A 16-year-old female with chronic migraine without aura comes to your clinic with her mother. She is having 2-3 migraines a week, but her mother notes she has milder headaches a couple of days a week as well. She is missing school frequently and has stopped participating in band. The patient has tried cyproheptadine and amitriptyline as preventive medications with naproxen as an abortive medication. She has not seen a decrease in the number of her monthly headaches, and the naproxen has been helpful, but it does not relieve the migraine. They received a few samples of rimegepant from their PCP, but their insurance company is not going to cover it. Despite her willingness to try off-label medications prior, now her mother is only interested in trying treatments that are FDA approved for pediatrics.
A 16-year-old male athlete with pectus excavatum is scheduled in the OR for Nuss repair.1 He has previously had general anesthesia at the age of 14, with postoperative nausea and vomiting (PONV) secondary to anesthesia and also post-operative opioids (both intravenous and enteral). Family is requesting a modified anesthetic plan to address his PONV, while also being concerned of the severe pain associated with this procedure. Which plan would be most effective for this patient, to avoid PONV, manage pain efficiently and minimize hospital length of stay?
A 16-year-old male basketball player arrives at the clinic with chronic bilateral lower leg pain. He reports a sharp cramping pain that begins while running and resolves 10-20 minutes after he stops exercising. He reports occasional paresthesias, and numbness to the extremity. He also reports mild swelling and tightness in both legs only during exercise. He denies any known trauma to the extremity. Physical exam is unremarkable.
What is the best initial treatment for the underlying cause of this patient’s condition?
A 19 year male is on Medication Assisted Treatment (MAT) with Buprenorphine maintenance daily. His current dosage is 6 mg of buprenorphine daily. He is scheduled for a NUSS procedure.
As his AYA (Adolescent and Young Adult) Pain Doctor what would you advise the patient about his Buprenorphine perioperatively?