The patient was a 31 year old female from GCC presenting with severe, intermittent right neck pain that developed after giving birth to her third child in May of 2015. In addition to the pain, during childbirth the patient developed hydronephrosis of the left kidney. In the GCC the patient tried numerous medications and interventions, none of which were successful in treating her pain. The patient, therefore, decided to pursue medical treatment in the USA.

Prior to arrival in the USA, the patient was scheduled with several specialists in Washington DC, including a pain specialist, a neurosurgeon, a nephrologist and also a general medicine primary care physician. After a number of appointments with the pain specialist, the physician concluded that the etiology of the neck pain was likely due to postural issues during and directly after child birth involving straining of the sternocleidomastoid muscle. Imaging was completed, including an MRI and cervical spine x-ray, and based on the results, neurosurgery cleared the patient. The pain specialist continued to treat the patient for her muscle pain and recommended multiple therapies including ice massages, Voltaren gel and powder, muscle relaxants as needed, Tylenol as needed, muscle injection therapy and also set the patient up with an intensive out-patient physical therapy regimen.

Meanwhile, the patient also had several appointments with a nephrologist to address the newly diagnosed hydronephrosis, as well as blood pressure issues she had previously experienced. The patient came to DC on two blood pressure medications, Norvasc and Bisoprolol, and was never educated about the importance of checking her blood pressure on her own prior to taking the medicine. Due to normotensive readings, at the request of her PCP in DC the patient stopped her blood pressure medicines and started to track and record her blood pressure twice daily. After tracking her blood pressure for three weeks, the nephrologist approved the patient to discontinue her blood pressure regimen.

To further evaluate the hydronephrosis, the nephrologist ordered several renal scans including two abdominal ultrasounds and an abdominal CT scan; from the scans it was concluded that the patient did not have a right kidney. The previously suspected hydronephrosis was caliectasis of the left kidney- likely a congenital anomaly. A blood renal function test was performed and the results were within normal limits, while the urine sample indicated slight proteinuria. The proteinuria prompted a urology consult. The urologist concluded that in the setting of normal renal function, preservation of the renal parenchyma by imaging, and the lack of symptoms or infections, an additional workup was not necessary at that time.

During the patient’s final appointments, the nephrologist explained to the patient that it was imperative for her to follow up with a nephrologist in the GCC and to have kidney function tests routinely performed every four to five months. The nephrologist also explained and reiterated to the patient the importance of staying away from NSAIDS to preserve kidney function.

Once all appointments were completed and the patient’s pain had been minimized, she was medically cleared by all physicians to return home. From the physicians, she obtained recommendations for pain management upon return home as well as lifelong recommendations for living a healthy lifestyle with one kidney.

In just over two months spent in DC, the patient had a total of eighteen appointments, not including her physical therapy sessions. The patient’s projected length of stay in DC was minimized due to PCI care navigation acting as oversight in conjunction with the Embassy. To minimize the length of stay, appointments were obtained in a timely fashion and patient needs were addressed in an expedited manner. By the time she was discharged, she received two sessions of injection therapy for pain, was able to manage her blood pressure without medications, learned home exercises from physical therapy, started taking Tylenol instead of Ibuprofen, her Vitamin D level was within normal limits and most importantly she learned new techniques to successfully control her pain.