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doctor: okay and so does the pain move anywhere like your upper back your shoulder patient: no it just stays on monday
D2N115
12
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and so does the pain move anywhere like your upper back your shoulder
2,900
doctor: okay and then any kind of hearing any kind of hearing problems visual disturbances patient: no
D2N115
13
[ "Vegetative History" ]
[ "Subjective" ]
okay and then any kind of hearing any kind of hearing problems visual disturbances
2,901
doctor: okay have you do have you ever like played sports before or had like a sports accident before patient: yeah i played football
D2N115
14
[ "Personal History" ]
[ "Subjective" ]
okay have you do have you ever like played sports before or had like a sports accident before
2,902
doctor: okay and then when you got in the car accident did you end up going to the emergency room patient: no i mean i i know that going to the emergency room that like the english rides like five hundred bucks so i did n't want to do that
D2N115
16
[ "Personal History" ]
[ "Subjective" ]
okay and then when you got in the car accident did you end up going to the emergency room
2,903
doctor: i understand i understand okay was there any like swelling or bruising on your neck patient: not that i know about no other mag of my neck i really ca n't see that
D2N115
17
[ "Personal History" ]
[ "Subjective" ]
i understand i understand okay was there any like swelling or bruising on your neck
2,904
doctor: yeah okay no just checking okay so if you do n't mind i'm gon na go ahead and do my physical exam so when i press on here on the side of your neck does it hurt patient: yeah a little bit
D2N115
18
[ "Physical Examination" ]
[ "Objective" ]
yeah okay no just checking okay so if you do n't mind i'm gon na go ahead and do my physical exam so when i press on here on the side of your neck does it hurt
2,905
doctor: okay positive pain to palpation of the soft tissues of the neck what about when i press on your back or your shoulders patient: no that's fine
D2N115
19
[ "Physical Examination" ]
[ "Objective" ]
okay positive pain to palpation of the soft tissues of the neck what about when i press on your back or your shoulders
2,906
doctor: okay so when you flex your neck when you're touching your chin to your chest does that hurt patient: mm-hmm
D2N115
20
[ "Physical Examination" ]
[ "Objective" ]
okay so when you flex your neck when you're touching your chin to your chest does that hurt
2,907
doctor: alright positive pain with flexion what about when you move it back patient: yeah that hurts worse
D2N115
21
[ "Physical Examination" ]
[ "Objective" ]
alright positive pain with flexion what about when you move it back
2,908
doctor: okay okay severe positive pain to extension okay so can you turn your head from side to side does that hurt patient: yeah a little bit
D2N115
22
[ "Physical Examination" ]
[ "Objective" ]
okay okay severe positive pain to extension okay so can you turn your head from side to side does that hurt
2,909
doctor: okay positive pain with rotation and then can you touch your ear to your shoulders patient: no
D2N115
23
[ "Physical Examination" ]
[ "Objective" ]
okay positive pain with rotation and then can you touch your ear to your shoulders
2,910
doctor: okay alright so positive pain on lateral bending wow this is pretty this is pretty serious not serious necessarily sorry about that so i reviewed the results of your x-ray but the results show no signs of fracture or bony abnormalities but let's go ahead and talk about my assessment and plan for you i believe what you have is something called neck strain for your neck pain i sorry treatments we are gon na go ahead and treat this a bit conservatively your i'm gon na put you on anti-inflammatories motrin six hundred milligrams and you're gon na take that every six to eight hours i also wan na give you a muscle relaxant called flexeril and it's gon na be ten milligrams and you'll take that every twelve hours as needed i'm gon na want you to try your best to to like relax your neck i'm sorry not to strain your neck anymore like to be conservative with how you move about and everything like that i also wan na order an mri just because you said you did n't go to the hospital or anything like that i just wan na make sure that you you're not suffering from like a concussion but this is something that's commonly referred to as like whiplash right your head just like it it just wiped essentially like back and forth to so severely and and that's probably what's causing your pain i think i wan na refer you to either physical rehab or a chiropractor once we get the results of the mri just to make sure that there is n't any impingement of like the nerves or anything like that do you have any questions patient: i heard the chiropractors will shake they work
D2N115
24
[ "Discussion", "Referral", "Medication", "Diagnostic Testing", "Acute Assessment" ]
[ "Assessment", "Plan" ]
okay alright so positive pain on lateral bending wow this is pretty this is pretty serious not serious necessarily sorry about that so i reviewed the results of your x-ray but the results show no signs of fracture or bony abnormalities but let's go ahead and talk about my assessment and plan for you i believe what you have is something called neck strain for your neck pain i sorry treatments we are gon na go ahead and treat this a bit conservatively your i'm gon na put you on anti-inflammatories motrin six hundred milligrams and you're gon na take that every six to eight hours i also wan na give you a muscle relaxant called flexeril and it's gon na be ten milligrams and you'll take that every twelve hours as needed i'm gon na want you to try your best to to like relax your neck i'm sorry not to strain your neck anymore like to be conservative with how you move about and everything like that i also wan na order an mri just because you said you did n't go to the hospital or anything like that i just wan na make sure that you you're not suffering from like a concussion but this is something that's commonly referred to as like whiplash right your head just like it it just wiped essentially like back and forth to so severely and and that's probably what's causing your pain i think i wan na refer you to either physical rehab or a chiropractor once we get the results of the mri just to make sure that there is n't any impingement of like the nerves or anything like that do you have any questions
2,911
