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[Other Socials][Doctor] okay and for you too were you on vacation last week and a lot of people had vacation last week [Patient] yes i was on vacation last week actually[SEP][Other Socials][Doctor] okay hopefully you were n't sick for too much of it [Patient] no i was feeling okay[SEP][Other Socials][Doctor] okay okay [Patient] got back and started feeling poorly[SEP][Physical Examination][Doctor] sorry about that alright so what i'm gon na do now is i'm gon na go ahead and start your physical exam i looking at your vitals vitals look overall pretty good i do see your blood pressure is elevated at here it's one forty four over seventy two otherwise everything else looks good so let's check you out so first starting i'm just gon na check start with your sinuses and when i press here do you have any pain any tenderness when i do that [Patient] no[SEP]
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"Physical Examination"
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[
"Objective"
] | 100
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[Personal History][Doctor] so health wise , how is everything going ? [Patient] good , the testosterone's going well .[SEP][Personal History][Vegetative History][Doctor] that's great . [Patient] uh , it helped me out . i feel good , more vigorous , sleeping well and i think it's having some positive effects . not so much physically because like i said i've- i've been this way my whole life , but i'm seeing some good improvements in my bloodwork .[SEP][Personal History][Therapeutic History][Doctor] okay , well that's good . [Patient] so the finasteride i'm only taking half a pill , it's the 5 milligram one .[SEP][Personal History][Therapeutic History][Doctor] yeah , i remember you telling me that . [Patient] and cialis , on the days i work out i take 5 milligrams otherwise i take two and a half milligram pills , but , uh , i have been out of it .[SEP]
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"Physical Examination"
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"Objective"
] | 101
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[Chitchat][Doctor] right i want you you can talk about those things yes [Patient] okay[SEP][Acute Symptoms][Personal History][Doctor] okay so with your newly diagnosed ovarian cancer so how are you feeling today how are you doing [Patient] i'm doing pretty good depressed[SEP][Acute Symptoms][Doctor] little depressed i can understand it's a lot to take on is n't it [Patient] yes[SEP][Personal History][Doctor] okay okay so lem me ask you some questions so what kind of symptoms were you having that prompted you your doctor to do the tests [Patient] i was having severe pain and bleeding[SEP][Vegetative History][Doctor] okay now do you have other symptoms such as weight loss constipation vomiting or issues with urination [Patient] no vomiting but constipation and weight loss[SEP]
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] |
[
"Subjective"
] | 102
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[Acute Symptoms][Doctor] okay and you said this happened yesterday correct [Patient] yeah[SEP][Acute Symptoms][Doctor] okay and have you been able to walk on it at all [Patient] no i was so initially when i first fell i was unable to walk at on it at all i had a friend that was visiting and so she heard me fall so she helped me inside now today i have been able to put a little bit more weight on it but i'm still limping[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and then what have you been doing for your foot or ankle pain since that happened [Patient] so i like iced it last night and kept it elevated and i also took some ibuprofen last night and this morning before coming in today[SEP][Acute Symptoms][Doctor] okay and can you rate your pain for me [Patient] i would say right now it's like a four out of ten[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and does the ibuprofen help with that pain [Patient] it does it does help with the pain[SEP]
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[
"Acute Symptoms",
"Therapeutic History"
] |
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"Subjective"
] | 103
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[Chitchat][Doctor] it's good to see you as well . are you ready to get started ? [Patient] yes , i am .[SEP][Acute Symptoms][Doctor] louis is a 58-year-old male here for follow up from an emergency room visit . so , louis , what happened ? [Patient] yeah . i was playing tennis on saturday . it was really , really hot that day , very humid . and about after about a half an hour i was very short of breath , i was struggling breathing . i thought i was having a heart attack , got really nervous . so , my wife took me to the er and , uh , everything checked out , but i was just very upset about it .[SEP][Acute Symptoms][Doctor] okay . all right . and how have you been feeling since that time ? [Patient] uh , foof , probably , probably about six hours after we got home , i felt very light-head and very dizzy and then , sunday , i felt fine . i just thought it was worth checking up with you though .[SEP][Personal History][Therapeutic History][Doctor] okay . and have you been taking all of your meds for your heart failure ? [Patient] i have . i have . i've been , uh , very diligent with it . and , uh , i'm in touch with the doctor and so far , so good , other than this episode on saturday .[SEP][Personal History][Doctor] okay . and , and you're watching your diet , you're avoiding salt . have you had anything salty ? [Patient] i cheat every now and then . you know , i try and stay away from the junk food and the salty foods . but , for the most part , i've been doing a good job of that .[SEP]
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[
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] |
[
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] | 104
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[Discussion][Doctor] okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job . [Patient] all right . so would you write a note to excuse me for another six weeks ?[SEP][Discussion][Doctor] sure . i'll have my nurse anna give it to you . [Patient] that's great . thank you .[SEP][Follow-up][Doctor] okay , so we'll talk again in six weeks , and we can discuss your job again at that time . [Patient] sounds good .[SEP][Discussion][Doctor] yeah , those , um , are the types of , of jobs that take a good three months until you're kind of ready to get back to doing that kind of labor-intensive work . [Patient] okay , and driving now ?[SEP]
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"Discussion"
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] | 105
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[Personal History][Doctor] and that was before we started the progesterone . [Patient] yes .[SEP][Personal History][Doctor] so i know we started it for regulating your periods , but perhaps it helped with this also . [Patient] yeah . and before , in november and december , i noticed that the week before my period , my anxiety would go through the roof . which then , i knew my period was coming . then it turned into my anxiety spiking just at random times .[SEP][Personal History][Doctor] hmm , okay . [Patient] and it seemed like it was for no reason .[SEP][Personal History][Therapeutic History][Doctor] but november and december you were on the progesterone at that time . [Patient] yes .[SEP][Personal History][Doctor] all right . so not really a link there , all right . [Patient] yeah , i do n't know .[SEP]
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[
"Personal History"
] |
[
"Subjective"
] | 106
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[Conversation Start][SEP][Greetings][Doctor] good morning carolyn how are you [Patient] i'm doing alright other than this ankle pain i've been having[SEP][Acute Symptoms][Doctor] so i see here that you hurt your right ankle can you tell me what happened [Patient] yeah so yesterday i was going to take out the trash and it was quite icy i thought i was doing okay job and i just slipped and and fell and i'm pretty sure i heard a pop[SEP][Acute Symptoms][Doctor] okay and you said this happened yesterday correct [Patient] yeah[SEP][Acute Symptoms][Doctor] okay and have you been able to walk on it at all [Patient] no i was so initially when i first fell i was unable to walk at on it at all i had a friend that was visiting and so she heard me fall so she helped me inside now today i have been able to put a little bit more weight on it but i'm still limping[SEP]
|
[
"Acute Symptoms",
"Therapeutic History"
] |
[
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] | 107
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[Conversation Start][SEP][Greetings][Doctor] hi , hannah . how are you ? [Patient] good , how are you ?[SEP][Chitchat][Doctor] i'm good . you ready to get started ? [Patient] yes , i am .[SEP][Personal History][Doctor] so , hannah is a , uh , 52-year-old female here for evaluation of a high blood sugar . so , hannah , what ha- what happened ? i heard you were in the emergency room with a high blood sugar . [Patient] yes . so , i've been eating a ton of sweets recently . with the holidays it just feels like there is always something sweet available. whether i am at work and there are holiday gift baskets or clients bringing in treats or when i visit my family for the holidays and there is every baked good imaginable, there is always something sweet i can be eating. in the beginning i felt fine, but i have started to feel it after a couple of weeks, and this past week i just felt really light-headed and i could ... was seeing spots , really dizzy . so i went into the emergency room and they said i had a high blood sugar . um , so i wanted to come in and follow up with you to get that , um , get checked out .[SEP][Acute Symptoms][Therapeutic History][Doctor] okay . all right . and how , how are you feeling now ? did they , did , did they treat you in the emergency room ? did they gi- they give you some iv fluids and things like that ? [Patient] yeah . they gave me some fluids and they told me just to try to really cut out eating any extra sweets and get back into my normal routine and diet, but i am still staying with my family, and my mom and grandmother are big bakers so i think it will be really hard to get into a routine there so i just want to make sure i am nipping this high blood sugar thing in the bud.[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 108
|
[Conversation Start][SEP][Personal History][Greetings][Doctor] judy gomez , mrn 869723 . date of birth , 5 , 7 , 1961 . she's in office today for ongoing management of psoriatic arthritis . hello , judy , how are you doing today ? [Patient] i'm doing good , thank you . how are you ?[SEP][Personal History][Therapeutic History][Doctor] i'm great , thanks . so how have you been since the last time ? i know the last time we were talking about decreasing your prednisone dose , correct ? [Patient] yes . i'm just on one now and that seems to be enough .[SEP][Therapeutic History][Doctor] aw , that's great to hear . [Patient] yeah , there were a couple days there i took an extra one , just because there was a little extra pain in my feet . and i do have a desk job , so when i have a day off where i'm moving around a lot they do tend to hurt a bit more .[SEP]
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"Therapeutic History"
] |
[
"Subjective"
] | 109
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[Acute Symptoms][Doctor] okay . on one side versus the other ? [Patient] um , kind of both equally .[SEP][Acute Symptoms][Doctor] okay . all right . and any numbing or tingling in your legs or your feet ? [Patient] no , i have n't felt anything like that .[SEP][Vegetative History][Doctor] okay . any weakness in your lower extremities ? [Patient] no .[SEP][Personal History][Doctor] okay . all right .and then in terms of your blood pressure , how are you doing ? [Patient] so i got that cuff that you suggested the ... our ... the last visit , and i've been doing readings at home . and that's been looking great , too . i've been watching my diet . again , my boyfriend's been great and dieting with me so i do n't have to do it alone . and everything's been good .[SEP][Personal History][Therapeutic History][Doctor] okay . excellent . and you're taking the lisinopril ? [Patient] yes .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 110
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[Chitchat][Doctor] alright [Patient] yeah[SEP][Vegetative History][Doctor] unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately [Patient] no not recall[SEP][Vegetative History][Doctor] alright how about your appetite are you hungry or or not as hungry [Patient] i i would say about his that that's pretty much unchanged[SEP][Vegetative History][Doctor] okay your appetite is unchanged alright what about your water consumption [Patient] that i'm sorry what did you say[SEP][Vegetative History][Doctor] no it's fine how about your water consumption [Patient] yes but i've been drinking a lot more water and i do realize that i i wake up sometimes during the night to you know use the restroom to pee more than i normally do[SEP]
|
[
"Other Socials"
] |
[
"Subjective"
] | 111
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[Therapeutic History][Doctor] and you're still taking the keppra ? [Patient] yes , i am .[SEP][Personal History][Doctor] okay , great . and then , tell me a little about your depression . how're you doing with that ? i know that you went into therapy last year , and you tried to avoid medication since you're already on the keppra . how's that doing ? [Patient] uh , therapy , therapy's been good . it , it has definitely helped . uh , i still feel a little down , uh , and , and stressed .[SEP][Vegetative History][Doctor] okay . all right , but no , no feelings of wanting to hurt yourself or somebody else ? [Patient] no , nothing like that .[SEP][Personal History][Doctor] okay . all right . and then , how are you doing with your , with your ulcer ? i know that you , you know , you had so much stress a year ago and , you know , you were having some issues there . we did the endoscopy- [Patient] mm-hmm .[SEP][Personal History][Doctor] . and they showed that . so , how are you doing with that ? [Patient] i'm doing , i'm doing better . i have n't had any , um , issues with that , um , since we did the procedure , and everything's been good .[SEP]
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[
"Acute Symptoms"
] |
[
"Subjective"
] | 112
