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doctor: absolutely okay totally understand that glad to hear that you're back out on the court playing with your son how is he doing by the way patient: he is doing great he is doing great i mean you know he is a big step kurry fan so he likes to keep up shots from from way out past the three point line and he is only ten and tiny so it's it's not a good idea for him to do that but he is doing really well and i'm just happy he's tried every sport and basketball's really what took so i'm just really happy that he has a sport and loves and couple of his buddies playing to lead with him so it's just makes me happy that he's found something he really enjoys
D2N124
3
[ "Chitchat" ]
[ "Null" ]
absolutely okay totally understand that glad to hear that you're back out on the court playing with your son how is he doing by the way
3,100
doctor: good good to hear alright well let's take a look at that ankle it looks like it's pretty swollen so let me just do a quick exam on that right now alright so looks like the outside of your ankle if i push on that does that hurt pretty bad patient: yeah yes
D2N124
4
[ "Physical Examination" ]
[ "Objective" ]
good good to hear alright well let's take a look at that ankle it looks like it's pretty swollen so let me just do a quick exam on that right now alright so looks like the outside of your ankle if i push on that does that hurt pretty bad
3,101
doctor: okay so exquisite tenderness tenderness laterally and then if i push here does that hurt too patient: yeah a little bit
D2N124
5
[ "Physical Examination" ]
[ "Objective" ]
okay so exquisite tenderness tenderness laterally and then if i push here does that hurt too
3,102
doctor: okay so some tenderness over the medial deltoid region so swelling on the lateral side of the ankle no epidermolysis skin is intact looks like you have brisk capillary refill no horrible malalignment so alright can you can you stand on it did you say that you're having trouble walking at all patient: yeah i mean i can stand on it and i ca n't walk on it it just it hurts and it feels like i'm going to possibly injure it more just because it does n't feel particularly solid
D2N124
6
[ "Physical Examination" ]
[ "Objective" ]
okay so some tenderness over the medial deltoid region so swelling on the lateral side of the ankle no epidermolysis skin is intact looks like you have brisk capillary refill no horrible malalignment so alright can you can you stand on it did you say that you're having trouble walking at all
3,103
doctor: sure so it does n't quite feel stable patient: yeah
D2N124
7
[ "Physical Examination" ]
[ "Objective" ]
sure so it does n't quite feel stable
3,104
doctor: okay okay i gotcha so i know you had an x-ray as you came in today and so i'm just looking at this x-ray here i'll show you on the screen right here i can turn my monitor towards you this is an ap lateral oblique and this is your right ankle so what we're looking at is a displaced lateral malleolus at the weber c level there's no evidence of medial or posterior malleolar fractures but this is a fracture on the lateral side of your ankle now based on the position it's a bit unstable that's why you're feeling some of that that instability when you're walking so for your diagnosis what i'm gon na put down is a lateral malleolar fracture and what i would recommend for that since it is in the location that it is is you're probably unfortunately gon na need surgery we're gon na wan na get that healed what that includes is putting some plate and some screws in and you're gon na be out for a little bit so i know you've been trying to work out and and you wan na get back on the court but but you may have to have to sit out for a little bit we'll get you some crutches patient: how long it's a little bit because i'm also i i forgot to say i'm also i did volunteer to coach
D2N124
8
[ "Other Treatments", "Radiology Examination", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay okay i gotcha so i know you had an x-ray as you came in today and so i'm just looking at this x-ray here i'll show you on the screen right here i can turn my monitor towards you this is an ap lateral oblique and this is your right ankle so what we're looking at is a displaced lateral malleolus at the weber c level there's no evidence of medial or posterior malleolar fractures but this is a fracture on the lateral side of your ankle now based on the position it's a bit unstable that's why you're feeling some of that that instability when you're walking so for your diagnosis what i'm gon na put down is a lateral malleolar fracture and what i would recommend for that since it is in the location that it is is you're probably unfortunately gon na need surgery we're gon na wan na get that healed what that includes is putting some plate and some screws in and you're gon na be out for a little bit so i know you've been trying to work out and and you wan na get back on the court but but you may have to have to sit out for a little bit we'll get you some crutches
3,105
doctor: alright well patient: how long
D2N124
10
[ "Chitchat" ]
[ "Null" ]
alright well
3,106
doctor: yeah you you're probably gon na be out for about three months but continue the coaching go ahead and and let's get you back out there we'll get you some crutches and and hopefully you can kinda you know get back on the court start coaching and then within that three months we'll we'll get you back out doing some exercise again patient: okay
D2N124
11
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
yeah you you're probably gon na be out for about three months but continue the coaching go ahead and and let's get you back out there we'll get you some crutches and and hopefully you can kinda you know get back on the court start coaching and then within that three months we'll we'll get you back out doing some exercise again