doctor: i do understand that some people have like reservations about going to the chiropractor but you know we do have some good ones that have like longstanding histories and patients that have had positive results from the experience but if you if you do n't like the idea of that we can consider other options like that rehab and physical therapy patient: okay
D2N115
25
[ "Discussion", "Referral" ]
[ "Plan" ]
i do understand that some people have like reservations about going to the chiropractor but you know we do have some good ones that have like longstanding histories and patients that have had positive results from the experience but if you if you do n't like the idea of that we can consider other options like that rehab and physical therapy
2,912
doctor: alright any other questions patient: no
D2N115
26
[ "Discussion" ]
[ "Plan" ]
alright any other questions
2,913
doctor: alright thank you
D2N115
27
[ "Chitchat" ]
[ "Null" ]
doctor: alright thank you
2,914
doctor: hey hi bobby how are you doing patient: i'm doing good how are you
D2N116
0
[ "Greetings" ]
[ "Subjective" ]
hey hi bobby how are you doing
2,915
doctor: i'm doing fine so i understand you're here having some left or some right shoulder pain that you've had for a few weeks now patient: yeah it was i was doing some work in my backyard and a lot of different projects going on and you know i was obviously sore all over the next couple of days but my my right shoulder just keeps on bothering me and it keeps it's just really sore and it just has n't been going away
D2N116
1
[ "Acute Symptoms" ]
[ "Subjective" ]
i'm doing fine so i understand you're here having some left or some right shoulder pain that you've had for a few weeks now
2,916
doctor: okay so have you had ever had any pain in that shoulder before patient: a little bit i you know i i hurt that same shoulder because it's my my dominant hand my right hand i hurt it playing baseball when i was younger
D2N116
2
[ "Personal History" ]
[ "Subjective" ]
okay so have you had ever had any pain in that shoulder before
2,917
doctor: mm-hmm patient: so i've always had a little bit issues but this is it's does n't feel like it's in the rotator cuff it's it's kinda more on the outside and it's kinda like it's more tender on the outside when i raise my arm up so
D2N116
3
[ "Personal History" ]
[ "Subjective" ]
mm-hmm
2,918
doctor: okay yeah are you able to move your arm very well or not patient: yeah there is no restriction with my arm it just i definitely feel some pain on the outside of it
D2N116
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay yeah are you able to move your arm very well or not
2,919
doctor: okay and are you having pain all the time or just or does it come and go patient: just whenever i move it if i'm sitting still i really do n't notice anything but whenever i move it then i can definitely feel some pain
D2N116
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and are you having pain all the time or just or does it come and go
2,920
doctor: okay how about at night is it bothering you at night also patient: a little bit because i sleep on that side so
D2N116
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay how about at night is it bothering you at night also
2,921
doctor: okay and i may miss did you say what have you been taking for pain for that patient: i just been taking some advil and then icing as much as i can so that's about it
D2N116
8
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay and i may miss did you say what have you been taking for pain for that
2,922
doctor: okay and does that seem to help or patient: a little bit yeah a little bit i mean it's it's still like you know sore to touch but it definitely dulls it a little bit
D2N116
9
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay and does that seem to help or
2,923
doctor: well sounds like you have quite a few projects going on what all what all are you doing for for your yard and patient: i well let's see i've been putting an outdoor shower in we're extending our patio putting making some flower boxes putting down some you know for stone and all the flower beds so my wife's really put me to work i got a laundry lift
D2N116
10
[ "Other Socials" ]
[ "Subjective" ]
well sounds like you have quite a few projects going on what all what all are you doing for for your yard and
2,924
doctor: wow it sounds like a variety of projects but if you're putting down stone you're probably lifting those as well and then patient: yeah
D2N116
11
[ "Other Socials" ]
[ "Subjective" ]
wow it sounds like a variety of projects but if you're putting down stone you're probably lifting those as well and then
2,925
doctor: yeah i bet that is sore now tell me this have you experienced any numbness in your arm or your hands or patient: no not really no numbness that i can think of
D2N116
12
[ "Vegetative History" ]
[ "Subjective" ]
yeah i bet that is sore now tell me this have you experienced any numbness in your arm or your hands or
2,926
doctor: okay alright so see i'm gon na i'd like to do just a quick physical exam and i've reviewed your vitals those look good your no fever so that's good you're ninety seven . eight and your heart rate looks good at sixty two respirations sixteen your blood pressures one sixteen over eighty four that looks fine your oxygen saturation is real good at ninety nine percent so that all looks good so let's take a look at your left at your right shoulder so you have limited active and passive range of motion and there is some tenderness at the great tuberosity of the humerus there is no tenderness at the sternoclavicular or acro acromioclavicular joints you do have a good hand grip okay and on neurovascular exam of your right arm your capillary refill is less than three seconds and your sensation to touch is intact so i've reviewed the results of your shoulder x-ray and there is no fracture so that's good so let me tell you a little bit about my assessment and plan so for your first problem the left shoulder pain your symptoms are most likely due to this rotator cuff rotator cuff tendinopathy that means you that you injured injured the tendons of the muscles that help make your shoulder muscles i think we had to go ahead and order just an mri since you have had some problems before as well to make sure there's nothing else going on with it and i also want to refer you to physical therapy for approximately six to eight weeks and so during that time continue the tylenol and if your symptoms do n't improve we can go ahead and consider a steroid injection of your shoulder which could provide some relief do you have any questions about your plan patient: no that sounds good