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[Acute Symptoms][Doctor] okay , and any problems breathing ? do you feel short of breath ? [Patient] uh , just when i'm doing doing the projects . again , not even lifting anything really heavy , it's just that if i'm ex- exerting any energy , i , i kinda feel it at that point .[SEP][Acute Symptoms][Doctor] okay . do you have any chest pain ? [Patient] slight cramps . that seems to go away after about , maybe about an hour or so after i first feel it .[SEP][Acute Symptoms][Doctor] okay , and how about a cough ? [Patient] a , a slight cough , and again , i'm not sure if it's just the change of seasons and i'm getting a cold .[SEP][Chitchat][Doctor] mm-hmm . okay . all right . well , you know , for the most part , how , you know , before all of this- [Patient] mm-hmm .[SEP][Personal History][Doctor] . how were you doing with your heart failure ? i know that we've kinda talked about you being able to watch your healthy food intake and that's been kind of a struggle in the past . [Patient] i , i , i've actually been pretty good about that ever since . the , the , the last year , it's been a little chaotic , but i wanted to make sure i stayed on top of that .[SEP]
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"Chitchat"
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] | 113
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[Conversation Start][SEP][Personal History][Greetings][Therapeutic History][Doctor] next patient is emily hernandez . date of birth , march 26 2001 . this is a 20 year old female being seen today for our yearly follow-up for asthma , allergic rhinitis and food allergy . due to insurance changes since our last office appointment in april 2020 , she was switched from symbicort to wixela . she also uses zyrtec in the spring , summer and fall for her seasonal allergy symptoms , which tend to work well . she also has known peanut allergy , she does tolerate almonds and cashews . please put in the asthma section at the very bottom that the act score is 21 . please put under interval history , written consent is obtained today to use dax for documentation . hi emily , how are you ? [Patient] i'm pretty good , how are you ?[SEP][Therapeutic History][Doctor] i'm good , thank you . so gosh , we last talked a little bit over a year ago and it was just a telemedicine visit , but it seems like you've been doing pretty good . i know there was an insurance change . i think you had switched over to wixela , is that right ? [Patient] yep , that's right , and it's what i'm currently using .[SEP][Therapeutic History][Doctor] okay , and that's the 250/50 dose , correct ? [Patient] yes , correct .[SEP]
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"Therapeutic History"
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[
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] | 114
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[Personal History][Doctor] and any additional weakness ? i know you were having some issues with your right leg , but that seems to have improved or ? [Patient] yes a lingering issue with my knee surgery . but other than that it's been fine .[SEP][Physical Examination][Doctor] okay . all right , well i know you did a review of systems sheet when you checked in . [Patient] mm-hmm .[SEP][Vegetative History][Doctor] and you were endorsing that insomnia . any other issues , chest pain , shortness of breath , anything ? [Patient] no .[SEP][Physical Examination][Doctor] all right . well lets go ahead and do a quick physical exam . [Patient] mm-hmm .[SEP]
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[
"Objective"
] | 115
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[Conversation Start][SEP]
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[
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[
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] | 116
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[Discussion][Medication][Doctor] it's called a calcineurin inhibitor . it's kinda like a steroid in that it calms inflammation . [Patient] okay .[SEP][Discussion][Medication][Doctor] but it's not a steroid , so do n't use steroids on your face , for sure , as they'll make this kind of rash worse . but also , steroids carry the risk of causing thinning of the skin . [Patient] all right .[SEP][Discussion][Medication][Doctor] these medications do n't cause thinning of the skin and they're not going to cause some other kind of rash . um , the thing to know is that sometimes five to 10 minutes after you put it on , it can cause this weird kind of tingly or needle-like sensation or make it redder or flush . but it should only last a few seconds and then go away . it's not an allergy or anything bad . [Patient] okay . got it .[SEP][Discussion][Medication][Doctor] so it only lasts a couple seconds . it does n't mean it's going to happen again . it's nothing bad . it will still work , so keep using it as long as you know you can stand it , okay ? [Patient] okay , thank you for explaining .[SEP][Discussion][Medication][Doctor] so i will say , " apply to rash on face twice daily , until resolved . " [Patient] okay . so only apply to the rash area ?[SEP]
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[
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"Medication"
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[
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] | 117
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[Therapeutic History][Personal History][Doctor] okay are you still taking your medication because i see you're on twenty milligrams of lisinopril [Patient] yeah most days i remember[SEP][Physical Examination][Personal History][Doctor] okay ra i'm not suspicious but we're just gon na go with that okay because looking at your vitals it it is of still a bit high i'm not really comfortable i see like a hundred and eighty over you know eighty and that's not where we wan na be so i wonder if we might need to adjust your medication but let's talk about your diabetes how are your blood sugars [Patient] i think they're little bit better[SEP][Personal History][Doctor] okay what makes you think that have you been taking them [Patient] yeah i check it you know most days again kinda when i remember[SEP][Personal History][Doctor] okay how often are you checking it [Patient] i would say four five times a week[SEP][Therapeutic History][Personal History][Doctor] okay you might wan na switch to maybe two or three times a day but you know that's something i'm glad that you are measuring are you taking your metformin [Patient] yes[SEP]
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[
"Therapeutic History"
] |
[
"Subjective"
] | 118
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[Acute Symptoms][Greetings][Doctor] so sophia i see that you you hurt your knee tell me about what happened [Patient] yeah i was jumping on my kid's trampoline and i could just slipped out from under me[SEP][Chitchat][Doctor] my gosh one of those big trampolines in your back yard [Patient] yeah a pretty big one[SEP][Acute Symptoms][Doctor] okay which knee was it [Patient] my right knee[SEP][Acute Symptoms][Doctor] right knee okay and when did this happen [Patient] about four days ago[SEP][Acute Symptoms][Doctor] great the weather was perfect this weekend so i'm glad you at least got outside sorry to hear you got hurt okay so your right knee did you did you feel it like pop or or snap or anything when you hurt it [Patient] yeah i felt a little pop and then it swelled up really big afterward[SEP]
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[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 119
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[Therapeutic History][Doctor] understood . okay . are you taking your medications regularly ? [Patient] uh- . i've been trying to keep up with that . there's a lot of extra pills now , but i have a reminder app , so i do pretty well .[SEP][Therapeutic History][Doctor] okay . that's great . and so , you're taking coumadin , right ? [Patient] yeah , also lasix and the atenolol .[SEP][Therapeutic History][Doctor] are you having any side effects from the medications at all ? [Patient] not really . uh , i notice that the atenolol is making me irritable in the beginning , but i guess i've gotten used to it , does n't seem to bother me as much now .[SEP][Physical Examination][Doctor] okay . well , that sounds good . sounds like you're well on the mend . so , why do n't i start out , um , with the physical exam , and just check you out . [Patient] okay .[SEP][Chitchat][Doctor] you're going to hear me describe things in detail or repeat things as i go to reference later for my notes . [Patient] okay .[SEP]
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"Physical Examination"
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[
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] | 120
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[Personal History][Therapeutic History][Doctor] okay okay great yeah you've learned a lot about it and and the treatments including the the term analgesic and all of that that's pretty impressive you've been you've been through the ringer i think with with those so okay and so you're taking excedrin when you get a migraine and then sort of would you say maybe for breakthrough migraines or worse migraines you'd take a sumatriptan occasionally [Patient] yeah[SEP][Personal History][Doctor] okay got it and how about your blood pressure how has that been running at home are you checking your blood pressures daily still and how how your how how have your blood pressures been [Patient] i have not been checking them daily i i probably check it about two or three times a week[SEP][Discussion][Medication][Therapeutic History][Doctor] okay okay not not too bad it does look like you're a little bit elevated today i i maybe i'm just making you nervous though so i hope not so are you but you're still on lisinopril twenty milligrams per day correct it looks like you might be running low do you need a refill of that [Patient] yeah actually i was going to ask you about that if i could get a refill that would be great[SEP][Personal History][Doctor] sure we can do that and so okay but you are still taking that twenty milligrams per day correct [Patient] correct[SEP]
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"Physical Examination"
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[
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] | 121
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[Personal History][Therapeutic History][Doctor] do you take any medications for it ? [Patient] um , ep- ... just an epipen .[SEP][Personal History][Doctor] just epipen for anaphylaxis when you need it . um , and what surgeries have you had before ? [Patient] yeah , so carotid . yeah-[SEP][Personal History][Physical Examination][Doctor] . yeah , no , uh , your , uh , neck surgery .all right . well let's , uh , examine you here for a second .so it's your , uh , this elbow right here ? [Patient] yeah .[SEP][Acute Symptoms][Doctor] and is it hurt- ... tender right around that area ? [Patient] yes , it is .[SEP][Physical Examination][Doctor] okay . can you flex it or can you bend it ? [Patient] it hurts when i do that , yeah .[SEP]
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"Physical Examination"
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[
"Objective"
] | 122
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[Conversation Start][SEP][Personal History][Greetings][Doctor] stephanie morales , medical record number 113322 . 44-year-old female that presents today six weeks status post right medial unicompartmental arthroplasty . hello ! [Patient] hi , how are you doing ?[SEP]
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[
"Chitchat"
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[
"Null"
] | 123
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[Discussion][Medication][Doctor] uh , but i would pickup the elidel too . [Patient] okay , i can do that .[SEP][Discussion][Medication][Doctor] i mean , out of known risks associated with medications , topicals are usually safer and preferable to oral medications . with that being said , doxycycline is low risk . [Patient] it is ? okay .[SEP][Medication][Doctor] um , and doxycycline can give you bad upset stomach or heartburn . um , it will make you sunburn , even if you never sunburn , so you have to protect yourself . [Patient] yeah , i mean , i feel sun sensitive whenever i go out , so i am taking all the precautions , with wearing a hat and all of that .[SEP][Discussion][Medication][Doctor] great . i just wanted to make sure you knew about that . [Patient] yes , i did . thank you .[SEP][Discussion][Medication][Doctor] all right . but i think to help get rid of it sooner rather than later , if insurance will cover the elidel , pick it up and start using it . [Patient] yeah , i did check . the insurance is not covering it .[SEP]
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[
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] | 124
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[Chitchat][Doctor] okay have you broke up with him already or [Patient] no i did n't know that knee injury was a reason to but now that you've told me maybe we should talk about that[SEP][Chitchat][Doctor] we'll talk about that later too [Patient] okay[SEP][Physical Examination][Doctor] alright so let's take a let's take a peek at your knee here [Patient] okay[SEP][Chitchat][Doctor] you gon na stick it through the screen or how you're gon na do this alright [Patient] okay[SEP][Physical Examination][Doctor] alright then i'm just i'm gon na i'm gon na grab your leg we're just gon na take it through just let it relax i'm just gon na take it through a little range of motion i'm gon na kinda poke around all different places you tell me where it hurts okay [Patient] okay okay[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 125
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[Personal History][Doctor] okay and what do you mean by bigger pieces of food like what's your diet like [Patient] well things have been stressed over the last couple of months so lacks a moving from the west coast of east coast so i've been drinking more eating things like pizza burgers i know it's not good but you know it's been pretty busy[SEP][Other Socials][Doctor] wow that sounds kinda stressful like what are you moving for [Patient] well i'm stressed because what i'm moving because you know i i do n't like the west goes so i i decided to move but you know it's just stressful[SEP][Other Socials][Doctor] okay so are you thinking of driving [Patient] i i think so i think i'm i think i'm gon na end up driving but that's still a a long trip[SEP][Vegetative History][Doctor] yeah absolutely i can see how that would that would increase your stress but like with that have you lost any weight because of your symptoms [Patient] no i wish unfortunately i've gained some weight[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 126
