. So, actually have a secondary look inside of your left ear.

[00:48:35]So, I'm just going to just scope and come in here and have a secondary look.

[00:48:51]So definitely still seeing that inflammation actually see a small actually see a small abrasion here which could be due to just some of the inflammation. I don't notice any excess ear wax, but there is some mild discoloration of the ear canal.

[00:49:25]Okay, definitely some swelling.

[00:49:37]Okay, what's in meis?

[00:49:43]normal. It's fairly gray. I don't notice any redness there. Just kind of the mid to shallow ear showing some signs of irritation.

[00:49:55]Okay.

[00:50:02]All right.

[00:50:04]So, I'm going to do those tests for sensory dysfunction.

[00:50:09]And I'm going to start with a very soft sensation. So feel this tool. It's kind of like a soft wispy cotton stand.

[00:50:21]Going to apply it to your skin. So you're going to feel a soft sensation.

[00:50:27]Good.

[00:50:29]Whispering across the skin. And I'm just looking for normal or abnormal reactivity of the nerves, the facial nerves that are responsible for sensory function. So just feel me touch your skin with this soft object. And I want you to just relax for me. I'm trying to get as natural of a response as I can.

[00:50:57]So I am seeing a bit of diminishment of reactivity here.

[00:51:05]It's not quite as responsive.

[00:51:23]Just here at the lob quick wispy motions I do notice a bit of diminishment there as well.

[00:51:42]Tracing along the meridians here. So I'm going to start at the forehead and come down towards the temple and then temple towards the ear and then ear towards the chin.

[00:52:04]So bit of a triangular region here that is mildly abnormal in sensation.

[00:52:11]So let me follow that up with something tad more distinct. So, why don't we do still in the family of softer sensation?

[00:52:23]I'm going to touch you with this sponge.

[00:52:27]So, it's just mildly abrasive. I'm going to start again at the forehead.

[00:52:38]Let me know if you feel any of that tingling sensation. If you feel any abnormality and texture. If you start to feel any pins and needles, again, I am noticing just a mild diminishment of sensory function here as well.

[00:53:05]Mostly on the lower third of her face.

[00:53:09]So, I might actually look into getting an MRI done of the left side of your face.

[00:53:14]See how much of that compression is affecting cream number five. So, just do some gentle precaution here before I test another All right. So, this time I'm going to come in with a sharper sensation. Can you feel that? That's fairly sharp.

[00:53:50]So, I'm going to move this down the forehead. I'm coming towards coming towards the temporal region. Do you feel any kind of tingling or pins and needles here?

[00:54:07]>> No.

[00:54:09]>> And then as I'm next to the ear, do you feel anything here?

[00:54:13]>> It's a little sharp.

[00:54:14]>> A little sharp. Good. And down the jaw.

[00:54:17]Does that feel fairly sharp?

[00:54:20]>> Does it feel the same sharpness on this side that it does on that side?

[00:54:25]>> Yes.

[00:54:27]It's a good sign.

[00:54:30]So, if I alternate this time using a similar sharp tool, this one is tad more distinct. Can you tell that that's sharp?

[00:54:45]Can you tell that this is dull or soft?

[00:54:48]Okay. So, I'm going to touch your face in various places. I'm just testing to see if it really is isolated to this lower left side. So, I want you to tell me if you feel soft or dull versus sharp. Okay.

[00:55:07]Soft.

[00:55:35]Good. So now I'm going to test from one side to the other once again. And I want you to let me know if it feels any different from your left side to your right side. Okay. So coming again with the soft, you're just going to feel kind of that wispy sensation. And this time I want you to let me know if there's any variable from the left or the right side. So now we're trying to do some isolation here. So does this here feel the same as this?

[00:56:03]>> And along the brow, does that feel about the same?

[00:56:08]>> Just below cheekbone, does that feel about the same?

[00:56:13]Then if we come here at the jawline, does that feel the same as that side?

[00:56:19]>> Oh, more det.

[00:56:21]>> Okay.

[00:56:23]>> So then if I come from the right side around, do you start to feel that it feels different?

[00:56:29]>> A little bit.

[00:56:29]>> Okay. And that's kind of still isolated to that area.

[00:56:33]>> Okay. I do see that there is some compression of the nerve. So let me test just Few more things here. I want you to tell me.