D2N116
13
[ "Physical Examination", "Discussion", "Medication", "Radiology Examination", "Referral", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay alright so see i'm gon na i'd like to do just a quick physical exam and i've reviewed your vitals those look good your no fever so that's good you're ninety seven . eight and your heart rate looks good at sixty two respirations sixteen your blood pressures one sixteen over eighty four that looks fine your oxygen saturation is real good at ninety nine percent so that all looks good so let's take a look at your left at your right shoulder so you have limited active and passive range of motion and there is some tenderness at the great tuberosity of the humerus there is no tenderness at the sternoclavicular or acro acromioclavicular joints you do have a good hand grip okay and on neurovascular exam of your right arm your capillary refill is less than three seconds and your sensation to touch is intact so i've reviewed the results of your shoulder x-ray and there is no fracture so that's good so let me tell you a little bit about my assessment and plan so for your first problem the left shoulder pain your symptoms are most likely due to this rotator cuff rotator cuff tendinopathy that means you that you injured injured the tendons of the muscles that help make your shoulder muscles i think we had to go ahead and order just an mri since you have had some problems before as well to make sure there's nothing else going on with it and i also want to refer you to physical therapy for approximately six to eight weeks and so during that time continue the tylenol and if your symptoms do n't improve we can go ahead and consider a steroid injection of your shoulder which could provide some relief do you have any questions about your plan
2,927
doctor: okay alright yeah a lot of patients it's very successful with the physical therapy so i really hope that will do it and so we'll just start there okay patient: sounds great
D2N116
14
[ "Chitchat" ]
[ "Null" ]
okay alright yeah a lot of patients it's very successful with the physical therapy so i really hope that will do it and so we'll just start there okay
2,928
doctor: okay thanks patient: thanks
D2N116
15
[ "Chitchat" ]
[ "Null" ]
okay thanks
2,929
doctor: did you have any other any other problems any other injuries that that went along with this or patient: my both my my feet are actually really sore too i obviously have been doing a lot of other yard work so you know it's kinda it's really stiff and stuff and they you know my ankle joints as well my wife seems to think that i do n't drink enough water so it could be something along that lines but i do n't know they're kinda this they just they're really sore and stuff so i've been trying to put them up and kinda put ice on them keep them elevated and it seems to be helping out a little bit but
D2N116
16
[ "Personal History" ]
[ "Subjective" ]
did you have any other any other problems any other injuries that that went along with this or
2,930
doctor: yeah so if you do n't feel that you did anything to injure it we might start just maybe do some epsom salts have you tried soaking your feet in epsom salts that will tend to kinda pull out what's going on in there and just help your those muscles to relax and the soreness to to go away you might try that patient: okay that sounds like a plan that sounds good
D2N116
17
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah so if you do n't feel that you did anything to injure it we might start just maybe do some epsom salts have you tried soaking your feet in epsom salts that will tend to kinda pull out what's going on in there and just help your those muscles to relax and the soreness to to go away you might try that
2,931
doctor: mister jackson is a 45 -year-old male who has a history of diabetes type two and mild intermittent asthma and he is here today with right elbow pain so hey there mark nice to see you again listen sorry you're having some elbow pain let's talk about it but i would like to record this conversation with this cool app that i'm using that's gon na help me focus on you a bit more would that be alright with you patient: yeah that sounds great
D2N117
0
[ "Acute Symptoms", "Personal History", "Greetings" ]
[ "Subjective" ]
mister jackson is a 45 -year-old male who has a history of diabetes type two and mild intermittent asthma and he is here today with right elbow pain so hey there mark nice to see you again listen sorry you're having some elbow pain let's talk about it but i would like to record this conversation with this cool app that i'm using that's gon na help me focus on you a bit more would that be alright with you
2,932
doctor: okay great so mark tell me about your right elbow pain what's been happening patient: so yeah i've been playing a lot of tennis recently buddy of mine you know you're always telling me to get off the couch and be more active so a buddy of mine asked me if i wanted to go play tennis he just joined a country club i've been hitting hitting the cord a lot more and it's just been killing me for the last three weeks or so
D2N117
1
[ "Acute Symptoms" ]
[ "Subjective" ]
okay great so mark tell me about your right elbow pain what's been happening
2,933
doctor: okay alright and where in your elbow is it hurting patient: outside part
D2N117
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright and where in your elbow is it hurting
2,934
doctor: hmmm okay does the pain radiate anywhere like down to your arm up to your shoulder or anywhere else patient: no it does n't
D2N117
3
[ "Acute Symptoms" ]
[ "Subjective" ]
hmmm okay does the pain radiate anywhere like down to your arm up to your shoulder or anywhere else
2,935
doctor: okay and what would you say the pain is you know on a scale of zero to ten patient: it's probably an eight when i'm just when i'm using it even if it's to get something out of the cupboard and it's a three when i'm just kinda resting
D2N117
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and what would you say the pain is you know on a scale of zero to ten
2,936
doctor: hmmm okay and do you would you say it's a sharp pain stabbing pain aching throbbing how would you describe it patient: all of the above shooting stabbing very sharp
D2N117
5
[ "Acute Symptoms" ]
[ "Subjective" ]