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[Vegetative History][Doctor] okay . all right . um , now , have you had ... have you noticed any blood in your stools at all ? [Patient] uh , no , not really . not , not at this time .[SEP][Vegetative History][Doctor] okay . and are your stools , like , dark or charry or black looking ? [Patient] no . not that i've noticed .[SEP][Vegetative History][Doctor] okay . and are you spotting a lot with your periods ? [Patient] no , i'm not .[SEP][Vegetative History][Doctor] okay . all right . um , and do you have any other ... i know that you are endorsing this fatigue and you feel kind of dizzy and that type of thing . do you have any other symptoms like chest pain , shortness of breath , fever , chills , body aches , anything ? [Patient] no , nothing like that .[SEP][Vegetative History][Doctor] okay . any weight loss ? [Patient] um , i've noticed a little bit , but that's because i think i've been doing really well with my exercise . um , but nothing too significant .[SEP]
|
[
"Drug History"
] |
[
"Subjective"
] | 127
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[Other Socials][Doctor] okay alright i just wan na get like a few more details do you like work out regularly was this for fun or for like an exercise class [Patient] no it's just for fun[SEP][Other Socials][Doctor] okay and do you have like a regular exercise regimen at all [Patient] try to not consistent with it[SEP][Acute Symptoms][Doctor] okay no that's fine this is not a place of judgment i just i'm just trying to understand like if a little bit more of the background okay so we went to the trampoline park which knee where did you hurt [Patient] my right[SEP][Acute Symptoms][Doctor] okay your right knee and so based on like your inside and outside which part hurts more [Patient] it's kind of the outside of the knee[SEP][Acute Symptoms][Doctor] alright so the lateral aspect not a problem and you said that you heard a pop when you landed right [Patient] yeah[SEP]
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[
"Acute Symptoms",
"Therapeutic History"
] |
[
"Subjective"
] | 128
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[Acute Symptoms][Drug History][Doctor] yeah , so ibs is one of those things where you are very sensitive to certain things such as spicy foods or fatty foods and alcohol . and this can cause lower belly stuff like cramps , or you can get upper belly stuff such as nausea . [Patient] i've been getting both .[SEP][Acute Symptoms][Doctor] okay . um , so how frequently have you been getting or having a bowel movement on normal days ? [Patient] i'm starting to notice it's between two and three times a day .[SEP][Acute Symptoms][Doctor] okay . and are they soft stools or formed stools ? [Patient] um , they're formed .[SEP][Acute Symptoms][Doctor] okay . and after you have gone out either drinking with your friends , do you tend to have more diarrhea ? [Patient] yeah , i do .[SEP][Acute Symptoms][Drug History][Doctor] okay . do you feel it's the food or the alcohol or both ? [Patient] uh , well usually we go to friday's restaurant . i always eat pasta , the chicken alfredo .[SEP]
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[
"Acute Symptoms"
] |
[
"Subjective"
] | 129
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[Chitchat][Doctor] it's pretty bad [Patient] okay[SEP][Chitchat][Doctor] we'll get we'll get to that too [Patient] okay[SEP][Radiology Examination][Doctor] so did you already have x-rays of this knee today [Patient] yes[SEP][Chitchat][Doctor] okay do i go into that to [Patient] yeah[SEP][Radiology Examination][Doctor] look at the x-rays do you or just stop here you can okay okay and so what would what would happen now you would you could pause it [Patient] you're only cup of this[SEP]
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[
"Acute Assessment",
"Radiology Examination"
] |
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"Assessment",
"Objective"
] | 130
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[Vegetative History][Doctor] okay i'm sorry i've never talked to you about that in the past i that's my fault so yeah so you wan na make sure you stay away from things like bananas oranges you know potatoes have lots of potassium that type of thing and so you know because with your kidney function you know that can cause your potassium levels to go up because you do n't get rid of the potassium as you should you know [Patient] something to eat[SEP][Vegetative History][Doctor] what's that [Patient] is there anything left is there anything left over that i ca n't eat[SEP][Referral][Other Treatments][Doctor] so yeah you can eat you know how about this how about we give you a a referral to a dietitian and they can help you with that [Patient] sounds good[SEP][Chitchat][Doctor] now are you watching the nba playoff should i or should i not bring that up i is that a sensitive subject i mean i'm a self expand and and we did sweep the nuts so [Patient] yeah well i mean that's fan and i could n't sleep last night but you know[SEP][Chitchat][Doctor] okay well maybe we should n't talk about [Patient] kinda used to it you know where they where the favorite to win and then like that[SEP]
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] | 131
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[Discussion][Doctor] they are going to be free ninety nine because your mom is paying for them [Patient] okay that's that's good to know[SEP][Discussion][Diagnostic Testing][Doctor] i would prefer you to get them done as soon as possible so when you walk out of this room there is a a blood lab right next door i need you to go ahead and do some of those draws some of them i will need you to not have eaten we are gon na do them it's called fasting and you can make sure that you have n't eaten when you do but they will the lab techs will know so you will be able to knock out most of those today [Patient] okay and i'm not sure i will be able to do that today because i have a class right after this[SEP][Discussion][Doctor] mm-hmm [Patient] and right after that i have to go to work[SEP][Discussion][Doctor] mm-hmm [Patient] you know if i told you i'm about changing jobs did i[SEP]
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[Acute Symptoms][Doctor] okay . and when- when did this happen ? [Patient] this was just yesterday .[SEP][Acute Symptoms][Therapeutic History][Doctor] all right . and have you tried anything for it ? i mean ... [Patient] i put ice on it . and i've been taking ibuprofen , but it still hurts at lot .[SEP][Acute Symptoms][Therapeutic History][Doctor] okay , what makes it better or worse ? [Patient] the ice , when i have it on , is better .[SEP][Personal History][Doctor] all right . uh , let's review your past medical history . uh ... looks like you've got a history of anaphylaxis , is that correct ? [Patient] yes . yes , i do . yeah .[SEP]
|
[
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"Therapeutic History"
] |
[
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[Physical Examination][Doctor] yeah i can do that but i do wan na just do a physical exam on you okay so and looking here at your vital signs here you know your your vital signs look quite good you know your blood pressure is what right where it should be it's about one twenty seven over eighty which is great so you're doing a good job taking your metoprolol now in terms of on your neck exam i do n't appreciate any jugular venous distention or carotid bruits on your heart exam i do appreciate a slight three out of six systolic ejection murmur heard at the left base and on your lower extremity exam i do appreciate some one plus nonpitting edema now what does that mean what does that mean jose so all of that means is that i do hear a little heart murmur on your heart which i've heard before in the past and it does n't it does n't look like you're retaining any fluid which is good but you do have a little puffiness in your legs which sometimes some of the medications can cause [Patient] yeah i do have that[SEP][Referral][Medication][Reassessment][Doctor] so let's just go over a little bit about my assessment and and plan for you going forward so for your first problem of your coronary artery disease i think you're doing really well i wan na go ahead and refer you for cardiac rehab just so that you can be more active and have some confidence in in exercising again okay and i am gon na go ahead and refill your metoprolol your crestor forty milligrams once a day as well as the aspirin okay i do n't think we need to proceed with a a stress test or anything at this time but you know to let me know if you have any symptoms okay [Patient] okay[SEP][Chitchat][Doctor] okay for your [Patient] sounds really good[SEP]
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[
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"Reassessment"
] |
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"Plan"
] | 134
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[Conversation Start][SEP]
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] |
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] | 135
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[Acute Symptoms][Therapeutic History][Doctor] okay very good alright and then you said you were you've taken some tylenol for that and you said it did help a little bit or did n't sorry [Patient] it does help[SEP][Therapeutic History][Doctor] it does help good very good so how often are you taking your your medication are you taking that as prescribed like daily it sounds like you missed a few times but for the most part are you taking it [Patient] yeah i forget a lot so i probably take it like every other day[SEP][Personal History][Therapeutic History][Doctor] okay every other day alright and then are you also now i know you also have some diabetes so are you how are you doing with that one are you pretty much taking your metformin everyday [Patient] hmmm i probably take it when i take my other medicine like every other day[SEP][Physical Examination][Personal History][Doctor] every other day okay so i do see that you know the nurse took your your vital signs this morning that your blood pressure is running quite a bit high it was like one seventy two over ninety eight so that's that's really a little higher than where we want it to be especially that you're on your medication but what we're gon na do is we're gon na take i'm gon na take a look at you real quick and then we can discuss you know maybe there's some changes that we can do in terms of your current regimen how about diet and your have you been sticking with that low sodium diet at all [Patient] no i love mcdonald's i eat it all the time[SEP][Vegetative History][Doctor] i love mcdonald's too my favorite is big mac i do n't know about you but i got ta have my big mac with those large fries which you what's your favorite mcdonald's treat there [Patient] i need to think of what fully of fish i love flare of fish[SEP]
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] |
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] | 136
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[Conversation Start][SEP]
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[
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] |
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] | 137
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[Personal History][Doctor] okay so right now you're experiencing right leg pain but you have injured your your left leg before is that what i'm hearing [Patient] yeah that's fine[SEP][Acute Symptoms][Doctor] alright were you able to continue playing [Patient] no i had to stop i actually it was like i had to be held from the field because i could n't put weight on my foot[SEP][Therapeutic History][Doctor] i'm sorry okay so what have you been doing for the pain since then [Patient] i wrapped it after a the game they had some ace wraps in their clubhouse and so i wrapped it up and then i iced it last night and i just kept it up on a pillow and then i took some ibuprofen[SEP][Acute Symptoms][Doctor] okay could you one more time when did this injury happen [Patient] this happened about couple days ago[SEP][Therapeutic History][Doctor] okay so did you say whether does the ibuprofen help at all [Patient] yeah it helps a little bit but then you know it it you know after a while it wears out[SEP]
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] |
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] | 138
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[Conversation Start][SEP][Greetings][Doctor] alright good morning Julie how are you doing today [Patient] i'm doing okay i'm just a little nervous about what's been going on with my headaches[SEP][Personal History][Doctor] okay so i know you were sent here by your your pcp what was your understanding of why you were sent here [Patient] yeah so i actually have been someone who been struggling with headaches for years now ever since i was a teenager and they used to be around my when i would have my menstrual my menses but as i got older i noticed that it has been with that and also i can get it when i'm really stressed but recently and why i went to her is because my headaches have been getting a lot more they've just been happening a lot more frequently and a lot more severe[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 139
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[Personal History][Doctor] yeah , this is much better . [Patient] okay , great . and then it dropped in january , and then it dropped a little more in march , since i stopped taking the medicine in december .[SEP][Discussion][Doctor] okay , that's good . so ... i'm proud of you with the course of your labs , so before i forget , i'm going to , uh , just put your labs into the computer today , and i wo n't be checking your vitamin d level for some time . [Patient] okay . so , with the thyroid , and the low vitamin d , does that always happen together ?[SEP][Discussion][Doctor] um , i do have a lot of people that have thyroid , thyroid issues and they have vitamin d deficiency . [Patient] okay .[SEP][Discussion][Medication][Doctor] this is what i'm , um , i'm going to do . i'm going to put , print out your prescriptions , so you can shop around at the pharmacies and see if you can find better prices . [Patient] okay , that way i can go ask them and try cvs .[SEP][Discussion][Doctor] yeah , that sounds like a plan . [Patient] okay , good . so , the weight loss study that you mentioned , when does that start ? or , how does that work ?[SEP]
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[Conversation Start][SEP][Greetings][Doctor] elizabeth , how are you ? [Patient] i'm doing okay . how are you ?[SEP]
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] | 141
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[Other Socials][Doctor] what kind of work do you do [Patient] i do yard work[SEP][Chitchat][Doctor] yard work [Patient] landscaping landscaping[SEP][Personal History][Other Socials][Doctor] landscaping okay so a lot of raking a lot of digging so a lot of repetitive type movements [Patient] yeah it's pretty heavy labor but it's yeah the same thing day in and day out[SEP][Acute Symptoms][Doctor] okay okay just a couple questions for you you did say that you have the pain at night in that and you have to you get that numbness into the hand is it in all the fingers [Patient] yeah it seems to happen to all my fingers but i notice it more in my thumb and pointer finger[SEP]
