DATEXIS/aci_bench_intent_annotated · Datasets at Hugging Face

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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	D2N033	14	[ "Physical Examination" ]	[ "Objective" ]	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	1,000
doctor: how about when i extend it patient: yeah that hurts	D2N033	15	[ "Physical Examination" ]	[ "Objective" ]	how about when i extend it	1,001
doctor: okay so little bit of limited range of motion as well as pain on both flexion and extension on the knee i'm gon na push on this a little bit looks like your mcmurray's test is negative just checking for a meniscus tear okay so let's talk a little bit about your plan what i am concerned about for your knee is it sounds like you have a torn or injured mcl i it's that inside tendon in your knee so i'm concerned about that since you're having trouble with weightbearing and you heard that pop so what i'm gon na do is i'm gon na put you in a straight leg brace and i'll prescribe some mobic you can start taking that as a a pain reliever and to try to get some of the swelling down i want you to ice your knee once an hour for about fifteen minutes but i'm also gon na send you out for an mri because we wan na make sure this is what happens see if there's any other damage to the knee does that sound good patient: yeah that sounds great thank you	D2N033	16	[ "Physical Examination", "Medication", "Other Treatments", "Diagnostic Testing", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	okay so little bit of limited range of motion as well as pain on both flexion and extension on the knee i'm gon na push on this a little bit looks like your mcmurray's test is negative just checking for a meniscus tear okay so let's talk a little bit about your plan what i am concerned about for your knee is it sounds like you have a torn or injured mcl i it's that inside tendon in your knee so i'm concerned about that since you're having trouble with weightbearing and you heard that pop so what i'm gon na do is i'm gon na put you in a straight leg brace and i'll prescribe some mobic you can start taking that as a a pain reliever and to try to get some of the swelling down i want you to ice your knee once an hour for about fifteen minutes but i'm also gon na send you out for an mri because we wan na make sure this is what happens see if there's any other damage to the knee does that sound good	1,002
doctor: yeah and then for your diabetes as long as you're here it sounds like you're managing that pretty well but i do wan na get a recheck on your hemoglobin a1c and then i'm also i'm going to get a refill on the metformin that you have been taking five hundred milligrams so you can keep taking that as well so do you have any other questions for me patient: no that's it thanks	D2N033	17	[ "Medication", "Therapeutic History", "Diagnostic Testing", "Reassessment" ]	[ "Subjective", "Assessment", "Plan" ]	yeah and then for your diabetes as long as you're here it sounds like you're managing that pretty well but i do wan na get a recheck on your hemoglobin a1c and then i'm also i'm going to get a refill on the metformin that you have been taking five hundred milligrams so you can keep taking that as well so do you have any other questions for me	1,003
doctor: alright well thank you hope that you feel better	D2N033	18	[ "Chitchat" ]	[ "Null" ]	doctor: alright well thank you hope that you feel better	1,004
doctor: hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so how you doing is it is it gotten any better patient: yeah yeah i've been having a lot of pain of my shoulder for the last three weeks now and it's not getting better	D2N034	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so how you doing is it is it gotten any better	1,005
doctor: okay do you remember what you were doing when the pain first started patient: so i i was thinking that i i ca n't recall like falling on it injuring it getting hit	D2N034	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay do you remember what you were doing when the pain first started	1,006
doctor: okay so do you remember hitting it or anything like that patient: no nothing at all	D2N034	3	[ "Acute Symptoms" ]	[ "Subjective" ]	okay so do you remember hitting it or anything like that	1,007
doctor: okay alright did you fall do you remember doing that patient: no	D2N034	4	[ "Acute Symptoms" ]	[ "Subjective" ]	okay alright did you fall do you remember doing that	1,008
doctor: okay hmmm so like a little mystery so have you had pain in that shoulder before patient: i mean i'm very active so i can get pains in my shoulders but it's nothing that sometime some tylenol can help	D2N034	5	[ "Personal History" ]	[ "Subjective" ]	okay hmmm so like a little mystery so have you had pain in that shoulder before	1,009
doctor: okay and are you able to move the arm or is it kinda just stuck patient: i'm having a lot of pain like i can move it but you know when i try to reach for something lifting anything and even like i do n't even try to put my hands over my head because it causes so much pain	D2N034	6	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and are you able to move the arm or is it kinda just stuck	1,010
doctor: alright so does that pain radiate anywhere or like where would you say it is in your shoulder patient: it actually it stays pretty much just right at the shoulder it does n't go down anywhere	D2N034	7	[ "Acute Symptoms" ]	[ "Subjective" ]	alright so does that pain radiate anywhere or like where would you say it is in your shoulder	1,011
doctor: okay and the pain is it is it all the time or does it come and go patient: it's pretty much all the time anytime i put any pressure on it like when i'm trying to sleep it hurts even more so it's been affecting my sleep as well	D2N034	8	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and the pain is it is it all the time or does it come and go	1,012
doctor: okay so i know you mentioned tylenol patient: so this time i have n't taken anything for it	D2N034	9	[ "Therapeutic History" ]	[ "Subjective" ]	okay so i know you mentioned tylenol	1,013
doctor: okay did you try icing it at all patient: i iced it initially but i have n't iced it at all recently	D2N034	11	[ "Acute Symptoms" ]	[ "Subjective" ]	okay did you try icing it at all	1,014
doctor: alright and so with your shoulder have you experienced any numbness in your arm or in your fingers patient: no numbness or tingling	D2N034	12	[ "Physical Examination" ]	[ "Objective" ]	alright and so with your shoulder have you experienced any numbness in your arm or in your fingers	1,015
doctor: okay good so i'm gon na go ahead and do a quick physical exam and take a look at your your shoulder so i reviewed your your vitals everything looks good with that so touch here in your shoulder so your left shoulder exam you have limited active and passive range of motion so pressure here so that there is tenderness of the greater patient: okay	D2N034	13	[ "Physical Examination" ]	[ "Objective" ]	okay good so i'm gon na go ahead and do a quick physical exam and take a look at your your shoulder so i reviewed your your vitals everything looks good with that so touch here in your shoulder so your left shoulder exam you have limited active and passive range of motion so pressure here so that there is tenderness of the greater	1,016
doctor: tuberosity of the humerus let's see there is no tenderness at the sternoclavicular or acro patient: yeah	D2N034	14	[ "Physical Examination" ]	[ "Objective" ]	tuberosity of the humerus let's see there is no tenderness at the sternoclavicular or acro	1,017
doctor: acromioclavicular joints patient: yeah	D2N034	15	[ "Physical Examination" ]	[ "Objective" ]	acromioclavicular joints	1,018
doctor: yeah and looks like you have good hand grip let me see so on the neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is is intact to light touch patient: yes thank you	D2N034	16	[ "Discussion", "Diagnostic Testing", "Acute Assessment", "Referral", "Radiology Examination" ]	[ "Objective", "Assessment", "Plan" ]	yeah and looks like you have good hand grip let me see so on the neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is is intact to light touch	1,019
doctor: yep so you did get a we get we had to get a x-ray of your shoulder before you came in and so it's normal so that's really good so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you you do have that left shoulder pain so your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured tendon you have injured tendons and muscles that make up your shoulder and make up your shoulder muscles so what i'm gon na do is i'm gon na order an mri of your left shoulder and so we're gon na begin with that just to make sure nothing else is going on have you done physical therapy before patient: i have n't	D2N034	17	[ "Discussion", "Referral", "Medication" ]	[ "Plan" ]	yep so you did get a we get we had to get a x-ray of your shoulder before you came in and so it's normal so that's really good so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you you do have that left shoulder pain so your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured tendon you have injured tendons and muscles that make up your shoulder and make up your shoulder muscles so what i'm gon na do is i'm gon na order an mri of your left shoulder and so we're gon na begin with that just to make sure nothing else is going on have you done physical therapy before	1,020