hmmm okay and do you would you say it's a sharp pain stabbing pain aching throbbing how would you describe it
2,937
doctor: okay alright and you let's see other than the the tennis you know increase in tennis activity you have n't had any trauma recently falling on it or you know felt a pop anywhere or anything like that have you patient: not that i can recall
D2N117
6
[ "Personal History", "Other Socials" ]
[ "Subjective" ]
okay alright and you let's see other than the the tennis you know increase in tennis activity you have n't had any trauma recently falling on it or you know felt a pop anywhere or anything like that have you
2,938
doctor: okay and and you said it's it's worse with movement better with rest is there anything else that makes it makes it worse or makes it better patient: i've taken some tylenol and ibuprofen but as soon as those wear off it it comes right back so they do n't really help
D2N117
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay and and you said it's it's worse with movement better with rest is there anything else that makes it makes it worse or makes it better
2,939
doctor: okay okay alright yeah well i definitely i'm glad you're getting some exercise now that's good for your diabetes and all that and out there playing tennis kinda back back to the back to the old days for you right did do i recall that were n't you a big tennis player back in the day like state champ in high school or something patient: yeah yeah that was a hundred years ago i ca n't i i try to play like that and i ca n't i ca n't do that anymore but yeah a good memory that's a that's a good memory
D2N117
9
[ "Personal History", "Other Socials" ]
[ "Subjective" ]
okay okay alright yeah well i definitely i'm glad you're getting some exercise now that's good for your diabetes and all that and out there playing tennis kinda back back to the back to the old days for you right did do i recall that were n't you a big tennis player back in the day like state champ in high school or something
2,940
doctor: i did i did yeah that was that was crazy that was a great tournament what a what a finish unbelievable patient: yeah hey did you see the masters i know you're a golfer
D2N117
11
[ "Chitchat" ]
[ "Null" ]
i did i did yeah that was that was crazy that was a great tournament what a what a finish unbelievable
2,941
doctor: yeah yeah yeah i do n't get out as often as i as as i like to but but the masters yeah that was that was amazing that was lot of fun to lot of fun did you catch it too patient: i did
D2N117
12
[ "Chitchat" ]
[ "Null" ]
yeah yeah yeah i do n't get out as often as i as as i like to but but the masters yeah that was that was amazing that was lot of fun to lot of fun did you catch it too
2,942
doctor: yep yep agreed agreed and so well listen we'll we'll hopefully get you feeling better here and get you back out on the court and out on the course and we'll talk about that but let's let me ask you about your diabetes a little bit a little bit here so how have your blood sugars been running mark have they been what in the low one hundreds two hundreds where are they patient: they are like one fifty one sixty you know we just had easter and my kids got a whole bunch of candies so i keep eating that
D2N117
16
[ "Personal History" ]
[ "Subjective" ]
yep yep agreed agreed and so well listen we'll we'll hopefully get you feeling better here and get you back out on the court and out on the course and we'll talk about that but let's let me ask you about your diabetes a little bit a little bit here so how have your blood sugars been running mark have they been what in the low one hundreds two hundreds where are they
2,943
doctor: hmmm okay yeah yeah understood so those cadboy eggs they'll get you every time too right patient: yes
D2N117
17
[ "Chitchat" ]
[ "Null" ]
hmmm okay yeah yeah understood so those cadboy eggs they'll get you every time too right
2,944
doctor: boy my gosh yeah those are the best so those are those are deadly do n't tell my cardiologist so okay so listen you know i see that we have you on metformin five hundred milligrams once a day no actually last visit we increased it so i've got you on metformin five hundred milligrams twice a day correct you're still taking that patient: yes twice a day
D2N117
18
[ "Therapeutic History" ]
[ "Subjective" ]
boy my gosh yeah those are the best so those are those are deadly do n't tell my cardiologist so okay so listen you know i see that we have you on metformin five hundred milligrams once a day no actually last visit we increased it so i've got you on metformin five hundred milligrams twice a day correct you're still taking that
2,945
doctor: okay and but your blood sugars are a bit off you know maybe those the cadberry eggs so how about your asthma how has that been doing you know have you had any asthma attacks you're still taking flovent twice a day and the albuterol as needed patient: yeah knock on wood i my asthma is pretty much under control
D2N117
19
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay and but your blood sugars are a bit off you know maybe those the cadberry eggs so how about your asthma how has that been doing you know have you had any asthma attacks you're still taking flovent twice a day and the albuterol as needed
2,946
doctor: okay excellent excellent alright and i recall you know just kinda review a few things i i think you've got an allergy to penicillin is that correct patient: that's correct yes
D2N117
20
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay excellent excellent alright and i recall you know just kinda review a few things i i think you've got an allergy to penicillin is that correct
2,947
doctor: okay and then you you know your surgical history you had your your gallbladder out what about ten years ago i think by doctor nelson correct patient: yes that's right
D2N117
21
[ "Personal History" ]
[ "Subjective" ]
okay and then you you know your surgical history you had your your gallbladder out what about ten years ago i think by doctor nelson correct
2,948
doctor: okay and then let's go ahead and examine you alright so mark your exam is pretty much you know for the most part normal with a few exceptions on your heart exam you still have a grade three out of six systolic ejection murmur and that's unchanged from prior exam we're watching that and so that just means i hear some some heart sounds as your heart is beating there i'm not too concerned about it as as that's not changed otherwise normal cardiovascular exam and your physical exam otherwise on your musculoskeletal exam on your right elbow you do have moderate lateral epicondylar tenderness of the right elbow and how about when i move this when i move your elbow like this does that hurt you patient: kills