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[
"Acute Symptoms"
] |
[
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] | 142
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[Acute Symptoms][Doctor] okay , and have you noticed , is his mucous clear right now ? [Patient Guest] it is , it is right now , yes .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . and , does he also have a cough ? [Patient Guest] yes , but it's not barky .[SEP][Acute Symptoms][Vegetative History][Doctor] and does he act like he has a sore throat or is he pulling on his ears ? [Patient Guest] well , i know he's been pulling on his ears , yeah .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . [Patient Guest] you know , he also , he's also been going crazy rubbing at his nose too .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . and , any fever you've noticed ? [Patient Guest] i checked his rectal temperature and it was 100.3 .[SEP]
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[
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"Vegetative History"
] |
[
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] | 143
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[Conversation Start][SEP][Greetings][Doctor] next patient is christine hernandez , uh , date of birth is january 13th , 1982 . hey , miss christine , how are you doing today ? [Patient] i'm good , thanks . how are you ?[SEP][Therapeutic History][Doctor] i'm pretty good . so it looks like you've completed the covid vaccine , that's great . [Patient] yes , i did .[SEP][Personal History][Doctor] anything new since your last visit ? [Patient] no , i did all the tests that you had recommended me to take . i have n't been able to take the thyroid medicine , the one that you prescribed , as i'm still taking my old one . um , the price was a little high on the new one .[SEP]
|
[
"Therapeutic History",
"Other Socials"
] |
[
"Subjective"
] | 144
|
[Vegetative History][Doctor] wow okay are you having any headaches [Patient] of course[SEP][Vegetative History][Doctor] any dizziness [Patient] just sometimes[SEP][Vegetative History][Doctor] any visual disturbances is it hard to like are you [Patient] not recently no[SEP][Vegetative History][Doctor] okay alright any numbness [Patient] yes[SEP]
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[
"Vegetative History"
] |
[
"Subjective"
] | 145
|
[Other Socials][Doctor] okay so the remodel tell me a little bit about that my wife and i were working on our remodel and we went they just built the brand-new lowe's here in town have you guys been there yet [Patient] no we have not[SEP][Chitchat][Doctor] well i did n't know if you know this or not but you can save big money there that's the rumor [Patient] okay[SEP][Chitchat][Doctor] so yeah we we've been down there we got some pain we we got went and got some samples and then hey while we were there we ended up deciding to put down a bunch of flooring too so i really recommend you guys if you get a chance go over there and take a look at their sales and and see if you ca n't finish your remodeled project [Patient] that sounds great i'll have to take a look at the flooring as well[SEP][Vegetative History][Doctor] that sounds good so now just out of curiosity are you experiencing any numbness or tingling in in your arm or hand [Patient] i did when i initially hurt it but i'm not no longer having any numbness or tingling[SEP][Physical Examination][Discussion][Medication][Radiology Examination][Referral][Diagnostic Testing][Acute Assessment][Doctor] okay so a little bit about my physical exam i'm gon na do a quick physical exam on you today now your vitals look good but specifically on your right shoulder exam you do have limited active and passive range of motion and there is tenderness to the greater tuberosity of the humerus now there is no tenderness at your sternoclavicular joint and you do have good strong bilateral hand grips and on your neurovascular exam of your right arm you do have brisk capillary refill of less than three seconds and you do have equal and bilateral response to sensation and touch which is good now taking a look at your x-ray that we did when you came in today good news is that right shoulder x-ray reveals no fracture or bony abnormality mkay so let me tell you a little bit about my assessment and plan now i your symptoms are most likely due to rotator cuff tendinopathy i think that you've injured the tendons of the muscles that make up the shoulder so that i think that's that's why you are having the that shoulder pain i do wan na order an mri of that right shoulder just to make sure that nothing else is going on now i'm gon na refer you to physical therapy and that's gon na be about six to eight weeks now my patients are very successful with their pt and let's see how you do before we make the decision that we would do additional treatment such as a steroid injection to that shoulder i do want you to continue to take an nsaid if you can tolerate tylenol i want you to go ahead and take tylenol for that pain do you have any questions comments or concerns about our treatment plan [Patient] no i think it sounds good ca n't wait to to get some relief[SEP]
|
[
"Follow-up"
] |
[
"Plan"
] | 146
|
[Personal History][Doctor] okay what makes you think that have you been taking them [Patient] yeah i check it you know most days again kinda when i remember[SEP][Personal History][Doctor] okay how often are you checking it [Patient] i would say four five times a week[SEP][Therapeutic History][Personal History][Doctor] okay you might wan na switch to maybe two or three times a day but you know that's something i'm glad that you are measuring are you taking your metformin [Patient] yes[SEP][Therapeutic History][Doctor] okay and then i think we have you on five hundred milligrams correct [Patient] yes[SEP][Personal History][Doctor] alright how is your diet [Patient] kinda the same as my exercise decent could be better[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 147
|
[Discussion][Medication][Radiology Examination][Referral][Acute Assessment][Doctor] okay alright and for diagnostics so your x-ray so there's no fracture appreciated no bony abnormalities so that looks alright so let me tell you a little bit about my impression and plan with this so you have a knee contusion so for treatment we'll we need to rest that apply ice you know two three times a day for twenty minutes at a time take some nsaids or you know nonsteroidal anti- inflamma medication such as ibuprofen every six to eight hours as needed so i just wan na really get some rest with that if that does n't improve then we can go ahead and maybe come back in and we might do some physical therapy as well i do n't know i'm not sure i like this one all that well any do you have any questions on that [Patient] no sounds very good[SEP][Other Socials][Doctor] okay let's venture a little bit more because i need five minutes so where so where were you skiing at [Patient] so i was actually up we actually took a trip up up north and i was in the i'm in mount saint helen and washington so i was just walking in myself going out and stuff but yeah it was it was a good trip but cut a little short because of that yeah it was fun though i like going i like going to skiing so hopefully i can do some more[SEP][Chitchat][Doctor] well washington sounds nice i have n't been there but it sounds like it's pretty nice area to be in and they have a lot of maple syrup there do n't they produce a lot of maple syrup [Patient] they do they do have a lot of maple syrup and it's it's it's interesting that the the winter actually is n't their busiest time for vacation or vacations or it's more into your spring into your fall with hikers and all the outdoor activities there's actually a very impulsive torist during the summertime which i never knew but one of the locals have told me that they do actually better business during the summer so the hikers kayakers and the maple syrup in the fall and everything so[SEP][Personal History][Doctor] that sounds good now i also meant to ask you so when you did this cartwheel through the air did you have any other injuries to any other parts of your body anything else that you're having any issues with [Patient] my shoulder feels a little bruised[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 148
|
[Personal History][Doctor] excuse me i feel rejected right now why why would you say something like that it's fine but you know i i like it when you're not here either because that means that you're doing a good job so let's see about like getting your knee fixed up but i want to talk about some of the other issues that you have first so we know that you have hypertension right and i discussed maybe you getting a blood pressure cuff because i needed you to measure those a bit more regularly did you get the cuff [Patient] what no[SEP][Personal History][Doctor] no okay that's fine have you measured your blood pressure recently at all [Patient] no[SEP][Therapeutic History][Personal History][Doctor] okay are you still taking your medication because i see you're on twenty milligrams of lisinopril [Patient] yeah most days i remember[SEP][Physical Examination][Personal History][Doctor] okay ra i'm not suspicious but we're just gon na go with that okay because looking at your vitals it it is of still a bit high i'm not really comfortable i see like a hundred and eighty over you know eighty and that's not where we wan na be so i wonder if we might need to adjust your medication but let's talk about your diabetes how are your blood sugars [Patient] i think they're little bit better[SEP][Personal History][Doctor] okay what makes you think that have you been taking them [Patient] yeah i check it you know most days again kinda when i remember[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 149
|
[Conversation Start][SEP]
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[
"Acute Symptoms",
"Personal History",
"Greetings"
] |
[
"Subjective"
] | 150
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[Personal History][Doctor] yeah i understand how has your diet been lately [Patient] it's been pretty good[SEP][Physical Examination][Doctor] okay okay good good you know it's hard to stay away from the sugary foods sometimes i i enjoy ice cream regularly okay so let's do physical exam as long as you are here so i'm just gon na listen to your heart your heart sounds normal no murmurs or gallops listen to your lungs quick if you can take a deep breath lungs are clear that's good news let's take a look at that knee right knee looks like it definitely has some swelling i'm gon na do some maneuvers here does it hurt when i push you on the inside of the knee [Patient] yeah that hurts[SEP][Physical Examination][Doctor] okay how about the outside [Patient] a little bit but not as much[SEP][Physical Examination][Doctor] okay so some pain on palpation on the inside little bit of pain on the outside of the knee if i bend the knee back does that hurt [Patient] yeah[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 151
|
[Therapeutic History][Doctor] okay . all right . and have you taken anything for the insomnia . have you tried any strategies for it . [Patient] i've tried everything from melatonin to meditation to , uh , t- stretching out every morning when i get up . nothing really seems to help though .[SEP][Personal History][Doctor] okay . all right . in terms of your osteoporosis , i know we have you on fosamax , any issues with your joints , any issues like- [Patient] no .[SEP][Personal History][Doctor] no broken bones recently ? [Patient] no .[SEP][Personal History][Doctor] no , nothing like that ? [Patient] no .[SEP][Personal History][Doctor] okay . and then in terms of your multiple sclerosis , when was the last time you saw the neurologist ? [Patient] uh , about six months ago .[SEP]
|
[
"Therapeutic History"
] |
[
"Subjective"
] | 152
|
[Other Socials][Doctor] okay and when you have that kind of pain does it keep you from doing other type of activities [Patient] yeah i mean i still try to like work through with using my arm but yeah it's it's it's difficult for me sometimes to lift and do things because of that pain[SEP][Acute Symptoms][Doctor] okay and then and how long has this pain been going on [Patient] about four days now[SEP][Acute Symptoms][Therapeutic History][Doctor] alright and anything you've done to help relieve or alleviate that pain any anything that that's giving you relief [Patient] i've tried ibuprofen that helps a little but not much[SEP][Physical Examination][Doctor] okay so if it's okay with you i would like to do a a quick physical exam your vitals look good and i'm gon na do a focused exam on that right elbow i'm gon na go ahead and and and press here do you do you have any pain when i press here [Patient] yes i do[SEP][Physical Examination][Doctor] okay so you are positive for pain to palpation you do note that moderate tenderness of the medial epicondyle now i'm gon na have you turn your wrist as if you're turning a door knob do you have any pain when you do that [Patient] not really[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 153
|
[Acute Symptoms][Doctor] is the pain there all the time ? [Patient] it's a nagging feeling and it just depends . sometimes it bothers me , sometimes it does n't .[SEP][Acute Symptoms][Personal History][Doctor] has this been the case over the past two years as well ? [Patient] more recently in the past couple months , at least with the constipation and diarrhea .[SEP][Personal History][Vegetative History][Doctor] and before that , how are your bowel movements ? [Patient] they were normal .[SEP][Vegetative History][Doctor] uh , okay . so any blood in your stool ? [Patient] nope .[SEP][Vegetative History][Doctor] do you feel like you have more constipation or diarrhea ? [Patient] probably more constipation .[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 154
|
[Personal History][Doctor] okay . and i know you had the , uh , bypass grafting last year . you're doing okay ? [Patient] it's been great .[SEP][Personal History][Vegetative History][Doctor] no chest pain ? [Patient] other than the congestion , no chest pain .[SEP][Other Socials][Doctor] okay . all right . and you're able to exercise ? [Patient] yes .[SEP][Other Socials][Doctor] okay . before you got sick . [Patient] that's correct . that's correct .[SEP][Physical Examination][Doctor] okay . all right . well , let's go ahead , i want to do a quick physical exam . okay ? [Patient] you got it .[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 155
|
[Acute Symptoms][Doctor] you actually no [Patient] yeah it hurts no[SEP][Acute Symptoms][Doctor] what about you i mean are you real weak [Patient] no i would say i'm pretty strong[SEP][Personal History][Doctor] did you go to the gym [Patient] i go to the gym but i swim so the[SEP][Chitchat][Doctor] okay i ca n't treat people like you you you you need to work harder [Patient] i quit complaining okay[SEP][Chitchat][Doctor] yes sir work harder [Patient] okay[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 156