doctor: okay so what i'm gon na do i'm going to refer you to physical therapy for approximately six to eight weeks and so they can help you strengthen those muscles around your shoulder and that should definitely help with the pain during that time you can also continue to take tylenol i do n't think i need to prescribe anything else for the pain you said as it's working pretty good for you so if your symptoms do n't improve we can consider a steroid injection of your shoulder which should provide some relief but i think right now we can just go with the the pt and hopefully that works to alleviate your injury so do you have any questions about the plan patient: so like i said i'm really active do you think that this pain will ever go away	D2N034	18	[ "Discussion" ]	[ "Plan" ]	okay so what i'm gon na do i'm going to refer you to physical therapy for approximately six to eight weeks and so they can help you strengthen those muscles around your shoulder and that should definitely help with the pain during that time you can also continue to take tylenol i do n't think i need to prescribe anything else for the pain you said as it's working pretty good for you so if your symptoms do n't improve we can consider a steroid injection of your shoulder which should provide some relief but i think right now we can just go with the the pt and hopefully that works to alleviate your injury so do you have any questions about the plan	1,021
doctor: yeah so many patients are very successful with rehab and so we'll start with that and see how you do most most of the time once we build up those muscles around that shoulder you know things things the pain alleviates itself and and and you will be good to go back to working on your basement and running and jogging and lifting weights all all the active things people do these days patient: okay alright thank you	D2N034	19	[ "Chitchat" ]	[ "Null" ]	yeah so many patients are very successful with rehab and so we'll start with that and see how you do most most of the time once we build up those muscles around that shoulder you know things things the pain alleviates itself and and and you will be good to go back to working on your basement and running and jogging and lifting weights all all the active things people do these days	1,022
doctor: well hello christina so how are you doing i was notified you were in the hospital for some heart failure what happened patient: well i'm doing better now but i just started having problems that my ankles were swelling and could n't get them to go down even when i went to bed and could n't breathe very good had to get propped up in bed so i could breathe at night and so i just really got to feeling bad i called my friend diane and she said i probably ought to call nine one one since i was having a hard time talking and so i called nine one one and they sent out an ambulance and they took me into the er on the it was quite an experience	D2N035	0	[ "Personal History", "Greetings" ]	[ "Subjective" ]	well hello christina so how are you doing i was notified you were in the hospital for some heart failure what happened	1,023
doctor: i'm sure you do n't yeah i see that your blood pressure was high also it was two hundred over ninety have you been patient: yeah i guess is that really high	D2N035	2	[ "Personal History" ]	[ "Subjective" ]	i'm sure you do n't yeah i see that your blood pressure was high also it was two hundred over ninety have you been	1,024
doctor: yeah that's patient: i feel really bad	D2N035	3	[ "Chitchat" ]	[ "Null" ]	yeah that's	1,025
doctor: yeah that's pretty high are you taking your medications or you missing some doses patient: i do n't know i might miss one now but i try to take them all time	D2N035	4	[ "Therapeutic History" ]	[ "Subjective" ]	yeah that's pretty high are you taking your medications or you missing some doses	1,026
doctor: yeah yeah you really need to take them very consistently now you also said you were watching your diet did you did you have some slips with that you said your ankles were swelling patient: no i yeah i do i like to i like to eat	D2N035	5	[ "Personal History" ]	[ "Subjective" ]	yeah yeah you really need to take them very consistently now you also said you were watching your diet did you did you have some slips with that you said your ankles were swelling	1,027
doctor: are you eating a lot of salty foods and pizza or patient: i like potato chips	D2N035	6	[ "Vegetative History" ]	[ "Subjective" ]	are you eating a lot of salty foods and pizza or	1,028
doctor: well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or patient: that's home snacking i buy the the the the brand name salt and vinitive because brand wo n't taste real good but the the brand names really tastes good	D2N035	8	[ "Other Socials", "Vegetative History" ]	[ "Subjective" ]	well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or	1,029
doctor: goodness well you know you we need to probably stop eating those now patient: yeah well i hate to hate to give those up but i guess i might have to	D2N035	10	[ "Other Treatments", "Vegetative History" ]	[ "Subjective", "Plan" ]	goodness well you know you we need to probably stop eating those now	1,030
doctor: well since you've been in the hospital and and they've helped you out with some with all that how are you feeling now patient: well i'm i'm doing better	D2N035	11	[ "Acute Symptoms" ]	[ "Subjective" ]	well since you've been in the hospital and and they've helped you out with some with all that how are you feeling now	1,031
doctor: mm-hmm and they patient: i do n't do n't have quite as much shortness of breath i think maybe getting up and walking a little more is helping	D2N035	12	[ "Acute Symptoms" ]	[ "Subjective" ]	mm-hmm and they	1,032
doctor: and they gave you a water pill and is that is that helping is that making you pee a lot patient: yeah yeah i have almost incontinence so	D2N035	13	[ "Therapeutic History", "Vegetative History" ]	[ "Subjective" ]	and they gave you a water pill and is that is that helping is that making you pee a lot	1,033
doctor: goodness patient: yes that's not very pleasant at all	D2N035	14	[ "Chitchat" ]	[ "Null" ]	goodness	1,034
doctor: and so they added another blood pressure medication also how are you doing with that are you feeling a little bit better patient: yeah i think so	D2N035	15	[ "Acute Symptoms", "Therapeutic History" ]	[ "Subjective" ]	and so they added another blood pressure medication also how are you doing with that are you feeling a little bit better	1,035
doctor: well a a pill box or maybe setting an alarm on your phone might really help patient: okay i'll i'll give that a try anything that will help	D2N035	18	[ "Discussion", "Medication" ]	[ "Subjective", "Plan" ]	well a a pill box or maybe setting an alarm on your phone might really help	1,036
doctor: yeah okay well that's good to hear so now have you bought a blood pressure cuff to have at home now patient: yes i already had one but i very failed if i ever used it	D2N035	19	[ "Discussion" ]	[ "Plan" ]	yeah okay well that's good to hear so now have you bought a blood pressure cuff to have at home now	1,037
doctor: okay and you might even just keep a log of what your blood pressures are and when it's up think about you know what you've eaten if you've done something different because that may help you to figure out what you need to cut back on or how you might need to change your your eating habits a little bit so patient: okay okay	D2N035	22	[ "Other Treatments" ]	[ "Plan" ]	okay and you might even just keep a log of what your blood pressures are and when it's up think about you know what you've eaten if you've done something different because that may help you to figure out what you need to cut back on or how you might need to change your your eating habits a little bit so	1,038
doctor: have you been short of breath or any problems sleeping since you've been home patient: no i've been sleeping like a log	D2N035	23	[ "Vegetative History" ]	[ "Subjective" ]	have you been short of breath or any problems sleeping since you've been home	1,039
doctor: okay good alright have you had any chest pain patient: no no chest pain	D2N035	24	[ "Acute Symptoms" ]	[ "Subjective" ]	okay good alright have you had any chest pain	1,040
doctor: okay alright well let's do a quick physical exam here so your vital signs your blood pressure looks pretty good today at one twenty eight over seventy two your temperature is ninety eight . seven and your heart rate is seventy two your respirations are eighteen your oxygen saturation looks pretty good at at ninety six percent okay now on your neck exam there is no jugular venous distention on your heart exam i appreciate a two over six systolic ejection murmur which i've heard before and so it's stable and your lungs are clear bilaterally and your lower extremities show just trace edema now now we since we did the echocardiogram i reviewed those results and it does show a preserved ef of fifty five percent abnormal diastolic filling and mild-to-moderate mitral regurgitation so let me tell you a little bit about my assessment and plan so for your first problem for your congestive heart failure it sounds like this was caused by dietary indiscretion and some uncontrolled hypertension so i want you to continue on your bumex two milligrams once daily continue to watch your diet and avoid salty foods might try keeping that log we talked about with your blood pressures and what you've eaten if if your blood pressure seems a little high also weigh yourself daily and call me if you gain three pounds in two days okay patient: okay	D2N035	25	[ "Physical Examination", "Follow-up", "Medication", "Other Treatments", "Radiology Examination", "Reassessment", "Acute Assessment" ]	[ "Objective", "Assessment", "Plan" ]	okay alright well let's do a quick physical exam here so your vital signs your blood pressure looks pretty good today at one twenty eight over seventy two your temperature is ninety eight . seven and your heart rate is seventy two your respirations are eighteen your oxygen saturation looks pretty good at at ninety six percent okay now on your neck exam there is no jugular venous distention on your heart exam i appreciate a two over six systolic ejection murmur which i've heard before and so it's stable and your lungs are clear bilaterally and your lower extremities show just trace edema now now we since we did the echocardiogram i reviewed those results and it does show a preserved ef of fifty five percent abnormal diastolic filling and mild-to-moderate mitral regurgitation so let me tell you a little bit about my assessment and plan so for your first problem for your congestive heart failure it sounds like this was caused by dietary indiscretion and some uncontrolled hypertension so i want you to continue on your bumex two milligrams once daily continue to watch your diet and avoid salty foods might try keeping that log we talked about with your blood pressures and what you've eaten if if your blood pressure seems a little high also weigh yourself daily and call me if you gain three pounds in two days okay	1,041