D2N117
22
[ "Physical Examination" ]
[ "Objective" ]
okay and then let's go ahead and examine you alright so mark your exam is pretty much you know for the most part normal with a few exceptions on your heart exam you still have a grade three out of six systolic ejection murmur and that's unchanged from prior exam we're watching that and so that just means i hear some some heart sounds as your heart is beating there i'm not too concerned about it as as that's not changed otherwise normal cardiovascular exam and your physical exam otherwise on your musculoskeletal exam on your right elbow you do have moderate lateral epicondylar tenderness of the right elbow and how about when i move this when i move your elbow like this does that hurt you
2,949
doctor: okay sorry about that so you've got moderate pain with passive range of motion of the right elbow there is no palpable joint effusion and now what if i press against your wrist like so does that hurt you patient: yeah it hurts a little bit
D2N117
23
[ "Physical Examination" ]
[ "Objective" ]
okay sorry about that so you've got moderate pain with passive range of motion of the right elbow there is no palpable joint effusion and now what if i press against your wrist like so does that hurt you
2,950
doctor: okay alright sorry so that's you have mild pain with resisted extension of the right wrist as well okay otherwise normal unremarkable exam and let's talk about your results now so your right elbow x-ray today shows no acute fracture or other bony abnormality so that's good there's no malalignment or sign of joint effusion and otherwise it's a normal right elbow x-ray so that's reassuring okay and hey you know i meant to ask you you know and do you have any history of fever recently you know along with the elbow pain you had noticed a fever patient: no i do n't think so
D2N117
24
[ "Personal History", "Radiology Examination", "Vegetative History" ]
[ "Subjective", "Objective" ]
okay alright sorry so that's you have mild pain with resisted extension of the right wrist as well okay otherwise normal unremarkable exam and let's talk about your results now so your right elbow x-ray today shows no acute fracture or other bony abnormality so that's good there's no malalignment or sign of joint effusion and otherwise it's a normal right elbow x-ray so that's reassuring okay and hey you know i meant to ask you you know and do you have any history of fever recently you know along with the elbow pain you had noticed a fever
2,951
doctor: okay great excellent alright so tell you what let's let's talk about my assessment and your plan here so for your first problem my assessment is is that you have acute lateral epicondylitis of your right elbow and this is also known as tennis elbow go figure right so this is due to overuse likely the increase in your your tennis activity which normally would be good but maybe we're overdoing it a little bit so i have a few recommendations i'd like you to rest your right arm as much as you can i want you to stop tennis for the next four to six weeks and please avoid repetitive stress in that right arm as well i want you to ice that right elbow for twenty minutes at least three times per day and this should reduce the pain and inflammation and then i'm also going to give you a brace for your right forearm and my nurse will give this to you before you leave that should help with the discomfort okay in that right elbow i will also write you a prescription for ultram and this should help with the pain i'll write you a prescription ultram fifty milligrams once per day that should help with your elbow pain so then i wan na see you in follow-up in four weeks and so we'll reevaluate your elbow at that time and if you we'll consider some additional imaging if needed possibly a physical therapy referral depending on how you're doing mkay now for your second problem of diabetes type two my assessment is is that your blood sugar is a little bit out of control mkay so we need to make some adjustments i'm going to increase your metformin to one thousand milligrams twice per day and i want you to check your blood sugar twice daily for the next two weeks and then let me know how your blood sugar is running and we can make some additional adjustments if needed but i will increase your metformin to one thousand milligrams twice a day now i'm going to also order a hemoglobin a1c level and and a cbc blood test today and and so we'll check those results the hemoglobin a1c and the cbc and then i'm going to also check a chem-12 blood test as well and now for your third problem of the mild acute intermittent asthma you my assessment is that it really remains under good control so let's keep you on that flovent and the albuterol no changes there and you can use those as tolerated it does look like you need a refill on your albuterol so i'm gon na write you a prescription for a refill of the albuterol and you can pick that up at your pharmacy as well so how does that all sound any questions for me patient: it sounds pretty good i ca n't believe it's just tennis elbow feel like a looser coming in here but it's okay i get it
D2N117
25
[ "Discussion", "Follow-up", "Medication", "Referral", "Diagnostic Testing", "Acute Assessment" ]
[ "Assessment", "Plan" ]
okay great excellent alright so tell you what let's let's talk about my assessment and your plan here so for your first problem my assessment is is that you have acute lateral epicondylitis of your right elbow and this is also known as tennis elbow go figure right so this is due to overuse likely the increase in your your tennis activity which normally would be good but maybe we're overdoing it a little bit so i have a few recommendations i'd like you to rest your right arm as much as you can i want you to stop tennis for the next four to six weeks and please avoid repetitive stress in that right arm as well i want you to ice that right elbow for twenty minutes at least three times per day and this should reduce the pain and inflammation and then i'm also going to give you a brace for your right forearm and my nurse will give this to you before you leave that should help with the discomfort okay in that right elbow i will also write you a prescription for ultram and this should help with the pain i'll write you a prescription ultram fifty milligrams once