3,107
doctor: alright in the meantime i'm gon na prescribe some medication for now let's try meloxicam and try to get some of the swelling down i want you to ice it and also keep that that ankle elevated do you have a job where you can elevate your ankle regularly patient: yeah i i work from home so that that should n't be a problem it's just everything else i do n't know who is gon na walk my dogs and and do all this stuff that's rest of my family refuses to walk my dog so we'll figure it out
D2N124
12
[ "Medication" ]
[ "Plan" ]
alright in the meantime i'm gon na prescribe some medication for now let's try meloxicam and try to get some of the swelling down i want you to ice it and also keep that that ankle elevated do you have a job where you can elevate your ankle regularly
3,108
doctor: yeah i i'm a dog walker as well so alright sorry for the bad news but let's get you healed up so that we can get you back out doing everything you need to do patient: alright thank you doctor
D2N124
13
[ "Chitchat" ]
[ "Null" ]
yeah i i'm a dog walker as well so alright sorry for the bad news but let's get you healed up so that we can get you back out doing everything you need to do
3,109
doctor: alright thanks
D2N124
14
[ "Chitchat" ]
[ "Null" ]
doctor: alright thanks
3,110
doctor: miss edwards is here for evaluation of facial pain this is a 54 -year-old male patient: how're you doing doctor cruz nice to see you today
D2N125
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
miss edwards is here for evaluation of facial pain this is a 54 -year-old male
3,111
doctor: good to see you mister edwards tell me what's been going on patient: yeah so i've got this stabbing shooting pain i've had for a while you know and it it especially right here in my right face right in that cheek bone area it's sometimes it gets super hot i've had it for i think a couple of months now and i went to my family doctor and they said i should come see you
D2N125
1
[ "Acute Symptoms" ]
[ "Subjective" ]
good to see you mister edwards tell me what's been going on
3,112
doctor: okay great i would like to ask you a little bit more about that had in your face do you remember how long that you had it patient: probably for about two or three months just just came on slowly i started noticing it but now it's i have episodes where just shooting stabbing kind of a pain in my right cheek bone right face area
D2N125
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay great i would like to ask you a little bit more about that had in your face do you remember how long that you had it
3,113
doctor: mm-hmm do you have any sensory loss meaning like numbness or tingling in that part of your face patient: not that i've noticed no
D2N125
3
[ "Acute Symptoms" ]
[ "Subjective" ]
mm-hmm do you have any sensory loss meaning like numbness or tingling in that part of your face
3,114
doctor: okay do you have any symptoms like this anywhere else on your face including the other side of your face patient: no it's just on the right side mostly not on the left side just on the right side of my face
D2N125
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay do you have any symptoms like this anywhere else on your face including the other side of your face
3,115
doctor: have you noticed any weakness on that side of the face like when you smile or while you're doing other things any weakness there patient: not really i mean i've i've i've tried to you know when i smile my smile seems equal on both sides my eyes i do n't have any weakness there my vision seems to be unchanged but just this stabbing severe pain it's just like excruciating pain that i get sometimes
D2N125
5
[ "Acute Symptoms" ]
[ "Subjective" ]
have you noticed any weakness on that side of the face like when you smile or while you're doing other things any weakness there
3,116
doctor: does it happen on its own or there are certain things that trigger it patient: sometimes if i'm if certain temperatures seem to trigger it sometimes or if it's super where it's cold i get a trigger sometimes sometimes certain kind of sensory outside of the wind sometimes that seems to trigger it but that's about it
D2N125
6
[ "Acute Symptoms" ]
[ "Subjective" ]
does it happen on its own or there are certain things that trigger it
3,117
doctor: okay and anything that you've done to to that helps for a little bit when you pain excess patient: you know i've tried ibuprofen and motrin that had really has n't helped it just comes on suddenly and then it's kinda stabbing excruciating pain i've tried rubbing some you know some tiger balm on it that did n't work but that's you know so i i went to my family doctor and he said you know i really need to see a neurosurgeon
D2N125
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay and anything that you've done to to that helps for a little bit when you pain excess
3,118
doctor: got it how long do these episodes last these pain patient: you know it can last for anywhere from a few minutes to sometimes about an hour but generally generally a few minutes
D2N125
8
[ "Acute Symptoms" ]
[ "Subjective" ]
got it how long do these episodes last these pain
3,119
doctor: any history of something like multiple sclerosis or any brain tumors that you know patient: no nothing like that
D2N125
9
[ "Personal History" ]
[ "Subjective" ]
any history of something like multiple sclerosis or any brain tumors that you know
3,120
doctor: alright any other kinda headache symptoms that have anything like you had migraines or anything related to the headaches patient: i mean i get occasional headaches but not really i do n't have a history of migraines but i occasionally get headaches like everybody else i take some tylenol that usually goes away but this is different
D2N125
10
[ "Personal History" ]
[ "Subjective" ]