doctor: and i also want you to see a nutritionist to give you some education about what foods you can eat okay now for your second problem for i know this sounds like this is just for you and so for your second problem for your hypertension i want you to continue on the cozaar one hundred milligrams daily continue on the norvasc five milligrams once daily also and i'm going to order a renal artery ultrasound just to be sure we're not missing anything and then like maybe you know some renal artery stenosis or something and so so for your third problem for your kidney disease i wan na get some more labs to make sure you tolerate this the new medications and then i'll see you again in three months do you have any questions patient: no i do n't think so not today	D2N035	26	[ "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Reassessment" ]	[ "Assessment", "Plan" ]	and i also want you to see a nutritionist to give you some education about what foods you can eat okay now for your second problem for i know this sounds like this is just for you and so for your second problem for your hypertension i want you to continue on the cozaar one hundred milligrams daily continue on the norvasc five milligrams once daily also and i'm going to order a renal artery ultrasound just to be sure we're not missing anything and then like maybe you know some renal artery stenosis or something and so so for your third problem for your kidney disease i wan na get some more labs to make sure you tolerate this the new medications and then i'll see you again in three months do you have any questions	1,042
doctor: alright it's good to see you and i hope we'll just keep getting you feeling better patient: okay	D2N035	27	[ "Chitchat" ]	[ "Null" ]	alright it's good to see you and i hope we'll just keep getting you feeling better	1,043
doctor: hey george how are you today i understand you're here for some numbness and tingling in your fingers and some pain in your wrist patient: right my right wrist and hand has been bothering me probably for a few months now with pain and numbness	D2N036	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hey george how are you today i understand you're here for some numbness and tingling in your fingers and some pain in your wrist	1,044
doctor: okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or patient: it just kinda started on it's own it i notice it mostly at night	D2N036	1	[ "Acute Symptoms" ]	[ "Subjective" ]	okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or	1,045
doctor: what kind of work do you do patient: i do yard work	D2N036	3	[ "Other Socials" ]	[ "Subjective" ]	what kind of work do you do	1,046
doctor: yard work patient: landscaping landscaping	D2N036	4	[ "Chitchat" ]	[ "Null" ]	yard work	1,047
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	D2N036	5	[ "Personal History", "Other Socials" ]	[ "Subjective" ]	landscaping okay so a lot of raking a lot of digging so a lot of repetitive type movements	1,048
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	D2N036	6	[ "Acute Symptoms" ]	[ "Subjective" ]	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	1,049
doctor: okay okay and anything into that little into your fifth finger your little finger any numbness there at times no patient: sometimes yeah it seems like it's numb too	D2N036	7	[ "Acute Symptoms" ]	[ "Subjective" ]	okay okay and anything into that little into your fifth finger your little finger any numbness there at times no	1,050
doctor: okay what about your right hand any problems with that hand patient: no i do n't seem to have any problems with my right hand so far it's just mostly my left	D2N036	8	[ "Personal History" ]	[ "Subjective" ]	okay what about your right hand any problems with that hand	1,051
doctor: okay okay good and just a couple you know do you how do you have many or do you drink often do you have you know many any alcohol consumption patient: i drink usually a a beer or two on fridays and saturdays on the weekends	D2N036	9	[ "Drug History" ]	[ "Subjective" ]	okay okay good and just a couple you know do you how do you have many or do you drink often do you have you know many any alcohol consumption	1,052
doctor: okay and do you have any evidence of any anybody ever said that you had some rheumatoid arthritis in your hand or wrist anything like that patient: no nobody say anything like that so i mean	D2N036	10	[ "Personal History" ]	[ "Subjective" ]	okay and do you have any evidence of any anybody ever said that you had some rheumatoid arthritis in your hand or wrist anything like that	1,053
doctor: okay okay good so let me go ahead and do a physical exam here real quick and you know i'm gon na quickly just listen to your heart and lungs okay that's good i'd like you to squeeze i'm gon na hold your hands here and i'd like you to squeeze both hands patient: okay	D2N036	11	[ "Physical Examination" ]	[ "Objective" ]	okay okay good so let me go ahead and do a physical exam here real quick and you know i'm gon na quickly just listen to your heart and lungs okay that's good i'd like you to squeeze i'm gon na hold your hands here and i'd like you to squeeze both hands	1,054
doctor: you seem a little bit weaker on that left hand is that what you've noticed patient: yeah i i i experienced some weakness in my left hand	D2N036	12	[ "Physical Examination" ]	[ "Objective" ]	you seem a little bit weaker on that left hand is that what you've noticed	1,055
doctor: okay do you you find that you're dropping things when you're picking it up is it to that level or patient: yeah i drop things mostly because i have a hard time feeling it	D2N036	13	[ "Physical Examination" ]	[ "Objective" ]	okay do you you find that you're dropping things when you're picking it up is it to that level or	1,056
doctor: okay okay good and so you you do have a a grip strength is less on the left and i just wan na touch your fingers here on the on the right side you can feel me touching all the fingers on the right patient: yeah i can i can say you touch me but it feels a little more weird on the thumb side than my pointer finger side	D2N036	14	[ "Physical Examination" ]	[ "Objective" ]	okay okay good and so you you do have a a grip strength is less on the left and i just wan na touch your fingers here on the on the right side you can feel me touching all the fingers on the right	1,057
doctor: okay okay and i wan na turn your wrist over here and turn your hand over and i'm gon na go ahead and tap on the right wrist on the back here does that do anything when i do that patient: i still i feel a little jolt or a zing in my finger tips	D2N036	15	[ "Physical Examination" ]	[ "Objective" ]	okay okay and i wan na turn your wrist over here and turn your hand over and i'm gon na go ahead and tap on the right wrist on the back here does that do anything when i do that	1,058
doctor: okay and then when i do that on the left side patient: yeah same thing	D2N036	16	[ "Physical Examination" ]	[ "Objective" ]	okay and then when i do that on the left side	1,059
doctor: same thing okay so you do have a bilateral positive tinel's sign so so here's here's where i'm at i think your your diagnosis is beginning to have some bilateral carpal tunnel syndrome usually we see that with repetitive actions such as the landscaping the heavy labor and you you know your your clinical exam and and history sound like it's a carpal tunnel syndrome i do want to order so where are we gon na go from here i would like to order a a study it's called an emg where it it measures some of that electrical impulses down into your fingers we will follow up with that but as far as your treatment so the treatment for carpal tunnel syndrome is really some activity modification now i know you are a landscaper is there any way that you could be work to have some lighter work during the time patient: i suppose i could try to pass it off to some of my other employes and delegate	D2N036	17	[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment", "Other Treatments" ]	[ "Objective", "Assessment", "Plan" ]	same thing okay so you do have a bilateral positive tinel's sign so so here's here's where i'm at i think your your diagnosis is beginning to have some bilateral carpal tunnel syndrome usually we see that with repetitive actions such as the landscaping the heavy labor and you you know your your clinical exam and and history sound like it's a carpal tunnel syndrome i do want to order so where are we gon na go from here i would like to order a a study it's called an emg where it it measures some of that electrical impulses down into your fingers we will follow up with that but as far as your treatment so the treatment for carpal tunnel syndrome is really some activity modification now i know you are a landscaper is there any way that you could be work to have some lighter work during the time	1,060
