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aci_bench_intent_annotated

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doctor: and you've lost a lot of the cartilage patient: oh
D2N057
23
[ "Acute Assessment" ]
[ "Assessment" ]
and you've lost a lot of the cartilage
1,500
doctor: and so you you've got some arthritis in there we we call this hallux rigidus and treatment for this to start off with we we put an insert in your shoe called an orthotic and we give you a little bit of anti-inflammatory medication or like a drug called meloxicam you only have to take it once a day patient: okay
D2N057
24
[ "Discussion", "Acute Assessment", "Other Treatments", "Medication" ]
[ "Assessment", "Plan" ]
and so you you've got some arthritis in there we we call this hallux rigidus and treatment for this to start off with we we put an insert in your shoe called an orthotic and we give you a little bit of anti-inflammatory medication or like a drug called meloxicam you only have to take it once a day
1,501
doctor: it's usually pretty well tolerated have you ever had any trouble with your stomach patient: no never never had any problems with my stomach i love the i love the mexican's food the hotter the better so i hope i never get a problem with my stomach
D2N057
25
[ "Personal History" ]
[ "Subjective" ]
it's usually pretty well tolerated have you ever had any trouble with your stomach
1,502
doctor: i hope you do n't either one of the things that we get concerned about with an anti-inflammatory like that is that it can irritate the stomach so if you do start to notice that you're getting heartburn or pain right there patient: yeah
D2N057
26
[ "Discussion" ]
[ "Plan" ]
i hope you do n't either one of the things that we get concerned about with an anti-inflammatory like that is that it can irritate the stomach so if you do start to notice that you're getting heartburn or pain right there
1,503
doctor: below your your sternum you would need to stop taking the medicine and give me a call patient: okay
D2N057
27
[ "Discussion" ]
[ "Plan" ]
below your your sternum you would need to stop taking the medicine and give me a call
1,504
doctor: and i wan na see you back in two weeks to see how you're doing with that if you're not seeing significant improvement then we may have to talk about doing things that are a little more invasive like doing a shot patient: okay
D2N057
29
[ "Follow-up", "Other Treatments" ]
[ "Plan" ]
and i wan na see you back in two weeks to see how you're doing with that if you're not seeing significant improvement then we may have to talk about doing things that are a little more invasive like doing a shot
1,505
doctor: or even surgery to clean out the joint sometimes patient: is that surgery
D2N057
30
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
or even surgery to clean out the joint sometimes
1,506
doctor: i have to patient: would that be
D2N057
31
[ "Discussion" ]
[ "Plan" ]
i have to
1,507
doctor: i'm sorry patient: would that be surgery clean out the joint
D2N057
32
[ "Discussion" ]
[ "Plan" ]
i'm sorry
1,508
doctor: yeah that would patient: okay
D2N057
33
[ "Discussion" ]
[ "Plan" ]
yeah that would
1,509
doctor: that would be surgery if if we went in and cleaned out the joint sometimes in really severe cases we even just have to fuse the big toe joint we put it in a position of optimal function and we fuse it there and then your pain goes away you lose some motion but you've already lost quite a bit of motion and and the pain goes away so that that surgery really is very effective but let's try to run from my knife a little bit longer patient: okay well you know i do n't think i'm gon na be able to do my work job i'm on my feet every day and i it's and and quite frankly it's fishing season so do you think you can give me a couple weeks off so i can get out and get some fishing done
D2N057
34
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
that would be surgery if if we went in and cleaned out the joint sometimes in really severe cases we even just have to fuse the big toe joint we put it in a position of optimal function and we fuse it there and then your pain goes away you lose some motion but you've already lost quite a bit of motion and and the pain goes away so that that surgery really is very effective but let's try to run from my knife a little bit longer
1,510
doctor: no i want you to be doing your regular activities i want to know how this because if i put you out of work can you come back in and say it feels better well is was it because of the treatment or because of the rest so no i want you to keep working i want you to do your regular activities and i really want you to put these orthotics to the test and this medicine to the test and we will see how you're doing in two weeks patient: okay where i really like catching blue going croppy so okay we'll we'll i'll i'll keep working then i'll find time to do that later
D2N057
35
[ "Discussion" ]
[ "Plan" ]
no i want you to be doing your regular activities i want to know how this because if i put you out of work can you come back in and say it feels better well is was it because of the treatment or because of the rest so no i want you to keep working i want you to do your regular activities and i really want you to put these orthotics to the test and this medicine to the test and we will see how you're doing in two weeks
1,511
doctor: very good we will see you in two weeks patient: okay thank you
D2N057
36
[ "Referral" ]
[ "Plan" ]
very good we will see you in two weeks
1,512
doctor: russell ramirez is a 45 -year-old male with past medical history significant for cad status post prior status post prior rca stent in twenty eighteen hypertension and diabetes mellitus who presents for hospital follow-up after an anterior stemi now status post drug-eluting stent and lad and newly reduced ejection fraction ejection fraction thirty five percent and moderate mitral regurgitation alright russell hi how are you doing today patient: hey document i i do n't know i'm doing alright i guess
D2N058
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
russell ramirez is a 45 -year-old male with past medical history significant for cad status post prior status post prior rca stent in twenty eighteen hypertension and diabetes mellitus who presents for hospital follow-up after an anterior stemi now status post drug-eluting stent and lad and newly reduced ejection fraction ejection fraction thirty five percent and moderate mitral regurgitation alright russell hi how are you doing today
1,513
doctor: just alright how's it patient: well
D2N058
1