alright any other kinda headache symptoms that have anything like you had migraines or anything related to the headaches
3,121
doctor: how severe is the pain on a scale of one to ten patient: when it comes on it's like a ten it's like somebody is stabbing you with an ice pick and but usually you know after a few minutes usually it goes away but sometimes it can last up to an hour
D2N125
11
[ "Personal History" ]
[ "Subjective" ]
how severe is the pain on a scale of one to ten
3,122
doctor: great . so mister i would like to do a physical exam if that's okay with you patient: sure
D2N125
12
[ "Physical Examination" ]
[ "Objective" ]
great . so mister i would like to do a physical exam if that's okay with you
3,123
doctor: i would like you to follow my finger here and i see that you're following my finger in in both directions can you show me your teeth . that looks nice and symmetric i'm gon na rub my fingers next to your ear can you hear that patient: yep
D2N125
13
[ "Physical Examination" ]
[ "Objective" ]
i would like you to follow my finger here and i see that you're following my finger in in both directions can you show me your teeth . that looks nice and symmetric i'm gon na rub my fingers next to your ear can you hear that
3,124
doctor: you can hear it on the other side as well patient: yep
D2N125
14
[ "Physical Examination" ]
[ "Objective" ]
you can hear it on the other side as well
3,125
doctor: okay i'm gon na take this cotton tape and run it along the side of your face can you feel that okay patient: yeah it's a little bit numb on my right side not so much on my left side
D2N125
15
[ "Physical Examination" ]
[ "Objective" ]
okay i'm gon na take this cotton tape and run it along the side of your face can you feel that okay
3,126
doctor: okay alright i'm gon na use this little needle here and i'm gon na poke here and i wan na see if you feel like it's being sharp or dull on that part of your face does that feel different or normal patient: it feels a little bit dull on my left on my right side my left side it feels sharp
D2N125
16
[ "Physical Examination" ]
[ "Objective" ]
okay alright i'm gon na use this little needle here and i'm gon na poke here and i wan na see if you feel like it's being sharp or dull on that part of your face does that feel different or normal
3,127
doctor: alright good well i had a chance to look at your mri patient: okay
D2N125
17
[ "Radiology Examination" ]
[ "Objective" ]
alright good well i had a chance to look at your mri
3,128
doctor: and i looked at your mri and it appears to have small blood vessel that is abutting and perhaps even pinching the trigeminal nerve the trigeminal nerve is nerve that comes from the brainstem that goes out to the face and provides the sensory inflammation from the face and you may have a condition called trigeminal neuralgia patient: okay
D2N125
18
[ "Acute Assessment", "Radiology Examination" ]
[ "Objective", "Assessment" ]
and i looked at your mri and it appears to have small blood vessel that is abutting and perhaps even pinching the trigeminal nerve the trigeminal nerve is nerve that comes from the brainstem that goes out to the face and provides the sensory inflammation from the face and you may have a condition called trigeminal neuralgia
3,129
doctor: where the nerve compression causes this kind of shooting electrical pain in the face patient: how do we treat it
D2N125
19
[ "Discussion" ]
[ "Objective", "Assessment" ]
where the nerve compression causes this kind of shooting electrical pain in the face
3,130
doctor: well the first line would be to try some medications usually we start with medications that are called gabapentin or tegretol these are medications that really help reduce the excitability of the nerve patient: okay
D2N125
20
[ "Medication" ]
[ "Plan" ]
well the first line would be to try some medications usually we start with medications that are called gabapentin or tegretol these are medications that really help reduce the excitability of the nerve
3,131
doctor: most people can get the pain control with that but there are some people where the medications are n't gon na be enough and in that situation we would consider surgery i would n't i would n't recommend that now we usually try the medications first . for considering a surgery to decompress the nerve the root cause of the problem is the compression of the blood vessel against the nerve patient: okay so we should be tried which one would you recommend the tegretol or
D2N125
21
[ "Discussion" ]
[ "Plan" ]
most people can get the pain control with that but there are some people where the medications are n't gon na be enough and in that situation we would consider surgery i would n't i would n't recommend that now we usually try the medications first . for considering a surgery to decompress the nerve the root cause of the problem is the compression of the blood vessel against the nerve
3,132
doctor: yeah i think we could start with the tegretol to start with i just want to make sure that you understand some of the potential side effects that you can have with this patient: sure
D2N125
22
[ "Discussion", "Medication" ]
[ "Plan" ]
yeah i think we could start with the tegretol to start with i just want to make sure that you understand some of the potential side effects that you can have with this
3,133
doctor: it's always a little bit of trial and error to figure out what the right dosing that would work for you but some common side effects can include you know memory loss tingling imbalance some people can actually have like dermatologic skin reaction to this medication and particularly people who have eustachian descent so that we may do some genetic testing just to make sure that it will be safe for you patient: okay sounds good let's do it
D2N125
23
[ "Discussion", "Diagnostic Testing", "Medication" ]
[ "Plan" ]