|
[Chitchat][Doctor] okay . all right . are you excited for halloween ? [Patient] uh , ca n't wait .[SEP][Chitchat][Doctor] all right , yeah , right . [Patient] yeah .[SEP][Personal History][Doctor] and , so , lastly , for your high blood pressure , how are you doing with that ? have , are , did you buy the blood pressure cuff like i asked ? [Patient] yeah , i , i did , and we do mon- , i , i monitor it regularly . my wife makes sure i stay on top of that , but it's been pretty good .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . all right . well , i know you did the review of systems sheet when you checked in , and you were endorsing this fatigue- [Patient] mm-hmm .[SEP]
|
[
"Acute Symptoms",
"Vegetative History"
] |
[
"Subjective"
] | 157
|
[Other Socials][Doctor] okay alright that's good to hear so you were playing tennis is that what you normally do to work out [Patient] i do i'm trying to learn but i can not afford tennis less lessons so me and my friends just hit the balls back and forth i do sleep[SEP][Chitchat][Doctor] i love it absolutely yeah my dad one time took me to play racquet ball and i learned the very bruisy way that that was n't for me yeah [Patient] that scares me[SEP][Physical Examination][Doctor] it's it they they move pretty fast i'm not gon na lie alright so if you do n't mind i'm gon na go ahead and do my my physical exam i'm gon na be calling out some of my findings but if you have any questions go ahead stop me let me know but i will be explaining along the way okay [Patient] okay[SEP][Physical Examination][Doctor] alright so i've looked at your vitals and honestly they look great you know your blood pressure i see is one twenty five over seventy that's almost textbook respiratory rate we are seeing you at a smooth eighteen excuse me your temperature you're running normal ninety seven . one you're you're satting at a hundred percent so and then your pulse so that's interesting like you're you're going at like about sixty beats a minute so i think they're i think we're doing pretty well i'm gon na go ahead and listen to your heart on your heart exam i do n't appreciate any like murmur rub or gallop we have a nice regular rate and rhythm for your lung exam i do appreciate a little bit of stridor that's really interesting but i do n't hear any wheezes or rales so that's great for your i know this sounds weird but for your abdominal exam i do n't appreciate any rebound no guarding on your skin exam i do n't sorry like on your your head everything looks symmetrical your your mucosal membranes are normal you do n't feel hot to touch so that's great but i'm gon na do my foot exam okay so on the right foot there is some bruising of the plantar and dorsal aspects of the foot there is associated swelling when i touch on your midfoot here does it hurt [Patient] no uh uh[SEP][Physical Examination][Discussion][Radiology Examination][Diagnostic Testing][Acute Assessment][Other Treatments][Doctor] okay alright tenderness to palpation of the midfoot and positive piano key test of the first and second metatarsals alright it's also warm to touch alright so on your neurovascular exam of your right foot your capillary refill is less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch your left foot exam is normal capillary refill is appropriate pedal pulses are strong and sensation is intact so i know that before here we before i came in that we got an x-ray so i've reviewed the results of your x-ray of your right foot and it showed subtle dorsal displacement of the base of the second metatarsal with a three millimeter separation of the first and second metatarsal bases and the presence of a bony fragment in the lisfranc joint space alright i know those were a bunch of fancy words so now i'm gon na explain to you what that all means for my impression and plan your first problem is right foot pain consistent with a lisfranc fracture which is a fracture to one of your second metatarsal bones near the top of your foot right so the big part of your toe is the first metatarsal the second part where you can kinda like bend it right that's the that's the metatarsal that we're talking about based on your exam and what i'm seeing on your x-ray i am gon na recommend surgery for your foot the surgery will help place the bones in their proper positions using plates and screws to help prevent further complications there are also many ligaments at the top of your foot so i will be ordering an mri to further assess the fracture and any injury to the ligaments i know this is a lot do you have any questions [Patient] yeah do i have to do the surgery[SEP]
|
[
"Discussion",
"Other Treatments"
] |
[
"Plan"
] | 158
|
[Follow-up][Doctor] yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay . [Patient] sure , okay . and can i ask you about work before i go ?[SEP][Discussion][Doctor] okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job . [Patient] all right . so would you write a note to excuse me for another six weeks ?[SEP][Discussion][Doctor] sure . i'll have my nurse anna give it to you . [Patient] that's great . thank you .[SEP][Follow-up][Doctor] okay , so we'll talk again in six weeks , and we can discuss your job again at that time . [Patient] sounds good .[SEP]
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[
"Discussion"
] |
[
"Plan"
] | 159
|
[Acute Symptoms][Therapeutic History][Doctor] okay that sound definitely understandable so you've been in a lot of pain so have you tried to take any medications to alleviate the pain [Patient] yeah i've been taking tylenol i have had to try some ibuprofen i know you said to be careful with my blood pressure but i have been trying to do that because i'm just in so much pain and it's not really working[SEP][Acute Symptoms][Doctor] okay and before what would you how long would you say it took you to pass the other stones or how was that that resolved [Patient] yeah usually usually about about three four days to pass it yeah[SEP][Acute Symptoms][Doctor] right so this is this is the looks like this is the third day [Patient] yeah[SEP][Acute Symptoms][Doctor] so we are getting close there [Patient] okay[SEP][Therapeutic History][Reassessment][Acute Assessment][Doctor] yeah so hopefully we can pass it but we'll i'll definitely we can take a look at it here in a second so while you are here i also wanted to check up on your your diabetes and and hypertension you have so i'm looking here at my notes and you're on two . five of norvasc for your high blood pressure when you came in today your blood pressure was a was a little bit high and i know that's probably because you are in a bunch of pain so that definitely makes sense but i think last time we talked a little bit about you getting a blood pressure cuff and taking your blood pressures regularly so those readings first off were you able to get the blood pressure cuff [Patient] i was i have n't been great about taking it but i did get the blood pressure cuff[SEP]
|
[
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[
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[Acute Symptoms][Doctor] all right . and when did this happen ? [Patient] it was yesterday .[SEP][Acute Symptoms][Doctor] all right . and , uh , where does it hurt mostly ? [Patient] it hurts like in , in , in the inside of my knee .[SEP][Acute Symptoms][Therapeutic History][Doctor] all right . and anything make it better or worse ? [Patient] i have been putting ice on it , uh , and i've been taking ibuprofen , but it does n't seem to help much .[SEP][Acute Symptoms][Doctor] okay . so it sounds like you fell a couple days ago , and you've hurt something inside of your right knee . [Patient] mm-hmm .[SEP]
|
[
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[Physical Examination][Diagnostic Testing][Acute Assessment][Radiology Examination][Doctor] all right . the patient is alert , oriented to time , place , and person . affect is appropriate and speech is fluent . cranial nerve examination is grossly intact . no focal , motor , or sensory deficit in the upper or lower extremities . visual acuity and eye movements are normal . pupils are equal and reactive . visual field testing reveals bitemporal hemianopia . and color vision is normal . all right , mr. ward . i'm going to review these pictures from the mri with you . um , now this appears to be a benign pituitary adenoma , but there's no way to be sure without sending the removed adenoma to pathology to make the diagnosis , which we will do . um , here you can see it's a well defined mass . and it's pressing right here on what we call the optic chiasm . and today when i was having you look at my fingers , you could n't see them off to the sides , that's what we call bitemporal hemianopia . and explains why you have been bumping into door frames . [Patient] yeah i never noticed that i could n't see out of the side until you did that test , and you closed one eye with both eyes . i really could n't tell .[SEP][Acute Assessment][Other Treatments][Doctor] no because you're having this vision loss from the mass compressing the optic chiasm , the only option we have is to do surgery . [Patient] okay , i understand . do you think i'll regain my vision ?[SEP][Diagnostic Testing][Referral][Other Treatments][Doctor] well there's no guarantees , but it is a possibility . i'm gon na refer you to the eye doctor for a full exam and they'll do what's called visual field test . this will map our your peripheral vision or side vision prior to surgery . and we can monitor after surgery to see if your vision is improving . [Patient] all right .[SEP][Discussion][Other Treatments][Doctor] and let's discuss the surgery a little more . um , we would do what's called a transsphenoidal approach to do the surgery . this is minimally invasive and we go through the sphenoid sinus . there are some risks i have to inform you of . uh , risk of anesthesia including but not limited to the risk of heart attack , stroke , and death . risk of surgery include infection , need for further surgery , wound issues such as spinal fluid leak or infection , uh , which may require long , prolonged hospitalization or additional procedure . uh , seizure , stroke , permanent numbness , weakness , difficulty speaking , or even death . [Patient] well i guess we have to do it regardless .[SEP][Diagnostic Testing][Other Treatments][Doctor] okay . so i will have you see our surgery scheduler , deborah , on the way out to get you set up . we will get this scheduled fairly quickly so i do n't want you to be alarmed . um , she'll also get you set up today or tomorrow to have the visual field test and you may not be able to see the eye doctor until after surgery . but we have the pre-surgery visual field test for comparison after surgery . [Patient] okay . i look forward to these headaches going away . i never thought it could be something like this going on .[SEP]
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[Chitchat][Doctor] it's good to see you too . so , i know the nurse told you about dax . [Patient] mm-hmm .[SEP][Chitchat][Doctor] i'd like to tell dax a little bit about you . [Patient] sure .[SEP][Acute Symptoms][Personal History][Doctor] so , lawrence is a 62-year-old male , with a past medical history significant for type i diabetes , congestive heart failure , depression , and reflux , who presents with complaints of shortness of breath . so lawrence , what's been going on ? wh- what's wrong with your breathing ? [Patient] uh , i , i've noticed that i've been swelling up a little bit . i think a lot of it has to do with going to some house parties , eating some salty foods . i feel really lethargic .[SEP][Acute Symptoms][Doctor] okay . all right . and when you get short of breath , are you short of breath when you're just sitting here ? do you feel short of breath when you're walking ? [Patient] it's something like walking up a flight of stairs i'll actually feel it .[SEP][Acute Symptoms][Doctor] okay . all right . now , um , how long has this been going on for ? [Patient] probably about 10 days .[SEP]
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[Acute Symptoms][Doctor] okay alright and and now are you having the pain all the time or does it come and go [Patient] the pain is always there and then it gets worse like if i try to put any pressure on it it gets worse so if i'm laying at night if i try to even lay on that shoulder it's unbearable[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and then tell me what have you taken for your pain [Patient] i've been taking two extra strength tylenol every six to eight hours[SEP][Acute Symptoms][Therapeutic History][Doctor] alright and and did that help [Patient] it does take the edge off but i still have some pain[SEP][Other Socials][Doctor] okay well i'm sorry to hear that you know you know renovating the basement it can be quite a task and it can take a toll on you [Patient] yeah i mean it's been fun but yeah i think it really did take a toll on me[SEP][Chitchat][Doctor] yeah what what are you doing with your basement are you are you doing like a a man cave or [Patient] yeah yeah that's exactly right[SEP]
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[Conversation Start][SEP][Greetings][Doctor] hi joyce , how are you ? [Patient] i'm good . how are you ?[SEP][Chitchat][Doctor] i'm doing well . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you when we get started , okay ? [Patient] okay .[SEP][Acute Symptoms][Personal History][Doctor] all right . so , joyce is a 50 year old female with a past medical history significant for copd , congestive heart failure who presents for follow-up to an abnormal lab finding . so , joyce , i , i got the results of your lab , uh , your labs . your hemoglobin was low . uh , so , i asked them to schedule a follow-up appointment with me . so , how are you feeling ? [Patient] i've been feeling really tired lately . over the past couple of months , i've noticed that my energy has really gone down . i used to be really active , um , just trying to be as healthy as i can be , running, climbing . um , i at least try to do an hour or two a day . and over the past month , it's gone slowly downhill . i've just been so tired and exhausted and i have n't been able to really keep up with the way i , i was g- was going with my exercise .[SEP]
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[Personal History][Doctor] good . good . so , i saw you were recently in the emergency room with high blood pressure and some palpitations . [Patient] yeah . that was back in march i think , but my girlfriend and i , we talked about it , and on that day i had a few cups of coffee , and no breakfast . so , i think it was probably more of a panic attack than anything else .[SEP][Personal History][Doctor] yeah . have you , uh , have you felt it again since ? [Patient] uh , no .[SEP][Personal History][Doctor] okay . uh , so tell me about the blood pressure then . [Patient] well , i've had issues with my blood pressure since i was young .[SEP][Family History][Doctor] do you have a family history of this ? [Patient] yeah . a lot of my family does have high blood pressure .[SEP]