[ "Chitchat" ]
[ "Null" ]
just alright how's it
1,514
doctor: how's it been since you've had your heart attack have you been have you been doing alright patient: no i've been seeing you for years since i had my last heart attack in two thousand eighteen but i've been doing pretty good i ca n't believe this happened again i mean i'm doing okay i guess i just feel tired every now and then and but overall i mean i guess i feel pretty well
D2N058
2
[ "Personal History" ]
[ "Subjective" ]
how's it been since you've had your heart attack have you been have you been doing alright
1,515
doctor: okay good were you able to enjoy the spring weather patient: yeah some i mean i'm hoping now that i've had my little procedure that i'll feel better and feel like getting back out and and maybe doing some walking there is some new trails here behind the rex center and maybe get out and walk those trails
D2N058
3
[ "Other Socials" ]
[ "Subjective" ]
okay good were you able to enjoy the spring weather
1,516
doctor: that will be fine i know you love walking the trails i know you like looking at the flowers because i think you you plant a lot of flowers as well do n't you especially around this time patient: yeah i do some gardening around the house
D2N058
4
[ "Other Socials" ]
[ "Subjective" ]
that will be fine i know you love walking the trails i know you like looking at the flowers because i think you you plant a lot of flowers as well do n't you especially around this time
1,517
doctor: okay well we'll we'll do what we can here to get you out and going doing all those fun activities again now tell me have you had any chest pain or any shortness of breath patient: no not really no chest pain or shortness of breath i've been doing some short walks right around the house so like around the block
D2N058
7
[ "Acute Symptoms" ]
[ "Subjective" ]
okay well we'll we'll do what we can here to get you out and going doing all those fun activities again now tell me have you had any chest pain or any shortness of breath
1,518
doctor: okay alright now tell me are you able to lay flat at night when you sleep or patient: well i mean i i never have truly laid flat on my back i've always slept with two pillows which is normal for me
D2N058
9
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright now tell me are you able to lay flat at night when you sleep or
1,519
doctor: okay good how about are your legs swelling up patient: nope i've always i always had skinny ankles like like i got dawn knots legs
D2N058
11
[ "Acute Symptoms" ]
[ "Subjective" ]
okay good how about are your legs swelling up
1,520
doctor: well that's cute were you able to afford your medications and are you taking them as prescribed patient: yeah i've been taking my medicine i got pretty good insurance there through the plant and and so the co-pay is n't too bad
D2N058
12
[ "Therapeutic History", "Other Socials" ]
[ "Subjective" ]
well that's cute were you able to afford your medications and are you taking them as prescribed
1,521
doctor: okay well very good i'm glad you're doing that good for you russell and and then please keep that up now tell me are you watching your salt intake and trying to change your diet patient: yeah so when i was in the hospital they said something about my way my heart pumps now
D2N058
14
[ "Personal History" ]
[ "Subjective" ]
okay well very good i'm glad you're doing that good for you russell and and then please keep that up now tell me are you watching your salt intake and trying to change your diet
1,522
doctor: mm-hmm patient: it it's it's a little low and i might keep fluid on my legs if i'm not careful
D2N058
15
[ "Vegetative History" ]
[ "Subjective" ]
mm-hmm
1,523
doctor: there is a lot of salt and pizza and you know and you're gon na have to be able to avoid all the other salty foods as well so and i know that's hard but it's very important for your heart to be able to function at it's best right and you wan na be able to get out and walk you know walk take those walks again at the park and then you know do your photography so in order to do that we're gon na have to really cut back on those okay patient: well
D2N058
17
[ "Other Treatments" ]
[ "Plan" ]
there is a lot of salt and pizza and you know and you're gon na have to be able to avoid all the other salty foods as well so and i know that's hard but it's very important for your heart to be able to function at it's best right and you wan na be able to get out and walk you know walk take those walks again at the park and then you know do your photography so in order to do that we're gon na have to really cut back on those okay
1,524
doctor: alright so why do n't we go ahead and do a quick physical exam on you here i just want to take a look at you your vital signs look good i'm glad to see you're tolerating the medication well i'm gon na go ahead and feel your neck here i do n't appreciate any jugular venous distention and there are no carotid bruits on your heart exam there is a three out of six six systolic ejection murmur it's heard at the left base but that's pretty much the same as last year so we'll continue to monitor that okay let me listen to your lungs here real quick russell your lungs are clear so good good and your extremities i do n't see any swelling or edema on your right radial artery the cath site there is clean and it's dry and intact and i do n't see any hematoma so that's good and there is a palpable rra pulse so russell i did review the results of your ekg which showed normal sinus rhythm good r wave progression and evolutionary changes which are anticipated so let's go ahead and talk about my assessment plan for you for your first diagnosis of coronary artery disease we are gon na have you continue your your aspirin eighty one milligrams daily and brilinta ninety milligrams twice daily and we're gon na have you continue on that high dose statin that atorvastatin you might call it lipitor eighty milligrams daily and then also continue on that toprol fifty milligrams daily okay and i'm also going to refer you to cardiac rehab so for you to get some education about your heart and also give you the confidence to get back exercising regularly now i know patients love the cardiac rehab program i think you will do well does that sound good to you patient: that sounds good document
D2N058
18
[ "Physical Examination", "Discussion", "Referral", "Medication", "Radiology Examination", "Reassessment" ]
[ "Objective", "Assessment", "Plan" ]