per day that should help with your elbow pain so then i wan na see you in follow-up in four weeks and so we'll reevaluate your elbow at that time and if you we'll consider some additional imaging if needed possibly a physical therapy referral depending on how you're doing mkay now for your second problem of diabetes type two my assessment is is that your blood sugar is a little bit out of control mkay so we need to make some adjustments i'm going to increase your metformin to one thousand milligrams twice per day and i want you to check your blood sugar twice daily for the next two weeks and then let me know how your blood sugar is running and we can make some additional adjustments if needed but i will increase your metformin to one thousand milligrams twice a day now i'm going to also order a hemoglobin a1c level and and a cbc blood test today and and so we'll check those results the hemoglobin a1c and the cbc and then i'm going to also check a chem-12 blood test as well and now for your third problem of the mild acute intermittent asthma you my assessment is that it really remains under good control so let's keep you on that flovent and the albuterol no changes there and you can use those as tolerated it does look like you need a refill on your albuterol so i'm gon na write you a prescription for a refill of the albuterol and you can pick that up at your pharmacy as well so how does that all sound any questions for me
2,952
doctor: yeah yeah well patient: i'm not i'm not young anymore
D2N117
26
[ "Chitchat" ]
[ "Null" ]
yeah yeah well
2,953
doctor: yeah well let's let's keep you active but take a break for a bit and let's ease back into it okay so it's great to see you and i'll see you back in four weeks let me know if you have other problems in the meantime patient: okay
D2N117
27
[ "Follow-up" ]
[ "Plan" ]
yeah well let's let's keep you active but take a break for a bit and let's ease back into it okay so it's great to see you and i'll see you back in four weeks let me know if you have other problems in the meantime
2,954
doctor: alright so how're you doing today angela patient: i'm doing pretty well
D2N118
0
[ "Greetings" ]
[ "Subjective" ]
alright so how're you doing today angela
2,955
doctor: alright so looking here at your appointment notes it says you're you're here you think you have a kidney stone you had some in the past so we're gon na take a look at that and then you also have a past medical history of hypertension and diabetes we want to take a look at those as well so first thing what's going on with your kidneys you as what how long ago have you been feeling pain and and how's all that patient: pain's been up and down i went to the emergency room last week but now i think i'm doing a little bit better
D2N118
1
[ "Personal History" ]
[ "Subjective" ]
alright so looking here at your appointment notes it says you're you're here you think you have a kidney stone you had some in the past so we're gon na take a look at that and then you also have a past medical history of hypertension and diabetes we want to take a look at those as well so first thing what's going on with your kidneys you as what how long ago have you been feeling pain and and how's all that
2,956
doctor: okay so the case of kidney stones so have you had you said you've had them in the past and how often would you say patient: i do n't know i this is probably like my seventh or eighth kidney stone
D2N118
2
[ "Personal History" ]
[ "Subjective" ]
okay so the case of kidney stones so have you had you said you've had them in the past and how often would you say
2,957
doctor: seven or eight kidney stones so do you think you passed it yet or is it still in the patient: i think this one passed yeah
D2N118
3
[ "Personal History" ]
[ "Subjective" ]
seven or eight kidney stones so do you think you passed it yet or is it still in the
2,958
doctor: this one passed how long would you say it took to patient: well i went last week and then i think it passed about three days ago
D2N118
4
[ "Personal History" ]
[ "Subjective" ]
this one passed how long would you say it took to
2,959
doctor: okay so are you still noticing any blood in your urine patient: no no more blood
D2N118
5
[ "Vegetative History" ]
[ "Subjective" ]
okay so are you still noticing any blood in your urine
2,960
doctor: alright are you still having pain patient: nope
D2N118
6
[ "Acute Symptoms" ]
[ "Subjective" ]
alright are you still having pain
2,961
doctor: okay that that's that's that's really good did they do anything for you at the hospital giving you any medications patient: they gave me some pain medicine
D2N118
8
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay that that's that's that's really good did they do anything for you at the hospital giving you any medications
2,962
doctor: okay do you remember what it was patient: i think it was percocet
D2N118
9
[ "Therapeutic History" ]
[ "Subjective" ]
okay do you remember what it was
2,963
doctor: okay well that's good i'm very glad to see that you were able to pass that stone have you seen a urologist before about this patient: i have n't seen one in a while but yes i saw someone maybe a year ago
D2N118
10
[ "Personal History" ]
[ "Subjective" ]
okay well that's good i'm very glad to see that you were able to pass that stone have you seen a urologist before about this
2,964
doctor: okay so yeah i know you keep having these recurrent kidney stones so i definitely think we can get you a referral to urology just to check up on that and also wan na do some labs as well patient: okay
D2N118
11
[ "Referral", "Diagnostic Testing" ]
[ "Plan" ]
okay so yeah i know you keep having these recurrent kidney stones so i definitely think we can get you a referral to urology just to check up on that and also wan na do some labs as well
2,965
doctor: so i also see you're here for you have a past medical history of of hypertension and when you came in today your blood pressure was a little bit high it was a one fifty over ninety i'm reading here in your chart you're on two point five of norvasc patient: hmmm
D2N118
12
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
so i also see you're here for you have a past medical history of of hypertension and when you came in today your blood pressure was a little bit high it was a one fifty over ninety i'm reading here in your chart you're on two point five of norvasc
2,966
doctor: now have you been taking that regularly patient: i have but at home my blood pressure is always great
D2N118
13
[ "Therapeutic History" ]