it's always a little bit of trial and error to figure out what the right dosing that would work for you but some common side effects can include you know memory loss tingling imbalance some people can actually have like dermatologic skin reaction to this medication and particularly people who have eustachian descent so that we may do some genetic testing just to make sure that it will be safe for you
3,134
doctor: okay so i will prescribe that for you and then we will see how that goes and if your pain continues we can talk about different surgical options to treat the pain patient: yeah i think i would like to try the tegretol first and if that does n't work then i can come back and so once should i come back and just to kinda check back with you and see if you know if it's had enough time for a fact or not
D2N125
24
[ "Discussion", "Medication" ]
[ "Plan" ]
okay so i will prescribe that for you and then we will see how that goes and if your pain continues we can talk about different surgical options to treat the pain
3,135
doctor: i think one month would be a great time to follow up patient: okay sounds good so if you want to send that prescription over to my pharmacy that would be fine and then why do n't i come back in about a month and we'll go from there
D2N125
25
[ "Follow-up" ]
[ "Plan" ]
i think one month would be a great time to follow up
3,136
doctor: great i'll see you then patient: alright
D2N125
26
[ "Chitchat" ]
[ "Null" ]
great i'll see you then
3,137
doctor: hi michelle what's been going on the medical assistant told me that you injured your knee patient: yeah i'm gon na have to keep this my favorite story is that i had a sandra who injured her knee cold dancing so that would immediately came up to mine but let's try skiing so i was skiing in vermont last weekend and i caught my ski when i was coming off the lift and i fell and my knee popped and it's hurt ever since
D2N126
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
hi michelle what's been going on the medical assistant told me that you injured your knee
3,138
doctor: okay and were you able to ski down the hill or did you have to be taken down by the ski patrol patient: i had to be taken down by the ski patrol i was unable to bear weight
D2N126
1
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and were you able to ski down the hill or did you have to be taken down by the ski patrol
3,139
doctor: okay is n't that slightly terrifying they had to do the same thing for me and you're just kind of sitting there watching all of the trees go by so anyway so what part of your knee is bothering you the most is it the inside the outside patient: it hurts on the outside but it also feels like it wo n't hold my weight
D2N126
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay is n't that slightly terrifying they had to do the same thing for me and you're just kind of sitting there watching all of the trees go by so anyway so what part of your knee is bothering you the most is it the inside the outside
3,140
doctor: okay so it feels like it's gon na buckle patient: hmmm yes
D2N126
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay so it feels like it's gon na buckle
3,141
doctor: okay alright and are you able to bend it patient: i was immediately after the injury but not really now
D2N126
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright and are you able to bend it
3,142
doctor: okay and how about straightening it are you able to straighten it at all patient: somewhat but it really hurts when i try to straighten all the way
D2N126
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and how about straightening it are you able to straighten it at all
3,143
doctor: okay alright now do you have any numbing or tingling in your toes patient: no
D2N126
6
[ "Vegetative History" ]
[ "Subjective" ]
okay alright now do you have any numbing or tingling in your toes
3,144
doctor: okay and can you feel your toes okay patient: i think so
D2N126
7
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and can you feel your toes okay
3,145
doctor: okay alright now are you a pretty active person you said you were skiing do you do what kind of other activities do you do patient: i chase my two four -year-old
D2N126
8
[ "Other Socials" ]
[ "Subjective" ]
okay alright now are you a pretty active person you said you were skiing do you do what kind of other activities do you do
3,146
doctor: okay do you have twins patient: i do
D2N126
9
[ "Other Socials" ]
[ "Subjective" ]
okay do you have twins
3,147
doctor: nice that's great patient: yeah
D2N126
10
[ "Chitchat" ]
[ "Null" ]
nice that's great
3,148
doctor: so okay and what's your support like at home who is who is able to help out are you still doing that kind of hobbling around on crutches or patient: yeah now my husband is home with me but he also works a job where he is gone quite a bit so it's just me and the kids
D2N126
11
[ "Other Socials" ]
[ "Subjective" ]
so okay and what's your support like at home who is who is able to help out are you still doing that kind of hobbling around on crutches or
3,149
doctor: okay alright and did the ski patrol give you crutches i i see you have them here with you okay alright great and are you otherwise generally healthy patient: yes
D2N126
12
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay alright and did the ski patrol give you crutches i i see you have them here with you okay alright great and are you otherwise generally healthy
3,150
doctor: okay and no high blood pressure diabetes anything like that patient: mm-hmm
D2N126
13
[ "Personal History" ]
[ "Subjective" ]
okay and no high blood pressure diabetes anything like that
3,151