doctor: okay that would be good so that's i i just want you to kinda eliminate that the active repetitive motions that you're doing all the time just for a couple weeks i'm also gon na give you a wrist splint to wear and that should help and i'd like you to take ibuprofen six hundred milligrams every six hours and then i wan na see you back here in the office in two weeks and in that two week period i think we're gon na see if there's need for any other intervention if i need to do more diagnostic testing or if there is a possibly looking at a surgical intervention to release that pressure that's on the nerves in that hand does that sound like a a good plan for you patient: yeah it sounds like a good first start	D2N036	18	[ "Discussion", "Diagnostic Testing", "Follow-up", "Other Treatments", "Medication" ]	[ "Plan" ]	okay that would be good so that's i i just want you to kinda eliminate that the active repetitive motions that you're doing all the time just for a couple weeks i'm also gon na give you a wrist splint to wear and that should help and i'd like you to take ibuprofen six hundred milligrams every six hours and then i wan na see you back here in the office in two weeks and in that two week period i think we're gon na see if there's need for any other intervention if i need to do more diagnostic testing or if there is a possibly looking at a surgical intervention to release that pressure that's on the nerves in that hand does that sound like a a good plan for you	1,061
doctor: okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do patient: mostly like yard work and maintenance flower beds not really designing just up keep	D2N036	19	[ "Chitchat" ]	[ "Null" ]	okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do	1,062
doctor: okay yeah i'm looking for a landscape designer i need somebody to put in some elaborate walkways back through the backyard so yeah we can do stuff like that i mean if you have an idea what you want i think that's easy patient: okay you know if you're looking for like some backyard elasis rehab remodel that's i mean i suppose we could do we have n't done things like that in a while because we're busy enough with just the up key but it's something to explore	D2N036	20	[ "Chitchat" ]	[ "Null" ]	okay yeah i'm looking for a landscape designer i need somebody to put in some elaborate walkways back through the backyard so yeah we can do stuff like that i mean if you have an idea what you want i think that's easy	1,063
doctor: okay yeah i may have to keep that in mind because i do wan na do some of that so let's listen i'm gon na get my my nurse in here to discharge you do you have any other questions for me before we end this patient: no i think it's all clear i appreciate it	D2N036	21	[ "Discussion" ]	[ "Plan" ]	okay yeah i may have to keep that in mind because i do wan na do some of that so let's listen i'm gon na get my my nurse in here to discharge you do you have any other questions for me before we end this	1,064
doctor: okay take care and i'll look forward to see you in two weeks patient: very good appreciate your time	D2N036	22	[ "Chitchat" ]	[ "Null" ]	okay take care and i'll look forward to see you in two weeks	1,065
doctor: hey dylan what's going on patient: so i lift quite a bit of weights i try to stay in shape as much as i can i'm not like normal people i lift heavy weights and my elbow is extremely sore	D2N037	0	[ "Acute Symptoms", "Greetings" ]	[ "Subjective" ]	hey dylan what's going on	1,066
doctor: which elbow is it patient: actually it's both my elbows but my right elbow is hurting me the most	D2N037	1	[ "Acute Symptoms" ]	[ "Subjective" ]	which elbow is it	1,067
doctor: okay and you said you lift a lot of weights patient: mm-hmm	D2N037	2	[ "Other Socials" ]	[ "Subjective" ]	okay and you said you lift a lot of weights	1,068
doctor: did you play any sports when you were younger patient: no anything you can think of primarily it was basketball baseball and football	D2N037	3	[ "Other Socials" ]	[ "Subjective" ]	did you play any sports when you were younger	1,069
doctor: okay and did your elbows hurt at that time or is this a a new injury patient: it's new	D2N037	4	[ "Personal History" ]	[ "Subjective" ]	okay and did your elbows hurt at that time or is this a a new injury	1,070
doctor: when did it start patient: probably year and a half ago	D2N037	5	[ "Personal History" ]	[ "Subjective" ]	when did it start	1,071
doctor: okay on both elbows about a year and a half ago patient: yeah	D2N037	6	[ "Personal History" ]	[ "Subjective" ]	okay on both elbows about a year and a half ago	1,072
doctor: okay have you taken anything for the pain patient: ibuprofen eight hundred milligrams three times a day	D2N037	7	[ "Therapeutic History" ]	[ "Subjective" ]	okay have you taken anything for the pain	1,073
doctor: okay and does anything make it better or worse patient: the more i use my hands or my arms the more it hurts	D2N037	8	[ "Therapeutic History" ]	[ "Subjective" ]	okay and does anything make it better or worse	1,074
doctor: okay have you tried icing patient: yes	D2N037	9	[ "Therapeutic History" ]	[ "Subjective" ]	okay have you tried icing	1,075
doctor: does that give you any relief patient: no	D2N037	10	[ "Therapeutic History" ]	[ "Subjective" ]	does that give you any relief	1,076
doctor: alright is it the inside or outside of your elbows patient: inside	D2N037	11	[ "Acute Symptoms" ]	[ "Subjective" ]	alright is it the inside or outside of your elbows	1,077
doctor: inside okay let's just do a quick physical exam here i'll take a look at your right elbow first patient: mm-hmm	D2N037	12	[ "Physical Examination" ]	[ "Objective" ]	inside okay let's just do a quick physical exam here i'll take a look at your right elbow first	1,078
doctor: if i bend it this way up does it hurt it's your left does that hurt patient: yes	D2N037	13	[ "Physical Examination" ]	[ "Objective" ]	if i bend it this way up does it hurt it's your left does that hurt	1,079
doctor: how about this patient: yes	D2N037	14	[ "Physical Examination" ]	[ "Objective" ]	how about this	1,080
doctor: okay so pain with both flexion and extension patient: mm-hmm	D2N037	15	[ "Physical Examination" ]	[ "Objective" ]	okay so pain with both flexion and extension	1,081
doctor: looks like you have little bit of limited range of motion on extension not on flexion though you said it hurts right here on the inside of your elbow patient: yes	D2N037	16	[ "Physical Examination" ]	[ "Objective" ]	looks like you have little bit of limited range of motion on extension not on flexion though you said it hurts right here on the inside of your elbow	1,082
doctor: okay so pain on the medial side with palpation patient: yes	D2N037	17	[ "Physical Examination" ]	[ "Objective" ]	okay so pain on the medial side with palpation	1,083
doctor: alright how about the outside patient: no	D2N037	18	[ "Physical Examination" ]	[ "Objective" ]	alright how about the outside	1,084
doctor: no pain with palpation outside of the elbow you have do you have normal sensation in your fingers patient: i think so	D2N037	19	[ "Physical Examination" ]	[ "Objective" ]	no pain with palpation outside of the elbow you have do you have normal sensation in your fingers	1,085
doctor: okay great patient: good to go	D2N037	21	[ "Chitchat" ]	[ "Null" ]	okay great	1,086
doctor: sensation is normal to the touch patient: yes	D2N037	22	[ "Physical Examination" ]	[ "Objective" ]	sensation is normal to the touch	1,087
doctor: pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt patient: not as much	D2N037	23	[ "Physical Examination" ]	[ "Objective" ]	pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt	1,088
doctor: how about this way patient: not as much	D2N037	24	[ "Physical Examination" ]	[ "Objective" ]	how about this way	1,089
doctor: alright so little bit of pain on flexion and extension little bit of limited range of motion on extension of the arm how about if you twist like you're opening a door patient: yes	D2N037	25	[ "Physical Examination" ]	[ "Objective" ]	alright so little bit of pain on flexion and extension little bit of limited range of motion on extension of the arm how about if you twist like you're opening a door	1,090
doctor: okay so some pain with torsion and twisting supination what about pronation patient: no	D2N037	26	[ "Physical Examination" ]	[ "Objective" ]	okay so some pain with torsion and twisting supination what about pronation	1,091
doctor: no pain with pronation on the right side patient: mm-hmm	D2N037	27	[ "Physical Examination" ]	[ "Objective" ]	no pain with pronation on the right side	1,092
doctor: same thing on the left patient: yes	D2N037	28	[ "Physical Examination" ]	[ "Objective" ]	same thing on the left	1,093
doctor: pain with supination no pain with pronation patient: correct	D2N037	29	[ "Physical Examination" ]	[ "Objective" ]	pain with supination no pain with pronation	1,094
doctor: alright so dylan it took some x-rays coming in looks like you do n't have any any fractures or any bony misalignment which i expect with this kind of injury i do think that what you have is medial epicondylitis which is patient: is that golfer's elbow	D2N037	30	[ "Acute Assessment", "Radiology Examination" ]	[ "Objective", "Assessment" ]	alright so dylan it took some x-rays coming in looks like you do n't have any any fractures or any bony misalignment which i expect with this kind of injury i do think that what you have is medial epicondylitis which is	1,095
doctor: yes same thing have you been golfing a lot patient: well not in the past year and a half i've had this for a long time	D2N037	31	[ "Other Socials" ]	[ "Subjective" ]	yes same thing have you been golfing a lot	1,096
doctor: okay also known as pictures elbow patient: well i have n't been pitching either	D2N037	32	[ "Chitchat" ]	[ "Null" ]	okay also known as pictures elbow	1,097
doctor: hmmm well in any case what i'm gon na have to do is i'm gon na send you up for mri to take another look at this patient: mm-hmm	D2N037	33	[ "Diagnostic Testing" ]	[ "Plan" ]	hmmm well in any case what i'm gon na have to do is i'm gon na send you up for mri to take another look at this	1,098
doctor: that will be our next step so we'll get you scheduled for the mri probably get you in pretty quick here since we're a private practice patient: thank god	D2N037	34	[ "Diagnostic Testing" ]	[ "Plan" ]	that will be our next step so we'll get you scheduled for the mri probably get you in pretty quick here since we're a private practice	1,099