[ "Subjective" ]
now have you been taking that regularly
2,967
doctor: okay maybe you have a little white coat syndrome some of my patients do have it i have it myself and i'm a provider so i definitely understand yeah i know we we talked about last time you getting a blood pressure cuff and taking those about two to three times a week so what have those readings been i'm usually like one thirty to one forty over sixty to seventy patient: okay
D2N118
14
[ "Chitchat" ]
[ "Null" ]
okay maybe you have a little white coat syndrome some of my patients do have it i have it myself and i'm a provider so i definitely understand yeah i know we we talked about last time you getting a blood pressure cuff and taking those about two to three times a week so what have those readings been i'm usually like one thirty to one forty over sixty to seventy
2,968
doctor: that's that's that's not too bad i think when you first came in you were around like one eighty so it seems to be that that norvasc is is working for you how about your diet i know you were having a little issue eating some fast food and and cakes and cookies and have you been able to get that under control patient: yeah it's hard to give up the fast food altogether because it's a lot of on the go you know
D2N118
15
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
that's that's that's not too bad i think when you first came in you were around like one eighty so it seems to be that that norvasc is is working for you how about your diet i know you were having a little issue eating some fast food and and cakes and cookies and have you been able to get that under control
2,969
doctor: okay so do you think you would be able to get that under control by yourself or would you do you think you would need help with that maybe a dietitian be able to help you out patient: yeah i do n't know i do n't know if i can make another appointment i just add to the extra
D2N118
16
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
okay so do you think you would be able to get that under control by yourself or would you do you think you would need help with that maybe a dietitian be able to help you out
2,970
doctor: yeah yeah definitely understand patient: mm-hmm
D2N118
18
[ "Chitchat" ]
[ "Null" ]
yeah yeah definitely understand
2,971
doctor: alright yeah so i mean that's one thing we just got ta work one is your diet we try to keep you at least just twenty three hundred milligrams or less of sodium per day i know that's hard for a lot of salads and stuff i know it's hard for lot of people especially with all like the the prepackage foods we have around today so that's definitely something we we should work on patient: mm-hmm
D2N118
19
[ "Other Treatments" ]
[ "Plan" ]
alright yeah so i mean that's one thing we just got ta work one is your diet we try to keep you at least just twenty three hundred milligrams or less of sodium per day i know that's hard for a lot of salads and stuff i know it's hard for lot of people especially with all like the the prepackage foods we have around today so that's definitely something we we should work on
2,972
doctor: so let's also look here you have a history of diabetes and so you're on that five hundred milligrams of metformin daily now have you been taking that as well patient: yeah i take my metformin
D2N118
20
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
so let's also look here you have a history of diabetes and so you're on that five hundred milligrams of metformin daily now have you been taking that as well
2,973
doctor: so what have your blood sugars been running daily patient: well i do n't check it very often
D2N118
22
[ "Personal History" ]
[ "Subjective" ]
so what have your blood sugars been running daily
2,974
doctor: okay so i'm looking here i think last after your last visit you got a1c now was six . seven so it's a little bit high it's gone down a little bit since you were first diagnosed with the type two diabetes a year ago so i'm glad we're making progress with that as well alright so i'm just gon na do a quick physical exam on you before i do just wan na make sure are you having any chest pain today patient: no
D2N118
24
[ "Physical Examination" ]
[ "Objective" ]
okay so i'm looking here i think last after your last visit you got a1c now was six . seven so it's a little bit high it's gone down a little bit since you were first diagnosed with the type two diabetes a year ago so i'm glad we're making progress with that as well alright so i'm just gon na do a quick physical exam on you before i do just wan na make sure are you having any chest pain today
2,975
doctor: alright any any belly pain patient: no
D2N118
25
[ "Physical Examination" ]
[ "Objective" ]
alright any any belly pain
2,976
doctor: alright so i'm gon na listen to your lungs your lungs are clear bilaterally i do n't hear any crackles listen to your heart so on your heart exam i do hear that grade two out of six systolic ejection murmur and we already knew about that previously so it has n't gotten any worse so that's good so i'm gon na just press here in your abdomen because that you did have those kidney stones does that hurt patient: no
D2N118
26
[ "Physical Examination" ]
[ "Objective" ]
alright so i'm gon na listen to your lungs your lungs are clear bilaterally i do n't hear any crackles listen to your heart so on your heart exam i do hear that grade two out of six systolic ejection murmur and we already knew about that previously so it has n't gotten any worse so that's good so i'm gon na just press here in your abdomen because that you did have those kidney stones does that hurt
2,977
doctor: alright i'm gon na press here on your back patient: no pain
D2N118
27
[ "Physical Examination" ]
[ "Objective" ]
alright i'm gon na press here on your back
2,978
doctor: okay so on your abdomen exam of your abdomen i'm showing no tenderness to palpation of the abdomen or tenderness of the the cva either on the right side so that that's good i think that's pretty much cleared up so let's we'll talk a little bit about my assessment and plan for you and so my assessment you you did have the those kidney stones but i i think they are passed this time but i do want to get a couple of labs so we'll get a urinalysis patient: okay
D2N118
28