alright so why do n't we go ahead and do a quick physical exam on you here i just want to take a look at you your vital signs look good i'm glad to see you're tolerating the medication well i'm gon na go ahead and feel your neck here i do n't appreciate any jugular venous distention and there are no carotid bruits on your heart exam there is a three out of six six systolic ejection murmur it's heard at the left base but that's pretty much the same as last year so we'll continue to monitor that okay let me listen to your lungs here real quick russell your lungs are clear so good good and your extremities i do n't see any swelling or edema on your right radial artery the cath site there is clean and it's dry and intact and i do n't see any hematoma so that's good and there is a palpable rra pulse so russell i did review the results of your ekg which showed normal sinus rhythm good r wave progression and evolutionary changes which are anticipated so let's go ahead and talk about my assessment plan for you for your first diagnosis of coronary artery disease we are gon na have you continue your your aspirin eighty one milligrams daily and brilinta ninety milligrams twice daily and we're gon na have you continue on that high dose statin that atorvastatin you might call it lipitor eighty milligrams daily and then also continue on that toprol fifty milligrams daily okay and i'm also going to refer you to cardiac rehab so for you to get some education about your heart and also give you the confidence to get back exercising regularly now i know patients love the cardiac rehab program i think you will do well does that sound good to you
1,525
doctor: alright so for your second diagnosis here the newly reduced left ventricular dysfunction and moderate mitral regurgitation i think your pumping function will improve in time you know they got you to the lab quickly so i think that heart muscle is just stunned and you're very compliant you're very good with your medications and following through with those so i think it will recover so that said i want you to go ahead and continue continue your lisinopril twenty milligrams a day i do n't think you need a diuretic at this time but i do want to add aldactone twelve . five milligrams daily and then you'll need to get labs next week okay and then we're gon na repeat another echocardiogram echocardiocardiogram in about two months patient: okay
D2N058
19
[ "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
alright so for your second diagnosis here the newly reduced left ventricular dysfunction and moderate mitral regurgitation i think your pumping function will improve in time you know they got you to the lab quickly so i think that heart muscle is just stunned and you're very compliant you're very good with your medications and following through with those so i think it will recover so that said i want you to go ahead and continue continue your lisinopril twenty milligrams a day i do n't think you need a diuretic at this time but i do want to add aldactone twelve . five milligrams daily and then you'll need to get labs next week okay and then we're gon na repeat another echocardiogram echocardiocardiogram in about two months
1,526
doctor: okay and then for your hypertension your third diagnosis of hypertension i want your to take your blood pressure just like you would you know every so often and then because your blood pressures actually seem fine at this time so we will continue to monitor that and i think you will tolerate the aldactone well as well patient: alright sounds good document
D2N058
20
[ "Discussion", "Reassessment" ]
[ "Assessment", "Plan" ]
okay and then for your hypertension your third diagnosis of hypertension i want your to take your blood pressure just like you would you know every so often and then because your blood pressures actually seem fine at this time so we will continue to monitor that and i think you will tolerate the aldactone well as well
1,527
doctor: okay well you take care and you have a good evening patient: yeah you too
D2N058
21
[ "Chitchat" ]
[ "Null" ]
okay well you take care and you have a good evening
1,528
doctor: okay good morning patient: good morning thanks doctor doctor cooper i'm i'm you know i'm a little i'm sad to be in here but you know thanks for taking me in i appreciate it
D2N059
0
[ "Greetings" ]
[ "Subjective" ]
okay good morning
1,529
doctor: sure absolutely what can i help you with today patient: so you know i've been dealing with my asthma and like i tried to join sports but it's really kind of it's getting hard you know and i i i just wonder if there's something that can be done because i really do like playing water polo and then like i'm kind of a little bit worried i think my mood is getting a little a little worrisome and i i wanted to explore like what my options were
D2N059
1
[ "Discussion" ]
[ "Subjective" ]
sure absolutely what can i help you with today
1,530
doctor: okay let's talk about the asthma first so what inhaler are you using now patient: i have an albuterol inhaler
D2N059
2
[ "Therapeutic History" ]
[ "Subjective" ]
okay let's talk about the asthma first so what inhaler are you using now
1,531
doctor: okay and when when you're having trouble it's usually just around sports that is it keeping you up at night patient: so i do n't really like wake up at night a lot typically like it's sports like you know if i'm doing anything like crazy aerobic or like running or anything i do notice that if any if i'm around smoke i do start coughing a little bit but most of the time it's sports
D2N059
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and when when you're having trouble it's usually just around sports that is it keeping you up at night
1,532
doctor: okay and can you describe a little bit for me what happens patient: i start to yeah no so i start to feel like there is like some phlegm building up in my in my throat and i start coughing like my chest gets tight i start wheezing and i just have to sit down or else i'm gon na get like lightheaded too
D2N059
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and can you describe a little bit for me what happens
1,533
doctor: okay and then when you use your inhaler patient: mm-hmm
D2N059
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and then when you use your inhaler
1,534
doctor: does it does it alleviate the problem patient: so yeah it helps with that like phlegm feeling you know but i still i still have to sit down you know and like breathe and then the thing that i hate about that inhaler is i start getting like shaky is that supposed to be happening
D2N059
6
[ "Acute Symptoms" ]
[ "Subjective" ]
does it does it alleviate the problem
1,535
doctor: yes that is unfortunately normal and a side effect with the inhaler patient: okay