doctor: no okay alright and well i i wan na go ahead let me just do a quick physical exam i'm gon na be calling out some of my exam findings and i'll let you know what that means when i'm done okay alright so on your heart exam your heart sounds in a nice regular rate and rhythm i do n't appreciate any murmur on your lung exam your lungs are nice and clear to auscultation and remind me what knee did you injure again patient: my right knee
D2N126
14
[ "Physical Examination" ]
[ "Objective" ]
no okay alright and well i i wan na go ahead let me just do a quick physical exam i'm gon na be calling out some of my exam findings and i'll let you know what that means when i'm done okay alright so on your heart exam your heart sounds in a nice regular rate and rhythm i do n't appreciate any murmur on your lung exam your lungs are nice and clear to auscultation and remind me what knee did you injure again
3,152
doctor: your right knee okay so on your right knee examination i do appreciate some edema and an effusion over the right knee does it hurt when i press patient: yes
D2N126
15
[ "Physical Examination" ]
[ "Objective" ]
your right knee okay so on your right knee examination i do appreciate some edema and an effusion over the right knee does it hurt when i press
3,153
doctor: okay there is pain to palpation of the right lateral knee there is decreased flexion and extension there is a positive lachman sign there is a palpable palpable dorsalis pedis and posterior tibial pulse there is no leg edema in the ankle okay well let's just talk a little bit about you know my assessment and you know my plan for you so you know i know that you had the x-ray done of your of your right knee that did n't show any bony abnormality but i i'm concerned that you have ruptured your your acl or your anterior cruciate ligament that's like a major ligament that helps connect and helps your knee move back and forth so i wan na go ahead and order a knee mri just so that we can get a a a good look and just you know confirm that physical exam okay now some people can have a normal physical exam and their acl can still be torn but you do have a lot of pain on the lateral aspect of your knee so i wan na make sure if there make sure that there is not any other structures that have been damaged by this accident okay i wan na go ahead and you know are you what are you taking for the pain patient: ibuprofen
D2N126
16
[ "Acute Symptoms", "Physical Examination", "Therapeutic History", "Radiology Examination", "Diagnostic Testing", "Reassessment" ]
[ "Subjective", "Objective", "Assessment", "Plan" ]
okay there is pain to palpation of the right lateral knee there is decreased flexion and extension there is a positive lachman sign there is a palpable palpable dorsalis pedis and posterior tibial pulse there is no leg edema in the ankle okay well let's just talk a little bit about you know my assessment and you know my plan for you so you know i know that you had the x-ray done of your of your right knee that did n't show any bony abnormality but i i'm concerned that you have ruptured your your acl or your anterior cruciate ligament that's like a major ligament that helps connect and helps your knee move back and forth so i wan na go ahead and order a knee mri just so that we can get a a a good look and just you know confirm that physical exam okay now some people can have a normal physical exam and their acl can still be torn but you do have a lot of pain on the lateral aspect of your knee so i wan na make sure if there make sure that there is not any other structures that have been damaged by this accident okay i wan na go ahead and you know are you what are you taking for the pain
3,154
doctor: is that helping patient: somewhat yes
D2N126
17
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
is that helping
3,155
doctor: okay alright do you want something stronger patient: no i'm okay
D2N126
18
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay alright do you want something stronger
3,156
doctor: alright so let's just continue with ibuprofen you can take you know six hundred to eight hundred milligrams every eight hours as needed i wan na go ahead and put you in a brace that's gon na help your knee feel a bit more supported okay and let's go ahead and i'm hoping that we can get this mri done in you know the next couple days and then we can have a conversation about what needs to be done now you said that you are are are you know obviously a very active active mom any other exercise or anything else that that i should be aware of that you do just wondering in terms of which kind of graft we would use to fix this with your with your acl being injured patient: hmmm no i not i i would like to get back to the running but currently not that active
D2N126
19
[ "Follow-up", "Medication", "Diagnostic Testing" ]
[ "Plan" ]
alright so let's just continue with ibuprofen you can take you know six hundred to eight hundred milligrams every eight hours as needed i wan na go ahead and put you in a brace that's gon na help your knee feel a bit more supported okay and let's go ahead and i'm hoping that we can get this mri done in you know the next couple days and then we can have a conversation about what needs to be done now you said that you are are are you know obviously a very active active mom any other exercise or anything else that that i should be aware of that you do just wondering in terms of which kind of graft we would use to fix this with your with your acl being injured
3,157
doctor: okay alright alright do you have any questions about anything patient: i think you've explained it well
D2N126
20
[ "Discussion" ]
[ "Plan" ]
okay alright alright do you have any questions about anything
3,158
doctor: okay alright so i'll see you again soon okay patient: okay thank you
D2N126
21
[ "Chitchat" ]
[ "Null" ]
okay alright so i'll see you again soon okay
3,159
doctor: alright take care bye
D2N126
22
[ "Chitchat" ]
[ "Null" ]
doctor: alright take care bye
3,160