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[Chitchat][Doctor] i bet . sounds like fun . [Patient] it is .[SEP][Vegetative History][Doctor] did you have any other pregnancies that were miscarriages or terminations ? [Patient] really , i did not .[SEP][Therapeutic History][Doctor] okay . so for the record , that's g5 p5 . and now that you're post-menopausal , are you currently or have you ever been on hormone replacement therapy ? [Patient] my primary care doctor gave me the option years ago but i decided against it .[SEP][Acute Symptoms][Vegetative History][Doctor] okay . and on your review systems form , you indicated that you've not had any recent weight loss or gain , headaches , bone pain , urinary symptoms , or blood in the stools . but you did indicate that you have some back pain , joint pain , and high cholesterol . tell me some more about those . [Patient] okay . so i've seen doctors for all of those . they've said , excuse me , the back and knee pain are age-related . and the cholesterol is a fairly new diagnosis , but i am working on exercise and cutting back on fatty foods to see if i can get it lower without any medication .[SEP][Acute Symptoms][Doctor] okay . and your primary care doctor is following you for that , right ? [Patient] that's correct .[SEP]
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[Chitchat][Doctor] i'd like to tell dax a little bit about you . [Patient] sure .[SEP][Acute Symptoms][Personal History][Doctor] so , lawrence is a 62-year-old male , with a past medical history significant for type i diabetes , congestive heart failure , depression , and reflux , who presents with complaints of shortness of breath . so lawrence , what's been going on ? wh- what's wrong with your breathing ? [Patient] uh , i , i've noticed that i've been swelling up a little bit . i think a lot of it has to do with going to some house parties , eating some salty foods . i feel really lethargic .[SEP][Acute Symptoms][Doctor] okay . all right . and when you get short of breath , are you short of breath when you're just sitting here ? do you feel short of breath when you're walking ? [Patient] it's something like walking up a flight of stairs i'll actually feel it .[SEP][Acute Symptoms][Doctor] okay . all right . now , um , how long has this been going on for ? [Patient] probably about 10 days .[SEP][Vegetative History][Doctor] okay . all right . and you said you're noticed some swelling in your legs ? [Patient] a little bit .[SEP]
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] | 168
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[Acute Symptoms][Doctor] alright so where exactly is it on the side on the back [Patient] it's in the back of my neck[SEP][Acute Symptoms][Therapeutic History][Doctor] okay has anything made it better [Patient] i mean i've tried some ibuprofen that helped a little bit but not too much[SEP][Acute Symptoms][Therapeutic History][Doctor] mm-hmm [Patient] just about five out of ten[SEP][Acute Symptoms][Doctor] mm-hmm alright and did you say whether the pain was getting worse [Patient] i mean it's been staying the same it just gets worse when i'm moving my neck[SEP]
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[Conversation Start][SEP][Greetings][Doctor] hi , anna . how are you ? [Patient] i'm doing okay . how are you ?[SEP][Chitchat][Doctor] i'm doing okay . so i know the nurse told you about dax . i'd like to tell dax a little bit about you . [Patient] all right .[SEP][Personal History][Doctor] so , anna is a 44-year-old female with a past medical history significant for arthritis , gout , and reflux , who presents today for follow up of her chronic problems . so , anna , it's been probably about six months since i've seen you . how are you doing ? [Patient] i'm doing okay . um , my arthritis is starting to get better . um , i've been trying to move my body , doing pilates , lifting weights , um , and that's , kind of , helped me build up some muscle , so the joint pain is , has been going away .[SEP][Personal History][Doctor] okay . yeah . i know you were having , you know , some problems with your right knee , uh , and we sent you for physical therapy . so , so that's going well ? [Patient] yeah . the physical therapy's gone really well . i've built up my strength back and it's been really great .[SEP]
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[Other Socials][Doctor] okay alright and what do you do for work [Patient] i i work as a cashier in a supermarket[SEP][Therapeutic History][Doctor] okay alright and did you get your covid vaccine [Patient] yep i did get my covid vaccine but it really made me feel sick so i'm hoping i do n't have to get another one later this year[SEP][Therapeutic History][Doctor] okay did so you just got the two vaccines you did n't get the booster [Patient] no i did n't get the booster because i really have n't had time to feel that sick again it really knocked me down for like two days and with the little kids it's really hard[SEP][Personal History][Doctor] okay alright well i saw that they did a rapid covid test when you came in here and that was negative so that's good so you do n't have covid which is which is good now let's talk a little bit about your hypertension and hypertension since i have you here did you ever buy that blood pressure cuff that i asked you to buy [Patient] yes i did i blood the blood pressure cuff and my blood pressure is like all over the place sometimes it could be like one twenty for the top number sometimes it could be one forty for the top number i i do n't really remember the bottom number though[SEP][Therapeutic History][Doctor] okay that's okay are you taking the lisinopril i think we have you on twenty milligrams a day [Patient] yep i take it every morning with my multivitamin and my vitamin d[SEP]
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[Conversation Start][SEP][Personal History][Greetings][Doctor] next patient is grace ross . date of birth 8-23-97 . ms. ross is a new patient . she's here today for a full spectrum std testing . the patient states that she's having symptoms of discomfort , a change in discharge , and odor in her vaginal region . she says that the right side of her vagina is starting to become painful . she denies any fevers or chills . she reports , that she recently learned , her partner has been in sexual encounters with other people , and she wants to be evaluated for all stds . hello , ms. ross . i'm dr. diaz . it's good to meet you . [Patient] hi . yes . nice to meet you , too .[SEP][Acute Symptoms][Doctor] so , how are you doing today ? i hear that you're here for std testing . is that correct ? [Patient] yeah . actually , i found out earlier this week , that my boyfriend has been cheating on me , for some time . i'm really worried , that i could have caught something , you know ?[SEP][Acute Symptoms][Doctor] mm-hmm . [Patient] i wanted to make sure i do n't have anything .[SEP][Acute Symptoms][Doctor] yeah . i'm sorry to hear that . of course , we can do that today . um . well , let's see . how do you feel ? do you have any symptoms ? [Patient] well , um , i started noticing some weird discharge last week .[SEP]
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[Physical Examination][Doctor] alright what about here [Patient] yeah[SEP][Physical Examination][Doctor] okay so looking at your ankle and your right ankle exam on the skin there is ecchymosis so you have that bruising which you can see of the lateral [Patient] malleolus[SEP][Physical Examination][Personal History][Radiology Examination][Acute Assessment][Doctor] malleolus associated with swelling there is tenderness to palpation of the anterior laterally in the soft tissue there is no laxity on the anterior drawer and inversion stress there is no bony tenderness on palpation of the foot on your neurovascular exam of your right foot there your capillary refill is less than three seconds strong dorsalis pedis pulse and your sensation is intact to light touch alright so we did get an x-ray of your ankle before you came in and luckily it's there is no fractures no bony abnormalities which is really good so let me talk a little bit about my assessment and plan for you so for your right ankle pain your symptoms your symptoms are consistent with a right ankle sprain have you sprained your ankle before most times people do the athletics play soccer it happens every so often but have you done that before [Patient] no i do n't think so[SEP][Discussion][Medication][Other Treatments][Doctor] okay well you're one of the lucky ones some of my my patients that play sports they sprain their ankle seems like every other week so good for you so for that that that ankle sprain i just want to keep i want you to keep your leg elevated when you're seated and i want you to continue to ice it you can ice it let's say five times a day for twenty minutes at a time just to help that swelling go down i'm gon na give you an air cast to help you stabilize the ankle so keep it from moving and then i'll give you crutches and so i want you to stay off that leg for about one to two days and then you can start walking on it as tolerated tolerated so how does that sound [Patient] it's alright[SEP][Discussion][Doctor] alright so do you have any questions for me [Patient] yeah like how long do you think it's gon na take for me to heal[SEP]
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[
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[Discussion][Other Treatments][Doctor] and we would then lift them and elevate the nipple position in order to help with your back pain , neck pain , and because i'm a plastic surgeon , of course i want them to look nice as well . [Patient] right .[SEP][Discussion][Other Treatments][Doctor] so typically , when you do the breast reduction , we make an incision around the nipple straight down and then underneath . and it kinda looks like , um , an anchor below . then straight down , and underneath , and through that incision , we're able to f- to lift the breast . and we'll take off any extra fat and breash- breast tissue . so that way it becomes smaller in size . and i noticed that you would like to be a b cup . so i do tell every patient we can make you as small as your blood supply allows . and what that means is we must move the nipple without cutting off any of its blood supply during the surgery . [Patient] okay . well , thank you for explaining that .[SEP][Discussion][Other Treatments][Doctor] you're welcome . and in your case , you'll probably be a small c. um , a b cup might be a little bit small , but we'll see once i'm doing the , the procedure for you . [Patient] okay .[SEP][Discussion][Other Treatments][Doctor] and typically the surgery takes about three hours . you will have drains , one in each side . and that helps prevent fluid from building up in the breast . and that stays in for about a week . and then we'll remove them in the clinic . and you'll have a clear plastic tape over your incision that should help with the scars . and , um , we've seen that patients who have lighter skin , the scars will tend to be red at first . and then it takes about a year for a scar to mature in line . [Patient] okay . well , i'm not too worried about the scars .[SEP][Discussion][Other Treatments][Doctor] okay . and i do like to keep patients overnight . it's just going to be for one night in the hospital . and we just wan na make sure your pain is controlled , make sure you're not nauseated , all of that stuff . some patients wan na go home that same day . but you know that some people get nauseated , and the last thing that i want is for you to be vomiting at home alone without the , the support here at the facility . [Patient] okay , yeah , that sounds good .[SEP]
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] | 174
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[Physical Examination][Doctor] no , okay , all right . well , i'm gon na go ahead and do a quick physical exam , okay ? [Patient] okay .[SEP][Physical Examination][Medication][Doctor] hey , dragon , show me the blood pressure . so , yeah , looking at your blood pressure today here in the office , it is a little elevated . you know , it could just , you could just be nervous . uh , let's look at some of the past readings . hey , dragon , show me the blood pressure readings . hey , dragon , show me the blood pressure readings . here we go . uh , so they are running on the higher side . um , y- you know , i , i do think that , you know , i'd like to see you take your medication a little bit more , so that we can get that under control a little bit better , okay ? [Patient] okay .[SEP][Physical Examination][Doctor] so , i'm just gon na check out your heart and your lungs . and you know , let you know what i find , okay ? [Patient] okay .[SEP][Physical Examination][Doctor] okay . so , on your physical examination , you know , everything looks good . on your heart exam , i do appreciate a three out of six systolic ejection murmur , which i've heard in the past , okay ? and on your lower extremities , i do appreciate one plus pitting edema , so you do have a little bit of fluid in your legs , okay ? [Patient] okay .[SEP][Lab Examination][Radiology Examination][Diagnostic Testing][Doctor] let's go ahead , i wan na look at some of your results , okay ? hey , dragon , show me the echocardiogram . so , this is the result of the echocardiogram that we did last year . it showed that you have that low-ish pumping function of your heart at about 45 % . and it also sh- shows some mitral regurgitation , that's that heart murmur that i heard , okay ? um , hey , dragon , show me the lipid panel . so , looking at your lipid panel from last year , you know , everything , your cholesterol was like , a tiny bit high . but it was n't too , too bad , so i know you're trying to watch your diet . so , we'll repeat another one this year , okay ? [Patient] okay .[SEP]
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[Vegetative History][Doctor] okay do you experience like any loss of control of your bladder or your bowels [Patient] no[SEP][Personal History][Therapeutic History][Doctor] okay now you mentioned earlier that you you have some tried tried some things in the past so tell me what were they [Patient] so i've tried some physical therapy before and so when it gets really bad they've even had to prescribe some strong pain medications for me but that was only temporary and they even mentioned surgery to me in the past but i really would like to avoid surgery[SEP][Other Socials][Doctor] okay sure so tell me what is your day like [Patient] my day so i try to be as active as i can but of course it's been difficult with my back pain and so because of that i have gained some weight over the past years[SEP][Other Socials][Doctor] okay alright well i'm sorry to hear that i know that you used to like playing golf [Patient] yeah i and you know golf is relatively new for me i've been trying to get into it but this has definitely set me back[SEP][Other Socials][Doctor] yeah i'm sorry yep probably now at the peak of you know just learning it and being able to do more with it this comes and this happens right [Patient] exactly[SEP]