D2N059
7
[ "Acute Symptoms" ]
[ "Subjective" ]
yes that is unfortunately normal and a side effect with the inhaler
1,536
doctor: so you use you're using two puffs of the inhaler patient: mm-hmm
D2N059
8
[ "Therapeutic History" ]
[ "Subjective" ]
so you use you're using two puffs of the inhaler
1,537
doctor: for the symptoms patient: yes
D2N059
9
[ "Acute Symptoms" ]
[ "Subjective" ]
for the symptoms
1,538
doctor: and then you sit down and does it does it get better within about fifteen minutes or so patient: yeah yeah it does but you know i had to like step out of the the pool to make that happen i'm hoping that there is something else we can do
D2N059
10
[ "Acute Symptoms" ]
[ "Subjective" ]
and then you sit down and does it does it get better within about fifteen minutes or so
1,539
doctor: okay have you ever taken any daily medications for your asthma an inhaler or singulair or anything like that patient: no i i just use my inhaler whenever i have an attack
D2N059
11
[ "Therapeutic History" ]
[ "Subjective" ]
okay have you ever taken any daily medications for your asthma an inhaler or singulair or anything like that
1,540
doctor: okay so that's something we might wan na consider but how often is it happening patient: pretty much every time i do any kind of aerobic workout
D2N059
12
[ "Acute Symptoms" ]
[ "Subjective" ]
okay so that's something we might wan na consider but how often is it happening
1,541
doctor: okay and outside of physical activity you're not having any problems patient: yeah there's that part where like if i'm around somebody who has been smoking a lot or is currently smoking but i usually just step away i do n't even like to be around them you know that makes sense
D2N059
13
[ "Acute Symptoms", "Drug History" ]
[ "Subjective" ]
okay and outside of physical activity you're not having any problems
1,542
doctor: alright well we will look at that tell me about the mood issues you are having patient: yeah so one of the reasons i got into like trying to get into sports is like i feel like you know you you feel a lot more energized and a lot you know happier but like lately i've just been kinda stressed out you know like i have i have like sats that i need to study for i've got like all these ap classes you know there's just it i feel like there's a lot of pressure and you know like i get it but there are times where i'm just like really down and i i do n't really know what else i can do
D2N059
14
[ "Acute Symptoms" ]
[ "Subjective" ]
alright well we will look at that tell me about the mood issues you are having
1,543
doctor: okay that makes sense any any difficulty with focusing or you're having difficulty retaining information or is it more feeling sad not having motivation patient: so i think it's like a lot of sadness a lot of like you know i do n't really i kinda feel like you know i do n't really like want to do anything you know my friends will go out and i'll just be like i'd rather be at home i am really tired a lot too
D2N059
15
[ "Acute Symptoms" ]
[ "Subjective" ]
okay that makes sense any any difficulty with focusing or you're having difficulty retaining information or is it more feeling sad not having motivation
1,544
doctor: okay alright well let me let me go ahead and check you out patient: mm-hmm
D2N059
16
[ "Physical Examination" ]
[ "Objective" ]
okay alright well let me let me go ahead and check you out
1,545
doctor: and then we can talk a little bit more patient: okay
D2N059
17
[ "Chitchat" ]
[ "Null" ]
and then we can talk a little bit more
1,546
doctor: i'm gon na take a listen to your heart and lungs patient: mm-hmm
D2N059
18
[ "Physical Examination" ]
[ "Objective" ]
i'm gon na take a listen to your heart and lungs
1,547
doctor: and everything sounds good let me take a look at your eyes patient: mm-hmm
D2N059
19
[ "Physical Examination" ]
[ "Objective" ]
and everything sounds good let me take a look at your eyes
1,548
doctor: and in your ears everything looks okay have you had any problems with allergies you have seasonal allergies or anything like that patient: yeah i think so yeah
D2N059
20
[ "Physical Examination", "Personal History" ]
[ "Subjective", "Objective" ]
and in your ears everything looks okay have you had any problems with allergies you have seasonal allergies or anything like that
1,549
doctor: i do see just a little bit of fluid in the ears patient: mm-hmm
D2N059
21
[ "Acute Assessment" ]
[ "Assessment" ]
i do see just a little bit of fluid in the ears
1,550
doctor: and i'm gon na look in your mouth too patient: okay
D2N059
22
[ "Physical Examination" ]
[ "Objective" ]
and i'm gon na look in your mouth too
1,551
doctor: and throat looks fine no tonsils patient: mm-hmm
D2N059
23
[ "Acute Assessment" ]
[ "Assessment" ]
and throat looks fine no tonsils
1,552
doctor: lem me go ahead and have you lay back on the table and i'll take a listen to your stomach patient: okay
D2N059
24
[ "Physical Examination" ]
[ "Objective" ]
lem me go ahead and have you lay back on the table and i'll take a listen to your stomach
1,553
doctor: everything sounds okay i'm gon na feel around just to make sure everything feels normal patient: mm-hmm
D2N059
25
[ "Physical Examination" ]
[ "Objective" ]
everything sounds okay i'm gon na feel around just to make sure everything feels normal
1,554
doctor: everything feels fine and i'm gon na check reflexes and they're all normal patient: awesome
D2N059
26
[ "Physical Examination" ]
[ "Objective" ]
everything feels fine and i'm gon na check reflexes and they're all normal
1,555
doctor: it's really hard to do with actual patient so in terms of the asthma i think we could try a daily medication since it looks like you might be having a little bit of allergies maybe we can try some singulair mm-hmm and start with that once you are on that daily and you can continue to use the albuterol inhaler those side effects unfortunately you're right it's it's just one of the expected side effects with an albuterol inhaler i would recommend just what you're doing just sit down for a little bit after you take it and we will get you started on the singulair probably within about a month you should see a difference so i will have you come back in about six weeks and follow up and see how you're doing with that in terms of the mood is this new for you patient: yeah i think so like when i started this year
D2N059
27
[ "Follow-up", "Other Treatments", "Medication" ]
[ "Plan" ]