[00:56:45]Do you feel vibration here?

[00:56:48]>> Okay.

[00:56:51]Do you feel vibration here?

[00:56:54]>> A little bit.

[00:56:57]A little on that side.

[00:56:59]>> Yeah.

[00:57:00]>> Okay.

[00:57:02]Would you say that that side feels the same or different than this side?

[00:57:07]>> Different.

[00:57:09]Okay.

[00:57:10]Now lastly for the sensation of your face I'm going to test just cold response from one side to the other. So same thing I want you to tell me if it feels the same coldness on both sides. Okay.

[00:57:25]So here and here. Does that feel the same?

[00:57:29]Either sides of the mouth. Does that feel the same?

[00:57:34]And then below the ear.

[00:57:37]Does that feel the same?

[00:57:38]>> A little bit.

[00:57:39]>> A little bit. And then as I come here and here, does that feel the same coolness?

[00:57:45]>> Less on the left side.

[00:57:46]>> Less on the left side with an identical object here. I'm going to touch you at the same time. I just want to confirm that does not feel the same temperature to you. Okay.

[00:58:01]>> Here it does. Here it does.

[00:58:04]>> Yes.

[00:58:05]>> Here it does not.

[00:58:06]>> No.

[00:58:07]>> Okay.

[00:58:08]So, some definite compression on the left side. So, we're going to go ahead and move on. I'm going to do a bit of palpation of the lower body. Okay.

[00:58:18]All right, Erica. So, coming down to your lower body. I'm just going to do a couple of those palpations that we talked about. Fill around for any signs of inflammation or anything abnormal.

[00:58:26]So, you're not really complaining about any signs of distension or anything at the abdomen.

[00:58:31]>> And then you said nothing really concerning of the lower extremities either. Okay. So, I'm going to do some superficial palpation to start. You can let me know if any of this causes you any discomfort. So, just feeling for, any signs of bloating, any signs of abnormal distension or any hardness or like rigidity of the abdomen. So, so far all of this feels okay. Nice and tender to pulpation. I don't feel any like lumping. I don't feel any hardness.

[00:59:09]Just feel around for any signs of umbilical hernia, which so far is not notable. Don't notice any distension there.

[00:59:20]Do some moderate palpation of the ribs for any signs of flaring.

[00:59:35]Nice and even at the rib cage, centered with the breast bone.

[00:59:41]So, I'm going to go in for a deeper pulpation here. Now, I'm feeling for the organs. So, I'm just going to palpate around in a circular motion.

[00:59:53]This allows me to feel for any sense of inflammation of the internal structure of the abdominal cavities. Of course, not notable.

[01:00:06]Okay.

[01:00:08]So, I'm going to do some percussion first just manually with my hands.

[01:00:15]Just listening for any abnormalities.

[01:00:17]Again, any signs of distension.

[01:00:24]Very good.

[01:00:28][snorts] If I could just have you take a deep breath in for me.

[01:00:33]Go ahead and release all the way out.

[01:00:36]Very good. Nice and even at the rib cage. Good. So, we can do some percussion with our secondary reflex hammer here.

[01:00:52]So, we're just going to feel some tapping.

[01:01:00]Normal density at the rib cage. Sounds good.

[01:01:09]Same on this side. So, always testing bilaterally, listening for any audible differences, the pony prominence. That sounds okay.

[01:01:18]Now, as I come centered with the abdomen, we'd expect a more hollow sound, which is notable, less shallow towards the lower abdomen.

[01:01:34]Just going to percuss along the pelvic bone. You can let me know if any of that's tender.

[01:01:42]Good.

[01:01:47]All right, looks okay. So, I'm not really noticing anything at the stomach. Looks good.

[01:01:54]So, I'm going to come down and palpate along the lower extremity. So, I'm going to feel your legs.

[01:02:02]Just briefly feel at the thigh. Feel for any signs of distension.

[01:02:12]It's particularly notable here on the right side.

[01:02:19]Same on the left.

[01:02:24]So it does appear as if most of your symptoms are kind of isolated to the upper chest area. Definitely that lower mandibular feel along the knee here. I don't feel anything at the joint. You never have any clicking or any pain or issues, inflammation at the knees.