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

D2N033

14

[ "Physical Examination" ]

[ "Objective" ]

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

1,000

doctor: how about when i extend it patient: yeah that hurts

D2N033

15

[ "Physical Examination" ]

[ "Objective" ]

how about when i extend it

1,001

doctor: okay so little bit of limited range of motion as well as pain on both flexion and extension on the knee i'm gon na push on this a little bit looks like your mcmurray's test is negative just checking for a meniscus tear okay so let's talk a little bit about your plan what i am concerned about for your knee is it sounds like you have a torn or injured mcl i it's that inside tendon in your knee so i'm concerned about that since you're having trouble with weightbearing and you heard that pop so what i'm gon na do is i'm gon na put you in a straight leg brace and i'll prescribe some mobic you can start taking that as a a pain reliever and to try to get some of the swelling down i want you to ice your knee once an hour for about fifteen minutes but i'm also gon na send you out for an mri because we wan na make sure this is what happens see if there's any other damage to the knee does that sound good patient: yeah that sounds great thank you

D2N033

16

[ "Physical Examination", "Medication", "Other Treatments", "Diagnostic Testing", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

okay so little bit of limited range of motion as well as pain on both flexion and extension on the knee i'm gon na push on this a little bit looks like your mcmurray's test is negative just checking for a meniscus tear okay so let's talk a little bit about your plan what i am concerned about for your knee is it sounds like you have a torn or injured mcl i it's that inside tendon in your knee so i'm concerned about that since you're having trouble with weightbearing and you heard that pop so what i'm gon na do is i'm gon na put you in a straight leg brace and i'll prescribe some mobic you can start taking that as a a pain reliever and to try to get some of the swelling down i want you to ice your knee once an hour for about fifteen minutes but i'm also gon na send you out for an mri because we wan na make sure this is what happens see if there's any other damage to the knee does that sound good

1,002

doctor: yeah and then for your diabetes as long as you're here it sounds like you're managing that pretty well but i do wan na get a recheck on your hemoglobin a1c and then i'm also i'm going to get a refill on the metformin that you have been taking five hundred milligrams so you can keep taking that as well so do you have any other questions for me patient: no that's it thanks

D2N033

17

[ "Medication", "Therapeutic History", "Diagnostic Testing", "Reassessment" ]

[ "Subjective", "Assessment", "Plan" ]

yeah and then for your diabetes as long as you're here it sounds like you're managing that pretty well but i do wan na get a recheck on your hemoglobin a1c and then i'm also i'm going to get a refill on the metformin that you have been taking five hundred milligrams so you can keep taking that as well so do you have any other questions for me

1,003

doctor: alright well thank you hope that you feel better

D2N033

18

[ "Chitchat" ]

[ "Null" ]

doctor: alright well thank you hope that you feel better

1,004

doctor: hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so how you doing is it is it gotten any better patient: yeah yeah i've been having a lot of pain of my shoulder for the last three weeks now and it's not getting better

D2N034

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hey alan i good to see you today so i looked here my appointment notes and i see that you're coming in you had some shoulder pain left shoulder pain for the last three weeks so how you doing is it is it gotten any better

1,005

doctor: okay do you remember what you were doing when the pain first started patient: so i i was thinking that i i ca n't recall like falling on it injuring it getting hit

D2N034

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay do you remember what you were doing when the pain first started

1,006

doctor: okay so do you remember hitting it or anything like that patient: no nothing at all

D2N034

3

[ "Acute Symptoms" ]

[ "Subjective" ]

okay so do you remember hitting it or anything like that

1,007

doctor: okay alright did you fall do you remember doing that patient: no

D2N034

4

[ "Acute Symptoms" ]

[ "Subjective" ]

okay alright did you fall do you remember doing that

1,008

doctor: okay hmmm so like a little mystery so have you had pain in that shoulder before patient: i mean i'm very active so i can get pains in my shoulders but it's nothing that sometime some tylenol can help

D2N034

5

[ "Personal History" ]

[ "Subjective" ]

okay hmmm so like a little mystery so have you had pain in that shoulder before

1,009

doctor: okay and are you able to move the arm or is it kinda just stuck patient: i'm having a lot of pain like i can move it but you know when i try to reach for something lifting anything and even like i do n't even try to put my hands over my head because it causes so much pain

D2N034

6

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and are you able to move the arm or is it kinda just stuck

1,010

doctor: alright so does that pain radiate anywhere or like where would you say it is in your shoulder patient: it actually it stays pretty much just right at the shoulder it does n't go down anywhere

D2N034

7

[ "Acute Symptoms" ]

[ "Subjective" ]

alright so does that pain radiate anywhere or like where would you say it is in your shoulder

1,011

doctor: okay and the pain is it is it all the time or does it come and go patient: it's pretty much all the time anytime i put any pressure on it like when i'm trying to sleep it hurts even more so it's been affecting my sleep as well

D2N034

8

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and the pain is it is it all the time or does it come and go

1,012

doctor: okay so i know you mentioned tylenol patient: so this time i have n't taken anything for it

D2N034

9

[ "Therapeutic History" ]

[ "Subjective" ]

okay so i know you mentioned tylenol

1,013

doctor: okay did you try icing it at all patient: i iced it initially but i have n't iced it at all recently

D2N034

11

[ "Acute Symptoms" ]

[ "Subjective" ]

okay did you try icing it at all

1,014

doctor: alright and so with your shoulder have you experienced any numbness in your arm or in your fingers patient: no numbness or tingling

D2N034

12

[ "Physical Examination" ]

[ "Objective" ]

alright and so with your shoulder have you experienced any numbness in your arm or in your fingers

1,015

doctor: okay good so i'm gon na go ahead and do a quick physical exam and take a look at your your shoulder so i reviewed your your vitals everything looks good with that so touch here in your shoulder so your left shoulder exam you have limited active and passive range of motion so pressure here so that there is tenderness of the greater patient: okay

D2N034

13

[ "Physical Examination" ]

[ "Objective" ]

okay good so i'm gon na go ahead and do a quick physical exam and take a look at your your shoulder so i reviewed your your vitals everything looks good with that so touch here in your shoulder so your left shoulder exam you have limited active and passive range of motion so pressure here so that there is tenderness of the greater

1,016

doctor: tuberosity of the humerus let's see there is no tenderness at the sternoclavicular or acro patient: yeah

D2N034

14

[ "Physical Examination" ]

[ "Objective" ]

tuberosity of the humerus let's see there is no tenderness at the sternoclavicular or acro

1,017

doctor: acromioclavicular joints patient: yeah

D2N034

15

[ "Physical Examination" ]

[ "Objective" ]

acromioclavicular joints

1,018

doctor: yeah and looks like you have good hand grip let me see so on the neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is is intact to light touch patient: yes thank you

D2N034

16

[ "Discussion", "Diagnostic Testing", "Acute Assessment", "Referral", "Radiology Examination" ]

[ "Objective", "Assessment", "Plan" ]

yeah and looks like you have good hand grip let me see so on the neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is is intact to light touch

1,019

doctor: yep so you did get a we get we had to get a x-ray of your shoulder before you came in and so it's normal so that's really good so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you you do have that left shoulder pain so your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured tendon you have injured tendons and muscles that make up your shoulder and make up your shoulder muscles so what i'm gon na do is i'm gon na order an mri of your left shoulder and so we're gon na begin with that just to make sure nothing else is going on have you done physical therapy before patient: i have n't

D2N034

17

[ "Discussion", "Referral", "Medication" ]

[ "Plan" ]

yep so you did get a we get we had to get a x-ray of your shoulder before you came in and so it's normal so that's really good so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you you do have that left shoulder pain so your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured tendon you have injured tendons and muscles that make up your shoulder and make up your shoulder muscles so what i'm gon na do is i'm gon na order an mri of your left shoulder and so we're gon na begin with that just to make sure nothing else is going on have you done physical therapy before

1,020

doctor: okay so what i'm gon na do i'm going to refer you to physical therapy for approximately six to eight weeks and so they can help you strengthen those muscles around your shoulder and that should definitely help with the pain during that time you can also continue to take tylenol i do n't think i need to prescribe anything else for the pain you said as it's working pretty good for you so if your symptoms do n't improve we can consider a steroid injection of your shoulder which should provide some relief but i think right now we can just go with the the pt and hopefully that works to alleviate your injury so do you have any questions about the plan patient: so like i said i'm really active do you think that this pain will ever go away

D2N034

18

[ "Discussion" ]

[ "Plan" ]

okay so what i'm gon na do i'm going to refer you to physical therapy for approximately six to eight weeks and so they can help you strengthen those muscles around your shoulder and that should definitely help with the pain during that time you can also continue to take tylenol i do n't think i need to prescribe anything else for the pain you said as it's working pretty good for you so if your symptoms do n't improve we can consider a steroid injection of your shoulder which should provide some relief but i think right now we can just go with the the pt and hopefully that works to alleviate your injury so do you have any questions about the plan