it's really hard to do with actual patient so in terms of the asthma i think we could try a daily medication since it looks like you might be having a little bit of allergies maybe we can try some singulair mm-hmm and start with that once you are on that daily and you can continue to use the albuterol inhaler those side effects unfortunately you're right it's it's just one of the expected side effects with an albuterol inhaler i would recommend just what you're doing just sit down for a little bit after you take it and we will get you started on the singulair probably within about a month you should see a difference so i will have you come back in about six weeks and follow up and see how you're doing with that in terms of the mood is this new for you
1,556
doctor: and it sounds like related to school expectations and the stress with saps and all of that patient: yeah
D2N059
28
[ "Discussion" ]
[ "Plan" ]
and it sounds like related to school expectations and the stress with saps and all of that
1,557
doctor: okay let's consider having you start seeing a therapist i think that would be a good place to start patient: mm-hmm
D2N059
29
[ "Referral" ]
[ "Plan" ]
okay let's consider having you start seeing a therapist i think that would be a good place to start
1,558
doctor: and we will do some screening questionnaires and and then follow up in a couple weeks on that too patient: okay
D2N059
30
[ "Diagnostic Testing", "Follow-up" ]
[ "Plan" ]
and we will do some screening questionnaires and and then follow up in a couple weeks on that too
1,559
doctor: alright sounds like a plan patient: okay thank you
D2N059
31
[ "Discussion" ]
[ "Plan" ]
alright sounds like a plan
1,560
doctor: hey jean how're you doing today patient: i'm doing alright aside from this foot pain that i have
D2N060
0
[ "Greetings" ]
[ "Subjective" ]
hey jean how're you doing today
1,561
doctor: so i see here that you looks like you hurt your left foot here where you were playing soccer can you tell me a little bit more about what happened patient: yeah so yeah i was playing in a soccer game yesterday and i was trying to steal the ball from another player and she ended up falling directly onto my right foot and i do n't know i i mean i was trying to get around her and my body ended up twisting around her and then i accidentally felt a pain in my foot
D2N060
1
[ "Acute Symptoms" ]
[ "Subjective" ]
so i see here that you looks like you hurt your left foot here where you were playing soccer can you tell me a little bit more about what happened
1,562
doctor: okay so have you ever hurt your left foot before patient: no i've had a lot of injuries in soccer but never injured this foot
D2N060
2
[ "Personal History" ]
[ "Subjective" ]
okay so have you ever hurt your left foot before
1,563
doctor: okay and then so after the fall and the entanglement with the other player were you able to continue playing patient: no i had to stop playing right away and actually being helped off the field
D2N060
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and then so after the fall and the entanglement with the other player were you able to continue playing
1,564
doctor: wow okay and what have you been doing for the the pain since then patient: so i've been keeping it elevated icing it the trainer wrapped it yesterday and taking ibuprofen as well
D2N060
4
[ "Therapeutic History" ]
[ "Subjective" ]
wow okay and what have you been doing for the the pain since then
1,565
doctor: okay alright so without any ibuprofen can you tell me what your pain level is patient: without ibuprofen i would say my pain is a three
D2N060
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright so without any ibuprofen can you tell me what your pain level is
1,566
doctor: okay and then with your ibuprofen can you tell me what your pain level is patient: like a seven eight
D2N060
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and then with your ibuprofen can you tell me what your pain level is
1,567
doctor: okay so how long have you been playing soccer patient: really since i was like four five i've been playing a long time
D2N060
7
[ "Other Socials" ]
[ "Subjective" ]
okay so how long have you been playing soccer
1,568
doctor: well that's cool yeah we our our youngest daughter she is almost sixteen and she plays the inner marrial soccer league they are down at the rex center did is that where you started playing or did you guys did you start playing somewhere else patient: yeah just like this local town leak i started playing that way and then played all throughout school
D2N060
8
[ "Chitchat" ]
[ "Null" ]
well that's cool yeah we our our youngest daughter she is almost sixteen and she plays the inner marrial soccer league they are down at the rex center did is that where you started playing or did you guys did you start playing somewhere else
1,569
doctor: that's patient: high school teams
D2N060
9
[ "Chitchat" ]
[ "Null" ]
that's
1,570
doctor: that's awesome so just out of curiosity with the left foot have you experienced anything like numbness or tingling or or any strange sensation patient: no i have not
D2N060
10
[ "Acute Symptoms" ]
[ "Subjective" ]
that's awesome so just out of curiosity with the left foot have you experienced anything like numbness or tingling or or any strange sensation
1,571
doctor: okay now if it's okay with you i would like to do a quick physical exam i reviewed your vitals and everything looks good blood pressure was one eighteen over seventy two heart rate was fifty eight respiratory rate was fourteen you are afebrile and you had an o2 saturation of ninety nine percent on room air on your heart exam your regular of rate and rhythm do n't appreciate any clicks rubs or murmurs no ectopic beats noted there on auscultation listening to your lungs lungs are clear and equal bilaterally so you're moving good air i'd like to do a focused foot exam on your left foot so i do see some bruising on the bottom of your foot and on the top of your foot as well now there is associated swelling and i do appreciate tenderness to palpation of your midfoot and you are positive for the piano key test on a neurovascular exam of your left foot you have a brisk capillary refill of less than three seconds dorsalis pedis pulse is intact and strong and you do have motor and sensation that it's intact to light touch now i would like to do a review of the diagnostic imaging that you had before you came in so i do notice a 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 so lem me talk to you a little bit about my assessment and plan now for for the first concern of right foot pain your right foot pain is due to a lisfranc fracture which is a fracture to one of your second metatarsal bones at the top of your foot where the metatarsals