|
[
"Family History"
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[
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] | 176
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[Acute Symptoms][Doctor] okay does it hurt more when you walk for longer periods of time [Patient] yes[SEP][Acute Symptoms][Doctor] okay how long does the pain last [Patient] for as long as my walk is and i do n't sometimes i walk five minutes kinda depends on the wind[SEP][Acute Symptoms][Doctor] okay alright [Patient] sometimes i walk there is[SEP][Acute Symptoms][Therapeutic History][Doctor] okay alright have you done anything to help with the pain [Patient] well i wear a brace and i have used a lot of thc cream on it[SEP][Acute Symptoms][Therapeutic History][Doctor] okay alright thc cream is an interesting choice but do you think that's been helpful [Patient] yes[SEP]
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[
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"Therapeutic History"
] |
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"Subjective"
] | 177
|
[Physical Examination][Doctor] no alright so i'm gon na have you flex your knee is that painful [Patient] yeah that's uncomfortable[SEP][Physical Examination][Doctor] that's uncomfortable and extend it so that's painful [Patient] yeah yes[SEP][Physical Examination][Medication][Other Treatments][Radiology Examination][Reassessment][Acute Assessment][Doctor] okay so on your knee exam i i see that you do have pain to palpation of the medial aspect of your right knee you have some pain with flexion extension i also identify some edema around the knee and some effusion you have a little bit of fluid in there as well so prior to coming in we did do an x-ray of that right knee and luckily you did n't break anything so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you have what we call a mcl strain so a medial collateral ligament strain so when you fell i think you twisted a little bit and so it irritated you strained that that ligament there so for that what we can do for you first i'm gon na prescribe you some ibuprofen eight hundred milligrams and you can take that twice a day and that's gon na help you with that swelling and that pain that you currently do have i'm also gon na put you in a a knee brace just to try and support those muscles to allow it to heal and then i want you to ice the knee you can do that for twenty minutes at a time for three to four times a day that should also help with the the swelling of your knee for your hypertension now i'm gon na keep you on that twenty of lisinopril okay because you are taking it and you you're doing pretty good with it i also want to get you a referral to nutrition just to try to help you with that diet you know because right now you are your diet is little bit out of control so we just need to rain you in a little bit and hopefully you know with their help we can eventually get you off that lisinopril alright so do you have any questions for me [Patient] do i need to elevate my leg or stay off my leg or[SEP][Discussion][Doctor] yeah i would yeah you can elevate your leg stay off your stay off your leg you know if you have any kids have them work out in the yard instead of you just to to for a couple of weeks it's a good thing if you want to do that [Patient] tell him this doctor's order[SEP][Discussion][Doctor] tell definitely tell him his doctor tell him i said it [Patient] alright do you have any other questions no that's it i appreciate you seeing me[SEP]
|
[
"Chitchat"
] |
[
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[Acute Symptoms][Therapeutic History][Doctor] alright and have you taken anything for the pain [Patient] yeah so i i had like a ulcer not too long ago so my doctor told me that i could n't take any like kind of advil or ibuprofen[SEP][Acute Symptoms][Therapeutic History][Doctor] mm-hmm [Patient] so i've been taking some tylenol and i wrapped it with kinesiology tape are you familiar with that[SEP][Acute Symptoms][Therapeutic History][Doctor] yep yeah i'm i'm familiar [Patient] okay[SEP][Acute Symptoms][Therapeutic History][Doctor] alright and has the has the ibuprofen been helping you at all [Patient] i ca n't take ibuprofen[SEP][Acute Symptoms][Therapeutic History][Doctor] i mean i'm sorry the tylenol [Patient] no it's okay but the tylenol it helps like a little bit but you know like it's it's got like a time limit right so by the time and i'm not supposed to take it like more than like every like four hours or something like that but by hour or two like it it hurts again[SEP]
|
[
"Acute Symptoms",
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[
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] | 179
|
[Acute Symptoms][Doctor] does it happen on its own or there are certain things that trigger it [Patient] sometimes if i'm if certain temperatures seem to trigger it sometimes or if it's super where it's cold i get a trigger sometimes sometimes certain kind of sensory outside of the wind sometimes that seems to trigger it but that's about it[SEP][Acute Symptoms][Therapeutic History][Doctor] okay and anything that you've done to to that helps for a little bit when you pain excess [Patient] you know i've tried ibuprofen and motrin that had really has n't helped it just comes on suddenly and then it's kinda stabbing excruciating pain i've tried rubbing some you know some tiger balm on it that did n't work but that's you know so i i went to my family doctor and he said you know i really need to see a neurosurgeon[SEP][Acute Symptoms][Doctor] got it how long do these episodes last these pain [Patient] you know it can last for anywhere from a few minutes to sometimes about an hour but generally generally a few minutes[SEP][Personal History][Doctor] any history of something like multiple sclerosis or any brain tumors that you know [Patient] no nothing like that[SEP][Personal History][Doctor] alright any other kinda headache symptoms that have anything like you had migraines or anything related to the headaches [Patient] i mean i get occasional headaches but not really i do n't have a history of migraines but i occasionally get headaches like everybody else i take some tylenol that usually goes away but this is different[SEP]
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[
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[
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|
[Acute Assessment][Doctor] you know , i , i think , you know , you're doing a ... it sounds like a doing a good job watching your diet . you could ... you just are retaining a little bit of fluid , maybe just from standing all day . [Patient] okay .[SEP][Chitchat][Doctor] okay ? let's take a look at some of your results . okay ? [Patient] okay .[SEP][Acute Assessment][Lab Examination][Doctor] hey , dragon . show me the endoscope results . so , this was the endoscopy that you had last year when you were having all that pain . it just showed that you had had some mild gastritis . so , it's good to hear that that , you know , protonix is helping you a lot . okay ? [Patient] okay . okay .[SEP][Reassessment][Discussion][Other Treatments][Medication][Doctor] that sounds great . all right . so , let's talk just a little bit about , you know , my assessment and my plan for you . for your reflux , i want you to continue on the protonix 40 mg a day , and continue with those lifestyle modifications with the dietary stuff- [Patient] okay .[SEP][Chitchat][Doctor] . okay ? do you have any questions ? [Patient] no questions .[SEP]
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] | 181
|
[Other Socials][Doctor] okay yeah yeah i mean that's that's definitely understandable it says you had a four point four centimeter left upper lobe nodule in there so it's kinda big but that's understandable and we're doing the chemo to try to reduce that that that tumor that you do have so how often do you normally run with your dogs [Patient] i mean i would i would take them for i would normally take them for like mile long walks everyday and just this weekend i could only walk down to the end of the street i had to have my husband take the dog fit walk[SEP][Other Socials][Doctor] man okay what kind of dog do you have [Patient] i have a dobrman[SEP][Vegetative History][Doctor] yeah they are pretty active that makes sense alright so have you been coughing have you had any phlegm [Patient] i've been having a dry cough no phlegm[SEP][Vegetative History][Doctor] okay have you noticed any fever [Patient] no fever[SEP][Vegetative History][Doctor] no fever alright what about any other symptoms like any body aches any sore throat sinus pain [Patient] well i mean now that you mentioned it like every time i swallow it hurts it does n't feel like i have a cold because it hurts down here more in my chest but every time i swallow it it's really painful[SEP]
|
[
"Vegetative History"
] |
[
"Subjective"
] | 182
|
[Acute Symptoms][Doctor] okay , that's good . [Patient] so i got up , i sat on the side of the bed and held my arm down , thinking it would , like , help the circulation , but it did n't .[SEP][Acute Symptoms][Doctor] okay , i see . [Patient] and so , after a while , when it eased off , maybe about four , five am , i laid back down and it did n't start up again .[SEP][Acute Symptoms][Doctor] mm-hmm , okay . [Patient] um . i went back to sleep but for several nights this happened , like , over and over . so , i finally went to see the doctor , and i do n't really recall her name .[SEP][Acute Symptoms][Doctor] okay . yeah , i think i know who you're talking about , though . [Patient] um , she's the one who sent me to you , so , i , i would , i would think so . but when i went to her after the third time it happened and she checked me out , she said it was most likely coming from a pinched nerve .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 183
|
[Diagnostic Testing][Doctor] if pamela said it's broken then you know what this is what we're gon na do we're gon na order something called a ct that's gon na give us even nope you know what let's upgrade to an mri it's gon na give us the most thorough image of everything that's going on the heart and the soft tissues is that gon na is that so that way we can really get a good image of what's happening inside right [Patient] okay because what the lawyer said i needed was an mri[SEP][Medication][Referral][Doctor] not a problem we're we're gon na make your lawyer happy next step we are going to try working like from the outside in so i do need you to work on getting like you're you're saying you've seen some bruising and some swelling yourself so i want you to put ice on that whenever you're experiencing that in the moment when you wake up i want you to do your best to just like i'm gon na give you some exercises on the sheet and i want you to roll through these exercises every morning right to just get some like movement and like free frenosive movement back into your neck i also wan na put you on a couple medications now i know that you said you were on fentanyl before that's a bit extreme and i i want i i i wan na like monitor this a little more conservatively so what we're gon na start with is something called robaxin [Patient] hurts a lot if i do n't get more fentanyl[SEP][Medication][Referral][Doctor] you know we can refer you to pain medicine if it really is getting that complicated but for this current period we're gon na put you on some robaxin it's gon na be fifteen hundred milligrams and you're gon na take that six to eight hours every six to eight hours and that really should help kinda relax the muscles in the area take off some of that tension and really help with that pain if you're noticing that the robaxin still is n't helping maybe then we can start we can like start using like a heat pad or maybe some icyhot the biofreeze is a really good one to kinda help with that and then we will refer you to physical therapy i think with the mri we can start evaluating maybe some additional steps so rather than you having to like take that fentanyl because i do n't want you to be in danger right like people i do n't want you to get rubbed so what we could explore are local injections right and we can refer you to pain medication and see about like locally injecting the area and that should be able to help you out hopefully with this [Patient] i ca n't go to work like this[SEP][Medication][Doctor] okay so if it's if it's that bad let's wait for the mri result we're gon na give you off for work because you know you ca n't move and we'll see what the mri says about what whether or not we can get you like true local injections in the moment is that alright for now [Patient] yeah[SEP][Discussion][Doctor] okay okay any other questions [Patient] not right now[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 184
|
[Conversation Start][SEP]
|
[
"Acute Symptoms",
"Personal History",
"Greetings"
] |
[
"Subjective"
] | 185
|
[Conversation Start][SEP][Acute Symptoms][Personal History][Greetings][Doctor] mister jackson is a 45 -year-old male who has a history of diabetes type two and mild intermittent asthma and he is here today with right elbow pain so hey there mark nice to see you again listen sorry you're having some elbow pain let's talk about it but i would like to record this conversation with this cool app that i'm using that's gon na help me focus on you a bit more would that be alright with you [Patient] yeah that sounds great[SEP][Acute Symptoms][Doctor] okay great so mark tell me about your right elbow pain what's been happening [Patient] so yeah i've been playing a lot of tennis recently buddy of mine you know you're always telling me to get off the couch and be more active so a buddy of mine asked me if i wanted to go play tennis he just joined a country club i've been hitting hitting the cord a lot more and it's just been killing me for the last three weeks or so[SEP][Acute Symptoms][Doctor] okay alright and where in your elbow is it hurting [Patient] outside part[SEP][Acute Symptoms][Doctor] hmmm okay does the pain radiate anywhere like down to your arm up to your shoulder or anywhere else [Patient] no it does n't[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 186
|
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] so barbara i i know you are here for some itchy scalp pain can you tell me a little bit about how you're doing [Patient] yeah it's still quite a problem you know something i've been suffering with for so long now it's still quite itchy and it's really embarrassing too because i'll have dandruff so much like all over me but but i just ca n't stop itching[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 187
|