[01:02:50]Coming down.

[01:02:52]Just feeling along the calf.

[01:02:58]Do feel a bit of temperature variation here at the skin. It's just mildly cool.

[01:03:05]Feel here.

[01:03:10]Go ahead and test while I'm here.

[01:03:26]Actually looks okay. Very consistent.

[01:03:28]Nothing abnormal. It is just a little bit lower than your baseline of 98.3. Okay, I'm getting an average of about 969. But you have been laying down, so not as much blood flow has been going to your feet.

[01:03:42]That's right. Nothing concerning.

[01:03:45]Just going to feel pulse here.

[01:03:53]Okay. Nice and strong.

[01:04:05]All right.

[01:04:06]So, now rolling your pants up just very slightly if that's all right. Just have about a 6 in area here, which is enough for me to test for sensory dysfunction.

[01:04:16]So, going to go in with our softer sensation. So, just like we did up near your face, I want you to tell me if you feel that this is soft. Okay? So, just have you close your eyes for me. Let me know if you feel soft.

[01:04:35]>> Good soft good equal on both sides. And if I come in with that sharper sensation. So same as near your face. Do you feel that this is sharp?

[01:04:57]>> Yes.

[01:04:58]>> Is there anywhere that it doesn't feel sharp?

[01:05:03]>> Feel the same on the side. Sharp.

[01:05:05]>> Yes.

[01:05:09]>> And then I'm going to test this last one bilaterally since we did see the dysfunction up near the face. So testing for cold. Can you tell that that feels cold?

[01:05:19]>> Is that equally as cold here?

[01:05:21]>> Yes.

[01:05:22]>> And here?

[01:05:23]>> Yes.

[01:05:24]>> And here? Yes.

[01:05:26]>> In here.

[01:05:27]>> Yes.

[01:05:27]>> Good. So, none of that felt different one side to the other. Okay.

[01:05:33]>> All right. And then one last test. I'm just going to test for a little bit of peripheral neuropathy. So, I'm going to slide this just kind of down your legs like this. I want you to let me know if you feel any tingling or like pins and needles. Okay. So, start at the outside here.

[01:05:52]Anything there?

[01:05:55]And then if we come center and then internally no burning sensation. Good. Okay.

[01:06:06]All right.

[01:06:11]Just pull your pant leg back down.

[01:06:17]I could have you just push up with your leg for me. Just push up into my hand and then down and then up here. and down. Very good. All of that feels okay.

[01:06:27]All right. So, I'm going to come back up and we'll kind of finish up our assessment. Okay.

[01:06:33]All right, Erica. So, I am going to go ahead and document those findings. Now, I did see what I would consider some mon moderate inflammatory response. You do have some swelling of the nodes specifically on the left side. I did also see a lot of distension, you know, kind of lower mandibular area. So behind your ear and kind of along your jawline and there definitely was some sensory dysfunction. The good news is that I don't think it's cranial dysfunction. I don't think there's anything wrong with your cranial nerve. I think it's more so just due to inflammation. So I do want to follow up and get some labs done if that's okay with you. So we'll do some blood work for sure and then depending on how your labs come back. We're going to hold off on imaging for now. So, if your labs end up coming back with anything out of normal range, then I am going to order an MRI to kind of have a look and make sure that there's not any excess compression there. Okay. All right. As far as the ringing of the ears, I want you to just watch your symptoms. If you notice that you start to have any like drainage or anything like that, definitely let me know.

[01:07:37]So, for now, we will go ahead and follow up with the blood work.

[01:07:43]And I am labeling your sensory dysfunction as moderate because there was there was just a little bit that was concerning to me there specifically with your bilateral sensation response.

[01:07:56]All right. Do you have any questions for me?

[01:07:59]>> No, I think that's it for now.

[01:08:01]>> All right. So, if it's all right with you, I'm going to go ahead and have our lab tech come in. Um, she will get your labs done and then we'll send that off and your results will come in usually in about a week or two. Okay. Of course, if your symptoms start to get worse, definitely let me know. We can maybe get you in for a secondary assessment and see if anything's gotten worse or if you're just not quite getting better, though. Okay. Okay. All right. Let me go put this in. She should be coming in shortly.

[01:08:25]>> Thank you.