meet your cuboids now there are ligaments at the top of your foot so i'm gon na be ordering an mri to assess for injury to any of these ligaments now based on your exam and from what i'm seeing on your x-ray you're most likely going to need surgery of that foot now the surgery will place the bones back in their proper position and using plates and screws will hold them there while they heal and this is gon na allow those bones and ligaments to heal properly it is a day surgery and you will be able to go home the same day and then i'm going to have you follow up with me here in the clinic you'll be in a cast and you will need to use crutches and you will not be able to use that left foot for about six to eight weeks now after that six to eight weeks you will gradually start walking on your foot based on how you tolerate it and we'll see how you do at that point so i do believe you're gon na need surgery i i'm recommending this because there are significant complications to your foot if we do not do this poor bone and ligament healing can lead to losing the arch of your foot and you're becoming flat-footed you also have a high likelihood of developing arthritis in that foot so what i'm gon na do unfortunately you'll be out the rest of the season but we are gon na get you fixed up and ready for next season if you're okay with all of this i'm gon na have the nurse come in and get you started on your paperwork and then i will see you on monday morning and we will get your foot taken care of patient: alright thank you
D2N060
11
[ "Physical Examination", "Radiology Examination", "Acute Assessment", "Other Treatments" ]
[ "Objective", "Assessment", "Plan" ]
okay now if it's okay with you i would like to do a quick physical exam i reviewed your vitals and everything looks good blood pressure was one eighteen over seventy two heart rate was fifty eight respiratory rate was fourteen you are afebrile and you had an o2 saturation of ninety nine percent on room air on your heart exam your regular of rate and rhythm do n't appreciate any clicks rubs or murmurs no ectopic beats noted there on auscultation listening to your lungs lungs are clear and equal bilaterally so you're moving good air i'd like to do a focused foot exam on your left foot so i do see some bruising on the bottom of your foot and on the top of your foot as well now there is associated swelling and i do appreciate tenderness to palpation of your midfoot and you are positive for the piano key test on a neurovascular exam of your left foot you have a brisk capillary refill of less than three seconds dorsalis pedis pulse is intact and strong and you do have motor and sensation that it's intact to light touch now i would like to do a review of the diagnostic imaging that you had before you came in so i do notice a 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 so lem me talk to you a little bit about my assessment and plan now for for the first concern of right foot pain your right foot pain is due to a lisfranc fracture which is a fracture to one of your second metatarsal bones at the top of your foot where the metatarsals meet your cuboids now there are ligaments at the top of your foot so i'm gon na be ordering an mri to assess for injury to any of these ligaments now based on your exam and from what i'm seeing on your x-ray you're most likely going to need surgery of that foot now the surgery will place the bones back in their proper position and using plates and screws will hold them there while they heal and this is gon na allow those bones and ligaments to heal properly it is a day surgery and you will be able to go home the same day and then i'm going to have you follow up with me here in the clinic you'll be in a cast and you will need to use crutches and you will not be able to use that left foot for about six to eight weeks now after that six to eight weeks you will gradually start walking on your foot based on how you tolerate it and we'll see how you do at that point so i do believe you're gon na need surgery i i'm recommending this because there are significant complications to your foot if we do not do this poor bone and ligament healing can lead to losing the arch of your foot and you're becoming flat-footed you also have a high likelihood of developing arthritis in that foot so what i'm gon na do unfortunately you'll be out the rest of the season but we are gon na get you fixed up and ready for next season if you're okay with all of this i'm gon na have the nurse come in and get you started on your paperwork and then i will see you on monday morning and we will get your foot taken care of
1,572
doctor: you're welcome
D2N060
12
[ "Chitchat" ]
[ "Null" ]
doctor: you're welcome
1,573
doctor: hi virginia how're you today patient: i'm good thanks how are you
D2N061
0
[ "Greetings" ]
[ "Subjective" ]
hi virginia how're you today
1,574
doctor: good so you know you got that knee x-ray when you first came in but tell me a little bit about what happened patient: i was playing basketball and jerry ran into me and the inside of my knee hurts
D2N061
1
[ "Acute Symptoms" ]
[ "Subjective" ]
good so you know you got that knee x-ray when you first came in but tell me a little bit about what happened
1,575
doctor: okay did you fall to the ground or did you just kinda plant and he pushed and you went one way and your knee did n't patient: i did fall to the ground
D2N061
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay did you fall to the ground or did you just kinda plant and he pushed and you went one way and your knee did n't
1,576
doctor: you did fall to the ground okay and did you land on the kneecap i mean did it hurt a lot were you able to get up and continue on patient: i landed on my side i was not able to continue on
D2N061
3
[ "Acute Symptoms" ]
[ "Subjective" ]
you did fall to the ground okay and did you land on the kneecap i mean did it hurt a lot were you able to get up and continue on
1,577
doctor: okay so you get off the off the court is jerry a good player you just got ta ask that question patient: not really
D2N061
4
[ "Chitchat" ]
[ "Null" ]
okay so you get off the off the court is jerry a good player you just got ta ask that question
1,578
doctor: okay okay well you know i love basketball i'm a little short for the game but i absolutely love to watch basketball so it's really cool that you're out there playing it so tell me about a little bit about where it hurts patient: on the inside
D2N061
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay okay well you know i love basketball i'm a little short for the game but i absolutely love to watch basketball so it's really cool that you're out there playing it so tell me about a little bit about where it hurts
