This is the report of the medical exam by the doctor paid for by the workers compensation insurance company. Keep in mind, Dr. Stirrat was aware of the trip to China and did not comment on it.  Dr. Stirrat did not dispute the three weeks away from work as recommended by Dr. Gordin's 8/9/96 note.

September 16, 1996
William Silverstein
Page 3

symptoms he has lessened those type or activities. Within my practice I would rely more on activities such as swimming that provide both gentle stretch and less resistance. A pool program might prove helpful. The patient comes across as fairly intense and thus probably is at risk for doing any activities because of the effort that he puts.into those activities. In regards to the treatment,he is currently receiving I think it is difficult to be precise about whether such treatment is curative. Basically one needs to alter his lifestyle to achieve some degree of relaxation and then gentle muscle re-training so that he doesn't have the inflammation provoked by his activities. The concept of muscle massage is reasonable, but I am not sure how cost effective it is to have the patient receive frequent muscle massages each week.
Ideally one should try to move his treatment into a self program where one does not have to rely on money being spent to provide treatments to compensate for an otherwise intense life style. As
with any treatment modality if short term interventions do not seem to give him improvement, then decisions need to be made about altering the treatment plan. I believe simply stopping his computer work is not going to be adequate as one needs to address the muscle complaints in the upper extremities that exist now.

DIAGNOSIS: Bilateral upper extremity tendonitis.

PROGNOSIS:  Good.

NEED FOR SURGERY: None recognized.

ABILITY TO WORK:  Patient states that he has not lost a great deal or time f rom work except for medical appointments. It is reasonable for him to continue working full time although one may want to restrict his minutes on the computer within any given hour. That restriction would be somewhat arbitrary but may realistically be 30-45 minutes per hour. Patient should also be encouraged to do less computer work at home while he is recovering. According to the patient, ergonomically things seem to be in good condition at his work place

DISABILITY:  Patient is not yet at a medical end result for his condition.