doctor: hey brandon you know glad to see you in here today i see on your chart that you're experiencing some neck pain could you tell me a bit about what happened patient: yeah i was in a car crash
D2N127
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
hey brandon you know glad to see you in here today i see on your chart that you're experiencing some neck pain could you tell me a bit about what happened
3,161
doctor: wow okay when was that patient: well which car crash
D2N127
1
[ "Acute Symptoms" ]
[ "Subjective" ]
wow okay when was that
3,162
doctor: okay so multiple car crashes alright so let's see if we can how many let's start patient: my therapist said well my well actually my mother said i should go see the therapist and the therapist said i should see the lawyer but my neck's hurting
D2N127
2
[ "Personal History" ]
[ "Subjective" ]
okay so multiple car crashes alright so let's see if we can how many let's start
3,163
doctor: okay so i'm glad that you know you're getting some advice and so let's let's talk about this neck pain how many car crashes have we had recently patient: well the ones that are my fault or all of them
D2N127
3
[ "Personal History" ]
[ "Subjective" ]
okay so i'm glad that you know you're getting some advice and so let's let's talk about this neck pain how many car crashes have we had recently
3,164
doctor: all of them patient: i was fine after the second crash although i was in therapy for a few months and then after the third crash i had surgery but i was fine until this crash
D2N127
4
[ "Personal History" ]
[ "Subjective" ]
all of them
3,165
doctor: okay the most recent crash when was that patient: that's when i was coming home from the pain clinic because my neck hurt and my back hurt but that was in february
D2N127
5
[ "Personal History" ]
[ "Subjective" ]
okay the most recent crash when was that
3,166
doctor: okay alright so we had a car crash in february patient: what year it was which february it was
D2N127
6
[ "Personal History" ]
[ "Subjective" ]
okay alright so we had a car crash in february
3,167
doctor: okay so let's let's try with this one see what happens hopefully you remember i need you to start writing down these car crashes that this is becoming a thing but you know it's okay so let's let's say maybe you had a patient: you're not judging me are you
D2N127
7
[ "Personal History" ]
[ "Subjective" ]
okay so let's let's try with this one see what happens hopefully you remember i need you to start writing down these car crashes that this is becoming a thing but you know it's okay so let's let's say maybe you had a
3,168
doctor: no there's no judgment here whatsoever i want to make sure that i'm giving you the best advise possible and in order to do that i need the most information that you can provide me makes sense patient: yes
D2N127
8
[ "Chitchat" ]
[ "Null" ]
no there's no judgment here whatsoever i want to make sure that i'm giving you the best advise possible and in order to do that i need the most information that you can provide me makes sense
3,169
doctor: alright so we're gon na say hope maybe that you had a car crash and we can verify this in february of this year and you've been experiencing some neck pain since then right patient: yes
D2N127
9
[ "Acute Symptoms" ]
[ "Subjective" ]
alright so we're gon na say hope maybe that you had a car crash and we can verify this in february of this year and you've been experiencing some neck pain since then right
3,170
doctor: okay alright on a scale of one to ten what ten is your arm is being cut off by a chainsaw severe how bad is your pain patient: twelve
D2N127
10
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright on a scale of one to ten what ten is your arm is being cut off by a chainsaw severe how bad is your pain
3,171
doctor: okay terrible pain now i know you mentioned you had previous car crashes and you've been to therapy has anyone prescribed you any medication it's you said you went to a pain clinic yes patient: well they had prescribed it recently i was i was on fentanyl
D2N127
11
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
okay terrible pain now i know you mentioned you had previous car crashes and you've been to therapy has anyone prescribed you any medication it's you said you went to a pain clinic yes
3,172
doctor: okay alright and so we will be able to check on that when you take your medication so before you take your medication rather like are you able to move like are you experiencing any stiffness patient: yes but it hurts
D2N127
13
[ "Therapeutic History" ]
[ "Subjective" ]
okay alright and so we will be able to check on that when you take your medication so before you take your medication rather like are you able to move like are you experiencing any stiffness
3,173
doctor: okay it hurts what kind of pain is it sharp is it dull is it throbbing patient: it's the sharp incapacitating pain i ca n't work
D2N127
14
[ "Acute Symptoms" ]
[ "Subjective" ]
okay it hurts what kind of pain is it sharp is it dull is it throbbing
3,174
doctor: wow okay are you having any headaches patient: of course
D2N127
15
[ "Vegetative History" ]
[ "Subjective" ]
wow okay are you having any headaches
3,175
doctor: any dizziness patient: just sometimes
D2N127
16
[ "Vegetative History" ]
[ "Subjective" ]
any dizziness
3,176
doctor: any visual disturbances is it hard to like are you patient: not recently no
D2N127
17
[ "Vegetative History" ]
[ "Subjective" ]
any visual disturbances is it hard to like are you
3,177
doctor: okay alright any numbness patient: yes
D2N127
18
[ "Vegetative History" ]
[ "Subjective" ]
okay alright any numbness
3,178
doctor: okay any spasms patient: of course
D2N127
20
[ "Vegetative History" ]
[ "Subjective" ]
okay any spasms
3,179
doctor: okay where patient: my body hurts i told you my neck hurts
D2N127
21
[ "Vegetative History" ]
[ "Subjective" ]
okay where
3,180