1,021

doctor: yeah so many patients are very successful with rehab and so we'll start with that and see how you do most most of the time once we build up those muscles around that shoulder you know things things the pain alleviates itself and and and you will be good to go back to working on your basement and running and jogging and lifting weights all all the active things people do these days patient: okay alright thank you

D2N034

19

[ "Chitchat" ]

[ "Null" ]

yeah so many patients are very successful with rehab and so we'll start with that and see how you do most most of the time once we build up those muscles around that shoulder you know things things the pain alleviates itself and and and you will be good to go back to working on your basement and running and jogging and lifting weights all all the active things people do these days

1,022

doctor: well hello christina so how are you doing i was notified you were in the hospital for some heart failure what happened patient: well i'm doing better now but i just started having problems that my ankles were swelling and could n't get them to go down even when i went to bed and could n't breathe very good had to get propped up in bed so i could breathe at night and so i just really got to feeling bad i called my friend diane and she said i probably ought to call nine one one since i was having a hard time talking and so i called nine one one and they sent out an ambulance and they took me into the er on the it was quite an experience

D2N035

0

[ "Personal History", "Greetings" ]

[ "Subjective" ]

well hello christina so how are you doing i was notified you were in the hospital for some heart failure what happened

1,023

doctor: i'm sure you do n't yeah i see that your blood pressure was high also it was two hundred over ninety have you been patient: yeah i guess is that really high

D2N035

2

[ "Personal History" ]

[ "Subjective" ]

i'm sure you do n't yeah i see that your blood pressure was high also it was two hundred over ninety have you been

1,024

doctor: yeah that's patient: i feel really bad

D2N035

3

[ "Chitchat" ]

[ "Null" ]

yeah that's

1,025

doctor: yeah that's pretty high are you taking your medications or you missing some doses patient: i do n't know i might miss one now but i try to take them all time

D2N035

4

[ "Therapeutic History" ]

[ "Subjective" ]

yeah that's pretty high are you taking your medications or you missing some doses

1,026

doctor: yeah yeah you really need to take them very consistently now you also said you were watching your diet did you did you have some slips with that you said your ankles were swelling patient: no i yeah i do i like to i like to eat

D2N035

5

[ "Personal History" ]

[ "Subjective" ]

yeah yeah you really need to take them very consistently now you also said you were watching your diet did you did you have some slips with that you said your ankles were swelling

1,027

doctor: are you eating a lot of salty foods and pizza or patient: i like potato chips

D2N035

6

[ "Vegetative History" ]

[ "Subjective" ]

are you eating a lot of salty foods and pizza or

1,028

doctor: well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or patient: that's home snacking i buy the the the the brand name salt and vinitive because brand wo n't taste real good but the the brand names really tastes good

D2N035

8

[ "Other Socials", "Vegetative History" ]

[ "Subjective" ]

well so do you do you go out to eat a lot or do you where you where where are you eating those potato chips or is that just the home snacking or

1,029

doctor: goodness well you know you we need to probably stop eating those now patient: yeah well i hate to hate to give those up but i guess i might have to

D2N035

10

[ "Other Treatments", "Vegetative History" ]

[ "Subjective", "Plan" ]

goodness well you know you we need to probably stop eating those now

1,030

doctor: well since you've been in the hospital and and they've helped you out with some with all that how are you feeling now patient: well i'm i'm doing better

D2N035

11

[ "Acute Symptoms" ]

[ "Subjective" ]

well since you've been in the hospital and and they've helped you out with some with all that how are you feeling now

1,031

doctor: mm-hmm and they patient: i do n't do n't have quite as much shortness of breath i think maybe getting up and walking a little more is helping

D2N035

12

[ "Acute Symptoms" ]

[ "Subjective" ]

mm-hmm and they

1,032

doctor: and they gave you a water pill and is that is that helping is that making you pee a lot patient: yeah yeah i have almost incontinence so

D2N035

13

[ "Therapeutic History", "Vegetative History" ]

[ "Subjective" ]

and they gave you a water pill and is that is that helping is that making you pee a lot

1,033

doctor: goodness patient: yes that's not very pleasant at all

D2N035

14

[ "Chitchat" ]

[ "Null" ]

goodness

1,034

doctor: and so they added another blood pressure medication also how are you doing with that are you feeling a little bit better patient: yeah i think so

D2N035

15

[ "Acute Symptoms", "Therapeutic History" ]

[ "Subjective" ]

and so they added another blood pressure medication also how are you doing with that are you feeling a little bit better

1,035

doctor: well a a pill box or maybe setting an alarm on your phone might really help patient: okay i'll i'll give that a try anything that will help

D2N035

18

[ "Discussion", "Medication" ]

[ "Subjective", "Plan" ]

well a a pill box or maybe setting an alarm on your phone might really help

1,036

doctor: yeah okay well that's good to hear so now have you bought a blood pressure cuff to have at home now patient: yes i already had one but i very failed if i ever used it

D2N035

19

[ "Discussion" ]

[ "Plan" ]

yeah okay well that's good to hear so now have you bought a blood pressure cuff to have at home now

1,037

doctor: okay and you might even just keep a log of what your blood pressures are and when it's up think about you know what you've eaten if you've done something different because that may help you to figure out what you need to cut back on or how you might need to change your your eating habits a little bit so patient: okay okay

D2N035

22

[ "Other Treatments" ]

[ "Plan" ]

okay and you might even just keep a log of what your blood pressures are and when it's up think about you know what you've eaten if you've done something different because that may help you to figure out what you need to cut back on or how you might need to change your your eating habits a little bit so

1,038

doctor: have you been short of breath or any problems sleeping since you've been home patient: no i've been sleeping like a log

D2N035

23

[ "Vegetative History" ]

[ "Subjective" ]

have you been short of breath or any problems sleeping since you've been home

1,039

doctor: okay good alright have you had any chest pain patient: no no chest pain

D2N035

24

[ "Acute Symptoms" ]

[ "Subjective" ]

okay good alright have you had any chest pain

1,040

doctor: okay alright well let's do a quick physical exam here so your vital signs your blood pressure looks pretty good today at one twenty eight over seventy two your temperature is ninety eight . seven and your heart rate is seventy two your respirations are eighteen your oxygen saturation looks pretty good at at ninety six percent okay now on your neck exam there is no jugular venous distention on your heart exam i appreciate a two over six systolic ejection murmur which i've heard before and so it's stable and your lungs are clear bilaterally and your lower extremities show just trace edema now now we since we did the echocardiogram i reviewed those results and it does show a preserved ef of fifty five percent abnormal diastolic filling and mild-to-moderate mitral regurgitation so let me tell you a little bit about my assessment and plan so for your first problem for your congestive heart failure it sounds like this was caused by dietary indiscretion and some uncontrolled hypertension so i want you to continue on your bumex two milligrams once daily continue to watch your diet and avoid salty foods might try keeping that log we talked about with your blood pressures and what you've eaten if if your blood pressure seems a little high also weigh yourself daily and call me if you gain three pounds in two days okay patient: okay

D2N035

25

[ "Physical Examination", "Follow-up", "Medication", "Other Treatments", "Radiology Examination", "Reassessment", "Acute Assessment" ]

[ "Objective", "Assessment", "Plan" ]

okay alright well let's do a quick physical exam here so your vital signs your blood pressure looks pretty good today at one twenty eight over seventy two your temperature is ninety eight . seven and your heart rate is seventy two your respirations are eighteen your oxygen saturation looks pretty good at at ninety six percent okay now on your neck exam there is no jugular venous distention on your heart exam i appreciate a two over six systolic ejection murmur which i've heard before and so it's stable and your lungs are clear bilaterally and your lower extremities show just trace edema now now we since we did the echocardiogram i reviewed those results and it does show a preserved ef of fifty five percent abnormal diastolic filling and mild-to-moderate mitral regurgitation so let me tell you a little bit about my assessment and plan so for your first problem for your congestive heart failure it sounds like this was caused by dietary indiscretion and some uncontrolled hypertension so i want you to continue on your bumex two milligrams once daily continue to watch your diet and avoid salty foods might try keeping that log we talked about with your blood pressures and what you've eaten if if your blood pressure seems a little high also weigh yourself daily and call me if you gain three pounds in two days okay