[Acute Symptoms][Therapeutic History][Doctor] okay alrighty and did that help [Patient] yeah the ibuprofen helped a little bit but i'm on it pretty on a pretty regular basis right now[SEP][Acute Symptoms][Doctor] gotcha okay now tell me are you able to bend or straighten your leg ever since then [Patient] i can bend it but it hurts towards the end of the motion and i can straighten it but it does n't it feels like i have to help get it straightened[SEP][Acute Symptoms][Doctor] okay alright and then how about you able to bear any weight on it or walk on it at all [Patient] i can still bear weight on it but it feels just really loose it it does n't feel normal[SEP][Physical Examination][Doctor] gotcha okay alright well let's go ahead and take a look at your knee here real quick before i take a look at your knee here i'm gon na do a physical exam and in terms of your gait here i did notice that you do have a marked limp on your looks like it's your right leg upon ambulation so let me go ahead and take a look at that right knee real quick i do appreciate some significant effusion in the right knee just a slight bit of ecchymosis let me just feel around here scott how does that feel does that hurt when i kinda press on that there [Patient] a little bit of pain there not not really bad it's it feels like it's just more on the inside of my knee[SEP][Physical Examination][Doctor] yep okay so you definitely feeling some a little bit of pain to palpation at the medial joint line now i'm gon na have you lie on your back and also i'm gon na do some maneuvering here of your leg i'm gon na do a real quick test on you here okay alright how does that feel [Patient] just feels just feels loose it hurts when you pull it at the very end[SEP]
|
[
"Physical Examination",
"Discussion",
"Medication",
"Other Treatments",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Assessment",
"Plan",
"Objective"
] | 188
|
[Chitchat][Doctor] doing okay . so i know the nurse told you about dax . i'd like to tell dax a little bit about you , okay ? [Patient] okay .[SEP][Personal History][Doctor] all right . elizabeth is a 66-year-old female with a past medical history of significant for depression and hypertension who presents for her annual exam . so elizabeth , it's been a year since i've seen you . [Patient] mm-hmm .[SEP][Acute Symptoms][Doctor] how are you doing ? [Patient] i'm doing well . there's been so many events now that we've been able to get vaccinated , i've been able to see my grandkids again , go to more birthday parties , it's been fantastic .[SEP][Personal History][Therapeutic History][Doctor] yeah , i know . i've ... i mean , we've had some communication over telehealth and that type of thing , but it's not the same as being in-person , so i'm happy to see you today . now tell me a little bit about , you know , we have n't really got a chance to talk about your depression . how are you ... how are you doing with that ? i know we have n't had you on medication in the past because you're on medication for other things . what are your strategies with dealing with it ? [Patient] so i've been going to therapy once a week for the past year . um , mostly virtually , um , but starting to get in-person . virtual was a bit of a struggle , but i feel like being in-person with someone really helps me .[SEP][Other Socials][Doctor] okay . and do y- do you have a good support system at home ? [Patient] yes , i do . i have my husband and , uh , my kids are right down the street from me , so i'm very lucky .[SEP]
|
[
"Personal History"
] |
[
"Subjective"
] | 189
|
[Conversation Start][SEP][Greetings][Doctor] hi gregory hi how are you doing today [Patient] good how are you[SEP][Acute Symptoms][Doctor] i'm alright so i understand that you were having some you know right ankle pain and some swelling after you fell can you can you tell me a little bit about what happened [Patient] yeah so i was going out to take off the trash and i you know i was icy and i i was being very careful and then i noticed that there must have been a little patch of ice or something because all i know is that i slipped and i was on the ground and i was being really really careful[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 190
|
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] hi elizabeth so i see that you were experiencing some kind of injury did you say that you hurt your knee [Patient] yes i hurt my knee when i was skiing two weeks ago[SEP][Acute Symptoms][Doctor] okay skiing that sounds exciting alright so what happened what what's when did the injury like what sorry what happened in the injury [Patient] so i was flying down this black diamond you know like i like to do[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 191
|
[Personal History][Doctor] okay alright so we had a car crash in february [Patient] what year it was which february it was[SEP][Personal History][Doctor] okay so let's let's try with this one see what happens hopefully you remember i need you to start writing down these car crashes that this is becoming a thing but you know it's okay so let's let's say maybe you had a [Patient] you're not judging me are you[SEP][Chitchat][Doctor] no there's no judgment here whatsoever i want to make sure that i'm giving you the best advise possible and in order to do that i need the most information that you can provide me makes sense [Patient] yes[SEP][Acute Symptoms][Doctor] alright so we're gon na say hope maybe that you had a car crash and we can verify this in february of this year and you've been experiencing some neck pain since then right [Patient] yes[SEP][Acute Symptoms][Doctor] okay alright on a scale of one to ten what ten is your arm is being cut off by a chainsaw severe how bad is your pain [Patient] twelve[SEP]
|
[
"Personal History",
"Therapeutic History"
] |
[
"Subjective"
] | 192
|
[Acute Symptoms][Doctor] okay so is the pain that you're having is it constant or does it come and go [Patient] it's constant[SEP][Acute Symptoms][Doctor] alright are you able to urinate [Patient] i am and this morning i actually started seeing some blood[SEP][Acute Symptoms][Doctor] okay yeah so and i know you said i see you've had some kidney stones in the past like how many times would you say you've had one of these episodes [Patient] i've had it for probably this might be my third time[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 193
|
[Conversation Start][SEP][Acute Symptoms][Greetings][Doctor] all right . today i am seeing jose james . uh , date of birth 9/29/1957 . mr . james is a new patient who's having pain in his left shoulder and elbow . he fell five months ago going up a stairs , and the pain has been present since . hi mr . james , i'm doctor isabella . how are you doing ? [Patient] i'm okay . thank you .[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 194
|
[Therapeutic History][Doctor] okay alright and i saw you you did see your pcp before you came in did they put you on antibiotics [Patient] they did start me on some medication but i did n't i did n't pick them up from the pharmacy yet[SEP][Therapeutic History][Doctor] okay do you know which ones that they prescribed for you [Patient] i do n't recall the name exactly[SEP][Therapeutic History][Doctor] do n't recall alright [Patient] something i had taken it before[SEP][Other Socials][Doctor] okay so when you what beach did you go to when you you hurt it [Patient] i'm sorry[SEP][Other Socials][Doctor] so i was asking which beach did you did you go to when you hurt your foot [Patient] at i was at dewey beach in my ambulance[SEP]
|
[
"Acute Symptoms"
] |
[
"Subjective"
] | 195
|
[Discussion][Medication][Doctor] okay , all right . and then for your last problem your hypertension , you know , again i , i , i think it's out of control . but we'll see , i think , you know , i'd like to see you take the lisinopril as directed , okay ? uh , i want you to record your blood pressures within the patient , you know , take your blood pressure every day . record them to me for like , about a week , so i have to see if we have to add another agent , okay ? 'cause we need to get that under better control for your heart failure to be more successful , okay ? [Patient] okay .[SEP][Discussion][Diagnostic Testing][Doctor] do you have any questions ? , and i forgot . for your annual exam , you're due for a mammogram , so we have to schedule for that , as well , okay ? [Patient] okay .[SEP][Discussion][Medication][Doctor] okay . do you have any questions ? [Patient] can i take all my pills at the same time ?[SEP][Discussion][Medication][Doctor] yeah . you can certainly take them , you know , all at the same time , as long , as yeah , they're all one scale . you can take them all at the same time . just set an alarm- [Patient] okay .[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 196
|
[Vegetative History][Doctor] okay excellent excellent and so right now you're on a combination of two different chemotherapies the cisplestan as well as the eupside and you had your last treatment just a few days ago but you're saying right now you've been able to tolerate the nausea and the fatigue [Patient] yes i have n't had any nausea but you know just slight fatigue it does n't seem to be overwhelming[SEP][Physical Examination][Discussion][Medication][Radiology Examination][Reassessment][Other Treatments][Doctor] okay okay so we are gon na go ahead if it's okay with you and start your physical exam reviewing your vitals so vitals look good especially your oxygen especially with the chemotherapy you've been getting and the cough so your oxygen looks good so i'm happy with that so now i'm just examining your neck especially with your sore throat and i do n't appreciate any cervical lymphadenopathy and also no supraclavicular adenopathy listening to your heart you have a nice regular rate and rhythm with no murmurs that i appreciate now on your lung exam when you're taking some deep breaths i do notice some crackles in your lungs bilaterally and what that means is there is there is some faint sounds that i'm hearing which could represent some fluid there so on looking at your skin exam on your chest you do have some erythema on the anterior side of the chest on the left side and this could be related to the radiation so on your lower extremities i appreciate no edema and everything else looks good and thank you i know you did a chest x-ray before coming in so on your results for the chest x-ray it does look like you have some mild radiation pneumonitis which basically means some inflammation of the lungs most likely due to the radiation so what does this all mean so for your assessment and plan so for the first diagnosis the first problem of the lung cancer so what we're gon na do is we're gon na continue with the current regimen of your chemotherapy of the cisplacin and the etoside and we're gon na continue with your current dose of radiation at forty five grade and when that's complete we will repeat some imaging and hopefully you know the tumor will shrink down enough that we can remove it surgically okay for problem number two so the radiation pneumonitis so that's what causing that cough as well as some of the shortness of breath i know you're not experiencing it much now so what i'm gon na do for that is actually gon na prescribe you a low dose of prednisone and so that's an will help with the inflammation i'm gon na give you forty milligrams daily for five days and so hopefully that will help reduce the inflammation and so that you can continue with the radiation okay how does that sound so far [Patient] that sounds great thank you[SEP][Medication][Other Treatments][Reassessment][Doctor] okay and then lastly for the painful swallowing that you're having so the inflammation you're having it not only in your lungs but it also in your esophagus as well so what i'm gon na do is prescribe you you're taking the the prednisone i'm also gon na give you a lidocaine swish and swallow and you can do that four times a day and so that will be able to help you so you can eat immediately after taking it and it can also help so that you can continue to take food and fluids prevent dehydration and any further weight loss [Patient] great[SEP][Discussion][Doctor] okay any questions for me [Patient] i do n't believe so at this time[SEP][Chitchat][Doctor] okay alright so i'll see you at your next visit [Patient] great thank you[SEP]
|
[
"Chitchat"
] |
[
"Null"
] | 197
|
[Physical Examination][Doctor] okay . so on physical examination , i do n't appreciate any carotid bruits in your neck . on your heart exam i do notice a slight 2/6 systolic ejection murmur , which we've heard in the past , so i think that's stable . your lungs in- are nice and clear , and you have some trace lower extremity edema bilaterally , so all that means is , you know , i agree , you know , maybe we should watch your diet a little bit better , okay ? but i wan na take a look at some of your results , okay ? [Patient] okay .[SEP][Discussion][Radiology Examination][Reassessment][Doctor] all right . hey , dragon , show me the ekg . and the nurses did an ekg before you came in , and that looks perfectly fine , okay ? so i wan na just go ahead and talk a little about your assessment and my plan for you . so for your first problem , your depression , i think you're doing a really good job with your strategies . i do n't think ... it does n't sound to me like i need to start you on any medication at this time , unless you feel differently . [Patient] no , i'm , i'm , good in that department .[SEP][Medication][Reassessment][Doctor] for your second problem , your high blood pressure , i agree , everything looks fine here now . i wan na just continue on the lisinopril , 20 milligrams a day . and i want you to continue to watch your blood pressures as well , and if they start rising , i want you to contact me , okay ? [Patient] okay .[SEP][Diagnostic Testing][Reassessment][Doctor] and for your third problem , for an annual exam maintenance , you know , you're due for a mammogram , so we'll go ahead and schedule that , okay ? [Patient] all right .[SEP][Discussion][Doctor] all right . do you have any questions ? [Patient] um , can i take all my medicine at the same time ? does it matter ?[SEP]
|
[
"Discussion",
"Medication"
] |
[
"Plan"
] | 198
|
[Chitchat][Doctor] okay . well , you know , you can only do what you can do . [Patient] yeah , i agree .[SEP][Chitchat][Doctor] all right . well , let's complete your exam . [Patient] all right .[SEP][Physical Examination][Doctor] so let's take a deep breath . and again . all right , you can breathe normally . all right , and take one more deep breath . okay , now i'm gon na touch your neck . go ahead and swallow . perfect . and just place your hand above your head . okay , i do feel some little bumps . [Patient] yeah , but they're not as big as they were .[SEP][Physical Examination][Doctor] mm-hmm . okay , in this breast it does feel a little bit denser . does it hurt at all ? [Patient] it does , where your left hand just was .[SEP][Physical Examination][Doctor] okay , right here ? [Patient] yeah , down here . but whenever i breastfed , it was always sore there too . i had a clog and something else . the lumps do feel smaller , but they are still there , unfortunately .[SEP]
|
[
"Physical Examination"
] |
[
"Objective"
] | 199
|
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