[ "Physical Examination", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay so on your abdomen exam of your abdomen i'm showing no tenderness to palpation of the abdomen or tenderness of the the cva either on the right side so that that's good i think that's pretty much cleared up so let's we'll talk a little bit about my assessment and plan for you and so my assessment you you did have the those kidney stones but i i think they are passed this time but i do want to get a couple of labs so we'll get a urinalysis
2,979
doctor: alright we'll get a urine culture just to make sure everything is is cleared up i also want to give you a referral to referral referral to urology patient: okay
D2N118
29
[ "Referral", "Diagnostic Testing" ]
[ "Plan" ]
alright we'll get a urine culture just to make sure everything is is cleared up i also want to give you a referral to referral referral to urology
2,980
doctor: because you do keep having these all the time and so maybe there's something else going wrong and so they can help get that under control patient: can i see doctor harris
D2N118
30
[ "Discussion", "Referral" ]
[ "Plan" ]
because you do keep having these all the time and so maybe there's something else going wrong and so they can help get that under control
2,981
doctor: of course yeah we can we can get you that road to doctor harris and patient: he's not like
D2N118
31
[ "Discussion", "Referral" ]
[ "Plan" ]
of course yeah we can we can get you that road to doctor harris and
2,982
doctor: he's great he's he's he he he's great i've heard he does really good work so that'll be good so for the hypertension you seem to be doing well on the two . five of norvasc so we are not gon na make any changes to that do you need any refills right now patient: no usually the pharmacy just sends them through when i call
D2N118
32
[ "Medication", "Other Treatments", "Reassessment" ]
[ "Assessment", "Plan" ]
he's great he's he's he he he's great i've heard he does really good work so that'll be good so for the hypertension you seem to be doing well on the two . five of norvasc so we are not gon na make any changes to that do you need any refills right now
2,983
doctor: okay great so we we wo n't we gave you refills with that i do wan na give you a consult to nutrition patient: okay
D2N118
33
[ "Referral" ]
[ "Plan" ]
okay great so we we wo n't we gave you refills with that i do wan na give you a consult to nutrition
2,984
doctor: just to help you with that diet patient: okay
D2N118
34
[ "Discussion", "Referral", "Other Treatments" ]
[ "Plan" ]
just to help you with that diet
2,985
doctor: because i think that's a major factor of us eventually getting you off of all medications patient: hmmm
D2N118
35
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
because i think that's a major factor of us eventually getting you off of all medications
2,986
doctor: and then for your diabetes i'm just keep you on that on that five hundred of metformin okay i think you're doing well with that as well also but i do want you to start taking your blood sugars if you can take them before every meal patient: okay
D2N118
36
[ "Discussion", "Reassessment" ]
[ "Assessment", "Plan" ]
and then for your diabetes i'm just keep you on that on that five hundred of metformin okay i think you're doing well with that as well also but i do want you to start taking your blood sugars if you can take them before every meal
2,987
doctor: just to gauge where you are so you can tell how much food you should actually be be eating patient: okay
D2N118
37
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
just to gauge where you are so you can tell how much food you should actually be be eating
2,988
doctor: alright patient: i can try that
D2N118
38
[ "Chitchat" ]
[ "Null" ]
alright
2,989
doctor: so how does that that sound patient: that sounds like a plan when should i come back and see you
D2N118
39
[ "Discussion" ]
[ "Plan" ]
so how does that that sound
2,990
doctor: so you can you can come back in three months and we'll check up again i forgot you did tell me last time that you were having some issues with insomnia patient: hmmm
D2N118
40
[ "Follow-up", "Personal History" ]
[ "Subjective", "Plan" ]
so you can you can come back in three months and we'll check up again i forgot you did tell me last time that you were having some issues with insomnia
2,991
doctor: how is that going for you is it still happening patient: i mean sometimes i stay awake just kinda worrying about things but but i've tried some meditation apps and that helps
D2N118
41
[ "Vegetative History" ]
[ "Subjective" ]
how is that going for you is it still happening
2,992
doctor: okay alright and i know we talked a little bit before about practicing proper sleep hygiene you know just making sure that all of your electronics are off you know dark room patient: yeah
D2N118
42
[ "Vegetative History" ]
[ "Subjective" ]
okay alright and i know we talked a little bit before about practicing proper sleep hygiene you know just making sure that all of your electronics are off you know dark room
2,993
doctor: cool room have you been doing that patient: well i do like to sleep with the tv on and my phone is right by my bed because i never know if someone's gon na call me you know
D2N118
43
[ "Vegetative History" ]
[ "Subjective" ]
cool room have you been doing that
2,994
doctor: yeah i i know i'm like apple i do n't know if you have an iphone or not but i know apple has this the the sleep mode now do that disturbance so you put that on patient: it's a good idea
D2N118
44
[ "Referral" ]
[ "Plan" ]
yeah i i know i'm like apple i do n't know if you have an iphone or not but i know apple has this the the sleep mode now do that disturbance so you put that on
2,995
doctor: interrupt you patient: yeah
D2N118
45
[ "Chitchat" ]
[ "Null" ]
interrupt you
2,996
doctor: okay have you tried taking melatonin to sleep patient: i used it a couple times but but it did n't seem to help that much
D2N118
46
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay have you tried taking melatonin to sleep
2,997
doctor: okay how about i do n't think i've prescribed you anything yet do you think you would need anything patient: hmmm i do n't really wan na take any sleeping pills
D2N118
47
[ "Discussion", "Medication" ]
[ "Plan" ]
okay how about i do n't think i've prescribed you anything yet do you think you would need anything
2,998
doctor: okay that's understandable alright so for the last issue for the insomnia i'm just gon na have you take ten milligrams of melatonin as needed patient: okay
D2N118
48
[ "Medication", "Reassessment" ]
[ "Assessment", "Plan" ]
okay that's understandable alright so for the last issue for the insomnia i'm just gon na have you take ten milligrams of melatonin as needed
2,999