1,041

doctor: and i also want you to see a nutritionist to give you some education about what foods you can eat okay now for your second problem for i know this sounds like this is just for you and so for your second problem for your hypertension i want you to continue on the cozaar one hundred milligrams daily continue on the norvasc five milligrams once daily also and i'm going to order a renal artery ultrasound just to be sure we're not missing anything and then like maybe you know some renal artery stenosis or something and so so for your third problem for your kidney disease i wan na get some more labs to make sure you tolerate this the new medications and then i'll see you again in three months do you have any questions patient: no i do n't think so not today

D2N035

26

[ "Follow-up", "Medication", "Other Treatments", "Diagnostic Testing", "Reassessment" ]

[ "Assessment", "Plan" ]

and i also want you to see a nutritionist to give you some education about what foods you can eat okay now for your second problem for i know this sounds like this is just for you and so for your second problem for your hypertension i want you to continue on the cozaar one hundred milligrams daily continue on the norvasc five milligrams once daily also and i'm going to order a renal artery ultrasound just to be sure we're not missing anything and then like maybe you know some renal artery stenosis or something and so so for your third problem for your kidney disease i wan na get some more labs to make sure you tolerate this the new medications and then i'll see you again in three months do you have any questions

1,042

doctor: alright it's good to see you and i hope we'll just keep getting you feeling better patient: okay

D2N035

27

[ "Chitchat" ]

[ "Null" ]

alright it's good to see you and i hope we'll just keep getting you feeling better

1,043

doctor: hey george how are you today i understand you're here for some numbness and tingling in your fingers and some pain in your wrist patient: right my right wrist and hand has been bothering me probably for a few months now with pain and numbness

D2N036

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hey george how are you today i understand you're here for some numbness and tingling in your fingers and some pain in your wrist

1,044

doctor: okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or patient: it just kinda started on it's own it i notice it mostly at night

D2N036

1

[ "Acute Symptoms" ]

[ "Subjective" ]

okay and you said that's been ongoing for several months do you know what caused this type of pain or is it just something that started slowly or

1,045

doctor: what kind of work do you do patient: i do yard work

D2N036

3

[ "Other Socials" ]

[ "Subjective" ]

what kind of work do you do

1,046

doctor: yard work patient: landscaping landscaping

D2N036

4

[ "Chitchat" ]

[ "Null" ]

yard work

1,047

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

D2N036

5

[ "Personal History", "Other Socials" ]

[ "Subjective" ]

landscaping okay so a lot of raking a lot of digging so a lot of repetitive type movements

1,048

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

D2N036

6

[ "Acute Symptoms" ]

[ "Subjective" ]

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

1,049

doctor: okay okay and anything into that little into your fifth finger your little finger any numbness there at times no patient: sometimes yeah it seems like it's numb too

D2N036

7

[ "Acute Symptoms" ]

[ "Subjective" ]

okay okay and anything into that little into your fifth finger your little finger any numbness there at times no

1,050

doctor: okay what about your right hand any problems with that hand patient: no i do n't seem to have any problems with my right hand so far it's just mostly my left

D2N036

8

[ "Personal History" ]

[ "Subjective" ]

okay what about your right hand any problems with that hand

1,051

doctor: okay okay good and just a couple you know do you how do you have many or do you drink often do you have you know many any alcohol consumption patient: i drink usually a a beer or two on fridays and saturdays on the weekends

D2N036

9

[ "Drug History" ]

[ "Subjective" ]

okay okay good and just a couple you know do you how do you have many or do you drink often do you have you know many any alcohol consumption

1,052

doctor: okay and do you have any evidence of any anybody ever said that you had some rheumatoid arthritis in your hand or wrist anything like that patient: no nobody say anything like that so i mean

D2N036

10

[ "Personal History" ]

[ "Subjective" ]

okay and do you have any evidence of any anybody ever said that you had some rheumatoid arthritis in your hand or wrist anything like that

1,053

doctor: okay okay good so let me go ahead and do a physical exam here real quick and you know i'm gon na quickly just listen to your heart and lungs okay that's good i'd like you to squeeze i'm gon na hold your hands here and i'd like you to squeeze both hands patient: okay

D2N036

11

[ "Physical Examination" ]

[ "Objective" ]

okay okay good so let me go ahead and do a physical exam here real quick and you know i'm gon na quickly just listen to your heart and lungs okay that's good i'd like you to squeeze i'm gon na hold your hands here and i'd like you to squeeze both hands

1,054

doctor: you seem a little bit weaker on that left hand is that what you've noticed patient: yeah i i i experienced some weakness in my left hand

D2N036

12

[ "Physical Examination" ]

[ "Objective" ]

you seem a little bit weaker on that left hand is that what you've noticed

1,055

doctor: okay do you you find that you're dropping things when you're picking it up is it to that level or patient: yeah i drop things mostly because i have a hard time feeling it

D2N036

13

[ "Physical Examination" ]

[ "Objective" ]

okay do you you find that you're dropping things when you're picking it up is it to that level or

1,056

doctor: okay okay good and so you you do have a a grip strength is less on the left and i just wan na touch your fingers here on the on the right side you can feel me touching all the fingers on the right patient: yeah i can i can say you touch me but it feels a little more weird on the thumb side than my pointer finger side

D2N036

14

[ "Physical Examination" ]

[ "Objective" ]

okay okay good and so you you do have a a grip strength is less on the left and i just wan na touch your fingers here on the on the right side you can feel me touching all the fingers on the right

1,057

doctor: okay okay and i wan na turn your wrist over here and turn your hand over and i'm gon na go ahead and tap on the right wrist on the back here does that do anything when i do that patient: i still i feel a little jolt or a zing in my finger tips

D2N036

15

[ "Physical Examination" ]

[ "Objective" ]

okay okay and i wan na turn your wrist over here and turn your hand over and i'm gon na go ahead and tap on the right wrist on the back here does that do anything when i do that

1,058

doctor: okay and then when i do that on the left side patient: yeah same thing

D2N036

16

[ "Physical Examination" ]

[ "Objective" ]

okay and then when i do that on the left side

1,059

doctor: same thing okay so you do have a bilateral positive tinel's sign so so here's here's where i'm at i think your your diagnosis is beginning to have some bilateral carpal tunnel syndrome usually we see that with repetitive actions such as the landscaping the heavy labor and you you know your your clinical exam and and history sound like it's a carpal tunnel syndrome i do want to order so where are we gon na go from here i would like to order a a study it's called an emg where it it measures some of that electrical impulses down into your fingers we will follow up with that but as far as your treatment so the treatment for carpal tunnel syndrome is really some activity modification now i know you are a landscaper is there any way that you could be work to have some lighter work during the time patient: i suppose i could try to pass it off to some of my other employes and delegate

D2N036

17

[ "Physical Examination", "Discussion", "Diagnostic Testing", "Acute Assessment", "Other Treatments" ]

[ "Objective", "Assessment", "Plan" ]

same thing okay so you do have a bilateral positive tinel's sign so so here's here's where i'm at i think your your diagnosis is beginning to have some bilateral carpal tunnel syndrome usually we see that with repetitive actions such as the landscaping the heavy labor and you you know your your clinical exam and and history sound like it's a carpal tunnel syndrome i do want to order so where are we gon na go from here i would like to order a a study it's called an emg where it it measures some of that electrical impulses down into your fingers we will follow up with that but as far as your treatment so the treatment for carpal tunnel syndrome is really some activity modification now i know you are a landscaper is there any way that you could be work to have some lighter work during the time

1,060

doctor: okay that would be good so that's i i just want you to kinda eliminate that the active repetitive motions that you're doing all the time just for a couple weeks i'm also gon na give you a wrist splint to wear and that should help and i'd like you to take ibuprofen six hundred milligrams every six hours and then i wan na see you back here in the office in two weeks and in that two week period i think we're gon na see if there's need for any other intervention if i need to do more diagnostic testing or if there is a possibly looking at a surgical intervention to release that pressure that's on the nerves in that hand does that sound like a a good plan for you patient: yeah it sounds like a good first start

D2N036

18

[ "Discussion", "Diagnostic Testing", "Follow-up", "Other Treatments", "Medication" ]

[ "Plan" ]

okay that would be good so that's i i just want you to kinda eliminate that the active repetitive motions that you're doing all the time just for a couple weeks i'm also gon na give you a wrist splint to wear and that should help and i'd like you to take ibuprofen six hundred milligrams every six hours and then i wan na see you back here in the office in two weeks and in that two week period i think we're gon na see if there's need for any other intervention if i need to do more diagnostic testing or if there is a possibly looking at a surgical intervention to release that pressure that's on the nerves in that hand does that sound like a a good plan for you

1,061

doctor: okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do patient: mostly like yard work and maintenance flower beds not really designing just up keep

D2N036

19

[ "Chitchat" ]