doctor: okay so i no i'm absolutely i wan na make sure that we are gon na give you the medication that works like the best for you so i'm sorry if these questions seem like frustrating i would just wan na make sure that i understand what the problem is so patient: i saw pamela and doctor collins's office she's much nicer than you know
D2N127
22
[ "Chitchat" ]
[ "Null" ]
okay so i no i'm absolutely i wan na make sure that we are gon na give you the medication that works like the best for you so i'm sorry if these questions seem like frustrating i would just wan na make sure that i understand what the problem is so
3,181
doctor: i mean okay so you know what like maybe maybe pamela would be better like we could maybe talk talk about a referral if that would make you more comfortable patient: my lawyer told me to come here
D2N127
23
[ "Discussion", "Referral" ]
[ "Plan" ]
i mean okay so you know what like maybe maybe pamela would be better like we could maybe talk talk about a referral if that would make you more comfortable
3,182
doctor: then you're stuck with me okay i'm so sorry but here it's we're gon na try and make it as good as possible alright so last thing i do wan na do my physical exam alright and i need you to let me know as as much as you as much as you can verbalize right so when i push here in the middle of your neck on top of the bone does it hurt patient: yes yes
D2N127
24
[ "Physical Examination" ]
[ "Objective" ]
then you're stuck with me okay i'm so sorry but here it's we're gon na try and make it as good as possible alright so last thing i do wan na do my physical exam alright and i need you to let me know as as much as you as much as you can verbalize right so when i push here in the middle of your neck on top of the bone does it hurt
3,183
doctor: okay alright sorry what about on the side does that hurt patient: yes
D2N127
25
[ "Physical Examination" ]
[ "Objective" ]
okay alright sorry what about on the side does that hurt
3,184
doctor: okay so pain on palpation both on the bony process and on the muscle can you move your neck from side to side can you move your neck can you swive it side to side no no alright so i'm i'm seeing i'm seeing some range of movement moderate range of movement that's fine okay i so when can you bend your neck forward that that's your whole body just just the neck are you capable of bending up patient: really hurts it really hurts
D2N127
26
[ "Physical Examination" ]
[ "Objective" ]
okay so pain on palpation both on the bony process and on the muscle can you move your neck from side to side can you move your neck can you swive it side to side no no alright so i'm i'm seeing i'm seeing some range of movement moderate range of movement that's fine okay i so when can you bend your neck forward that that's your whole body just just the neck are you capable of bending up
3,185
doctor: okay it really hurts to bend forward and backwards okay alright so i'm just gon na make a little note here i do n't i do n't see any bruising i'm not noticing any swelling there is i i do n't see any laceration what patient: just sometimes it bruises
D2N127
27
[ "Physical Examination" ]
[ "Objective" ]
okay it really hurts to bend forward and backwards okay alright so i'm just gon na make a little note here i do n't i do n't see any bruising i'm not noticing any swelling there is i i do n't see any laceration what
3,186
doctor: okay sometimes alright that's fine i i just i'm not seeing one here today so that's okay alright so with that being said i do wan na ask have you been experiencing any fatigue are you tired patient: well since the accident yes
D2N127
28
[ "Vegetative History" ]
[ "Subjective" ]
okay sometimes alright that's fine i i just i'm not seeing one here today so that's okay alright so with that being said i do wan na ask have you been experiencing any fatigue are you tired
3,187
doctor: okay alright just making sure okay so this is what this is my assessment and plan this is what we are gon na do i want to be able to like we had you do an x-ray before you came in here and looking at it i'm not noticing any fracture that's a really good sign considering how many car accidents we've been in lately patient: it hurts it hurts
D2N127
29
[ "Radiology Examination" ]
[ "Objective" ]
okay alright just making sure okay so this is what this is my assessment and plan this is what we are gon na do i want to be able to like we had you do an x-ray before you came in here and looking at it i'm not noticing any fracture that's a really good sign considering how many car accidents we've been in lately
3,188
doctor: absolutely no i we're gon na address the pain so for my first so looking at your imaging results though i'm not seeing a fracture that's a great sign so for your first diagnosis i'm gon na say that you have what is called a neck sprain that patient: thinking are are you saying i'm thinking
D2N127
30
[ "Radiology Examination", "Acute Assessment" ]
[ "Objective", "Assessment" ]
absolutely no i we're gon na address the pain so for my first so looking at your imaging results though i'm not seeing a fracture that's a great sign so for your first diagnosis i'm gon na say that you have what is called a neck sprain that
3,189
doctor: no not by any means i am saying patient: pain i have a lot of pain
D2N127
31
[ "Acute Assessment" ]
[ "Assessment" ]
no not by any means i am saying
3,190
doctor: yes and your pain can be explained by multiple things but thankfully it's not a broken neck is that okay patient: yes
D2N127
32
[ "Acute Assessment" ]
[ "Assessment" ]
yes and your pain can be explained by multiple things but thankfully it's not a broken neck is that okay
3,191
doctor: alright so what we are gon na do when we are gon na like try and treat this as conservatively as possible patient: said it might be broken
D2N127
33
[ "Discussion" ]
[ "Plan" ]
alright so what we are gon na do when we are gon na like try and treat this as conservatively as possible