1,579
doctor: on the inside of it okay and after the injury did they do anything special for you or you know did you get ice on it right away or try anything patient: i had ice and an ace wrap
D2N061
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
on the inside of it okay and after the injury did they do anything special for you or you know did you get ice on it right away or try anything
1,580
doctor: you had ice and what patient: an ace wrap
D2N061
8
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
you had ice and what
1,581
doctor: and an ace wrap okay now how many days ago was this exactly patient: seven
D2N061
9
[ "Acute Symptoms" ]
[ "Subjective" ]
and an ace wrap okay now how many days ago was this exactly
1,582
doctor: seven days ago okay yeah your right knee still looks a little swollen for seven days ago so i'm gon na go ahead and now i also see that you're diabetic and that you take five hundred milligrams of metformin twice a day are you still you're still on that medication is that correct patient: correct
D2N061
10
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
seven days ago okay yeah your right knee still looks a little swollen for seven days ago so i'm gon na go ahead and now i also see that you're diabetic and that you take five hundred milligrams of metformin twice a day are you still you're still on that medication is that correct
1,583
doctor: and do you check your blood sugars every morning at home patient: every morning
D2N061
11
[ "Personal History" ]
[ "Subjective" ]
and do you check your blood sugars every morning at home
1,584
doctor: okay great and since this i'm the reason i'm asking all these questions i'm a little concerned about the inactivity with your your knee pain and you know how diabetes you need to be very you know active and and taking your medicine to keep that under control so you know may wan na continue to follow up with your pcp for that diabetes as we go through here and just watch your blood sugars extra as we go through that now i'm gon na go ahead and examine your your right knee and when i push on the outside does that hurt at all patient: no
D2N061
12
[ "Physical Examination" ]
[ "Objective" ]
okay great and since this i'm the reason i'm asking all these questions i'm a little concerned about the inactivity with your your knee pain and you know how diabetes you need to be very you know active and and taking your medicine to keep that under control so you know may wan na continue to follow up with your pcp for that diabetes as we go through here and just watch your blood sugars extra as we go through that now i'm gon na go ahead and examine your your right knee and when i push on the outside does that hurt at all
1,585
doctor: okay and when i push on this inside where it's a little swollen does that hurt patient: yes
D2N061
13
[ "Physical Examination" ]
[ "Objective" ]
okay and when i push on this inside where it's a little swollen does that hurt
1,586
doctor: yeah okay i'm just gon na ask a question did you hear or feel a pop in your knee when you were doing this patient: i did not no
D2N061
14
[ "Acute Symptoms" ]
[ "Subjective" ]
yeah okay i'm just gon na ask a question did you hear or feel a pop in your knee when you were doing this
1,587
doctor: you did not okay okay what are you doing for the pain today patient: some exercises ice and mobic
D2N061
15
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
you did not okay okay what are you doing for the pain today
1,588
doctor: okay okay so i'm gon na continue all of my exam when i go ahead and pull on your knee the first thing i'm looking at is i do see some ecchymosis and swelling on the inside of that right knee and when i push around that knee i can see that there is fluid in the knee a little bit of fluid in the knee we call that effusion so i can appreciate some of that effusion and that could be either fluid or blood at this point from the injury that you had now you do have pain with palpation on the medial aspect of that right knee and that's that's concerning for me when i'm gon na just i just wan na move your knee a little bit it does n't look like when i extend it and flex it that you have a full range of motion does it hurt a lot when i moved it back a little more than normal patient: yes it hurts
D2N061
16
[ "Physical Examination" ]
[ "Objective" ]
okay okay so i'm gon na continue all of my exam when i go ahead and pull on your knee the first thing i'm looking at is i do see some ecchymosis and swelling on the inside of that right knee and when i push around that knee i can see that there is fluid in the knee a little bit of fluid in the knee we call that effusion so i can appreciate some of that effusion and that could be either fluid or blood at this point from the injury that you had now you do have pain with palpation on the medial aspect of that right knee and that's that's concerning for me when i'm gon na just i just wan na move your knee a little bit it does n't look like when i extend it and flex it that you have a full range of motion does it hurt a lot when i moved it back a little more than normal
1,589
doctor: okay okay yeah so you do have some decreased range of motion in that right knee now i'm just gon na sit here and and lay you back and i'm gon na pull on your knee and twist your knee a little bit okay you currently there is a negative varus and valgus stress test that's really important so here's what i'm thinking for that right knee i think you have may have a medial collateral ligament strain from you know maybe the twisting motion be right before you fell to the ground i want you to continue to use an ace wrap i'm gon na give you a right knee brace we're gon na wear that for a few days and then i'm gon na send you to physical therapy so we can continue strengthening the muscles around the right knee now that x-ray as far as the x-ray results that x-ray that i did it this morning in the office the the bony alignment's in good position i do n't see any evidence of any fractures i do notice the the effusion around the right knee just a small amount of fluid but we're just gon na continue to watch that i'm gon na give you a prescription i'd like you to stop taking any of the nonsteroidals that you're taking the motrin or advil whichever one of those and i'm gon na give you meloxicam fifteen milligrams and i want you to take that daily for the pain and swelling i want you to just continue exercising with the the braces and everything on so if you can you can get out and do some light walking that'll be good and then again for your diabetes like i said just continue to watch those blood sugars daily and if you start to see any significant increase in them because of your loss of activity just reach out to your primary care physician now do you have any questions for me patient: when can i play basketball again