[ "Null" ]

okay okay so i i just just off off the record here what kind of what do what do you specialize in landscaping is your company do

1,062

doctor: okay yeah i'm looking for a landscape designer i need somebody to put in some elaborate walkways back through the backyard so yeah we can do stuff like that i mean if you have an idea what you want i think that's easy patient: okay you know if you're looking for like some backyard elasis rehab remodel that's i mean i suppose we could do we have n't done things like that in a while because we're busy enough with just the up key but it's something to explore

D2N036

20

[ "Chitchat" ]

[ "Null" ]

okay yeah i'm looking for a landscape designer i need somebody to put in some elaborate walkways back through the backyard so yeah we can do stuff like that i mean if you have an idea what you want i think that's easy

1,063

doctor: okay yeah i may have to keep that in mind because i do wan na do some of that so let's listen i'm gon na get my my nurse in here to discharge you do you have any other questions for me before we end this patient: no i think it's all clear i appreciate it

D2N036

21

[ "Discussion" ]

[ "Plan" ]

okay yeah i may have to keep that in mind because i do wan na do some of that so let's listen i'm gon na get my my nurse in here to discharge you do you have any other questions for me before we end this

1,064

doctor: okay take care and i'll look forward to see you in two weeks patient: very good appreciate your time

D2N036

22

[ "Chitchat" ]

[ "Null" ]

okay take care and i'll look forward to see you in two weeks

1,065

doctor: hey dylan what's going on patient: so i lift quite a bit of weights i try to stay in shape as much as i can i'm not like normal people i lift heavy weights and my elbow is extremely sore

D2N037

0

[ "Acute Symptoms", "Greetings" ]

[ "Subjective" ]

hey dylan what's going on

1,066

doctor: which elbow is it patient: actually it's both my elbows but my right elbow is hurting me the most

D2N037

1

[ "Acute Symptoms" ]

[ "Subjective" ]

which elbow is it

1,067

doctor: okay and you said you lift a lot of weights patient: mm-hmm

D2N037

2

[ "Other Socials" ]

[ "Subjective" ]

okay and you said you lift a lot of weights

1,068

doctor: did you play any sports when you were younger patient: no anything you can think of primarily it was basketball baseball and football

D2N037

3

[ "Other Socials" ]

[ "Subjective" ]

did you play any sports when you were younger

1,069

doctor: okay and did your elbows hurt at that time or is this a a new injury patient: it's new

D2N037

4

[ "Personal History" ]

[ "Subjective" ]

okay and did your elbows hurt at that time or is this a a new injury

1,070

doctor: when did it start patient: probably year and a half ago

D2N037

5

[ "Personal History" ]

[ "Subjective" ]

when did it start

1,071

doctor: okay on both elbows about a year and a half ago patient: yeah

D2N037

6

[ "Personal History" ]

[ "Subjective" ]

okay on both elbows about a year and a half ago

1,072

doctor: okay have you taken anything for the pain patient: ibuprofen eight hundred milligrams three times a day

D2N037

7

[ "Therapeutic History" ]

[ "Subjective" ]

okay have you taken anything for the pain

1,073

doctor: okay and does anything make it better or worse patient: the more i use my hands or my arms the more it hurts

D2N037

8

[ "Therapeutic History" ]

[ "Subjective" ]

okay and does anything make it better or worse

1,074

doctor: okay have you tried icing patient: yes

D2N037

9

[ "Therapeutic History" ]

[ "Subjective" ]

okay have you tried icing

1,075

doctor: does that give you any relief patient: no

D2N037

10

[ "Therapeutic History" ]

[ "Subjective" ]

does that give you any relief

1,076

doctor: alright is it the inside or outside of your elbows patient: inside

D2N037

11

[ "Acute Symptoms" ]

[ "Subjective" ]

alright is it the inside or outside of your elbows

1,077

doctor: inside okay let's just do a quick physical exam here i'll take a look at your right elbow first patient: mm-hmm

D2N037

12

[ "Physical Examination" ]

[ "Objective" ]

inside okay let's just do a quick physical exam here i'll take a look at your right elbow first

1,078

doctor: if i bend it this way up does it hurt it's your left does that hurt patient: yes

D2N037

13

[ "Physical Examination" ]

[ "Objective" ]

if i bend it this way up does it hurt it's your left does that hurt

1,079

doctor: how about this patient: yes

D2N037

14

[ "Physical Examination" ]

[ "Objective" ]

how about this

1,080

doctor: okay so pain with both flexion and extension patient: mm-hmm

D2N037

15

[ "Physical Examination" ]

[ "Objective" ]

okay so pain with both flexion and extension

1,081

doctor: looks like you have little bit of limited range of motion on extension not on flexion though you said it hurts right here on the inside of your elbow patient: yes

D2N037

16

[ "Physical Examination" ]

[ "Objective" ]

looks like you have little bit of limited range of motion on extension not on flexion though you said it hurts right here on the inside of your elbow

1,082

doctor: okay so pain on the medial side with palpation patient: yes

D2N037

17

[ "Physical Examination" ]

[ "Objective" ]

okay so pain on the medial side with palpation

1,083

doctor: alright how about the outside patient: no

D2N037

18

[ "Physical Examination" ]

[ "Objective" ]

alright how about the outside

1,084

doctor: no pain with palpation outside of the elbow you have do you have normal sensation in your fingers patient: i think so

D2N037

19

[ "Physical Examination" ]

[ "Objective" ]

no pain with palpation outside of the elbow you have do you have normal sensation in your fingers

1,085

doctor: okay great patient: good to go

D2N037

21

[ "Chitchat" ]

[ "Null" ]

okay great

1,086

doctor: sensation is normal to the touch patient: yes

D2N037

22

[ "Physical Examination" ]

[ "Objective" ]

sensation is normal to the touch

1,087

doctor: pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt patient: not as much

D2N037

23

[ "Physical Examination" ]

[ "Objective" ]

pulses equal in all extremities how about the left elbow same thing if i bend it this way does that hurt

1,088

doctor: how about this way patient: not as much

D2N037

24

[ "Physical Examination" ]

[ "Objective" ]

how about this way

1,089

doctor: alright so little bit of pain on flexion and extension little bit of limited range of motion on extension of the arm how about if you twist like you're opening a door patient: yes

D2N037

25

[ "Physical Examination" ]

[ "Objective" ]

alright so little bit of pain on flexion and extension little bit of limited range of motion on extension of the arm how about if you twist like you're opening a door

1,090

doctor: okay so some pain with torsion and twisting supination what about pronation patient: no

D2N037

26

[ "Physical Examination" ]

[ "Objective" ]

okay so some pain with torsion and twisting supination what about pronation

1,091

doctor: no pain with pronation on the right side patient: mm-hmm

D2N037

27

[ "Physical Examination" ]

[ "Objective" ]

no pain with pronation on the right side

1,092

doctor: same thing on the left patient: yes

D2N037

28

[ "Physical Examination" ]

[ "Objective" ]

same thing on the left

1,093

doctor: pain with supination no pain with pronation patient: correct

D2N037

29

[ "Physical Examination" ]

[ "Objective" ]

pain with supination no pain with pronation

1,094

doctor: alright so dylan it took some x-rays coming in looks like you do n't have any any fractures or any bony misalignment which i expect with this kind of injury i do think that what you have is medial epicondylitis which is patient: is that golfer's elbow

D2N037

30

[ "Acute Assessment", "Radiology Examination" ]

[ "Objective", "Assessment" ]

alright so dylan it took some x-rays coming in looks like you do n't have any any fractures or any bony misalignment which i expect with this kind of injury i do think that what you have is medial epicondylitis which is

1,095

doctor: yes same thing have you been golfing a lot patient: well not in the past year and a half i've had this for a long time

D2N037

31

[ "Other Socials" ]

[ "Subjective" ]

yes same thing have you been golfing a lot

1,096

doctor: okay also known as pictures elbow patient: well i have n't been pitching either

D2N037

32

[ "Chitchat" ]

[ "Null" ]

okay also known as pictures elbow

1,097

doctor: hmmm well in any case what i'm gon na have to do is i'm gon na send you up for mri to take another look at this patient: mm-hmm

D2N037

33

[ "Diagnostic Testing" ]

[ "Plan" ]

hmmm well in any case what i'm gon na have to do is i'm gon na send you up for mri to take another look at this

1,098

doctor: that will be our next step so we'll get you scheduled for the mri probably get you in pretty quick here since we're a private practice patient: thank god

D2N037

34

[ "Diagnostic Testing" ]

[ "Plan" ]

that will be our next step so we'll get you scheduled for the mri probably get you in pretty quick here since we're a private practice

1,099