3,192
doctor: if pamela said it's broken then you know what this is what we're gon na do we're gon na order something called a ct that's gon na give us even nope you know what let's upgrade to an mri it's gon na give us the most thorough image of everything that's going on the heart and the soft tissues is that gon na is that so that way we can really get a good image of what's happening inside right patient: okay because what the lawyer said i needed was an mri
D2N127
35
[ "Diagnostic Testing" ]
[ "Plan" ]
if pamela said it's broken then you know what this is what we're gon na do we're gon na order something called a ct that's gon na give us even nope you know what let's upgrade to an mri it's gon na give us the most thorough image of everything that's going on the heart and the soft tissues is that gon na is that so that way we can really get a good image of what's happening inside right
3,193
doctor: not a problem we're we're gon na make your lawyer happy next step we are going to try working like from the outside in so i do need you to work on getting like you're you're saying you've seen some bruising and some swelling yourself so i want you to put ice on that whenever you're experiencing that in the moment when you wake up i want you to do your best to just like i'm gon na give you some exercises on the sheet and i want you to roll through these exercises every morning right to just get some like movement and like free frenosive movement back into your neck i also wan na put you on a couple medications now i know that you said you were on fentanyl before that's a bit extreme and i i want i i i wan na like monitor this a little more conservatively so what we're gon na start with is something called robaxin patient: hurts a lot if i do n't get more fentanyl
D2N127
36
[ "Medication", "Referral" ]
[ "Plan" ]
not a problem we're we're gon na make your lawyer happy next step we are going to try working like from the outside in so i do need you to work on getting like you're you're saying you've seen some bruising and some swelling yourself so i want you to put ice on that whenever you're experiencing that in the moment when you wake up i want you to do your best to just like i'm gon na give you some exercises on the sheet and i want you to roll through these exercises every morning right to just get some like movement and like free frenosive movement back into your neck i also wan na put you on a couple medications now i know that you said you were on fentanyl before that's a bit extreme and i i want i i i wan na like monitor this a little more conservatively so what we're gon na start with is something called robaxin
3,194
doctor: you know we can refer you to pain medicine if it really is getting that complicated but for this current period we're gon na put you on some robaxin it's gon na be fifteen hundred milligrams and you're gon na take that six to eight hours every six to eight hours and that really should help kinda relax the muscles in the area take off some of that tension and really help with that pain if you're noticing that the robaxin still is n't helping maybe then we can start we can like start using like a heat pad or maybe some icyhot the biofreeze is a really good one to kinda help with that and then we will refer you to physical therapy i think with the mri we can start evaluating maybe some additional steps so rather than you having to like take that fentanyl because i do n't want you to be in danger right like people i do n't want you to get rubbed so what we could explore are local injections right and we can refer you to pain medication and see about like locally injecting the area and that should be able to help you out hopefully with this patient: i ca n't go to work like this
D2N127
37
[ "Medication", "Referral" ]
[ "Plan" ]
you know we can refer you to pain medicine if it really is getting that complicated but for this current period we're gon na put you on some robaxin it's gon na be fifteen hundred milligrams and you're gon na take that six to eight hours every six to eight hours and that really should help kinda relax the muscles in the area take off some of that tension and really help with that pain if you're noticing that the robaxin still is n't helping maybe then we can start we can like start using like a heat pad or maybe some icyhot the biofreeze is a really good one to kinda help with that and then we will refer you to physical therapy i think with the mri we can start evaluating maybe some additional steps so rather than you having to like take that fentanyl because i do n't want you to be in danger right like people i do n't want you to get rubbed so what we could explore are local injections right and we can refer you to pain medication and see about like locally injecting the area and that should be able to help you out hopefully with this
3,195
doctor: okay so if it's if it's that bad let's wait for the mri result we're gon na give you off for work because you know you ca n't move and we'll see what the mri says about what whether or not we can get you like true local injections in the moment is that alright for now patient: yeah
D2N127
38
[ "Medication" ]
[ "Plan" ]
okay so if it's if it's that bad let's wait for the mri result we're gon na give you off for work because you know you ca n't move and we'll see what the mri says about what whether or not we can get you like true local injections in the moment is that alright for now
3,196
doctor: okay okay any other questions patient: not right now
D2N127
39
[ "Discussion" ]
[ "Plan" ]
okay okay any other questions
3,197
doctor: alright
D2N127
40
[ "Chitchat" ]
[ "Null" ]
doctor: alright
3,198
doctor: hi , carolyn . how are you ? patient: good . how are you ?
D2N128
0
[ "Greetings" ]
[ "Subjective" ]
hi , carolyn . how are you ?
3,199