D2N061
17
[ "Physical Examination", "Discussion", "Medication", "Other Treatments", "Radiology Examination", "Referral", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay okay yeah so you do have some decreased range of motion in that right knee now i'm just gon na sit here and and lay you back and i'm gon na pull on your knee and twist your knee a little bit okay you currently there is a negative varus and valgus stress test that's really important so here's what i'm thinking for that right knee i think you have may have a medial collateral ligament strain from you know maybe the twisting motion be right before you fell to the ground i want you to continue to use an ace wrap i'm gon na give you a right knee brace we're gon na wear that for a few days and then i'm gon na send you to physical therapy so we can continue strengthening the muscles around the right knee now that x-ray as far as the x-ray results that x-ray that i did it this morning in the office the the bony alignment's in good position i do n't see any evidence of any fractures i do notice the the effusion around the right knee just a small amount of fluid but we're just gon na continue to watch that i'm gon na give you a prescription i'd like you to stop taking any of the nonsteroidals that you're taking the motrin or advil whichever one of those and i'm gon na give you meloxicam fifteen milligrams and i want you to take that daily for the pain and swelling i want you to just continue exercising with the the braces and everything on so if you can you can get out and do some light walking that'll be good and then again for your diabetes like i said just continue to watch those blood sugars daily and if you start to see any significant increase in them because of your loss of activity just reach out to your primary care physician now do you have any questions for me
1,590
doctor: yeah that's a great question i'm gon na ask well my first off i want to see you back here in in seven days you know in a week i want you to make an appointment we're gon na relook at it we're gon na determine if that swelling got any worse and if we need to go on to potentially ordering like a cat scan or an mri of that knee to look and see if there was any significant damage to the ligament so that's for for sure for seven days you're not gon na be playing basketball now are you in a ligue or is that just you get like pick up basketball patient: i just played the wife with fun
D2N061
18
[ "Discussion", "Follow-up", "Diagnostic Testing" ]
[ "Plan" ]
yeah that's a great question i'm gon na ask well my first off i want to see you back here in in seven days you know in a week i want you to make an appointment we're gon na relook at it we're gon na determine if that swelling got any worse and if we need to go on to potentially ordering like a cat scan or an mri of that knee to look and see if there was any significant damage to the ligament so that's for for sure for seven days you're not gon na be playing basketball now are you in a ligue or is that just you get like pick up basketball
1,591
doctor: okay okay good that's a great activity like i said i wish i could play now i i also know your your family do n't they own that sports store down right off a main street that sells a lot of sporting equipment patient: yeah they do
D2N061
19
[ "Chitchat" ]
[ "Null" ]
okay okay good that's a great activity like i said i wish i could play now i i also know your your family do n't they own that sports store down right off a main street that sells a lot of sporting equipment
1,592
doctor: okay i you know i'm i'm just thinking you know i need to get some new shoes for some of it my activities i love the i wish i could play basketball but i do a lot of bike riding so i'm always looking for anything that's gon na help me on the bike do you does your family have supplies like that patient: we do let me know and i can get you the hook up
D2N061
20
[ "Chitchat" ]
[ "Null" ]
okay i you know i'm i'm just thinking you know i need to get some new shoes for some of it my activities i love the i wish i could play basketball but i do a lot of bike riding so i'm always looking for anything that's gon na help me on the bike do you does your family have supplies like that
1,593
doctor: okay great great so i'll i i will let you know i'll just get on and take a look first but i'm gon na go ahead and get get you discharged i'll have my assistant come in we will get you discharged and like i said we will make an appointment for seven days and we will go from there any questions patient: i think you've answered them all thank you
D2N061
21
[ "Follow-up" ]
[ "Plan" ]
okay great great so i'll i i will let you know i'll just get on and take a look first but i'm gon na go ahead and get get you discharged i'll have my assistant come in we will get you discharged and like i said we will make an appointment for seven days and we will go from there any questions
1,594
doctor: okay great
D2N061
22
[ "Chitchat" ]
[ "Null" ]
doctor: okay great
1,595
doctor: okay raymond it looks like you've been having some difficulty swallowing over for a period of time could you tell me like what's going on patient: well i've been better for the last several weeks i've been noticing that it's been hard for me to swallow certain foods and i also have pain when i swallow down in my chest
D2N062
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
okay raymond it looks like you've been having some difficulty swallowing over for a period of time could you tell me like what's going on
1,596
doctor: okay and when does it does it happen every time you eat patient: it hurts not every time it hurts when i when i swallow most foods but it's really just the bigger pieces of food that seem like they're getting stuck
D2N062
1
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and when does it does it happen every time you eat
1,597
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
D2N062
2
[ "Personal History" ]
[ "Subjective" ]
okay and what do you mean by bigger pieces of food like what's your diet like
1,598
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
D2N062
3
[ "Other Socials" ]
[ "Subjective" ]
wow that sounds kinda stressful like what are you moving for
1,599